From: http://rnspeak.

com/community-health-
nursing/family-nursing-care-plan/

FAMILY NURSING CARE PLAN

- In community health nursing, the family will be the
considered as a client aside from individual
clients in the family.
- Family Nursing Care Plan 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. The nursing process is still implemented
in making this type of care plan.
- It is important to take in mind that Family Nursing
Care Plans are unique since it is continuous in
nature.
- A community health nurse must be able to understand
that he or she must keep on updating the nursing
care plan as the family is a dynamic unit of the
community.
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
Process in making the Family Nursing Care Plan
1. Assessment Phase – Happens on the first and
succeeding home visits. Making objective observation
can be coupled with subjective statements by each
family member.
2. Identification of the Problem/s – Make a list of
the problems sited. Prioritization of the needs must
be applied.
3. Formulation of Goals and Objectives – Referring on
the problems, goals and objectives must be measurable,
attainable, realistic and time-oriented.
4. Plot Nursing Interventions – The objectives must be
the guidelines in making nursing interventions.
Nursing interventions must be rational enough.
5. Evaluate the outcomes – This stage will be the
determining stage whether the goals and objectives
have been met or not. Nursing interventions can be
modified at this stage.

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 FIRST LEVEL ASSESSMENT

From: http://nurseslabs.com/family-nursing-care-plan-
assessment-diagnoses-in-family-nursing-practice/
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
 First level Assessment
The process of determining existing and
potential health conditions or problems of
the family. These health conditions are
categorized as:

I. PRESENCE OF WELLNESS CONDITION

II. PRESENCE OF HEALTH THREATS
III. PRESENCE OF HEALTH DEFICITS
IV. PRESENCE OF STRESS POINTS/FORESEEABLE
CRISIS SITUATIONS

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 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. Wellness potential is a nursing judgment on
wellness state or condition based on client’s
performance, current competencies, or performance,
clinical data or explicit expression of desire to
achieve a higher level of state or function in a
specific area on health promotion and maintenance.
Examples of this are the following:

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 I. PRESENCE OF WELLNESS CONDITION
A. Potential for Enhanced Capability for:
Healthy lifestyle-e.g. nutrition/diet,
exercise/activity
Healthy maintenance/health management
Parenting
Breastfeeding
Spiritual well-being-process of client’s
developing/unfolding of mystery through harmonious
interconnectedness that comes from inner
strength/sacred source/God (NANDA 2001)
Others. Specify.

B. Readiness for Enhanced Capability for:

Healthy lifestyle
Health maintenance/health management
Parenting
Breastfeeding
Spiritual well-being
Others. Specify.
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
 II. PRESENCE OF HEALTH THREATS
Are conditions that are conducive to disease and
accident, or may result to failure to maintain
wellness or realize health potential. Examples are the
following:
A. Presence of risk factors of specific diseases (e.g.
lifestyle diseases, metabolic syndrome, smoking)

B. Threat of cross infection from communicable disease

case

C. Family size beyond what family resources can

adequately provide
D. Accident hazards specify.
Broken chairs
Pointed /sharp objects, poisons and medicines
improperly kept
Fire hazards
Fall hazards
Others specify.
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
 II. PRESENCE OF HEALTH THREATS
E. Faulty/unhealthful nutritional/eating habits or
feeding techniques/practices. Specify.
Inadequate food intake both in quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques

F. Stress Provoking Factors. Specify.

Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family members
Care-giving burden

G. Poor Home/Environmental Condition/Sanitation.

Specify.
Inadequate living space
Lack of food storage facilities
Polluted water supply
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
Presence of breeding or resting sights of vectors of
diseases
Improper garbage/refuse disposal
Unsanitary waste disposal
Improper drainage system
Poor lightning and ventilation
Noise pollution
Air pollution

H. Unsanitary Food Handling and Preparation

I. Unhealthy Lifestyle and Personal Habits/Practices.

Specify.
Alcohol drinking
Cigarette/tobacco smoking
Walking barefooted or inadequate footwear
Eating raw meat or fish
Poor personal hygiene
Self medication/substance abuse
Sexual promiscuity
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
Engaging in dangerous sports
Inadequate rest or sleep
Lack of /inadequate exercise/physical activity
Lack of/relaxation activities
Non use of self-protection measures (e.g. non use of
bed nets in malaria and filariasis endemic areas).

J. Inherent Personal Characteristics

e.g. poor impulse control

K. Health History, which may Participate/Induce the

Occurrence of Health Deficit
e.g. previous history of difficult labor.

L. Inappropriate Role Assumption

e.g. child assuming mother’s role, father not assuming
his role.

M. Lack of Immunization/Inadequate Immunization Status:

Especially of Children
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
N. Family Disunity
Self-oriented behavior of member(s)
Unresolved conflicts of member(s)
Intolerable disagreement

O. Others. Specify._________

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 III. PRESENCE OF HEALTH DEFICITS
These are instances of failure in health maintenance.
Examples include:
A. Illness states, regardless of whether it is
diagnosed or undiagnosed by medical practitioner.

B. Failure to thrive/develop according to normal rate

C. Disability
Whether congenital or arising from illness;
transient/temporary (e.g. aphasia or temporary
paralysis after a CVA) or permanent (e.g. leg
amputation, blindness from measles, lameness from
polio)

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 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 of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
 Example: PRIORITIZATION OF PROBLEM
Problem: ______________________________

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
 SECOND-LEVEL ASSESSMENT

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 SECOND-LEVEL ASSESSMENT
Second level assessment identifies the nature or type
of nursing problems the family experiences in the
performance of their health tasks with respect to a
certain health condition or health problem.

I. Inability to recognize the presence of the

condition or problem due to:
A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result
of fear of consequences of diagnosis of problem,
specifically:
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 _________
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
II. Inability to make decisions with respect to taking
appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the
problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or
resignation brought about by perceive
magnitude/severity of the situation or problem, i.e.
failure to 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
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
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._________

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

III. Inability to provide adequate nursing care to the
sick, disabled, dependent or vulnerable/at risk member
of the family due to:
A. Lack of/inadequate knowledge about the
disease/health condition (nature, severity,
complications, prognosis and management)
B. Lack of/inadequate knowledge about child
development and care
C. Lack of/inadequate knowledge of the nature or
extent of nursing care needed
D. Lack of the necessary facilities, equipment and
supplies of care
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).

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

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 confusion
Role strain Role conflict
Role dissatisfaction Role overload
L. Others. Specify._________
Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
IV. Inability to provide a home environment conducive
to health maintenance and personal development due to:
A. Inadequate family resources specifically:
Financial constraints/limited financial resources
Limited physical resources-e.i. lack of space to
construct facility

B. Failure to see benefits (specifically long term

ones) of investments in home environment improvement

C. Lack of/inadequate knowledge of importance of

hygiene and sanitation

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

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

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._________

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

V. Failure to utilize community resources for health
care due to:
A. Lack of/inadequate knowledge of community resources
for health care

B. Failure to perceive the benefits of health

care/services

C. Lack of trust/confidence in the agency/personnel

D. Previous unpleasant experience with health worker

E. Fear of consequences of action (preventive,

diagnostic, therapeutic, rehabilitative) specifically :
Physical/psychological consequences
Financial consequences
Social consequences

F. Unavailability of required care/services

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

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 __________

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

 Example of Family Nursing Care
Plan
Case:
This is a case of S. Family. S. Family is composed
of 5 children and both parents were alive. Upon
observation the family practices improper hygiene in
eating and waste disposal. The 5 children have 2 to 3
years of age gaps, having the youngest child to be 1
year old and the oldest to be 9 years old.

Problem Identified: Improper Hygiene

Date Identified: January 5, 2012 7:00AM

Date Evaluated: January 5, 2012 1:00PM

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Problem Cues:
Subjective data: “Dahil sa dami ng anak ko, minsan ang
dudungis na nila. Mabuti na lang nandyan ang panganay
ko na si Nene, siya yung nagbabantay sa dalawang
kapatid niya.”

Objective data: Nene, her nine-year-old daughter

cuddles her younger brother Jose who has flu at this
time. She manages to feed her other sibling with bare
hands without hand washing. The fingernails and
toenails of these children were not trimmed properly
and filled with dirt. The other two siblings came into
the house sweating and their feet were smudged with
mud. Jose suddenly wet his shorts and Nene must clean
him up. The place wherein he peed was not cleaned but
left only. The pillow that was affected by the urine
was just placed outside for the sun to dry.

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Family Nursing Diagnosis:
Inability to provide home environment conducive for
health and maintenance secondary to unhygienic
practices

Goal of Care:
Within 3 hours of nursing interventions, the family
will be able to recognize the current home environment
and health practices. They must be able to identify
healthy practices and be able to practice them
habitually. These hygienic measures are as follows:
proper hand washing, proper waste disposal and proper
house cleaning.

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Objectives:
Within 3 hours of nursing interventions, the family
will be able to:
1. Recognize the need for proper hand washing before
and after meals as well as after using the toilet
2. Enumerate factors that promote in unhygienic
practices
3. be knowledgeable in ways on how to maintain hygiene
4. Accept the importance of proper hygiene in the
activities of daily living
5. Exhibit the desire to change the current unhygienic
practices

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Interventions & Rationale:
1. Check if the family is aware of their health
practices. This will help the nurse to know the
severity of the health problem.
2. Demonstrate the proper hand washing. The nurse must
perform the proper hand washing technique so that the
family will be able to see the proper technique. A
return demonstration will be necessary so that the
nurse can assess if the family members can absorb the
lesson.
3. Emphasize the importance of proper hygiene in
preventing health problems. This step will enable the
family members to know the consequences if health
practices were not observed in their family.
4. Listen to the concerns of the family regarding the
hindrance to practice such hygienic practices. This
will be a way of keeping in touch with the family and
facilitate them to be able to find concrete ways to
achieve the goal of observing hygienic practices.

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Tools:
1. Home Visits
2. Diagram of path of infection, steps in correct hand
washing
3. Demonstration
4. Hand washing supplies
5. Time and Effort for the family members as well as
to the nurse

Evaluation:
After 3 hours of nursing interventions, the goal was
met. The parents were able to demonstrate proper hand
washing. The siblings who were five years old and
above were able to wash their hands with assistance
from their parents. Lunch was served and the children
filed for a line in washing their hands before and
after the meal

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)
 . . . THANK YOU . . .

Prepared by: ARVIE E. ARRIETA, RN, MAN (2015)