Box 13-7 Family Assessment Guide
I Identifying Data
Household members (relationship, gender, age, occupation, education):____________________________________________________
Financial data (sources of income, financial assistance, medical care; expenditures):___________________________________________
Source of referral and reason: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Include household members, extended family, and significant others
Age or date of birth, occupation, geographical location, illnesses, health problems, major events
Triangles and characteristics of relationships
III Individual Health Needs (for each household family member)
Identified health problems or concerns: ________________________________________________________________________________
Medical diagnoses: _____________________________________________________________________________________________
Recent surgery or hospitalizations: _________________________________________________________________________________
Medications and immunizations: _________________________________________________________________________________
Physical assessment data: ______________________________________________________________________________________
Emotional and cognitive functioning: _______________________________________________________________________________
Sources of medical and dental care: ____________________________________________________________________________
Health screening practices: ____________________________________________________________________________________
IV Interpersonal Needs
Identified subsystems and dyads:________________________________________________________________________________
Prenatal care needed: _________________________________________________________________________________________
Concerns about older members:___________________________________________________________________________________
Caring for other dependent members:________________________________________________________________________________
V Family Needs
Children and ages:____________________________________________________________________________________________
Responsibilities for other members: _____________________________________________________________________________
Recent additions or loss of members:_____________________________________________________________________________
Other major normative transitions occurring now:____________________________________________________________________
Transitions that are out of sequence or delayed:_____________________________________________________________________
Tasks that need to be accomplished:_______________________________________________________________________________
Daily health-promotion practices for nutrition, sleep, leisure, child care, hygiene, socialization, transmission of norms and values: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Family planning used:_______________________________________________________________________________________
B. Loss or Illness
Nonnormative events or illnesses:______________________________________________________________________________
Reactions and perceptions of ability to cope:________________________________________________________________________
Coping behaviors used by individuals and family unit:_________________________________________________________________
Meaning to the family:_________________________________________________________________________________________
Adjustments family has made:________________________________________________________________________________
Roles and tasks being assumed by members:_________________________________________________________________________
Any one individual bearing most of responsibility:_____________________________________________________________________
Family idea of alternative coping behaviors available:____________________________________________________________________
Level of anxiety now and usually:_________________________________________________________________________________
C. Resources and Support
General level of resources and economic exchange with community:_________________________________________________________
External sources of instrumental support (money, home aides, transportation, medicines, etc.):____________________________________
Internal sources of instrumental support (available from family members):___________________________________________________
External sources of affective support (emotional and social support, help with problem solving):_____________________________________
Internal sources of affective support (who in family is most helpful to whom?): _________________________________________________
Family more open or closed to outside?______________________________________________________________________________
Family willing to use external sources of support?_______________________________________________________________________
Type of dwelling:________________________________________________________________________________________________
Number of rooms, bathrooms, stairs; refrigeration, cooking:_______________________________________________________________
Water and sewage:______________________________________________________________________________________________
Types of jobs held by members:_______________________________________________________________________________________
Exposure to hazardous conditions at job:___________________________________________________________________________
Level of safety in the neighborhood:____________________________________________________________________________________
Level of safety in household:________________________________________________________________________________________
Attitudes toward involvement in community:___________________________________________________________________________
Compliance with rules and laws of society:____________________________________________________________________
How are values similar to and different from those of the immediate social environment?_____________________________________
E. Internal Dynamics
Roles of family members clearly defined?______________________________________________________________________
Where do authority and decision making rest?_____________________________________________________________________
Subsystems and members:__________________________________________________________________________________
Hierarchies, coalitions, and boundaries:________________________________________________________________________
Typical patterns of interaction:_______________________________________________________________________________
Communication, including verbal and nonverbal:__________________________________________________________________
Expression of affection, anger, anxiety, support, etc.:________________________________________________________________
Degree of cohesiveness and loyalty to family members:___________________________________________________________________________________________________________________________________________________________________________
Identification of family style:__________________________________________________________________________________
Identification of family strengths:_____________________________________________________________________________
Identification of family functioning:____________________________________________________________________________
What are needs identified by family? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What are needs identified by community/public health nurse?______________________________________________________________________________________________________________________________________________________________
The eco-map presents a picture to both the nurse and Mr. and Mrs. R. of a family that is not well connected to outside resources. Little energy is coming in or going out of the immediate family system, with the exception of intervention by the health care system, which the family wants to discontinue. When the community health nurse later completes a family map, she becomes aware of Mrs. R.’s tendency to act as a parent and Mr. R.’s tendency to act as a child. This blurring of boundaries has set up a behavior pattern in which Mr. R. gives away responsibility for his own health. At the same time, however, the rigidity of these boundaries keeps the children out of these interactions. After assessing the family, the nurse tries to guide her practice with some questions. She asks herself about the family’s needs, strengths, functioning, and style. She examines the family’s priorities and the resources they are using or are potentially able to use. She looks at her own skills and abilities and attempts to define her responsibility to the family system. These questions help her begin to analyze the family data. This analysis leads to several determinations.
Family Health Needs
The family needs help coping with this illness and connecting with resources and sources of support. Some minor disturbances in internal dynamics are influencing the way the family is dealing with the problem. The nurse assigns the family the nursing diagnosis of â€œFamily Coping: Compromised.â€
This family is a distancing family that prefers to keep its problem-solving activities to itself. However, this isolation limits family membersâ€™ ability to support each other. The community health nurse must adjust her nursing interactions to accommodate this family’s style of operating. The nurse should respect the family’s need for distance, approach them cautiously, and observe for cues that indicate that they are becoming anxious.
This family has some ability to organize activities that need to be accomplished to maintain Mr. R.’s health. Family members are concerned about each other and may be able to adjust schedules or routines. Mrs. R. is committed to Mr. R.’s health care and will try to do what is required. The family has a long history together and in the past has developed a sense of identity and common purpose.
Even though the family is currently stressed, long-term functioning is fairly healthy. No one member has consistently been a problem or has failed to fulfill her or his role. The adult children are not acting in their age-appropriate roles of support to parents. This status seems to reflect the family style but can possibly be modified.
Targets of Care
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