Family Nursing Care Plan

A, D, P

Basiloy, Clarizsa Jae P.

Cedana, Joana Shaine
Legaspi, Andrei Yuuna
ASSESSMENT
Cedana, Joana Shaine
Nursing Assessment: Operational Framework
It is the first major phase of the nursing process. In family
health nursing practice, this involves a set of actions by which
the nurse determines the status of the family as a client, its
ability to maintain itself as a system and functioning unit, and
its ability to maintain wellness, prevent, control or resolve
problems in order to achieve health and illness experiences.
 Nursing Assessment: Operational Framework

Nursing assessment includes data collection, data

analysis or interpretation and problem definition or nursing
diagnosis. Nursing diagnosis is the end result of two major
types of nursing assessment in family nursing practice based
on the framework used.
● First-level of assessment
● Second-level of assessment
 Nursing Assessment: Operational Framework

● First-level assessment
a process whereby data about the current health status of
individual members, the family as a system and its
environment compared against norms or standards of
personal, social and environmental health and
interactions/interpersonal relationships within the family
system.
 Nursing Assessment: Operational Framework

● Second-level assessment
specifies the nursing problems that the family encounters
in performing the health tasks with respect to a given health
condition or problem, and the causes, barriers or etiology of
the family’s inability to perform the health task.
 Steps in Family Nursing Assessment
There are three major steps in nursing assessment as
applied to family nursing practice: data collection; data
analysis; and formulation of diagnosis.
Data collection for first-level assessment involves
gathering of five types of data which generates the categories
of health conditions or problems of the family.
 Steps in Family Nursing Assessment

These data include:

1. Family structure, characteristics and dynamics;
2. Socio-economic and cultural characteristics;
3. Home and environment;
4. Health status of each member; and
5. Values and practices on health promotion/maintenance
and disease prevention.
 Steps in Family Nursing Assessment

Second-level assessment data include those that specify

or describe the family’s realities, perceptions about and
attitudes related to the assumption or performance of family
health tasks on each health condition or problem identified
during the first-level assessment.
 Steps in Family Nursing Assessment

The last step in family nursing assessment involves making a diagnosis.

This includes:
1. Definition of wellness state/potential or health condition or problems as
an end product of first-level assessment;
2. Definition of family nursing problems as an end result of second-level
assessment.
The family nursing problem is stated as an inability to perform a specific
health task and the reasons why the family cannot perform such task.
 Types of Family Nursing Assessment

● Family structure, characteristics and dynamics

a. Family composition and demographic data
b. Type of family form and structure
c. Decision-making patterns
d. Interpersonal relationships
e. Interactional patterns
f. Communication patterns or processes affecting family relatedness
g. Consistency and congruence between intended and received messages
h. Explicitness of message for appropriateness
i. Effectivity and efficiency of the communication process related with role
performance
j. Individual members’ health and family system integrity
 Types of Family Nursing Assessment

● Socio-economic and cultural characteristics

a. Occupation
b. Place of work
c. Income of each working member
d. Educational attainment of each family member
e. Ethnic background and religious affiliation
f. Family traditions, events or practices affecting members’
health or family functioning; significant others and the role(s)
they play in the family’s life
g. Relationship of the family to the larger community
 Types of Family Nursing Assessment

● Home and Environment

a. Information on housing and sanitation facilities
b. Kind of neighborhood and availability of social, health,
communication and transportation facilities in the
community,
 Types of Family Nursing Assessment

● Health status of each member

a. Current and past significant health condition or illness
b. Beliefs and practices conducive to health illness
c. Nutritional and developmental status
d. Physical assessment findings and significant results of
laboratory/diagnostic tests/screening procedures.
 Types of Family Nursing Assessment

● Values and practices on health promotion/maintenance

and disease prevention
a. Promotive/preventive services as evidenced by
immunization status of at-risk members and use of other
healthy lifestyle related services
b. Adequacy of rest/sleep, exercise, relaxation activities,
stress management or other healthy lifestyle practices;
opportunities which enhance feeling of self-worth, self-
efficacy and connectedness to self, others, and a higher
power
c. Essence of meaningfulness
 Data-gathering Methods and Tools
There are several methods of data-gathering that the
nurse can select from, depending on availability of resources
such as material, manpower, time and facilities. The critical
point in the choice is concern for accuracy, validity, reliability,
and adequacy of assessment data.
 Data-gathering Methods and Tools

● Observation
○ It is done through the use of the sensory capacities.
Through direct observation, the nurse gathers information
about the family’s state pf being andb behavioral
responses.
● Physical examination
○ Significant data about the health status of individual family
members can be obtained through direct examination.
This is done through inspection,palpation, percussion,
auscultation, measurement of specific body parts and
reviewing the body systems.
 Data-gathering Methods and Tools

● Interview
○ It is completing a health history for each family
member.
● Record Review
○ The nurse may gather information through reviewing
existing records and reports pertinent to the client.
● Laboratory/Diagnostic Tests
○ It is through performing laboratory tests, diagnostic
procedures, or other test of integrity and functions
carried out by the nurse hearse;f and/or other health
workers.
 Assessment Data Base (ADB)

It is supported and complemented by other family

assessment tools elicit generational information about family
structure and processes (genogram), factual data about
family relationship with external environment and its
resources (ecomap), and interactive processes and family
relationship problems/difficulties and strengths (family-life
chronology).
DIAGNOSIS
Basiloy, Clarizsa Jae P.
Nursing Problem/Diagnosis
The Nursing problems pertain to a
client/patient’s inability to effectively
perform certain health tasks that would
contribute to and result in optimum
health due to lack of or inadequate will,
strength, knowledge, capabilities
and/or resources. As in other care
environments, the nurse identifies both
actual and potential client problems.
Prioritizing Health and Nursing Problems

1. The Client’s perception of the problems and his/her set of priorities

- The problem(s) which the client perceives to be the most urgent, serious and
priority should be given attention first.
1. Immediacy and urgency of the problem
- Actual problems that are staring the client/patient right in the eye should be
given priority over potential problems.
1. Seriousness of the problem
- Life threatening problems obviously demand priority attention over minor,
nonlife-threatening ones.
Prioritizing Health and Nursing Problems

4. Magnitude of the problem

- The bigger the problem and undesirable consequences it produces, the more priority it
should be given.

5. Potential for successful resolution

- Problems with a good potential to be successfully and positively resolved with available
intervention measures and resources should be addressed first.

6. Potential to prevent other problems

- Problems whose resolution will prevent the development of other problems should be
given priority attention.
Inability to recognize the presence of the condition or problem due to:

1. Lack of inadequate knowledge

2. Denial about its existence or severity as a result of fear or
consequences of diagnosis or problems
- Social-stigma, loss of respect of peer/significant others
- Economic/cost implications
- Physical consequences
- Emotional/psychological issues/concerns
1. Attitude/Philosopy in life, which hinders recognition/acceptance of a
problem.
Inability to make decisions with respect to taking appropriate health action due to:

1. Failure to comprehend the nature/magnitude of the problem/condition

2. Low salience of the problem/condition
3. 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.
4. Lack of/inadequate knowledge/insight as to alternative courses of action
open to them
5. Inability to decide which action to take from among a list of alternatives
Inability to make decisions with respect to taking appropriate health action due to:

6. Conflicting opinions among family members/significant others regarding action to

take.

7. Lack of/inadequate knowledge of community resources for care

8.. Fear of consequences of action, specifically:

9. Social, Economic, Physical, Psychological consequences

10. Negative attitude towards the health condition or problem-by negative attitude is
meant one that interferes with rational decision-making.

11. Inaccessibility of appropriate resources for care

Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to:

1. Lack of/inadequate knowledge about the disease/health condition (nature,

severity, complications, prognosis and management)

2. Lack of/inadequate knowledge about child development and care

3. Lack of/inadequate knowledge of the nature or extent of nursing care needed

4. Lack of the necessary facilities, equipment and supplies of care

Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to:

5. 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).

6. Inadequate family resources of care specifically:

- Absence of responsible member

- Financial constraints
- Limitation of luck/lack of physical resources

7. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair,

rejection) which his/her capacities to provide care.
Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to:

8. Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
vulnerable/at risk member
9. Member’s preoccupation with on concerns/interests
10. Prolonged disease or disabilities, which exhaust supportive capacity of family
members.
11. Altered role performance, specify.
Role denials or ambivalence, Role strain, Role dissatisfaction, Role conflict, Role
confusion, Role overload
Inability to provide a home environment conducive to health
maintenance and personal development due to:

1. Inadequate family resources specifically:

- Financial constraints/limited financial resources
- Limited physical resources-e.i. lack of space to construct facility

2. Failure to see benefits (specifically long term ones) of investments in home

environment improvement

3. Lack of/inadequate knowledge of importance of hygiene and sanitation

4. Lack of/inadequate knowledge of preventive measures

Inability to provide a home environment conducive to health maintenance and personal development due to:

5. Lack of skill in carrying out measures to improve home environment

6. Ineffective communication pattern within the family
7. Lack of supportive relationship among family members
8. Negative attitudes/philosophy in life which is not conducive to health maintenance and
personal development
9. 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.
Failure to utilize community resources for health care due to:

1. Lack of/inadequate knowledge of community resources for health care

2. Failure to perceive the benefits of health care/services

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

4. Previous unpleasant experience with health worker

5. Fear of consequences of action (preventive, diagnostic, therapeutic,

rehabilitative) specifically :

Physical/psychological, financial, social consequences

Failure to utilize community resources for health care due to:

6. Unavailability of required care/services

7. Inaccessibility of required services due to:

Cost constraints and Physical inaccessibility

8. Lack of or inadequate family resources, such as:

Manpower resources, e.g. baby sitter

9. Financial resources, cost of medicines prescribed

Failure to utilize community resources for health care due to:

10. Feeling of alienation to/lack of support from the community

ex. stigma due to mental illness, AIDS, etc.
11. Negative attitude/ philosophy in life which hinders
effective/maximum utilization of community resources for health
care
PLANNING
Legaspi, Andrei Yuuna
 PLANNING
It is a systematic approach in developing a plan of action based on careful
assessment.
Planning phase consist of:
- Establishing priorities for the problems diagnosed.
- Setting objective
- Writing nursing intervention that will lead to achievement of proposed
objective.
- Recording nursing diagnosis, reasons, objectives, and nursing
interventions.
 COMPONENTS OF PLANNING

1. Objective
2. Nursing Interventions
 OBJECTIVE
Objectives help the nurse and patient to evaluate the patient progress
towards desired outcomes well as the effectiveness of the nursing
interventions.
Objectives should be:
- Related to the problem statement
- Client centered
- Clear and concise
- Observable & measurable
- Realistic
- Time Limited
- Determined by the nurse and client
 NURSING INTERVENTIONS
Nursing interventions focus on the activities required to promote, maintain
or restore the patient’s health.
Types of Nursing Intervention
1. Dependent Intervention
2. Interdependent Intervention
3. Independent Intervention
 DEPENDENT INTERVENTION
It is related to implementation of medical orders.
Eg: discuss about the medicine regimen with the patient as prescribed by
doctor.
 INTERDEPENDENT INTERVENTION
Describe the activities that nurses carries out in cooperation with the other
health team members.
Eg:
- sterile instruments to be used
- takes out the record.
- gets the clinic personnel to arrange the clinic.
 INDEPENDENT INTERVENTION
These are the activities performed by the nurse without direct doctor’s
order.
Eg:
- Community health nurse will give group teaching and health
education.
- Assist the patient to identify potential hazards at home.
 GUIDELINES FOR EFFECTIVE
INTERVENTION
1. Precise Action Verbs
2. Dated
3. Consistent with Plan of Care
4. Based on scientific principles
5. Individualized to Client
6. Modification of standard therapy
7. Signed
References
Vera, M. (2014). Family Nursing Care Plan: Assessment & Diagnoses in Family
Nursing Practice. Retrieved from:
https://nurseslabs.com/family-nursing-care-plan-assessment-diagnoses-in-family-nursi
ng-practice/

http://www.authorstream.com/Presentation/randhawakiran23-1101710-community-heal
th-nursing-process/

Bailon-Reyes (2006). Community Health Nursing. The Basic Practice.