1. How would you describe your family’s current state of health, and what are you doing to promote health?
2. Are there any habits that can be detrimental to your of your families health, for example anyone in the household smoke, use alcohol, or any drugs (street or prescription).
3. Are there any safety issues or physical, emotional barriers to maintaining/promoting the family’s health?
Nutrition and Metabolism:
1. Is there any diseases or medical complications that affect nutritional or metabolic function?
2. What is a typical family meal, and typical daily fluid intake? Are supplements a part of your diet regiment?
3. Are there any physical complications preventing or making obtaining the proper nutrition or daily caloric or fluid intake?
1. Explain your normal bowel, bladder patterns. Have there been any changes in these patterns?
2. Any problems with constipation, diarrhea, dysuria or polyuria?
3. Any physical or safety barriers that limit your movement or ability to eliminate?
Activity and Exercise:
1. What are you and your families feeling towards physical activity and exercise?
2. Describe a typical daily schedule, work, school, weekday and weekend days. Does physical activity play a role in your daily or weekly routine?
3. How many days/hours of physical activity a week and what types do you or your family participates?
1. What are your preferred ways of learning, retaining and obtaining information pertaining to your health? Do you have any problems with medical terms or information received from providers?
2. How does your family acquire information and who makes decisions about health care in the household?
Sleep and Rest:
1. How would you describe your rest, relaxation time as a family?
2. How many hours of sleep on average per night do you and family members get?
3. Are there any difficulties with falling or staying asleep? Do you feel rested in the morning?
Self -Perception- Self-Concept:
1. How does your family perceive itself, similar or different from other families?
2. How does your family feel they assimilate into the community and neighborhood?
3. How does the family describe the events that led to a change?
Roles and Relationships:
1. How does the family manage daily living and how are household tasks divided?
2. Who is employed outside of the house and what is long term plans for the future as a family?
3. Who are the role models for the adults?
1. How does the family commit love and care for each other are needs and responsibilities toward one another being met?
2. Individually are you comfortable with your partner in discussing sexuality.
3. How do as a married couple view marriage, parenthood and relationship as lovers?
1. How does your family cope with stressful life events?
2. Have any family members had a chemical dependence issue and how did the family deal with the problem?
3. What resources do you have access to or use already?
1. Do you as a family identify with any cultural, ethnic, religious, or other organizations?
2. What principals as a child are still important to you?
3. What are your family’s values and beliefs and how do they influence your daily life?