FAMILY NURSING CARE PLAN Introduction: The Family is the basic unit of the society.

Formulation of the care plan is the next step in the nursing process after assessment, when health and family nursing problems have been clearly defined. A family nursing care plan is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods, and tools. Features: The definition points to specific features of a nursing care plan. These characteristics are based on the concept of planning as a process. 1. The nursing care plan focuses on actions which are designed to solve or minimize existing problem. The plan is a blueprint for action. The care of the plan is the approaches, strategies, activities, methods, and materials which the nurse hopes will improve the problem situation. 2. The nursing care plan is a product of a deliberate systematic process. The planning process is characterized by logical analyses of data that are put together to arrive at rational decisions. The interventions the nurse decides to implement are chosen from among the alternatives after careful analysis and weighing of available options. 3. The nursing care plan, as with all other plans, relates to the future. It utilizes events in the past and what is happening in the present to determine patterns. It also projects the future scenario if the current situation is not corrected. 4. The nursing care plan is based upon identified health and nursing problems. The problems are the starting points for the plan, and the foci of the objectives of care and intervention measures. 5. The nursing care plan is a means to an end, not an end in itself. The goal in planning is to deliver the most appropriate care to the client by eliminating barriers to family health development. 6. Nursing care planning is a continuous process, not a one-shot-deal. The results of the evaluation of the plans effectiveness trigger another cycle of the planning process until the health and nursing problems are eliminated.

Types of health problems 1. health deficit 2. health threat 3. foreseeable crisis

After the assessment phase, the nurse may realize that the family is faced with a number of health and nursing problems which cannot be taken up all at the same time considering the available resources of both the family and the nurse. There are four criteria for determining priorities among health conditions or problems. 1. Nature of the condition or problem presented categorized into wellness state/potential, health threat, health deficit and foreseeable crisis. 2. Modifiability of the conditions or problems refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. 3. Preventive potential refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the condition or problem under consideration. 4. Salience refers to the familys perception and evaluation of the condition or problem in terms of seriousness and urgency of attention needed or family readiness. Scale for Ranking Health Conditions and Problem According to Priorities: Criteria Weight 1. Nature of the condition or problem presented Scale: wellness state 3 health deficit 3 health threat 2 foreseeable crisis 1

2. Modifiability of the condition or problem Scale: easily modifiable 2 partially modifiable 1 not modifiable 0

3. Preventive Potential Scale: High 3 Moderate 2 Low 1

4. Salience Scale: a condition or problem needing immediate attention a condition or problem not needing immediate attention not perceived as a problem or condition needing change

2 1 0

Scoring: 1. Decide on a score for each of the criteria. 2. Divide the score by the highest possible score and multiply by the weight: (Score/ Highest Score) x Weight 3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight.

The components of Family Nursing Care Plan include: 1. Health Problem the current problem of the family. 2. Family Nursing Problem the problem that cannot be solved by the family alone, thus, needing the assistance of the nurse. 3. Goal of Care is a general statement of the condition or state to be brought about by specific courses of action. It must set jointly with the family. This ensures the familys commitment to their realization. It should also be realistic and attainable. Barriers: a. Failure on the part of the family to perceive the existence of the problem. In many instances the problem is seen only by the nurse while the family is perfectly satisfied with the existing situation. b. The family may realize the existence of a health condition or problem but too is too busy at the moment with other concerns and preoccupations. c. Sometimes the family perceives of a problem but does not see it as a serious enough to warrant attention d. The family may perceive the presence of the problem and the need to take action. It may, however, refuse to face and do something about the situation. e. A big barrier to collaborative goal setting between the nurse and the family is failure to develop a working relationship. The elements of mutual trust and confidence are crucial to the success of the nurse-family endeavor towards better health.

Objectives of Care refer to more specific statements of the desired results or outcomes of care. They specify the criteria by which the degree of effectiveness of care is to be measured. Objectives are the milestones to reach the destination. Objectives vary according to the time span required for their realization. j Short-term/immediate objective are formulated for problem situations which require immediate attention, and results can be observed in a relatively short period of time. j Medium-term/intermediate objective are those which are not immediately achieved and are required to attain the long-term ones. j Long-term/ultimate objectives require several nurse-family encounters and an investment of more resources. The nature of outcomes sought requires time to demonstrate.

Intervention Plan this involves selection of appropriate nursing interventions based on the formulated goals and objectives. - Nursing Interventions are identified and written during the planning process. The nurse decides on appropriate nursing actions among a set of alternatives, specifying the most effective or efficient methods of nurse-family contact and the resources needed. It is classified into: a. Independent interventions are those activities that nurses are licensed to initiate on the basis of their knowledge and skills. b. Dependent interventions are activities carried out under the physicians orders or supervision, or according to specified routines. c. Collaborative interventions are actions the nurse carries out in collaboration with other health team members. Collaborative nursing activities reflect the overlapping responsibilities of, and collegial relationships between, health personnel. - Method of Nurse-Family Contact it refers to what method the nurse is using to come up with the problem. Some examples of methods of nurse-family contact are home visit, clinic conference, visit in the work place, school visit, etc. - Resources Required it includes the materials (e.g. charts, visuals, handouts, etc.), or human (e.g. other health members, development workers, community leaders)

Evaluation The assessment phase of the nursing process generates the health and nursing problems which become the bases for the development of the nursing care plan.

COMMUNITY HEALTH NURSING FOCUS: Promotion and Preservation of the health of populations NATURE OF PRACTICE: comprehensive, general, continual and not episodic KNOWLEDGE BASE: from nursing and public health LEVELS OF CLIENTELE: individuals, family, population groups and community as a whole COMMUNITY - A group of people sharing common geographic boundaries and common values and interests. HEALTH- state of complete physical, mental and social well-being, not merely the absence of disease or infirmity WORLD HEALTH ORGANIZATION - Optimum level of individuals, families and communities MODERN CONCEPT OF HEALTH - This factor pertains to the power and authority to regulate the environment PRINCIPLES OF COMMUNITY HEALTH NURSING Community health nursing is based on recognized needs of communities, families, groups and individuals The community health nurse must understand fully the objectives and policies of the agency she represents FAMILY unit of service Community health nursing must be available to all HEALTH TEACHING primary responsibility of the community health nurse The community health nurse works as a member of the health team There must be periodic evaluation Opportunities for continuing staff education program must be provided PRINCIPLES OF COMMUNITY HEALTH NURSING Make use of available community health resources Utilize existing active groups in the community Educative supervision Accurate recording and reporting ULTIMATE GOAL: Raise the level of health of the citizenry

CATEGORIES OF HEALTH PROBLEMS (First Level Assessment) A. HEALTH DEFICIT - A gap between actual and achievable health status; Instances of failure in health maintenance; j Possible precursors of health deficit: History of repeated infections or miscarriages; No regular health check-up j ILLNESS states, diagnosed or undiagnosed j Failure to thrive/develop j Disability j Transient (aphasia or temporary paralysis after a CVA) j Permanent (leg amputation secondary to diabetes, blindness from measles, lameness from polio)

B. HEALTH THREAT - conditions that are conducive to disease, accident or failure to realize ones potential j Family history of hereditary disease j Threat of cross infection j Accident hazards j Faulty eating habits j Poor environmental sanitation j Unhealthy lifestyle/personal habits C. FORESEEABLE CRISIS - anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources j Marriage j Pregnancy j Parenthood j Divorce or separation j Loss of job j Menopause j Death Second Level Assessment: Recognition of the problem Decision on appropriate health action Care to affected family member Provision of healthy home environment Utilization of community resources for health care

ASSESSMENT OF COMMUNITY HEALTH NEEDS Community Diagnosis - A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies **2 Types of Community Diagnosis 1. Comprehensive Community Diagnosis - aims to obtain general information about the community 2. Problem-Oriented Community Diagnosis - type of assessment responds to a particular need STEPS: Preparatory Phase 1. site selection 2. preparation of the community 3. statement of the objectives 4. determine the data to be collected 5. identify methods and instruments for data collection 6. finalize sampling design and methods 7. make a timetable Implementation Phase 1. data collection 2. data organization/collation 3. data presentation 4. data analysis 5. identification of health problems 6. prioritization of health problems 7. development of a health plan 8. validation and feedback Evaluation Phase