Care of Family at Risk or with Problems

Course Objectives
y 1. Utilize the nursing process in the holistic care of

client for the promotion and maintenance of health in community and hospital settings
y Assess with the client his/her health condition and

risk factors affecting health
y Identify actual/at risk nursing diagnosis

y Plan






identified problems
y Implement with client appropriate interventions for

identified problems
y Evaluate with client the progress of their condition and

outcomes of care

Observe bioethical principles and the core values (love of God. Relate effectively with clients. . caring.2. love of country and of people) 4. Ensure a well-organized recording and reporting system 3. members of the health team and others in work situations related to nursing and health.

Introduction to Family Health Nursing y y y y Definition of Family Health Functions of a Family The Family Health Tasks Difference of Health Problem from Nursing Problem .Topic Coverage for the Day I.

II. Nursing Assessment y Data Collection Methods of Data Gathering Data Analysis Problem Definition First Level Assessment Second Level Assessment y y y .

. Define Family Health. student nurses will be able to: 1. 2. 3. Discuss the family health tasks.Objectives for the day: y At the end of the three-hour class. Enumerate functions of a family.

Discuss the process involved in data collection and analysis. 5.4. Differentiate health problem from nursing problem. Explain activities undertaken during first and second level assessments. 6. .

mental and social well-being and not merely the absence of disease or infirmity. .y FAMILY defined as the basic unit of the community y HEALTH - the state of complete physical.

sociocultural and spiritual factors of the family system. psychological.Family Health -a dynamic relative state of well being which includes the biological. .

Recognize the presence of a wellness state or health condition/problem. . Make decisions about taking appropriate health actions to maintain wellness or manage the health problems.FIVE FAMILY HEALTH TASKS 1. 2.

3. 4. Utilize community resources for health care. Maintain a home environment conducive to health maintenance and personal development. dependent or at risk members. . 5. disabled. Provide nursing care to the sick.

yHEALTH PROBLEM -a situation or condition. which interferes with the promotion and/or maintenance of health and recovery from illness and injury. .

When does it become a nursing problem? .

Nursing Problem .A health problem that can be modified or resolved through nursing intervention .

How will we know if there is presence of a problem? .

characteristics and dynamics b) Socio-economic & cultural characteristics . y Nursing Assessment includes the following: 1. DATA COLLECTION a) Family structure.yNursing Assessment -is the first major phase of the nursing process.

dynamics characteristics and b) Socio-economic & cultural characteristics c) Home and environment d) Health Status of each member e) Values and practices on health promotion / maintenance and disease prevention .a) Family structure.

Laboratory or diagnostic tests 3. Interview 4. Observation 2. Record Review .Methods of data gathering: 1. Physical Exam 5.

2.DATA ANALYSIS 1) 2) 3) 4) 5) 6) Sort data Cluster/ Group related data Distinguish Relevant from Irrelevant Data Identify Patterns with norms or standards Interpret results Make Inferences/ Draw Conclusions .

Health Deficit. Wellness State  Ranking Health Conditions and Problems according to Priorities . Foreseeable Crisis.Topic Coverage for the Day  Problem Definition: First & Second Level Assessments  Sequence of Activities in Family Nursing Practice  Categories of Health Problem  Health Threat.

4. 2. . Enumerate and discuss the sequence of activities in family nursing practice. Discuss activities conducted during first and second level assessments. and Prioritize health problems through a standardized computation. 3. Categorize health problems correctly. the students will be able to: 1.Objectives for the Day At the end of the two-hour class.

is a classification system used by nurses and community health practitioner to facilitate the process of defining family nursing problems. PROBLEM DEFINITION/ NURSING DIAGNOSIS ‡ First Level Assessment ‡ Second Level Assessment y Typology of Nursing Problems .3. .

Presence of health threats y III. Presence of health deficits y a process whereby existing and potential health problems/ conditions of the family are determined y I.FIRST LEVEL ASSESSMENT/ Primary Assessment . Presence of wellness condition ‡ Wellness potential ‡ Readiness for enhanced wellness state y II. Presence of stress points/foreseeable crisis situations .

defines the nature or the type of nursing problems that the family encounters in performing the health tasks y I. . Inability to recognize the presence of the condition or problem.SECOND LEVEL ASSESSMENT/Secondary Assessment .

disabled. Inability to make decisions with respect to taking appropriate health actions y III. y V. dependent or vulnerable/at risk member of the family.y II. Inability to provide a home environment conducive to health maintenance and personal development. . Failure to utilize community resources for health care. y IV. Inability to provide adequate nursing care to the sick.

SEQUENCE OF ACTIVITIES IN FAMILY NURSING PRACTICE 1. Conducts an initial assessment to determine the presence of any health problem 3. Categorizes health problem into: a) Health Threat b) Health Deficit c) Foreseeable Crisis/ Stress Point d) Enhanced capability for health promotion (Wellness State) . 2. Establishes a working relationship with the family.

Determines the nature and extent of the family s performance of the health tasks on each of the health problems.4. defines the family nursing problems y Health status problems y Health resources problems y Health-related problems .

Nature of the problem b. Magnitude of the problem c. Determines priorities among the list of health problems/ Criteria of priority setting among family health problems a. Salience .5. Modifiability of the problem d. Preventive potential e.

Nature of the condition or problem presented 1 3 3 2 1 Wellness state Health deficit Health threat Foreseeable Crisis .6. Ranks health problems according to priorities SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES 1.

Modifiability of the condition or problem ‡Easily modifiable ‡Partially modifiable ‡Not modifiable 2 1 0 2 .

Preventive potential ‡High ‡Moderate ‡Low 3 2 1 1 Salience ‡a condition or problem needing immediate attention ‡a condition or problem not needing immediate attention ‡not perceived as a problem or condition needing change 2 1 1 0 .

)Sum up the scores for all the criteria. y 2.y Scoring: y 1. .) Divide the score by the highest possible score and multiply by the weight: (Score/Highest Score) x weight y 3. The highest score is 5 equivalent to the total weight.) Decide on a score for each of the criteria.

Modifiability of the problem 2/2 x 2 2 3. Nature of the problem 2. The possibility of complications during labor and delivery and occurrence of abnormalities in the infant are prevented if preeclampsia is eliminated as early as possible The family does not recognize the existence of the problem p 1. Salience of the problem 0/2 x 1 0 Total Score 4 . Preventive potential 3/3 x 1 1 4.Criteria Computation 3/3 x 1 Actual Score 1 Justification It is a health deficit requiring more immediate intervention The resources and interventions needed to solve the problem are available to the family.


ooo y Eldest child is 12 yrs old. y Father verbalized.Gathered Data y The Kunsay family is composed of 7 members all in all y Father is the only one earning income for the family y Monthly salary is Php 5. y The mother verbalized. water and electricity y Youngest is an infant. Nahihirapan na kami kasi ang daming gastos pero ang liit lang ng kinikita ni mister. currently in the 5th grade y They are paying monthly for the house. Promise last na si jun-jun (5th child) .

ature of the problem Computation / x1 Actual Score / Justification This is a health threat . Preventive potential / x1 1 vailability of family resources can be utilize to encourage growth promoting experiences for members There is an explicit expression of the couple that the condition is considered a problem .Family size beyond what the family resources can adequately provide Criteria 1. Salience of the problem / x1 1 Total Score / . odifiability of the problem / x urrent knowledge and resources are available .

markedly underweight and undernoursihed. looks pale.Gathered Data y Karla. y Family income of P300 a day y Mother and father are busy working that they could barely see the needs of the 4 kids. y Mother said. . 4 years of age weighs 12 kgs. weak and lethargic. Ganyan talaga yan siya maliit na bata simula nung ipanganak ko pa.

the family can also modify their budget to ensure that nutritious foods can be served. 4. Other complications like immunosuppression can be prevented Mother does not perceive the child s condition as a health problem.Criteria 1. Modifiability of the problem 2/2 x 2 2 3. Nature of the problem Computation 3/3 x 1 Actual Score 1 Justification Health deficit 2. Preventive potential 3/3 x 1 1 The knowledge about proper nutrition can be provided through health teaching. Salience of the problem 0/2 x 1 0 Total Score 4 .

Plans approaches. . Defines nursing objectives in realistic measurable terms jointly with the family.7. Decides on what problems to tackle in the order of immediacy/ urgency. 8. based on priorities set. strategies of action (intervention). 9. criteria and standards for evaluation.

11. 12. .10.Evaluates the effectivity of implemented aspects of the plan. Implements the plan of care. Redefines nursing problems and reformulates objectives according to evaluation findings.

y Definition of contributing risk factors ‡ Predisposing factors ‡ Enabling factors ‡ Reinforcing factors The social determinants of health .They are the economic and social conditions under which people live which determine their health .

Characteristics of FNCP b. Desirable Qualities .y Planning of Individual and Family Health Nursing Care y Family Nursing Care Plan is the blueprint of care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems a.

is a general statement of the condition or state to be brought about by specific courses of action. The plan for evaluating care Goal . The prioritized condition/problem 2. The plan of intervention guide in selecting appropriate nursing intervention 4. Steps in developing an FNCP 1.c. Objectives refer to the more specific statements of the desired results or outcomes of care . The goals and objectives of nursing 3.

Resources available to solve the problem 1. Nurse 3.y Variables affecting choice of nursing intervention: Nature of the problem 2. Community 1. . y Types of Resources: Family resources 2.

Qualitative 2. Make decisions 6. Collect Relevant data 4.y Evaluation determines the effectivity of the nurse s efforts y Types of Evaluation 1. Analyze data 5. Decide what to evaluate 2. Quantitative y Steps in Evaluating Nursing Care 1. Design the evaluation plan 3. Report and give feedbacks .

Checklist 2.Methods and tools for evaluation 1. Questionnaire. Simulation Exercise . Interview. Direct Observation -Rating Scale. Surveys 5. Verbal Reports 4. Records and reports review and analyze 3.

t e c il is fe at eal rs. Ti e f r re 7-8 lar eals . ex. Q antity f f and f d intake a .Items Assessed/ Criteria Check if observed YES NO Remarks 1.t e c il s eal ear adeq ate in q antity 3. Kinds f f d a. 12 nn. 2. a . Incl des s ilk and t er f d le ents . C ntains ve etables and fr its b.

y Scoring System y YES = 2. NO=0. Partially yes = 1 y Add the scores y Interpretation y 7-8 y 5-6 y 3-4 y 1-2 yO excellent very good good poor very poor .

Sample FNCP
y Problem Identified: Improper Food Handling

y Subjective Cue: Pasensya kaayo mo ha. Gubot kaayo

nang among kusina. Nah! Wala raba nay hugas among mga kinan-an dinha. Wala pa man gyud nahuman among kusina mao ang among butangan ug mga plato wala puy tabon. as verbalized by Mrs. L.

y OC: The family kitchen has unwashed plates,

unorganized placements of utensils, their kitchen utensils are exposed to insects and rodents. Their cooked foods are being placed on the table covered by a basin, which they also use for washing their dishes. During one of the home visits conducted by the group, while they were preparing their meals for lunch, they just leave the food unattended, which is also exposed to flies.

y Family Nursing Diagnosis: Inability to decide about








comprehend the identified problem as a health threat

y Goal of

Care: Within 45 minutes of nursing

interventions, the family will be able to practice the proper ways on handling and preparing food.

the family will be able to: y 1. identify different measures to prevent the arousal of the risk factors of the problem . name risk factors that will contribute to the identified problems.y Objectives: Within 45 minutes of nursing interventions. y 2.

. practice and apply the techniques of food handling and preparation. determine the importance of preparing and handling the food properly. keep their kitchen clean and free from insects and rodents. 5. 4.y 3.

y Interventions with Rationale y Resources *Methods and Materials used y Evaluation .

Programs and series that focus on primary and secondary prevention of communicable and non-communicable diseases .2.

Disease Prevention . Restorative d. Component of care in acute and chronic illness a.Implementation of Individual and Family Health Nursing Care 1. Rehabilitative care . Curative e.Primary and Secondary c. Health Promotion b.

Bio-behavioral interventions and holistic care for individuals and family y to improve the health and healthcare of children.2. adolescents and their families through behavioral research on vulnerable individuals and populations. . using a multidisciplinary and biopsychosocial approach.

Modalities . mind. 1. Awareness 2.a practice that focuses on healing the whole person through the unity of body. spirit and environment. emotion. Practices 3.y Holistic Nursing Care .

3. Referral System y Partnership and Collaboration AIM: to get people to work together in order to address problems or concerns that affect them . .

Coalition or multi-sectoral collaboration . Collaboration 5. Coordination 3. Networking 2. Cooperation 4.y Different ways of partnership and collaboration 1.

Advocacy y Is one way of promoting active community participation. y The nurse helps the people to attain optimal degree of independence in decision making in asserting their rights to a safe and better community .

their content and possible consequences 2. Influencing public opinion . Thoroughly discussing with the people the nature of 3. Informing the people about the rightness of the cause alternatives. Supporting people s right to make a choice and to act on their choice 4.y Advocacy work involves: 1.

Standard format 2.y Ensuring a well organized and accurate documentation and reporting 1. Legal principles involved in documentation .

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