NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

FAMILY HEALTH NURSING - level of community health nursing practice that is directed or focused on the family as the unit of care, with HEALTH as the goal and NUR !N" as the medium, channel or provider of care FAMILY HEALTH NURSING PROCESS - a chosen set of actions that guides the health care provider in his approach to individuals, families, and communities in an attempt to maintain and promote accepta#le health conditions and to increase the client$s capa#ilities to cope with the occurrence of health pro#lems Purpose: To provide a systematic methodology for the health wor%er To give direction, guidance, and planning for health care Levels of Clientele: &' !ndividual (' )amily -#asic unit of care in the community -the source of most solid social support to its mem#ers Family Health Tasks a' Recogni*es the presence of wellness state or health condition+pro#lem #' ,a%e decisions a#out ta%ing appropriate action+s to maintain wellness or manage the health pro#lem c' -rovide nursing care for the sic%, disa#led, dependent or at-ris% mem#er+s d' ,aintain a home environment conducive to health maintenance and personal development e' Utili*e community resources for health care .' -opulation "roup -shares common characteristics, development stage, and common e/posure thus, resulting to common health pro#lems E/amples0 children farmers elderly factory wor%ers women commercial se/ wor%ers 1' 2ommunity P !ses " Steps of F!#il$ He!lt C!re Pro%ess:

ASSESSMENT - first ma3or phase - involves a set of actions #y which the nurse and the client measures the health status of the family, its a#ility to maintain itself as a system and functioning unit, and its a#ility to maintain wellness and to prevent, control or resolve pro#lems in order to achieve health and well #eing among its mem#ers 3 Major Steps in Nursing Assessment: !& '!t! Colle%tion
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

ources of 4ata0 i' )amily mem#ers ii' Relatives or significant others of the family iii' 2ommunity where the family #elong iv' 5ther health care provider+s who served the family v' Relevant records ,ethods + Tools0 i' 5cular survey + o#servation ii' !nterview iii' -hysical E/amination iv' Review of records v' La#oratory + diagnostic tests )ive Types of 4ata + !nitial 4ata 6ase0 i' )amily tructure, 2haracteristics and 4ynamics -mem#ers of the household and relationship to the head of the family -demographic data -place of residence of each mem#er -type of family structure -dominant family mem#ers in decision ma%ing in terms+matters of health care -general family relationship + dynamics ii' ocio-economic and 2ultural 2haracteristics -income and e/penses - 5ccupation, place of wor% and income of each wor%ing mem#er -Ade7uacy to meet #asic necessities -4ecision ma%er in terms of money and how it is spent + #udgeting -educational attainment of each mem#er -ethnic #ac%ground and religious affiliation -significant others 8role+s they in the family9 -relationship of the family to larger community iii' Home and Environment -housing Ade7uacy of living space leeping arrangement -resence of #reeding or resting sites of vectors or -resence of accident ha*ard )ood storage and coo%ing facilities :ater supply Toilet facility "ar#age + refuse disposal 4rainage system -%ind of neigh#orhood -social and health facilities availa#le -communication and transportation facilities availa#le iv' Health tatus of Each ,em#er
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diseases

Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

-past and present significant medical and nursing history and practices -nutritional assessment Anthropometric data 4ietary history specifying 7uality and 7uantity of food+nutrient inta%e per day Eating + feeding ha#its + practices -developmental assessment of infants, toddlers and preschoolers -ris% factor assessment indicating presence of ma3or and contri#uting modifia#le ris% factors for specific lifestyle diseases -physical assessment indicating presence of illness state 8diagnosed or not9 -results of la#oratory + diagnostic and other screening procedures supportive of assessment findings v' ;alues, Ha#its, -ractices on health -romotion, ,aintenance and 4isease -revention -immuni*ation status of each family mem#ers -specify healthy lifestyle practices -ade7uacy of Rest and sleep E/ercise + activities Use of protective measures Rela/ation and other stress management activities -use of promotive-preventive health services T(o M!+or T$pes of F!#il$ Nursin, Assess#ent: - Typology of Nursing -ro#lems in )amily Nursing -ractice i& First Level of Assess#ent -process wherein actual and potential health conditions+pro#lems of the family are determined -reflects the depth of data gathered including the analysis on what health pro#lems e/ist 1 2ategories :ellness tate+s Health Threat+s Health 4eficit+s )oreseea#le 2risis + tress -oint+s ii& Se%on) Level of Assess#ent -defines the nature or type of nursing pro#lems that the family encounters in performing the health tas%s with respect to a given health condition+pro#lem, and the etiology or #arriers to the family$s tas%+s assumption -stated as e/planations a#out the family$s pro#lems related to maintaining wellness <+or provide a home environment conducive to health maintenance and personal development -reflects the e/tent to which the family can perform the health tas%s on each health condition+pro#lem identified during the first level of assessment0
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

)amily$s perception regarding the pro#lem 4ecisions made and its appropriateness 8give the reasons if no decisions made9 Actions ta%en and its result 8give reasons if no actions were done9 Effects of decision+s or action+s to the other family mem#ers

(nd level of assessment can #e done for each health threat or pro#lem identified during the course of the interview -rocedures0 a. 4etermine if the family recogni*es the e/istence of the pro#lem, if not, e/plore reasons why b. !f the family recogni*es the presence of the pro#lem, determine what they have done to resolve it' !f not, determine the reasons why' !f the family has done something to resolve the pro#lem, determine the effectivity of this to the pro#lem' c. 4etermine if the family encounters other p/ in implementing the solutions to the health threats, what are these pro#lems= d. 4etermine how the other family mem#ers are affected #y the health threats or deficits' &' Record review- information may #e ta%en from previous records of the family (' La#oratory and d/ tests- performing la#oratory tests, and diagnostic procedures -& '!t! An!l$sis " Interpret!tion ,ethods + Activities ort data 2lassify + group + integrate data Relate data with each other 4etermine patterns 2ompare data with standard norms

'!t! An!l$sis0 sorting out and classifying data #y type and nature, relating them with each other and determining patterns or recurring themes with norms or standards' The standard or norms of the family as a functioning unit involves the a#ility to perform the following health tas%s0 a' recogni*e the presence of a health pro#lem #' ma%e decisions a#out ta%ing appropriate health action c' provide nursing care to the sic%, disa#led, dependent, and at ris% family mem#ers d' maintain a home environment conducive to health maintenance and personal development e' utili*e com$ty resources for health care -ro#lem 4efinition0 a' health pro#lem #' nursing pro#lem 'IAGNOSIS %& Nursin, 'i!,nosis " Pro-le# 'efinition
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

-end result of the two ma3or types of nursing assessment in family nursing practice particularly the econd Level of Assessment statement of family$s failure to perform specific tas%s reasons why the family can perform tas%s

T(o P!rts of t e Nursin, 'i!,nosis a' The statement of unhealthful response -ina#ility to perform a specific health tas%+s #' The statement of factors which are maintaining the undesira#le response and preventing the desired changes 8etiology9 Nursin, 'i!,nosis: &' definition of health pro#lem (' definition of family nursing pro#lem 4ata "athering0 &' !dentify the %inds of data needed (' specify the methods of data gathering . critical points in 4ata gathering &' ;alidity (' Relia#ility .' Ade7uacy of data 4ata "athering ,ethods0 .' 5#servation- ma%es use of sensory capacities 8 hearing, sight, smell, touch, and taste9 1' -hysical e/amination through a' !--A #' &. areas of assessment >' interview- completing a health h/ for each family mem#er - -ersonally as%ing 7uestions regarding health Five M!in T$pes .St!te#ent of Un e!lt ful Response/ i' !na#ility to recogni*e the presence of the pro#lem+condition due to? ii' !na#ility to ma%e decisions with respect to ta%ing appropriate health actions due to? iii' !na#ility to provide nursing care to the sic%, disa#led, or dependent family mem#ers due to? iv' !na#ility to provide a home environment which is conducive to health maintenance and personal development due to? v' )ailure to utili*e community resources for health care due to? T$polo,$ of Nursin, Pro-le#s in F!#il$ He!lt First0Level Assess#ent Se%on)0level Assess#ent PLANNING - setting of criteria or indicators for evaluation 8goals <+or o#3ective9 -identification of specific nursing interventions and resources needed @developing a )amily Nursing 2are -lan
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C!re

Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

FAMILY NURSING CARE PLAN - is the #lue print that the nurse designs to systematically minimi*e or eliminate the identified health and family nursing pro#lems through formulated outcomes of care and deli#erately chosen set of interventions, resources and evaluation criteria, standards, methods and tools C !r!%teristi%s i' !t focuses on actions which are designed to solve or minimi*e e/isting pro#lem ii' !t is a product of a deli#erate systematic process iii' !t relates to the future iv' !t is #ased upon identified health and nursing pro#lems v' !t is a means to an end, not an end in itself vi' !t is a continuous process, not a one shot deal 1u!lities i' !t should #e #ased on clear, e/plicit definition of the pro#lem+s ii' A good plan must #e realistic iii' !t should #e prepared 3ointly with the family iv' !t is most useful in written form I#port!n%e of Pl!nnin, C!re i' !ndividuali*e care to clients ii' Helps in setting priorities iii' -romotes a systematic communication among those who are involved in the health care effort iv' 2ontinuity of care is facilitated v' )acilitates the coordination of care with the other mem#er+s of the health care team Steps in 'evelopin, F!#il$ Nursin, C!re Pl!n i' -rioriti*ing of Health -ro#lems or 2ondition+s - ran% the identified health pro#lems #ased on the Scale for Ranking Family Health Pro lems accor!ing to Priorities Scoring: a' 4ecide on a score for each of the criteria #' 4ivide the score #y the highest possi#le score and multiply #y the weight score '/ weight highest score c' um up the scores for all the criteria 8highest score is 2, e7uivalent to the total weight9 Criteri! &' Nature of -ro#lem -resented -wellness state -health deficit -health threat -foreseea#le crisis (' ,odifia#ility of the -ro#lem
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S%ore . . ( &

3ei, t &

Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

-easily modifia#le -partially modifia#le -not modifia#le .' -reventive -otential -high -moderate -low 1' alience -a condition needing immediate attention -a condition not needing immediate attention -not perceived as a pro#lem needing change 4 Criteria in Determining Priorities: Nature of Problem Presented Modifiability of the Problem -refers to the pro#a#ility of success in minimi*ing or alleviating or totally eradicating the pro#lems through appropriate interventions Preventive Potential -refers to the nature and magnitude of future pro#lems that can #e minimi*ed or prevented if intervention+s is+are done on the pro#lem under consideration Salience -refers to the family$s perception and evaluation of the pro#lem in terms of seriousness and urgency of attention needed ( & A & . ( & & ( & A

For#ul!tion of Go!ls or O-+e%tives - specify the e/pected health+clinical outcomes, family response+s, #ehavior or competency outcomes Goal B a general statement of condition+s or state+s to #e #rought a#out #y specific courses of action Objective B refers to a more specific statements of the desired outcome of care - specify the criteria #y which degree of effectiveness of care are to #e measured

N5TE@The more specific the o#3ective, the easier is the evaluation of their attainment' *!rriers in Go!l 4 O-+e%tive Settin, a' )ailure on the part of the family to perceive the e/istence of the pro#lem #' The family may reali*e the e/istence of the health pro#lem #ut is too #usy at the moment with other concerns c' ometimes, the family perceives the e/istence of a pro#lem #ut does not see it as serious enough to warrant attention d' The family may perceive the presence of the pro#lem and the need to ta%e action #ut may refuse to face and do something a#out the situation due to some reasons, such as0
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

fear of conse7uences of ta%ing action respect for tradition failure to perceive the #enefits of action proposed failure to relate the proposed action to the family$s goal )ailure to develop a good wor%ing relationship T$pes of O-+e%tives &' hort-term + immediate o#3ective -can #e accomplished with few nurse-family contacts and with the use of fewer resources (' ,edium-term + intermediate o#3ective -not immediately achieved and are re7uired to attain the long-term ones .' Long-term o#3ective -also %nown as the ultimate o#3ectives Sele%tion of Appropri!te Interventions -focuses on alternatives and decision on appropriate intervention measures #ased on the appropriate o#3ectives and goals that was formulated -includes the most effective method of nurse-client+family resources that are necessary for the plan contact and the

ocus on !nterventions to "el# the amily in Performing their "ealth $as%s a' Help the family in recogni*ing the pro#lem #' "uide the family on decision ma%ing and on appropriate actions to ta%e c' 4evelop the family$s a#ility and commitment to provide nursing care to the sic% d' Enhance the capa#ility of the family to provide a home environment that is conducive to health maintenance and personal development e' )acilitate the family$s capa#ility to ma%e use of the community resources for health care

IMPLEMENTATION - action phase E5ALUATION - process of ma%ing 3udgments as to the e/tent of whether the set of o#3ectives were achieved or not Develo# the !ntervention Plan

SUMMARY Steps in 'evelopin, t e FNCP

Prioriti&e the "ealth Conditions and Problems based on: - nature of condition+pro#lem -modifia#ility -preventive potential
8 -salience Gre$(olfRe)
Ms& April Anne '& *!l!non

@4ecide on0 -measures to help family eliminate0 a' #arriers to performance the 'valuation Plan ofDevelo# health tas%s #' underlying cause+s of nonpecify0 performance of health tas%s -criteria + outcomes #ased on to -family-centered alternatives o#3ectives of care monitor, recogni*e+detect, control or manage health -methods + tools condition+s or pro#lem+s @4etermine methods of Nurse)amily contact @ pecify resources needed

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

Define Goals ( Objectives of Care )ormulate0 -E/pected outcomes0 @conditions to #e o#served to show pro#lem is prevented, controlled, resolved or eliminated @client response+s or #ehavior+s - pecific, measura#le, clientcentered statements or competencies

PERFORMING THE E5ALUATION: ASSESSMENT -4etermine whether there are changes in health status -,a%e sure that assessment data are accurate and complete DIAGNOSIS -4etermine if pro#lem+s re7uiring nursing care is+are resolved, improved or controlled -consider new pro#lems PLANNING
-4etermine if the interventions are appropriate and ade7uate to achieve client outcomes - pecify client$s status #ased on e/pected outcomes of

IMPLEMENTATION
-Analy*e how the plan was implemented' -4etermine what factors are related with the success in implementing the plan - pecify what factors created pro#lems or #arriers to care

F!%tors Affe%tin, Ev!lu!tion

i' Effectiveness of specific interventions ii' Efficiency iii' Appropriateness iv' Ade7uacy of the interventions rendered
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

Met o)s "Steps in Ev!lu!tin, i' 4ecide what to evaluate ii' 4esign the evaluation plan iii' 2ollect relevant data iv' Analy*e the collected data v' ,a%e decisions vi' "ive feed#ac% FAMILY NURSING CARE PLAN: - the #lueprint of the care that the nurse designs to systematically minimi*e or eliminate the identified health and family nursing pro#lems through formulated outcomes of care, and chosen set of interventions, resources, and evaluation criteria, standards, methods, and tools' C !r!%teristi%s: &' )ocuses on actions designed to solve or minimi*e e/isting pro#lems' (' is a product of a deli#erate systematic process .' it relates to the future 1' !s #ased on identified health and nursing pro#lems' >' it is a means to an end and is not an end in itself C' !s a continuous process, and not a one shot deal' 1u!lities for effe%tiveness: &' should #e #ased on a clear and e/plicit definition of the pro#lems (' should #e realistic .' is prepared 3ointly with the family 1' !s most useful in written form' I#port!n%e of pl!nnin,: &' )or individuali*ed care' (' Helps set priorities' .' promotes systematic communication among those involved 1' continuity of care is facilitated >' Helps in coordination of care' Steps in )evelopin, !n FNCP: &' -rioriti*ing pro#lems' (' formulating goals and o#3ectives .' plan of interventions 1' plan of evaluation Prioriti6in, e!lt pro-le#s0 &' Nature of the pro#lem' (' ,odifia#ility .' preventive potential 1' alience F!%tors !ffe%tin, priorit$ settin,: &' current %nowledge, technology, and interventions (' family resources .' resources of the nurse 1' com$ty resources )ormulating goals and o#3ectives0 GOAL- is a general statement of the condition or state to #e #rought a#out #y specific courses of action'
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

must #e set 3ointly with the family- 2AR4!NAL -R!N2!-LE !N "5AL ETT!N"

6arriers to 3oint goal setting0 &' failure to see the e/istence of the pro#lem (' availa#ility of the family 8time factor9 .' doesn$t see the pro#lem as too serious to warrant attention 1' #ehavioral a' fear of conse7uences #' respect for tradition c' failure to see the #enefits of the interventions proposed d' failure to relate the proposed intervention to the family$s goals >' failure to develop a wor%ing relationship O*7ECTI5ES- more specific statements of the desired outcomes of care' NURSING INTER5ENTIONS: 2onsiderations a' Analy*e with the family the current situation and determine choices and possi#ilities #ased on lived e/periences of meanings and concerns' #' 4evelop and enhance family$s competencies c' )ocus on interventions to help perform health tas%s &' help the family recogni*e the pro#lem (' guide the family on how to decide on appropriate health actions to ta%e .' 4evelop a#ility and commitment to provide nursing care to its mem#ers' 8 2ontract9 1' Enhance capa#ility of the family to provide a home environment conducive to health maintenance and personal development' >' )acilitate their capa#ility to utili*e com$ty resources for health care' d' 2ataly*e #ehavior change through motivation and support' 'E5ELOPING THE E5ALUATION PLAN: - specifies how the nurse will determine the achievement of the outcomes of care 8 goals and o#3ectives9 IMPLEMENTING THE NCP -erformance- focused learning through competency #ased teaching ,a/imi*ing caring possi#ilities for personal and professional development COMPETENCY *ASE' TRAINING: 4irected towards developing the family$s competencies to perform health tas%s' 8Dnowledge, Attitudes, %ills9 Health Tas%0 the family recogni*es the possi#ility of cross infection of sca#ies to other family mem#ers' 2ognitive competencies0 the family e/plains the cause of sca#ies' the family enumerates ways #y which cross infection can occur among family mem#ers' Health tas%0 the family provides and environment conducive to health maintenance' -sychomotor competency0
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Gre$(olfRe)
Ms& April Anne '& *!l!non

NCM 101 Lecture Notes PRELIMS Handout 1 _____________________

the family carries out the agreed upon measures to improve home sanitation and personal hygiene of family mem#ers'

Health tas%0 the family decides to ta%e appropriate health action' Attitudinal competencies0 family mem#ers e/press feelings or emotions that act as #arriers to decision ma%ing' family mem#ers ac%nowledge the presence of these feelings and identify ways and means on how to wor% around these factors that could hinder their decision ma%ing'

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Gre$(olfRe)
Ms& April Anne '& *!l!non