FAMILY NURSING DIAGNOSIS & FORMULATING THE Application of principles of personal and general hygiene: health

promotion and preventive measures

PLAN OF CARE

5. Healthcare Attitude: perception of healthcare in general

Nursing diagnosis may be formulated at several levels:

1. Individual family members

6. Emotional competence: degree of emotional maturity according to
2. As a family unit their development stage (how they deal with daily challenges, their
3. A family in relation to its environment or community ability to sacrifice and think for others)

Specific diagnosis: NANDA-International (NANDA-I, 2011) serves as a 7. Family living patterns: relationship among family members, mgmt. of
common framework of expressing human responses to actual and family resources and discipline at home
potential health problems

8. Physical environment

Family Coping Index: alternative tool for nursing diagnosis 9. Use of community facilities: ability to seek and utilize community
services

- nursing action may help a family in providing for a health need

or resolving a health problem by promoting the family’s coping FORMULATING PLAN OF CARE (FCP)
capacity

Involves (a) priority setting, (b) establishing goals and objectives, and (c)
- rather than identifying the problem, the index focuses on determining appropriate interventions to achieve goals and objectives
identifying coping patterns of the family in 9 areas of assessment

Family has the right to self-determination; family’s decision must be

A family is treated as a unit respected

If a family member is unable to cope in a particular category, but other The nurse’s role is offering guidance, proving information and assisting
family members are able to compensate, the family is still rated as the family in the family process
adequately coping

A. PRIORITY SETTING
Rate using a 5-point Likert scale, then justifying the score by writing
down observations that support the rating given

Determining the sequence in dealing with identified needs and

problems
9 areas of assessment of the Family Coping Index:

THE NURSE CAN NOT DEAL WITH ALL FAMILY NEEDS AND CONERNS
Physical independence: ability to perform ADLs ALL AT ONCE
Therapeutic competence: ability to comply with recommended
procedures and treatments to be done at home
To guide the nurse in priority setting, the following factors need to be
Knowledge of health condition: understanding of the health condition considered:
or essentials of care
1. FAMILY SAFETY
A life threatening situation is given TOP PRIORITY
ex. Communicable disease requires immediate attention to
promote healing and to prevent its spread
2. FAMILY PERCEPTION
Next to emergencies, priority is given to the need that the
FAMILY RECOGNIZES AS MOST IMPORTANT
In an instance the family fails to recognize issues that may
affect safety, the nurse MAY STRIVE TOWARDS PATIENT
EDUCATION
3. PRACTICALITY
the nurse and family looks for existing resources and
constraints
ex. Are the resources required to address a particular need
available to the nurse and family?
ex. Does the nurse have the necessary competence to deal
with the situation? If not, how feasible is a referral?
ex. What are the constraints the family and nurse have to deal
with?
4. PROJECTED EFFECTS
Immediate resolution gives the family a sense of
accomplishment and confidence in themselves and the nurse
Providing a clear-cut intervention during a family-nurse contact
raises the level of trust in the nurse
B. ESTABLISHING GOALS AND OBJECTIVES
A goal is a desired observable family response to planned interventions
in response to a mutually identified family need
Setting realistic goals within the limits of the family, the nurse, the
health agency is of UTMOST IMPORTANCE
FAMILY’S PERCEPTION of its needs: the likelihood of attaining a goal is
higher if the family “owns” the goal and if it is achievable within the
existing family situation
Objectives define the step-by-step family response as they work
toward a goal
S-M-A-R-T: SPECIFIC- MEASURABLE- ATTAINABLE- REALISTIC-TIME
BOUND
C. DETERMINING APPROPRIATE INTERVENTION
Interventions may range from simple or immediate, such as offering
information about external health resources available to the family
(health education) to the complicated or prolonged such as providing
care to a family member with PTB
3 categories of intervention according to Freeman and Heinrich (1981):
Supplemental interventions
the nurse performs in behalf of the family when it is unable
to do things for itself
ex. direct nursing care to sick or disabled
2. Facilitative interventions
actions to remove barriers to appropriate health actions ex.
Assisting family to avail prenatal services and immunization
3. Developmental Interventions
aims to improve the capacity of the family to provide for its own
health needs; directed towards family empowerment
ex. Guiding the family to make responsible health decisions
Interventions may be a combination of this categories, with the nurse
making sure that they are appropriate to the family situation
Ex. Overuse of supplemental interventions may hold back
development of self-reliance
Since the plan is aimed to benefit the family, the outcomes of
interventions are observable changes in the family.
The plan should therefore observe the ff. principles:
a. Mutuality: the family is given the opportunity to decide for
itself on how they can best deal with the health situation just as how
the nurse considers his or her own resources (competence, material
resources, time, policies of the health agencies)
 - opportunity for initial contact with target families of the
community
b. Personalization: the plan best fits the unique situation of
the family (needs, style, strengths, pattern of functioning) - may take place in the health facility or community

- develops: cooperation, leadership, self-reliance, community

awareness among group members
- families with the same concerns DO NOT REQUIRE THE SAME
NURSING ACTIONS, nor can the nurse expect the family to act in the - share experiences and practical solutions
same manner as another family confronted with a similar situation
Disadvantage:

- attendance requires motivation and availability of target family

- family values and beliefs are basis of family health behavior members
(uniqueness of each family)

C. Telephone calls: easy access between the nurse and family;

c. Coordination: avoids duplication of services
- calls or text messaging

- encouraging the family to communicate with the clinic when

A pre-requisite to designing an effective FCP is the nurse’s capacity of they feel the need cultivates the family’s confidence towards the
determining self. health agency

- the demand of family health care is GREATER than the

resources available to the nurse and family
Disadvantage:
- the nurse has to delineate the purpose, resources (time,
material resources, competencies) and limitations - accurate assessment requires face-to-face contact

- avoids frustrations and disappointments (more realistic) d. Written communication:

- reviews on values and beliefs (ethically) - has the potential for reaching many families

Types of family-nurse contact (choose the most suitable): Disadvantage:

- one-way

Clinic Visit: takes place in a private clinic, health center, barangay - requires literacy and interest
health station, or in an ambulatory clinic - the nurse cannot be certain if it has reached the intended
Major advantage: recipients

- the family member takes the initiative of visiting the health

worker (indicates family’s readiness to participate in the healthcare d. Written communication:
process)
- has the potential for reaching many families
- allows the nurse to maximize the resources (supplies)

- distractions are lessened (nurse has greater control of

environment) Disadvantage:

- one-way

Disadvantage: - requires literacy and interest

- unable to transport the family member requiring care - the nurse cannot be certain if it has reached the intended
recipients
- family feels less confident to discuss concerns

Advantages:
B. Group conference: ex. Mothers’ class
 Firsthand assessment (family dynamics, environmental factors Principles in planning a home visit:
affecting health, and resources within the home)
The home visit should have a purpose
 The nurse can seek out previously unidentified needs
- the visit is not for social reasons; should be therapeutic
 Interventions adapted to family resources

 Promotes family participation and focus on the family as a unit

Purpose:
 Teaching is made easier by the familiar environment;
recognition of the need to learn as how they are faced by actual
home situation To have a more accurate assessment of the family’s living condition
 Gives the family a sense of confidence and adapt interventions accordingly

Disadvantages: Educate about measures for health promotion, disease prevention

and control of health problems
 The cost in terms of time and effort

 Distractions at home (nurse has less control)

To prevent the spread of infection among family members
 Nurse’s safety

To provide supplemental interventions and provide guidance

Phases of home visit

Pre-visit
To provide greater access to health resources in the community by
In-home establishing a close relationship with them, providing information and
making referrals as necessary
Postvisit

2. Use information about the family collected from all possible sources;
Pre-visit secondary data (determine and analyze family situation)
Nurse contacts the family and determines willingness; sets
appointment
3. Focuses on identified needs, particular needs recognized by the
A family care plan is formulated in this phase family as requiring urgent attention

Principles in planning a home visit: 4. The responsible family member continues the care; therefore the
The home visit should have a purpose client and the family should actively participate in planning for
continuing care
- the visit is not for social reasons; should be therapeutic

5. The plan should be practical and adaptable, considering the actual

Purpose: family situation and the resources available to the nurse and the
family

- flexibility is important in working with families because

To have a more accurate assessment of the family’s living condition priorities can only be identified during home visit
and adapt interventions accordingly

b. In-home phase
Educate about measures for health promotion, disease prevention
and control of health problems - begins as the nurse seeks permission to enter and lasts until
she leaves the home. (1) Initiation, (2) Implementation, and (3)
termination.
Initiation 3. Termination

- knock the door or ring the bell (non-threatening voice) - Summarizing the events during the home visit

- the nurse acknowledges the family members with a greeting - record findings such as vital signs and body weight
and introduces him/herself and the agency he or she represents
c. Postvisit Phase
- the nurse observes for personal safety; sit where the family
directs you to sit - Take place when the family has returned to the health facility

- involves documentation of the visit (may include observation

and feelings of the nurse): helps the other members of the health
team to understand the family, providing for a more effective
intervention
Before living the health center, the nurse must check the contents of
the nursing bag and other articles she needs in order to carry out the
home visit efficiently and safely
- referral may be made; planning for a next visit is done at this
time

The buddy system is suggested for nursing students and personnel

Spot map is needed in the absence of a buddy. Identify the time the
nurse is expected to be back at the health facility. This will help
colleagues in determining the whereabouts of the nurse in case she’s
not back

- initiate a short social conversation

- he then states the purpose of home visit

2. Implementation

- Application of the nursing process: assessment, provision of

care and evaluation

- assessment: physical, simple diagnostic exam like CBG,

observation of family dynamics, environment, use FHAF

- Physical care, health teachings and counseling are done

according to plan; if the demand is higher than capability,
the nurse explores with the family other community facilities
that the family can be referred to

- observe handwashing before and after touching the family

members and proper disposal of soiled materials and body secretions;
opportunity for the nurse to teach practical methods in preventing
spread of infection

- objectives are evaluated towards the end of the visit, while

some requires further nurse-family contact; evaluate what have been
accomplished during the visit