Family assessment: structure, life cycle, genogram, ecomap and family APGAR
- Assessment
The nurse looks at the family as a whole: who belongs to it, what stage it is in, how it works inside and what support it has outside.
What it is
Family assessment treats the family as a collective subject of care, not as a set of separate patients. The nurse identifies the family type, its stage in the family life cycle, its roles and dynamics, its strengths and stressors, and the support it receives from outside. In Colombia the basic health teams record this in the family folder (carpeta familiar) with a family characterisation, the genogram (familiograma), the family APGAR and the ecomap, and use the results to build the family's integral primary care plan (PICP). The family APGAR, designed by Gabriel Smilkstein, captures how one member perceives the functioning of the family at a given moment.
What you need
- A private, calm moment and the consent of the family members who take part.
- Paper or the institution's family folder to draw the genogram and the ecomap with standard symbols.
- The family APGAR form adopted by the institution (MinSalud includes it among the route's instruments).
- Time to listen: the assessment may take more than one visit.
How to measure it (and why)
- Explain the purpose and ask who forms part of the household — the family itself defines who its members are.
- Identify the family type (nuclear, single-parent, extended, blended, others) — structure changes roles and risks.
- Place the family in its life-cycle stage — each stage brings expected tasks and possible crises.
- Draw the genogram with at least three generations, illnesses and relationships — it shows inherited risks and patterns.
- Draw the ecomap with school, work, health services, church, friends and other networks — it shows outside support and stress.
- Apply the family APGAR to the members who can answer, as indicated by the institution — it shows how each one perceives family function.
- Ask about strengths, stressors, decision-makers and response to illness — strengths are the base of the plan.
- Agree on goals with the family and record findings and commitments — the plan works only if the family owns it.
Family assessment instruments and what each one shows
| Instrument | What it shows | Typical finding |
|---|---|---|
| Family characterisation | Composition, social and demographic data, housing and risks | Overcrowding, a person with disability, an unvaccinated child |
| Genogram (familiograma) | Structure over three generations, relationships, health and disease patterns | Diabetes in several relatives, a conflictive or distant relationship |
| Family life cycle | The stage the family is going through and its expected crises | Expansion stage after the birth of the first child |
| Family APGAR | Perceived family function in five areas (intrafamily resources) | One member perceives some degree of dysfunction |
| Ecomap | Links with outside resources: strong, weak, stressful or absent | Weak link with health services, stressful link with transport |
How to read it
- A healthy family communicates clearly, respects privacy and individual choices, and is flexible and stable.
- Most families work well in some areas and poorly in others; look for strengths as well as problems.
- A low perceived family function is a reason to talk and to offer family guidance, not a label for the family.
- Weak or absent links in the ecomap point to networks the team can activate (school, social programmes, support groups).
- Changes of life-cycle stage, such as a first child or adolescents at home, are moments of higher stress.
Next step: when to call for help
- Signs of violence, abuse, neglect or sexual abuse: protect the person, inform the nurse in charge and activate the institutional route the same day.
- Suicidal ideas or a serious mental-health crisis in a member: do not leave the person alone and seek immediate help.
- Perceived family dysfunction or major stressors: inform the team to plan family guidance (atención básica de orientación familiar).
- Members missing vaccination, screening or route consultations: refer them and record the referral for follow-up.
Test yourself
Think of the answer, then tap the question to see it.
What does an ecomap show?
The links between the family and outside resources, such as school, work, health services or friends, drawn as strong, weak, stressful or absent.
How many generations does a genogram usually include?
At least three generations, with structure, relationships and health events.
Who designed the family APGAR and what does it measure?
Gabriel Smilkstein. It measures how a family member perceives family functioning at a given moment, in five areas: adaptation, partnership, growth, affection and resolve.
Which life-cycle stages does MinSalud's guidance use for families?
Formation, expansion, consolidation, opening, empty nest and dissolution.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Lineamientos para la organización y operación de los Equipos Básicos de Salud (Resolución 2788 de 2022): valoración familiar (Ministerio de Salud y Protección Social, Colombia, 2023); Nursing Health Promotion, 4.2 Family Structures, Cultural Practices, Roles and Functions (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2023); Nursing Health Promotion, 4.7 Applying the Nursing Process to Caring for Clients in the Context of Family (Open RN, CC BY 4.0) (Open Resources for Nursing (Open RN) / LibreTexts, 2023); Proceso enfermero en el cuidado de las familias de estudiantes de Enfermería (Villegas D et al.) (Aquichan, Universidad de La Sabana, 2025).
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Representative model, for educational purposes only.