FAMILY NURSING CARE PLAN

Prepared by : Mrs. Maricris D. Banquilay, R.N.,M.A.N.

vii. CATEGORIES OF NURSING INTERVENTIONS

HUMAN BECOMING
Just as the self aims to achieve body-mind integration to achieve wholeness in the experience of being and becoming, the nurse must engage in full awareness of being and becoming in expert caring. Unless there is such a dynamic and active involvement between the nurse and the family in understanding and making choices in this meaningful world of coping, aspirations, emotions and skills the nurse cannot hope to achieve expert caring.
3

COMPETENCY-BASED TEACHING
-A substantive part of the implementation phase which is directed towards developing the familys competencies to perform the health tasks -include the cognitive (knowledge), psychomotor (skills), and attitudinal or effective (emotions, feelings, values)

Example : Scabies as a Health Deficit

Health Task: The family recognizes the possibility of cross infection of scabies to other members Cognitive competencies: a. The family explains the cause of scabies b. The family enumerates ways by which cross-infection of scabies can occur among the family members

Health Task: The family provides a home environment conducive to health maintenance and personal development of its members Psychomotor Competency: The family carries out the agreed upon measures to improve home sanitation and personal hygiene of family members. Health Task: The family decides to take appropriate health action. Attitudinal or Affective Competencies: a. Family members express feelings or emotions that act as a barriers to decision-making b. Family members acknowledge the existence of these feelings or emotions
6

EXAMPLES OF LEARNING PRINCIPLES AND TEACHING LEARNING METHODS AND TECHNIQUES THE NURSE CAN USE
Learning is both an intellectual and emotional process. Help the family handle the affective components of learning for sustained behavior. 2. Learning is facilitated when experience has meaning. Focus learning on the familys meanings, concerns and situated possibilities. 3. Learning is an individual matter. Ensure mastery by working on the familys current capabilities and potentials
1.
7

LEARNING IS AN INDIVIDUAL AND EMOTIONAL PROCESS

1.

2.
3.

4.
5.

6.

Provide information to shape Attitudes. Providing experiential Learning Activities to Shape Attitudes. Providing Examples or models to Shape Attitudes. Providing Opportunities for Small Group Discussion to Shape Attitudes. Role-playing Exercises. Explore the benefits of Power of Silence.

LEARNING IS FACILITATED WHEN EXPERIENCES HAVE MEANING TO THE LEARNER

Analyze and process with family members all teachinglearning based on their grasp of the lived experience of the situation in terms of its meaning for the self. 2. Involve the family actively in determining areas for teaching- learning based on the health tasks that members need to perform. 3. Use example or illustrations that the family is familiar with.
1.

LEARNING IS AN INDIVIDUAL MATTER: ENSURE MASTERY OF COMPETENCIES FOR SUSTAINED ACTION

Make the learning active by providing opportunities for the family to do specific activities, answer questions or apply learning in solving problems. 2. Ensure clarity in teaching. Use words, examples, visual materials and handouts that the family can understand. teaching skills : a. explain why it is important b. when it should be used. c. the stages and steps in performing the skill and demonstrate it correctly explaining each step as she demonstrate and emphasize important points 10
1.

3. Ensure adequate evaluation, feedback, monitoring and support for sustained action. a. Explain well how the family is doing b. give the necessary affirmations or reassurances c. explain how the skill can be improved, and d. explore with the family how modifications can be carried out to maximize situated possibilities or best options available to the family

11

MOTIVATION-SUPPORT FOR BEHAVIOR CHANGE/LIFESTYLE MODIFICATION

To bring about self-directed change, people must learn to

learn from their experiences. Frequently people have learned to defend against the potential lessons of experience when these threaten existing equilibria, whether in the person or in the social system.
12

 In order to help people lower their defenses and allow

themselves to experience the needed change, it is necessary to have learning environment that nurtures the change. The change agent can help the client put to maximum use valid knowledge through concern for: 1. human needs or the use-value of a given piece of knowledge 2. security, trust, self-esteem, self-identify, group esteem and group identity 3. accurate and appropriate preparation and transmission of messages

13

VIII. STRATEGIES OF NURSING INTERVENTIONS

1. PREVENTIVE 2. CURATIVE 3. REHABILITATIVE 4. FACILITATIVE 5. FACILITATION 6. DIRECT
14

IX. EVALUATION
phase which is concerned with the determination of whether the objectives set were attained, or to what degree they were attained -also involved decision making. Based on the answer to the questions, Did nursing makes a difference?, or What results came out of the nursing activity?, decisions have to be made on whether the objectives
15

-that

have to be formulated, approaches and strategies modified, resources increased and the like. If evaluation shows that an objective was not attained, the nurse has to find out the reasons why: the objectives may be unrealistic, nursing actions may be inappropriate or uncontrollable environmental factors may be operative in the situation

16

IMPORTANCE OF EVALUATION
To eliminate or stop the continued performance of useless activities and/or interventions 2. To increase the efficiency of nursing interventions 3. To provide documentation of the results of nursing efforts and justification for the cost of nursing services 4. To promote growth of the profession and refinement of nursing practice
1.

17

QUANTITATIVE VS QUALITATIVE EVALUATION

QUANTITATIVE accounting is done in terms of quantity
or number of services or activities performed e.g. number of prenatal patients attended in the clinic, number of home visits made, number of immunizations given or number of school children assessed - the more common type of evaluation done for health services and understandably because of its relative ease compared to an evaluation of quality - Taylor contends that this kind of evaluation is irrelevant in todays complex health care system
18

QUANTITATIVE
Disadvantage: has one obvious limitation : It assumes that the more tasks or activities are done, the better - a lot of health service activities may be virtual waste of resources

19

QUALITATIVE can be focused on either of the 3

dimensions: 1. Structure or Resources this refers to human and material things that are needed to carry out the desired services or activities, and their supporting organization e.g. Nurse Practitioner level the nurse qualifications, interest and motivation, amount of nursing time and effort spent, nature and quantity of equipment and supplies used in the delivery Program level covers manpower, (quantity and quality), supplies and equipment, buildings, money, statement of philosophy and objectives,

20

organization of teams and departments, employee education and training and description of policies and standard operating procedures 2. Process includes activities done to achieve the objectives. In nursing, this invariably relates to the nurses performance or actions e. g. the quality of anticipatory guidance or health teaching given to an expectant mother 3. Outcome refer to the end results of care and from the point of view of the patient can be in terms of physical condition, psychological or attitudinal status and behavior

21

EXAMPLE ILLUSTRATION:
OBJECTIVE : As a result of nursing intervention, the family will be able to provide adequate care to the malnourished child EVALUATION OF RESOURCES Criteria : Resources of the nurse (knowledge of nutrition, normal and therapeutic, interest and motivation in the case and the family), resources of the family (income, proportion alloted to food, dietary habits and practices, knowledge of proper nutrition), and resources of the community (availability of feeding centers, other health personnel like doctors and nutritionists, community interest in nutrition, food supply)
22

EVAUATION OF PROCESS Criteria : Nature of family-nurse relationship, method of nurse-family contacts, content and methods of health teaching, approaches and strategies used by the nurse
EVALUATION OF OUTCOME Criterion : Childs weight

23

METHODS AND SOURCES OF EVALUATIVE DATA

1.

DIRECT OBSERVATION the most valid method of determining change, that is, if subjective observer interpretation can be minimized with the use of precision instruments and predetermined objective indices of process or outcome e.g. changes in physical condition of a patient can be enhanced by the use of such devices as weighing scale, stethoscope, sphygmomanometer and the like

24

e.g. Behavioral changes in individual members or of the whole family as of the a unit, are more objectively determined by having predetermined criteria on specific behaviors to look for that suggestive of successful attainment of the objective
2. RECORD REVIEW - reports of diagnostic tests that are indicative of a change in health status can be gleaned from the patients record. Likewise, individual patient or family behavior and general response to service delivered may be determined from nursing notes as well as from entries of other members of the health team
25

3. INTERVIEW OR QUESTIONNAIRE to determine broad and complex attitudinal and behavioral changes, an interview or questionnaire may be constructed and administered to an individual patient or key members of a family. There are rules for construction and administration of these instruments which have to be observed. They also require pretesting for validity and reliability before actual use
4. SIMULATION EXERCISE this involves presenting real-life problem situations to the client and asking how he will react. This is useful for determining success in cognitive skill development like decision making and problemanalysis skills
26

CLIENT SATISFACTION AS CRITERION OF SUCCESS

the difficulty with the use of patient/family satisfaction as

27

evidence of good nursing care is the fact that satisfaction does not always mean good care. Clients usually have different criteria o what constitute good care. The criteria used frequently relate to the quality of nursepatient relationship and seldom consider the technical elements of good care. Ascertaining the clients satisfaction with services provided has some uses, though, because they affect the development and maintenance of a working relationship between the nurse and the patient/family. The establishment of a working relationship is crucial to the successful implementation of the nursing care plan

STEPS IN EVALUATION

28

Establish a baseline in terms of health problem areas for an individual patient or the entire family. This means specifically describing the status at the moment. It is answering the question: What health problems (health threats, health deficits and foreseeable crises) exist, and how is the family coping with these problems? 2. Define the objectives of nursing care specifically and in terms of client outcomes. 3. Determine the criteria and standards for evaluation. The criteria may be in relation to resources, process or outcomes depending upon the dimension of evaluation desired.
1.

29

Decide on the methods/techniques of evaluation and sources of data. 5. Compare the actual situation (after care was provided)with the criteria and standard for evaluation) 6. Identify the causes for less than optimum performance. If the objectives have not been fully attained, analyze possible reasons, like inadequate assessment, wrong definition of the problem, unrealistic objectives, inappropriate approaches and strategies, or family and community factors beyond the control of the nurse. 7. Redefine the objectives. Based on the conclusions derived from the evaluation process, the objectives of care are redefined in the light of new problems identified
4.
30

X. RECORDS IN FAMILY HEALTH NURSING

31

IMPORTANCE:
A good information or record system is wellrecognized and very important tool in the provision of comprehensive health care. 2. Records are specially related to such qualities of care as adequacy, continuity and patient/family centeredness. 3. The writing and keeping of good records has become almost mandatory at this time when the consumers of care have increasingly high expectations and are becoming more and more critical of the services they receive.
1.
32

PURPOSES/USES OF RECORDS:
They document the care rendered to the patient and/or family, and show the particular contribution of each member of the health team in the health care effort. Records substantiate claims of achievement by any one member. 2. They serve as a tool for planning care. Records provide the source for some initial data a health worker seeks about a patient or family. The public health nurse, for instance, can identify some health and nursing problems from a mere review of family health records, and plan the content and conduct of her initial contact with the family
1.
33

3. Records facilitate the delivery of continuous care to the individual patient or family. They show what has been done, what transpired in the past and from what point care should be continued. A record review saves a lot of time and effort by preventing needless repetition of activities that have already been done. 4. Records serve as a tool for evaluating care. They indicate the nature, quantity and quality of care provided to clients and can thus be used as a measure of personnel performance. A record audit is a common tool utilized by nurse supervisors to evaluate performance of their staff.

34

5. Good records are very valuable teaching devices for using students and staff alike. They are a source of educational materials, and reveal strengths and weaknesses in staff performance that can serve as a basis for educational activities. 6.Records are an important source or research data. They are frequently utilized in epidemiological and evaluative research studies. 7. Lastly, records are legal documents that are used as evidence in litigations. Clients of health services are increasingly using the courts to obtain redress for their grievances. For the protection of the health worker he has to keep adequate records.
35

36

Thank you!