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CHN REVIEWER MIDTERMS the client meet psychological needs must

also be considered.
FAMILY AS CLIENT
The family is seems as the sum of
“Family as Basic Unit of the Society” individuals family members. The focus
THE FAMILY: A fundamental unit of is concentrated on each and every
society. A group of people of various individual as they affect the whole
ages who are usually related by birth, family.
marriage or adoption.
AS SYSTEM
Family is referred to a basic unit of the The focus is on the family as a client and
society and the social structure, the it is viewed as an international system in
precise definition of which can differ which the whole is more than the sum of
largely from time to time and from its parts. This approach focuses on the
culture to culture. How a society defines individual and family members become
family as a primary group, and the tasks the target for nursing interventions.
it expects from the families to perform,
are by no means continuous. AS COMPONENT OF SOCIETY
The family is seen as one of many
Relationship between Family & Society institutions in society, along with health,
The primary function of the family is to educational, religious, or economic
ensure the continuation of society, both institution. The family is a basic or
biologically through procreation, and primary unit of society, as are all the
socially through socialization. Given other units and they are all a part of the
these functions, the nature of one's role larger system of society.
in the family changes over time.
FAMILY SYSTEMS THEORY DEFINITION
Function of the Family The family systems theory suggests that
The family serves many functions for its a family functions as an emotional
members. Families and society affect system wherein each member plays a
each other in many ways. Society is specific role and must follow certain
strong when the families in it are strong. rules. Based on the roles within the
system, people are expected to interact
Level of Society with and respond to one another in a
Neighborhood certain way. Patterns develop within the
City system, and each member's behavior
Country impacts the other members in
State predictable ways.
TYPES (4)
THE EIGHT CONCEPTS OF FAMILY
SYSTEMS THEORY
AS CONTEXT
Although the nurse focuses the nursing
process on the individual’s health status, 1. Triangles
the nurse also assesses the extent to 2. Differentiation of Self
which the family provides the 3. Nuclear Family Emotional Process
individual’s basic needs. These needs 4. Family Projection Process
vary, depending on the individual’s 5. Multigenerational Transmission Process
development level and situation. 6. Emotional Cutoff
Because families provide more than just 7. Sibling Position
material essentials, their ability to help 8. Societal Emotional Process

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PROVIDER
Provides the family basic needs

NUCLEAR FAMILY EMOTIONAL PROCESS


PROBLEM-SOLVER
These four basic relationship patterns are: Resolves family problem to maintain
Marital Conflict: As family tension unity and solidarity.
increases, spouses will externalize the
anxiety they are feeling onto their HEALTH MANAGER
marital partner and their relationship. Monitor the health and ensures that
member return to health appointment.
Dysfunction in One Spouse: One spouse
will pressure another spouse to think or GATE KEEPER
act a certain way, exerting control over Determines what information will be
their partner. This change in another release from the family or what new
spouse’s behavior due to dysfunction in information can be introduced.
one spouse leads to a period of perceived
harmony, but if any family tension FAMILY HEALTH TASK
arises, the subordinate partner may
experience high levels of anxiety. 1. RECOGNIZING INTERRUPTION OF
HEALTH OR DEVELOPMENT
Impairment of One Or More Children: A
parent may focus all of their anxieties on 2. MAINTAINING A HOME
one or more of their children. They may ENVIRONMENT CONDUCTIVE TO
worry obsessively about the child, or GOOD HEALTH AND PERSONAL
have an unrealistically ideal or negative DEVELOPMENT
view of the child. The more a parent
focuses on the child, the more reactive 3. PROVIDING CARE TO ALL MEMBERS
and responsive the child becomes to the OF THE FAMILY
parent, limiting their differentiation of
self. This makes the child vulnerable to 4. SEEKING HEALTH CARE
internalize family tensions, which can
lead to problems like anxiety, 5. DEALING EFFECTIVELY HEALTH
depression, or poor performance in AND NON-HEALTH SITUATION
school.
CONCEPT OF FAMILY
Emotional Distance: Emotional
distance often occurs in tandem with
Psychological:
one of the other relationship patterns.
Composed of two or more people who
To avoid family tension, family members
are emotionally involved with each other
will distance themselves from one
and live in a close geographical
another to reduce the intensity of
proximity.
emotions that may arise from the
tension.
Sociological:
A social group characterized by common
FAMILY ROLES residence, economic cooperation and
reproduction. It includes both sexes, at
NURTURING FIGURE least two of who maintain and approve
Primary caregiver to children or any sexual relationship, and with one or
dependent member more children. ( Murdock, 1949)

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Communal family (two families with the same
facilities)

Gay (with gay parents and adopted children)

Biological:
Group of persons united by ties of
marriage, blood or adoption, FAMILY BY RESIDENCE
constituting a single household,
interacting and communicating with Patrilocal- requires the newlywed couple to
each other in their respective social roles live with the family of the groom or near the
of husband and wife, mother and father, residence of the parents of the groom.
son and daughter, brother and sister,
and creating and maintaining a common Matrilocal- requires the newlywed couple
culture. to live with or near the bride’s parents.

Filipino Family Bilocal- provides the newlywed couple the


choice of staying with either the groom’s or
Happiness is being with the family. bride’s parents.
The Filipino family is closely-knit, where
strong ties are maintained even after the Neolocal- permits the couple to reside
children have married. independently from their parents.
Faithfulness to the family is a tradition
that is characteristic of Filipino society. FAMILY BY DESCENT

TYPES OF FAMILY Patrilineal - affiliates a person with a group


of relatives through his/her father.
Nuclear family:
conjugal family or family of procreation Matrilineal- affiliates a person with a group
of relatives through his/her mother.
Extended family:
Grandparents, married offspring, and Bilateral- affiliates a person with a group of
grandchildren. relatives related through both his or her
parents.
Extended family or Three –generational
family FAMILY BY AUTHORITY

Childless family Patriarchal- authority is vested in the


oldest male in the family.
Single – parent family
Matriarchal- authority is vested in the
Grandparent-led family oldest female in the family.

Step – parent family Egalitarian- the husband and wife exercise


equal amount of authority.
Blended or reconstituted family (with children
from previous relationships) STAGES OF FAMILY DEVELOPMENT

Cohabiting / Live – in 1. Beginning Family


2. Early Childbearing

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3. Family with Pre-school Maintaining kin ties with older and
4. Family with School-age younger generations.
5. Family with Teens & young adults
6. Launching Center 8. Aging Family
7. Middle yrs. / post parental Family Coping with bereavement and living
8. Aging Family alone.
Closing the family home.
Adjusting to retirement.

1. Beginning Family
Establishing a mutually satisfying TETANUS TOXOID
relationship.
Adjusting to pregnancy and the promise
of parenthood.
Fitting into the kin network.

2. Early Childbearing
Having, adjusting to, and encouraging
the development of infants.
Establishing a satisfying home for both
parents and infants.

3. Family with Pre-school child


Adapting to the critical needs and
interests of preschool children in
stimulating and growth promoting
ways.
Coping with energy depletion and lack
of privacy as parents.

4. Family with School-age child


Fitting into the community of school-
aged families in constructive ways.
Encouraging children’s school Family Health Nursing Process
achievement.

5. Family with teenagers and young adults Rationales for focusing on the Family as
Balancing freedom with responsibility a Basic Unit of Care
as teenagers mature and emancipate 1. The family is considered the nature and
themselves. fundamental unit of society.
Establishing post-parental interests and
careers as growing parents. 2. The family as a group generate, prevent,
tolerate and correct health problem
6. Launching Center within its membership.
Releasing young adults into work,
military service, college and marriage 3. The health problems of family members
with appropriate rituals and assistance.
are interlocking.
Maintaining a supportive home base.
4. The family is the most frequent locus of
7. Middle years Family health decisions and actions in personal
Rebuilding the marriage relationship. care.
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5. The family is an effective and available
channel for much of the community
health nursing effort.

Family Health Nursing


Level of CHN practice directed or
focused on the family as a unit of care,
with health as the goal, and nursing as
the medium, channel or provider of care

Primary Concern of FHN


Develop and strengthen the F’s ability to
Cope Effectively with Health Problems.
Family Health Nursing Process
Nurse’s Roles in Family Health Nursing Deliberate and systematic set of actions
that standardizes the nurses approach in
1. Health Monitor an attempt to effect improvement in
2.Provider of Care to A Sick Family Member Family’s status and increase
3. Coordinator of Family Services capabilities to cope with health
4. Facilitator problems.
5. Teacher
6. Counselor

Family Health Tasks By Freeman:

1. Recognize the interruptions of health


development.
2. Making decisions about taking
appropriate actions to maintain wellness
or manage HLT problems.
3. Providing nursing care to the sick,
disabled and/or dependent members of
the family.
4. Maintaining a home environment
conducive to health maintenance and Family Assessment
personal development.
5. Maintaining a reciprocal relationship Nurse measures:
with the community and its institution. • Status of the family as a client.
6. Managing developmental or situational • Ability to maintain itself as a system and
crisis. a functioning unit.
7. Utilizing community resources for health • Ability to maintain wellness, prevent,
care. control or resolve problems.

Family Case Load


Number and kind of Families a nurse
handles at a given time.

Nursing Process

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Health and Nursing Problem
HP- Situation or condition that interferes with
promotion of health and recovery from illness
or injury.

NP- Situation or condition that interferes with


promotion of health and recovery from illness
or injury which is subject to modification
through nursing interventions.

2 Levels of Assessment
Data Gathering Tools In Family
Assessment 1St Level Assessment
1. Observation
2. Physical Examination • The Nurse collects the Initial
3. Interview
Data Base of the Family.
4. Record Review
5. Actual laboratory exam and findings
• Process whereby existing and
potential Health Problems of the
Steps in Family Assessment family are identified.

Data Analysis Family Structure Characteristics and


Dynamics
Sub-steps: Socio-economic and cultural
1. Sorting of data for broad categories. characteristics
2. Clustering of related cues to determine Home and environment
the relationships between and among Health status of each member
data. Values and practices on health
3. Distinguishing relevant from irrelevant promotion, maintenance and disease
data. prevention.
4. Identifying patterns.
5. Comparing patterns with norms or 2nd Level Assessment
standards. • The Nurse collects data that
6. Interpreting results of comparisons to reflects the extent to which the
determine categories of HLT problem. family can perform the health
7. Making inferences or draw conclusions tasks on each health problem.
about the reasons for the existence of
the health condition. • Process whereby existing and
Sort Data potential Nursing Problems of
Cluster related data the family are identified.
Distinguish relevant from irrelevant
Identify patterns • The family’s Perception of the problem.
Compare patterns with norms or standards • Decisions made and appropriateness.
Interpret results • Actions taken and results.
Make inference or draw conclusions • Effects of decisions and actions on other
family members.
SCDICIM

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○ Head of the Family : Pedro Iballa, 56 y/o,
widower

○ Mother: Rosalina Iballa, 53 y/o (deceased)

○ First child: Raul, 36 y/o, male, single

○ Second child:Renato, male (died when he


was only 11 months)

○ Third child: Marylin, 32 y/o, female, married

○ Fourth child: Marilou, 30 y/o, female,


married

○ Fifth child:Janet, 28 y/o, female, married


Categories of Nursing Problems
1. Inability to recognize the presence of the • Extended Family
condition or problem due to… • Both the head of the family and his wife
are involved in the decision-making, but
2. Inability to make decisions with respect when the wife died, the head of the
to making appropriate health actions family assumed all the decision-making
due to… process.
• Family relationship is still good despite
3. Inability to provide adequate nursing the death of the mother; the members of
care to the sick, disabled, dependent or the family have an open communication
vulnerable member of the family due with the head of the family.
to…
B. Socio-economic & Cultural
4. Inability to provide a home environment characteristics
conducive to health maintenance and • Head: Pedro Iballa, elementary
personal development due to… graduate, vendor of vegetables

5. Failure to utilize community resources • Mother: Elementary undergraduate


due to… (grade 5); deceased

Example of IDB • First child: College undergraduate (1st


yr college); unemployed
A. Family Structure, Characteristics and
Dynamics • Second child: Deceased

• Family is composed of nine (9) • Third child: College graduate


members. The father, four (4) children, (commerce); housewife
one (1) son in-law, and three (3)
grandchildren. Among the children, one • Fourth child: College undergraduate
(1) is already dead, the other one (1) is (3rd yr college); housewife
living within the family and the other
three (3) have their own families—(one • Fifth child: 2nd yr college at present
lives within the house and the other two (commerce)
have their own house).

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• The son in-law living within the house Drainage system
also contributes in the financial needs of Open drainage
the family.
Kind of Neighborhood
• Family income: Php 2,000 per month, The neighborhood is congested
and sometimes, it depends upon the
income of the head of the family from Social and health facilities available
selling vegetables at the market and There is a functional barangay health
from the contributions that the son in- center in their community.
law gives. When the services in the barangay
health center are inadequate, referral is
• All family members are Roman Catholic made for them to consult the RHU
physician.
C. Home and Environment
Housing Communication and transportation facilities
Adequacy of living space available.
• The house measures approximately 5m x 5m Pedicab and tricycle are available for
• There is an enough space for the living room transportation.
and dining area. Telephone is available at the sari-sari
• The house is composed of 2 rooms, the head store.
of the family and the first child (Raul) occupies
one room and the third child (Marylin) D. Health Status of Each Family Member
together with her 3 children and husband • Head of the family verbalized that he
occupies the second room. seldom experiences illness.
• The first child, Raul, often complains of
Presence of breeding or resting sites of back and stomach problems, but he is at
vectors of diseases good condition at present.
Flies and mosquitoes enters freely into
the house due to lack of screen on the • Nutritional assessment: They usually eat
door and windows fish and vegetables rather than meat and
There are empty open jars at the beef, and they seldom include fruits in
backyard, Presence of accident hazards their meals.
The house is made up of wood and nipa • Risk factor assessment: The head of the
that may predispose the members of the family is a moderate cigarette smoker and
family into accident (fire) is a chronic drinker for the past 12 years,
but at present, he limits these habits
Housing because he knows the bad effects that it
Food storage & cooking facilities could bring. (3 sticks/day; drinks alcohol
They are using Tupperware and plastic at least 2x a week)
containers for food storage
They use charcoal in cooking. E. Values, Habits, Practices on Health
Promotion
Water supply Immunization: All children had
Community owned deep well, potable completed the immunization.
Mother had the complete dose of
Toilet facility Tetanus Toxoid vaccine.
Water-sealed, owned by the family
Adequacy of:
Garbage/refuse disposal – Rest and sleep: adequate; they even
Their refuse are being burned at the have a time to take a nap in the
back of the house afternoon.
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– Exercise/activities: less activity and 3. Inability of provide nursing care to the
time for exercise. sick, disabled and dependent family
member due to..
– Use of protective measures: have 4. Inability to provide a home environment
adequate footwear in parasite- which is conducive to health
infested areas, lack of screen on the maintenance and personal development
door and windows, for protection due to..
against mosquitoes and insects but 5. Failure to utilize community resources
they use mosquito nets. for health care due to..

Whenever a family member is ill, they Example of Health Problem


would directly go to the health center for
initial assessment and if referral to the Presence of Health Threat
RHU is given, they would immediately
go there for check-up. Poor Home/Environmental
Condition/Sanitation
Formulation of Family/ Nursing
Problem Presence of breeding or resting sites of
vectors of diseases.
HEALTH PROBLEM- a situation or Cue: They have open drainage at the
condition that interferes with the back of their house. There have empty
promotion of health and/or open jars with water at their backyard.
maintenance and recovery from illness
or injury. Inadequate living space
Cue: There are only two bedrooms, and
NURSING PROBLEM- a situation or the size of one bedroom is inadequate to
condition which interferes with the accommodate five (5) members of the
promotion of health maintenance and family.
recovery from illness and injury and
which is subject to modification through Improper garbage/refuse disposal
nursing intervention. Cue: Their refuse are being burned at
the back of the house.
1st LEVEL OF ASSESSMENT
Presence of Health Threats
TYPOLOGY OF HEALTH PROBLEMS IN
FAMILY HEALTH CARE Accident Hazards
1. Wellness State
2. Health Threat Fire Hazards
3. Health Deficit Cue: The house is mainly made up of
4. Foreseeable Crisis / Stress Points nipa and wood and the spacing of the
neighbourhood house can predispose to
2nd LEVEL OF ASSESSMENT fire hazards.

TYPOLOGY OF NURSING PROBLEMS IN Broken stairs


FAMILY HEALTH CARE Cue: The stairs which is made up of
1. Inability to recognize the presence of the wood is broken.
problem due to..
2. Inability to make decisions with respect
to taking appropriate health actions due
to..

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Unhealthful Lifestyle and Personal
Habits/Practices B. Accident Hazards
1. Fire Hazards
Alcohol drinking and cigarette/tobacco » Inability to provide a home environment
smoking conducive to health maintenance and
Cue: The head of the family is a personal development due to inadequate
moderate cigarette smoker and is a family resources specifically:
chronic drinker for the past 12 yrs., but
at present, he limit these habits -- (3 -financial constraint
sticks/day; drinks alcohol at least 2x a -limited physical resources
week)
2. Broken stairs
Presence of Stress points » Inability to provide a home environment
conducive to health maintenance and
Parenthood personal development due to inadequate
Cue: Single parenting due to death of his family resources specifically:
wife.
-financial constraint
A.Poor Home/Environmental -limited physical resources
Condition/Sanitation
C. Unhealthful Lifestyle and Personal
1. Presence of breeding or resting sites of Habits/Practices
vectors of diseases.
1. Alcohol drinking and cigarette/tobacco
» Inability to provide a home environment smoking.
conducive to health maintenance and
personal development due to lack/ » Inability to make decisions with respect
inadequate knowledge of importance of to taking appropriate health action due
hygiene and sanitation. to failure to comprehend the
nature/magnitude of the
2. Inadequate living space problem/condition.

» Inability to provide a home environment Parenthood


conducive to health maintenance and » Inability to make decisions with respect
personal development due to inadequate to taking appropriate health action due
family resources specifically: to low salience of the problem/ due to
feeling of confusion, helplessness and/
-financial or resignation brought about by
-limited physical resources perceived severity of the problem.
3.Improper garbage/refuse
disposal.

» Inability to provide a home environment


conducive to health maintenance and
personal development due to failure to
see benefits (specifically long-term ones)
of investment in home environment
improvement.

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4. The NCP is based upon identified health
and nursing problems.

5. The NCP is a means to an end, not an


end itself.

6. The NCP is a continuous process, not a


one-shot deal.

Desirable Qualities Of A FNCP

1. It should be based on clear, explicit


Developing The Family Care Plan definition of the problems.
2. A good plan is realistic.
FAMILY NSG CARE PLAN- is the blueprint of 3. The NCP is prepared jointly with the
care that the nurse designs to systematically family.
minimize or eliminate the identified health and 4. The NCP is most useful in written form.
family nursing problems.
Importance of Planning Care

1. It individualizes care to client/ family.


2. It help in setting priorities.
3. It promotes systematic communication
among those involved in the health care
effort.
4. Continuity of care is facilitated.
5. NCP facilitates coordination of care.

Steps In Developing FNCP

1. Prioritization of problems.
2. Formulation of Goals and Objectives.
3. Selection of appropriate Nursing
Intervention.
4. Development of the Evaluation plan.

Prioritization Of Problems

Scale for Ranking Health Problems According


to Priorities (Bailon & Maglaya)
Characteristics Of The FNCP:
1. The NCP focuses on actions which are 1. Nature of the HLT Problem
designed to solve or minimize existing 2. Modifiability of the HP
problem. 3. Preventive Potential
4. Salience
2. The NCP is a product of deliberate
systematic process.
Formulation Of Goals And Objectives
3. The NCP, as with all other plans, relates
to the future.

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4. The F may perceive the presence of the
problem and the need to take action. It
may be possible however to refuse to
face and do something about the
situation.

5. A big barrier to collaborative goal setting


is failure to develop a working
relationship.

Developing the Intervention Plan

It involves selection of appropriate


Nursing Interventions based on the
GOAL- is a general statement of the condition formulated goals and objectives.
or state to be brought about by specific courses
of action. PHN decides on Nursing actions to
eliminate the barriers of the
OBJECTIVES- refer to more specific performance of the HLT tasks.
statements of the desired results or outcome of
care. It should specify the physical, Include the categories of interventions,
psychosocial states of F behavior. N-F contact and the resources needed.

Objectives: Selection Guide For Appropriate


Nursing Interventions:
1. Short-term- formulated for problem 1.
situations which require immediate Analyze with the F the current situation
attention and results can be observed in and determine choices and possibilities.
a relatively short period of time.
2. Medium-term- or intermediate are those 2. Develop Family’s competencies as
which are not immediately achieved and Thinker, Doer and Feeler.
are required to attain the long term
ones. 3. Focus on interventions to help perform
3. Long term- require several N-F contact the HLT tasks.
and an investment of more resources.
4. Catalyze behavior change through
Barriers To Joint Goal Setting: motivation and support.

1. Failure on the part of the Family to Catalyze behavior change through motivation
perceive the existence of the problem. and support.

2. The F may realize the existence of a HLT Experience or information that


condition or problem but is too busy at maintains, restore or enhance the
the moment with other concerns and capabilities or resources of family to
preoccupations. complete the change process.

3. Sometimes the F perceives the existence Experience or information that leads the
of a problem but does not see it as family to desire and agree to undergo
serious enough to warrant attention. behaviour change or proposed measure
and take initial action to bring about
change.
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Categories of Interventions in FNCP Evaluation Plan

1. Preventive 1. Criteria- refers to the signs or indicators


2. Curative that tell if the objectives are achieved.
3. Rehabilitative 2. Standard- criterion against which actual
4. Facilitative performance is compared.
5. Direct intervention
» Malnourished Child
Methods of N-F contact 1. Criteria- weight
2. Standard- increase in weight of two or
1. Home visit more pounds per month.
2. Clinic visit
3. Conference » Pregnant mother
4. School visit 1. Criteria- prenatal check-up
5. HLT classes 2. Standard- follow schedule of prenatal
visit.
Resources Needed
» Mother with NB
Material 1. Criteria- Cord Care
– Supplies 2. Standard- follow the steps provided by
the nurse.
– Equipment
– Teaching aids
» TB patient
– Handout
1. Criteria- Compliance to medication
– Chart
2. Standard- take the prescribed
Human
medications according to schedule.
– CHWs
– Community Leaders
– Family Family Health Nursing Process

Implementation Evaluation

The N experiences with the F a lived Evaluation is the phase which is


meaningful world of mutual dynamic concerned with the determination of
interchange of meanings, concerns, whether the objectives set were attained
perceptions, biases, emotions and skills. or to what degree they were attained.

Barriers To Implementation Dimensions of Evaluation

1. The family becomes APATHETIC. 1. Effectiveness- attainment of objectives.


2. The family’s indecision about use of the 2. Efficiency- save time, effort and money.
interventions to solve the problem. 3. Appropriateness- ability to correct and
solve problems.
Formulation of Evaluation Plan 4. Adequacy- activities were implemented.

It specifies the criteria and standards of Importance of Evaluation


outcome as explicit measure that
determine achievement of formulated 1. To eliminate or stop the continued
goals and objectives. performance of useless activities and
interventions.

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2. To increase the efficiency of nursing 3. Facilitates the delivery of continuous
interventions. care to the individual patient or family.

3. To provide documentation of nursing 4. Records are an important source for


efforts and justification of cost of research data.
nursing services.
Problems of Records
4. To provide growth of the profession and
refinement of nursing practice. 1. Attitude towards records and recording.
2. Quality of records.
Quantitative and Qualitative Evaluation 3. Utilization of records.
4. Administrative and logistical support.
1. Quantitative- evaluation is done in
terms of quantity or number of services » …By being expert in caring,
or activities performed. nurses must take over and transform the
notion of expertise. Expert caring has
2. Qualitative- interventions are evaluated nothing to do with possessing privileged
through resources, process and information that increases one’s control
outcome. and domination of another. Rather,
expert caring unleashes the possibilities
Steps in Evaluation inherent in the self and the situation.
Expert caring liberates and facilitates in
1. Establish a baseline in terms of health such a way that the one caring is
problem areas of an individual patient enriched in the process…
or the entire family. THANKYOU!
2. Define the objectives of nursing care in
terms of client outcomes.
3. Determine the criteria and standard of
evaluation.
4. Decide on the methods of evaluation and
sources of data.
5. Compare the actual situation with the
criteria and standard of evaluation.

Recording and Reporting


1. Records- refer to forms on which
information pertaining to I and F are
noted.

2. Reports- refer to the periodic


summaries of the services of the DOH or
to the analysis of certain phases of work.

Purpose of Records

1. They document the care rendered to the


patient and/or family.

2. They serve as a tool for planning and


evaluating care.

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