Family Assessment Guide

Box 13-7 Family Assessment Guide

I Identifying Data

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Name: ___________________________________________________________________________________________________

Address: __________________________________________________________________________________________________

Phone number(s):_____________________________________________________________________________________________

Household members (relationship, gender, age, occupation, education):____________________________________________________

Financial data (sources of income, financial assistance, medical care; expenditures):___________________________________________

Ethnicity: __________________________________________________________________________________________________

Religion: __________________________________________________________________________________________________

Identified client(s):______________________________________________________________________________________________

Source of referral and reason: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

II Genogram

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: _______________________________________________________________________________

Coping: _____________________________________________________________________________________________________

Sources of medical and dental care: ____________________________________________________________________________

Health screening practices: ____________________________________________________________________________________

IV Interpersonal Needs

Identified subsystems and dyads:________________________________________________________________________________

Prenatal care needed: _________________________________________________________________________________________

Parent–child interactions:_______________________________________________________________________________________

Spousal relationships:_________________________________________________________________________________________

Sibling relationships:_________________________________________________________________________________________

Concerns about older members:___________________________________________________________________________________

Caring for other dependent members:________________________________________________________________________________

Significant others:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

V Family Needs

A. Developmental

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?_______________________________________________________________________

D. Environment

Type of dwelling:________________________________________________________________________________________________

Number of rooms, bathrooms, stairs; refrigeration, cooking:_______________________________________________________________

Water and sewage:______________________________________________________________________________________________

Sleeping arrangements:_____________________________________________________________________________________________

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.:________________________________________________________________

Problem-solving style:________________________________________________________________________________________

Degree of cohesiveness and loyalty to family members:___________________________________________________________________________________________________________________________________________________________________________

Conflict management:________________________________________________________________________________________


VI Analysis

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 “Family Coping: Compromised.”

Family Style

This family is a distancing family that prefers to keep its problem-solving activities to itself. However, this isolation limits family members’ 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.

Family Strengths

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.

Family Functioning

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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