Community Health Nursing 217

Family Nursing Care Plan (FNCP)

 Learning Objectives:
At the end of the discussion, student learners will be able
to:
a.Discuss the definition, and the five (5) steps of Family
Nursing Care Plan (FNCP)
b. Develop their own FNCP
c. Case Presentation
 FNCP Definition
 guide or framework of nursing care designed to provide ways
in solving health related problems of the family as a whole
 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
Process in making the Family Nursing Care Plan

1. Assessment Phase – Happens on the first and succeeding home visits. Making objective
observation can be coupled with subjective statements by each family member.

2.Identification of the Problem/s – Make a list of the problems sited. Prioritization of the
needs must be applied.

3.Formulation of Goals and Objectives – Referring on the problems, goals and objectives
must be measurable, attainable, realistic and time-oriented.

4. Plot Nursing Interventions – The objectives must be the guidelines in making nursing
interventions. Nursing interventions must be rational enough

5. Evaluate the outcomes – This stage will be the determining stage whether the goals and
objectives have been met or not. Nursing interventions can be modified at this stage.
(1) Assessment Phase
Survey Form (Initial Data Base)
Sample initial data base (msword)
(2) Identification of Health Problems
First Level
 Health Deficit
 Health Threat Practices
 Foreseeable Crisis or stresses
Second Level
 Assessment of Health Problems (1st level)
 Health Problems can be identified into three categories:
(1) HEALTH DEFICITS
 Refers to instances of failure in health maintenance and development
 It includes:
a. diagnosed/suspected illness states of family members
b. sudden or premature or untimely death illness or disability
and failures to adapt reality of life, emotional control and stability
c. deviations in growth and development
d. personality disorders
(2) HEALTH THREAT PRACTICES
 Refers to conditions which predispose to disease, accident,
poor or retarded growth and development, personality
disorder, and a failure to realize one’s health potentials
 It includes:
a. incomplete immunizations/vaccinations among children
/pregnant women
b. environmental hazards, poverty
c. family history of chronic illness, e,g. hypertension,
diabetes
(3) FORESEEABLE CRISIS OR STRESSES
 Refers to anticipated periods of unusual demands on the
individual or the family in terms of adjustment on family
resources
 It may be:
a. pregnancy (unplanned or unwanted)
b. retirement from work (sudden/unplanned)
c. adolescence
 Prioritizing Health Problems

Criteria Weight
1. NATURE OF THE PROBLEM
SCALE: (a) Health Deficit 2
(b) Health Threat 3 1
(c) Foreseeable Crisis 1
2. MODIFIABILITY OF THE PROBLEM
SCALE: (a) Easily Modifiable 2
(b) Partially Modifiable 1 2
(c) Not Modifiable 0
 Prioritizing Health Problems
Criteria Weight
3. PREVENTIVE POTENTIAL
SCALE: (a) High 3
(b) Moderate 2 1
(c) Low 1
4. SALIENCE
SCALE: (a) A serious problem immediate
2
attention needed
(b) A problem but not needing 1
1
immediate attention
(c) Not a felt/need problem 0
 Scoring
1. Decide on score for each criteria
2. Divide the score by the highest possible score and multiply by
weight
Criteria score x Weight
highest criteria score
3. Sum up the scores for all criteria. The highest score is 5.
 Cases
Pre-natal - (1)
Post natal or Infant up to 7 weeks old - (1)
Morbid cases (Hypertension, Diabetes Mellitus, Renal Disease,
Cat 1 PTB) – (1)
Pre-Natal:
1.
2.
3.

Post-Natal or/ Infants 0 – 7 weeks old

1.
2.
3.

Morbid Case:
1.
2.
3.
Example of Prenatal Case
1. No Birth Plan
2. Low Gestational weight gain
3. Disturbed sleeping pattern
 Problem 1: No Birth Plan as Health Threat
Criteria Weight Score Justification
1. NATURE OF This is considered as health threat because women with
PROBLEM no or incomplete birth plan tends to feel lees safe and
2 1 0.67
• Health Threat more stressed at childbirth which results to panic attacks
during labor and delivery (Aerseth et al, 2004)
Health teaching about the importance of having a birth
2. MODIFIABILITY OF plan and be able to encourage the mother to fill up the
2 2 2
THE PROBLEM birth plan section in the mother’s book will be an
• Easily Modifiable indication of effective health teaching.
3. PREVENTIVE This is highly preventive because with the use of IEC,
POTENTIAL health teaching and encouragement about birth plan are
3 1 1
• Highly big factor that will affect their readiness in the upcoming
Preventable birth.
4. SALIENCE
“Birth plan? Ano ‘yon? Wala.” and ‘Kailangan pa ba
• Not a problem
‘yun?” as verbalized by the client we can say that this is
needing 0 1 0
not a problem perceived by the client due to lack of
immediate
knowledge over the said matter
attention
Total Score 3.67
 Problem 2: Low Gestational Weight as Health Threat
Criteria Weight Score Justification
1. NATURE OF According to Pilliteri (2018), normal weight gain for the
PROBLEM whole pregnancy should be 25-35 lbs , specifically 1 lb per
• Health Threat week during the 2nd and 3rd trimester. Slow weight gain in
2 1 0.67 pregnancy may indicate poor nutrition and eating habits by
the mother, affecting the growth and development of the
baby.

With the right health teaching about proper food intake in

2. MODIFIABILITY OF
2 2 2 accordance with gaining weight, this problem will be easily
THE PROBLEM modifiable for the client.
• Easily Modifiable
3. PREVENTIVE The PHN’s health teaching, IEC and free vitamins at the
POTENTIAL 3 1 1 health center will make sure that the client understands the
• Highly Preventable importance of gaining proper weight during pregnancy
4. SALIENCE The family recognizes it as a problem needing immediate
• A problem needing attention evidenced by: “Ayun basta kumakaian ako ganon
immediate 2 1 1 kasi sabi sakin kulang daw ako sa timbinang,” as stated by
attention the mother.

Total Score 4.67

 Problem 3: Disturbed sleeping pattern as Health Threat
Criteria Weight Score Justification
1. NATURE OF PROBLEM Poor sleep related to changes sleeping pattern can
• Health Threat adversely affect health, and it also has a critical
2 1 0.67 impact on pregnant women, potentially leading to
maternal complications such as hypertension and
gestational diabetes (Peters, 2019)

This is easily modifiable if proper health teaching is

2. MODIFIABILITY OF THE
2 2 2 given to the client. There are actions that can
PROBLEM
promote easy sleeping for women.
• Easily Modifiable
3. PREVENTIVE This is highly preventable with the4 use of proper
POTENTIAL 3 1 1 actions and position for a good sleep. Monitoring the
• Highly Preventable time of sleep is also important.
4. SALIENCE
• Not a problem It is not perceived as a problem as evidenced by,
needing immediate 0 1 0 “Nakakatulog naman ako hanggang hapon kaya okay
attention lang.”

Total Score 3.67

 2nd Level Assessment
1. 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:
- Social-stigma, loss of respect of peer/significant others
- Economic/cost implications
- Physical consequences
- Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
D. Others. Specify
 2nd Level Assessment
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
 2nd Level Assessment
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:
- Social consequences
- Economic consequences
- Physical consequences
- Emotional/psychological consequences
 2nd Level Assessment
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:
- Physical Inaccessibility
- 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.
 2nd Level Assessment
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
 2nd Level Assessment
E. Lack of the necessary facilities, equipment and supplies of care
F. 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)
G. Inadequate family resources of care specifically:
- Absence of responsible member
- Financial constraints
- Limitation of luck/lack of physical resources
 2nd Level Assessment
H. Significant persons unexpressed feelings (e.g. hostility/anger,
guilt, fear/anxiety, despair, rejection) which his/her capacities to
provide care
I. Philosophy in life which negates/hinder caring for the sick,
disabled, dependent, vulnerable/at risk member
J. Member’s preoccupation with on concerns/interests
K.Prolonged disease or disabilities, which exhaust supportive
capacity of family members.
 2nd Level Assessment
K. Altered role performance, specify.
- Role denials or ambivalence
- Role strain
- Role dissatisfaction
- Role conflict
- Role confusion
- Role overload
L. Others. Specify.
 2nd Level Assessment
IV. Inability to provide a home environment conducive to
health maintenance and personal development due to:
A. Inadequate family resources specifically:
- Financial constraints/limited financial resources
- 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
 2nd Level Assessment
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.
 2nd Level Assessment
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 :
- Physical/psychological consequences
- Financial consequences
- Social consequences
 2nd Level Assessment
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
- Cost constrains
- Physical inaccessibility
H. Lack of or inadequate family resources, specifically
- Manpower resources, e.g. baby sitter
- 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.
 2nd Level Assessment
J.Negative attitude/ philosophy in life which hinders
effective/maximum utilization of community resources for
health care
K. Others, specify
 General Information on FNCP
1. Do thorough initial data base (basis for health problem
identification)
2. On top of your daily journals, do include journals of family’s
eating, sleeping pattern, etc. to be used as evidences
3. Prioritize health problems accordingly
4. 1st and 2nd level assessment must be based on youridentified
health problem
5. The goal of care should addressed the 1st level assessment or the
identified health problem
6. The objectives of care should addressed the 2nd level assessment,
and/or answer “HOW” will you achieve your goal of care
 General Information on FNCP
- preferably the objectives of care should touch the knowledge, skills
and attitudes/practices of the patient and family
7. Intervention Plan is subdivided into:
a. Nursing interventions - should answer “HOW” will you achieve
your objectives of care
- preferably the nursing intervention should also touch the
knowledge, skills and attitudes/practices of the patient and family
b. Methods of Nurse - Family contact
- initial home visit /first contact – survey/interview
- second home visit – nursing interventions
- third home visit – evaluation phase and farewell
 General Information on FNCP
c. Resources required: 3M’s (Money, Manpower, Materials)

8. Evaluation should addressed if the goal is:

- FULLY MET
- PARTIALLY MET
- NOT MET
- state/indicate reason/s, and/or indications/ evidences for each
 InterventionPlan
Health Problem
Family Nursing Evalu
Identified Goal of Care Objective/s Nursing Interventions Method 0f Nurse- Resources
Problem ation
Assessment Family Contact Required/
Used
Inadequate Within 3 Within 3 weeks of The PHN will: a. Clinical Visit a. Materials Withi
Low Gestational weight for a weeks of nursing intervention, -August 22,2019 1. PHN Bag n3
Weight as Health pregnant woman nursing the family will: 1. Establish rapport. 2. Initial Database week
Threat in the 2nd intervention, b. Home Visit 3. Ballpen s of
trimester. the client will a. Learn the 2. Explain to the 1. First Home Visit – 4. IEC (see annex nursi
Subjective Data: be able to gain importance of weight client about August 22,2019 E) ng
Lack of at least 1-2 kg. gain in pregnancy. Gestational weight interv
“Ay yung timbang, knowledge about gain both normal and 2. Second Home Visit b. Manpower entio
hindi ko chinecneck proper food b. Enumerate foods abnormal and its – August 23,2019 1. Francisco n, the
yun, ngayon lang din intake. that are essential in possible outcomes. Health Center, client
nung nagpacheck up gaining weight . 3. Third Home Visit – Caloocan City gaine
ako ngayon.” 3. Discuss to the August 2. BSN 2Y1 – 1 d 2 kg
c. Comply in the family the 29,2019 Group 1A from
Sabi sakin ng midwife necessary tasks that is importance of foods 3. Clinical 49 kg
kulang daw ako sa essential in gaining that should be taken 4. Fourth Home Visit Instructor: Mrs. to 51
timbang kaya kumain weight . and to avoid. – August 30,2019 Maria Belinda P. kg as
daw ako ng mabuti Castaneda of
para mahabol ko 4. Instruct the family 5. Fifth Home Visit – 4. Relox Family Septe
daw.” about proper September 5,2019 mber
preparation of food 5,201
Objective Data: to decrease risk of 6.Farewell Home Visit 9
Temp: 36 ◦C contamination – September 6,2019
PR : 95 bpm
RR: 19 bpm 5. Encourage the
BP: 100/70 mmHg pregnant woman to
Age:20 always check and
Pre-Pregnant monitor weight gain
 Helpful links
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/typology-nursing-
problems-family-nursing-practice/

https://www.scribd.com/document/119768916/Typology-of-Nursing-Problems-in-Family-
Nursing-Practice

https://www.scribd.com/doc/50667976/First-Level-and-Second-Level-Assessment