ASSESSMENT FORM
- Integrated Primary Care Nursing Clinical Family Assessment Form 1 (65.49 KiB) Viewed 32 times
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM c) What does each member expect from their parent/s or head of the family or spouse? d) What does the parent/s expect from their child/children? e) Are these expectations realistic? If yes, how can these be achieved? If no, why not? 1) Are these expectations met? If no, what are the possible hindrances? 3. Family Lifeline. Major significant life events (positive and negative; successes and losses) that had impact on the family. Indicate year of occurrence. (5 Marks)
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM 4. FAMILY APGAR QUESTIONNAIRE (10 Marks) Introduction: To be read to the family. "The following questions have been designed to help us better understand you and your family. You should feel free to ask questions about any item in the questionnaire. Answer each question as “almost always”, "sometimes”, or “hardly ever". Add any additional comments you want. Family is defined as the individ- ual(s) with whom you usually live. Instruction: For each question, check only one box. Almost always Sometimes Hardly Ever 4.1. I am satisfied that I can turn to my family for help when something is troubling me. 0 Comments: 4.2. 0 I am satisfied that my family talks things over with me and shares problems with me. Comments: 4.3. I am satisfied that my family accepts and supports my wishes to take on new activities or directions, Comments:
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM 4.4. I am satisfied that my family expresses affection and responds to my emotions, such as anger, sorrow and love. Comments: 4.5. I am satisfied with the way my family and I share time together. Comments: Scoring: The patient checks one of three choices which are scored as follows: "Almost always" (2 points), "Some of the time" (1 point), or "Hardly ever) (0 points). The scores for each of the five questions are then totaled. A score of 7-10 suggests a highly functional family. A score of 4 to 6 suggests a moderately dysfunctional family. A score of 0 to 3 suggests a severely dysfunctional family. . . . “According to which member of the family is being interviewed the nurse my substitute for the word “family" either spouse, significant other, parents or children. In the future, what is the family's primary (most important) goal? Name two (2) other priorities, At this point, what does the family wish for? Why? Do all the members work together toward these goals/desires? How? If not, what seems to be the hindrance for working together? Who is the main person responsible for these goals?
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM 5. SCREEM. Briefly specify/explain other items not included or described in the checklist. (10 Marks) PARAMETER STRENGTH WEAKNESS SOCIAL Open intrafamilial lines of communication Absence of animosity/rivalry Healthy/supportive intrafamilial relationships Healthy/supportive extrafamilial relationships Others: Lack of intrafamilial lines of communication Presence of animosity/rivalry Unhealthy intrafamilial relationships Unhealthy extrafamilial relationships Others: CULTURAL Absence of or very few beliefs/practices that are unacceptable to our culture or nega- tively affect way of living (e.g. institutionali- zation of elderly, dependency of married children to parents, value for education, does not advocate family closeness, seeking help from traditional healers, etc.) Others: Presence of some belief/s practices that are unacceptable to our culture or nega- tively affect way of living (Specify these practices): RELIGIOUS Spirituality is positively influencing way of life (Practicing one's faith, enduring because of his faith Others: goes to mosque once a month Others: Spirituality is negatively or not at all influencing way of life Not practicing one's faith Others: EDUCATIONAL Level of education is not a hindrance to achievement, livelihood, success Level of education facilitates comprehen- sion of most challenging circumstances Others: Level of education is a hindrance to achievement, livelihood, success Level of education hinders comprehen- sion of most challenging circumstances Others: _finishing grade 6 is a hindrance to her liveli- hood.
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM ECONOMIC Ability to allocate funds appropriately Inability to allocate funds appropriately Ability to make ends meet most of Inability to make ends meet most of the time the time Others: Others: MEDICAL Good compliance with medical management Timely and appropriate medical consultation Aware and practices wellness and environmental sanitation Others: Poor compliance with medical management Inappropriate medical consultation Not aware/does not practice wellness and environmental sanitation Others: To what groups or organizations do the family members belong? What national / community resources has the family used? What are the primary concerns of the family with their immediate environment?
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM What are the positive and negative points of the community where the family resides? Positive points Negative points 5. Family Health Care Plan (10) Types of Care Family member WELLNESS Problem Recommendations MEDICAL PSYCHOSOCIAL
INTEGRATED PRIMARY CARE NURSING CLINICAL (NURS 536) FAMILY ASSESSMENT FORM Genogram
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