 FAMILY HEALTH NURSING

- Level of community health nursing practice directed or focused on the family as the unit of care
 FAMILY NURSING CARE PLAN
- Blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and
family nursing problem through explicitly formulated outcomes of care and deliberately chosen set of
interventions, resources and evaluation criteria, standards, methods and tools.
 FEATURES OF NCP
- Focuses on actions which are designed to solve or minimize existing problem
- Product of a deliberate systematic process
- Relates to the future – projects the future scenario if the current situation is not corrected
- Based upon identified health and nursing problems
- Means to an end, not an end by itself - the goal in planning is to deliver the most appropriate care to the
client by eliminating barriers to family health development.
 FEATURES OF NCP
- Continuous process, not a one – shot deal – the results of the evaluation of the plan’s effectiveness trigger
another cycle of the planning process until the health and nursing problems are eliminated
 STEPS OF FAMILY NURSING PROCESS
- First major phase of the nursing process
- Involves a set of actions by which the nurse measures the status of the family as a client, its ability to
maintain itself as a system and functioning unit and its ability to prevent, control or resolve problems in
order to achieve health and well – being among its members.

 Composition and demographic data of the members of the family and household, their relationship to the
head and place of residence
- Type of family and family interaction/communication
- Decision - making patterns and dynamics
- Occupation, place of work and income of each working member
- Educational attainment of each family member
- Ethnic background and religious affiliation
- Significant others and the other role/s they play in the family’s life
- Relationship of the family to the larger community
- Housing and sanitation facilities
- Kind of neighborhood
- Availability of social, health communication
- Transportation facilities in the community
- Preventive services
- Adequacy of rest and sleep
- Relaxation activities
- Stress management or other healthy lifestyle activities
- Immunization status of at – risk family members
 DATA GATHERING METHODS
- Observation
- Physical examination
- Interview
- Record review
- Laboratory / diagnostic tests
 DATA GATHERING METHODS
OBSERVATION
 Use of sensory capacities
 sight, hearing, smell, touch
 DATA GATHERING METHODS
PHYSICAL EXAMINATION
 IPPA – inspection, percussion, palpation, auscultation
 IAPP – inspection, auscultation, percussion, palpation
 Measurement of specific body parts and reviewing the body systems
 DATA GATHERING METHODS
INTERVIEW
 Another major method of data gathering
 Completing health history
 Personally asking significant family members or relatives questions regarding health, family life experiences and
home environment
 DATA GATHERING METHODS
RECORD REVIEW
 Reviewing existing records
 - individual clinical records
- laboratory and diagnostic reports
- immunization records
- home and environment conditions
 DATA GATHERING METHODS
LABORATORY / DIAGNOSTIC TESTS
 E.g. cbc, x- ray, MRI, CT scan..etc
 TWO MAJOR TYPES OF NURSING ASSESSMENT
1. FIRST LEVEL ASSESSMENT
 Is a process whereby existing and potential health conditions or problems of the family are determined.
- wellness state
- health threats
- health deficits
- stress points / foreseeable crisis situations
 TYPOLOGY OF NURSING PROBLEMS
WELLNESS STATE
 A clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a
higher level
 Opportunity to improve
 Stated as POTENTIAL OR READINESS
 TYPOLOGY OF NURSING PROBLEMS
Wellness Potential
 Nursing judgment on wellness state or condition based on client’s performance, current competencies or clinical
data but no explicit expression of client desire.
 Eg. Potential for Enhanced Capability for
- healthy lifestyle
- health maintenance
- parenting
- breast feeding - spiritual well being

 TYPOLOGY OF NURSING PROBLEMS

Readiness for enhanced wellness state
 Nursing judgment on wellness state or condition based on client’s current competencies or performance,
clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on
health promotion and maintenance
 Eg. Readiness for Enhanced Capability for
- healthy lifestyle - health maintenance
- parenting - breast feeding
- spiritual well being

 TYPOLOGY OF NURSING PROBLEMS

HEALTH THREAT
 Conditions that are conducive to disease, accident or failure to realize one’s health potential
 Factors that leads to disease
 Eg. - family hx - threats of cross infection
- accident - faulty eating habits
- stress - poor home / sanitation
- unsanitary food handling and preparation
- unhealthful lifestyle
 TYPOLOGY OF NURSING PROBLEMS
HEALTH DEFICITS
 Instances of failure in health maintenance
 Deviation from normal health
 Eg. - illness states
- failure to thrive/develop according to normal rate
- disability
 TYPOLOGY OF NURSING PROBLEMS
STRESS POINTS/FORESEEABLE CRISIS SITUATION
 Anticipated periods of unusual demand on the individual or family in terms of adjustment / family resources
 May arise in the future
 Eg. - marriage - pregnancy, labor
- parenthood - abortion
- menopause - loss of job
- hospitalization - entrance at school
  TYPOLOGY OF NURSING PROBLEMS
- adolescence
- additional member
- death of a member
- resettlement in a new community

 TWO MAJOR TYPES OF NURSING ASSESSMENT

2. SECOND LEVEL ASSESSMENT
 Defines the nature or type of nursing problems that the family encounters in performing the health tasks with
respect to a given health condition or problem.
 ABILITIES BASED ON HEALTH TASKS BY RUTH FREEMAN
1. Ability to recognize the existence of a wellness state, health condition or a health problem.
2. Ability to make decisions with respect to taking appropriate health actions
3. Ability to provide nursing care to the affected family member
4. Ability to provide a home environment conducive to health maintenance and personal development.
5. Ability to utilize community resources for health care
 5 MAIN TYPES OF FAMILY NURSING PROBLEMS by Dr. Maglaya
1. Inability to recognize the existence of a wellness state, health condition or a health problem.
2. Inability to make decisions with respect to taking appropriate health actions
3. Inability to provide nursing care to the affected family member
4. Inability to provide a home environment conducive to health maintenance and personal development.
5. Inability to utilize community resources for health care
 It is the end result of two major types of nursing assessment in family nursing practice
TWO PARTS:
 Statement of unhealthful response
 Statement of factors which are maintaining the undesirable response and preventing the desired change
STEPS OF FAMILY NURSING- PROCESS
Example
 Inability to make decisions with respect to taking appropriate health action due to lack of knowledge as to
alternative courses of action open to the family
STEPS OF FAMILY NURSING- PROCESS
Components for planning phase
1. prioritized conditions or problems
2. goals and objectives of nursing care
3. plan of interventions
4. plan for evaluating care
 Criteria for prioritization
1. NATURE OF CONDITION/ PROBLEM PRESENTED
 Categorized as wellness state/potential, health threat, health deficit, foreseeable crisis
2. MODIFIABILITY OF THE CONDITION/PROBLEM
 Probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally
eradicating the problem through intervention
3. PREVENTIVE POTENTIAL
 Nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on
the problem under consideration
 Criteria for prioritization
4. SALIENCE
 Family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed or
family readiness
Ex. The nurse conducted a home visit to the family of Mr. Pedro dela Cruz. The following were the initial data that she
was able to gather:
 Mang Pedro, 42 yrs old has been coughing for 2 weeks now and has hemoptysis. He has a medical history of
PTB, underwent treatment,and was declared cured of PTB in 2006. His wife, Aling Linda, recognizes the need for
him to undergo sputum microscopy. She verbalized “Ganyan din yung sintomas na ipinakita nya nung sinabi ng
Doctor na may TB sya. Natatakot kami na baka maulit yon. Balak naming ipatingin sya sa center sa susunod na
linggo.”
 Pedrito, 4 years old, weighs 12.5 kgs, looks pale and is noticeably underweight, as manifested by the evident
bony prominences. Aling Linda verbalized “Naku, mahina lang kumain ang batang yan. Palibhasa nauubos ang
oras sa paglalaro. Tsaka naisip ko, nasa lahi naman talaga namin ang hindi tabain kaya siguro payat din si
Pedrito.” The nurse observed that Aling Linda gave the child a small pack of fish crackers for his morning snack.
Aling Linda is the homemaker, while Mang Pedro earns a net income of Php 250 per day as tricycle driver.
 Goals and objectives of care
 GOAL – a desired outcome or change in the client’s behavior
- general/broad statement of the condition ; state to be brought about by specific courses of action
  E.g. after nx intervention, the family will be able to take care of the disabled child competently
CARDINAL PRINCIPLE IN GOAL SETTING
 Goals must be set jointly with the family
 Objectives
 more specific statements about the effects of nursing intervention.
1. EXPECTED OUTCOMES
 The most specific, measurable criteria used to evaluate whether the goal has been met.
 CRITERION – an objective, measurable, relevant, and flexible indicator related to performance, behavior or
circumstances or clinical status.
 STANDARD – the desired and achievable level of performance against which actual practice is compared.
Ex.
Goal – After nursing intervention, the client’s nutritional status will improve.
Objective – After nursing intervention, the client will have a weight gain after two weeks
 Expected Outcome – After nursing intervention, the client will have a weight gain of 4 pounds by Sept. 15 (two
weeks after the goal of care has been identified)
 Criteria – Weight gain
 Standard – 4 pounds
 PURPOSE OF GOALS/EXPECTED OUTCOMES
 Provide direction for planning nursing interventions
 Provide a time span for planned activities
 Serve as a criteria for evaluation of client progress
 Enable client and nurse to determine when the problem has been resolved
 Help motivate client and nurse by providing a sense of achievement
 Barriers to joint goal setting nurse - patient
 Failure on the part of the family to perceive existence of the problem
 The family may realize the existence of a health condition or problem but too busy at the moment with other
concerns and preoccupations
 Family perceives the existence of problem but does not see it as serious to warrant attention
 Family may perceive the presence of the problem and the need to take action
 Failure to develop working relationship
 Reasons – refuse the problem
 Fear of consequence
 Respect for tradition
 Failure to perceive the benefits of action proposed
 Failure to relate the proposed action to the family’s goals
 Categories - objectives
 LONG TERM/ULTIMATE – require several nurse – family encounters and an investment of more resources
 SHORT TERM / IMMEDIATE – require immediate attention and results can be observed in a relatively short
period of time
 MEDIUM TERM / INTERMEDIATE – not immediately achieved and are required to attain long – term ones
 Appropriate nx interventions
 Decide on:
MEASURES TO HELP FAMILY ELIMINATE: barriers to performance of health tasks; underlying cause of non – performance
of health tasks
 FAMILY CENTERED: alternatives to recognize/detect monitor, control for manage health condition or problems
 Determine methods of family contact
 Specify resources needed
 Evaluation plan
Specify
 CRITERIA/OUTCOMES BASED ON OBJECTIVES OF CARE
 METHODS/TOOLS
 Writing of Family Nursing Care Plan
(Dr. Maglaya)
 Health Problem
 Family Nursing Problem
 Goal of Care
 Objectives of Care
 Nursing Interventions
 Methods of family-nurse contact
 Resources required
 Evaluation criteria and standard
STEPS OF FAMILY NURSING- PROCESS
 CARRYING OUT OF INTERVENTIONS
 UTILIZATION OF RESOURCES
  MONITORING OF PROGRESS
 SKILLS:
- Cognitive skills
- - interpersonal skills or communication skills
- - technical skills
 GUIDELINES:
 BASED ON SCIENTIFIC KNOWLEDGE, NURSING RESEARCH AND PROFESSIONAL STANDARDS OF CARE
 NURSES SHOULD UNDERSTAND CLEARLY THE ORDERS TO BE IMPLEMENTED
 NURSING ACTIONS SHOULD BE ADAPTED TO THE INDIVIDUAL CLIENT
 SHOULD ALWAYS BE SAFE
 SHOULD BE HOLISTIC
 SHOULD RESPECT THE DIGNITY OF THE CLIENT
 CLIENTS SHOULD BE ENCOURAGED TO PARTICIPATE ACTIVELY
STEPS OF FAMILY NURSING- PROCESS
 Appraisal / audit
ELEMENTS
 S – STRUCTURE – input - resources
 P – PROCESS - methods
 O – OUTCOME – output/results
 TYPES:
 ON-GOING – done while or immediately after implementing an order
 INTERMITTENT (PROCESS EVALUATION) - performed at a specified time intervals to show extent of progress
toward the goal and enables the nurse to correct any deficiencies and modify care plan
 TERMINAL – indicates client condition ; at the time of discharge; includes status of goal achievement and an
evaluation of the client’s self-care abilities with regard to follow-up care