ANGELES UNIVERSITY FOUNDATION

Angeles City
COLLEGE OF NURSING

A GUIDE IN MAKING
THE FAMILY CASE ANALYSIS
CHN II

I. INTRODUCTION
 May be started with a striking quote, to be explained on the succeeding
paragraph
 Define what a community and a family is
 Define and elaborate family, community and/or public health nursing
 Include current issues about families in the Philippines or in the world and
explain how this affects
 Define family case analysis and give an overview
 2nd to the last paragraph: cite your criteria for choosing your family; examples:
 a family with not less than 7 members
 a household with an obvious need of help in health and environment
 last paragraph: answer the WHO, WHAT, WHERE, WHEN, & HOW of the FCA
 WHO: pseudonym of the family
 WHAT: FCA
 WHERE: name of street, purok and barangay where the
family resides
 WHEN: number of home visits and duration (from what
date to what date?)
 HOW: briefly explain the nursing process in family health
nursing

A. Objectives

1. Student-Centered
 You should be able to incorporate the Nursing Process in your
objectives.
a. Short-term
 The timeframe in this part may vary. It may be on the initial
home visit alone or on the first two home visits, depending on
the objectives you have set yourself.
b. Long-term
 The timeframe on this part will depend on how many home visits
you have made.
2. Client-Centered
 The things you expect with your family should match with your own
objectives.
a. Short-term
b. Long-term

3. Research-Centered
 When we say research-centered objectives, these are objectives that
should answer all the questions that are expected to be seen in the
completion of this study. Everything in the format should be
reflected on this part.
 Example:
This family case analysis aims to answer the following
questions:
 1. How may the profile of each member of the family be
described as to:
a. age;
b. sex;
c. educational status;
d. position in the family; &
e. present health status?

 Notice that the answers to this set of questions may

be seen in Chapter 2 where the Family Constellation
can be seen.
 Continue formulating the objectives. What is expected
to be seen in Chapter 3? 4? And so on..

B. Entry, Climate of acceptance, First few words, Number of home visits

 ENTRY: Describe briefly your entry in the community; explain how you
came to encounter your current family; express how you were rejected by
other families and how many times that happened

 CLIMATE OF ACCEPTANCE: Describe how the family accepted you or your

group. Were they hesitant or welcoming? Was the family member present
unreceptive or hospitable?

 FIRST FEW WORDS: In another paragraph, state your exact first

statement/s you said to the family member/s present during your initial
encounter. State also in verbatim the response of the client to your
greeting.

 NUMBER OF HOME VISITS: Like a diary, tell the story of each home visit
you made. Indicate the date and the time when you did the visit. Describe
what were the family members doing when you arrived, what you did that
day, and how the family responded. The Nursing Process should be reflected
in your story. For each home visit, you should be able to come up with an
illustration, representing that day which will be part included in the last part
of this study under Chapter 9: SOCIOGRAM.
 II. FAMILY CONSTELLATION

 Provide a brief introduction on what the reader would expect to see in a family constellation and its significance in the family case
analysis

Name Age Position in the Family Sex Educational Status Present Health Status
 State our initial encounter with
your client including the
activity she was doing and
what she was wearing.
 Include the initial assessment
findings comprising of the
general appearance plus
 May be written as head of  May be written as: Going to mental status.
 Write the current age
the family, father, School, Not Going to School or  Include also the overt or
in years
 Give a mother, eldest child, etc. Never Been To School obvious abnormal findings
 Include age in
pseudoname for  If the family is an  Gender of the  if the family member is NGTS written in Chapter 3 that were
months for children
the head of the extended type, be more family member or GTS, write the year in inspected during the initial
6 years old and
family specific. Include, e.g. elementary, high school or visit
below
grandmother, uncle, college he/she had finished or  Include actual weight and
 Include birthday
niece, etc. is currently enrolled height
 Include computed BMI plus its
interpretation
 Include waist-hip ratio result
and interpretation
 Take note that all of these
data must be present in
chapter 3
 III. HEALTH ASSESSMENT

 Provide a brief introduction on what health assessment is and its

significance in the study

c. Start with the head of the family

 Introduce the first member of the family by stating his

pseudoname, position in the family, age, sex, weight and height.
 Example:

TATAY MOLA VE (increase in font size and bold the name to

highlight which member of the family is taken
into consideration)

Tatay Mola, age 51, is the head of the Ve family. He stands 5

feet 6 inches tall and weighs 65 kilograms.

Physical Assessment (you may bold and underline this part)

 Cephalocaudal approach
 Start with the General Appearance and Mental Status,
followed by the Vital Signs during the date of assessment,
and then to the different sections of the body.
 Remember to include the date when you did the
assessment. At times, you will be required to do a daily
physical assessment with each member of the family.
 With each section of the body, state your assessment
findings in paragraph form, meaning, a collection of
sentences, not phrases.
 Cranial Nerves Assessment may be done only once during
the course of the home visits. It must be written in a
tabular form as follows:

Cranial Type and Assessment

Expected Result Actual Result
Nerve Function Procedure
 CN number  Sensory  Discuss how this  State the normal  State the actual
and name or Motor cranial nerve is result that is findings based from
 e.g. assessed expected of the your assessment
sense of client
smell

 You may include your Motor Function Tests in a tabular form

patterned with the table in your cranial nerve assessment

d. Mother’s Obstetrical History (past to present)

 State her obstetrical diagnosis GPTPALM
 Describe all her pregnancies and include her children’s birth
dates
 Tetanus toxoid immunization status
 Prenatal practices
 Complications before and after delivery

e. Growth and Development (below seven years old)

- Erik Erikson’s Psychosocial Stages
- Sigmund Freud’s Psychosexual Stages
 Write the description of the stage identified in your client
on the first paragraph.
 On the next paragraph, state a concrete manifestation of
this stage.
 If there is a noticeable delay in the growth and
development of the child, state the reason why and back
it up with your findings in your physical assessment.
f. Immunization Status (below 12 months)
 Tell whether the infant member already acquired the vaccines
required for his/her age that is available in the barangay health
center.

g. Nutrition Status by Age, Weight and Height

 Using the computation for getting the Body Mass Index (BMI),
determine the nutritional status of each member of the family.
 You may use the parameters based on Asia-Pacific Obesity
Guideline as seen in the Public Health Nursing in the Philippines
textbook for interpreting the result you got.
 For adults 18 years and above, you may also get their Waist
Circumference and compute for their Waist-Hip Ratio.
 Example:

Tatay Mola, age 51, has a height of 5 feet 6

inches tall and weighs 65 kilograms. His waist measures
32 inches and his hips, 30 inches.

BMI = weight in kg
(height in m)2
= 65 kg
(1.68 m)2
= 65 kg
2.82 m2

= 23.05 kg/m2

Asia-Pacific Obesity Guidelines

BMI Interpretation
< 18.5 Underweight
18.6 – 22.9 Healthy Weight
≥ 23.0 Overweight
23.0 – 24.9 At risk
25.0 – 29.9 Obese I
≥ 30.0 Obese II

Basing the result of the computation on the above parameters, Tatay

Mola is considered overweight and at risk for future health problems
such as progression to Obese I, diabetes mellitus, and heart problems.

WC = 32 inches

Clinical Thresholds
Men < 90 cm (35 inches)
Women < 80 cm (31.5 inches)

Degree of Risk Based on Body Mass Index and Waist

Circumference
Classification BMI Waist Circumference
M: < 90 cm ≥ 90 cm
F: < 80 cm ≥ 80 cm
Underweight < 18.5 Low but at risk Average
for other
clinical
problems
Normal 18.6 – 22.9 Average Increased
Overweight ≥ 23 Increased Moderate
At risk 23.0 – 24.9 Moderate Severe
Obese I 25.0 -29.9 Severe Very
Obese II ≥ 30.0 Severe
 Tatay Mola’s waist circumference is considered
normal. However, considering his BMI along with his
WC, he will be considered on an increased/moderate
degree of risk for various illnesses.

BMI = waist circumference

hip circumference
= 32 in
30 in
= 1.07

WHR Interpretation
WHR Men Women
Normal < 1.0 < 0.85
Central or Android ≥ 1.0 ≥ 0.85
Obesity

h. History of Past and Present Illness

 On the first paragraph, state all the illnesses experienced by
the client including childhood illnesses such as chicken pox,
measles, mumps, etc. plus the management done during that
time.
 State the present disease conditions that the patient was
experiencing during the time of the home visits and how they
managed such. Did they go to the barangay health center? Did
they self-medicate?

i. Activities of Daily Living

 Include vices such as cigarette smoking (compute for pack
years) and drinking of alcoholic beverages (drinks/day;
frequency).
 Whatever you state in this part, you collectively assess your
adopted family and the assessment findings should be reflected
also in your Family Coping Index.
- Sleeping Pattern
 State when the client sleeps during the day including
naps and rest periods. What you will include here
must reflect in one of the categories in the Family
Coping Index.
- Eating Pattern
 State the eating time and habit of the client. What
does he/she eats? How many times a day will he/she
have a complete meal?
 Anything you state in this part must support the
result of this client’s nutritional status you have
computed previously.
- Leisure Time Activities
 What does your client do for recreation? Does he/she
still have time for that?

IV. SOCIO-ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT

a. Type of family
 Discuss what type your adopted family is and discuss as to why
you have said so.
 You may enumerate the members of the family and their
position.
b. Dominant family member/s in terms of decision-making especially to
health care
  Who is the head of the family that principally makes the
decisions? Who is concerned with the health condition of each
member?
c. Source of income, expenditures
 Make a list of the source of monthly income in the family in
vertical form
 Explain in the subsequent paragraph from which each income
comes from.
 Also include a breakdown of the monthly expenses. If given
with daily or weekly expenses, just multiply as appropriate.
 Compare total income and monthly expenditures.
- Adequacy to meet basic needs
 Divide the total monthly income by the number of
family members and indicate whether they were able
to meet NEDA’s requirement of Php2,768.60 per
month per individual.
- Any financial assets available in case of emergency
 Indicate whether the family has savings.
 State the ones they run to in cases of emergency.
d. Working hours
 State the schedule of working individuals in the family whether
at home or in their respective jobs.
e. Ethnic background and religious affiliation
 State where the family originated from.
 Indicate their religion plus the activities that they do to practice
their faith.
f. Significant others’ role/s in the family life
 What does their significant others for them? If it is support,
indicate what type (financial, emotional, etc.)
g. Health habits and beliefs
 Include in here the interventions that they do during times of
illnesses. Where do they run in case of sickness? Is it in the
health center, to a private physician, or to a quack doctor? This
should be reflected also in Chapter 3, in the History of Past and
Present Illness.
 If alternative medical approaches, such as going to the
herbolario and acupuncture, include those practices in this part.
 Self-medication is common. If the family is doing such, indicate
the medications taken and the conditions that they believe they
treat.
 Indicate too all the of the family’s superstitious beliefs that may
affect their health.
h. Family’s involvement in community activities
 Ask the family if they actively involve themselves with the
activities that the community offers and state what are those.
i. Family’s utilization of community resources
 There are various resources that a certain community has
including schools, basketball courts, grocery stores, etc.
 Indicate which ones are used and the specific family member
that benefits from such.
j. Housing condition
(type of building, adequacy of living space, sleeping arrangement,
adequacy of furniture, presence of insects/rodents, accident hazards)
 Type of Building—describe whether the house is made of
concrete, wood, galvanized iron.
 Adequacy of Living Space
 Compute for the total floor area of the house.
 Make/Illustrate a FLOOR MAP of the house indicating the
measurements of the different sides of the house plus
the location and measurement of the windows. For e.g.,
  To compute for the adequacy of living space, determine
the total space requirement (TSR) of the family. Be
aware of the following space requirements:
Space Requirement
Adults 3 m2
Children 1.5 m2
Infants 0 m2
 After getting the TSR, compare with the total floor area
(TFA) to identify if living space is adequate for all the
members of the family.

 Adequacy of Ventilation
 Computation for adequacy of ventilation is as follows:
Total Window Opening (TWO) x 100
Total Floor Area (TFA)
 In interpreting the result, use the following guidelines
(Note: this is according to the COPAR):
< 18% poor ventilation
18-19% fair
> 19% adequate
 Sleeping Arrangement—describe where each member of the
family sleeps.
 Adequacy of Furniture—enumerate the pieces of furniture in the
family’s home and describe its adequacy
 Presence of insects and rodents—state if you saw vectors for
different diseases and describe the possible locations in and
around the house where these insects or rodents may dwell.
 Accident hazards—enumerate and describe all the things and
certain conditions that may precipitate the family to various
accidents such as fire, falls, and injuries.
b. Food sources, storage and cooking facilities
 Aside from determining their Food sources, storage and cooking
facilities, assess and determine their food handling practices
and food preparation.
c. Water supply
 Verify their source and type of ownership. Ascertain the
potability of the water and where they store their drinking
water and water used for hygiene and household chores.
d. Toilet facility
 Determine the type (toilet w/ or w/o water carriage, cat hole,
etc.), their ownership (owned or shared) and sanitary condition
(poor, fair, good).
e. Drainage system
 Find out the type (open or closed, flowing or stagnant) and
sanitary condition of the household’s drainage system.
f. Social and health facilities available
 Identify the social (club houses, basketball courts, function
halls, etc.) and health (health centers, hospitals, clinics, etc.)
 facilities in the community and state whether the family is using
those enumerated or not.
g. Communication and transportation facilities
 Enumerate the ways in which the family communicates with the
other members of the family or their significant others. It may
be through cellular phones, land line, internet, etc.
 State how the family transports from one place to another
(PUVs, bicycles, motors, cars, etc.).
 V. PROBLEM IDENTIFICATION

A. List of problems Identified (prioritized)

 On this part, you will list the problems identified according to
the score that you got from the computation you made as you
justify each problem. The problem with the highest score will be
listed first.
 E.g.

Presence of Fever………………………………………….. 4.67

Family Size Beyond What Family Resources Can
Adequately Provide ……………………………. 3.34
Presence of Accidental Hazards …………………….. 2.67

B. Priority Setting

PROBLEM #
TITLE: Simply state here the problem you detected. Make the FIRST-LEVEL
ASSESSMENT in the Typology of Nursing Problems in Family Nursing Practice
your guide in identifying conditions that affect the family.

CRITERIA COMPUTATION SCORE JUSTIFICATION

Nature of the Problem  Assign the score for  Write in  Justify in this part
each problem here the why you
 You may identify each according to the score that considered the
problem as: following: you got problem you
 Health Deficit—instance  Health Deficit—3 from the identified as
wherein there is failure in  Health Threat—2 computa- health threat,
health maintenance  Foreseeable Crisis— tion done. health deficit or
 Health Threat—condition 1  E.g. foreseeable crisis.
that is conducive to  Divide the score you
disease, accident or failure assigned with the 1
to realize one’s health highest possible score
potential for this particular
 Foreseeable Crisis— criterion which is 3
anticipated periods of and multiply by the
unusual demand on the weight which is 1.
individual or family in  E.g. (Presence of
terms of Fever = health deficit)
adjustment/family
resources 3/3 x 1

Modifiability of the Problem  Assign the score for  Write in  On this part,
each problem here the explain each
 This criterion refers to the according to the score that subcriterion and
probability of success in following: you got identify the things
enhancing the wellness  All factors present— from the that made a
state, improving the 2 computa- contribution in
condition, minimizing,  2-3 factors tion done. the presence of
alleviating or totally present—1  E.g. that factor.
eradicating the problem  0-1 factor present—  E.g.
through intervention. 0 2  Current
 You will have to consider  Divide the score you knowledge,
the availability of the assigned with the technology and
following factors in highest possible score intervention
determining the for this particular _____________
modifiability of a health criterion which is 2 _____________
condition or problem. and multiply by the _____________
weight which is 2. _____________
 E.g. (Presence of
 Current knowledge, Fever = all factors are  Family
technology and present) Resources
intervention _____________
—This refers to the 2/2 x 2 _____________
family’s knowledge, the _____________
technology available _____________
and the interventions
done to enhance the  Resources of the
wellness state or Nurse
manage the problem. √ _____________
— If this factor is _____________
present, check this box _____________
 _____________
Family Resources
— This refers to the  Community
physical, financial and Resources
manpower resources _____________
available to solve the _____________
problem identified _____________
— If this factor is √ _____________
present, check this box

Resources of the Nurse
— This refers to the
knowledge, skills and
time of the student
nurses in alleviating the
problem
— Almost always, this √
factor is present. Check
this box. 
Community Resources
— This refers to the
facilities and community
organization or support
present that could help
in managing the
problem
— If this factor is √
present, check this box


Preventive Potential (PP)  Assign the score for  Write in  On this part,
each problem here the explain, justify
 This criterion refers to the according to the score that and describe each
nature and magnitude of following: you got factor as to why it
future problems that can be  4 ↑— 3 from the increased or
minimized or totally  2-3 ↑— 2 computa- decreased the PP
prevented if intervention is  0-1 ↑— 1 tion done. of the problem.
done on the problem under  Divide the score you  E.g.  E.g.
consideration. assigned with the  Gravity/severity
 To decide on an appropriate highest possible score 1 of the problem
score for the preventive for this particular _____________
potential of a health criterion which is 3 _____________
condition or problem, the and multiply by the _____________
following factors are weight which is 1. _____________
considered:  E.g. (Presence of  Duration of the
Fever = all factors ↑ problem
Gravity/severity of the PP) _____________
problem _____________
— It refers to the 3/3 x 1 _____________
progress of the ↓ _____________
disease/problem
indicating extent of
damage on the  Current
patient/family; also Management
indicates the prognosis, ↑ _____________
reversibility or _____________
modifiability of the _____________
problem. In general, _____________
the more severe or
advanced the problem  Exposure of
is, the lower is the High-Risk Group
preventive potential. _____________
— If the problem is _____________
already severe, put this _____________
symbol: ↓ indicating _____________
that the situation
lowers the preventive
potential of the
problem.
If not yet severe (for
example, a present
health threat does not
have history that
problems have occurred
from it or a member
with a certain
communicable disease
has not been passed on
yet to other members),
place this symbol: ↑
indicating that the
condition increases the
preventive potential of
the problem.
Duration of the problem
— This refers to the
length of time the ↓
problem has been
existing. Generally
speaking, duration of
the problem has a
direct relationship to ↑
gravity; the nature of
the problem is a
variable that may,
however, alter this
relationship. Because of
this relationship to
gravity of the problem,
duration has also a
direct relationship to
preventive potential.
— If you think that the
length of time of the
problem is already long
taking in consideration
its nature, then put the
symbol ↓ to indicate
that the condition
decreases the PP of the
problem. If the
situation existed for
only a short period of
time, this increases the
PP. You may put this
symbol: ↑.
 Current management
— This refers to the
presence and
appropriateness of ↓
intervention measures
instituted to remedy the
problem. The institution
of appropriate
intervention increases ↑
the problem’s
preventive potential.
— If there are actions
done by the family,
which are proper and
appropriate in nature,
this basically adds to
the increase (↑) of the
PP.
If the family is not
aware (as seen in the
modifiability of the
problem) of the
condition or is given no
importance (as
explained in the
salience) and therefore
no interventions are
done, then the situation
decreases (↓) the PP.
Exposure of any
Vulnerable or High-Risk
Group
— This increases the ↓
preventive potential of
the problem.
— When the problem
exposes many family
members especially ↑
those that belong to the
high risk group, it
increases (↑)the PP
since if most of them
are possibly affected,
then measures to
eliminate the problem
are more likely to
happen.

Salience  Assign the score for  Write in  On this part,

each problem here the explain and
 This criterion refers to the according to the score that justify as to why
family’s perception and following: you got you were able to
evaluation of the problem  A condition or a from the say that degree
in terms of seriousness and problem needing computa- of salience.
urgency of attention immediate attention tion done.
needed or family readiness. —2  E.g.
 Salience of the problem is  A condition or a
solely based from the way problem NOT 1
the family perceives the needing immediate
problem. attention — 1
 Not perceived as a
problem or
 condition needing
change — 0
 Divide the score you
assigned with the
highest possible score
for this particular
criterion which is 2
and multiply by the
weight which is 1.
 E.g. (Presence of
Fever = A condition or
a problem needing
immediate attention)

2/2 x 1
TOTAL SCORE: Write the
total score
rounded
off to 2
decimal
places.
The
highest
possible
score is 5.
 NURSING SUPPORTING DATE GOALS AND INTERVENTION PLANS EVALUATION
PROBLEMS DATA CUES IDENTIFIED: OBJECTIVES

(2ND Level DATE

Assessment) RESOLVED:
Nursing Method and Standards Methods and Tools
Interventions Resources

In here, you S= Include all Objectives Enumerate your Methods of contact Increase of at M= Weight monitoring
may get the the statements should be interventions include the least 1 kg in 6
analysis of the mentioned by SMART. utilizing the following. Write the weeks T= Weighing scale
the family method/s
problem from sequence of the
members that Short Term: applicable for the
the SECOND- has a _____________ NURISNG problem.
LEVEL connection with _____________ PROCESS
ASSESSMENT the given _____________ HOME VISIT
in the Typology problem. — if the problem
of Nursing Long Term: can be solved
Problems in O= Include all _____________ through health
objective cues _____________ teachings and
Family Nursing
related to the _____________ modifications in the
Practice problem. home
Include all
individual family CLINIC VISIT
members — if the problem
can be solved by
manifesting the
visiting the health
problem center for
including the consultation and
assessment prescription of
made that medications
verified the
presence of the SCHOOL VISIT
— if the problem
condition
can be supported
by educating family
members affected
through school
teachings
 VI. FAMILY COPING INDEX

 The Family Coping Index (FCI) was developed for a tool for practice as
an approach to identifying the family need for nursing care, assessing
the potential for behavioural changes and as a method of determining
in a more systematic way in which the nurse can help the family to
manage. This index continues to be used today as a relevant method
of evaluating a family’s ability to cope life’s daily challenges.
 The “cues” to help you rate family coping are limited to three points:
 1 = no competence
 3 = moderate competence
 5 = complete competence
 You will find, however, that most families will fall somewhere in
between these points. Mark the point you feel most nearly describing
the level of competence they have.

INITIAL FINAL
CATEGORY JUSTIFICATION
1 3 5 1 3 5

 There are nine categories under this part:  Use a legend to  Justify as to why you
 PHYSICAL INDEPENDENCE mark the score have said that the
 THERAPEUTIC COMPETENCE you assigned for family’s competence is
 KNOWLEDGE OF HEALTH CONDITION each category. as such for the initial
 APPLICATION OF PRINCIPLES OF  For e.g., and final home visit.
GENERAL AND PERSONAL HYGIENE  For e.g.,
 HEALTH CARE ATTITUDES
 EMOTIONAL COMPETENCE
 FAMILY LIVING PATTERNS Initial:
 PHYSICAL ENVIRONMENT _____________________
 USE OF COMMUNITY FACILITIES _____________________
_____________________
 On this column, you may include the _____________________
description of the category. For e.g., _____________________

PHYSICAL INDEPENDENCE Final:

___________________________________ √ √ _____________________
___________________________________ _____________________
___________________________________ _____________________
___________________________________ _____________________
___________________________________ _____________________
___________________________________
VII. LEARNING DERIVED

 This part includes the learning that rooted from the making of the
Family Case Analysis written in first person.
 If the FCA was done in group, each member should include his or her
own learning derived.

VIII. SOCIOGRAM

 This part should show an illustration of the interaction done in each

home visit.
 For e.g.,

 Describe each legend you have shown.

IX. SPOT MAP AND DOCUMENTATION

 SPOT MAP is an illustration of the place or community from the house

of residence to the health center including the major spots or facilities
in the community such as the barangay hall, school, church, etc.
 DOCUMENTATION should include the interaction of the student nurses
with the family plus the assessment of the each member and the
residence itself.

X. BIBLIOGRAPHY

 List all the sources you have used in the completion of the study.
 REFERENCES that are utilized as guides in the completion of the FCA
are as follows:
 Maglaya, Araceli (2004) Nursing Practice in the Community 4th
Edition Argonauta Corp, Marikina City
 Cuevas, Frances Prescilla L., et. al. (2007), Public Health
Nursing in the Philippines, 10th Edition National League of
Philippine Government Nurses
 Untalan, Aaron Tuesca (2005) Concepts and Guidelines in
COPAR Giuani Prints House, Malabon, Philippines