MODULE Finale 2015

U N C I A N O C O L L E G E S, I N C.
College of Nursing Antipolo City
2
TABLE OF CONTENTS
1. Establishing a good working relationship
2. Family assessment
3. Family health care planning
4. Family health care implementation
5. Family health care evaluation
6. Self-evaluation
7. Client Evaluation

3
GENERAL OBJECTIVES
This module will enable students to:
1. Establish good working relationship
2. Comprehensively assess client families
3. Involve client families in preparing health care plans
4. Assist clients families in implementing family health care plan
5. Evaluate health care conducted on the client family

4
ESTABLISHING A GOOD WORKING RELATIONSHIPS WITH FAMILIES
Objectives:
1. Using the guide form, establish good working relationships with families in a
community.
2. Properly conduct home visits; and
3. Determine other means of communicating with client families whenever a home visits
is not possible
Direction: assess level of accomplishment in establishing a good working relationship
with each client family by truthfully filling up the required form
ESTABLISHING A WORKING RELATIONSHIP WITH THE CLIENT FAMILY
NAME OF FAMILY HEAD: FAMILY X
CRITERIA CHECK IF DONE
(INDICATION DATE)
1. Initiate contact through home visit. 
2. Introduce yourself and your agency. 
3. Communicate interest in family welfare 
4. Maintain a two-way communication with the family. 
5. Show willingness to help with expressed needs. 

5
CONDUCTING A HOME VISIT
Objectives: Using the guide form, perform the duties and responsibilities of a CHN
during home visits of families.
Direction: Conducting home visits require accomplishing a specific form.
NAME OF FAMILY HEAD: Family X DATE OF VISIT: August 20, 2015
STEPS IN HOME VISIT CHECK UP
(INDICATE DATE)
1. Greet client or household member and introduce yourself. 
2. Explain purpose of home visit. 
3. Inquire about health and welfare of client/patient and other
family members. Ask about any health and health-related
problems.

4. Place health bag in a convenient place using bag technique. 
5. Wash hands, take out needed articles from bag. 
6. Perform physical examination. Administer nursing care. If
more than one member has to be supervised/cared for, start
with the well member to avoid transfer of infection.

7. Give necessary health advice or teach basic health care
based on client´s needs and condition.

8. Wash hands and close bag. 
9. Record the health status of family members and care
administered

10.Make an appointment for next visit either at the clinic or
another Home visit


6
IDENTIFYING AND CATEGORIZING FAMILY HEALTH PROBLEMS
Objectives:
Students should be able to:
1. List down the health problems recognized in each family.
2. Categorize each health problem into health threat, health deficit, or foreseeable
crisis.
3. Prioritized health problems according to nature, modifiability, preventive potential
and salience to the family.
4. Justify the scores given according to each problem; and
5. Rank health problems according to priorities.
Direction: Within two days, list down the health problems recognized in each of the
families you have visited and interviewed. Compute the score of each problem, justify
scores given and rank problems according to priority.
FAMILY NO.
NAME OF FAMILY HEAD: Family X
ADDRESS: MARIGMAN ST. GOLDEN HILLS BRGY. SAN ROQUE,
ANTIPOLO CITY
LIST OF HEALTH PROBLEMS NATURE OF PROBLEMS
1. Non-utilization of health center Health Threat
2. No AP Check-up Health Threat
3. Poor personal health practices Health Threat
4.
5.
6.
7.

7
COMPUTING AND JUSTIFYING SCORES OF HEALTH PROBLEMS
Direction: Encircle the actual standard scores and the scores that apply to the family’s
problems. Justify the scores you gave the indicated column. Compute the sum of all the
actual scores you have encircled and write them on the space provided.
FAMILY NO. Family X
PROBLEM: NON-UTILIZATION OF HEALTH
CENTER
CRITERIA STANDARD SCORE WEIGHT ACTUAL
SCORE
JUSTIFICATION
1.Nature of the
Problem Health Deficit
Health Threat
Foreseeable Crisis
3
(2)
1
1 O.67
It is considered
HEALTH THREAT
because it requires an
immediate attention.
2. Modifiability of
the problem Modifiable
Partially Modifiable
Not Modifiable
2
(1)
0 2 1
The problem is
PARTIALLY
MODIFIABLE
because of failure to
understand the
benefits of health
care/services.
3.Preventive
Potential High
Moderate
Low
3
2
(1)
1 0.33
The PREVENTIVE
POTENTIAL is LOW
because the client
shows not interested
to utilize at the health
center.
4. Salience of the
problem Needs immediate
attention
Does not need
immediate
attention
Not a problem
2
1
(0)
1 0
SUBJECTIVE CUE:
“Libre kasi lahat sa
shalom” as verbalized
TOTAL
SCORE 2

8
Scoring:
1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply by weight.
______Score______ x weight
FAMILY NO. Family X
PROBLEM: NO AP CHECK-UP
SCORE
JUSTIFICATION
1. Nature of the
Health Threat
Foreseeable Crisis
3
(2)
1
1
0.67
It is considered HEALTH
THREAT due to lack of
knowledge about
community health
care/services.
2. Modifiability of
the Problem Modifiable
Not Modifiable
2
(1)
0
2 1
It is PARTIALLY
MODIFIABLE because
the client used to visit
“Shalom paanakan” than
health center.
3. Preventive
Potential High
Moderate
Low
3
2
(1)
1
0.33
The PREVENTIVE
POTENTIAL is LOW
because the client
shows not interested to
have an AP Check-up at
the health center
4. Salience of the
Problem Needs immediate
attention
Does not need
immediate
attention
Not a problem
2
1
(0)
1 0
SUBJECTIVE CUE:
“Libre kasi lahat ng
laboratory sa Shalom”
as verbalized.
TOTAL
SCORE 2

9
Highest Score
3. Sum up the scores for all the criteria. The highest score is 5.
RANKING HEALTH PROBLEMS ACCORDING TO PRIORITY
Direction: Rank the health problems of each family. Priority 1 has the highest score.
Priority 2 has the second highest, Priority 3, the next highest, and so on.
FAMILY NO. Family X
PROBLEM: POOR PERSONAL HEALTH PRACTICES
SCORE
JUSTIFICATION
1. Nature of the
Health Threat
Foreseeable Crisis
3
(2)
1
1
0.67
HEALTH THREAT:
Because it requires
an immediate
attention
2. Modifiability of the
problem Modifiable
Not Modifiable
(2)
1
0
2 2
The problem is
MODIAFIABLE since
the client knows
some ways how to
take care of herself.
3. Preventive
Potential High
Moderate
Low
(3)
2
1
1 1
The problem is
HIGHLY
PREVENTIVE
because the client
understand the
importance of health
maintenance and
personal hygiene.
4. Salience of the
problem Needs immediate
attention
Does not need
immediate attention
Not a problem
2
1
(0)
1 0
The client does not
view this as a
problem because the
client verbalized “Ang
haggard ko, wala ng
time mag-ayos”.
TOTAL
SCORE 3.67

10
RANKING HEALTH PROBLEMS OF FAMILY
PRIORITY PROBLEM SCORE
1 Poor Personal Health Practices 3.67
2 Non-Utilization of Health Center 2
3 No AP Check-up 2
4
5
RANKING HEALTH PROBLEMS OF FAMILY
PRIORITY PROBLEM SCORE
1
2
3
4
5
FAMILY HEALTH CARE PLANNING
Objectives:

11
Completion of the forms in this module will enable students to:
1. List the top priority families requiring follow-up
2. Prepare family health-care plans for the top priority families
3. Work out details of the family health care plan with the families concerned.
4. Make a contact with the families for the implementation of the family health care
plan.
DETERMINING FAMILY NURSING PROBLEMS
Objectives: Using the forms for determining family nursing problems, student should be
able to:

12
1. List down the possible causes of health problems of identified priority families.
2. Identify possible intervening measures for their problems.
Direction: Within the day, determine the root causes of the priority families health
problems as well as their family nursing problems. FAMILY NAME: MURILLO FAMILY
FAMILY NAME Family X
FAMILY NURSING PROBLEMS
HEALTH
PROBLEMS
FIRST LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT
FAMILY NURSING PROBLEMS
HEALTH
PROBLEMS
FIRST LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT
Non-Utilization of
Health Center
No AP Check-up
Presence of Health Threat
Presence of Health Threat
Presence of Health Threat due to
failure to utilize community
resources for health care.
Presence of Health Threat due to
lack of knowledge about community
health care/services.

13
Poor Personal
Health Practices
Inability to provide health
maintenance and personal
development
Inability to provide health
maintenance and personal
development due to lack of
knowledge regarding the importance
of hygiene.
PREPARING FAMILY HEALTH NURSING CARE PLANS FOR PRIORITY
FAMILIES

14
Objectives: Using the forms for preparing a family nursing care plan, students and the
priority families concerned should be able to:
1. Identify the family health problems
2. Formulate the goals and objectives of health care.
3. Discuss and list planned interventions for identified problems.
Direction: Within three days, prepare, together with the families concerned, family
nursing care plans for the families you have assessed.
HEALTH PROBLEMS FAMILY PROBLEMS GOALS OBJECTIVES
NON-UTILIZATION OF
HEALTH CENTER
SUBJECTIVE CUE:
laboratory sa Shalom” as
verbalized.
OBJECTIVE CUES:
 V/S- 80/60 bpm
 LMP- NOV. 14,
2014
 EDD- AUG. 21,
2015
 GP- 5 (LIVING)
 AOG- 48 week(s),
0 day(s) or 11.04
month(s) months.
Presence of Health
Threat due to failure
to utilize community
resources for health
care.
They rather visit
“Shalom Paanakan”,
center for good
benefits.
After a week of
community exposure
the client will be able
to visit the Health
Center.
After a week the client
will be able to:
A. Discuss/Encourage
the benefits of Health
Center such as:
 Free AP Check-
UP
 Free Dental
 Free Medication
 TT Immunization
 Health
Teachings
B. Encourage and
motivate the client

15
INTERVENTION
METHODS
METHODS OF
NURSING FAMILY
CONTACT
RESOURCES
REQUIRED
EVALUATION
Discuss to the client
the benefits of the
Health Center
utilization such as:
Encourage/Motivate
the client to visit the
Health Center
Winshield
(AUG. 20, 2015)
-Home Visit
-Health Center Visit
(SEPT 2, 3 2015)
-Home Visit
-Farewell Visit
(DEC 16, 2015)
-Follow up visit
MATERIAL:
 Family Health
Care
Assessment
Form
 Pencil
 Umbrella
 BP Apparatus
MONEY:
 Transportation
MANPOWER:
 Brgy. Officials
 Students
 Family
 Clinical
Instructor
 Health Center
Staff
After a week of
community exposure the
client was able to:
 Utilized the Health
Center.
 Appreciate the
Health Center
within their
community.

16
HEALTH
PROBLEMS
FAMILY PROBLEMS GOALS OBJECTIVES
NO AP CHECK-UP
SUBJECTIVE CUE:
laboratory sa
Shalom” as
verbalized.
OBJECTIVE CUES:
 V/S- 80/60
bpm
 LMP- NOV.
14, 2014
 EDD- AUG.
21, 2015
 GP- 5
(LIVING)
 AOG- 48
week(s), 0
day(s) or
11.04
month(s)
months.
Presence of Health
Threat due to lack of
knowledge of
community health
care/services.
After a week of
community exposure,
the client will be able
to have her next AP
Check-up at the
Health Center.
After a week of
community exposure
the client will be able to:
A. Discuss/Enumerate
the importance of
having AP Check-up in
Health Center such as:
 Free AP Check-
up
 Giving free
Medication
 Vaccination
 Health
Teachings
 Safety measure
to pregnancies
 Conditions of the
baby/mother
B. Encourage and
motivate the client.

17
INTERVENTION
METHODS
METHODS OF
NURSING FAMILY
CONTACT
RESOURCES
REQUIRED
EVALUATION
Encourage and
motivate the client to
visit the Health
Center.
Winshield
(AUG. 20, 2015)
-Home Visit
(SEPT 2, 3 2015)
-Home Visit
-Farewell Visit
(DEC 16, 2015)
-Follow up visit
MATERIALS:
 Family Health
Care
Assessment
Form
 Pencil
 Umbrella
MONEY:
 Transportation
MANPOWER:
 Brgy. Officials
 Students
 Family
 Clinical
Instructor
After a week of
community exposure
the client was able to
subject herself to have
an AP Check-Up at
Health Center.

18
HEALTH
PROBLEMS
FAMILY PROBLEMS GOALS OBJECTIVES
POOR PERSONAL
HEALTH
PRACTICES
SUBJECTIVE CUE:
“Ang haggard ko,
wala ng time mag-
ayos” as verbalized.
OBJECTIVE CUES:
 Restlessness
 Puffy eyes
 Stress
 Lack of sleep
Inability to provide
health maintenance
and personal
development due to
lack of knowledge of
importance of
hygiene.
After a week of
community exposure,
The client will be able
to adopt at least 3
Healthy Practices
After a week of
community exposure,
the client will be able to:
A. Discuss/Enumerate
the list of having an
active healthy lifestyle
such as:
 Not smoking
 No Drinking
Alcohol
 Get enough
sleep
 Eat healthy
foods
 Drink a lot of
water everyday
 Exercise
B. Proper Hygiene such
as:
 Fully bath of
shower
 Wash the face
daily
 Brushing teeth
thrice a day
 Changing
clothes as
needed
 Eat healthy
foods
 Drink a lot of
water everyday
 Get enough
sleep
 Exercise
C. Encourage and
motivate the client.
INTERVENTION
METHODS
METHODS OF
NURSING FAMILY
CONTACT
RESOURCES
REQUIRED
EVALUATION
Encourage and
motivate the client
to maintain daily
personal hygiene.
.
Winshield
(AUG. 20, 2015)
-Home Visit
(SEPT 2, 3 2015)
-Home Visit
-Farewell Visit
(DEC 16, 2015)
-Follow up visit
MATERIALS:
 Family Health
Care
Assessment
Form
 Pencil
 Umbrella
MONEY:
 Transportation
MAN POWER:
 Brgy. Officials
 Students
 Family
 Clinical
Instructor
After a week of
community exposure
the client was able to:
 Improved proper
hygiene

19
FAMILY HEALTH CARE EVALUATION
Objectives: Using the form for family nursing care plan evaluation, together with client
family, students should be able to:
EVALUATE FAMILY HEALTH CARE
1. Document and determine whether health intervention results are positive or
negative.
2. Formulate alternative plans if the evaluation result is negative.
FAMILY HEALTH CARE EVALUATION FORM
Sa pagdalaw ko sa pamilya Family X
Pangalan ng pamilya
MGA BATAYAN (LAGYAN NG TSEK ANG ANGKOP NA SAGOT) OO HINDI
1. Ipinakilala ko and aking sarili.

2. Ipinakilala ko ang aking kasama.

3. Ako ay gumagamit ng tamang pananalita sa pakikipag-usap.

4. Ako ay nagpapakita ng katapatan sa pagtulong.

5. Madali kong nakapalagayan ng loob ang mga miyembro ng pamilya.

6. Ako ay nagpakita ng ugaling madaling pakitunguhan.

7. Ginagamit ko ang pagkakataon upang magturo ng kaalamang pang-
kalusugan.

8. Tinitiyak ko na naiintindihan ang aking itinuturo.

9. Ipinaliwanag ko ang mga salitang medical.

10. Ako ay naging maayos at mabilis sa paggawa.


20
IBA PANG MASASABI:
__________________________________________________
PANGALAN NG CHN AT LAGDA:
_______________________________________
Pangalan ng pamilya






kalusugan.




IBA PANG MASASABI:
__________________________________________________
________________________________________

21
Pangalan ng pamilya






kalusugan.




IBA PANG MASASABI:
__________________________________________________
________________________________________

22
FAMILY ASSESSMENT GUIDE
INITIAL DATA BASE
Head of the family: Family X
Address: MARIGMAN ST. GOLDEN HILLS BRGY. SAN ROQUE, ANTIPOLO CITY
I. FAMIILY DATA:
Length of Residency: 33 YEARS Family Size: LARGE
Place of origin: Husband: URDANETA
Wife: ANTIPOLO
Religion: Husband: ROMAN CATHOLIC
Wife: ROMAN CATHOLIC
FAMILY MEMBER’S CHART
II. Family Structure and Characteristics:
1. Type of Family Structure
 A. NUCLEAR C. PATRIARCHAL
FAMILY
MEMBERS
AGE SEX CIVIL
STATUS
POSITION
IN THE
FAMILY
RELATIONSHIP
TO FAMILY
HEAD
EDUCATIONAL
ATTAINMENT
OCCUPATION
Father X
38 M Married
Head of
the family Father
College
Graduate
Construction
Worker
Mother X
33 F Married Mother H.S Under Grad
Housewife
Daughter X
13 F Eldest Child High School
Daughter X
10 F Middle Child Grade School
Daughter X
8 F Grade School
Son X
1 M Youngest Child

23
B. EXTENDED D. MATRIACHAL
2. General Family Relationship?
WITH CONFLICTS BETWEEN MEMBERS
 WITHOUT CONFLICTS BETWEEN FAMILY MEMBERS
3. Monthly Family Income Source
 HUSBAND: WIFE:
OTHER
4. Monthly Family Income
Total (check bracket)
Below 5,000
Above 5,000 – 10,000.00
Above 10,000.00 – 15,000.00
Above 15,000.00 – 20,000.00
Above 20,000.00 – 30,000.00
Above 30,000.00 – 40,000.00
Above 40,000.00 – 50,000.00
More than 50,000.00
5. Family Health Status/Health History
Father: None
Mother: None
Children: None
III. Home and Environmental Factors
A. Housing
1. Ownership

24
Owned Rented
2. Type of Housing Materials
Wood mixed
Concrete makeshift
others, specify
B. Is the living space adequate? (yes) (no)
C. What are the appliances owned by the family?
D. Type of garbage disposal
 collected waste segregation
feeding to animals burning
burying open dumping
throw in the river others, Specify
E. Type of waste disposal
flush water-sealed
wrap and throw others, specify (Pale,Deeper)
F. Type of drainage system open closed
G. Source of water supply
owned bought
 shared others, specify
H. Drinking water storage
 covered uncovered

25
I. Food storage
 covered uncovered
refrigerator cabinet
jars pots
J. Cooking facility
electric stove firewood
gas stove kerosene stove
K. Sanitary condition
fair good poor
L. Neighborhood
Congested slum other
M. Common household pests found at home: Mosquitoes and Cockroaches
N. Are the breeding sites of insects, rodents, etc., present?
(yes) (none)
O. Pets/animals kept in the yard/home: NONE
P. Are there accident hazards present?
(yes) (none)
IV. Health and health practices
A. Common illness encountered for the last 6 months and the treatment applied.
_____________________________________________________________________
B. Whom do you consult for health – related problems?
manghihilot albularyo

26
midwife nure
doctor Health Center
Barangay Health Worker others, specify
C. For problems other than health, whom do you consult?
family members relatives
friends barangay officials
priest others, specify
D. Immunization status of children below 5 years old
_____________________________________________________________________
______________________________________________________________________
E. HAVE YOU HAD ADEQUATE
1. Rest and sleep? (yes) (no)
2. Exercise? (yes) (no)
3. Relaxation activities? (yes) (no)
4. Stress management activities (yes) (no)

MODULE Finale 2015

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