NRCM

Community
0104
Health Nursing

2ND YEAR, 1ST SEMESTER J. B. L &

R.M.A
Home Visiting and Bag Technique
CHN CLINICAL ROTATION – TOPIC
1
J.B.L and R.M.A

INTRODUCTION 6. Soap in soap dish

 Home visit is a professional face to face contact

made by a nurse to the patient and family in order to
provide necessary health care activities aimed at
promoting, maintaining and restoring health.

BAG TECHNIQUE
□ is a tool by which the nurse, during her visit will
enable her to perform a nursing procedure with
ease and deftness, to save time and effort with the
end view of rendering effective nursing care to
clients.

Public Health Bag

□ is an essential and indispensable equipment of a

public health nurse which she has to carry along
during her home visit. It contains basic
medication and articles which are necessary for
giving care. 7. Thermometers (oral
□ Performing the bag technique will minimize, if and rectal)
not, prevent the spread of any infection.
□ It saves time and effort in the performance of
nursing procedures. 8. 2 pairs of scissors
□ The bag technique can be performed in a variety (surgical and
of ways depending on the agency’s policy, the bandage)
home situation, or as long as principles of
avoiding transfer of infection is always observed.

THE FOLLOWING ARE THE CONTENTS OF A

PUBLIC HEALTH NURSE BAG:
1. Paper Lining

2. Extra paper for

making waste bag

3. Plastic/Linen lining

4. Apron

5. Hand towel
 J.B.L and R.M.A
9. 2 pairs of forceps  70% Alcohol
(curved and
straight)
 Zephiran
10. Disposable syringes Solution
with needles (g. 23
& 25)

11. Hypodermic
Needles (g. 19,
22,23,25)

12. Sterile dressing

13. Cotton balls

14. Cord clamp

15. Micropore plaster

16. Tape measure

17. 1 pair of sterile

gloves

 Hydrogen
18. Baby’s scale peroxide

 Spirit of
19. Alcohol lamp Ammonia

 Ophthalmic
ointment
20. 2 test tubes/ test  Acetic Acid
tube holders

 Benedict’s
21. Solutions of:
solution
 Betadine
 J.B.L and R.M.A
1. Upon arrival at the patient’s home, place
To protect the bag
the bag on the table lined with a clean
from getting
paper. The clean side must be out and
contaminated
the folded part, touching the table.
BP apparatus and 2. Ask for a basin of water or glass of
To be used for
Stethoscope are drinking water if tap water is not
handwashing.
available.
carried separately and
3. Open the bag and take out the To prepare for
are NEVER placed in towel and soap handwashing
4. Wash hands using soap and water, wipe
To prevent infection
from the care
to dry
provider to the client
5. Take out the apron from the bag and put To protect the
it on with the right side out nurse’s uniform
6. Put out all necessary articles needed for To have them
CONTENT AND ARRANGEMENT OF THE the specific care. readily accessible
BAG: 7. Close the bag and put it one corner of To prevent
the working area. contamination
 Front of bag left to right 8. To give comfort and
Proceed performing the necessary
security and haste
○ Digital thermometer nursing care and treatment.
recovery
9. After giving the treatment, clean all To protect the
○ Rectal thermometer in case things that were used and perform caregiver and
handwashing. prevent infection.
 On right rear of bag
10. Open the bag and return all things
a. Test tube and holder that were used in their proper places
b. Medicine dropper after cleaning them.
 On left rear end 11. Remove apron, folding it away
a. Medicine glass from the person, the soiled side in
b. Baby scale the clean side out. Place it in the
c. Bandage scissor bag
12. Fold the lining, place inside the
 Back of bag left to right bag, and close the bag
a. Alcohol 70%; acetic acid 5%; aromatic 13. Take the record and have a talk with the For reference in the
spirit of ammonia; liquid soap and mother. Write down all the necessary next visit
data that were gathered, observations,
cotton in sterile water for cleaning nursing care and treatment rendered.
thermometers. Give instructions for care of patients in
 In the center of the bag the absence of nurse.
a. Hemostat forceps; sterile dressing (OS 14. Make appointment for the next visit For follow up care
and cotton balls); Tape measure; Roller (either home or clinic), taking note of
the date and time.
bandage; Syringe and needles in
container; Cotton applicator
 On top pile center of bag
a. Hand towel; Soap in soap case; Paper POINTS TO REMEMBER
waste bag in pocket of bag
 BP apparatus carried separately  The bag should contain all the necessary articles,
 Umbrella supplies and equipment that will be used to
answer the emergency needs

 The bag and its contents should be cleaned very

often, the supplies replaced and ready for use
anytime.

 The bag and its contents should be well protected

from contact with any article in the patient’s
home.

 Consider the bag and its contents clean and

sterile, while articles that belong to the patients as
dirty and contaminated.
Steps in Performing Bag Technique and Rationale
Steps Rationale
 J.B.L and R.M.A
 The arrangement of the contents of the bag □ In 1976, the Philippines through a
should be the one most convenient to the user, to presidential decree (PD 996)
facilitate efficiency and avoid confusion. established the national EPI with a
mission to promote universal access to
safe and effective vaccines for common
VACCINE-PREVENTABLE
DISEASES (VPDs).
□ The country’s commitment to
strengthen the implementation of EPI
was once again reinforced through
Republic Act no. 10152 of 2011 which
mandates free routine vaccination for
11 VPDs (Ulep & Uy, 2021).

 The Expanded Program on Immunization

(EPI) mission is also to ensure that

BRIEF LESSON
infants/children and mothers have access to
routinely recommended infant/childhood
vaccines.
 SIX VACCINE-PREVENTABLE DISEASES
were initially included in the EPI (DOH,2012):
× Tuberculosis
× Poliomyelitis
× Diphtheria
× Tetanus
× Pertussis
× Measles.
□ Vaccines under the EPI are:
× BCG birth dose
× Hepatitis B birth dose
× Oral Poliovirus Vaccine
× Pentavalent Vaccine
× Measles Containing Vaccines
(Antimeasles Vaccine, Measles,
Mumps, Rubella)
× Tetanus Toxoid
□ In 2014, PNEUMOCOCCAL
CONJUGATE VACCINE 13 was
Expanded Program on Immunization included in the routine immunization
of EPI (DOH CCHD,2016).
CHN CLINICAL ROTATION – TOPIC
 The PHILIPPINE EPI has achieved many
2
milestones in this regard. There is no doubt that
 In 1974, the World Health Organization mortality and morbidity due VPDs have declined
(WHO) conceived of an idea for a global precipitously over the years, saving the lives of
Expanded Program on Immunization (Expanded countless of Filipino children.
Program on Immunization – Philippines, 1988). □ Moreover, polio was certified
□ The GLOBAL EPI aimed to promote eliminated in 2000 and maternal and
and develop immunization programs in neonatal tetanus in 2017.
all countries, improve vaccination Undoubtedly, the program has saved
uptake, and establish monitoring thousands of Filipino children from
systems. disabilities and premature death
□ The Philippines was one of the first because of vaccine-preventable
adopters of EPI.

diseases (VPDs) like diphtheria,
pertussis, tetanus, and measles.
□ Routine vaccination has contributed to
substantial improvements in childhood
survival and increased life expectancy
in the Philippines and globally
(Ehreth, 2003 and Rodrigues, 2020).
J.B.L and R.M.A
First Expiry and First Out (FEFO) – vaccine is practiced
to assure that all vaccines are utilized before its expiry date.
Cold Chain – a system for ensuring the potency of a
vaccine from the time of manufacture to the time it is given
to an eligible client.

 According to MCGOVERN &

CANNING (2015), perennial challenges in the
DOH EPI program remain. The Philippines has
struggled to maintain immunization coverage at
par with global recommendations for herd
immunity as well as reach its target to fully
immunize at least 95% of all children.
 Immunization or Vaccination is a process of
protecting every child through introduction of
antibodies in the system.
 It is therefore every child should be fully
immunized at the age of 12 months.
 Aside from the regular vaccines given the NIP
introduce additional protective vaccines like
pentavalent, rotavirus, IPV, MMR, Japanese
encephalitis.
 Cold chain management is observed to maintain
potency of vaccine and the public health nurse is
called the COLD CHAIN MANAGER. She
being the manager regularly monitor the
temperature of the storage vaccine.
Immunization – is the process by which the
vaccines are introduced into the body before
infection sets in.
Cold Chain Officer – person directly
responsible for the cold chain
management
 P.D 996 - Providing for
LEGAL MANDATE
compulsory basic immunization for infants
and children below 8 years old
 R.A. 10152 – Mandatory Infants and
Children Health Immunization Act of 2011
 R.A. 7846 – Compulsory immunization
against Hepatis B for infants and children
below 8 years old
 P.D 996 - Providing for compulsory basic
immunization for infants and children below
8 years old.
□ To reduce the morbidity and mortality
among infants and children caused by the
seven childhood immunizable diseases.
□ Initially the Coverage of VACCINE-
PREVENTABLE DISEASES were only 6
1. TB
2. Poliomyelitis
3. Diphtheria
4. Pertussis

Goal of EPI:
Vaccines – are the fluid administered to
induced immunity thereby causing the 5. Tetanus
recipient’s immune system to react to the 6. Measles
vaccine that produces antibodies to fight
infection.
R.A. 10152 – Mandatory Infants and Children
Health Immunization Act of 2011 (Repealing for the
purpose P.D. 996)
Fully Immunized Child (FIC)– when a child
receives one dose of BCG, 3 doses of OPV, 3  With the addition of:
doses of DPT, 3 doses of HB and one dose of 1. Mumps
MEASLES before a child’s first birthday. 2. Rubella/German Measles
3. Hepatitis B
4. H. Influenza type B (HiB)

□ Such other types as may be determined by
the Secretary of Health.
□ Government Hospitals and HEALTH
CENTERS to provide free mandatory basic
immunization to infants and children up
to 5 years old.
to
EPI CHANGED TO NIP
IN 2016 WHICH INCLUDE A SEPARATE
ANNOTATION
 JE vaccine included in the recommended vaccine
group
 Quadrivalent influenzae vaccine included in
influenza vaccine recommendation
 Hib recommendation for high-risk children
included in vaccines for high risk/special groups
National Immunization Program
□ A SCHOOL-BASED IMMUNIZATION
PROGRAM to provide catch-up doses for
school children and adolescents has been
established.
□ Measles-Rubella (MR) and Tetanus-
Diphtheria (Td) vaccines are administered to
Grade 1 and Grade 7 students enrolled in public
schools.
THE NATIONAL IMMUNIZATION PROGRAM (NIP)
CONSISTS OF THE FOLLOWING ANTIGENS:
1. BCG VACCINE - single dose given at birth
2. MONOVALENT HEPATITIS B VACCINE -
given at birth
3. DPT-HIB-HEP B VACCINE - 3 doses given at 6-
10-14 weeks of age
4. ORAL POLIO VACCINE (OPV) - 3 doses given
at 6-10-14 weeks of age, a single dose of
INACTIVATED POLIO VACCINE (IPV) is
given with the 3rd dose of OPV at 14 weeks
5. PNEUMOCOCCAL CONJUGATE VACCINE
(PCV) - 3 doses given at 6-10-14 weeks of age
6. ROTAVIRUS VACCINE - given at a minimum
age of 6 weeks with a minimum interval of 4 weeks
between doses.
□ The last dose should be administered not
later than 32 weeks of age.
7. MEASLES –CONTAINING VACCINE (either
monovalent measles vaccine or MMR)
J.B.L and R.M.A
given at 9 months of age.
8. MEASLES-MUMPS-RUBELLA (MMR) -
vaccine given at 12 months of age.
9. HUMAN PAPILLOMAVIRUS (HPV)- shall be
given to female children 9-10 years old at health
facilities in priority provinces. Quadrivalent HPV 2
doses are given at 0, 6 months.
□ Individuals 18 years and older should
receive a single dose only
□ Given subcutaneously
□ Given at a minimum age of 9 months
□ Children 9 months to 17 years of age
should receive one primary dose
followed by a booster dose 12-24 months
after the primary dose
10. JAPANESE ENCEPHALITIS - is endemic in the
Philippines:
JE is responsible for 7.4% to 40% of meningitis-
encephalitis syndrome, it affects children younger than 15
years old
□ Given subcutaneously
□ Given at a minimum age of 9 months
□ Children 9 months to 17 years of age should
receive one primary dose followed by a
booster dose 12-24 months after the primary
dose
□ Individuals 18 years and older should receive
a single dose only
Concept and Importance of
Vaccination
□ VACCINES - are administered to introduced
immunity thereby causing the recipient’s
immune system to react to the vaccine that
produces antibodies to fight infection.
□ Vaccinations - promote health and protect
children from disease – causing agents.
□ Infants and newborn - need to be vaccinated at
an early age since they belong to vulnerable age
group.
 J.B.L and R.M.A

ANTIGEN/ MINIMUM NUMBE MINIMUM REASON

VACCINE AGE AT 1ST R OF INTERVAL
DOSE DOSES BETWEEN DOSES
BCG Birth or any time 1 To protect the possibility of TB
after birth meningitis and other TB
infectious in which infants are
prone
DPT 6 weeks 3 4 weeks Reduces the chance of severe
pertussis
OPV 6 weeks 3 4 weeks Increased protection
against polio if given
earlier. Keeps the Phil.
polio free
HEPA B At birth 3 6 weeks interval from first An early start of Hepa B
dose to second dose, and 8 reduces the chance of being
weeks interval from second infected and becoming carrier.
dose to third dose Prevent liver cirrhosis and liver
cancer.
MEASLES ROUTINE
9 months IMMUNIZATION SCHEDULE At FORleast 85% of measles can be
prevented at this age.
INFANTS
SCHEDULE AND MANNER OF ADMINISTRATION OF INFANTS IMMUNIZATION
Antigen Age Dose Route Site
BCG At birth 0.05 ml Intradermal Right deltoid region (arm)
VACCINE
HEPATITIS B At birth 0.5 ml. Intramuscular Anterolateral thigh muscle
VACCINE
DPT-HEPA B- 6 weeks, 10 weeks, 0.5 ml Intramuscular Anterolateral thigh muscle
HIB 14 weeks
(PENTAVALE
NT)
ORAL POLIO 6 weeks, 10 weeks, 2 drops Oral Mouth
VACCINE 14 weeks
ANTI- 9-11 months 0.5 ml Subcutaneous Outer part of the upper arm
MEASLES
VACCINE
(AMV)
MEASLES- 12-15 months 0.5 ml Subcutaneous Outer part of the upper arm
MUMPS
RUBELLA
VACCINES
(AMV2)
ROTAVIRUS 6 weeks, 10 weeks

VACCINE, CONTENTS AND FORM

VACCINE CONTENT FORM
BCG (BACILLUS Live attenuated bacteria Freeze-dried. Reconstituted with a
CALMETTE-GUERIN) special diluent
HEPATITIS B VACCINE RNA-recombinant using Hepatitis B Cloudy, liquid, in an auto-disable
surface antigen injection syringe if available
 J.B.L and R.M.A
(HBs Ag)
DPT-HEPA-HIB Diphtheria toxoid, inactivated pertussis Liquid, in an auto-disable injection
(PENTAVALENT VACCINE) bacteria, tetanus toxoid, recombinant syringe
DNA surface antigen, and synthetic
conjugate of Haemophiles influenzae B
bacilli
ORAL POLIO VACCINE Live, attenuated virus (trivalent) Clear, pinkish liquid
ANTI-MEASLES VACCINE Live, attenuated virus Freeze-dried reconstituted with a
special diluent
MEASLES-MUMPS- Live, attenuated viruses Freeze-dried reconstituted with a
RUBELLA VACCINE special diluent
ROTAVIRUS VACCINE Live attenuated viruses Clear, colorless liquid in a container
with an oral applicator
TETANUS TOXOID Weakened toxin Sometime slightly turbid in
appearance: Clear colorless liquid
sometimes slightly turbid

VACCINE
TETANUS TOXOID IMMUNIZATION
MINIMUM AGE/ PERCENT
SCHEDULE
DURATION OF PROTECTION
TETANUS FORPROTECTION
INTERVAL WOMEN
TT1 As early as possible during
pregnancy
TT2 At least 4 weeks later 80% Infants born to mother will be protected
from neonatal tetanus
Gives 3 years protection for the mother
TT3 At least 6 months later 95% Infants born to the mother will be
protected from neonatal tetanus
Gives 5 years protection for the mother
TT4 At least one year later 99% Infants born to the mother will be
protected from neonatal tetanus
Gives 10 years protection for the
mother
TT5 At least one year later 99% Gives lifetime protection for the mother
All infants born to that mother will be
protected.

RECOMMENDED STORAGE TEMPERATURE FOR

TYPE OF VACCINE
EPIOral
VACCINES
Polio (live attenuated) -15 C to -25 C (at the freezer)
MOST SENSITIVE TO Measles (freeze dried)
HEAT
DPT/Hepatitis B
“D” toxoid which is a weakened toxin”
“P” Killed bacteria
“T” toxoid which is a weakened toxin + 2 C to +8 C (in the body of the
LEAST SENSITIVE TO BCG (freeze dried) refrigerator)
HEAT Tetanus toxoid

VACCINES SIDE EFFECTS MANAGEMENT

Kock’s phenomenon: an acute inflammatory
reaction within 2-4 days after vaccination; usually No management is needed
indicates previous exposure to tuberculosis
Deep abscess at vaccination site: almost invariably Refer to the physician for incision and
due to subcutaneous or deeper injection drainage
BCG Indolent ulceration: an ulcer which persists after 12
weeks from vaccination date Treat with INH powder
 J.B.L and R.M.A
Glandular enlargement: enlargement of lymph If suppuration occurs, treat as deep
glands draining the injection site abscess
HEPATITIS B Local soreness at the injection site No treatment is necessary
VACCINE
DPT-HEPA B-HIB Fever that usually last for only 1 day. Advise parent to give antipyretic
(PENTAVALENT) Fever beyond 24 hours is not due to the vaccine but
other causes
Local soreness at the injection site Reassure parents that soreness will
disappear after 3-4 days
Abscess after a week or more usually indicates that Incision and drainage may be necessary
the injection was not deep enough or the needle was
not sterile
Convulsions: although very rare, may occur in Proper management of convulsion;
children older than 3 months, caused by pertussis pertussis vaccine should not be given
vaccine anymore
OPV None
ANTI-MEASLES Fever 5-7 days after vaccination in some children; Reassure parents and instruct them to
VACCINE sometimes there is a mild rash give antipyretic to the child
MMR Local soreness, fever irritability, and malaise in Reassure parents and instruct them to
some children give antipyretic to the child
ROTAVIRUS Some children develop mild vomiting and diarrhea, Reassure parents and instruct them to
VACCINE fever, and irritability give antipyretic and ORESOL to the
child
TETANUS TOXOID Local soreness at the injection site Apply cold compress at the site. No
other treatment is need

PROCEDURE FOR IMMUNIZATION

BCG VACCINE
RECONSTITUTING THE
FREEZE-DRIED BCG VACCINE
1. Always keep the diluent cold.

2. Using a 5 ml. syringe fitted with long needle, aspirate 2 ml. of saline solution from the open ampule of diluent.

3. Inject the 2 ml. saline into the ampule of freeze-dried BCG.

4. Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and expel it slowly into the ampule
several times.
5. Return the reconstituted vaccine on the slit of the foam provided in the vaccine.

BCG VACCINE
Giving BCG Vaccine:
1. Clean the skin with a cotton ball moistened with water and let skin dry.

2. Hold the child’s arm with your left hand so that your hand is under, and your thumb and finger come around the arm and
stretch the skin.
3. Hold the syringe in your right hand with the bevel and the scale pointing up towards you

4. Lay the syringe and needle almost flat along the child’s arm

5. Insert the tip of the needle into skin – just above the bevel. Keep the needle flat along the skin and the bevel facing upwards, so
the vaccine only goes into the upper layers of the skin.
6. Put your left thumb over the needle end to hold it in position. Hold the plunger between the index and middle finger of the right
hand and press the plunger in with your right thumb.
7. If the vaccine is injected correctly into the skin, a flat wheal with the surface fitted like an orange peel will appear on the
injection site
 J.B.L and R.M.A
8. Withdraw the needle gently.

Note: Any remaining reconstituted vaccine must be discarded after 6 hours or at the end of the day.

FREEZE-DRIED MEASLES VACCINE MEASLES VACCINES

Administering the Freeze-Dried Measles Vaccine Giving Measles Vaccines
1. Using 10 ml syringe pitted with a long needle, aspirate 5 ml. of Ask the mother to hold the child firmly.
special diluent from the ampule.

2. Empty the diluent from the syringe into the vial with the Clean the skin with a cotton ball, moistened with water and let
`vaccine the skin dry.

3. Thoroughly mix the diluent and vaccine by drawing the `mixture With the finger of one hand, pinch up the skin on the outer side
back into the syringe and expelling it slowly into the vial several of the upper arm
times. Do not shake the vial.
4. Protect the reconstituted vaccine from sunlight. Wrap vial in Without touching the needle, push the needle into the pinched-
`foil. up skin so that it is not pointing

5. Place the reconstituted vaccine in the slit of the foam `provided Slightly pull the plunger back to make sure the vaccine is not
in the vaccine carrier. injected into a vein

6. Press the plunger gently and inject.

7. Withdraw the needle and press the injection spot quickly with a
piece of cotton.

TETANUS TOXOID (TETOX) VACCINE ORAL POLIO VACCINE (OPV)

Giving Tetanus Toxoid (TeTox) Vaccine Giving Oral Polio Vaccine (OPV)
1. Shake the vial. Read instructions

2. Clean the skin with a cotton ball, moistened with water and let Let mother hold the child
skin dry.

3. Place your thumb and index finger on each side of the injection Open child’s mouth
site and grasp the muscles slightly. The best injection site for a
woman is outer side of the upper arm.
4. Quickly push the needle, going deep into the muscle. Put drop of vaccine on the child’s tongue but don’t let dropper
touch the tongue

5. Slightly pull the needle back to be sure it is not into a vein. Make sure child swallows’ vaccine

6. Inject a vaccine, withdraw the needle and press the injection

spot quickly with a piece of cotton.

Epi Cold Chain and Logistics □ The vaccine cold chain is a global network of cold
rooms, freezers, refrigerators, cold boxes, and carriers
(like the one shown above) that keep vaccines at just
 J.B.L and R.M.A
the right temperature during each link on the long
journey from the manufacturing line to the syringe.
□ Excess heat or cold will reduce the vaccine potency
(strength), increasing the risk that recipients will not
be protected against vaccine-preventable diseases.
□ The person directly responsible for cold chain
management at each level is called the Cold Chain
Officer
□ Public Health Nurse is the Cold Chain Officer in the
RHU/health center
□ Temperature monitoring of vaccines is done in all
levels of health facilities to monitor vaccine
temperature
□ Temperature checking is done twice a day early in
the morning and in the afternoon before going home.
□ Temperature is plotted every day in monitoring chart
to monitor break in cold chain

Vaccine Cold Chain

Components of the Cold Chain

□ The cold chain has three main components, each
of which must combine to ensure safe vaccine
transport and storage:
a. Transport and storage equipment
b. Trained personnel
c. Efficient management procedures.

This study session is about the first of these components.

You can see the cold chain equipment in Figure 6.1,
together with the storage temperatures required at each
storage place, from arrival in the to the storage in your
Health Post. Next, we will describe the common cold chain
equipment you will use when you collect vaccines from the
health center and in your practice at the Health Post and in
the community.

Importance of Cold Chain

□ The cold chain is standard practice for vaccines
throughout the pharmaceutical industry.
□ Maintaining the cold chain ensures that vaccines
are transported and stored according to the
manufacturer’s recommended temperature range
+ 2C to 8 C until point of administration.
 J.B.L and R.M.A
Key Points:
 The global EPI aimed to promote and develop immunization
 Saving the lives of countless of Filipino children.
 The program has saved thousands of Filipino children from
disabilities and premature death because of vaccine-preventable
diseases

Definition of terms:

Philippine Family Planning Program

Communication - A process by which information is exchanged between
individuals through a common system of symbols, signs, or behavior.

CHN CLINICAL ROTATION – TOPIC

3
Key Points:
 Therapeutic relationship is very important in mental health
 Therapeutic relationship between nurses and patient in mental
health is a helping relationship that's based on mutual trust and
respect
Definition of terms:
Psychiatric mental Health – is the appointed position of a nurse that
Key Points:
 Measles-Rubella (MR) and Tetanus-Diphtheria (Td) vaccines
are administered to Grade 1 and Grade 7 students enrolled in public
schools
 Human Papillomavirus (HPV) shall be given to female children 9-
10 years old at health facilities in priority provinces.
Definition of terms:
Bacille Calmette Guerin - is a vaccine primarily used against
tuberculosis.
Introduction:
□ The Philippine Family Planning Program
(PFPP) started in 1970s as a family planning
service delivery component to achieve fertility
reduction.
□ It has evolved to its present-day health
orientation of improving the health of women
and children and has been integrated with other
reproductive health programs giving importance
to recognizing choice and rights of family
planning users.
□ This is now a priority public health program
for the attainment of the country's national
health development: to improve the health
condition of women and children and other
members of the family.
□ Couples of reproductive ages provided
information and services to plan their family
according to their beliefs and circumstances
through legally and medically acceptable family
planning methods.

Rotavirus vaccine- is a vaccine used to protect against rotavirus

infections, which are the leading cause of severe diarrhea among young Program Goal:
children
□ To provide universal access to FP
Human Papillomavirus (HPV) - are vaccines that prevent infection by information, education, and services
certain types of human papillomavirus.
whenever and wherever these are needed.

Four Pillars of PFPP or Guiding

Key Points: Principles: (Famorca, et al 2013)
 Every child should be fully immunized at the age of 12 months.
1. RESPONSIBLE
 Cold chain management is observed to maintain potency of vaccine
and the public health nurse is called the cold chain manager PARENTHOOD –
 this refers to the will
and ability to respond
Definition of terms: to the needs and
Japanese Encephalitis - It is the leading cause of viral encephalitis in
Asia. Humans can get the disease a mosquito that carries the virus bites
them. Japanese encephalitis virus (JEV) cannot transmit from one person
to another.

Measles Mumps Rubella - vaccine protects people from 3 serious viral

diseases. The diseases are spread from direct contact with droplets from
 J.B.L and R.M.A
aspirations of the family. It promotes the freedom
of responsible parents to decide on the timing and
size of their families in pursuit of a better life.
Natural Family Planning Method - is the method that
uses the body’s natural physiological changes and
2.RESPECT FOR symptoms to identify the fertile and infertile phases of the
LIFE – The 1987 Constitution menstrual cycle. Such methods are also known as Fertility-
protects the life of the unborn Based Awareness Methods.
from the moment of conception.
FP aims to prevent abortions, Natural Family Planning (NFP) as defined by WHO are
thereby saving lives of both methods for planning or avoiding pregnancy by observation
women and children. of the natural signs and symptoms of the fertile and infertile
phase of the menstrual cycle.
3. BIRTH SPACING – Proper spacing of 3-5
years from a recent pregnancy and to improve her
well-being, the health of the child, and the
relationship between husband and wife, and
between parents and children.

4. INFORMED Advantages Disadvantages Effectiveness

CHOICE – 1. Generally, is the 1. Are unreliable in 1. The
preferred preventing effectiveness
Couples and
contraceptive unwanted pregnancy of any method
individuals are fully method for of natural
informed on the women who do family
different modern not wish to use planning can
family planning artificial methods vary from
of contraception couple to
methods. Couples and
for reasons of couple, and
individuals decide and may choose the methods religion, or who, all these
that they will use based on informed choice and due to rumors methods are
to exercise responsible parenthood in accordance and myths, fear less effective
with their religious and ethical values and other methods for couples
2. Effective when 2. Takes time to who do not
cultural background, subject to conformity with follow the
used correctly practice and use
universally recognized international human rights them properly, method
(DOH, 2006) which adds to their carefully.
unreliability.
3. No physical side 3. Do not protect
effects against sexually
Benefits of Family Planning 4. Inexpensive transmitted
5. No need for infections (stis),
follow-up including the human
medical immunodeficiency
Mothers Children Fathers appointments virus (HIV).
Enable her to regain Healthy mothers Lightens the burden 6. Couple develops
her health after produce healthy and responsibility in better
delivery children supporting his understanding
family about their sexual
Gives enough time Will get all the Enable him to give physiology and
and opportunity to attention, security, his children their reproductive
love and provide love, and care they basic needs (food, functions
attention to her deserve shelter, education
husband and and better future) 7. Promotes shared
children responsibility for
Gives more time for Give him time for family planning
her family and own his family and own
personal personal 8. Fosters better
advancement advancement. communication
When suffering When suffering between spouses
from an illness, from an illness,
gives enough time gives enough time 9. Couple may
for treatment and for treatment and utilize signs and
recovery recovery. symptoms of the
woman’s fertility
to avoid or

FAMILY PLANNING METHODS


achieve
pregnancy based
on the couple’s
decision
Types of Natural Family Planning Methods
A. Periodic Abstinence / Fertility-Awareness
Based Method
□ are family planning methods that focus on the
awareness of the beginning and end of the fertile
time of a woman’s menstrual cycle.
□ These methods involve:
 Determination of the fertile and
infertile periods of a woman within the
menstrual cycle
 Observation of the signs and symptoms
of infertility and fertility during the
menstrual cycle
□ Effectiveness: All FAB methods are 95%
effective.
1. Cervical Mucus Method (Billings Ovulation
Method)
□ is based on the recognition and
interpretation of changes in cervical mucus
and sensations in the vagina, due to the
effect of changes in estrogen
levels during the menstrual
cycle. This method is also an
OVULATION METHOD used by women
trying to get pregnant and have
a child.
□ The basis of this method is the changes in
the cervical mucus during ovulation.
□ To check if the woman is ovulating, the
cervical mucus must be copious, thin, and
watery.
J.B.L and R.M.A
□ The cervical mucus must exhibit the
property of SPINNBARKEIT, wherein it
can be stretched up until at least 1 inch and
feels slippery.
□ The fertile days of a woman according to
this method is as long as the cervical mucus
is copious and watery and a day after it.
Therefore, she must
avoid coitus during
these days.
□ When used typically,
it has a fail rate of
25%.
 How is the method used?
- the client is required to observe what she feels
(wetness or dryness in the vulva) and sees
(characteristic of the cervical mucus), and to
record her observation daily in a chart. The
husband is also encouraged to do the recording
to promote better cooperation and compliance.
1. Record the menstruation and dry days
2. Check sensation of wetness and dryness
while standing and walking around.
3. Inspect underwear regularly for presence
of mucus.
4. Wipe the vulva with a piece of clean
tissue paper or clean cloth.
5. Record the most fertile observation /
characteristics at the end of the day.
Symbols used in Charting to determine the
Fertile and Infertile Days:
R - menstruation or “regla”, spotting
- dry or no mucus.
D
M - dry with sticky, pasty, or crumbly mucus
- wet with slippery, clear, or watery mucus
X
1,2,3 - post peak days / dates of love making
Guidelines for Postponing Pregnancy:
Menstruation days are considered fertile days.
For dry days following menses, advise client to HAVE SEXUAL
INTERCOURSE on alternate evenings (Early Days Rule or EDR).
Any mucus observed following the dry days after menses signifies
the onset of the fertile period.
× Thus, sexual intercourse on these days should be
AVOIDED.
× The woman should identify the peak day as the last day
 J.B.L and R.M.A
of wetness. □ Effectiveness:
The next 3 days of dry sensation after the last day of wetness are  Perfect use - 99%
considered fertile.
 Typical use – 80%
× Sexual intercourse should be AVOIDED on
these 3 days.
From the 4th day after the peak day, all days are considered  How is the method used?
infertile until menstruation. 1. Use BBT or OVULATION
× Sexual intercourse on these days WILL NOT THERMOMETER, although a fever
RESULT in a pregnancy thermometer, may also be used.
For short cycles, (below 25 days), there is NO PREOVULATORY
PERIOD of relative infertility. 2. Take the temperature EVERY MORNING
upon waking up and before any activity at
the same time every day and in the same
Guidelines for Achieving Pregnancy: manner throughout the menstrual cycle,
after least 3 hrs. of undisturbed rest.
Tell your client to determine the mucus pattern to assess fertile
and infertile day. 3. Take the thermometer under the tongue or
Intercourse 2-3 times a week even before the fertile days occur so axilla.
that the number of sperms is optimized.  The temp. should be taken in the
Couple should aim to have intercourse AS CLOSE AS POSSIBLE SAME MANNER/SITE throughout the
TO THE PEAK, the day BEFORE, or the day AFTER the peak day. menstrual cycle.
4. Read and record the temp immediately on
the BBT chart.
2. Basal Body Temperature
5. Determine the cover line (by placing a
horizontal line across the highest temp.
□ Identifying the fertile and
from days 6 to 10 of the menstrual cycle in
infertile period of a woman’s
the chart) to identify the thermal shift (the
cycle by daily taking and
three consecutive temperatures above the
recording of the rise in body
cover line which are labeled as days 1, 2,
temperature during and after
3).
ovulation. 6. Establish the pattern of use for 3 mos. and
□ BBT is the temperature of the body AT REST discuss with a service provider to assist in
after at least 3 hours of continuous sleep before interpreting the data.

3. Calendar / Rhythm Method

□ Calendar method is a calculation-based approach

where previous menstrual cycles are used to
predict the first and the last fertile day in future
menstrual cycles.

temperature taking.
□ A woman’s BBT rises during her ovulation
period and stays high until the next menstruation
due to a rise in progesterone level.
□ The woman must take her temperature early
every morning before any activity, and if she
notices that there is a
slight decrease and
then an increase in
her temperature, this □ Requires a good understanding of the fertile and
is a sign that she has infertile phases of the woman’s menstrual cycle.
ovulated. □ Based on the regularity of the menstrual cycle
□ The woman must and the fact that an ovum (egg) can only be
ABSTAIN FROM COITUS for the next 3 days. fertilized within 24 hours of ovulation.
□ The BBT method has an ideal fail rate of 9% and
has a typical use fail rate of 25%.

□ For IRREGULAR CYCLES, identify the longest
and the shortest cycles recorded over six to eight
cycles.
□ Subtract 18 from the shortest cycle
 (Gives the first day of the fertile phase).
□ Subtract 11 from the longest cycle
 (Gives the last day of her fertile time).
□ AVOID SEX, use a barrier method, or use
withdrawal during the fertile phase calculated.
4. Symptothermal Method (STM)
□ Identifying the fertile and infertile days of the
menstrual cycle as determined through a
combination of observations made on the
cervical mucus, basal body temperature
recording, and other signs of ovulation such as
mittelschmertz, spinnbarkeit, breast
tenderness, increased libido, and mood
changes such as depression and mood swings.
□ Effectiveness:
 Perfect use - 98%
5. Standard Days Method (SDM)
□ A “new” method of natural FP in which all users
with menstrual cycles between 26 and 32 days
are COUNSELED TO ABSTAIN FROM
SEXUAL INTERCOURSE on days 8-19 to avoid
pregnancy.
□ The couple uses the device, the color coded
“cycle beads”, to mark the fertile and infertile
days of the menstrual cycle.
□ Effectiveness:
 Perfect use: 95%
 Typical use: 88%
6. Cycle Beads.
□ There are 33 colored beads and a moveable
rubber ring on the string.
□ The FIRST BEAD is black with a white arrow.
□ The NEXT ONE is red (menstrual cycle)
□ The NEXT SIX are brown (days that a woman
cannot get pregnant)
J.B.L and R.M.A
□ The NEXT 12 are white (days that a woman can
get pregnant)
□ The LAST 13 are brown. (days that a woman
cannot get pregnant)
□ EACH ONE, except the black one, represents a
day.
Advantages of FAB Methods
□ Effective when used correctly and consistently
□ No physical side effects
□ No prescription required.
□ Inexpensive; no medication involved
□ No follow-up medical appointments required
□ Better understanding of the couple about their
sexual physiology and reproductive functions.
□ Shared responsibility between partners.
□ All FAB methods can be used for spacing,
limiting, and achieving pregnancy.
Disadvantages of FAB Methods
□ May inhibit sexual spontaneity.
□ Except for SDM, need extensive training – it
takes 2-3 cycles to accurately identify the fertile
period & how to effectively use it.
□ Require consistent and accurate record keeping
and close attention to body changes.
□ Require periods of abstinence from sexual
intercourse, which may be difficult for some
couples.
□ Require rigid adherence to daily routine of
awaking at a
fixed time,
without any
disturbance
before taking the
temperature (for
BBT and STM)
□ Can be used
only by women whose cycles are within 26-32
days (for SDM)
□ Offer no protection against STI, HIV/AIDS.
B. Lactational Amenorrhea Method (LAM)
□ The use of breastfeeding as a temporary
introductory postpartum method of postponing
pregnancy based on physiological infertility
experienced by breastfeeding women.
□ “LACTATIONAL” – means R/T breastfeeding
□ “AMENORRHEA” – not having menstrual
bleeding

□ Effectiveness:
 Perfect use: 99.5 %
 Typical use: 98 %
 Criteria for LAM use:
1. Amenorrhea (menses have not yet returned)
2. Fully or nearly fully breastfeeding
3. Infant is less than 6 mos.
 Criteria for LAM use:
 The normal physiology of breastfeeding and the
hormonal response of a woman’s body to her
infant’s suckling at her breast suppresses
ovulation.
Advantages of LAM Methods
□ Universally available
□ Does not require physical examination
□ Protection from an unplanned pregnancy begins
immediately postpartum
□ Contributes to improved maternal and child
health and nutrition
□ Encourages optimal breastfeeding and weaning
practices
□ Serves as bridge to the use of other FP methods.
Disadvantages of LAM Methods
□ Full or nearly breastfeeding pattern may be
difficult for some women to maintain.
□ The duration of the method’s effectiveness is
limited to a brief six-month postpartum period.
× If a mother and child are separated for
extended periods of time, the
breastfeeding practice required for LAM
cannot be followed.
□ There is no protection against STI, including
HIV
□ In addition, it may be difficult to convince some
providers who are unfamiliar with the method
that LAM is a reliable contraceptive.
Categories of Choice of FP Methods for Post-
partum Breastfeeding Women
1st choice IUD, condom, BTL, NFP or vasectomy (for the
2nd choice
woman’s partner)
DMPA and Progestin-Only Pills which can be
initiated after 6 weeks postpartum
3rd choice Combined Oral Contraceptives (COC) only after
6 mos. When complementary foods are introduced,
and the baby is less dependent on breast milk.
Estrogen can reduce breast
milk volume.
J.B.L and R.M.A
C. Coitus Interruptus (Withdrawal or Pulling-
out Method)
□ is a traditional family planning method in which
the man withdraws or pulls out his penis from his
partner’s vagina and ejaculates outside, keeping
his semen away from her genitalia
□ Coitus interruptus prevents fertilization by
stopping contact between spermatozoa in the
sperm and the ovum or egg.
Effectiveness of Withdrawal Method
□ It is the least effective method because it
depends on the man’s ability to withdraw before
he ejaculates. However, it is about 73%
effective if used correctly.
Advantages Withdrawal Method
□ costs nothing and requires no devices or
chemicals.
□ available in any situation and can be used as a
back-up method of contraception.
INTERVIEW
□ With one or more family members individually,
interviews of subsystems within the family (e.g
dyads of mother-child, parent-parent and sibling-
sibling), or
□ Group interviews with more than two members
of the family.
□
OBSERVATION
Observation of individual family members, dyads
and the entire family.
 Dyads – two people.
□ Observation of the environment in which the
family lives.
 housing, neighborhood and larger
community.
 J.B.L and R.M.A

In the Family Assessment Form, family

(And other health assessment techniques)
□ Anthropometry
 measurement of weight and height.
□ The nurse must assess if the weight or height of
the patients are appropriate in their age.
 Through this, you would be able to
know if the needs of the family are
met.
is differentiated from household, which is
term applied to a social unit consisting of
a person living alone or a group of
persons who sleep in the same housing
Physical
unit and have a common arrangement in
the preparation and consumption of food.
Examination
Domestic helper/worker who resides in the
family home is a member of the household but
is not a family member.
GENOGRAM

SECONDARY
□ Can be derived from a review of records like DATA

Other tools used in assessing the

Family
(Friedman et al 2003, Wright and Leahey, 2005 and
charts, health center records, and/or agency Butler, 2008)
records.

 Is a tool that helps the nurse outline the

family’s structure.
 It is a way to diagram the family.

 Generally,
□ Three (3) generations of family members
are included in the family tree with symbols
denoting genealogy.

□ Children are picture from left to right,

beginning with the oldest child.
□ Communication with other health
workers or agencies who have
worked with the family.
 In cases where the spouse has a previous
marriage or marriage, he or she must be
positioned closer to his/her first partner, then the
POINTS TO REMEMBER second partner if any and so on.

Example:
This illustration is patterned from the Nursing Care in the
Community (Famorca et al 2013). In here, the genogram
of Dela Cruz Family will be discussed.
 Family order across generations can be
illustrated and specific personal characteristics
can be noted in the drawing.
 Conditions or factors affecting members of
Dela Cruz family are noted down by the nurse, as
this need to be considered in the plan for nursing
interventions.
Family health tree
 Based on the genogram, the family health tree
provides a mechanism for recording the
ecomap
family’s medical and health histories
(Diekelmann 1977, Friedman et a. 1992.)
 The nurse should note the following points on
the family health tree:
o Causes of death of deceased family
members
o Genetically linked disease including
heart disease, cancer, diabetes,
hypertension, allergies, asthma and
mental retardation
o Environmental and occupational
diseases
o Psychosocial problems, such as
mental illness and obesity
o Infectious diseases
J.B.L and R.M.A
o Familial risk factors from health
problems
o Risk factors associated with the
family’s methods of illness
prevention, such as having periodic
physical examination, Pap Smears and
immunizations
o Lifestyle related risk factors ( i.e by
asking what family members do to
“handle stress” and “keep in shape.”)
 Note:
- If a health condition runs in you family, this
can be a sign that you are at increased risk.
- Even if you do not have a family history about
certain diseases, you could still be at risk
because of certain factor such as environment
etc.
- Knowing your family health history helps
maintain & protect your health.
 As with the genogram, the nurse can fill out
the ecomap during an early family interview,
noting people, institutions and agencies significant
to the family.
 The nurse must assess the environment,
neighborhood or the people around the
family.
 To know the interpersonal ability of a
person or family.
 The nurse can use symbols used in attachment
diagrams to denote the nature of the ties that
exist.
 According to Hartman, the eco-map portrays an
overview of the family in their situation.

□ It depicts the important nurturant or
conflict-laden connections between the
family and the world.
 Will be able to know the tensions
within the family.
□ It demonstrates the flow of resources or
the lack of deprivations.
□ This mapping procedure highlights the
nature of the interfaces and the points to
conflicts to be mediated, bridges to be
built and resources to be sought and
mobilized.
Ecomap of Dela Cruz Family
J.B.L and R.M.A
 In the family interview, the community health
nurses use general systems and
communication concepts to conceptualize the
health needs of families and to assess family’s
responses to events such as birth, retirement, or
chronic illness.
 With experience, they believe that the family
interview can be accomplished in 15 minutes.
CRITICAL COMPONENTS OF THE FAMILY
INTERVIEW (WRIGHT AND LEAHEY 2005):
1. Manners
□ The nurse introduces himself or herself to the

 The ecomap shows contact that

occur between the family and the
supersystems.
 It suggests that the Dela Cruz family
does not actively participate in the
community organization and does not
utilize services of the nearby barangay
health station.

 The community health nurse my use

the ecomap to discuss with the Dela
Cruz family the types of resources
in the community and the types of
relationships they want to
establish with them.

client by name and title.

POINTS TO REMEMBER
□ The nurse can use these tools for family assessment
with families in every health care setting.
□ Always addresses the client and family members
by name and title (Mr, Mrs, Ms,) unless
otherwise directed by the client or using Filipino
titles such as Mang and Ale)

□ These tools help increase the nurse’s awareness of the

family within the community and help guide the nurse
and the family in the assessment and planning phases
of care.
□ Keeps appointment
□ Explain the reason for the interview or the visit
□ Brings a positive attitude.
□ Other behavior that invites rapport include being
honest with the client and checking attitude of
the nurse before each client encounter.

Family interview
 in addition to using the interview as an
assessment tool, Wright and Leahey (2005)
suggest family interviewing as a medium
for providing family intervention.
POINTS TO REMEMBER
Wright and Leahey (2005) believe that erosion of these
social skills prevents the family nurse from collecting
essential data. Many nurses argue that too much formality
established artificial barriers on communication; however,
studies identify that the essentials of a therapeutic
relationship begin with manners.
 J.B.L and R.M.A
background and basic health status, in a way that
2. Therapeutic engages the family in the interview process.

5. Commending family or
individual strengths
Questions □ Wright and Leahey suggest commending at least
two (2) strength areas and during each family
□ The questions are specific from the context or interview, sharing them with the family or
family situation but have the following basic individual.
theme:
□ Sharing strengths reinforces immediate and
 Family expectations of the interview or home long-term positive relationships between the
visit nurse and family.
 Challenges, concerns and problems
encountered by the family at the time of the □ Note:
interview  You will not only focus on the problems
 Sharing information (e.g who will relate the or weakness of the family, but you also
family history or information) have to look for the strength to come up
with a positive relationship with the
□ Note: Use appropriate words in giving questions, family.
be casual as possible, don’t give questions  They should know how to work on their
answerable by yes or no, ask open ended own, don't intervene.
questions.  This will lead to a positive relationship
with the family.
3. Therapeutic
Conversations
□ It is focused and planned and engages the FAMILY DATA ANALYSIS
family.
 conversation with the patient must be  Data analysis is done by
engaging, it must have its focus, it has to comparing findings with accepted
be planned standards for individual family
members and for the family unit.
□ The nurse must listen and remember that even
one sentence has the potential to heal or help a  The nurse correlates
family member. findings in the
different data
□ The nurse encourages questions, engages the categories and checks
family in the interview and assessment process for significant gaps in
and commends the family when strengths are information or the
identified.
need for more details related to a finding.
□ Every encounter, whether brief or extended, has
“healing potential.” SYSTEM OF ORGANIZING FAMILY DATA
(ADAPTED FROM NIES AND MCEWEN, 2011)

1. Family Structure and

4. Genogram and characteristics are reflected
Ecomap in:
 Data on household membership
□ These tools provide essential information of
 How many members are there in
family structure and are an efficient way to gather
a family?
information, such as family composition,
 Demographic characteristics
 J.B.L and R.M.A
 How many boys and girls are  Nursing diagnoses may be formulated at several
there in a family? levels:
 Family members living outside the □ As Individual family members
household □ As a family unit
 Family mobility □ As the family in relation to its
 How many times a family environment/community.
transfer from one house to
another?  Check the possible health problems of a family.
 Family dynamics
 emotional bonding  International (NANDA-I, 2011)
 authority and power structure □ Serve as a common framework of expressing
 autonomy of members human responses to actual and potential health
 division of labor problems.
 patterns of communication
 decision making
 problem and conflict resolution
FAMILY COPING INDEX
 Data on family structure can be visualized  This tool is based on
clearly through graphic tools such as: premise that nursing
 genogram action may help a
 ecomap family in providing for
 family tree. a health need or
resolving a health
2. Socioeconomic characteristics problem by promoting
the family’s coping capacity.
include:
 Data on social integration
 Provides a system of identifying area that may
 ethnic origin
require nursing intervention and areas of family
 languages and dialects spoken
strengths that may be used to help the family deal
 social networks with the health needs and problems.
 Educational experiences and literacy
 Work history
 Financial resources Leisure time interests
 Cultural influences NINE AREAS OF ASSESSMENT OF THE
 Spirituality or religious affiliation FAMILY COPING INDEX (FREEMAN AND
HEINRICH, 1981):
3. Family environment 1. Physical Independence
 Refers to the physical environment inside
□ Family members’
the family’s home/residence and its
neighborhood mobility and ability
to perform
activities of daily
4. Family health and health living
behavior include:  Feeding
themselves and personal hygiene
 Family’s activities of daily living
 Self-care
 Risk behaviors
 Health history 2. Therapeutic Competence
 Current health status □ Ability to comply
 Health care resources with prescribed or
 home remedies recommended
 health services procedures and
treatments to be
done at home.
FAMILY NURSING DIAGNOSIS
 J.B.L and R.M.A
□ Degree of emotional maturity of family
members according to their developmental
3. Knowledge of Health Condition stage.
□ Understanding of the
health condition or
essentials of care
according to the 7. Family living patterns
developmental stages □ Interpersonal relationships
of family members. among family members,
management of family
□ Degree of knowledge finances, and the type of
of responsible family discipline in the home.
members
in terms
of
8. Physical Environment
□ includes home, school, work, and
community environment that influence the
health of family members.
communicability of
disease and its mode of
transmission.
 how a family manage or understand a health.
condition.
Priority is given to the
need that the family
recognizes as urgent or
4. Application of principles of important.
personal and general hygiene
□ practice of general
health promotion
and recommended
preventive
9. Use of
measures.
Community
Facilities
□ ability of
the family to seek and utilize, as needed,
5. H both environment-run and private health.
ea
lth FORMULATING THE PLAN OF
Care Attitudes CARE
□ family’s perception of health care in general.

6.  Planning involves priority setting, establishing

goals and objectives, and determining appropriate
E interventions to achieve goals and objectives.

motional  Stancope and Lancaster (2010): The nurse’s role

at this stage consists of offering guidance,
Competence providing information, and assisting the family in
the planning process.
 J.B.L and R.M.A
1. Priority Setting
□ determining the sequence in dealing with
identified family needs and problems.
R The objective is appropriate for the family need or
problem that is intended to be minimized, alleviated or
□ Necessary because the nurse cannot possibly
resolved.
deal with all identified family needs and
concerns all at once.

FACTORS TO CONSIDER
Having a specified IN the family
target time or date helps T
and the nurse in focusing their attention and efforts
GUIDING
toward the
NURSE
FAMILY SAFETY
attainment of
IN
the
PRIORITY
FAMILY
objective.
PRACTICALITY PROJECTED
SETTING: PERCEPTION EFFECTS

3. Determining Appropriate
Together with the The immediate
Intervention
A life-threatening situation
family the nurse looks □ Depend on the identified family needs and the
is given top priority. resolution of a family
into existing resources concern gives the goals and objectives, interventions may range
“The
andsafety of the family
constraints. family a sense of from simple or immediate, complicate, and
accomplishment and prolonged.
is always a priority.”
“Look for an existing confidence in
resources or themselves and the 3 Types of Nursing Intervention
consequences as we do nurse.
1. the nursing process” INTERVENTIONS – actions
SUPPLEMENTAL (Freeman and
“Have an immediate Heinrich)
that nurse performs on behalf of the family when it is unable to
resolution to a family's
do things for itself
problem.”

2. Establishing Goals and

2. FACILITATIVE INTERVENTIONS – actions that
Objectives
remove barriers to appropriate health action such as assisting
the□family
Goal
to avail of maternal and early childcare services.
 Desired observable family response to
planned interventions in response to a
mutually identified family need.

□ Objectives
 the desired step by stepfamily responses as
they work toward a goal. 3. DEVELOPMENTAL INTERVENTIONS – aim to
improve the capacity of the family to provide for its own health
Workable, well stated objectives needs such as guiding the family to make responsible health
decisions.
should be SMART:
S The objective clearly articulates who is expected to do
what the family or a target family member will manifest
a particular behavior

M IMPLEMENTING
Observable, measurable THE andPLAN
wheneverOFpossible,
quantifiable indication of the family’s achievement as a
result of their CARE
efforts toward a goal provide a concrete
 basis for monitoring
Implementation andwhen
is the step evaluation.
the family or
the nurse execute the plan of action.
Objective has to be realistic and in conformity with
A available resources, existing constraints and family
traits, such as style and functioning.
 J.B.L and R.M.A
 The pattern of implementation is determined by  In family nursing, evaluation is determining the
the mutually agreed upon goals and objectives value of nursing care that has been given to a
and the selected course of action. family.

 When appropriate, it involves providing direct

nursing care, helping family members do what is KEY POINTS:
necessary to meet health needs and problems, or
referring the family members do what is
necessary to meet the health needs and problems  The product of this step is used to further decision
or referring the family to another health worker making:
or agency.

---------------------
BARRIERS-----------------
1. FAMILY-BARRIERS:
 In these instances, the nurse has to exert effort to
find out what is actually happening to the family to
be able to effectively deal with the situation.

□ Apathy
 Feelings of hopelessness and powerlessness

□ Indecision
 May result in family allowing events just to
happen.

2. NURSE-BARRIERS
□ Imposing ideas
 The nurse who imposes ideas on the family
keeps the family from taking responsibility
for decision making and appropriate action.

□ Negative labeling
 The nurse may label a family as stubborn
(matigas ang ulo) if it is unable to comply
with the instructions or it may lead the nurse
to label himself or herself as ineffective.

□ Overlooking Family Strength

 Usually results from the tendency of the
nurse to focus on family problems and
weaknesses.

 Note: We must focus on their strengths

more.

□ Neglecting Cultural and Gender Implications

 The nurse who fails to consider cultural
differences and gender issues in
implementing interventions risks making
plan unacceptable to the family.

EVALUATION
 J.B.L and R.M.A
 To terminate, continue or modify the
 Nursing Process
interventions.
 Family Nursing
 Family
 To evaluate is to determine or fix the value.
Definition of Terms:
ASPECTS OF EVALUATION Nursing Process- Functions as a systematic guide to client-
centered care with 5 sequential steps. These are assessment,
 EFFECTIVENESS
diagnosis, planning, implementation, and evaluation
 determination of whether goals and
objectives were attained. Family Nursing - Part of the primary care provided to patients
of all ages, ranging from infant to geriatric health. ... Family
 APPROPRIATENESS nurses often work with patients through their whole life cycle.
 suitability of the goals/objectives and This helps foster a strong relationship between health care
interventions. provider and patient.

Family - A group of one or more parents and their children

 ADEQUACY living together as a unit.
 degree of sufficiency of goals/objectives and
interventions. Assessment - First step and involves critical thinking skills
and data collection; subjective and objective.
 EFFICIENCY  Subjective data involves verbal statements from the
 relationship of resources used to attain the patient or caregiver.
desired outcomes.  Objective data is measurable, tangible data such as
vital signs, intake and output, and height and weight.
Generalizat Manners - Common social behavior that set the tone for the
Working in the communityion
and giving appropriate interview and begin the development of a therapeutic
care deserved by each member of the family is a relationship.

challenging experience but also an opportunity also Therapeutic questions - These are the key questions that the
to see the beauty on how community health nurses nurse uses to facilitate the interview.
can uplift the status of health of the family. Family Coping Index- These are the key questions that the
nurse uses to facilitate the interview.
Community health nurses should not only focus
on the deficiencies in the family but equally  Rather than identifying problems, the index focuses
on identifying coping patterns of the family in nine
important also are the strengths that will motivate areas of assessment.
these families further in their daily living.  The family is treated as a unit.
 Thus, if a family member is unable to cope in a
APPLICA particular category, but other family members are
According to World Health Organization (WHO),
TION
nurses have always cared for individuals, families,
able to compensate, the family is still rated as
adequately coping.
and communities in their practice. Recently, there
has been an increase in the number of nurses
working outside the hospital, primarily in
community-based settings that focus on individuals
and families. There is also increasing emphasis on
community-focused nursing care with the