IMPLEMENTATION OF THE FAMILY CARE PLAN

Since the plan is aimed to benefit the family, the

expected outcomes of interventions are
observable changes in the family.
• The plan should therefore be based on the principle of
mutuality (Maurer and Smith, 2009). This means that the
family is given the opportunity to decide for itself how they
can best deal with a health situation, just as the nurse takes
into consideration his/her own resources, competence,
material resources, time as well as resources and policies of
health agency.
• The principle of personalization (Maurer and
Smith, 2009) requires that the nursing plan fits
the unique situation of a family: its needs,
style, strengths and patterns of functioning.
Families with similar concerns do not
necessarily require the same nursing actions
nor can the nurse expect the family to act in
the same manner as another family
confronted with a similar situation.
• A related principle is
consideration is
consideration of family
values and health care
beliefs which are the
basis for family health
behavior (Maurer and
Smith, 2009).
• Coordination with the
other members of the health
team and other agencies
involved in the care of the
family maximizes resources
by preventing duplication of
services.
• The nurse’s capacity of defining self is a
prerequisite to designing an effective family
care plan. Many times, the demands of
family health care will be greater than the
resources available to the nurse and the
family. The nurse has to delineate the
purpose, resources (competencies, time and
material resources) and limitations.
 IMPLEMENTING THE PLAN OF CARE
• Implementation is the step when the family and/ the nurse
execute the plan of action. The pattern of implementation is
determined by th e m u tu al l y ag reed u p o n g o al s an d
objectives and the selected courses of action. When
appropriate, it involves providing direct nursing care,
helping family members do what is necessary to meet health
needs and problems, or referring the family to another health
worker/agency.
FAMILY RELATED BARRIERS:

1.Apathy - maybe a
manifestation of the family’s
feelings of hopelessness and
powerlessness
2.Indecision - may result in the
family allowing events just to
happen
• Barriers may also arise from the nurse’s
behavior such as imposing ideas, negative
labeling, overlooking family strengths and
neglecting cultural and gender implications of
family interventions. The nurse who imposes
ideas on the family keeps the family from
taking responsibility for decision making and
appropriate action.
• The nurse may label a family as stubborn
(matigas ang ulo) if it is unable to comply with
instructions, or it may lead the nurse to label
himself/herself as ineffective. Overlooking family
strengths usually results from the tendency of the
nurse to focus on family problems and
weaknesses. The nurse who fails to consider
cultural differences and gender issues in
implementing interventions risks making the plan
unacceptable to the family.
 EVALUATION
• In family nursing, evaluation
is determining the value of
nursing care that has been
given to a family. The product
of this step is used for further
decision making: to terminate,
continue or modify the
intervention(s).
 FORMATIVE EVALUATION
- is judgement made about effectiveness of
nursing interventions as they are implemented.
- This is ongoing and continuing while family
nursing care is being implemented and family-
nurse interactions are taking place. Results of
formative evaluation guide the Nurse and the
family in updating plans as necessary.
SUMMATIVE EVALUATION

- is determining the end

results of family nursing
care and usually involves
measuring outcomes/the
degree to which the goals
have been achieved.
Aspects of evaluation that are useful in family
health care
EFFECTIVENESS
• APPROPRIATENESS - refers to the suitability
of the goals/objectives and interventions to
the identified family health needs. An accurate
assessment of family health needs is the
basis for appropriate goals/objectives and
interventions. It answers the question, “Are
our goals/objectives and interventions correct
in relation to the family health needs we
intend to address?”
• ADEQUACY - means the
degree of sufficiency of
goals/objectives and
interventions in attaining
the desired change in the
f a m i l y. I t a n s w e r s t h e
question, “Were our
interventions enough to
bring about the desired
change in the family?”
• EFFICIENCY - is the
relationship or resources
used to attain the desired
outcomes. It answer the
question, “Are the
outcomes of family nursing
care worth the nurse’s time,
effort and other resources?”
 FAMILY-NURSE CONTACTS
• The family-nurse relationship is developed
through family-nurse contacts, which may take
the form of a clinic visit , group conference,
telephone contact, written communication or
home visit (David et al., 2007). the nurse uses
the type of family-nurse contact that is most
suitable to the purpose/situation at hand.
• Clinic visit - takes
place in a private clinic,
health center, barangay
health station or in
ambulatory clinic during
a community outreach
activity.
 ADVANTAGES
Family member takes the initiative of visiting the
professional health worker usually indicating the
family’s readiness to participate in the health care
process.
It allows the nurse to maximize resources (time,
other health care provider to whom the client can
be referred as needed and material resources such
as supplies and equipment)
The nurse has greater control over the
environment
CLINIC SERVICES
• There are conditions,
however when a clinic
visit presents an
obvious hardship for the
family such as when the
family is unable to
transport the family
member requiring
nursing care.
• Group conference such as a conference of mothers in
the neighborhood, provides an opportunity for initial
contact between the nurse and target families of the
community.
• - It may take place at a health facility /in the community
• - It is appropriate for developing cooperation, leadership,
self-reliance, and/
• community awareness among group members.
GROUP CONFERENCE
• Advantage: Opportunity to share experiences
and practical solutions to common health
concerns
• However, attendance in a group conference
usually requires motivation and availability of
target family members. The nurse may not be
able to reach the families in greatest need of
help through a group conference. `
• Telephone (landline/mobile/cell) - provides easy
access between the nurse/health worker and the
family.

• The wide reach of mobile /cellphone communication

services in the country provides the nurse and the
family with opportunities to contact each other
through calls/short messaging service (text
messaging).
• Encouraging the family to
communicate with the
clinic/health center when they
feel the need for it cultivates the
family’s confidence in the health
agency. Information transmitted
through the telephone is limited.
Accurate assessment of family
conditions usually requires face-
to-face contact.
• Written communication -
used to give specific
information to families such
as instructions given
through school children
HOME VISIT

- is a professional,purposeful
interaction that takes place in the
family’s residence aimed at
promoting, maintaining or
restoring the health of the family
or its members.
• - It is a family-nurse contact where instead
of the family going to the nurse, the nurse
goes to the family. The nurse makes a home
visit upon the family’s request, as a result of
case finding in response to a referral, or to
follow-up clients who have utilized services
of a health facility such as a health center,
lying-in clinic or hospital.
 ADVATAGES:
vIt allows firsthand assessment of the home situation: family
dynamics, environmental factors affecting health and
resources within the home.
vThe nurse is able to seek out previously unidentified needs.
vIt gives the nurse an opportunity to adapt interventions
according to family resources.
vIt promotes family participation and focuses on the family as
a unit.
ADVANTAGES
Teaching family members in the
home is made easier by the familiar
environment and the recognition of
the need to learn as they faced by the
actual home situation.
The personalized nature of a home
visit gives the fami l y a sense of
confidence in themselves and in the
agency.
DISADVANTAGES:
vCost in terms of time and
effort
vNurse is unable to control
the environment
vMore distractions in the
home
vNurse safety