FAMILY NURSING CARE PLAN

-the blue print of the care that the nurse designs to systematically minimize or eliminate the
identified health and nursing problem through explicitly formulated outcomes of care (goals and
objectives) and deliberately chosen set of interventions, resources and evaluation criteria,
standards, methods and tools.

FAMILY HEALTH NURSING PROCESS

• A systematic approach to help family to develop and strengthen its capability to meet its
health needs and solve health problem.
• The main objective or goals of family health nursing process are health promotion,
prevention from disease and control of health problem.
• Phases:
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Implementation
5. Evaluation
Family health assessment
• Initial contact
• Demonstrate caring attitude
• Mutual trust & confidence
• Collect data from all possible sources
• Identify health problems
• Assess coping ability
• Analyze and interpret data
STEPS:
Data Data
Diagnosis
Collection Analysis

Data collection - gathering data about recent family condition and compared it to
norms/standards

• Methods and Tools of Data Collection

– Observation
– Physical Examination
– Interview
– Records review
– Laboratory/Diagnostic Tests
 Initial Database
A. Family structure, characteristics and dynamics
B. Socio-economic and cultural characteristics
C. Home and environment
D. Health status of each member
E. Values and practices on health promotion/ maintenance and disease prevention

1st level assessment: IDENTIFY EXISTING OR POTENTIAL HEALTH CONDITIONS

• Typology of Nursing Problem/ Categories of Health Needs
– Wellness Condition: stated as readiness or potential; a clinical or nursing
judgment about a client in transition from a specific level of wellness or
capability to a higher level.
– Health Deficits: a gap between actual or achievable health status; instances of
failure in health maintenance
– Health Threat: conditions that promote disease or injury and prevent people
from realizing their health potential
– Foreseeable crisis: stressful occurrences like death or illness of a family
member, marriage, menopause, abortion, pregnancy, or hospitalization
Wellness Condition Health Threats Health Deficits Foreseeable Crisis

1. Potential for 1. Presence of 1. Illness 1. Marriage

Enhanced risk factors of states 2. Pregnancy
Capability for: specific (wellness 3. Parenthood
2. Readiness for diseases diagnosed 4. Additional
Enhanced 2. Threat of or family member
Capability for: cross infection undiagnose 5. Abortion
a. Healthy from a d) 6. Entrance to
lifestyle communicable 2. Failure to school
b. Health disease thrive/ 7. Adolescence
Maintenance 3. Family size develop 8. Divorce
c. Parenting beyond what according 9. Menopause
d. Breastfeeding resources can to normal 10. Loss of job
e. Spiritual Well- adequately rate 11. Hospitalization
being provide 3. Disability 12. Death of a
4. Accident member
hazards 13. Resettlement in
5. Faulty/ a new
unhealthful community
nutritional/
eating habits
for feeding
techniques/pra
ctices
6. Stress
provoking
factors
7. Poor
environmental
condition
8. Unsanitary
food handling
and
preparation
9. Unhealthful
lifestyle and
personal
habits
10. Inherent
personal
characteristics
11. Inappropriate
role
consumption
12. Lack of
immunization
13. Family
disunity

2ND LEVEL ASSESSMENT: IDENTIFY THE NATURE OR TYPE OF NURSING

PROBLEMS
I. Inability to recognize the presence of the condition or problem due to:
A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequences of diagnosis of
problem, specifically:
1. Social-stigma, loss of respect of peer/significant others
2. Economic/cost implications
3. Physical consequences
4. Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
D. Others. Specify _________
 II. Inability to make decisions with respect to taking appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by perceive
magnitude/severity of the situation or problem, i.e. failure to breakdown problems into
manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding action to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude is meant one that
interferes with rational decision-making.
J. In accessibility of appropriate resources for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of action
M. Others specify._________

III. Inability to provide adequate nursing care to the sick, disabled, dependent or
vulnerable/ at-risk member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature, severity,
complications, prognosis and management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or
treatment/procedure of care i.e. complex therapeutic regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair,
rejection) which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at
risk member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.
K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify._________

IV. Inability to provide a home environment conducive to health maintenance and

personal development due to:
A. Inadequate family resources specifically:
1. Financial constraints/limited financial resources
2. Limited physical resources-i.e. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments in home environment
improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life which is not conducive to health maintenance and
personal development
I. Lack of/inadequate competencies in relating to each other for mutual growth and maturation
(e.g. reduced ability to meet the physical and psychological needs of other members as a result of
family’s preoccupation with current problem or condition.
J. Others specify._________

V. Failure to utilize community resources for health care due to:

A. Lack of/inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically:
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness,
AIDS, etc.
J. Negative attitude/ philosophy in life which hinders effective/maximum utilization of
community resources for health care
K. Others, specify __________

Planning phase
• Features/Desirable Qualities:
– Focuses on action
– A product of a deliberate systematic action
– Relates to the future
– Based upon identified health and nursing problems
– A means to an end, not an end in itself
– A continuous process, not a one-shot-deal
– Based on clear, explicit definition of the problem(s)
– Realistic
– Prepared jointly with the family
– Most useful in written form
STEPS: 1. Prioritize problems
2. Formulate the goals and objectives of nursing care
3. Develop the plan of interventions
4. Develop the plan for evaluating care

Prioritizing health problems

• Four Criteria for Determining Priorities:
1. Nature of the condition or problem – categorized into wellness state/potential, health
threat, health deficit of 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 problem that can be
minimized or totally prevented if interventions are 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.
SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO
PRIORITIES
Criteria Weight

Nature of the condition or problem 1

Scale: Wellness state (3)
Health Deficit (3)
Health Threat (2)
Foreseeable Crisis (1)

Modifiability of the condition 2

Scale: Easily Modifiable (2)
Partially Modifiable (1)
Not modifiable (0)

Preventive Potential 1
Scale: High (3)
Moderate (2)
Low (1)

Salience 1
Scale: A condition needing immediate attention (2)
A condition not needing immediate condition (1)
Not perceived as a condition needing change (0)

Formulation of Goals and Objectives

• GOAL-is a general statement of condition or state to be brought about by specific courses
of action.
• OBJECTIVE-refers to a more specific statement of the desired results or outcomes of
care. They specify the criteria by which the degree of effectiveness of care is to be
measured.
*A cardinal principle in goal setting states that goal must be set jointly with the family. This
ensures family commitment to realization.
* Basic to the establishment of mutually acceptable goals is the family’s recognition and
acceptance of existing health needs and problems.

Develop the plan of interventions

• Focus on Interventions to Help The Family Performs Health Tasks:
1. Help the family recognize the problem
2. Guide the family on how to decide on appropriate health actions to take.
3. Develop the family’s ability and commitment to provide nursing care to each member
4. Enhance the capability of the family to provide home environment conducive to health
maintenance and personal development.
5. Facilitate the family’s capability to utilize community resources for health care.

Implementation
• Putting nursing care to action, coordinating services, utilizing community resources,
providing health education and training, and documenting responses to nursing action.
• This phase is concern with direct interaction of community health nurse to family &
family member. Different approaches which are planned can be applied for intervention
activity.

Evaluation
- is the phase which is concerned with the determination of whether the objectives set were
attained or to what degree they were attained
Purposes:
• Determine client’s behavioral response to nursing interventions.
• Compare the client’s response with predetermined outcome criteria.
• Appraise the extent to which client’s goals were attained.
• Identify the errors in the plan of care.
• Monitor the quality of nursing care.
Dimensions of Evaluation
1. Effectiveness - attainment of objectives
2. Efficiency - saves time, effort and money
3. Appropriateness - ability to correct and solve problems
4. Adequacy - activities were implemented
TYPES:
Qualitative Evaluation
- Interventions are evaluated through resources, process and outcome
Quantitative Evaluation
- Interventions are evaluated through resources, process and outcome
- Evaluation is done in terms of quantity/number of services/activities performed

REFERENCE/S:
Family Nursing Care Plan. (n.d.). Retrieved August 2020, from
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/family-care-
plan/#:~:text=Modifiability%20of%20the%20condition%20or,eradicating%20the%20problem%2
0through%20intervention.

Valenzuela, C. (2014, November 3). Updated Community Health Nursing. Retrieved August 29,
2020, from https://www.slideshare.net/csteve21/updated-community-health-nursing

Public Health Nursing in the Philippines, 10th Edition, National League of Philippine
Government Nursing, Inc

Prepared by: JUDY ANNE B. MOICO, RN

Clinical instructor