In Philippine community health nursing, the family is the basic unit of care. A health problem of one member affects the whole family, and the family's ability to act determines whether care succeeds. Family health nursing applies the nursing process to the family as client, and its written product is the Family Nursing Care Plan (FNCP).

Family structures commonly assessed: nuclear, extended, single-parent, blended, skip-generation (grandparents raising grandchildren), and families of overseas workers where a parent is abroad.

Family developmental stages (Duvall) help anticipate needs: married couple → childbearing (oldest child up to 30 months) → preschool → school-age → teenage → launching → middle-aged parents → aging family members. Each stage has tasks; for example, the launching stage involves releasing young adults with appropriate independence.

Family assessment tools

• Genogram — three or more generations showing members, relationships, and health conditions (useful for hereditary risks)
• Ecomap — the family's links with outside systems (school, church, work, health center, relatives); shows resources and stressors
• Family APGAR — a brief questionnaire on the family member's satisfaction with adaptation, partnership, growth, affection, and resolve
• Caregiver burden scales (e.g., the Zarit Burden Interview) for families caring for chronically ill members
• Observation during home visits, interviews, records review, and physical assessment of members

Two levels of family assessment (Philippine typology of nursing problems)

First-level assessment — identifies the health condition or problem (the "what"). Four categories:

Second-level assessment — identifies the nursing problem (the "why"): the family's inability to perform the five family health tasks (derived from Freeman):

1. Recognize the presence of the condition or problem
2. Make decisions about taking appropriate health action
3. Provide nursing care to sick, disabled, dependent, or at-risk members
4. Provide a home environment conducive to health maintenance and personal development
5. Use community resources for health care

Each inability is usually stated with its reason, for example: "Inability to provide adequate nursing care to the sick member due to lack of knowledge about the disease and its management" or "Inability to use community resources due to lack of knowledge of available services."

Prioritization scale (widely used Philippine scale, attributed to Maglaya)

Computation for each criterion: (score ÷ highest possible score) × weight. Add the four results; the highest possible total is 5. The problem with the highest total is the first priority.

Factors considered for each criterion

• Modifiability: current knowledge and technology; family resources (physical, financial, manpower); the nurse's resources (knowledge, skills, time); community resources
• Preventive potential: gravity or severity; duration; current management; presence of high-risk groups exposed
• Salience: the family's own perception of seriousness and urgency

Parts of the FNCP (typical columns): health problem (first-level) → family nursing problem (second-level) → goal of care → objectives of care → nursing interventions → methods of nurse–family contact → resources required → evaluation (criteria and methods).

• Goal: a broad statement of what the family should achieve, set with the family (e.g., "After nursing intervention, the family will manage the father's hypertension").
• Objectives: specific, measurable, time-limited steps (e.g., "Within 2 weeks, the family will state three low-salt food choices and show correct BP recording").
• Methods of contact: home visit, clinic visit, telephone or text follow-up, group conference, written communication.

Worked prioritization example — the Santos family. The father (52) has hypertension and stopped his medicines because he feels well; the family burns garbage in the yard and keeps uncovered water drums (mosquito breeding). The family is worried about the father's recent headaches. When asked, they agree the uncovered water drums could be a problem but do not see it as urgent; they say they could cover them.

Problem 1: Hypertension of the father — health deficit

Check: 1 + 1 + 0.667 + 1 = 3.667 → 3.67 ✓

Problem 2: Uncovered water containers (dengue breeding site) — health threat

Check: 0.667 + 2 + 1 + 0.5 = 4.167 → 4.17 ✓

Result: Problem 2 (4.17) ranks above Problem 1 (3.67). The double weight on modifiability and the high preventive potential lift the threat above the deficit. The nurse addresses both in the care plan. (If the family had not seen the drums as a problem at all, salience would be 0/2 × 1 = 0, the total would be 0.67 + 2 + 1 + 0 = 3.67, and the two problems would tie.)

The score ranks family nursing problems for the care plan; it never delays urgent care. At this same visit the nurse measures the father's blood pressure and refers him promptly if it is severely elevated or he has warning signs (severe headache, chest pain, shortness of breath, weakness or numbness, visual or speech changes).

Sample FNCP entry for Problem 1

• Second-level problem: inability to provide adequate care to the father due to lack of knowledge that hypertension needs continuous treatment even without symptoms.
• Goal: the family will manage the father's hypertension.
• Objectives (within 2 weeks): the father will resume his prescribed medicine daily; the wife will take and record his BP correctly; the family will name three high-salt foods to limit.
• Interventions: explain the disease and why medicines continue without symptoms; teach BP measurement with return demonstration; plan low-salt meals with the family; link with the health center for medicine supply and follow-up.
• Evaluation: BP record, pill count, return demonstration, teach-back.

• Builds a trusting relationship and involves the family in every step (assessment, priority setting, goals)
• Assesses the whole family, not only the sick member
• Uses the typology and scale consistently and documents justifications
• Provides health teaching, demonstrates care, and gives return-demonstration practice
• Links the family to resources (health center, PhilHealth-covered services, social welfare, support groups)
• Evaluates and revises the plan; terminates when goals are met or the family can manage independently

• Family autonomy and consent: the family decides; the nurse informs and supports.
• Confidentiality within and outside the family: the adult member's information is shared with other members only with consent; family records are sensitive personal information under the Data Privacy Act of 2012 (RA 10173).
• Duty to protect: suspected child abuse, elder abuse, or intimate partner violence requires safety assessment and referral or reporting through the proper channels (e.g., the local social welfare office or the police) according to agency policy; safety comes before other family goals.
• Scope of practice: the nurse teaches and gives prescribed treatments; medicines are not prescribed by the nurse (RA 9173, Section 28).
• Cultural respect: harmless traditional practices may be accepted; harmful ones are discussed tactfully.

Case 1 — Classify the problem. A 17-year-old daughter is 5 months pregnant and the family worries about the added expenses.

• First-level: stress point / foreseeable crisis (pregnancy, parenthood); a health threat may coexist if prenatal care is missing.
• Action: prenatal care referral, adolescent-friendly counseling, and anticipatory guidance.

Case 2 — Salience score. The family of a child with repeated diarrhea says, "All children get diarrhea; it's normal."

• Salience = 0 (not perceived as a problem).
• Action: first work on the task of recognizing the problem through teaching.

Case 3 — First step. A new family is referred to the nurse.

• Correct first step: assessment (first-level, then second-level) before planning.

• Mixing up the levels: the first level names the health condition; the second level names the family's inability to perform a health task.
• Forgetting to divide by the highest possible score before multiplying by the weight.
• Giving modifiability a weight of 1 — its weight is 2.
• Scoring "not modifiable" as 1 — it is 0; "low" preventive potential scores 1, not 0.
• Treating wellness state as low priority by nature — it scores the same (3) as a health deficit.
• Writing goals without the family's agreement.
• Setting objectives that are not measurable or time-bound.

• Family = basic unit of care; FNCP = written family nursing process.
• First-level assessment: wellness state, health threat, health deficit, stress point/foreseeable crisis.
• Second-level: five family health tasks — recognize, decide, provide care, maintain a healthy home, use community resources.
• Scale: nature (weight 1: wellness 3, deficit 3, threat 2, crisis 1); modifiability (weight 2: 2/1/0); preventive potential (weight 1: 3/2/1); salience (weight 1: 2/1/0).
• Score = (score ÷ highest score) × weight; maximum total = 5; highest total = first priority.
• Goal = broad; objectives = specific, measurable, time-bound.
• Genogram = generations and hereditary risk; ecomap = links with outside systems.
• Safety issues (abuse) override usual prioritization.