COR JESU COLLEGE, INC.

Tres de Mayo, Digos City 8002, Davao del Sur

Tel No. 553-9714/ Fax No. (082) 553-2433

Course Title: Community Health Nursing (Individual and Family)

Course No.: NCM 104
Learning Outcome:
1. Formulate with the client a plan of care to address
the health conditions, needs, problems, and issues
based on priorities.
2. Implement safe and quality interventions with the
client to address the health needs, problems, and
issues.
3. Provide health education using selected planning
models to targeted clientele (individual and families)
in the community.
4. Formulate with the client a plan of care to address
the health conditions, needs, problems, and issues
based on priorities.
5. Implement safe and quality interventions with the
client to address the health needs, problems, and
issues.
6. Provide health education using selected planning
models to targeted clientele (individual and families)
in the community.
Topic:
Module 6: Formulating Family Nursing Care Plan
This module aims to explain how to develop Family Nursing Care Plan.

Topic 1: Family Health Assessment

Topic 2: Family Nursing Diagnosis

Concept/Digest
THE FAMILY CARE PLAN
• 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 above 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.
2. The nursing care plan is a product of a deliberate systematic process.
3. The nursing care plan, as with all other plans, relates to the future.
4. The nursing care plan is based upon identified health and nursing
problems.
5. The nursing care plan is a means to an end, not an end in itself.
6. Nursing care planning is a continuous process, not a one shot deal.
The results of the evaluation of the plan's effectiveness trigger
another cycle of the planning process until the health and nursing
problems are eliminated.

Desirable Qualities of a Nursing Care Plan

• There are specific qualities of a nursing care plan which help to maximize
it effectiveness.
1. It should be based on clear, explicit definition of the problem
2. A good plan is realistic. It can be implemented with reasonable
chance of success.
3. The nursing care plan is prepared jointly with the family.
4. The nursing care plan is most useful in written form.

THE IMPORTANCE OF PLANNING CARE

• Little and Carnevali (1969, pp. 2-5) discuss the importance of nursing care
plans:
1. They individualize care to clients. Whether an individual patient, the
family or the entire community, clients are different from each other. In
order to be appropriate, nursing care should suit and be unique to a
particular client. Planning facilitates the delivery of the most appropriate
care by considering the uniqueness of each client.
2. The nursing care plan helps in setting priorities by providing information
about the client as well as the nature of his problems. From the available
data the nurse sets her priorities for care.
3. The nursing care plan promotes systematic communication among
those involved in the health care effort. It defines the problems and
details of the nursing interventions to resolve them.
4. Continuity of care is facilitated through the use of nursing care plans.
Gaps and duplications in the services provided are minimized. If not
totally eliminated. Gaps and duplication of services are bound to occur
in settings where there is frequent turnover of staff or when several health
workers are providing care to the same family.
5. Nursing care plans facilitate the coordination of care by making known
to other members of the health team what the nurse is doing.
 Coordination of care prevents fragmentation of services and increases
the efficiency of health service delivery system.

STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN

• 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. The planning phase takes off from there.
• Developing a family care plan involves many steps. Generally, a plan
consists of the following:
1. The prioritized condition/s
or problems;
2. The goals and objectives
of nursing care;
3. The plan of interventions;
4. The plan for evaluating
care
• The prioritized health
condition or problems and
their corresponding nursing
problems become the basis
for the next step which is the
formulation of goals and
objectives of nursing care.

• This is a schematic presentation of the nursing care plan process. It starts

with a list of health condition or problems prioritized according to the
nature, modifiability, preventive potential and salience. The prioritized
health condition or problems and their corresponding nursing problems
become the basis for the next step which is the formulation of goals and
objectives of nursing care. The goals and objectives specify the expected
health/clinical outcomes, family response/s, behavior of competency
outcomes.

PRIORITIZING HEALTH PROBLEMS

• 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.
• Bailon and Maglaya (1990) devised a tool called Scale for Ranking Health
Conditions and Problems According to Priorities (See Table 4 for updated
version). This tool aims to objectivize priority setting.
• There are four criteria for determining priorities among health condition/s or
problems. These include:
 1. Nature of the condition or problem presented - categorized into wellness
state/potential, health threat, health deficit and foreseeable crisis:
2. Modifiability of the condition or problem - 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 family's perception and evaluation of the
condition or problem in terms of seriousness and urgency of attention
needed or family readiness.

Factors Affecting Priority-Setting

• Considering the first criterion - nature of the condition or problem presented
- the biggest weight is given to we of the premium on client's efforts or desire
to Sustain/maintain high level wellness.
• The same weight is assigned to a health deficit because of its sense of
clinical urgency which may require immediate intervention. Foreseeable
crisis is given the least weight because culture-linked variables/ factors
usually provide our families or situational crisis.
Table 4. SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES
Criteria Weight
1. Nature of the condition or problems
presented. 3 1
Scale**: Wellness state 3
Health deficit 2
Health threat 1
Foreseeable crisis

2
2. Modifiability of the condition or problem 2
Scale **: Easily Modifiable 1
Partially Modifiable 0
1
Not Modifiable
3
4.Preventive Potential 2
Scale **: High 1
Moderate 1
Low

4.Salience 2
Scale **: A condition or problem needing
immediate attention 1
A condition or problem not needing
immediate attention 0
Not perceived as a problem or
condition needing change
 Scoring:
1. Decide for a score on 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 score for all the criteria. The highest score is 5 equivalent to
the total weight.

• The nurse considers the availability of the following factors in deter mining
the modifiability of a health condition or problem:

1. Current knowledge, technology and interventions to enhance the

wellness state or manage the problem.
2. Resources of the family
3. Resources of the nurse
4. Resources of the community

To decide on an appropriate score for the PREVENTIVE POTENTIAL of a health

condition or problem, the following factors are considered:
1. Gravity or severity of the problem-refers to the progress of the
disease/problem indicating extent of damage on the patient/family; also
indicates prognosis, reversibility or modifiability of the problem. In general,
the more severe the problem is, the lower is the preventive potential of the
problem.
2. Duration of the problem-refers to the length of time the problem has existed.
Generally speaking, duration of the problem has a direct relationship to
gravity; the nature of the problem is variable that may, however, alter this
relationship. Because of this relationship to gravity of the problem, duration
has also a direct relationship to preventive potential.
3. Current management-refers to the presence and appropriateness of
intervention measures instituted to enhance the wellness state or remedy
the problem. The institution of appropriate intervention increases
condition’s preventive potential.
4. Exposure of any vulnerable or high risk group-increases the preventive
potential of condition or problem

• To determine the score for salience, the nurse evaluates the family’s
perception of the condition or problem. As a general rule the family’s
concerns, felt needs and/or readiness increase the score on salience.

SCORING
• After the score for each criterion has been decided on, the number divided
by the highest possible score in the scale.
• The quotient is multiplied by the weight indicated for the criterion being
considered.
• Then the sun the scores for all the criteria is taken.
• The highest score is five (5), equivalent of the total weight.
 • The nurse considers as priority those conditions and problems with total
scores nearer five (5). Thus, the higher the score of a given condition or
problem the more likely it is taken as a priority.
• With the available scores, the nurse then ranks health conditions and
problems accordingly.

Concept/Digest

FORMULATION OF GOALS AND OBJECTIVES OF CARE

GOAL- is a general statement of the condition or state to he brought about by
specific courses of action.
• An example of statement of goal in family health nursing practice is:
After nursing intervention the family will be able to take care of the disabled
child competently
• A cardinal principle in goal setting states that goals must be set jointly with
the family.
• This ensures the family's commitment to their realization.
• Basic to the establishment of mutually acceptable goals is the family's
recognition and acceptance of existing health needs and problems.
• The nurse must ascertain the family's knowledge and acceptance of the
problem as well as the desire to take actions to resolve them. This is done
during the assessment phase.
Barriers to joint goal setting between the nurse and the family include the
following:
1. Failure on the part of the family to perceive the existence of
the problem
2. The family may realize the existence of a health condition or
problem but is too busy at the moment with other concerns
and preoccupations.
3. Sometimes the family perceives the existence of a problem but
does not see it as serious enough to warrant attention.
4. The family may perceive the presence of the problem and the
need to take action. It may, however, refuse to face and do
something the situation. Freeman (1957, pp. 126-128) offers the
following reasons for this kind of behavior.
a. Fear of consequence(s) of taking action - For example, diagnosis
of a disease condition may mean expense or social
b. Respect for tradition - In Philippine culture, elders play a part mom
oor in decision making. Behavior which are not sanctioned by the
old folks in the family are not likely to be adopted. A couple, for
instance, may not accept the goal of limiting family size to just
three children if their parents do not approve of contraceptive
practice.
c. Failure to perceive the benefits of action proposed -This could be
a function of a client's previous experience with health workers
and their services. Going to a health center, for example, is an
advice frequently given by nurses. When this does not yield
 beneficial results from the point of view of the family it will be
ignored the next time it is offered.
d. Failure to relate the proposed action to the family's goals - Families
differ in their prioritizing of their goals. Economic and social goals
generally occupy a higher position than health goals in families'
ranking of their concerns and preoccupations. When proposed
actions to improve health are not related to the family's goals of,
say, economic stability they are not likely to be accepted.
5. 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.

▪ Goals set by the nurse and the family should be realistic or attainable.
▪ They should therefore, be set at reasonable levels. Too high goals and their
consequent failure frustrate both the family and the nurse.

▪ Goals, like objectives, are best stated in terms of client out whether at the
individual, family or community levels.

▪ Objectives in contrast to goals, 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 are to be measured. Goals tell where the
family is going ; objectives are the milestones to reach the destination.
▪ Objectives stated as outcomes of care in family health nursing practice
specify physical, psychosocial states or family behavior (or competencies).
o Examples are given below:
▪ Example 1. After nursing intervention, the malnourished
preschool members of the family will increase their weights by
at least one pound per month.
▪ 2. After nursing intervention, the family will be able to:
a. Feed the mentally retarded child according to prescribed
quantity and quality of food.
b. Teach the mentally retarded child simple skills related to the
activities of daily living.
c. Apply measures taught to prevent infection in the mentally
retarded member.
▪ The more specific the objectives, the easier is the evaluation of their
attainment. Specifically stated objectives define the criteria for evaluation.
▪ Objectives vary according to the time span required for their realization.

Short-term or immediate objectives - are formulated for problem situations which

require immediate attention, and results can be observed in a relatively short
period of time.
Long-term or ultimate objectives- require several nurse-family encounters and an
investment of more resources. The nature of outcomes sought require time to
demonstrate. Such is the nature of behavior change which is often the object of
nursing intervention.
Medium-term or intermediate objectives- are those which are not immediately
achieved and are required to attain the long-term ones.
Example: Nursing goal – the family will manage malaria as a disease and
threat.

Short-term/immediate objective - The sick members will take drugs

accurately as to dose, frequency, duration and drug combination. All
members will use self-protection measures at night till early morning when
biting time of malaria vector is expected.

Medium-term/intermediate objective - All members will have medical

check-up and laboratory confirmation (i.e..blood smear) to diagnose
malaria

Long-term objective - All members will carry out mosquito vector control
measures.

DEVELOPING THE INTERVENTION PLAN

▪ This involves selection of appropriate nursing interventions based on the
formulated goals and objectives.
▪ In selecting the nursing interventions, the nurse decides on appropriate
nursing actions among a set of alternatives, specifying the most effective
or efficient method of nurse-family contact and the resources needed.
The following general directions for nursing interventions can guide
selection of appropriate nursing interventions:
1. Analyze with the Family the Current Situation and Determine Choices and
Possibilities based on a Lived Experience of Meanings and Concerns.
2. Develop/Enhance Family's Competencies
3. Focus on Interventions to Help Perform Health Task
▪ The nurse needs to focus her choice of interventions on helping the family
minimize or eliminate the possible reasons for or causes of the family's
inability to do the health tasks:
1. Help the Family Recognize the Problem.
o Examples of nursing interventions to enhance the family's ability to
recognize at its health needs and problems include:
(a) increasing the family's knowledge on the nature, magnitude and
cause of the problem;
(b) helping the family see the implications of the situation, or the
consequences of the condition;
(c) relating health needs to the goals of the family (both health and
non health related goals);
(d) encouraging positive or wholesome emotional attitude toward
the problem by affirming the family's capabilities/qualities/resources
and providing information on available options.
2. Guide the Family on How to Decide on Appropriate Health Actions to
Take.
▪ This can be done through:
 (a) identifying or exploring with the family the courses of action
available and the resources needed for each;
(b) discussing the consequences of each course of action available;
(c) analyzing with the family the consequences of inaction.
3. Develop the Family's Ability and Commitment Nursing Care to its
Members.
▪ The nurse can increase the family's confidence in providing nursing
care to its sick, disabled and dependent member through
demonstration and practice sessions on procedures, treatments or
techniques utilizing readily available, low-cost materials and
equipment and other resources.
Contracting is creative intervention that can maximize opportunities to
develop the ability and commitment of the family to provide nursing
care to its members.
4. Enhance the capability of the Family to provide a Home Environment
Conducive to Health Maintenance and Personal Development.
▪ The family can be taught specific competencies to ensure such a
home environment through environmental modification,
manipulation or management to minimize or eliminate health threats
or risks or to install facilities for nursing care.
5. Facilitate the Family's Capability to Utilize Community Resources for
Health Care.
▪ Another major intervention involves maximum use of available
resources through the coordination collaboration and team work
provided by an effective referral system.
▪ Easy access to available health and socio-economic resources starts
with maintaining an updated file that lists
▪ A two-way referral system can facilitate mobilization of resources for
families. The nurse or the agency establishing such a system can have
previous arrangements or agreements on the referral procedures
and services with the agencies or resources involved.

4. Catalyze Behavior Change through Motivation and support.

▪ To bring about self-directed change, people must learn to learn from their
experiences. According to Chin and Benner (1976, p.37), 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.
▪ 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-identity, group esteem and group
identity;
(3) accurate and appropriate preparation and transmission or messages.
Records in Family Health Nursing
Records
▪ are necessary for the continuation of delivery of family health care services
and its evaluation while evaluation of family health services is necessary to
identify the new and continuing family health needs.
Family records
▪ include information based on factual events, observation results or
measurements taken such as height, weight, body circumference or
laboratory examinations carried out like hemoglobin, urine test, stool test
and sputum examination depending upon the problem of the family. These
also includes records of immunization, nutritional status, medical
prescription and curative procedures carried out. Demographic data and
individual personal history are also included in the family folders.
Health records
▪ refer to forms on which information about an individual and family is
noted. Information varies from socio-economic, psychological,
environmental factors etc. Records are a practical and indispensable aid
to the doctor, nurse and other health care workers in giving best service to
individual, family or community.

A. Importance and Uses

• Provides documentation of services that have been rendered and
supply data that are essential for program planning.
• To provide the practitioner with data required for application of
professional services for improvement of family's health
• Records are tools of communication.

Purpose of documenting Family Health History which is an important component

of family health records are the following:
• Provides facts that are necessary for evaluating health situation of the
family; it should also describe the nature and impact on health threat. It
should describe the health condition and interacting forces within the
family in their daily living.

Family health records should represent a comprehensive, systematically

organized data and information that are essential for nursing care decisions.
• The community health nurse must ensure adequacy of support records for
her action.

Criteria for Recording in Family Health Records

The criteria should reflect both the purpose and process of community health
nursing practice:
• Records should concentrate on the family and community focus of care. It
should reflect not only the health of the members of the family but also the
ways in which the functioning of the family as a unit has an impact on the
health of family as a whole. It should also specify the ways in which family
functions within its physical and social environment.
Use of Records
1. For a Nurse
• Provides basic facts for services. Shows health condition as it is and as
accepted by individual/family
• Provides a basis for analyzing needs, short and long-term planning
• Prevents duplication of services and helps follow up effectively
• Helps the nurse to evaluate care and teaching
• Helps to organize her work in an orderly way and to make effective use of
time
• Serves as a guide to professional growth
• Enables the nurse to judge the quality and quantity of work done
2. For Individual/Family
• Help them to become aware and to recognize their health needs
• Can be used as a teaching tool too

3. For the Doctor

• Serves as a guide for diagnosis, treatment and evaluation of services
• Indicates progress
• May be used in research

4. For the Organization and Community

• Helps to assess the health assets and needs of the community
• Helps in making studies for research, legislative action and planning budget
• is legal evidence of the services rendered by each worker
• Provides a justification for expenditure of funds

B. Types of Records and Reports

1) Cumulative or continuing records
• This is found to be time saving, economical and also it is helpful to review
the total history of an individual and evaluate the progress of a long period.
(e.g.) child’s record should provide space for newborn, infant and
preschool data.
2) Family records
• The basic unit of service is the family. All records, which relate to members
of family, should be placed in a single family folder. This gives the picture of
the total services and helps to give effective, economic service to the
family as a whole.

The records may be grouped according to:

1. Age of the family member for whom records are used
• a New boll1 care
• Road to health card -e
• Toddler card e
• Old age or elderly card e
• Mother-child link card

2. Health care requirement cards as per health conditions and morbidity status
• Pregnant women or antenatal card
 • Intra natal card or labor record
• Person with illnesses (e.g. Tuberculosis record, Diabetes record,
Hypertension case card)
• Drug addicts or alcoholics record
• Any chronic care records
• Immunization record

❖ Usually for family health service a family folder including different cards is
maintained. This includes socio-demographic information, children’s health
status (including height, weight, immunization and feeding habits etc.)
maternal records, morbidity records and observations of general health
status of family and the environment of the family.

FILLING OF RECORDS
Different systems may be adopted depending on the purposes of the records and
on the merits of a system. Records could be arranged in the following ways:
• Alphabetically
• Numerically
• Geographically and
• With index cards

REGISTERS
It provides indication of the total volume of service and type of cases seen.
Clerical assistance may be needed for this. Registers can be of varied types such
as immunization register, clinic attendance register, family planning register, birth
register and death register.

REPORTS
Reports can be compiled daily, weekly, monthly, quarterly and annually.
Report summarizes the services of the nurse and/or the agency and may be in
the form of an analysis of some aspect of a service.
PURPOSES OF WRITING REPORTS
• To show the kind and quantity of service rendered over to a specific period.
• To show the progress in reaching goals.
• As an aid in studying health conditions.
• As an aid in planning.
• To interpret the services to the public and to other interested agencies.

In addition to the statistical reports, the nurse should write a narrative report every
month which provides as opportunity to present problems for administrative
considerations. Maintaining records is time consuming, but they are of definite
importance today in the community health practice in solving its health problems.

Learning Activity:
1. Collect data on population, location, and social systems of an assigned
community.
2. Make a plan of community health interventions for the top priority problem.
3. Prepare a plan for evaluation of the community health interventions in the plan.