Home Visit

Description

A nursing home visit is a family-nurse contact which allows the health worker to assess the
home and family situations in order to provide the necessary nursing care and health related
activities. In performing home visits, it is essential to prepare a plan of visit to meet the needs of
the client and achieve the best results of desired outcomes.

Purposes

1. To give care to the sick, to a postpartum mother and her newborn with the view teach a
responsible family member to give the subsequent care.
2. To assess the living condition of the patient and his family and their health practices in order
to provide the appropriate health teaching.
3. To give health teachings regarding the prevention and control of diseases.
4. To establish close relationship between the health agencies and the public for the
promotion of health.
5. To make use of the inter-referral system and to promote the utilization of community
services

Principles

The following principles are involved when performing a home visit:

1. A home visit must have a purpose or objective.

2. Planning for a home visit should make use of all available information about the
patient and his family through family records.
3. In planning for a home visit, we should consider and give priority to the essential needs
if the individual and his family.
4. Planning and delivery of care should involve the individual and family.
5. The plan should be flexible.

Guidelines

The following guidelines are to be considered regarding the frequency of home visits:
 1. The physical needs psychological needs and educational needs of the individual and family.
2. The acceptance of the family for the services to be rendered, their interest and the
willingness to cooperate.
3. The policy of a specific agency and the emphasis given towards their health
programs.
4. Take into account other health agencies and the number of health personnel already involved
in the care of a specific family.
5. Careful evaluation of past services given to the family and how the family avails of the
nursing services.
6. The ability of the patient and his family to recognize their own needs, their knowledge of
available resources and their ability to make use of their resources for their benefits.

Steps

1. Greet the patient and introduce yourself.

2. State the purpose of the visit
3. Observe the patient and determine the health needs.
4. Put the bag in a convenient place and then proceed to perform the bag technique.
5. Perform the nursing care needed and give health teachings.
6. Record all important date, observation and care rendered.
7. Make appointment for a return visit.
Home visit 1
o Assessment, problem identification and prioritization, planning
Home visit 2
o Implementation of plan of care, structured health teaching class based on problems identified

Home visit 3
o Evaluation
A Typology of Nursing Problems in Family Nursing Practice

First Level Assessment

I. Presence of Wellness Condition-stated as potential or Readiness-a clinical or nursing judgment about
a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is
a nursing judgment on wellness state or condition based on client’s performance, current
competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of
state or function in a specific area on health promotion and maintenance. Examples of this are the
following

A. Potential for Enhanced Capability for:

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity

2. Healthy maintenance/health management

3. Parenting

4. Breastfeeding

5. Spiritual well-being-process of client’s developing/unfolding of mystery through

harmonious interconnectedness that comes from inner strength/sacred source/God
(NANDA 2001)

6. Others. Specify.

B. Readiness for Enhanced Capability for:

1. Healthy lifestyle

2. Health maintenance/health management

3. Parenting

4. Breastfeeding

5. Spiritual well-being

6. Others. Specify.

II. Presence of Health Threats-conditions that are conducive to disease and accident, or may result
to failure to maintain wellness or realize health potential. Examples of this are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)

B. Threat of cross infection from communicable disease case

C. Family size beyond what family resources can adequately provide

D. Accident hazards specify.

1. Broken chairs

2. Pointed /sharp objects, poisons and medicines improperly kept

 3. Fire hazards

4. Fall hazards

5. Others specify.

E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify.

1. Inadequate food intake both in quality and quantity

2. Excessive intake of certain nutrients

3. Faulty eating habits

4. Ineffective breastfeeding

5. Faulty feeding techniques

F. Stress Provoking Factors. Specify.

1. Strained marital relationship

2. Strained parent-sibling relationship

3. Interpersonal conflicts between family members

4. Care-giving burden

G. Poor Home/Environmental Condition/Sanitation. Specify.

1. Inadequate living space

2. Lack of food storage facilities

3. Polluted water supply

4. Presence of breeding or resting sights of vectors of diseases

5. Improper garbage/refuse disposal

6. Unsanitary waste disposal

7. Improper drainage system

8. Poor lightning and ventilation

9. Noise pollution

10. Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.

1. Alcohol drinking

2. Cigarette/tobacco smoking
 3. Walking barefooted or inadequate footwear

4. Eating raw meat or fish

5. Poor personal hygiene

6. Self medication/substance abuse

7. Sexual promiscuity

8. Engaging in dangerous sports

9. Inadequate rest or sleep

10. Lack of /inadequate exercise/physical activity

11. Lack of/relaxation activities

12. Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis
endemic areas).

J. Inherent Personal Characteristics-e.g. poor impulse control

K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous history
of difficult labor.

L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not assuming his role.

M. Lack of Immunization/Inadequate Immunization Status Specially of Children

N. Family Disunity-e.g.

1. Self-oriented behavior of member(s)

2. Unresolved conflicts of member(s)

3. Intolerable disagreement

O. Others. Specify.

III. Presence of health deficits-instances of failure in health

maintenance. Examples include:

A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner.

B. Failure to thrive/develop according to normal rate

C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary

paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from
measles, lameness from polio)

IV. Presence of stress points/foreseeable crisis situations-anticipated periods of unusual demand

on the individual or family in terms of adjustment/family resources. Examples of this include:
A. Marriage

B. Pregnancy, labor, puerperium

C. Parenthood

D. Additional member-e.g. newborn, lodger

E. Abortion

F. Entrance at school

G. Adolescence

H. Divorce or separation

I. Menopause

J. Loss of job

K. Hospitalization of a family member

L. Death of a member

M. Resettlement in a new community

N. Illegitimacy

O. Others, specify.

Second-Level Assessment

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-e.i. 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 _
Family Nursing Care Plan (FNCP)

Definition

 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 FNCP

1. The nursing care plan focuses on actions which are designed to solve or minimize existing
problem. The plan is a blueprint for action. The cores of the plan are the approaches,
strategies, activities, methods and materials which the nurse hopes will improve the problem
situation.

2. The nursing care plan is a product of a deliberate systematic process. The planning process is
characterized by logical analyses of data that are put together to arrive at rational decisions.
The interventions the nurse decides to implement are chosen from among alternatives after
careful analysis and weighing of available options.

3. The nursing care plan, as with all plans, relates to the future. It utilizes events in the past and
what is happening in the present to determine patterns. It also projects the future scenario
if the current situation is not corrected.

4. The nursing care plan is based upon identified health and nursing problems. The problems are
the starting points for the plan, and the foci of the objectives of care and intervention
measures.

5. The nursing care plan is a means to an end, not an end in itself. The goal in planning is to
deliver the most appropriate care to the client by eliminating barriers to family health
development.

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.

Steps in Making 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 nursing care plan. The planning phase takes off from
there.

Formulating a family care plan involves the following steps:

1.

1. The prioritized condition/s or problems

2. The goals and objectives of nursing care

3. the plan of interventions

4. The plan of 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.

Factors Affecting Priority Setting

Nature of the problem

 The biggest weight is given to the wellness state or potential because of the premium on
client’s effort or desire to sustain/maintain high level of wellness.

 The same weight is given to 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 with adequate support to cope with developmental or situational
crisis.

Modifiability if the problem

 Current knowledge, technology and interventions to enhance the wellness state or manage
the problem.

 Resources of the family

 Resources of the nurse

 Resources of the community

Preventive potential

 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.

 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.

 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.

 Exposure of any vulnerable or high risk group-increases the preventive potential of condition or
problem

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.

Barriers to Joint Goal Setting Between the Nurse and the Family:

1. Failure on the part of the family to perceive the existence of the problem.

2. The family may realize the existence of the health condition or problem but is too busy at
the moment.

3. Sometimes the family perceives the existence of the 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 about the situation.

 Reasons to this kind of behavior:

a. Fear of consequences of taking actions.

b. Respect for tradition.

c. Failure to perceive the benefits of action.

d. Failure to relate the proposed action to the family’s goals.

5. A big barrier to collaborative goal setting between the nurse and the family is the
working relationship.

Focus on Interventions to Help The Family Performs Health Tasks:

1. Help the family recognize the problem

  Increasing the family’s knowledge on the nature, magnitude and cause of the problem.

 Helping the family see the implications of the situation or the consequences of
the condition.

 Relating the health needs to the goals of the family.

 Encouraging positive or wholesome emotional attitude toward the problem by affirming

the family’s capabilities/qualities/resources and providing information on
available actions.

2. Guide the family on how to decide on appropriate health actions to take.

 Identifying or exploring with the family courses of action available and the resources
needed for each.

 Discussing the consequences of action available.

 Analyzing with the family of the consequences of inaction.

3. Develop the family’s ability and commitment to provide nursing care to each member.

 Contracting-is a creative intervention that can maximize the 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 home environment conducive to

health maintenance and personal development.

 The family can be taught specific competencies to ensure such home environment
through environmental manipulation or management to minimize or eliminate
health threats or risks or to install facilities of nursing care.

5. Facilitate the family’s capability to utilize community resources for health care.

 Involves maximum use of available resources through the coordination,

collaboration and teamwork provided by effective referral system.

Criteria for Selecting the Type of Nurse Family Contact

1. Effectivity

2. Efficiency

3. Appropriateness

Types of Nurse Family

Contact Home Visit

 While it is expensive in terms of time, effort and logistics for the nurse, it is an effective and
appropriate type of family nurse contact if the objectives and outcomes of care require
accurate appraisal of family relationship, home and environment and family competencies. i.e.
The best opportunity to serve the actual care given by family members.
Clinic or Office Conference

 It is less expensive for the nurse and provides the opportunity to use equipment that can’t
be taken to the home. In some cases, the other team members in the clinic may be consulted
or called in to provide additional service.

Telephone Conference

 May be effective, efficient, and appropriate if the objectives and outcomes of care require
immediate access to data given problems on distance or travel time. Such data include
monitoring of health status or progress during the acute phase of an illness state, change in
schedule of visit or family decision, and updates on outcomes or responses to care and
treatment.

Written Communication

 It is another less time consuming option for the nurse in instances when there are large
number of families needing follow-up on top of problems of distance or travel time.

School Visit or Conference

 It is done to work with family and school authorities on how to appraise the degree of
vulnerability of and worked out interventions to help children and adolescence on specific
health risks, hazards or adjustment problems.

Industrial or Job Site Visit

 It is done when the nurse and family need to make an accurate assessment of health risks or
hazards and work with employer or supervisor on what can be done to improve on provisions
for health and safety of workers.

Implementing the Nursing Care Plan

 During this phase, the nurse encounters the realities in family nursing practice that motivates
her to try out creative innovations or overwhelm her to frustration or inaction. A dynamic
attitude on personal and professional development is, therefore, necessary if she has to face
up challenges of nursing practice.

Implementation Phase: A Phenomenological Experience

 Meeting the challenges of this phase is the essence of family nursing practice. During this phase,
the nurse experiences with the family a lived meaningful world of mutual, dynamic interchange
of meanings, concerns, perceptions, biases, emotions and skills. Just as the self aims to achieve
body-mind integration to achieve wholeness in the experience 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 can’t hope to achieve expert caring.

Expert Caring: Methods and Possibilities

  Expert caring in the implementation phase is demonstrated phase is demonstrated when the
nurse carries out interventions based on the family’s understanding of the lived experience of
coping and being in the world. Expert caring is developing the capability of the family for
“engage care” through the nurses skilled practice, the family learns to choose and carry out
the best possibilities of caring given the meanings, concerns, emotions and resources(skills &
equipments) as experienced in the situation. While the challenge for expert caring is a reality,
the nurse is enriched as a result of such an experience (Benner & Wrubel 1989).

 …By being experts in caring, nurses must takeover and transform the notions of expertise.
Expert caring has nothing to do with possessing privileged information that increases one’s
control and domination of another. Rather, expert caring unleashes the possibilities inherent in
the self and the situation. Expert caring liberates and facilitates in such a way that the one
caring is enriched in the process.

 While expert caring does not happen overnight to the novice nurse, there are methods and
possibilities that can enhance learning towards expert caring. Such methods and
possibilities need to be carried out and experienced in real contexts and real relationships to
achieve skillfully comportment and excellence in the current situation.

Two such major methods and possibilities:

1. Performance-focus learning through competency-based teaching

2. Maximizing caring possibilities for personal and professional

development Competency-Based Teaching

 A substantive part of the implementation phase is directed towards developing the family’s
competencies to perform the health tasks. Competencies include the cognitive (knowledge),
psychomotor (skills) and attitudinal or affective(emotions, feelings, values). The following are
examples of these family health competencies using the corresponding health task in our case
illustration:

 Health Task: The family recognizes the possibility of cross-infection of scabies to other
family members.

Cognitive Competency:

1. The family explains the cause of scabies

2. The family enumerates ways by which cross-infection of scabies can occur among the family
members.

3. 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:

1. Family members express feelings or emotions that act as barriers to decision-making

2. Family members acknowledge the existence of these feelings or emotions.

 In order to systematically work towards development of the family’s competencies,

such competencies need to be explicitly defined. Cognitive and psychomotor
competencies are reflected explicitly as objectives in the family nursing care plan. The
attitudinal or affective competencies may also be translated into objective of care as
feelings,
emotions or philosophy in life that enhance the family’s desire or commitment to
behavior change and sustain the needed action.

Learning Principles and Teaching- Learning Methods and Techniques that the Nurse Can Use
in Competency-Based Teaching:

1. Learning is both intellectual and emotional process.

2. Learning is facilitated when experience has meaning.

3. Learning is individual matter.

Learning is Both Intellectual and Emotional Process

Six General Methods and Techniques:

1. Provide information to shape attitude

2. Provide experiential learning activities to shape attitudes

3. Provide examples or models to shape attitudes

4. Providing opportunities for small group discussion

5. Role playing exercises

6. Explore the benefits of power of silence

Learning is Facilitated When Experience Has

Meaning

1. Analyze and process family members all teaching-learning based on their grasp on the live
experience of the situation in terms of the meaning for the self.

2. Involve the family actively in determining areas for teaching-learning based on the health tasks
that members made to perform.

3. Used examples or illustrations that the family is familiar with.

Learning is Individual Matter: Ensure Mastery of Competencies for Sustained Actions:

Some Techniques to Develop Mastery:

1. 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. Use words, examples, visual materials and handouts that the family
can understand.

3. Ensure adequate evaluation, feedback, monitoring and support for sustained action by:

 Explaining well how the family is doing

 Giving the necessary affirmations or reassurances

 Explaining how the skill can be improved

 Exploring with the family how modifications can be carried out to maximize
situated possibilities or best options.
 How to Structure an Evidence-based Report:
An evidence-based report is structured in sections that do the following:
I. Title/ Topic
 Topic must be related to the area of exposure or cases handled in the duty
 Topic may include new treatments (medical/nursing), diagnostics, nursing process, etc.

II. Research Findings

 Findings must be synthesized;

III. Conclusion
 Direct statement of the outcome of the study
IV. Analysis
 How would the study affect the nursing profession

V. Reference
 APA style; website address if taken from internet
 Can be taken from journals, magazines and internet
 GIBBS Reflective Cycle

Gibbs’ reflective cycle is a popular model for reflection. The model includes 6 stages of
reflection and is presented below as cited in Dye (2011, p. 230).

Description
In this section, you need to explain what you are reflecting on to your reader. Perhaps include
background information, such as what it is you’re reflecting on and tell the reader who was
involved.

Guide Questions:
 What happened?
 When and where did it happen?
 Who was present?
 What did you and the other people do?
 What was the outcome of the situation?
 Why were you there?
 What did you want to happen?

Feelings
Discuss your feelings and thoughts about the experience.

Guide Questions:
 What were you feeling during the situation?
 What were you feeling before and after the situation?
 What do you think other people were feeling about the situation?
 What do you think other people feel about the situation now?
 What were you thinking during the situation?
 What do you think about the situation now?

Evaluation
Discuss how well you think things went.
Guide questions
 What was good and bad about the experience?
 What went well?
 What didn’t go so well?
 What did you and other people contribute to the situation (positively or negatively)?

Analysis
In your analysis, consider what might have helped or hindered the event. You also have the
opportunity here to compare your experience with the literature you have read.
Guide Questions:
 Why did things go well?
 Why didn’t it go well?
 What sense can I make of the situation?
 What knowledge – my own or others (for example academic literature) can help me
understand the situation?

Conclusions
In this section you can make conclusions about what happened. This is where you summarize
your learning and highlight what changes to your actions could improve the outcome in the
future. It should be a natural response to the previous sections.
Guide Questions:
 What did I learn from this situation?
 How could this have been a more positive situation for everyone involved?
 What skills do I need to develop for me to handle a situation like this better?
 What else could I have done?

Action Plan
Action plans sum up anything you need to know and do to improve for next time.
Guide Questions:
 If I had to do the same thing again, what would I do differently?
 How will I develop the required skills I need?
 How can I make sure that I can act differently next time?
Individual Case Study
Family Individual Case Study

 Family influences the health and activities of their members

 Importance in ensuring that families in the community are aware of the necessary
information and practices pertaining to their health

Parts of Individual Case Study

 Introduction
 Initial Data Base
 Genogram
 Family Developmental Task
 List of Family Health Nursing Problems
 Problem Prioritization
 Family Coping Index
 Family NCP
 Learning Outcome
Genogram
A genogram is a format for drawing a family tree that records information about family members and
their relationships over a period of time, usually three generations.

Standard Symbols for Genogram

Family Developmental Tasks
Evelyn Duvall’ (1977) family developmental framework
provides guide to examine and analyze the basic changes and
developmental tasks common to most families during their life
cycle. Although each family has unique characteristics
normative patterns of sequential development are common to
all families. These stages and developmental tasks illustrate
common family behaviors that may be expected at specific
times in the family life cycle. The stages are marked by the age
of the oldest child however some overlapping occurs in families
with several children.
 Family Coping Index
Introduction:

Family coping index comes under non-physical assessment of the family nursing
process. This is the scale, which helps the individual to assess the need of nursing
care to the particular family.

Meaning:
It is the tool used to assess the family’s coping index coping means dealing with
problems associated with health care and index means measurement of something.
Thus the family coping index means the measurement of the family capacity to
deal with the problems associated with the health
care. When the family is unable to cope with the aspects of the health care they
may be said to have a “coping deficit”.

NOTE: The following points should be kept in mind when we use the family
coping index: -
 It is the coping capacity being rated not the problems.
 It is the family but not the individual being rated.
Health Care Need
A family health care need is present when:

1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in
the family’s ability to cope.
Relation to Coping Nursing Need:
 COPING may be defined as dealing with problems associated with
health care with reasonable success.
 When the family is unable to cope with one or another aspect of health care,
it may be said to have a “coping deficit”
Direction for Scaling
 Two parts of the Coping index:
1. A point on the scale
2. A justification statement
  The scale enables you to place the family in relation to their ability to cope
with the nine areas of family nursing at the time observed and as you would
expect it to be in 3 months or at the time of discharge if nursing care were
provided. Coping capacity is rated from 1 (totally unable to manage this
aspect of family care) to 5 (able to handle this aspect of care without help
from community sources). Check “no problem” if the particular category is
not relevant to the situation.
 The justification consists of brief statement or phrases that explain why you
have rated the family as you have.
General Considerations

1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more
acquainted with the family.
4. The scale is as follows:
 1 or no competence
 3 moderately competent
 5 competent
5. Justification- a brief statement that explains why you have rated the family as
you have. These statements should be expressed in terms of behavior of
observable facts. Example: “Family nutrition includes basic 4 rather than
good diet.
6. Terminal rating is done at the end of the given period of time. This enables
the nurse to see progress the family has made in their competence; whether
the prognosis was reasonable; and whether the family needs further nursing
service and where emphasis should be placed.
Scaling Cues

 The following descriptive statements are “cues” to help you as you rate
family coping. They are limited to three points – 1 or no competence, 3 for
moderate competence and 5 for complete competence.
Areas to be assessed and how to rate?
1.Physical Independence:
This category is concerned with ability to move about, to get in and out of bed,
activities of daily living etc., Note that it is the family competence that is
measured even though an individual is dependent if the family is able to
 compensate for this. The family may be independent however, the quality as
well as quantity of ability is important.

 1- Family failing entirely to provide personal care to its members: No

competence
 3- Family providing partially the needs of its members or proving care for some
members but not for others: - Incomplete Independence.
 5- All family members receiving necessary care to maintain health and
personal hygiene: - Complete Independence
2. Therapeutic Competence:
This category includes management of prescribed drugs diet, exercises,
procedures, using appliances etc.
 1- Family either not carrying out procedures prescribed or doing it unsafe: - No
competence.
 3- Family carrying out some but not all of the treatments: - Moderately
Competence.
 5- Family able to demonstrate that they can carryout the prescribed
procedures safely and efficiently: - Complete Competence.

3. Knowledge of Health Conditions:

This category is concerned with the particular health condition, that is the occasion
for care, for ex:- knowledge of the disease, understanding the communicability of
disease and modes of transmission etc,.
 1- Totally uninformed about the condition or misinformed: -unsatisfactory
knowledge.
 3- Has some knowledge of the disease or condition but has not grasped the
underlying principles: - Satisfactory Knowledge.
 5- Knows the salient facts about the disease well enough to take necessary action
at proper time: - Good Knowledge.

4. Application of Principles of General Hygiene:

This is concerned with family action in relation to maintaining family
nutrition, securing adequate rest and relaxation for family members carrying
out accepted preventive measures such as immunization etc.,
  1- Family diet grossly inadequate or unbalanced, necessary immunizations not
secured for children, house dirty, food handled in an unsanitary way: - No
Application.
 3- Failing to apply some general principle of hygiene for instance secure initial
immunizations but not boosters or some but not all available immunization: -
Moderate Application.
 5- Household runs smoothly, family meals well selected, habits to sleep and
rest adequate to needs: -Complete Application.

5. Health Attitude:
This category is concerned with the way the family feels about health care in
general including preventive measures and services.
 1- Family resents and resists all health care, has no confidence in doctors uses
patent medicines: - Unsatisfactory Attitude
 3- Accepts health care to some degree, but with reservations. Ex: - Accept need for
medical care for illness but not preventive measures: - Satisfactory Attitude.
 5- Understands and recognizes need for medical care in illness and for usual
preventive services: - Good Attitude.

6. Emotional Competence:
This category has to do with the maturity and integrity with which the members of
family are able to meet the usual stresses and problems of life.
 1- Family does not face realities, assume moribund patient will get well: - No
Competence.
 3- Family members usually do fairly well but one or more members
evidences lack of security or maturity: -Moderate Competence.
 5- All members of the family able to maintain a reasonable degree of
emotional calm, face up to illness realistically and hopefully: -Complete
Competence.

7. Family living:
This category is concerned largely with the interpersonal or group aspects of
family life how all the members of the family get along with one another the
ways in which they support one another.
  1- Family consists of a group of individuals indifferent or hostile to one another
or strongly dominated and controlled by a single-family member, no control of
children: - Unsatisfactory
 3- Family gets along but has habits or customs that interfere with their
effectiveness or coherence as a family: -Satisfactory.
 5- Family cohesive does things together each members acts for the good of the
family as whole children respect parents and vice versa: - Good

8. Physical Environment:
This category is concerned with the home and community or work environment as
it affects family health. The conditions of housing, presence of accident hazards,
facilities for cooking or social hazards such as bare street. Availability and
conditions of schools transportation etc.,
 1- House in poor condition, unsafe, unscreened, poorly ventilated
neighborhood deteriorated, no playing space except streets: -
Unsatisfactory environment.
 3- House need some repair or painting but fundamentally sounds: -
Satisfactory environment.
 5- House in good repair, provides for privacy for members and is free of
accident and best hazards: - Good environment.

9. Use of Community facilities:

This category has to do with the degree to which the family knows about and
the wisdom with which they use available community recourses for health,
education and welfare. This would include the way, in which they use services
of private physicians, clinics, emergency, rooms, hospitals, schools, churches
etc.,
 1- Family has obvious and serious social needs, but has not sought or found
any help for them: - No usage
 3- Family knows about or uses some but not all of the available community
resources that they need: - moderate usage
 5- Family using the facilities they need appropriately and promptly know
when and whom to call for help: - complete usage