COMMUNITY HEALTH

NURSING
FAMILY NURSING CARE PLAN
What is Community Health Nursing?

 “The utilization of the nursing process in the

different levels of clientele-individuals, families,
population groups and communities, concerned
with the promotion of health, prevention of
disease and disability and rehabilitation.”
- Maglaya, et al
BASIC PRINCIPLES OF CHN
 The community is the patient in CHN, the family is the unit of
care and there are four levels of clientele: Individual, family,
population group, community.
 InCHN, the client is considered as an ACTIVE partner NOT
PASSIVE recipient of care
THE FAMILY NURSING CARE PLAN

 The FNCP is the blue print of the nursing care designed to

systematically enhanced the family’s capability to maintain
wellness and/or manage health problems through explicitly
formulated goals and objectives of care and deliberately chosen
set of interventions, resources and evaluation criteria, standards,
methods and tools.
Categories of Intervention

 Promotive
 Preventive
 Curative
 Rehabilitative
3 LEVELS OF HEALTH CARE

1. Primary - Prevention of illness or promotion of

health
2. Secondary - curative
3. Tertiary - rehabilitative
PRIMARY PREVENTION

 PRE-PATHOGENESIS
1. Promotion and general or holistic health
 Nutrition and Exercise (healthy lifestyle)
 Regular Check-ups
 Stress management

2. prevention of specific diseases

 Vaccination and personal surveillance
 isolation/quarantine
SECONDARY PREVENTION

 Pathogenesis

1. Early detection
 With signs and symptoms
2. Immediate treatment of acute condition
 Mode of Tx: Pharmacologic management, surgical
management, Nursing management
TERTIARY PREVENTION

 Post-pathogenesis/Convalescence
1. Rehabilitation
 Optimize the client’s remaining function after being sick.
 Delay the complication that decrease your function.
 Example: giving insulin to a diabetic patient to delay complications.
2. Pallation
 Promote comfort
 Management of symptoms of pain
Tools of Public health nurse

PHN Bag
 Principles
 Techniques
Types of Nurse-Family Contact

 Clinic visit
 Home visit
 Group conference
 Telephone calls
 Written communication
CLINIC VISIT

 process of checking the client’s health condition in a medical

clinic

 Phases of clinic visit

 Pre consultation conference
 Medical examination
 Nursing intervention
 Post consultation conference
Pre-Consultation Conference

1. Take clinical history after greeting and making client at ease.

2. Take the vital signs, Weight and height
3. Perform a thorough physical assessment
4. Do selective laboratory examinations such as Urinalysis for sugar and albumin as
necessary, sputum exam, stool examination for parasites, vaginal smear for STD
screening after taking necessary training
5. Write findings on the client’s record
Medical Examination

1. Assist the client before, during and after examination by physician

2. Inform physician of relevant findings gathered in pre-conference
3. Work with the physician during the examination
4. Ensure privacy, safety and comfort of patient throughout
procedure.
5. Observe confidentiality of examination of results
Nursing Interventions

1. Carry out physician’s orders as giving medication or injection

2. Explain and reinforce physician’s orders and advises
3. Teach client measures designed to promote and maintain health as proper diet, exercise
and personal hygiene
4. Seek information regarding health status of other family members.
(example: immunization status of children, health and problems of elderly if any, health of
husband)
5. Counseling
Post Consultation Conference

1. Explain findings and needed care intervention.

2. Refer client to other health of related staff/agency
if necessary.
3. Make appointment for next clinic/home visit
4. Referral as needed.
Reasons for planning care

1. A systematic way to guide the nurse

2. Enhances the foresight for team work and coordination of
services to ensure adequacy and continuity of care
3. In written form, the plan promotes systematic communication
among those involved in the care effort, thus minimizing gaps
and duplication of services, especially if there is frequent turn
over of staffs or there are several health workers providing
care to the same family
FAMILY HEALTH NURSING PROCESS

a systematic approach of solving an existing problem/meeting

the needs of family
R apport
A ssessment
P lanning
I ntervention
E valuation
FAMILY HEALTH NURSING PROCESS

I. RAPPORT
 Trust building
 Knowing your client
 Adjusting to the situation and environment
 RESPECT
FAMILY HEALTH NURSING PROCESS
II. ASSESSMENT
 Data Gathering: tools or instruments used during survey:
 Interview
 Observation
 Questionnaires-mostly patronized & used in CHN
 Records & Reports available
 Consolidation or Collation: collecting back the
questionnaires, tabulate and summarize
FAMILY HEALTH NURSING PROCESS

Validation: uses statistical approaches

Statistical Approaches:
1. Central Tendencies: 3 M’s
2. Standard Deviation
3. Percentile (%) Method
TYPOLOGY OF NURSING PROBLEMS

A. First Level Assessment:

 determine problems of family
 Sources of Problems using initial data base

 Family: use of Initial Data Base (IDB)

 Nature:Health Deficit (HD), Health Threat (HT),
Foreseeable Crisis (FC)
USE OF INITIAL DATA BASE (IDB):
1. Family Chart Structure:
 Nuclear -Father, mother, children
 Extended (3rd generation)-Relatives staying with the family
 Multi-generational extended-“apo sa tuhod” or “apo sa talampakan”
 Dyad -Husband & wife only (childless couple)
 Blended -widow married another widow & have children
 Gay -Same sex living together
 Matriarchal -Mother is the decision maker
 Patriarchal -Father is the decision maker
 Communal -different families forming a community
USE OF INITIAL DATA BASE (IDB):

2. Socio-economic: poverty level, educational attainment

& nature of occupation of members of the family (sources
of income)
3. Socio-cultural: different nature of religion
4. Home environment: treatment of garbage, preparation
of food, availability of toilet, water & food sanitation,
sources of diseases
USE OF INITIAL DATA BASE (IDB):
5. Medical history
6. Resources available in community for use by the family:
5 Generalized M’s in resources available in community:
 Man/Manpower
 Money
 Machine
 Materials
 Methods
 DEFINE THE PROBLEM ACCORDING TO NATURE

Health Deficit (HD)

 if identified problem is an abnormality(disabilities), illness or disease, there’s a
gap/difference between normal status and actual status and (the
outcome/result/problem encountered on that actual day)

Health Threat (HT)

 any condition or situation which will be conducive to health alteration, health
interference & health disturbance.
 DEFINE THE PROBLEM ACCORDING TO NATURE

Stress points/Foreseeable Crisis (FC)

 anything which is anticipated/ expected to become a problem/stress

Stress point – stressful condition happening now

Foreseeable Crisis – See in the near future
 JOBLESS FATHER
 SUFFERING FROM TB
 WIFE IS PREGNANT FOR THE 8TH
TIME
 2 y/o youngest child lacks
immunization
 9 y/o eldest child is 3rd degree
malnourished
 Poor environmental sanitation
 Upcoming tuition fees
 Piggery near the water source
 Child suffers from pneumonia
 There’s a gap between father and son
 Pregnancy
 Not using soap when washing hands
 Father is smoking
 Mother is Mute
 JOBLESS FATHER
 SUFFERING FROM TB
 WIFE IS PREGNANT FOR THE 8TH TIME
2 y/o youngest child lacks immunization
9 y/o eldest child is 3rd degree malnourished
 Poor environmental sanitation
III. PLANNING

Four (4) Standard Steps:

1. Prioritization -start if there are multiple identified problems
2. Formulation of goals and objectives -planning a procedure
will start here if there is only one problem
3. Developing strategies of action/intervention
4. Formulation of evaluation tools for the identified strategy
developed
Prioritize the health condition
and problems based on Develop evaluation plan
•Nature of the problem Specify:
•Modifiability •Criteria, standards, outcome
•Preventive Potential based on objective of care
•Salience •Methods/tools

Define Goals and Objectives

of Care Develop the intervention plan
Formulate: Decide on:
•Expected Outcomes: •Measures to help family
eliminate:
•Condition which sustain 1.Barriers to performances of
wellness state health task
•Condition to be observed to 2. Underlying causes of non
show problem is prevented, performance of health task
controlled, resolved or • Family centered alternatives
eliminated to recognize/detect, monitor,
•Clients’ response/s behavior control or manage health
•Specific, measurable., client condition or problems
centered •Determine Methods of Nurse-
statements/competencies Family Contact
•Specify resources needed
Steps in developing FNCP
1. Prioritizing Health Conditions and Problems

 Case load are given to a nurse in which she is going to handle in a specific municipality
or village
 Given a case load the nurse may realize, even for just one family , a number of health
conditions and family health problem cannot be addressed at the same time within a
specific period. With this in mind ranking the
identified health and health related problems is needed
 Bailon and Maglaya designed a tool called Scale for Ranking health Conditions and
problems According to Priorities
 Scale Ranking Health Conditions and Problems According to priorities
Criteria Score Weight

1. Nature of the condition or problem

Scale ** Wellness state 3
Health deficit 3 1
Health Threat 2
Foreseeable Crisis 1

2. Modifiability of the condition or problem

Scale ** Easily modifiable 2
partially modifiable 1 2
Not modifiable 0

3. Preventive Potential
Scale ** High 3
Moderate 2 1
Low 1

4. Salience
Scale ** A condition or problem needing immediate attention 2
A condition or problem nor needing immediate attention 1 1
Not perceived as a problem or condition needing change 0
Factors affecting priority setting

1. Nature or condition of health problem presented

 Health deficit requires immediate intervention
 Foreseeable crisis- least weight because culture linked /factors usually provide families with
adequate support to cope with developmental and situational crisis
2. Modifiability of the problem. Consider the ff. Factors
a. Current knowledge, technology and interventions to enhance the wellness state or manage the
problem
b. Resources of the family (physical, financial and manpower
c. Resources of the nurse (knowledge, skills and time)
d. Resources of the community-facilities and community organizations or support
Factors affecting priority setting

To decide on preventive potential score

a. Gravity or severity of the problem-progress of the disease/problem indicating the extent of damage
, prognosis, reversibility or modifiability. The more advance the problem the lower the
preventive potential
b. Duration of the problem- duration has direct relationship to gravity, duration has direct relationship
to preventive potential.
c. Current management – presence and appropriateness of intervention measure . The institution of
appropriate intervention increases the preventive potential
d. Exposure to any vulnerable/high risk group- increase the preventive potential of condition
/problem
2. Formulation of goals and objectives

 Goal- is a broad desired outcome towards which the behavior is directed

After nursing intervention the family will be able to take care of the disabled child
competently

 Cardinal rule- goals must be set with the family to ensure family commitment. The
family’s recognition and acceptance of the existing health problem is crucial
2. Formulation of goals and objectives

Barriers to goal setting between the nurse and the family

1. Failure of the family to perceive the existence of the problem, the family is satisfied
with the present situation. Ex. Lack of sanitary toilet facilities
2. The family may recognize the existence of a problem but to busy at the moment. Ex. A
mother may perceived the importance of immunization but to busy with household
chores.
2. Formulation of goals and objectives

 Barriers to goal setting between the nurse and the family

3. Sometimes the family may perceive the existence of a problem but does not see it as
serious enough to warrant attention Ex. Common colds, intestinal parasitism that are
regarded as normal condition in childhood
4. The family may perceived the presence of the problem and the need to take action because;
- Fear of consequences
Formulation of goals and objectives

 Barriers to goal setting between the nurse and the family

 Respect for tradition
 Failure to perceived the benefit of the action
 Failure to relate the proposed goals to the family’s goal
5. Big barrier is the development of working relationship; mutual respect, trust and
confidence
Goals should be realistic, attainable.
Best stated in client outcome
Formulation of goals and objectives

 Objectives- objectives stated as outcome of care specify physical, psychosocial

family behavior

After nursing intervention , the malnourished preschooler member of the family

will increase the weight by at least one pound a month

After nursing intervention the family will be able to;

a. Feed the mentally retarded child according to the prescribed quantity and quality of
food
b. Teach the mentally retarded child simple skills related to activity of daily living.
c. Apply measures taught to prevent infection in the mentally retarded member
Formulation of goals and objectives

 Objectives may be short term, medium term, long term

 Objective should be realistic and attainable
 Objective and evaluation are directly related
 Objectives stated in observable facts and behavior , the criteria for evaluation become
inherent
 Example of well written goal and objective

Nursing Goal: The family will manage malaria as a disease and threat in an
endemic area.

Short term / immediate objective : The sick member will take the drug accurately as
to dose, frequency, duration and drug combination. All members will use self-
protection measures at night till early morning when biting time of mosquito vector
is expected.

Medium – term/ intermediate objective; all members will have regular medical
check up and ;laboratory confirmation( Blood smear) to monitor presence of
malaria

Long term objective- all members will carry out mosquito vector control measures
IV. INTERVENTION

 Isthe capacity to provide management Is the

professional phase of nursing process
 Is the time when the PHN executes the standard function
of an RN
 Three (3) Standard Functions of RN:
Dependent-giving of medicines
Independent-monitor, assess, provide, educate
Interdependent-referrals
Developing the intervention plan

 Select nursing intervention based on formulated goals and

objectives, specifying the most effective and efficient
method of nurse-family contact and resources needed
Ex of nurse-family contact ; home visit, clinic conferences,
visit in the work place, school visit, telephone call, group
approach, use of mail
Ex. Of resources; man, money , materials
Guide in selecting appropriate nursing intervention

1. Analyze with the family the situation and determine the

choices/possibilities on lived experiences meanings and
concern (look – think - act
2. Develop/enhanced family’s competency as thinker , doer ,
and feeler ( family as a system)
3. Focus intervention to help perform the health task
4. Catalyze behavior change through motivation and support
Criteria in selecting the type of nurse- family contact

 Criteria is selection- effective, efficient and appropriate

1. Home visit- expensive in terms of time, effort and logistic but it is
effective and appropriate
2. Clinic- less expensive and provide the nurse the opportunity to use
equipment that cannot be taken at home. Other team member may be
consulted
3. Telephone –effective and appropriate if the objectives and outcomes
require immediate access to data, given problem on distance and or travel
time
Criteria in selecting the type of nurse- family contact

4. Letter- sending a note s reminder

5. School visit- opportunity to work with the family
and school authority to determine the degree of
vulnerability of children and work on
interventions
 V. EVALUATION

Three (3) Things to be evaluated: SPO

1. Structure of program & activity -what articles, equipment's, supplies are utilized
2. Process utilized -steps used
3. Outcome of activity -results can be:
 Desirable -to be implemented, advocated, strengthen
 Undesirable -to be avoided
Two (2) Aspects to be evaluated in the Outcome:
 Quality and Quantity
Developing Evaluation Plan

 Determine the changes in health status , condition

or situation and achievement of outcome care
specified in the objective
 Sample Evaluation Plan
Outcome
Goal: Improve the
nutritional status of the 2
year old family member
Objectives;
The family will be able to:
1. Provide adequate care
to the two-year old
member
Evaluation
criteria/indicators
Weight (nutritional status
criterion)
Performance
criteria/indicator’
1. a. Indentify
inadequacies in
specific nutrients
generated form the
baseline dietary intake
of the child
2. Prepare meals based on
cycle menu plan
Evaluation standards Evaluation
Method Tools/ data sources
Increase at least 1 Weight monitoring Weighing scale. Early
kilograms in six weeks Childhood Care and
Development Card fro 0-6
years
Correct identification of
inadequacies in intake of Dietary history Food recall or food
specific macronutrients, frequency record
vitamins and minerals
critical growth, bone
development and strong
immune system
Accurate application of
Daily Nutrition Guide
pyramid for Filipino
children 1-6 years
Record review Menu plan
 Sample Evaluation Plan

Outcome Evaluation criteria/ Evaluation standards Evaluation

indicators
Method Tool/ data source

Preparation of meals guided Observation Performance evaluation

by principles such as checklist
nutrients preservation,
increased variety and
appealing taste

Child’s daily food intake

1.C feed the children based based on recommended Record review Estimated food record
on agreed upon quality and energy and nutrient intake Observation and interview Performance evaluation
quantity of food for age group checklist

Appropriate and effective

1.d. Carry out strategies/ measures based on child's Interview and observation
measures to address child’s age and nature/magnitude of Performance evaluation
eating idiosyncrasies and eating/feeding problems checklist
problems

2. Utilize community 2.a bring the child to the Clinic follow – up at least Record review Early childhood care and
resources for care health center for regular once during the month development chart
early childhood growth
monitoring and care