DE LA SALE HEALTH SCIENCES INSTITUTES COLLEGE OF NURSING AND SCHOOL OF MIDWIFERY COMMUNITY HEALTH NURSING

FAMILY NURSING CARE PLAN SAUREL HEALTH CENTER

PRESENTED TO: CLINICAL INSTRUCTOR

PRESENTED BY: JONIA KAYE R. VILLAMIN BSN32; GROUP 3

DE LA SALE HEALTH SCIENCES INSTITUTES COLLEGE OF NURSING AND SCHOOL OF MIDWIFERY FAMILY NURSING CARE PLAN

HEAD OF THE FAMILY: FAMILY MEMBER: ADDRESS: FAMILY STRUCTURE: PLACE OF ORIGIN: RELIGION: ETHNIC GROUP:

Assessment of family structures and dynamics/ socio- economic and cultural characteristics: A. Family structure/ socio economic Family Member Relation Sex Birth date Civil Highest Occupation To Head Status Education No. Name Month Year Age Type Of Place Work 1 2 3 4

I.

Monthly Earning

Remarks

a.1 Dominant Family members in terms of decision making especially on the aspect of health care: a.2 presence of any obvious/ readily observable conflict between family members of the family: () yes () No a.3 Adequacy to meet basic necessities (food, clothing, shelter etc.) () yes () No a.4 who makes decisions about money:

a.5 membership in organization: () yes ()No name of organization: nature of organization: position in the organization: B. Home and environment Date assessed 1. Home a. Ownership: ( ) owned ( ) rented ( ) rent-free b. Construction materials used: ( ) light ( ) mixed ( ) strong c. Numbers of rooms used for sleeping: d. Lighting facilities: ( ) electricity ( )kerosene ( ) others. Specify: e. Ventilation: ( ) good ( ) poor f. General Sanitary Condition ( overall surroundings of house and environment):

2. Drinking water supply Source: ( ) Private ( ) Public Potability: Distance from the house: Storage: ( ) None (direct from faucet or pipe) ( ) Large covered container with faucet ( ) Large uncovered container with faucet ( ) Others, specify:

3. Kitchen Cooking facility: ( ) electric stove ( ) gas stove Sanitary condition: Drainage facility: ( ) open drainage ( ) blind drainage ( ) none

( ) firewood/ charcoal

4. Waste disposal a. Refuse and garbage Container: ( ) covered Method of disposal: ( ) hog feeding ( ) open dumping ( ) burial in pit b. Toilet type ( ) none ( ) composting ( ) open burning ( ) others, specify

( ) open

( ) none

( ) pail system

( ) overhang latrine ( ) Antipolo ( ) open pit privy ( ) closed pit privy ( ) bore hole latrine ( ) others, specify Distance from house: Sanitary condition: 5. Domestic Animals Kind Number Where kept ( ) water sealed latrine ( ) flushed type

C. Health status of each family member i. Nursing history ii. Developmental assessment for infants, toddlers and preschoolers (MMDST): iii.PHYSICAL ASSESSMENT/ RESULT OF LABORATORY/ DIAGNOSTIC EXAMINATION SYSTEM ROS General/ overall health status SHEENT CHEST/ LUNG CARDIO ABDOMEN GUT EXTREMITIES D. Values, habits practices on health promotion, maintenance and disease prevention 1. Immunization status of family members Name Age BCG Heap B OPV DPT VAC 1 2 3 1 2 3 1 2 3

P.E.

VIT.A

M Vac

remarks

2. Healthy lifestyle practices: 3. Adequacy of rest and sleep: 4. Relaxation/ stress management: 5. Use of protective measures:

( )yes Specify: ( ) yes ( )yes Specify:

( ) no ( ) no ( ) no how many hours:

( ) mosquito net

( ) footwear ( ) protective clothing

( ) others: specify

II.

Problem sheet Health conditions and problems

Cues/data

Family nursing problems

III.

Prioritization of nursing problems A. SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES CRITERIA WEIGHT 1. NATURE OF THE CONDITION OR PROBLEM PRESENTED 1 A. WELLNESS STATE 3 B. HEALTH DEFICIT 3 C. HEALTH THREAT 2 D. FORSEABLE CRISIS 1 2. MODIFIABILITY OF THE CONDITION OR PROBLEM 2 A. EASILY MODIFIABLE 2 B. PARTIALLY MODIFIABLE 1 C. NOT MODIFIABLE 0 3. PRETENTIVE POTENTIAL 1 A. HIGH 3 B. MODERATE 2 C. LOW 1 4. SALIENCE 1 A. A CONDITION OF PROBLEM NEEDING IMMEDIATE ATTENTION 3 B. A CONDITION OF THE PROBLEM NOT NEEDING IMMEDIATE 2 ATTENTION 1 C. NOT PERCEIVED AS A PROBLEM OR CONDITION NEEDING CHANGE SCORING:
1. DECIDE ON A SCORE FOR EACH OF THE CRITERIA 2. DIVIDE THE SCORE BY THE HIGHEST POSSIBLE AND MULTIPLY BY THE WEIGHT. (SCORE/ HIGHEST SCORE X WEIGHT) 3. SUM UP THE SCORE FOR ALL THE CRITERIA. THE HIGHEST SCORE IS 5 EQUIVALENT TO THE TOTAL WEIGHT y MAGLAYA, A.S 2003. NURSING PRACTICE IN THE COMMUNITY. ARGONAUTA CORP. PHILIPPINES

B. Case illustration on priority setting

CRITERIA NATURE OF THE PROBLEM

Computation

Actual score

Justification

MODIFIABILITY OF THE PROBLEM

PRETENTIVE POTENTIAL

SALIENCE

Total score

IV.

Family nursing care plan Health problem Family nursing problems

Objectives of care Nursing intervention

Plan of intervention Methods or tools Resources required

Evaluation plan Outcome criteria/ indicators

V.

SUMMARY OF LAST DAY OF HOME VISIT

VI.

PHOTO DOCUMENTATION