College of Nursing

NCM 104 – Community Health Nursing I

ASSESSMENT DATA BASE IN FAMILY NURSING PRACTICE

A. Family Structure, Characteristics, and Dynamics/Relational Patterns

1. Members of the household: birthdate, sex, civil status, position in the
family and relationship to the head of the family
2. Socio-demographic data of members not currently living in the
household but with major role in resource generation and use.
3. 3. Type of family structure and form – e.g. matriarchal or patriarchal,
nuclear or extended or blended
4. Dominant family members in terms of decision-making ( especially
on matters of health care) and care tending.
5. 5. Family dynamics, communication pattern/s, interactional
processes and interpersonal relationships (e.g. dyadic and triadic
interactions) which possess innate or great potential to mediate or
potentiate factors relevant to health, illness, growth, development
and the family’s ability to handle conflict, change, anticipated and
unexpected events

B. Socio – economic and Cultural Characteristics

1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent.
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Family traditions, events or practices affecting members’ health or
family functioning
5. Significant others – role/s they play in family’s life
1. 6. Relationship of the family to larger community – nature and extent
of participation of the family in community activities.

C. Home and Environment

1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of diseases (e.g.
mosquitoes, roaches, flies, rodents)
d. Presence of accident and fire hazards
e. Food storage and cooking facilities
f. Water supply – source, ownership, potability
g. Toilet facility – type, ownership, sanitary condition
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 h. Garbage/refuse disposal – type, sanitary condition
i. Drainage system – type, sanitary condition
2. Kind of neighborhood, e.g. congested, slum, etc.
3. Social and health facilities available
4. Communication and transportation facilities available

D. Health Status of each Family Member

1. Medical and nursing history indicating current or past significant
illnesses or beliefs and practices
a. conducive to health and illness.
2. Nutritional assessment (specially for vulnerable or at-risk members)
a. Anthropometric data:
▪ Measures of nutritional status of children –weight, height,
mid- upper arm circumference.
▪ Risk assessment measures for Obesity – body mass index
(BMI) = weight in kilograms
• divided by height in meters square
▪ Waist circumference (WC: greater than 90 cm. in men
and greater than 80 cm. in women)
▪ Waist hip ratio (WHR) = waist circumference in cm.
divided by hip circumference in cm.
▪ Central Obesity : WHR equal to or greater than 1.0 cm. in
men and 0.85 in women
b. Dietary history specifying quality and quantity of food/nutrient
intake per day
c. Eating/feeding habits/practices
3. Developmental assessment of infants, toddlers, and preschoolers
e.g. Metro Manila Developmental Screening Test (MMDST)
4. Risk factors assessment indicating presence of major and
contributing modifiable risk factors for specific lifestyle diseases –
e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/
tobacco smoking, elevated blood lipids/cholesterol, obesity,
diabetes mellitus, inadequate fiber intake, stress, alcohol drinking
and other substance abuse.
5. 5. Physical assessment indicating presence of illness state/s
(diagnosed or undiagnosed by medical practitioners)
6. Results of laboratory/diagnostic and other screening procedures
supportive of assessment findings.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention
1. Immunization status of family members
2. Healthy lifestyle practices. Specify Adequacy of:
a. rest and sleep
b. exercise/activities
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 c. use of protective measures – e.g. adequate footwear in
parasite-infested areas, use of bednets and protective
clothing in malaria and filariasis endemic areas
d. relaxation and other stress management activities
e. opportunities which enhance feelings of self-worth, self-
efficacy and sense of connectedness to self, others and a
higher power, essence of meaningfulness.
2. Use of promotive-preventive health services(such as maternal and
child health supervision) and use of healthy life style-related services.

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST-LEVEL ASSESSMENT
1. Presence of Wellness Condition - stated as Potential or Readiness – a
clinical or nursing judgment about a client in transition from a specific
level of wellness or capability to a higher level (NANDA 2001). Wellness
potential is a nursing judgment on wellness state or condition based on
client’s performance, current competencies or clinical data but no
explicit expression of client desire. Readiness for enhanced wellness state
is a nursing judgment on wellness state or condition based on client’s
current competencies or performance, clinical data and explicit
expression of desire to achieve a higher level of state or function in a
specific area on health promotion and maintenance.

Examples of these are the following:

Potential for enhanced capability for:
Healthy lifestyle – e.g. nutrition/diet, exercise/activity
Health maintenance/health management
Parenting
Breastfeeding
Spiritual well-being – process of a client’s developing unfolding
of mystery through harmonious interconnectedness that
comes from inner strength/sacred source/God(NANDA
2001)
Others, specify
Readiness for enhanced capability for:
Healthy lifestyle
Health maintenance/health management
Parenting
Breastfeeding
Spiritual well-being
Others, specify

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2. Presence of Health Threats – conditions that are conducive to disease and
accident, or may result to failure to maintain wellness or realize health
potential.
Examples of these are the following:
A. Presence of risk factors of specific diseases (e.g. lifestyle diseases,
metabolic syndrome)
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately
provide
D. Accident/fire hazards, example:
1. broken stairs
2. pointed/sharp objects, poisons, and medicines improperly
kept
3. fire hazards
4. fall hazards
5. others (specify)
E. Faulty/unhealthful nutritional/eating habits or feeding techniques,
practices.
Specify: 1. inadequate food intake both in quality and quantity
2. excessive intake of certain nutrients
3. faulty eating habits
4. ineffective breastfeeding
5. faulty feeding techniques
F. Stress-provoking factors – specify
1. strained marital relationship
2. strained parent-sibling relationship
3. interpersonal conflicts between family members
4. care-giving burden
G. Poor home/environmental condition/sanitation – specify:
1. inadequate living space
2. lack of food storage facilities
3. polluted water supply
4. presence of breeding or resting sites of vectors of diseases
(e.g. mosquitoes cockroaches, rodents, etc.)
5. improper garbage/refuse disposal
6. unsanitary waste disposal
7. improper drainage system
8. poor lighting and ventilation
9. noise pollution
10. air pollution
H. Unsanitary food handling and preparation
I. Unhealthful lifestyle and personal habits/practices – specify
1. alcohol drinking
2. cigarette/tobacco smoking
3. walking barefooted or inadequate footwear
4. eating raw meat or fish

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 5. poor personal hygiene
6. self-medication/substance abuse
7. sexual promiscuity
8. engaging in dangerous sports
9. inadequate rest or sleep
10. lack of/inadequate exercise/physical activity
11. lack of/inadequate relaxation activities
12. non-use of self-protection measures (e.g. non-use of bed
nets in malaria
and filariasis endemic areas)
J. Inherent personal characteristics – e.g. poor impulse control
K. Health history which may participate/induce the occurrence of a
health deficit,
e.g. previous history of difficult labor
L. Inappropriate role assumption – e.g. child assuming mother’s role,
father not assuming his role
M. Lack of immunization/inadequate immunization status specially of
children
N. Family disunity – e.g.
1. self-oriented behavior of member/s
2. unresolved conflicts of member/s
3. intolerable disagreement
O. Others, specify:

3. Presence of Health Deficits - instances of failure in health maintenance.

Example include:
a. Illness states, regardless of whether it is diagnosed or
undiagnosed by medical practitioner
b. Failure to thrive/develop according to normal rate
c. Disability – whether congenital or arising from illness,
transient/temporary (e.g. aphasia or temporary paralysis
after a CVA ) or permanent (e.g. leg amputation
secondary to diabetes, blindness from measles, lameless
from polio)

4. Presence of Stress Points/Foreseeable Crisis Situations – anticipated periods

of unusual demand on the individual or family in terms of adjustment/family
resources; transition ( passage from one life phase, condition or status to
another, causing a forced or chosen change that results in the need to
construct a new reality.
Examples of these include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member – e.g. newborn ,lodger
E. Abortion
F. Entrance at school

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 G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify

FAMILY COPING INDEX

PURPOSE: To provide a basis for estimating the nursing needs of a particular
family.
NURSING NEEDS:
1. Family has a health problem with which they are unable to cope:
a. threat to health promotion
b. disease or disability
2. There is a reasonable likelihood that nursing will make a difference
in the family’s ability to cope.

COPING: dealing with problems associated with health care with

reasonable success
- index of nursing needs because its contribution to health care
include:
a. strengthening the capacity of the individual as it encounters
the stress of illness, the opportunity to prevent disease and to
promote health.

DIRECTION FOR SCALING

Point on the scale – coping capacity is rated
Rate 1 - totally unable to manage this aspect of family care
Rate 3 - some are unable to cope
Rate 5 - able to handle this aspect of care without help from
community resources
Justification Statement – consist of brief statements or phrases that
explain the rating of the family. It should be express in terms of
behavioral or observable facts.

GENERAL CONSIDERATION:
1. It is the coping capacity and not the underlying problem that is
being rated.
2. It is the family not the individual that is being rated.

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SCALING CUES
1 – No competence
3 – Moderate competence
5 – Complete competence

NINE AREAS
1. PHYSICAL INDEPENDENCE – refers to the family members mobility
and ability to perform activities of daily living such as feeding
themselves and performing activities necessary for personal hygiene.

✓ Rate 1 – family failed to entirely provide required personal care

tone or more of its members
✓ Rate3 – family providing partially for needs of its members,
providing care for some members but not for others
✓ Rate 5 – all family members whether or not there is infirmity or
disability in one or more of its members receiving the necessary
care to maintain cleanliness without interruption or undue delay.

2. THERAPUETIC COMPETENCE – refers to the family’s ability to comply

with prescribed or recommended procedures and treatments to be
done at home, which include medications, dietary
recommendations, exercises, application of wound dressings, and
use of prosthetic devices and other adaptive appliances such as
wheelchairs and walkers. .
✓ Rate 1 - family either not carrying out procedures prescribed or
doing it unsafely
✓ Rate 3 - family carrying out some but not all of the treatment
✓ Rate 5 - family able to demonstrate that the members can carry
out prescribed procedures safely and efficiently with the
understanding of the principles involved.

3. KNOWLEDGE OF HEALTH CONDITION – means the understanding of

the health condition or essentials of care according to the
developmental stages of the family members. Example are the
degree of knowledge of responsible family members in terms of
communicability of a disease and its modes of transmission or that a
disease is genetically transmitted as in the case of diabetes mellitus.

✓ Rate 1 – totally uninformed or misinformed about the condition

✓ Rate 3 – has some general knowledge of the disease or
condition but has nor grasp the underlying principles or its
partially informed
✓ Rate 5 – knows the salient facts about the disease well enough
to take necessary action at the proper time, understand the
significant symptoms

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 4. APPLICATION OF PRINCIPLES OF GENERAL HYGIENE AND NUTRITION –
includes practice of general health promotion and recommended
preventive measures
✓ Rate 1 – family diet grossly inadequate or unbalanced;
necessary immunization not secured for children; food
handled in unsanitary way; members of the family working
beyond reasonable limits
✓ Rate 3 –failing to apply some general principles of hygiene
✓ Rate 5 – household runs smoothly, family meals well served,
habits of sleep and rest adequate to needs

5. HEALTH CARE ATTITUDES – refers to the family’s perception of health

care in general. This is being observed in the family’s degree of
responsiveness to the promotive, preventive, and curative efforts of
health workers.

✓ Rate 1 – family resents and resist all health care

✓ Rate 3 – accepts health care in some degrees but with
reservation
✓ Rate 5 - understand and recognizes needs for medical care in
illness is for the usual preventive services; accepts illness calmly
and recognizes the limits it impose while doing all possible to
effect recovery and rehabilitation

6. EMOTIONAL COMPETENCE – is concerned with the degree of

emotional maturity of family members according to their
developmental stages or it has to do with maturity and integrity with
which the members of the family are able to meet the usual stresses
and problems of life and to plan for happy and fruitful living. This may
be observed in behaviors such as how the family members deal with
daily challenges, their ability to sacrifice and think of others, and
acceptance of responsibility.

✓ Rate 1 – family does not face reality

✓ Rate 3 – family members usually do fairly but one or more
members lack security & maturity
✓ Rate 5 – all members of the family are able to maintain a
reasonable degree of emotional calm, face up to illness
realistically and differences with objectivity and reasonable
emotional control

7. FAMILY LIVING PATTERNS – refer to interpersonal relationship among

family members, management of family finances, and the type of
discipline in the home. It concerned largely with the interpersonal or
group aspect of family life – how well the members of the family get
along with one another, the ways in which they make decisions
affecting the family as a whole.

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 ✓ Rate 1 – family consists of group of individual indifferent or hostile
to one another or strongly dominated and controlled by a single
family members
✓ Rate 3 – family gets along but has habits or customs that interfere
with unity of the family
✓ Rate 5 – family does things together, each members acts for the
good of the family as a whole, children respects parents and vice
versa, family task shared

8. PHYSICAL ENVIRONMENT – includes the home that may influence the

health of family members.

✓ Rate 1 – house in poor condition

✓ Rate 3 – house needs some repair or painting but fundamentally
sound
✓ Rate 5 – house in good repair

9. USE OF COMMUNITY FACILITIES – is the ability of the family to seek

and utilize as needed both government-run and private health,
education, and other community services.
✓ Rate 1 – family has obvious and serious social needs but has
not sought or found any help
✓ Rate 3 – family is aware of and uses some but not all of the
available community resources that they need
✓ Rate 5- family uses the facilities they need appropriately and
promptly, knows when and whom to call for help

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO

PRIORITIES

CRITERIA SCORE WEIGHT

1. Nature of the condition or problem presented 1
Scale: Wellness state 3
Health deficit 3
Health threat 2
Forseeable crisis 1
2. Modifiability of the condition or problem 2
Scale: Easily modifiable 2
Partially modifiable 1
Not modifiable 0
3. Preventive potential 1
Scale: High 3
Moderate 2
Low 1

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4. Salience 1
Scale:A condition or problem 2
needing immediate attention

A condition or problem not 1

needing immediate attention

Not perceived as a problem 0

or condition needing change

SCORING:
1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply by the
weight:
(SCORE/HIGHEST SCORE) x WEIGHT.
3. Sum up the scores for all the criteria. The highest score is 5,
equivalent to the total weight.

Example: Possible Pre-eclampsia

Criteria Computation Actual Score Justification
1. Nature of the problem 3/3 x 1 1 The problem requires
immediate interventions to
minimize the occurrence of
further complications.
2.Modifiability of the problem 2/2 x 2 2 There is a program of the
DOH that caters to the needs
of pregnant mothers.
Assigned health care providers
per catchment area have
constant visit to the family.
Health care facilities are
available and accessible thus
resources and interventions
needed to solve the problem
are available to the family.
3. Preventive potential 3/3 x 1 1 The possibility of
complications during labor
and delivery and occurrence
of abnormalities in the
newborn are prevented if
pre-eclampsia is eliminated as
early as possible.
4. Salience of the problem 0/2 x 1 0 As verbalized by the
mother, “ Ganyan, naman
yung iba kong pagbubuntis di

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 ako nagpapacheck up.”thus
the family does not recognize
the existence of the problem.
T OTAL 4

SECOND-LEVEL ASSESSMENT
I. Inability to recognize the presence of the condition or problem due to:
A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of
consequences of diagnosis of
problem, specifically:
1. social-stigma, loss of respect of peer/significant others
2. economic/cost implications
3. physical consequences
4. emotional/psychological issues/concerns
C. Attitude/philosophy in life which hinders recognition/acceptance of
a problem
D. Others, specify
II. Inability to make decisions with respect to taking appropriate health
action due to:
A. Failure to comprehend the nature/magnitude of the
problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about
by perceived magnitude/ severity of the situation or problem, i.e.,
failure to break down problems into manageable units of attack
D. Lack of/inadequate knowledge/insight as to alternative courses of
action open to them
E. Inability to decide which action to take from among a list of
alternatives
F. Conflicting opinions among family members/significant others
regarding action to take
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1. social consequences
2. economic consequences
3. physical consequences
4. emotional/psychological consequences
I. Negative attitude towards the health condition or problem - - by
negative attitude is meant one that interferes with rational decision
making
J. Inaccessibility of appropriate resources for care, specifically:
1. physical inaccessibility
2. cost constraints of economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
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 L. Misconceptions or erroneous information about proposed course/s of
action
M. Others, specify

III. Inability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable/at-
Risk member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition
(nature, severity, complications, prognosis and management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature and extent of nursing
care needed
D. Lack of the necessary facilities, equipment and supplies for care
E. Lack of/inadequate knowledge and skill in carrying out the
necessary interventions/treatment/procedures/care (e.g. complex
therapeutic regimen or healthy lifestyle program)
F. Inadequate family resources for care specifically:
1. absence of responsible member
2. financial constraints
3. limitations/lack of physical resources – e.g. isolation room
G. Significant person’s unexpressed feelings (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection) which disable his/her capacities to
provide care
H. Philosophy in life which negates/hinder caring for the sick, disabled,
dependent,
vulnerable/at- risk member
I. Member’s preoccupation with own concerns/interests
J. Prolonged disease or disability progression which exhausts supportive
capacity of family Members

K. Altered role performance, specify:

1. role denial or ambivalence
2. role strain
3. role dissatisfaction
4. role conflict
5. role confusion
6. role overload
L. Others, specify

IV. Inability to provide a home environment conducive to health

maintenance and personal
development due to:

A. Inadequate family resources, specifically:

1. financial constraints/limited financial resources
2. limited physical resources- e.g. lack of space to construct
facility

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 B .Failure to see benefits (specifically long term ones) of investment in
home
environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and
sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude/philosophy in life which is not conducive to health
maintenance and personal development
I. Lack of/inadequate competencies in relating to each other for
mutual growth and maturation(e.g. reduced ability to meet the
physical and psychological needs of other members as a result of
family’s preoccupation with current problem or condition)
J. Others, specify

V. Failure to utilize community resources for health care due to

A. Lack of/inadequate knowledge of community resources for health
care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic,
therapeutic, rehabilitative)
specifically:
1. physical/psychological consequences
2. financial consequences
3. social consequences (e.g. lost of esteem of peer/significant others
F. Unavailability of required care/service
G. Inaccessibility of required care/service due to:
1. cost constraints
2. physical inaccessibility, i.e. location of facility
H. Lack of/inadequate family resources, specifically:
1. manpower resources- e.g. baby sitter
2. financial resources – e.g. cost of medicine prescribed
I. Feeling of alienation to/lack of support from the community, e.g.
stigma due to mental illness, AIDS , etc.
J. Negative attitude /philosophy in life which hinders effective
maximum utilization of
a. community resources for health care
K. Others, specify

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References:

Berman, A. , Snyder, S. J., & Frandsen, G. (2016). Kozier and Erb’s “Fundamentals of Nursing: Concepts,
Process, and Practice”. England: Pearson Education Limited. 10th ed.
Doenges, M.E., Moorhouse, M. F. and Murr, A.C. (2016). “Nurse’s Pocket Guide: Diagnoses, Prioritized
Interventions, and Rationales”. Philadelphia: F.A.Davis Company.1 4thed.
Famorca, Z.U., Nies, M.A., and McEwen, M. (2013).” Nursing Care of the Community. A Comprehensive Text on
Community and Public Health Nursing in the Philippines”. Singapore: Elsevier Mosby.
Kaakinen, J.R., Gedafy-Duff, V. , Coehlo, D.P. , and Hanson, S. M. H.( 2010).”Family Health Nursing Care:
Theory, Practice and Research”. Philadelphia. F.A. Davis Company. 4th ed.
Maglaya, A. (2009). “Nursing Practice in the Community”. Marikina City: Argonauta Corporation. 5th ed.
Friedman, M.M.” Family Nursing: Theory and Practice”. Connecticut: Appleton and Lange

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