SKILLS LAB:

FAMILY
CARE PLAN
TITLE
Subtitle

Date
NCM 104
AY ‘19-’20
FAMILY NURSING
CARE PLAN
Is a blueprint of nursing care designed to
systematically enhance the family’s
capability to maintain wellness, manage
health problems through explicitly
formulated goals and objectives of care
and deliberately chosen set of
interventions, resources, & evaluation
criteria, standards, methods/tools.

2
STEPS IN DEVELOPING A FAMILY
NURSING CARE PLAN
 Health Problem Goal of Care Health Strategies Evaluation
Goal:

Family Nursing Problem Objectives: “

4
HEALTH PROBLEM
Process whereby existing and
potential health conditions or
problem of the families are
determined.

They reflect depth of data

gathering and analysis on
what health conditions or
problems exists.
HEALTH PROBLEM
This is derived from the First Level Assessment of the
Typology of Nursing Problems.

Which categorizes the presence of:

- Wellness state
- Health deficits
- Health threats
- Foreseeable crisis or stress points
 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.

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 7

 Presence of Wellness Condition
A. Potential or Capability for:
B. Readiness for Enhanced Capability for:
• Healthy Lifestyle – e.g. nutrition, diet,
exercise, activity
• Health Maintenance/ Health
Management
• Parenting
• Breastfeeding
• Spiritual Well-being
• Others

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 8

 Presence of Wellness Condition
B. Readiness for Enhanced Capability for:

• Healthy Lifestyle
• Health Maintenance/ Health
Management
• Parenting
• Breastfeeding
• Spiritual Well-being
• Others

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 9

 Presence of Health Threat

Conditions that are conducive to

disease and accident, or may result
to failure to maintain wellness or
realize health potential

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 10

 Presence of Health Threat
A. Presence of risk factors of specific
diseases
B. Threat of cross infection from a
communicable disease case
C. Family size beyond what family
resources can adequately provide
D. Accident/ fire hazards
E. Faulty/ unhealthful nutritional/
eating habits or feeding techniques
or practices
TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 11
 Presence of Health Threat
F. Stress provoking factors
G. Poor home environmental
condition/ sanitation
H. Unsanitary food handling and
preparation
I. Unhealthful lifestyle and personal
habits/practices
J. Inherent personal characteristics
K. Health history which may
participate/ induce the occurrence
of a health deficit
TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 12
 Presence of Health Threat
L. Inappropriate role assumption
M. Lack of immunization/ inadequate
immunization status specially of
children
N. Family disunity
O. Others

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 13

 Presence of Health Deficit

Instances of failure in health maintenance

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

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 14

 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 I. Menopause
B. Pregnancy, labor, puerperium J. Loss of job
C. Parenthood K. Hospitalization of a family
D. Additional member-e.g. member
newborn, lodger L. Death of a member
E. Abortion M. Resettlement in a new
F. Entrance at school community
G. Adolescence N. Illegitimacy
H. Divorce or separation O. Others, specify.__________

TYPOLOGY OF NURSING PROBLEM: FIRST LEVEL ASSESSMENT 15

Health problem statement:
P = Problem
E = Etiology (Cause)
S = Signs/Symptoms

STATEMENT OF THE
PROBLEM
 Health Problem Goal of Care Health Strategies Evaluation
Diarrhea as Health Deficit Goal:
related to ingestion of
contaminated water and
unclean food as evidenced
by loose watery stool,
defecation of more than 5x
a day for 3 days, muscle

“
weakness, and as verbalized
“Kahapon pa ako ga sige-
sige pamus-on”

Family Nursing Problem Objectives:

17
FAMILY NURSING
DIAGNOSIS
Defines the nature or type of
nursing problems that the
family encounters in
performing the health tasks
with respect to a given health
condition or problem, and the
etiology or barriers to the
family’s assumption of these
tasks.
FAMILY NURSING
DIAGNOSIS
This is derived from the Second Level Assessment
of the Typology of Nursing Problems.

This include those that specify or describe the

family’s realities, perceptions about and attitudes
related to the assumption or performance of
family health tasks on each health condition or
problem identified during the first-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 _________

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 20

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
TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 21
II. Inability to make decisions with respect to taking
appropriate health action due to:
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

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 22

II. Inability to make decisions with respect to taking
appropriate health action due to:
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of
action
M. Others specify._________

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 23

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).

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 24

III. Inability to provide adequate nursing care to
the sick, disabled, dependent or vulnerable/at risk
member of the family due to:
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

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 25

III. Inability to provide adequate nursing care to
the sick, disabled, dependent or vulnerable/at risk
member of the family due to:
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._________

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 26

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

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 27

IV. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
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._________

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 28

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

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 29

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

TYPOLOGY OF NURSING PROBLEM: SECOND LEVEL ASSESSMENT 30

 Health Problem Goal of Care Health Strategies Evaluation
Diarrhea as Health Deficit Goal:
related to ingestion of
contaminated water and
unclean food as evidenced
by loose watery stool,
defecation of more than 5x
a day for 3 days, muscle

“
weakness, and as verbalized
“Kahapon pa ako ga sige-
sige pamus-on”

Family Nursing Problem Objectives:

1. Inability to provide
adequate nursing care
to the sick member of
the family due to:

a. Lack of knowledge
about the health
condition

b. Lack of knowledge and

skills in carrying out the
necessary treatment of
care

31
GOAL OF CARE
a broad desired
outcome toward which
behavior is directed.

The Cardinal Principle:

Goals must be jointly
set with the family. This
ensures the family
commitment to their
realization.
GOAL OF CARE
• Goals set by the nurse & family should be realistic or
attainable.
• Too high goals & their consequent failure frustrate both the
family & the nurse.
 Health Problem
Diarrhea as Health Deficit
related to ingestion of
contaminated water and
unclean food as evidenced
by loose watery stool,
defecation of more than 5x
a day for 3 days, muscle
Goal of Care Health Strategies Evaluation
Goal:
After 1 day of effective
health care strategies, the
client will defecate, semi-
solid stool, once a day if not
totally cured.

“
weakness, and as verbalized
“Kahapon pa ako ga sige-
sige pamus-on”

Family Nursing Problem Objectives:

1. Inability to provide
adequate nursing care
to the sick member of
the family due to:

a. Lack of knowledge
about the health
condition

b. Lack of knowledge and

skills in carrying out the
necessary treatment of
care

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OBJECTIVES OF CARE
This refers to a more
specific / more precise
statements of the
desired results or
outcome of care.

The more specific the

objective, the easier is
the evaluation of their
attainment.
OBJECTIVES OF CARE
Types of objective:
1. Short term/ Immediate objective
• Formulated for problem which require immediate
attention and results observed is short time period with few
nurse family contacts, use of less resources.
2. Long term/ Ultimate objective
• Require several nurse-family encounters & investment of
more resources. Outcomes sought require time to
demonstrate.
3. Medium term/ Intermediate objective
• Those which are not immediately achieved.
OBJECTIVES OF CARE
Components of an objective (ABCD):

1. Actor / Subject – client, any part of the client or some

attributes of the client.
2. Behavior / Verb – action of the client to perform.
3. Conditions / Modifiers - explain the circumstances under
which the behavior is to be performed, (what, where, when,
how)
4. Determinant / Criterion of Desired Performance - Level at
which the client will perform the specified behavior.
 Health Problem
Diarrhea as Health Deficit
related to ingestion of
contaminated water and
unclean food as evidenced
by loose watery stool,
defecation of more than 5x
a day for 3 days, muscle
weakness, and as verbalized
“Kahapon pa ako ga sige-
sige pamus-on”
Family Nursing Problem
1. Inability to provide
adequate nursing care
to the sick member of
the family due to:
a. Lack of knowledge
about the health
condition
b. Lack of knowledge and
skills in carrying out the
necessary treatment of
care
Goal of Care Health Strategies Evaluation
Goal:
After 1 day of effective
health care strategies, the
client will defecate, semi-
solid stool, once a day if not
totally cured.
“
Objectives:
Within 2 hours of health
education and nursing care,
the family will be able to:
a. Identify the factors
leading to diarrhea and
how it could be
prevented
b. Provide adequate
nursing care in treating
the problem
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HEALTH CARE STRATEGIES
This involves selection
of appropriate nursing
interventions/ health
care strategies based
on the formulated goal
and objective.
HEALTH CARE STRATEGIES
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.
 Health Problem
Diarrhea as Health Deficit
related to ingestion of
contaminated water and
unclean food as evidenced
by loose watery stool,
defecation of more than 5x
a day for 3 days, muscle
weakness, and as verbalized
“Kahapon pa ako ga sige-
sige pamus-on”
Family Nursing Problem
1. Inability to provide
adequate nursing care
to the sick member of
the family due to:
a. Lack of knowledge
about the health
condition
b. Lack of knowledge and
skills in carrying out the
necessary treatment of
care
Goal of Care Health Strategies Evaluation
Goal:
After 1 day of effective After 1 day of health care
health care strategies, the strategies, the client’s
client will defecate, semi- diarrhea was partially
solid stool, once a day if not controlled as evidenced
totally cured. by defecation of 2x in a
span of 8 hours and the
“
mother now knows how to
prevent diarrhea and how
to take care of the client.
Objectives:
Within 2 hours of health
education and nursing care,
the family will be able to:
a.1.Teach the mother on proper handwashing
a. Identify the factors
and handling of food and water.
leading to diarrhea and
a.2. Teach the mother to sterilize water for
how it could be
drinking
prevented
b.1. Teach and demonstrate to the mother
b. Provide adequate
how to mix and give ORS as follows: 1 L of
nursing care in treating
clean & potable water mix with 8 level tsps.
the problem
Sugar and 1 level tsp. salt
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EVALUATION
Specifies how the nurse
will determine changes in
health status, condition
and achievement of
outcomes of care
specified in the objectives
of family nursing care
plan.
 Health Problem
Diarrhea as Health Deficit
related to ingestion of
contaminated water and
unclean food as evidenced
by loose watery stool,
defecation of more than 5x
a day for 3 days, muscle
weakness, and as verbalized
“Kahapon pa ako ga sige-
sige pamus-on”
Family Nursing Problem:
1. Inability to provide
adequate nursing care
to the sick member of
the family due to:
a. Lack of knowledge
about the health
condition
b. Lack of knowledge and
skills in carrying out the
necessary treatment of
care
Goal of Care
Goal:
After 1 day of effective
health care strategies, the
client will defecate, semi-
solid stool, once a day if not
totally cured.
“
Objectives:
Within 2 hours of health
education and nursing care,
the family will be able to:
a. Identify the factors
leading to diarrhea and
how it could be
prevented
b. Provide adequate
nursing care in treating
the problem
Health Strategies Evaluation
After 1 day of health care
strategies, the client’s
diarrhea was partially
controlled as evidenced
by defecation of 2x in a
span of 8 hours and the
mother now knows how to
prevent diarrhea and how
to take care of the client.
a.1.Teach the mother on proper handwashing
and handling of food and water.
a.2. Teach the mother to sterilize water for
drinking
b.1. Teach and demonstrate to the mother
how to mix and give ORS as follows: 1 L of
clean & potable water mix with 8 level tsps.
Sugar and 1 level tsp. salt
43
PRIORITIZING HEALTH
CONDITIONS AND PROBLEMS
 CRITERIA WEIGHT
1. Nature of the condition or problem presented 1
Scale: wellness state 3
health threat 3
health deficit 2
foreseeable crisis 1

“
2. Modifiability of the condition or problem 2
Scale: easily modifiable 2
partially modifiable 1
not modifiable 0
3. Preventive Potential 1
Scale: high 3
moderate 2
low 1
4. Salience 1
Scale: a condition or problem needing immediate attention 2
a condition or problem not needing immediate attention 1
not perceived as a condition or problem needing change 0

TOTAL SCORE: 5

Scale for Ranking Health Conditions & Problems According to Priorities. 45

Four criteria for Determining
Priorities among Health Condition

NATURE OF THE CONDITION OR

PROBLEM PRESENTED
“ Categorized into wellness state/ potential, health
threat, health deficit, foreseeable crisis

46
Four Criteria for Determining
Priorities among Health Condition

MODIFIABILITY OF THE CONDITION

OR PROBLEM

“
Probability of success in enhancing wellness state,
improving the condition, minimizing, alleviating or
totally eradicating the problem through intervention.

47
 1. Current knowledge,
Factors to technology and interventions
consider in to enhance wellness state or
manage the problem
determining 2. Resources of the family-
modifiability physical, financial and
manpower
of the 3. Resources of the nurse-
knowledge, skill and time
problem 4. Resources of the community-
facilities and community
organization or support.
48
Four criteria for determining
priorities among health condition

PREVENTIVE POTENTIAL
Nature and magnitude of future problems that

“ can be minimized or totally prevented if

interventions is done on the problem.

49
 1. Gravity or severity of the problem –
Factors to refers to the progress of disease
indicating extent of damage on the
consider in client. The more severe of
advanced the problem, the lower is
determining the preventive potential.

Preventive 2. Duration of the problem – refers to

Potential the length of time the problem has
been existing. Has a direct
relationship to gravity & preventive
potential.
50
 3. Current Management – refers to the
presence and appropriateness of
intervention measures instituted to
Factors to enhance the wellness state or

consider in remedy the problem. The institution

of appropriate intervention
determining increase the preventive potential.

Preventive 4. Exposure of any vulnerable or high

risk group – Increases the
Potential preventive potential in determining
the score for salience. The family’s
concerns, felt needs, or readiness
increases the salience.
51
Four criteria for determining
priorities among health condition

SALIENCE
Family’s perception & evaluation of the problem

“ in terms of seriousness & urgency of attention

needed or family readiness.

52
 1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and
multiply by the weight.

Score X Weight
Highest Score

3. Sum up the scores for all the criteria.

The highest score is 5, equivalent to the total weight.

SCORING
(Developed by Salvacion G. Bailon and Araceli S. Maglaya)
53
 CRITERIA WEIGHT SCORING
1. Nature of the condition or problem presented 1
Scale: wellness state 3
health threat 3
(3 /3)x1 1
health deficit 2
foreseeable crisis 1

“
2. Modifiability of the condition or problem 2
Scale: easily modifiable 2
partially modifiable 1 (2/2)x2 2
not modifiable 0
3. Preventive Potential 1
Scale: high 3
moderate 2 (3/3)x1 1
low 1
4. Salience 1
Scale: a condition or problem needing immediate attention 2
a condition or problem not needing immediate attention 1 (2 /2)x1 1
not perceived as a condition or problem needing change 0

TOTAL SCORE: 5 Problem’s Score

5
HIGHEST POSSIBLE SCORE 54
 CRITERIA WEIGHT SCORING
1. Nature of the condition or problem presented 1
Scale: wellness state 3
health threat 3
(1 /3)x1 1/3
health deficit 2
foreseeable crisis 1

“
2. Modifiability of the condition or problem 2
Scale: easily modifiable 2
partially modifiable 1 (0/2)x2 0
not modifiable 0
3. Preventive Potential 1
Scale: high 3
moderate 2 (1/3)x1 1/3
low 1
4. Salience 1
Scale: a condition or problem needing immediate attention 2
a condition or problem not needing immediate attention 1 (0 /2)x1 0
not perceived as a condition or problem needing change 0

TOTAL SCORE: 5 Problem’s Score

2/3
LOWEST POSSIBLE SCORE 55
The nurse considers Problem Score Priority
as priority those
conditions and
problems with total Problem 1 4 2nd
scores nearer 5.
Thus, the higher the Problem 2 2 2/3 Last
score of a given
Problem 3 3 2/3 3rd
condition or
problem the more
Problem 4 5 1st
likely it is priority

RANKING OF HEALTH PROBLEMS

56
THANK YOU
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