Lesson 2.

2 Computing
and Justifying Health
Problems
Manny Louie C. Autajay RN
NCM 104
Family Assessment: Identifying Health
Problems

• First Level Assessment

• Second Level Assessment
• Criteria for Determining
Priorities
Lesson Objectives:
1. List down the health problems recognize in each
family;
2. Categorize each health problem into health threat,
health deficit or foreseeable crisis;
3. Prioritize health problems according to nature,
modifiability, preventive potential and salience to the
family;
4. Justify the score given to each problem: and
5. Rank health problems according to priorities.
First Level Assessment
• The process whereby existing and potential
health conditions or problems of the family are
determined.
• It relates what health problems exist and will
exist.
• Categories of Health Problems: Wellness
Condition, Health Threats, Health Deficits and
Foreseeable Crisis
Typology of Problems in Family
Health – FIRST LEVEL
ASSESSMENT
• Presence of Wellness Condition
• Presence of Health Threats
• Presence of Health Deficits
• Presence of Foreseeable Crisis
Presence of Wellness Condition
• 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.
• Wellness potential
• a nursing judgment on wellness state or condition based on
client’s performance, current competencies, or performance,
clinical data or explicit expression of desire to achieve a
higher level of state or function in a specific area on health
promotion and maintenance.
Example
Potential for Enhanced • Healthy lifestyle-e.g. nutrition/diet,
exercise/activity
Capability for: • Healthy maintenance/health
management
• Parenting
• Breastfeeding
• Spiritual well-being-process of
client’s developing/unfolding of
mystery through harmonious
interconnectedness that comes from
inner strength/sacred source/God
(NANDA 2001)
• Others. Specify.

Readiness for Enhanced • Healthy lifestyle

• Health maintenance/health
Capability for: management
• Parenting
• Breastfeeding Spiritual well-being
• Others. Specify
Presence of Health Threats
• Conditions that are conducive to disease
and accident, or may result to failure to
maintain wellness or realize health
potential.
Example
Presence of risk factors of specific
diseases
Threat of cross infection from
communicable disease case
Family size beyond what family
resources can adequately provide
Accident hazards specify.
Faulty/unhealthful nutritional/eating
habits or feeding techniques/practices.
Specify.
lifestyle diseases, metabolic syndrome
Broken chairs
Pointed /sharp objects, poisons and
medicines improperly kept
Fire hazards
Fall hazards
Others specify.
Inadequate food intake both in quality and
quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques
Example
Stress Provoking Factors. Specify.
Poor Home/Environmental
Condition/Sanitation. Specify
Poor Home/Environmental
Condition/Sanitation. Specify
Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family
members
Care-giving burden
Inadequate living space
Lack of food storage facilities
Polluted water supply
Presence of breeding or resting sights of
vectors of diseases
Improper garbage/refuse disposal
Unsanitary waste disposal Improper
drainage system
Poor lightning and ventilation
Noise pollution
Air pollution
Example
Unsanitary Food Handling and
Preparation
Unhealthy Lifestyle and Personal
Habits/Practices. Specify.
Alcohol drinking
Cigarette/tobacco smoking
Walking barefooted or inadequate
footwear
Eating raw meat or fish
Poor personal hygiene
Self medication/substance abuse
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest or sleep
Lack of /inadequate exercise/physical
activity
Lack of/relaxation activities Non use of
self-protection measures (e.g. non use of
bed nets in malaria and filariasis endemic
areas).
Example
Inherent Personal Characteristics. poor impulse control
Health History, which may previous history of difficult labor.
Participate/Induce the Occurrence of
Health Deficit
Inappropriate Role Assumption child assuming mother’s role, father not
assuming his role.
Lack of Immunization/Inadequate
Immunization Status Specially of Children
Family Disunity Self-oriented behavior of member(s)
Unresolved conflicts of member(s)
Intolerable disagreement
Others. Specify
Presence of Health Deficits
• Instances of failure in health maintenance.
Example
Illness states, regardless of whether it is diagnosed or undiagnosed by medical
practitioner.
Failure to thrive/develop according to normal rate

Disability-whether congenital or arising from illness; transient/temporary (e.g.

aphasia or temporary paralysisafter a CVA) or permanent (e.g. leg amputation
secondary to diabetes, blindness from measles, lameness from polio)
Presence of Foreseeable Crisis
• Anticipated periods of unusual demand on
the individual or family in terms of
adjustment/family resources.
Example
• Marriage • Hospitalization of a
• Pregnancy, labor family member
• Parenthood • Death of a member
• Additional member • Resettlement in a new
• Abortion community
• Entrance at school • Illegitimacy
• Adolescence • Other, specify.
• Divorce or separation
• Menopause
• Loss of job
 Activity Assessment
List of Problems Nature of the Problem (Wellness
Condition, Health Threat, Health
Deficit, Forseeable Crisis)
1. Cough and Cold of Jose Jr (3 yr old
son)
2. Jose Sr. (Husband/Father) is a smoker
3. Sheena (12 year old daughter) have
Scabies
4. No potable Drinking Water
5. Garbage dump is near
6. Family conflict between Jose Sr. and
Shana (Wife/Mother)
7. Juana 15 years old Pregnant
 Activity Assessment
List of Problems Nature of the Problem (Wellness
Condition, Health Threat, Health
Deficit, Forseeable Crisis)
1. Cough and Cold of Jose Jr (3 yr old Health Deficit
son)
2. Jose Sr. (Husband/Father) is a smoker Health Threat
3. Sheena (12 year old daughter) have Health Deficit
Scabies
4. No potable Drinking Water Health Threat
5. Garbage dump is near Health Threat
6. Family conflict between Jose Sr. and Health Threat
Shana (Wife/Mother)
7. Juana 15 years old Pregnant Forseeable Crisis
Second Level Assessment
• Determining family’s ability to perform the
Family Health Tasks on each health threat,
health deficit, foreseeable crisis on wellness
potential.
Typology of Problems in Family Health-
Second Level Assessment
1. Inability to recognize the presence of the condition or
problem
2. Inability to make decisions with respect to taking appropriate
health action
3. Inability to provide adequate nursing care to the sick,
disabled, dependent or vulnerable/at risk member of the
family
4. Inability to provide a home environment conducive to health
maintenance and personal development
5. Failure to utilize community resources for health care
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: Social-
stigma, loss of respect of peer/significant others Economic/cost
implications Physical consequences Emotional/psychological
issues/concerns
C. Attitude/Philosophy in life, which hinders
recognition/acceptance of a problem
D. Others. Specify
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
perceive magnitude/severity of the situation or problem, i.e. failure to
breakdown 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
Inability to make decisions with respect to
taking appropriate health action due to:
H. Fear of consequences of action, specifically: Social consequences
Economic consequences Physical consequences
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. In accessibility of appropriate resources for care, specifically: Physical
Inaccessibility Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of
action
M. Others specify.
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 or extent of nursing
care needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the
necessary intervention or treatment/procedure of care (i.e.
complex therapeutic regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically: Absence of
responsible member Financial constraints Limitation of luck/lack
of physical resources
Inability to provide adequate nursing care to the
sick, disabled, dependent or vulnerable/at risk
member of the family due to:
G. Significant persons unexpressed feelings (e.g. hostility/anger,
guilt, fear/anxiety, despair, rejection) which 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 on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity
of family members.
K. Altered role performance, specify. Role denials or ambivalence
Role strain Role dissatisfaction Role conflict Role confusion Role
overload
L. Others. Specify
Inability to provide a home environment conducive to
health maintenance and personal development due to:
A. Inadequate family resources specifically: Financial
constraints/limited financial resources Limited physical
resources-e.i.lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of
investments 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 pattern within the family
Inability to provide a home environment conducive to
health maintenance and personal development due to:
G. Lack of supportive relationship among family members
H. Negative attitudes/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.
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 :
Physical/psychological consequences Financial consequences
Social consequences
F. Unavailability of required care/services
Failure to utilize community resources for
health care due to:
G. Inaccessibility of required services due to: Cost constrains
Physical inaccessibility
H. Lack of or inadequate family resources, specifically
Manpower resources, e.g. baby sitter Financial resources, cost of
medicines prescribe
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 community resources for health
care
K.Others, specify.
Factors Affecting Priority Status
The community health manager must consider the some
important factors in defining modifiability of health problem-or
probability of success in minimizing, alleviating, or totally
eradicating the problem through health interventions. These are:
1. Current knowledge, technology and intervention to manage
the problem
2. Resources of the family (physical, financial, and man power)
3. Resources of the community (facilities and community
organizations)
4. Resource of the community health manager (knowledge, skill
and time.)
Four Criteria for Determining
Priorities
• 1. Nature of the condition or problem presented-categorized into
wellness state/potential, health threat, health deficit and
forseeablecrisis.
• 2. Modifiability of the condition or problem-refers to the probability
of success in enhancing the wellness state, improving the condition,
minimizing, alleviating or totally eradicating the problem through
intervention
• 3. Preventive Potential-refers to the nature and magnitude of future
problems that can be minimized or totally prevented if intervention is
done on the condition or problem under consideration.
• 4. Salience-refers to the family’s perception and evaluation of the
condition or problem in terms of seriousness and urgency of attention
needed of family readiness
Nature of the condition or problem
presented
presented-categorized into wellness state/potential,
health threat, health deficit and forseeablecrisis.
Criteria Score Weight
1.NATURE OF THE
CONDITION
A. WELLNESS STATE 3 1
B. HEALTH DEFICIT 3
2
C. HEALTH THREAT 1
D. FORSEEABLE CRISIS
Modifiability of the condition or problem
refers to the probability of success in enhancing the wellness
state, improving the condition, minimizing, alleviating or
totally eradicating the problem through intervention

Criteria Score Weight

2. Modifiability of
the health
condition or 2
problem
a. easily modifiable 2
b. partially 1
modifiable
0
c. not modifiable
Preventive potential
refers to the nature and magnitude of future problems that can
be minimized or totally prevented if intervention is done on
the condition or problem under consideration

Criteria Score Weight

3. Preventive
potential
a. high 3 2
b. moderate 2
2
c. low
Salience
refers to the family’s perception and evaluation of the
condition or problem in terms of seriousness and urgency of
attention needed of family readiness
Criteria Score Weight
4.Salience
a. a condition or problem 2
needing immediate
attention 2
b. a condition or problem 1
not needing immediate
attention
c. not perceived as a 0
problem 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
--------------------------- X WEIGHT
Highest Score
3. Sum up the scores for all the criteria. The highest score is 5,
equivalent to the total weight.
4. The higher the score (near 5) of a given problem, the more likely it is
taken as a PRIORITY.
5. With the available scores, the nurse then RANKS health problems
accordingly.
PRIORITY PROBLEM ARE THOSE WITH SCORE NEARER 5. THE HIGHER
THE SCORE OF A PROBLEM, THE HIGHER ITS RANK
SAMPLE PRIORITIZATION
COMPUTATION
• HEALTH PROBLEMS OF LUNA FAMILY
1. PEDICULOSIS
2. IMPROPER GARBAGE DISPOSAL
3. COUGH AND COLDS
4. SCABIES
5. FAMILY SIZE BEYOND WHAT THE FAMILY
RESOURCES CAN ADEQUATELY PROVIDE
PROBLEM: 1. PRESENCE OF
PEDICULOSIS
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

1. NATURE OF SCORE = 3 Pediculosis

THE PROBLEM considered to be a
WEIGHT = 1 1 health deficit
brought about by
COMPUTATION the infestations of
larvae or adult lice
3÷3 x 1
 PROBLEM: 1. PRESENCE OF PEDICULOSIS
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

2. MODIFIABILITY SCORE = 2 The family’s problem

regarding Pediculosis has
OF THE PROBLEM an easily modifiable status
WEIGHT = 2 as reflected by the ff
2 criteria below:
COMPUTATION • The family has a current
knowledge about the
Current / problem
knowledge 2÷2 x 2 • The family has manpower
resources that can use to
Family / minimize pt’slice by
Resources removing them
• The student nurse’s
SN resources / knowledge and initiative
will enable them to provide
Community / health education for the
Resources family on how to minimize
if not to eradicate their
problem
• The brgyhealth center is
open for consultations in
which the ptand the mother
can come and asked for
necessary actions
 PROBLEM: 1. PRESENCE OF PEDICULOSIS
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

3. PREVENTIVE SCORE = 2 It shows that the problem

has a moderate preventive
POTENTIAL WEIGHT = 1 potential as evidenced by
(subjective scoring) the following criteria
0.67
COMPUTATION The problem is considered
to be severe since 4 of the
family members are
2÷3 x 1 infected with lice
Severity /
The problem is
Duration / approximately existing for
Current / almost a month, as
reported by the mother
Management
High Risk / The family has current
management on the
group problem as the mother
manually removes the
pt’slice whenever she has
free time

The family is high risk

group as they share the
same comb for the family
 PROBLEM: 1. PRESENCE OF PEDICULOSIS
CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION

4. Salience of the SCORE = 1 Prior to the student nurse’s

interventions, the mother
problem WEIGHT = 1 was aware of the problem
but does not need
COMPUTATION 0.5 Immediate action
1÷2 x 1

TOTAL SCORE : 4.17

 Group ACTIVITY
• Group 1 - POOR ENVIRONMENTAL SANITATION
SPECIFICALLY IMPROPER GARBAGE DISPOSAL
• Group 2 - COUGH AND COLDS
• Group 3 - SCABIES
• Group 4 - FAMILY SIZE BEYOND WHAT THE FAMILY
RESOURCES CAN ADEQUATELY PROVIDE
 Group ACTIVITY
• Group 1 - POOR ENVIRONMENTAL SANITATION
SPECIFICALLY IMPROPER GARBAGE DISPOSAL
• The family has a current knowledge about the problem and has
manpower resources to address the problem. Furthermore, the student
nurse’s knowledge and initiative will enable them to provide health
education for the family on how to prevent an occurrence of a problem.
The barangay have collects garbage daily.
• The family dumps and burn their garbage in a vacant lot near their house,
they have been doing this for 15 years. However, they recycle their
empty bottles and cans.
 Group ACTIVITY
• Group 2 - COUGH AND COLDS
• The family has a current knowledge about the problem have resources to
address the problem. Furthermore, the student nurse’s knowledge and
initiative will enable them eradicate and minimize the problem. The
community has the necessary resources to treat coughs and cold.
• The child has cough and colds for two days. Although the possibility of
transferring infection to the other members of the family is high, the
mother is aware that immediate attention should be given. Mother knows
ways of treating coughs and colds and has used herbal medicines.
• Although there is a possibility of transferring infection to other family
member, theinfectionis notlife threatening.
 Group ACTIVITY
• Group 3 - SCABIES
• The family has no knowledge about the problem and lacks adequate resources
to solve the problem. Inadequacy of the living space is a barrier which is
important in the management and prevention of scabies. However, the
student nurse’s knowledge about the treatment and prevention can help the
family solve the problem. The brgy. health center is open for consultations in
which the pt and the mother can come and asked for necessary actions.
• Two out of 6 children in the children in the family have scabies for
approximately a month. No current action taken by the mother but verbalized
the need to. Given their living conditions, possibility of transferring infection
to the other members of the family is high and should be managed adequately
as soon as possible.
• The motherverbalized theneedfor seeking consultationto thehealthfacility.
 Group ACTIVITY
• Group 4 - FAMILY SIZE BEYOND WHAT THE FAMILY
RESOURCES CAN ADEQUATELY PROVIDE
• The family has no knowledge and resources on how to start family
planning. The student nurse’s knowledge about family planning methods
can help the family solve this problem. The brgy. health center is open
for consultations and public health workers conducts seminars about
family planning methods.
• The Family has 6 children aged 11 y.o, 9 y.o, 6 y.o, 4 y.o, 2 y.o, and a 5-
month old baby. The couple doesn’t use contraceptive or any natural
family planning methods and doesn’t plan to use any.
• The father verbalized that their children can help him earn a living for
the family someday
ACTIVITY - RANKING HEALTH
PROBLEMS ACCORDING TO PRIORITY
RANK THE HEALTH PROBLEMS OF THE LUNA FAMILY.
PRIORITY 1 HAS THE HIGHEST SCORE,PRIORITY2
HASTHESECONDHIGHEST,PRIORITY3,
THENEXTHIGHEST,AND
Priority SOON.
Problem Score
Pediculosis 4.17
Improper garbage 3.84
disposa
Cough and colds 4.5
Presence of scabies 3.67

Family size beyond 2

what the family
resources can
adequately provide
ACTIVITY - RANKING HEALTH
PROBLEMS ACCORDING TO PRIORITY
RANK THE HEALTH PROBLEMS OF THE LUNA FAMILY.
PRIORITY 1 HAS THE HIGHEST SCORE,PRIORITY2
HASTHESECONDHIGHEST,PRIORITY3,
THENEXTHIGHEST,AND
Priority SOON.
Problem Score
2 Pediculosis 4.17
3 Improper garbage 3.84
disposa
1 Cough and colds 4.5
4 Presence of scabies 3.67

5 Family size beyond 2

what the family
resources can
adequately provide
Lesson 2.3
Determining Priorities
and High-Risk Groups
Manny Louie C. Autajay RN
NCM 104
LESSON OBJECTIVES
• Using the forms for determining priority
problems and high risk group, student
should able to:
• 1. List down the top three priority health
problems of each family interviewed; and
• 2. identify families belonging to high risk
groups in the community.
RANKING HEALTH PROBLEMS OF
FAMILIES IN THE BARANGAY
Ranking Health Problems of Families in Barangay : Uno, Sitio
Kamanggahan

PRIORI FAMILY NAME PROBLEMS SCORE

TY
1 Dela Cruz Cough and Cold 4.87
2 Santos Primary Complex 5
3 Dacanay Scabies 5
4 Rodolfo Tuberculosis 4
5 Antonio Pneumonia 3.67
6 Chan Asthma 4.67
7 De Leon Third Degree Malnutrion 5
8 Balano Scabies 5
9 Ramos Second Degree Malnutrition 5
10 Lazaro Tuberculosis 5
RANKING HEALTH PROBLEMS OF
FAMILIES IN THE BARANGAY
Ranking Health Problems of Families in Barangay : Uno, Sitio
Kamanggahan

PRIORI FAMILY NAME PROBLEMS SCORE

TY
De Leon Third Degree Malnutrion 5
Balano Scabies 5
Ramos Second Degree Malnutrition 5
Lazaro Tuberculosis 5
Santos Primary Complex 5
Dacanay Scabies 5
Dela Cruz Cough and Cold 4.87
Chan Asthma 4.67
Rodolfo Tuberculosis 4
Antonio Pneumonia 3.67
Lesson 3.2
Determining Family
Nursing Problems
Manny Louie C. Autajay RN
NCM 104
LESSON OBJECTIVES
• Using the forms for determining family nursing
problems, student should be able to:
• 1. List down the possible causes of health problem
of identified priority families (first and second level
assessment – refer to Maglaya 2000 family Nursing
Care); and
• 2. Identify possible intervening measures for their
problems.
Health Family nursing problems
problems First level Assessment
1. cold and persistent 1. inability to recognize the existence of
a problem
coughs as health deficits 2. inability to make decisions with
respect to make appropriate health
actions
2. scabies 1.inability to recognize the existence of
the problem
2. inability to provide home environment
which is conductive to health maintenance
and development
3.failure to utilize community resources
for health maintenance and personal
development
Second level Assessment
1. Inability to recognize the existence
of a problem due to ignorance of
facts.
2. inability to make decisions with
respect to taking appropriate health
action due to:
a. failure to comprehend the nature,
magnitude of scope of the problem
b. lack of knowledge as to alternate
courses of action open to them
1. inability to recognize the existence
of a problems due to ignorance of
facts
2. inability to provide a home
environment that is conductive to
health maintenance and development
due to :
a. inadequate family resources
b. ignorance of preventive measure
3. failure to utilize community
resources for health care due to:
a. lack of appropriate information
b. negative attitude.(hiya)
Health Family nursing problems
problems First level Assessment Second level Assessment

3.poor environmental Inability to provide a home Inability to provide a home

sanitation environment that is environment that is
a. inadequate potable conductive to health conductive to heath
water supply maintenance and personal maintenance and personal
b. inappropriate waste development development due to:
disposal method a. inadequate family
c. presence of breeding resources (financial,
area for insects and inadequacy and lack of
rodent space to construct
facility)
b. ignorance of the
importance of hygiene
and sanitation
c. ignorance of preventive
measure
Thank You Very Much!!!