tool used to assess the coping

ability of the family for certain

health situation with its purpose
of providing a basis for
estimating the nursing needs of a
particular family
• A nursing care is needed when:

The family has a health problem with

which they are unable to cope.

There is reasonable likelihood that

nursing will make a difference in the
family’s ability to cope.
Coping
• defined as dealing with problems
associated with care with reasonable
success
Coping deficit
• when the family is unable to cope with one
and other aspect of health care
To Cope
• ability or capacity to deal with health
situation; the control with the health
competence of the family
Direction for Scaling:

A Point of the Scale

• Enables you to place the family in relation
to their ability to cope with nine areas of the
family nursing at the time observed and as
you would expect it to be in 3 months or at
time of discharged if nursing care were
provided.

Coping capacity is rated from

• 1--totally unable to manage this aspect of
family care
• 5--able to handle the aspect of care and
help from community sources
Scaling Cues: (limited to 3 points)

Scale1—poor or low competence

3—moderate competence
5—high competence (complete)

• When each of 9 categories has been rated,

the result will be a profile of family coping
capacity in relation to the family nursing
required and by the changes you expect to
occur in the course of nursing service.
Justification Statement
• Consist of brief statements or
phrases that explain why you
have rated the family as you have
• expressed in terms of behavior
or observable facts rather than in
adjectives
It is the coping capacity and not the
underlying problem that is being rated.
It is the family and not the individual
that is being rated. In rating, it is your
own professional judgment that will be
needed to
make a decision.
 Nine Areas of Family Nursing
Family Coping Index:

1) Physical Competence
2) Therapeutic Competence
3) Knowledge of Health Condition
4) Application of Principle of General
Hygiene
5) Health Attitudes
6) Emotional Competence
7) Family Living
8) Physical Environment
9) Use of Community Facilities
 PHYSICAL COMPETENCE
• Concerned with ability to move about, to
get out of bed, to take care of daily
grooming, walking, etc.

• Note that it is the family competence that

is measured even though an individual is
dependent, if the family is able to
compensate for this, the family may be
independent.
 PHYSICAL COMPETENCE
Quality and quantity of care is important
• if the focus of care is poor
• if a mother is giving care to a handicapped
child that he could give himself
• if a person is giving care that should be
shared with other members
*the independence might be considered
incomplete.
The causes of dependence may vary and
may be due to:
actual physical incapacity
the inability of “know-how” to
unwillingness; or
fear of doing the necessary tasks
 PHYSICAL COMPETENCE

Family failing entirely to provide required

personal care to one or more of its
members.
Family providing partially for needs of its
Examples: members, or providing care for some
members but not for others.
Arthritic patient unable to get out of bed
alone, no one available to help Example:

Patient “cannot” give his hypodermic Mother may be doing well with own and
husband’s care but failing to give daily care
medication because of fear efficiently to a newborn baby
 THERAPEUTIC COMPETENCE

includes all of the procedures or

treatments prescribed for the care of
illness, such as giving medications,
using appliances (including crutches),
dressings, exercises and relaxation,
special diets, etc.
 THERAPEUTIC COMPETENCE

Family either not carrying out

procedure prescribed or doing it
unsafely. Family carrying out some but not all of
Examples:
: giving several medications without being
the treatments
Examples:
able to distinguish one from the other, or
: giving insulin but not adhering strictly to diet
taking them inappropriately, applying
braces so they throw the limb out of line,
: may be giving medication correctly, but not
measuring insulin incorrectly;
understanding purposes of the drug, or
symptom to be observed
: family resents, rejects, or refuses to give
necessary care.
 KNOWLEDGE OF HEALTH
CONDITION

concerned with the particular health

condition that is the occasion for care.

knowledge of the disease or inability to

understand communicability of disease and
modes of transmission

understanding of general pattern of

development of a newborn baby, and the
basic needs of infants for physical care or
tender loving care
 KNOWLEDGE OF HEALTH
CONDITION
Totally uninformed or misinformed about
the condition.
Examples:
Has some general knowledge of the disease
believes tuberculosis is caused by sin or condition, but has not grasped the
underlying principles, or is only partially
syphilis cured when symptoms subside
informed.
believes stroke patient must be bedridden, and
that it is cruel to make them do something for Example:
themselves may understand dietary and insulin control of
diabetes, but not need for special care of feet.
overweight in the school-age child is “healthy.”
 APPLICATION OF PRINCIPLE OF
GENERAL HYGIENE

concerned with family action in relation to

maintaining family nutrition, securing
adequate rest and relaxation for family
members, carrying out accepted preventive
measures such as:

Immunizations
medical appraisal
safe homemaking habits in relation to storing and
preparing foods
 APPLICATION OF PRINCIPLE OF
GENERAL HYGIENE

Family diet grossly inadequate or unbalanced,

necessary immunization not secured for children
Failing to apply some general principles of
Examples hygiene—for instance,
house dirty, food handled in unsanitary way
members of family working beyond reasonable
Examples:
limits
keeping house in excellent condition but
children and adults getting too little sleep
expending too much energy and becoming
family members unkempt, filthy, over fatigue as a result
inadequately clothed in relation to weather
secured initial immunization
 HEALTH ATTITUDES
concerned with the way the family feels
about health care in general, including
preventive service, care of illness and public
health measures.
 HEALTH ATTITUDES
Family resents and resist all health care
Examples:
has no confidence in doctors
uses patent medicines and quack nostrums
feels illness is unavoidable and to be borne rather
than treated
feels community health agencies should not
interfere or bother them
practice folk medicine or superstitious rites of
illness
Accepts health care in some degree, but with
reservations
Examples:
may accept need for medical care for illness, but
not general preventive measure
may have confidence in doctors generally, but not
in the clinic or in “free” doctors
may feel certain illnesses are hopeless (such as
cancer), or care unnecessary—for instance dental
care for the young child
 EMOTIONAL COMPETENCE

This category has to go with the maturity and

integrity with which the members of the family
are to meet the usual stresses and problems of
life, and to plan for happy and fruitful living.

The degree to which individuals accept the necessary

disciplines imposed by one’s family and culture

the development and maintenance of individual

responsibility and decision

Willingness to meet responsibility and decision

 EMOTIONAL COMPETENCE

Family does not face realities

Examples: Family members usually do fairly well, but one or

assumes moribund patient will get well, that an
more members evidence lack of security or
unwanted pregnancy isn’t so
maturity.
one or more member lacking in any emotional control—
uncontrollable rages Examples:
Thumb sucking in late childhood
irresponsible sexual activities
Unusual concern with what the neighbors will think
one or more members are alcoholic
Failure to plan ahead for foreseeable emergencies
family torn, suspicious of one another
Leaving children unattended
evidence of great insecurity, guilt or anxiety
“Fighting” in the family on occasion
 FAMILY LIVING
This category is concerned largely with the
interpersonal or group aspects 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

the degree to which they support one another and do

the things as a family

the degree of respect and affection they show for one

another

the ways in which they manage the family budget

the kind of discipline that prevails

 FAMILY LIVING
Family consists of a group of individuals indifferent
or hostile to one another, so strongly dominated
and controlled by a single family member
Examples:
mother developing habits of dependence in sons thereby
threatening future capacity for independence in own
family life
no rational plan for managing available money
“battered” child
Family gets along but has habits or customs that
interfered with the unity of the family.
Examples:
a family fond of one another have many home activities,
but is dominated by a father in a kindly way
recreational habits separated members of the family much
of the time
children somewhat overprotected
parents’ expectations on their children are sometimes
unrealistic—parents expecting children with low academic
competence to become successful professionals
 PHYSICAL ENVIRONMENT
This topic is concerned with the home, the
community and the work environment as it
affects family health.

The condition of the house such as the

presence of accident hazards, screening,
plumbing system, facilities for cooking and privacy

level of community (deteriorated neighborhood,

presence of social hazards such as rats),
transportation, condition of schools, and
availability.
 PHYSICAL ENVIRONMENT
House in poor condition—unsafe,
unscreened, poorly ventilated
Neighborhood deteriorated—juvenile and
adult delinquency, no recreational space
except streets
House needs some repair or painting but
fundamentally sound
Neighborhood with some undesirable social
elements but possible to protect children
from poor social influence through education
and other community activities
House crowded but adjustments can be made
USE OF COMMUNITY FACILITIES
This category has to do with the degree of
the family use and awareness of the
available community facilities for health
education and welfare.

This includes the ways in which they would

use services of private physicians, clinics,
hospitals, schools, welfare organizations,
churches, and so forth.
 USE OF COMMUNITY FACILITIES

Family has obvious and serious social needs,

but has not sought or found any help. Family is aware of and uses some, but not all
Examples: of the available community resources that
A family may be borrowing unreasonable sums of money
for medical care, instead of availing of the free hospitals they need.
or clinics Examples:

Leaving children without any supervision while the The family may be under welfare care, and seeks the
mother works assistance of the social worker responsible.

Failing to take steps to register for public housing when But on the other hand, overlooks the help that could be
available extended them by the school counselors or the spiritual
guidance the church can provide.
THANK YOU!