FAMILY NURSING PROCESS

Is a systematic approach to assess the health needs,

analyze, identify health problems and their solutions by
using the Family Nursing Care Plan as applied to the family
in the community
 Family Nursing Care Plan (FNCP)

Is defined as a guide or framework of nursing care

designed to provide ways in solving health-related
problems of the family as a whole.
STEPS OF FAMILY NURSING CARE PLAN (FNCP)

Assessment
Diagnosis
Planning
Implementations/ Interventions
Evaluation
 Happens on the
first and
succeeding home
visits. Making
objective
observation can
be coupled with
subjective
statements by
each family
member.
✓Identify both
actual and
potential client
health
problem/s

✓ Prioritization
must be
applied.
✓ Formulation of goals
and objectives.

✓ Encourage and
permit client’s to
make their own
health management
decisions.
 ✓ Objective/s must be
the guidelines in
making nursing
interventions including
health teachings,
coordinates and uses
referrals and resources,

provides and monitors all levels of technical care or skills

(BP taking and wound care etc.)
 ✓Determining step
whether the
EVALUATION goals and
objectives have
been met or not.

✓ Documentation
of care given and
the client’s
progress toward
goal
achievement.
 ✓ A tool to facilitate the process of
defining family health nursing
problems, a classification system of
family health nursing problems.
✓ it utilizes Family Nursing Assessment
 ✓ It involves a set of actions
FAMILY by which the nurse
NURSING determines the status of
ASSESSMENT the family as a client, the
ability to maintain
wellness, prevent, control
or resolve problems in
order to achieve health
and well being among its
members.

✓ Includes data collection,

data analysis, formulation
of family nursing
diagnosis.
 ❖2 Types of Family Nursing Assessment
I. First Level Assessment II. Second Level Assessment

✓ Identifies the nature or

✓ The process of determining type of nursing problems
existing and potential the family experiences in
health conditions or the performance of their
problems of the family. health tasks with respect
to a certain health
condition or health
problem.
✓ It specified the measures
that the family did NOT
DO due to INABILITY.
 FIRST LEVEL ASSESSMENT
CATEGORIES OF HEALTH CONDITIONS/
NATURE OF THE PROBLEMS:

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.
Example of Wellness Condition:

A. Wellness Potential – is a nursing judgment

on wellness state but NO EXPLICIT
EXPRESSION of client desire.

B. Readiness for enhanced wellness state – is

a judgment on wellness state based on current
competencies and performance, clinical data and
explicit expression of desire to achieve higher
level of functioning or state.
Health Threats
II. Presence of Health Threats

➢are conditions that are conducive to disease,

accident or failure.

➢Examples: Family size beyond family resources

can adequately provide, Faulty/Unhealthy Nutritional
Habit, Accident/Fire Hazards, Poor
Home/environmental Condition/Sanitation,
Unsanitary Food Handling and Preparation,
Unhealthy Lifestyle and Personal Habits
Health Deficits
III. Presence of Health Deficits

➢are instances of failure in health

maintenance

➢Examples: Illness states, regardless of

whether is diagnosed or undiagnosed,
Failure to Thrive/ Develop according to
normal rate, Disability
Foreseeable
Crisis
IV. Presence of Stress Points/ Foreseeable Crisis
Situations

➢are anticipated periods of unusual demand on the

individual or family in terms of adjustment/ family
resources.

➢ Examples: Marriage, Pregnancy, Parenthood, Loss

of Job, Entrance at school, Chronic Illness,
Hospitalization, Death of a family member,
Resettlement in a new community
 SECOND LEVEL ASSESSMENT
1. Inability to recognize the presence of the
condition or problem
2. Inability to make decisions with respect to
taking the appropriate health action
3. Inability to provide nursing care to the sick,
disabled, dependent or vulnerable/ at-risk
member of the family
4. Inability to provide a home environment
conducive to health maintenance and
personal development.
5. Inability to utilize community resources for
health care.
1. Inability to recognize the presence of the condition or
problem related 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 _________
2. Inability to make decisions with respect to taking the
appropriate health action related 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 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:
Social consequences
Economic consequences
Physical consequences
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:
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._________
3. Inability to provide nursing care to the sick, disabled,
dependent or vulnerable/ at-risk member of the family
related 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:
Absence of responsible member
Financial constraints
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.
Role denials or ambivalence, Role strain, Role dissatisfaction, Role
conflict, Role confusion, Role overload
L. Others. Specify._________
4. Inability to provide a home environment conducive to
health maintenance and personal development related
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
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 adequate competencies in relating to each
other for mutual growth and maturation
Example: 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._________
5. Inability to utilize community resources for health care
related 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
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
Cost constraints
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.
J. Negative attitude/ philosophy in life which hinders
effective/maximum utilization of community resources for
health care
K. Others, specify __________
 I. PROBLEM LIST

Health condition/ Supporting Data/ Family Nursing

problem Cues Problem

1. Presence of Health Spread of scabies among Presence of poor lifestyle and

Threats: family members that started personal habits as a health
Unhealthy lifestyle with one family member only threat:
practices and personal 1. Inability to provide a
habits specifically home environment conducive
poor personal hygiene. to health maintenance and
contracting the disease and
treatment.
 II. PROBLEM LIST
Health condition/ Supporting Data/
problem Cues
2. Presence of health The head of the family
deficits: Scabies verbalized,“Lima na kabulan na
ga antos kami sg ka katol bag-o
na check sg doctor”
Presence of scabies among all
family members
Family Nursing
Problem
Presence of scabies as a health
deficit:
1. Inability to decide about
making appropriate health
action due to failure to
comprehend the magnitude of
the problem.
2. Inability to provide adequate
nursing care to the sick
members of the family due to
lack of knowledge about the
disease 'nature, severity,
complication, prognosis and
management.
 III. PROBLEM LIST

Health condition/ Supporting Data/ Family Nursing

problem Cues Problem

Presence of health threat:

3. Presence of Health - Father is a Pedicab driver family size beyond
Threats: Family size - earns P200/day what family
beyond what family - With 6 school-aged resources can adequately
resources can adequately children provide R/T inability to
provide provide a home environment
conducive to health
maintenance and personal
development due to a limited
financial resources.
 ❖ FAMILY NURSING CARE PLAN (FNCP)
FAMILY GOALS/ NURSING
NURSING OBJECTIVES OF INTERVENTION EVALUATION
DIAGNOSIS NURSING CARE

Presence of a 1. Assess the Goal partially met.

health threat: poor After nursing family’s level of After _ weeks of
understanding nursing
home and intervention regarding the intervention the
environmental the family will problem family
sanitation R/T be able to: Identified. demonstrated
inability to identify the 2.Establish proper method of
rapport from the waste disposal.
recognize the different ways family.
presence of the of proper 3.Demonstrate
condition or disposal of proper ways on
problem due to garbage how to segregate
waste
lack of knowledge 4. Encourage
family to clean
their surroundings
Objective Cues:
▪ Garbage
 EXAMPLE OF HEALTH PROBLEMS:
• Improper Waste Disposal
• Poor Personal Hygiene
• Presence of Fire Hazards
• Alcoholic drinking
• Cigarette Smoking
• Nutritional Imbalance
• Improper Food Handling
• Poor Water Supply or No Potable Water Supply
• Poor Toilet Facility
• Inadequacy of living space
• Presence of breeding or resting sites of vectors of
diseases
• Family size beyond what family resources
SCALE FOR RANKING FAMILY HEALTH
CONDITONS/ PROBLEMS ACCORDING TO
PRIORITIES:
 PRIORITIZING HEALTH PROBLEMS
1. Nature of the Problem ✓ Categorized into HD, HT, FC
2. Modifiability of the problem ✓ Refers to the probability of success in
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 problems in terms of
seriousness and urgency of attention
needed.
 Criteria Score Weight
I. Nature of the condition
❑ Health Deficit (HD) 3
❑ Health Threat (HT) 2 1
❑ Foreseeable Crisis (FC) 1

II. Modifiability of the condition

❑Easily Modifiable 2
❑Partially modifiable 1 2
❑ Not modifiable 0

III. Preventive Potential

❑High 3
❑Moderate 2 1
❑Low 1

IV. Salience of the Problem

❑Problem needing immediate attention 2
❑Problem not needing immediate attention 1 1
❑Not perceived as problem needing change 0
 SCORING:
1. Decide on a score for each of the criteria

2. Divide the score of the highest possible

score and multiply by the weight
Formula : SCORE/HIGHEST SCORE X WEIGHT

3. Sum up the score for all the criteria the highest

score is equivalent to the total weight.
 Scale for Ranking Health Conditions According to Priorities:
1. Unhealthy lifestyle practices and personal habits
specifically poor personal hygiene
Criteria Computation Actual Score Justification

Nature of the 2/3X1 0.6 It is a health threat

Problem does not demand
immediate action
Modifiability of the 2/2X2 2 The resources and
Problem interventions needed
to solve the problem
are available to the
family.

Preventive Potential 3/3X1 1 Occurrence of

diseases can be
prevented if proper
personal hygiene will
be practiced
Salience 0/2X1 0 The family does not
recognize it as a
problem.
TOTAL SCORE: 3.6
 Scale for Ranking Health Conditions According to Priorities:
2. Presence of Scabies
Criteria Computation Actual Score Justification

Nature of the 3/3X1 1 It is a health deficit

Problem that requires
immediate attention
& management to
minimize
transmission
Modifiability of the 1/2X2 1 The family lack
Problem resources to solve
the problem.
Preventive Potential 3/3X1 1 Aggravation of
scabies can be
reduced or
eliminated if
managed as soon as
possible
Salience 0/2X1 0 The family does not
recognize it as a
problem.
TOTAL SCORE: 3
 Scale for Ranking Health Conditions According to Priorities:
3. Family size beyond what family resources
Criteria Computation Actual Score Justification

Nature of the 2/3X1 0.6 It is a health threat

Problem does not demand
immediate action.
Modifiability of the 1/2X2 1 Problem can be
Problem partially modified
due to inadequacy of
resources.
Preventive 3/3X1 1 Can be moderately
Potential prevented by
applying family
planning.

Salience 0/2X1 0 The family does not

recognize it as a
health threat.
TOTAL SCORE: 2.6
SCALE RANKING RESULT:
HEALTH
RANK CONDITION/ TOTAL SCORE
PROBLEM
Unhealthy lifestyle
1 practices and personal 3.6
habits specifically
poor personal hygiene

2 Presence of Scabies 3

3 Family size beyond what 2.6

family resources
 Criteria Incomplete Poor Fair Good
4pts. 6pts. 8pts. 10 pts.

Assessment Assessment portion Does not include all Includes all Includes all
is incomplete. pertinent data pertinent data pertinent data
related to nursing related to nursing related to nursing
diagnosis. May also diagnosis, but also diagnosis and does
include data that includes data not not include data that
does not relate to related to nursing is not related to
nursing diagnosis. diagnosis. nursing diagnosis.

Diagnosis Diagnosis portion is Diagnosis is not Diagnosis is Diagnosis is

incomplete. appropriate for appropriate for appropriate for
client and ordinal client and ordinal client and ordinal
level (first diagnosis, level. level. and diagnosis
second diagnosis also includes all
etc). parts and
. information is listed
in correct part of
diagnosis

Family Nursing Care Plan Rubric (50 Points)

 Criteria Incomplete Poor Fair Good
4pts. 6pts. 8pts. 10 pts.

Planning Goal portion is Goal statement is not Goal statement is client Goal statement is client
incomplete. client or family oriented or family oriented, and or family oriented, and
and may not have contains at least one contains two measurable
measurable criteria or a measurable criteria or a criteria and a target date
target date or time. target date/time. or time.

Implementation Interventions portion is Interventions portion Interventions portion Interventions portion

incomplete. does not include contains adequate contains adequate
adequate number of number of interventions number of interventions
interventions to help to help client/family to help client/family meet
client/family meet goal. meet goal. goal.

Evaluation Evaluations portion is Evaluation portion does Evaluation portion does Evaluation portion does
incomplete. not contain data that is contain data that is listed contain data that is listed
listed as criteria in goal as criteria in goal as criteria in goal
statement. May also not statement, but does not statement. Does describe
describe goal as met, describe goal as met, goal as met, partially met,
partially met, or not met. partially met, or not met. or not met. If goal was
May also not include May also not include partially met or not met,
Family Nursing Care Plan Rubric revision or new
evaluation date/time.
revision or new
evaluation date/time.
includes revision and/or
new evaluation date/time.