INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. Family Structure, Characteristics, and Dynamics

1. Members of the household and relationship to the head of the family
2. Demographic data- age, sex, civil status, position in the family
3. Place of residence of each member- whether living with the family or
elsewhere
4. Type of family structure- e.g. matriarchal, patriarchal, nuclear or extended
5. Dominant family members in terms of decision-making, especially in matters
of health care
6. General family relationship/dynamics- presence of any obvious/readily
observable conflict between members; characteristic
communication/interaction patterns among members

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. Significant Others- role(s) they play in family’s life
5. 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 the living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of diseases (e.g.
mosquitoes, roaches, flies, rodents, etc.)
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply- source, ownership and potability
g. Toilet facility – type, ownership, sanitary condition
h. Garbage/refuse disposal- type sanitary condition
i. Drainage system- type, sanitary condition
2. Kind of neighbourhood, 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 conducive to health and illness

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 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 kgs. Divided
by height in meters2), 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 cm in women).
b. Dietary history specifying quality and quantity of food/nutrient intake
per day
c. Eating/ feeding habits and practices
3. Developing assessment of infants, toddlers, and pre-schoolers –e.g. Metro
Manila Development Screening Test (MMDST).
4. Risk factor 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.

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

Prevention. Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
a. Rest and sleep
b. Exercises/activities
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
4. Use of promotive- preventive health services

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 A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST LEVEL ASSESSMENT

I. 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:

A. Potential for Enhanced Capability for:

1. Healthy Lifestyle- e.g. nutrition/diet, exercise/activity
2. Health Maintenance/ Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well-being- process of a client’s developing/unfolding of
mystery through harmonious interconnectedness that comes from inner
strength/ sacred source/ God
6. Others, specify________________
B. Readiness for Enhanced Capability for:
1. Healthy Lifestyle
2. Health Maintenance/ Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well-being
6. Others, specify

II. Presence of Health Threats- conditions that are conducive to disease or

accidents, 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 hazards, specify:
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

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 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, flies, roaches, 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
5. Poor personal hygiene
6. Self-medication/ substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest and 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 bednets 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 behaviour of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others, specify

III. Presence of Health Deficits- instances of failure in health maintenance. Examples

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, lameness from
polio)

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IV. Presence of Stress Points/ Foreseeable Crisis Situations- anticipated periods of
unusual demand on the individual or family in terms of adjustment/family
resources. Examples of these include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member –e.g. newborn, lodger
E. Abortion
F. Entrance in school
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

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

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 J. Inaccessibility of appropriate resources for care, specifically:
1. Physical inaccessibility
2. Cost constraints or economic/ financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconception 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 or inadequate knowledge and skill in carrying out the necessary
interventions/procedures/treatment/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
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

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 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. loss 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 or inadequate family resources, specifically:
1. Manpower resources- e.g. baby sitter
2. Financial resources –e.g. cost of medicine prescribed
I. Feeling of alienation too/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

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SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING
TO PRIORITIES

CRITERIA WEIGHT
1. Nature of the condition or problem presented
Scale 1
Wellness state 3
Health deficit 3
Health threat 2
Foreseeable crisis 2
2. Modifiability of the condition or problem
Scale 2
Easily modifiable 2
Partially modifiable 1
Not modifiable 0
3. Preventive potential
Scale 1
High 3
Moderate 2
Low 1
4. Salience
Scale 1
A condition or problem needing immediate attention 2
A condition or problem not needing immediate attention 1
Not perceived as a problem or condition needing change 0

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