I.

Introduction:

Family is the basic unit of society. Family is frequently defined as two or more

persons who are related through marriage, blood, birth, or adoption (Duvall 1977).

Although this definition characterized a large number of families, it does not adequately

describe the membership of many families today. In many families there are no legal or

blood relationships among its members. As the structure of the family has become more

diverse, it has been necessary to define the family more broadly to encompass the wide

variety of family forms seen in today’s s society. To provide flexibility in the study of

families, Friedman (1981, p8.) defines family as follows “ a family is composed of people

(two or more) who are emotionally involve with each other and live in close-

geographical proximity.

Nursing assessment is the first major phase of nursing process. In the family

health nursing practice, this involves a set of actions by which the nurse measures the

status of the family as a client, its ability to maintain itself as a system and functioning

unit, and its ability to maintain wellness, prevent, control, resolve problems in order to

achieve health and well-being among its members. Data about the present condition or

status of the family are compared against norms and standards of personal, social and

environment health, system integrity and ability to resolve system problems. These

norms or standards are derived from values, beliefs, principles, rules or expectations.

(Turner 1947, p. 17)

 For the nurse to able to assess the family there are necessary steps to

accomplish. The nurse should apply nursing assessment. Nursing assessment is the

major step; it includes data collection, data analysis or interpretation and problem

definition or nursing diagnosis. Nursing diagnosis is the end result of two major types of

nursing assessment in the family nursing practice based on the framework of the

community health nursing book. First level assessment is a process whereby existing

and potential health conditions and problems of the family are determined. Second

Level of assessment defines the nature or type of nursing problem that the family

encounters in performing the health tasks with respect to a given health condition or

problem, and the etiology or barriers to the family’s assumption of these task. These two

levels of assessment specify a hierarchy of two sets of data and their analyses. They

reflect depth of data gathering and analysis on what health conditions or problem exist,

and why each health condition or problem related with the maintaining the wellness

exists.

Gama Family is a nuclear family at matriarchal due to the loss job of the head of

the family, currently only the mother is working for the family. Both of the couple

graduated in college. The family is composed of six members, two children of the

couple is currently at college. The family have financial problem because the income is

not enough for the whole family, to compensate with the crisis the couple tried to sell

frozen goods. The father is a smoker. That is one health in the family. In terms of eating

habits the family is used of eating meat but sometimes they also try to cook vegetable.

Mrs. Gama has the habit of drinking slimming tea. The family is very close to each
other. I as the researcher and a nursing student could teach and help the family to see

the presence of a health problem, and help them how to prioritize each problem. Based

on the observation and assessment that I have done to the family, their unhealthy

lifestyle increases the risk of the family to acquire severe illness.

II. General Objective:

 To create awareness for the family to know the factors that makes a family

healthy and to plan an action to lessen the risk of possible disease.

Specific Objectives:

 To assess the conditions of the family’s health condition, wellness and the

problems that is present.

 To be able teach the family on how to prevent disease, promote wellness and

curative measurements

 .To be able prepare the family to enhanced their wellness state.

III. Family Assessment

1. Family Structure , Characteristics and Dynamics

 The family is composed of six (6) members namely Jomer Gama head of

the family 42 years old, Lina wife 40 years old. They have four children Lovelaine

joy the eldest daughter is 19 years old, Kenneth Arvin the second child is 18

years old, Leahfel the third one is 12 years old and the youngest daughter

Vivialine is 7 years old. The family lived at 1535 Prudencio st. Sampaloc Manila,

two of the children is in college. The family is nuclear family and renting a

apartment unit worth 6,000 a month. Both of the couple is making a decision for

the family especially in health and money. The family is much closed to each

other, they often bond, and the family always eats together.

2. Socio- economic and Cultural Characteristics

In terms of income and expenses of the family, according to the Lina’s

statement the family’s income is below php19, 000 a month. Lina, the mother is

the only one working for the family at the public elementary school with the

income of php .15, 000. The family eats three times a day and can able to meet

basic needs. Educational attainment of each member of the family; Mr. and Mrs.

Gama is both a college graduate. All of the children is studying: Lovelaine Joy is

currently 4th year college student; Kenneth Arvin is 2nd year college student and

Danica the third one is 1st year high school, Vivialine the youngest is in grade 2

all of them is at public school. The family is from Isabela, the family is Ilocano.
 The family is Roman Catholic. The family is not that active in terms of the

community program inside their community the father Jomer stated that:

“chairman does not have any program”.

3. Home and Environment

Based on the observation that I have done home environment of the

Gama family the space is adequate for the family and the house have two rooms

and one comfort room. In sleeping arrangement the one room is occupied by the

four children and couple sleeps in another room. Because of the oldness of the

house there is a presence of breeding site cockroaches and rats, and

mosquitoes because of the stagnant canals. Refrigerator is their food storage

and have dirty kitchen at the back of their house, but sometimes the family also

used “kalan” to cook. Their water supply comes from the local water system but

their drinking water source is commercially prepared. The family has their own

toilet and it is pail system. Their garbage is being collected. Their drainage

system is blind and stagnant because of lack of canals. The family’s surrounding

is congested. The only social facility that is available in their barangay is the

Basketball court and it is occupied every morning for games. Health center which

is 3 blocks away from their house in the only health facilities available. In terms of

their transportation the family owns a car but there are jeepneys and tricycles

near to their house.

 4. Health Status of each of the family Member:

Based on the interviewed that I’ve done the mother Lina told me that her

husband Jomer was rush to the hospital last November because of the sudden increase

in blood pressure. Jomer is also a heavy smoker and obese, and prescribe a diet but

Jomer doesn’t follow. The head of the family Jomer is diagnose to be hypertensive.

With the laboratory result of: cholesterol 5.50, triglycerides 1.02, and fasting blood sugar

6.86. His normal blood pressure is 140/100. Lina, the mother is always drinking

slimming tea and if she doesn’t drink she can’t bowel. Lovelaine joy the eldest daughter

is 19 years old weight 75 and 5’5 ft in height with BMI of 27.89 = obese. Kenneth Arvin

18 years old 65 kgs and 6ft in height undergone appendectomy 3 years from ago. Two

of the young children Leahfel 12 years old 55 kgs and 163cm in height and Vivialine

seven years old 35kgs and 143cm in height have lice home medication is done, Lina

tried to used “Licealis” a kind of shampoo used to remove lice.

5. Values, habits, Practices on health Promotion

Based on my interview to the mother daisy she said her children all her children is

complete. The family does practice healthy lifestyle like using hygienic product, brushes

teeth 2x a day, cut toenails and finger nails, cleans ears, change clothes. In terms of

sleep the family does get enough sleep because of their environment. The family used

bed nets and protective clothing like pajamas. The family doesn’t exercise and the only

activities they do together is watch television. The family is going to mall every Saturday

as a stress management. The family only consults doctor if needed the family is use of

self medication.
IV. Cues and Data

Cues and Data First Level Assessment Second Level

Assessment

 40 years old jomer is  Hypertensive as  Inability to make

diagnose health deficit. recognize the

hypertensive with presence of the

laboratory results of: hypertension due to

cholesterol 5.50, denial about its

fasting blood sugar existence or severity

6.86, Triglycerides as a result of fear of

1.02. With blood consequences of

pressure of 140/100. diagnosis of

 Father verbalizes “ok problem, specifically

naman kasi yung due to cost

pakiramdam ko hindi implication.

ako nahihilo, di

naman mataas

maasyado mga

laboratory resulte ko,

kaya yan sa gamot”.  Cigarette smoking as

 Jomer, the father is health threats. Inability to provide home

a heavy smoker. environment conducive to

health maintenance and

 personal development due

to lack of knowledge of

 Excessive intake of preventive measures.

 Lina, the mother is tea as a health Inability to recognize the

used of drinking threat. presence of excessive use

sliming tea or other of tea due to lack of

tea like “biguerlai” to knowledge.

get bowel.

 The mother

verbalizes “pag hindi

ako uminom ng tea

hindi ako

makakatae”

 Unhealthy eating

 Lovelaine joy the habits as health Inability to make decision

eldest is obese with threats. with respect to taking

BMI of 27.89. appropriate health action

. due to failure to

 Threat of cross comprehend the magnitude

 Leahfel 12 years old infection of the health condition.

50 kgs and vivialine Inability to provide home

7 years old 35 kgs environment conducive to

 both have head lice. health maintenance and

personal development due

 Leahfel verbalizes to inadequate knowledge

“gumaling nako dati of importance of hygiene

e, kaso natabi ulet and sanitation.

ako ky vivialine kay

nahawa ako”.

V. Identified problem

Based on assessment there are six health problems that are existing in the

Gama family:

a. Hypertension as a health deficit

b. Smoking as a health threat

c. Excessive use of tea as a health threat

d. Unhealthy eating habits

e. Lice as a threat of cross infection in the family

VI. Scoring

o Hypertension

Criteria Computation Actual score Justification

1. Nature of the 3/3x1 1 The problem is

problem health deficit and

demand for

immediate

2. Modifiability of 2/ 2 x 2 2 intervention.

the problem The resources and

intervention needed

are available in the

family and

3. Preventive 3/ 3 x 1 1 community.

potential The hypertension

can be prevented to

worsen if proper

4. Salience of the 2/ 2 x 1 1 medication is done

problem The family

perceives it as a

serious problem

needing an

immediate attention.
Total = 5
o Unhealthy lifestyle as a health threat (Smoking)

Criteria Computation Actual score Justification

1. Nature of the 2/3x1 2/3 It is a health threat

problem and should be

eliminated to reduce

the threat in the

health of each

family member.

2. Modifiability of 2/2x2 2 The problem is

the problem easily modifiable if

the member of the

family is willing to

practice healthy

3. Preventive 3/3x1 1 lifestyle.

potential The problem can be

prevented if health

teachings are done

about the effect of

tobacco use in

4. Salience of 2/ 2 x 1 0 system.

problem The family

perceived it as a

problem.
 Total = 4 2/3

o Unhealthy eating habits (excessive intake of tea)

Criteria Computation Actual score Justification

1. Nature of the 2/3x1 2/3 It is health threat

problem needing an

2. Modifiability of 1/2x2 1 attention.

the problem Partially modifiable

3. Preventive 3/3x1 1

potential Normal bowel

4. Salience of the 1/2x1 1/2 movement can

problem achieved if proper

diet and exercise is

emphasized
Total = 3
o Faulty eating habits

Criteria Computation Actual score justification

1. Nature of the 2/3x1 2/3 It is a health threat

problem needing a

immediate attention
 to reduce the

severity of the

2. Modifiability of 1/2x2 1 condition.

the problem Partially modifiable

3. Preventive 3/3x1 1

potential Susceptibility to

4. Salience of the 1/ 2 x 1 1/2 disease can be

problem prevented if proper

nutrition is

emphasized.
Total = 3

o Lice as a threat of cross infection

Criteria Computation Actual score Justification

1. Nature of the 2/3x1 2/ 3 It is a health threat

problem that requires an

immediate attention

and intervention to

reduce the spread

 of the disease.

2. Modifiability of 1/2x2 1 The family has

the condition adequate

or problem resources.

3. Preventive 1/3x1 1/ 3

potential Transfer of lice to

the other member of

the family if the

problem is adequate

4. Salience of the 2/2x1 1 management is

problem done.

The family id

recognized it as a

problem and

intervened already.
Total = 3

VII. Prioritized problem

List of prioritized problem

 Hypertension 5

 Smoking 4 2/ 3

 lice as a threat of cross infection 3

 Excessive intake of tea 3

  Faulty eating habits 3

XI. Family health Task

Health problem Assessment Health task

1.Hypertension as a health Inability to make recognize The family will be able to

deficit the presence of the accept the hypertension

hypertension due to denial and will be able to find

about its existence or alternative ways to less the

severity as a result of fear cost implicated by the

of consequences of disease.

diagnosis of problem,

specifically due to cost

implication
2.Smoking as a health Inability to provide home The family will be able to

threat environment conducive to provide home environment

health maintenance and conducive for the wellness

personal development due state of each member of

to lack of knowledge of the family

preventive measures
3.Lice as a threat of cross Inability to provide home The family will be able to

infection environment conducive to provide medication and

health maintenance and proper isolation of the

personal development due linens and clothes infected

to inadequate knowledge of and able to understand the

 importance of hygiene and importance of hygiene.

sanitation.
4.Excessive use of tea Inability to recognize the The mother will be able to

presence of excessive use recognized the presence of

of tea due to lack of excessive use of tea and

knowledge able to find alternative

ways of returning to healthy

lifestyle.
5.Faulty eating habits Inability to make decision The family will be able to

with respect to taking provide an immediate

appropriate health action action about the faulty

due to failure to eating habits.

comprehend the magnitude

of the health condition

VIII. Evaluation

After the assessment, the student nurse able to list down the problem

occurring in the Gama family and formulated a plan for the wellness of the

family and to improve the health of each member. The prioritized problem

discuss with the family to be able to explain further how to intervene with the

problem. The general objective and the goal of care is achieved.