Definition and Concepts

Nursing assessment - first major phase

“This involves a set of actions by which the nurse
measures the status of the family as a client, its ability
to maintain itself as a system and functioning unit, its
ability to maintain wellness, prevent, control or
resolve problems in order to achieve health and well-
being among its members”
It also includes data collection, data analysis or
interpretation and problem definition or nursing
diagnosis.

Home
Two major types of nursing assessment in the family
nursing practice
 (1) First level assessment a process whereby
existing and potential health conditions or
problems of the family are determined.
 (2) Second level assessment 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.
 •Recognize Need to Use Data based on Evidence
•Ensure Accuracy and Reliability of Data
•Check for Inconsistencies
•Complete Missing Information

DATA COLLECTION HEALTH CONDITIONS /

Framework: Use an Organized and Comprehensive Approach to PROBLEMS AND
Assessment
FAMILY NURSING
First-level – Data on Status/ Condition of: DIAGNOSES
DATA ANALYSIS
•Family/Household Members
•Home and Environment First-level Assessment:
• Sort Data
Define the Health
Second-level – Data on Family’s Assumption of Health Tasks on Conditions/ Problems
each Health Condition/Problem identified in first-level • Cluster/ Group
(categorized as: wellness
assessment Related Data
states, health deficits,
health threats,
Methods/Sources: • Distinguish Relevant
foreseeable crises or
First-level Assessment from Irrelevant Data
stress points)
• Health Status of Family/ Household Member: • Identify Patterns
• Health Assessment “IPPA” Second-level Assessment:
(e.g., function,
• Laboratory/ Diagnostic Test Results Define the Family
behavior, lifestyle)
• Records/Reports Immunization Nursing Problems/
Diagnoses as Statements
• Home and Environment •Compare Patterns
of:
• Observation/ Ocular Survey with Norms or
•Interview Standards
Family’s Inability to
• Laboratory/ Diagnostic Test Results Perform Health Tasks
• Records/ Reports • Interpret Results
on each Health
Second-level Assessment: Condition/ Problem
• Make Inferences/
• In-depth Interview on Realities/Perceptions about and Attitudes specifying the Barriers
Draw Conclusions
towards Assumption/ Performance of Health Tasks to Performance or
• Observation: Relate Verbal with Non-verbal Cues Reasons for Non-
performance of Family
Health Tasks

Continuous Data Validation/ Update for Adequacy of Evidence to Support Diagnosis

Steps in Family Nursing Assessment
Data collection for first level assessment involves
gathering of five types of data which will generate the
categories of health conditions or problems of the family.
These data include:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance
and disease prevention
 Second level assessment data 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.
Data Collection
The nurse is concerned about two important things to
ensure effective and efficient data collection in family
nursing practice. Firstly, she has to identify the types
or kinds of data needed. Secondly, she needs to specify
the methods of data-gathering and the necessary tools
to collect such data.
Initial Data Base for Family Nursing Practice
A. Family Structure, Characteristics, and Dynamics
1. Members of the household and relationship to the head
of the family
2. Demographic data – age, sex, civil status, position in the
family
3. Place of residence of each member – whether living with
the family or elsewhere
4. Type of family structure – e.g. matriarchal or patriarchal,
nuclear or extended
5. Dominant family members in terms of decision-making,
especially in matters of health care
6. General family relationship/dynamics – presence of any
obvious/readily observable conflict between members;
characteristic communication/interaction patterns
among members
B. Socio-economic and Cultural Characteristics

1. Income and Expenses

a. Occupation, place of work and income of each working
member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2.Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant Others – role(s) they play in family’s life
5. Relationship of the family to larger community – Nature and
extent of participation of the family in community activities
C. Home and Environment
1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of diseases
(e.g. mosquitoes, roaches, flies, rodents, etc.
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply – source, ownership, potability
g. Toilet facility – type, ownership, sanitary condition
h. Garbage/refuse disposal – type, sanitary condition
i. Drainage system – type, sanitary condition
2. Kind of neighborhood, e.g., congested, slum, etc.
3. Social and health facilities available
4. Communication and transportation facilities available
D.Health Status of each Family Member
1. Medical and nursing history indicating current or past significant
illnesses or beliefs and practices conducive to health and illness
2. Nutritional assessment (specially for vulnerable or at-risk
members)
a. Anthropometric data: Measures of nutritional status of
children – weight, height, mid-upper arm circumference; Risk
assessment measures for Obesity: body mass index (BMI =
weight in kgs. divided by height in meters2), waist
circumference (WC: greater than 90cm. in men and greater
than 80cm. in women), waist hip ration (WHR = waist
circumference in cm. divided by hip circumference in cm.
Central Obesity: WHR equal to or greater than 1.0cm. in men
and 0.85 in women)
b. Dietary history specifying quality and quantity of
food/nutrient intake per day
c. Eating/feeding habits/practices
3. Developmental assessment of infants, toddlers, and
preschoolers – e.g., Metro Manila Developmental
Screening Test (MMDST)
4. Risk factor assessment indicating presence of major
and contributing modifiable risk factors for specific
lifestyle diseases – e.g. hypertension, physical
inactivity, sedentary lifestyle, cigarette/tobacco
smoking, elevated blood lipids/cholesterol, obesity,
diabetes mellitus, inadequate fiber intake, stress,
alcohol drinking and other substance abuse
5. Physical assessment indicating presence of illness
state/s (diagnosed or undiagnosed by medical
practitioners)
6. Results of laboratory/diagnostic and other screening
procedures supportive or assessment findings.
F. Values, Habits, Practices on Health Promotion
Maintenance and Disease Prevention. Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
a. Rest and sleep
b. Exercise/activities
c. Use of protective measures – e.g. adequate
footwear in parasite-infested areas; use of
bednets and protective clothing in malaria and
filariasis endemic areas
d. Relaxation and other stress management
activities
4. Use of promotive-preventive health services
Data gathering Methods and Tools
1. Observation
a. Communication and interaction patterns expected, used,
and tolerated by family members.
b. Role perceptions/task assumptions by each member,
including decision-making patterns, and
c. Conditions in the home and environment
2. Physical Examination
a. Inspection
b. Palpation
c. Percussion
d. auscultation
3. Interview
4. Record Review
5. Laboratory/Diagnostic Tests
Data Analysis

Sorts out and classifies or groups data by type or nature (e.g.,

which are wellness states, threats, deficits or stress
points/foreseeable crises). She relates them with each other
and determines patterns or reoccurring themes among the
data. She then compares these data and the patterns or
recurring themes with norms or standards
 In order to achieve wellness among its members
and reduce or eliminate health problems, the standard
or norm of the family as a functioning unit involves
the ability to perform the following health tasks:
1. Recognize the presence of a wellness stae or health
condition or problem;
2. Make decisions about taking appropriate health
action to maintain wellness or manage the health
problem;
3. Provide nursing care to the sick, disabled,
dependent or at-risk members;
4. Maintain a home environment conducive to health
maintenance and personal development; and,
5. Utilize community resources for health care.
4 TH LECTURE
NURSING DIAGNOSES: FAMILY NURSING PROBLEMS
A wellness condition is a nursing judgment related
with the client’s capability for wellness. A health
condition or problem is a situation which
interferes with the promotion and/or
maintenance of health and recovery from illness
or injury. A wellness state or health
condition/problem becomes a nursing problem
when it is stated as the family’s failure to perform
adequately specific health tasks to enhance the
wellness state or manage the health problem.
This is called the nursing diagnosis in family
nursing practice
 One of the major barriers to the effective
operationalization and application of the nursing
process in family health care is the absence of a
classification system for nursing problems that
reflect the family status and capabilities as a
functioning unit. To facilitate the process of
defining family nursing problems, a classification
system of family nursing problems was developed
and field-tested in 1978. this tool, called A Typology
of Nursing Problems in Family Nursing Practice
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 (NANDA, 2001). Wellness
potential is a nursing judgment on wellness state or condition based on
client’s performance, current competencies or clinical data but no explicit
expression of client desire. Readiness for enhanced wellness state is a
nursing judgment on wellness state or condition based on client’s current
competencies or performance, clinical data and explicit expression of
desire to achieve a higher level of state or function in a specific area on
health promotion and maintenance.
Example of these are the following:
A. Potential for Enhanced Capability for:
1. Healthy Lifestyle – e.g., nutrition/diet, exercise/activity
2. Health Maintenance/Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well-being – process of a client’s developing/
unfolding of mystery through harmonious interconnectedness
that comes from inner strength/sacred source/God (NANDA
2001)

B. Readiness for Enhanced Capability for:

1. Healthy Lifestyle
2. Health Maintenance/Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well-being
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 these are the following:
A. Presence of risk factors of specific diseases (e.g.
lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from a communicable
disease case
C. Family size beyond what family resources can
adequately provide
D. Accident hazards, specify:
1. Broken stairs
2. Pointed/sharp objects, poisons, and medicines
improperly kept
3. Fire hazards
4. Fall hazards
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 sites of vectors of diseases
(e.g. mosquitoes, flies, roaches, rodents, etc.)
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lighting and ventilation
9. Noise pollution
10. Air pollution

H. Unsanitary food handling and preparation

I. Unhealthful 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/inadequate relaxation acitivitiess
12. Non-use of self-protection measures (e.g. non-use
of bednets 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 a 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
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. 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 these 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
 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
II. Inability to make decisions with respect to taking appropriate
health action due to:
A. Failure to comprehend the natured/magnitude of the
problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation
brought about by perceived magnitude/severity of the
situation or problem, i.e., failure to break down 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. Inaccessibility of appropriate resources for care, specifically:
1. Physical inaccessibility
2. Cost 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
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 and extent of
nursing care needed
D. Lack of the necessary facilities, equipment and supplies for
care
E. Lack of or inadequate knowledge and skill in carrying ot
the necessary interventions/treatment/produce/care (e.g.,
complex therapeutic regimen or healthy lifestyle program)
F. Inadequate family resources for care, specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitations/lack of physical resources – e.g., isolation room
G. Significant person’s unexpressed feelings (e.g., hostility/anger,
guilt, fear/anxiety, despair, rejection) which disable 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 own concerns/interests
J. Prolonged disease or disability progression which exhausts
supportive capacity of family members
K. Altered role performance – specify:
1. Role denial or ambivalence
2. Roles strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
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.g. lack of space to construct facility
B. Failure to see benefits (specifically long-term ones) of
investment 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 patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude/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
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 workier
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/service
G. Inaccessibility of required care/service due to:
1. Cost constraints
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources
2. Financial resources
I. Feeling of alienation to/lack of support from the community
J. Negative attitude/philosophy in life which hinders effective/maximum
utilization of community resources for health care
Developing the Nursing Care Plan
THE FAMILY CARE PLAN
Formulation of the care plan is the next step in the nursing process
after assessment, when health and family nursing problems have been
clearly defined.

Definition
A family nursing care plan is the blueprint of the care that the nurse
designs to systematically minimize or eliminate the identified health
and family nursing problems through explicitly formulated outcomes
of care (goals and objectives) and deliberately chosen set of
interventions, resources and evaluation criteria, standards, methods
and tools.
Features
1. The nursing care plan focuses on actions which are
designed to solve or minimize existing problem.
2. The nursing care plan is a product of a deliberate
systematic process
3. The nursing care plan, as with all other plans,
relates to the future.
4. The nursing care plan is based upon identified
health and nursing problems
5. The nursing care plan is a means to an end, not an
end in itself.
6. Nursing care planning is a continuous process, not
a one-shot-deal
Desirable Qualities of a Nursing Care Plan

1. It should be based on clear, explicit definition of the

problem(s)

2. A good plan is realistic

3. The nursing care plan is prepared jointly with the family

4. The nursing care plan is most useful in written form

THE IMPORTANCE OF PLANNING CARE
1. They individualize care to clients
2. The nursing care plan helps in setting priorities by providing
information about the client as well as the nature of his problems
3. The nursing care plan promotes systematic communication among
those involved in the health care effort
4. Continuity of care is facilitated through the use of nursing care plans
5. Nursing care plans facilitate the coordination of care by making
known to other members of the health team what the nurse is doing
STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN
1. List of health condition or problems prioritized according to the
nature, modifiability, preventive potential and salience

2. Formulation of goals and objectives of nursing care

3. Selection of appropriate nursing interventions.

4. Development of the evaluation plan

Prioritize the Health
Conditions and Problems
based on:
• Nature of Condition or
Problem
• Modifiability
• Preventive Potential
•Salience
Defines Goals and Objectives of
Care
Formulate:
• Expected Outcomes:
•Conditions to be observed to
show problem is prevented,
controlled, resolved or
eliminated
•Client response/s or behavior
• Specific, Measurable Client-
centered Statements/Competencies
Develop the Evaluation Plan
Specify:
• Criteria/Outcomes Based on Objectives of Care
• Methods/Tools
Develop the Intervention Plan
 Decide on:
o Measures to help family eliminate:
 Barriers to performance of
health tasks
 Underlying cause/s of non-
performance of health tasks
o Family-centered alternatives to
recognize/detect, monitor, control
or manage health condition or
problems
 Determine Methods of Nurse-Family
Contact
 Specify Resources Needed
4 th SKILLS
PRIORITIZING HEALTH PROBLEMS
Bailon and Maglaya devised a tool called SCALE FOR
RANKING FAMILY HEALTH CONDITIONS AND
PROBLEMS ACCORDING TO PRIORITIES. This tool
aims to objectivize priority setting. There are four criteria
for determining priorities among health condition or
problems. These includes:
1. Nature of the condition or problem presented –
categorized into wellness state/potential, health threat,
health deficit and foreseeable crisis;
2. Modifiability of the condition or problem – refers to the
probability of success in enhancing the wellness state,
improving the condition, minimizing, alleviating or totally
eradicating the problem through intervention;
3. Preventive potential - refers to the nature and
magnitude of future problems that can be
minimized or totally prevented if intervention is
done on the problem under consideration;
4. Salience - refers to the family’s perception and
evaluation of the problem in terms of seriousness and
urgency of attention needed or family readiness.
TABLE 4. SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS
ACCORDING TO PRIORITIES
Criteria Weight
1. Nature of the condition or problem presented 1
Scale **: Wellness state 3
Health deficit 3
Health threat 2
Forseeable 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, 2
needing immediate
attention

A condition or problem not 1

needing immediate
attention

Not perceived as a 0
problem or condition
needing change
Scoring
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 / Highest Score) x Weight
3) Sum up the scores for all the criteria. The highest score is 5, equivalent to the
total weight
Factors Affecting Priority Setting
 Modifiability
1. Current knowledge, technology, and interventions to
enhance the wellness state or manage the problem
2. Resources of the family – physical, financial and
manpower
3. Resources of the nurse – knowledge, skills and time
4. Resources of the community – facilities and
community organization or support
Factors Affecting Priority Setting
 Preventive Potential
1. Gravity or severityof the problem – refers to the progress of the
disease/problem indicating extent of damage on the patient/family; also
indicates the prognosis, reversibility or modifiabilty of the problem. In
general, the more severe or advanced the problem is the lower is the
preventive potential of the problem
2.Duration of the problem – refers to the length of the problem has been
existing, duration has also a direct relationship to preventive potential
3. Current management – refers to the presence and appropriateness of
intervention measures
4. Exposure of any vulnerable or high risk group 0 increases the
preventive potential of a condition or problem
Malnutrition

Criteria Computation Actual Justification

Score
1. Nature of the 3/3 x 1 1 It is a health deficit that requires
Problem immediate management to eliminate
untoward consequences
2. Modifiability of 2/2 x 2 2
the Problem The problem is easily modifiable since
the nurse’s resources are available; she
can help the family on effective
budgeting of money and scheduling of
time; she can develop the skills of other
members to achieve good nutrition-
proper food selection and preparation,
and feeding practices.

3. Preventive 3/3 x 1 1 Susceptibility to other diseases and

Potential infections can be prevented if
malnutrition is eliminated; normal growth
and development can thus be achieved.

4. Salience of the 0/2 x 1 0 It is not a felt problems

Problem
Total Score 4
 Criteria Computation Actual Justification
Score
1. Nature of the 3/3 x 1 1 It is health deficit that requires
Problem immediate attention and adequate
management to reduce likelihood of
transfer of the disease to the rest of the
family members
2. Modifiability of 1/2 x 2 1 The family does not have adequate
the Problem resources to solve the problem.
Inadequacy of living space and water
supply are barriers to achievement of
good personal hygiene, which is
important in the management and
prevention of scabies
3. Preventive 3/3 x 1 1 Transferability of scabies to other family
Potential members is reduced or eliminated if the
problem is managed adequately as
soon as possible
4. Salience of the 1/1 x 1 1 The family recognizes it as a problem. It
Problem consulted the health personnel a month
ago. However, it does not see the
problem as needing immediate action
Total Score 4
FORMULATION OF GOALS AND OBJECTIVES OF CARE
Goal – is a general statement of the condition or state to be brought about
by specific courses of action

A cardinal principle in goal setting states that goals must be set jointly
with the family

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 a health condition or
problem but is too busy at the moment with other concerns and
preoccupations
3. Sometimes the family perceives the existence of a problem but does
not see it as serious enough to warrant attention
4. The family may perceive the presence of the problem and the
need to take action
a. Fear of consequence(s) of taking
b. Respect for tradition
c. Failure to perceive the benefits of action proposed
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 failure to develop a working relationship

Objectives refer to more specific statements of the desired results

or outcomes of care. Goals tell where the family is going;
objectives are the milestones to reach the destination
1. Short-term or immediate objectives
2. Long-term or ultimate objectives
3. Medium-term or intermediate objectives
DEVELOPING THE INTERVENTION PLAN
General directions
1. Analyze with the Family the Current Situation and Determine
Choices and Possibilities based on a Lived Experience of
Meanings and Concerns.
2. Develop/enhance Family’s Competencies as Thinker, Doer and
Feeler
3. Focus on Interventions to Help Perform the Health Tasks
a. Health the Family Recognize the Problem.
b. Guide the Family on How to Decide on Appropriate Health
Actions to Take
c. Develop the Family’s Ability and Commitment to Provide
Nursing Care to its Members
 Contracting is creative intervention that can maximize
opportunities to develop the ability and commitment of the
family to provide nursing care to its members
d. Enhance the Capability of the Family to Provide a Home
Environment Conducive to Health maintenance and
Personal Development
e. Facilitate the Family’s Capability to Utilize Community
Resources for Health Care

Motivation leads the family to desire and agree to undergo

the behavior change or proposed measure and take the
initial action to bring about the change

Support any experience or information that maintains,

restores or enhances the capabilities or resources of the
family to sustain these actions and complete the change
process
Criteria for Selecting the Type of Nurse-Family Contact
Effectively, efficiency, and appropriateness are major criteria for
selecting the type of family-nurse contact.

 Clinic or office conference

 Telephone conference
 Written communication
 School visit or conference
 Industrial plant
 Job site visit
IMPLEMENTING THE NURSING
CARE PLAN
During the implementation phase, the nurse encounters the realities in
family nursing practice which can motivate her to try out creative
innovations or overwhelm her to frustration or inaction.

IMPLEMENTATION PHASE: A PHENOMENOLOGICAL EXPERIENCE

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
EXPERT CARING: METHODS AND POSSIBILITIES
Expert caring is developing the capability of the family for
“engaged care”, through the nurse’s skilled practice, the family
learns to choose and carry out the best possibilities of caring
given the meanings, concerns, emotions and resources (skills
and equipment) as experienced in the situation.

3 methods
1. Performance-focused Learning through Competency-based
Teaching
2. Maximizing Caring Possibilities for Personal and Professional
Development
3. Reflective Practice
A. COMPETENCY – BASED TEACHING

Competencies include the cognitive (knowledge), psychomotor,

(skills), and attitudinal or affective (emotions, feelings, values)
1. Learning is an Intellectual and Emotional Process
a. Provide Information to Shape Attitudes
b. Providing Experiential Learning Activities to Shape
Attitudes
c. Providing Examples or Models to Shape Attitudes
d. Providing Opportunities for Small Group Discussion
to Shape Attitudes
e. Role-playing Exercises
f. Explore the Benefits of Power of Silence
2. Learning is facilitated when experiences have meaning
to the learner
a. Analyze and process with family members all teaching-learning
based on their grasp of the lived experience of the situation in
terms of its meaning for the self.
b. Involve the family actively in determining areas for teaching-
learning based on the health tasks that members need to perform
c. Use examples or illustrations that the family is familiear with.
3. Learning is an individual Matter: Ensure Mastery of
Competencies for Sustained Actions
a. Make the learning active by providing opportunities for the
family to do specific activities, answer questions or apply
learning in solving problems
b. Ensure clarity in teaching. Use workds, examples, visual
materials and handouts that the family can understand.
c. Ensure adequate evaluation, feedback, monitoring and
support for sustained action.
a) Explaining well how the family is doing;
b) Giving the necessary affirmations or reassurances
c) Explaining how the skill can be improved; and,
d) Exploring with the family how modifications can be carried
out to minimize situated possibilities or best options
available to the family
B. MAXIMIZING CARING POSSIBILITIES
Caring the real essence of nursing
Philosophy and commitment are ingredients of effective nursing
practice of the family’s faulty comprehension or non-acceptance
of conditions
1. The family’s information may be inadequate or inaccurate
consequently it may not see or see only a part of the problem
2. The family has the necessary information but fails to relate
them to the problem situation
3. The family is not willing to face the reality of the situation
4. The members may not be willing to oppose family, peer or
social pressures.
5. There may be adherence to patterned behavior
6. There is failure to relate the needed action to family goals
7. There is lack of confidence in the action proposed
Causes of inappropriate choice of nursing interventions
1. Tendency of the nurse to use patterned or “canned”
approaches in working with families
2. Inadequate appreciation of social and cultural
factors
3. Inadequate or limited repertoire of intervention
techniques and skills
Rosenstock’s three principles of motivation
1. Preventive or therapeutic behavior
2. Behavior emerges out of frequent conflict among motives and
among courses of action
3. Health-related motives may not always give rise to health-
related behavior

C. EXPERTISE THROUGH REFLECTIVE PRACTICE

1. Reflection-in-action means to think what one is doing while
one is doing it.
2. Reflection-on-action involves reviewing or re-evaluating
one’s actions to:
a. Relate what one has learned from this experience to her existing
knowledge structures;
b. Mentally test her new understandings in new contexts
c. Make the knowledge gained her own tools for critical thinking and expert
caring
Using Parse’s Theory of Human Becoming as a guide, the nurse
learns to understand fully the client’s responses, feelings, and
perceptions
 Reflective Practice

Implementation Phase

Reflection-in-Action Reflection-on-Action

1. What am I trying to achieve in this 1. How do I feel about what happened?

experience? 2. Have I fully understood the client’s reality or
2. How am I feeling at the moment? responses to the health-illness experience?
3. How is my client responding to this 3. How did my actions match my
experience/situation? beliefs/values
4. What are my client’s 4. What other possible options can I pursue to
concerns/feelings/needs in this here-and- improve on how I can understand the
now experience? client’s concerns, needs, feelings and
5. Am I addressing these concerns, feelings, potentials? How can I use these options to
and needs appropriately? improve my capability to help the client
6. How can I work with my client to transform transcend to a higher level of state or
this here-and-now experience to the client’s functioning?
best possible higher level of state or 5. What would be the consequences of
functioning? alternative actions for the family? Myself?
7. How might I do things differently to achieve 6. How has this experience changed my ways
the expected outcomes more efficiently? of knowing about: (a) this client; (b) myself
as a person and as a nurse/change agent?