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FAMILY HEALTH
NURSING
BY ROMMEL LUIS C. ISRAEL III
BY ROMMEL LUIS C. ISRAEL III
1
FAMILY HEALTH
NURSING
• Level of
community
health nursing
practice
directed or
focused on the
family as the
unit of care
Goal – HEALTH
Medium - NURSING
Channel/Provider of care - NURSE
BY ROMMEL LUIS C. ISRAEL III
2
FAMILY NURSING
CARE PLAN
• Blueprint of the care that
the nurse designs to
systematically minimize or
eliminate the identified
health and family nursing
problem through explicitly
formulated outcomes of
care and deliberately
chosen set of
interventions, resources
and evaluation criteria,
standards, methods and
tools.
BY ROMMEL LUIS C. ISRAEL III
3
FEATURES OF NCP
Focuses on actions which are
designed to solve or
minimize existing problem
Product of a deliberate
systematic process
Relates to the future –
the future scenario if the
current situation is not
corrected
Based upon identified health
and nursing problems
Means to an end, not an end
by itself - the goal in
is to deliver the most
appropriate care to the client
by eliminating barriers to
family health development.
BY ROMMEL LUIS C. ISRAEL III
4
FEATURES OF NCP
• Continuous process, not
a one – shot deal – the
results of the evaluation
of the plan’s
effectiveness trigger
another cycle of the
planning process until
the health and nursing
problems are eliminated
BY ROMMEL LUIS C. ISRAEL III
5
STEPS OF FAMILY NURSING
PROCESS
ASSESSMENT
DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
BY ROMMEL LUIS C. ISRAEL III
6
• First major phase of the nursing process
• Involves a set of actions by which the nurse
measures the status of the family as a client, its
ability to maintain itself as a system and
functioning unit and its ability to prevent, control
or resolve problems in order to achieve health
and well – being among its members.
STEPS OF FAMILY NURSING-
PROCESS
ASSESSMENT
BY ROMMEL LUIS C. ISRAEL III
7
STEPS OF FAMILY NURSING- PROCESS
ASSESSMENT
Identifying assessment priorities
Prioritizing types of data to be collected
systematically
Establishing the data base
- Nursing history
- Physical examination
- Review of client record
- Consultation with health professionals
BY ROMMEL LUIS C. ISRAEL III
8
STEPS OF FAMILY NURSING- PROCESS
ASSESSMENT
Continuous updating of records
Validating data
Communicating data
BY ROMMEL LUIS C. ISRAEL III
9
• Composition and demographic data of the members of the
family and household, their relationship to the head and place
of residence
• Type of family and family interaction/communication
• Decision - making patterns and dynamics
TYPES OF DATA IN FAMILY
NURSING ASSESSMENT
Family structure, characteristics and dynamics
BY ROMMEL LUIS C. ISRAEL III
10
• Occupation, place of work and income of each working
member
• Educational attainment of each family member
• Ethnic background and religious affiliation
• Significant others and the other role/s they play in the family’s
life
• Relationship of the family to the larger community
TYPES OF DATA IN FAMILY
NURSING ASSESSMENT
Socio – economic and cultural characteristics
BY ROMMEL LUIS C. ISRAEL III
11
• Housing and sanitation facilities
• Kind of neighborhood
• Availability of social, health communication
• Transportation facilities in the community
TYPES OF DATA IN FAMILY
NURSING ASSESSMENT
Home and environment
BY ROMMEL LUIS C. ISRAEL III
12
• Preventive services
• Adequacy of rest and sleep
• Relaxation activities
• Stress management or other healthy lifestyle activities
• Immunization status of at – risk family members
TYPES OF DATA IN FAMILY
NURSING ASSESSMENT
Values and practices on health promotion/
maintenance and disease prevention
BY ROMMEL LUIS C. ISRAEL III
13
DATA GATHERING METHODS
• Observation
• Physical examination
• Interview
• Record review
• Laboratory / diagnostic tests
BY ROMMEL LUIS C. ISRAEL III
14
DATA GATHERING
METHODS
OBSERVATION
• Use of sensory capacities
• sight, hearing, smell, touch
BY ROMMEL LUIS C. ISRAEL III
15
DATA GATHERING
METHODS
PHYSICAL EXAMINATION
• IPPA – inspection, percussion, palpation,
auscultation
• IAPP – inspection, auscultation, percussion,
palpation
• Measurement of specific body parts and
reviewing the body systems
HEALTH DEFICITS
BY ROMMEL LUIS C. ISRAEL III
16
DATA GATHERING
METHODS
INTERVIEW
• Another major method of data gathering
• Completing health history
• Personally asking significant family
members or relatives questions regarding
health, family life experiences and home
environment
BY ROMMEL LUIS C. ISRAEL III
17
DATA GATHERING
METHODS
RECORD REVIEW
• Reviewing existing records
- individual clinical records
- laboratory and diagnostic reports
- immunization records
- home and environment conditions
BY ROMMEL LUIS C. ISRAEL III
18
DATA GATHERING
METHODS
LABORATORY / DIAGNOSTIC TESTS
•E.g. cbc, x- ray, MRI, CT scan..etc
BY ROMMEL LUIS C. ISRAEL III
19
TWO MAJOR TYPES OF NURSING
ASSESSMENT
1. FIRST LEVEL ASSESSMENT
• Is a process whereby existing and potential health
conditions or problems of the family are
determined.
- wellness state
- health threats
- health deficits
- stress points / foreseeable crisis situations
BY ROMMEL LUIS C. ISRAEL III
20
TYPOLOGY OF NURSING
PROBLEMS
WELLNESS STATE
• A clinical or nursing judgment about a client in
transition from a specific level of wellness or
capability to a higher level
• Opportunity to improve
• Stated as POTENTIAL OR READINESS
BY ROMMEL LUIS C. ISRAEL III
21
TYPOLOGY OF NURSING
PROBLEMS
Wellness Potential
• Nursing judgment on wellness state or condition
based on client’s performance, current competencies
or clinical data but no explicit expression of client
desire.
• Eg. Potential for Enhanced Capability for
- healthy lifestyle
- health maintenance
- parenting
- breast feeding - spiritual well being
BY ROMMEL LUIS C. ISRAEL III
22
TYPOLOGY OF NURSING
PROBLEMS
Readiness for enhanced wellness state
• Nursing judgment on wellness state or condition
based on client’s current competencies or
performance, clinical data and explicit expression of
desire to achieve a higher level of state or function in
a specific area on health promotion and maintenance
• Eg. Readiness for Enhanced Capability for
- healthy lifestyle - health maintenance
- parenting - breast feeding
- spiritual well being
BY ROMMEL LUIS C. ISRAEL III
23
TYPOLOGY OF NURSING
PROBLEMS
HEALTH THREAT
• Conditions that are conducive to disease, accident or failure
to realize one’s health potential
• Factors that leads to disease
• Eg. - family hx - threats of cross infection
- accident - faulty eating habits
- stress - poor home / sanitation
- unsanitary food handling and preparation
- unhealthful lifestyle
BY ROMMEL LUIS C. ISRAEL III
24
TYPOLOGY OF NURSING
PROBLEMS
HEALTH DEFICITS
• Instances of failure in health maintenance
• Deviation from normal health
• Eg. - illness states
- failure to thrive/develop according to normal rate
- disability
BY ROMMEL LUIS C. ISRAEL III
25
TYPOLOGY OF NURSING
PROBLEMS
STRESS POINTS/FORESEEABLE CRISIS SITUATION
• Anticipated periods of unusual demand on the individual or
family in terms of adjustment / family resources
• May arise in the future
• Eg. - marriage - pregnancy, labor
- parenthood - abortion
- menopause - loss of job
- hospitalization - entrance at school
BY ROMMEL LUIS C. ISRAEL III
26
TYPOLOGY OF NURSING
PROBLEMS
- adolescence
- additional member
- death of a member
- resettlement in a new community
BY ROMMEL LUIS C. ISRAEL III
27
TWO MAJOR TYPES OF NURSING
ASSESSMENT
2. SECOND LEVEL ASSESSMENT
• Defines the nature or type of nursing
problems that the family encounters in
performing the health tasks with respect to
a given health condition or problem.
BY ROMMEL LUIS C. ISRAEL III
28
ABILITIES BASED ON HEALTH
TASKS BY RUTH FREEMAN
1. Ability to recognize the existence of a
wellness state, health condition or a
health problem.
2. Ability to make decisions with respect to
taking appropriate health actions
3. Ability to provide nursing care to the
affected family member
BY ROMMEL LUIS C. ISRAEL III
29
4. Ability to provide a home environment
conducive to health maintenance and
personal development.
5. Ability to utilize community resources for
health care
BY ROMMEL LUIS C. ISRAEL III
30
5 MAIN TYPES OF FAMILY NURSING
PROBLEMS BY DR. MAGLAYA
1. Inability to recognize the existence of a
wellness state, health condition or a
health problem.
2. Inability to make decisions with respect to
taking appropriate health actions
3. Inability to provide nursing care to the
affected family member
BY ROMMEL LUIS C. ISRAEL III
31
4. Inability to provide a home environment
conducive to health maintenance and
personal development.
5. Inability to utilize community resources
for health care
BY ROMMEL LUIS C. ISRAEL III
32
• It is the end result of two major types of nursing
assessment in family nursing practice
TWO PARTS:
• Statement of unhealthful response
• Statement of factors which are maintaining the
undesirable response and preventing the desired
change
STEPS OF FAMILY NURSING- PROCESS
DIAGNOSIS
BY ROMMEL LUIS C. ISRAEL III
33
STEPS OF FAMILY NURSING- PROCESS
Example
• Inability to make decisions with respect to
taking appropriate health action due to
lack of knowledge as to alternative courses
of action open to the family
DIAGNOSIS
BY ROMMEL LUIS C. ISRAEL III
34
STEPS OF FAMILY NURSING- PROCESS
DIAGNOSIS
data utilization
problem identification
BY ROMMEL LUIS C. ISRAEL III
35
STEPS OF FAMILY NURSING-
PROCESS
PLANNING
prioritization
plan formulation
identification of resources
goal setting
BY ROMMEL LUIS C. ISRAEL III
36
Components for planning phase
1. prioritized conditions or problems
2. goals and objectives of nursing care
3. plan of interventions
4. plan for evaluating care
BY ROMMEL LUIS C. ISRAEL III
37
CRITERIA FOR
PRIORITIZATION
1. NATURE OF CONDITION/ PROBLEM PRESENTED
• Categorized as wellness state/potential, health threat,
health deficit, foreseeable crisis
2. MODIFIABILITY OF THE CONDITION/PROBLEM
• Probability of success in enhancing the wellness state,
improving the condition, minimizing, alleviating or
totally eradicating the problem through intervention
3. PREVENTIVE POTENTIAL
• Nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on
the problem under consideration
BY ROMMEL LUIS C. ISRAEL III
38
CRITERIA FOR
PRIORITIZATION
4. SALIENCE
Family’s perception and
evaluation of the
in terms of seriousness
and urgency of attention
needed or family
BY ROMMEL LUIS C. ISRAEL III
39
CRITERIA SCORE WEIGHT
NATURE OF THE CONDITION
Wellness state
Health Deficit
Health threat
Forseeable crisis
3
3
2
1
1
MODIFIABILITY OF THE CONDITION
Easily Modifiable
Partially Modifiable
Not Modifiable
2
1
0
2
PREVENTIVE POTENTIAL
High
Moderate
Low
3
2
1
1
SALIENCE
a condition needing immediate action
a condition not needing immediate attention
not perceived as a condition needing change
2
1
0
1
BY ROMMEL LUIS C. ISRAEL III
40
Ex. The nurse conducted a home visit to the family of Mr. Pedro
dela Cruz. The following were the initial data that she was able to
gather:
Mang Pedro, 42 yrs old has been coughing for 2 weeks now
and has hemoptysis. He has a medical history of PTB,
underwent treatment,and was declared cured of PTB in 2006.
His wife, Aling Linda, recognizes the need for him to undergo
sputum microscopy. She verbalized “Ganyan din yung sintomas
na ipinakita nya nung sinabi ng Doctor na may TB sya.
Natatakot kami na baka maulit yon. Balak naming ipatingin sya
sa center sa susunod na linggo.”
BY ROMMEL LUIS C. ISRAEL III
41
 Pedrito, 4 years old, weighs 12.5 kgs, looks pale and is
noticeably underweight, as manifested by the evident bony
prominences. Aling Linda verbalized “Naku, mahina lang
kumain ang batang yan. Palibhasa nauubos ang oras sa
paglalaro. Tsaka naisip ko, nasa lahi naman talaga namin ang
hindi tabain kaya siguro payat din si Pedrito.” The nurse
observed that Aling Linda gave the child a small pack of fish
crackers for his morning snack. Aling Linda is the homemaker,
while Mang Pedro earns a net income of Php 250 per day as
tricycle driver.
BY ROMMEL LUIS C. ISRAEL III
42
GOALS AND OBJECTIVES
OF CARE
• GOAL – a desired outcome or change in the
client’s behavior
- general/broad statement of the
condition ; state to be brought about by specific
courses of action
• E.g. after nx intervention, the family will be able
to take care of the disabled child competently
CARDINAL PRINCIPLE IN GOAL SETTING
• Goals must be set jointly with the family
BY ROMMEL LUIS C. ISRAEL III
43
OBJECTIVES
• more specific statements about the
effects of nursing intervention.
BY ROMMEL LUIS C. ISRAEL III
44
1. EXPECTED OUTCOMES
• The most specific, measurable criteria used
to evaluate whether the goal has been met.
BY ROMMEL LUIS C. ISRAEL III
45
• CRITERION – an objective, measurable,
relevant, and flexible indicator related to
performance, behavior or circumstances or
clinical status.
• STANDARD – the desired and achievable
level of performance against which actual
practice is compared.
BY ROMMEL LUIS C. ISRAEL III
46
Ex.
Goal – After nursing intervention, the
client’s nutritional status will improve.
Objective – After nursing intervention,
the client will have a weight gain after
two weeks
BY ROMMEL LUIS C. ISRAEL III
47
• Expected Outcome – After nursing
intervention, the client will have a weight
gain of 4 pounds by Sept. 15 (two weeks
after the goal of care has been identified)
• Criteria – Weight gain
• Standard – 4 pounds
BY ROMMEL LUIS C. ISRAEL III
48
PURPOSE OF GOALS/EXPECTED
OUTCOMES
• Provide direction for planning nursing
interventions
• Provide a time span for planned activities
• Serve as a criteria for evaluation of client
progress
• Enable client and nurse to determine
when the problem has been resolved
• Help motivate client and nurse by
providing a sense of achievement
BY ROMMEL LUIS C. ISRAEL III
49
BARRIERS TO JOINT GOAL
SETTING NURSE - PATIENT
• Failure on the part of the family to perceive existence of the
problem
• The family may realize the existence of a health condition or
problem but too busy at the moment with other concerns
and preoccupations
• Family perceives the existence of problem but does not see it
as serious to warrant attention
• Family may perceive the presence of the problem and the
need to take action
• Failure to develop working relationship
BY ROMMEL LUIS C. ISRAEL III
50
REASONS – REFUSE THE PROBLEM
• Fear of consequence
• Respect for tradition
• Failure to perceive the benefits of action proposed
• Failure to relate the proposed action to the family’s goals
BY ROMMEL LUIS C. ISRAEL III
51
CATEGORIES - OBJECTIVES
• LONG TERM/ULTIMATE – require several nurse – family
encounters and an investment of more resources
• SHORT TERM / IMMEDIATE – require immediate attention
and results can be observed in a relatively short period of
time
• MEDIUM TERM / INTERMEDIATE – not immediately achieved
and are required to attain long – term ones
BY ROMMEL LUIS C. ISRAEL III
52
APPROPRIATE NX
INTERVENTIONS
• Decide on:
MEASURES TO HELP FAMILY ELIMINATE: barriers to
performance of health tasks; underlying cause of non –
performance of health tasks
• FAMILY CENTERED: alternatives to recognize/detect monitor,
control for manage health condition or problems
• Determine methods of family contact
• Specify resources needed
BY ROMMEL LUIS C. ISRAEL III
53
EVALUATION PLAN
Specify
• CRITERIA/OUTCOMES BASED ON OBJECTIVES OF CARE
• METHODS/TOOLS
BY ROMMEL LUIS C. ISRAEL III
54
WRITING OF FAMILY NURSING
CARE PLAN
(DR. MAGLAYA)
• Health Problem
• Family Nursing Problem
• Goal of Care
• Objectives of Care
• Nursing Interventions
• Methods of family-nurse contact
• Resources required
• Evaluation criteria and standard
BY ROMMEL LUIS C. ISRAEL III
55
STEPS OF FAMILY NURSING- PROCESS
• CARRYING OUT OF INTERVENTIONS
• UTILIZATION OF RESOURCES
• MONITORING OF PROGRESS
• SKILLS:
- Cognitive skills
- - interpersonal skills or communication skills
- - technical skills
IMPLEMENTATION
BY ROMMEL LUIS C. ISRAEL III
56
GUIDELINES:
• BASED ON SCIENTIFIC KNOWLEDGE, NURSING RESEARCH AND
PROFESSIONAL STANDARDS OF CARE
• NURSES SHOULD UNDERSTAND CLEARLY THE ORDERS TO BE
IMPLEMENTED
• NURSING ACTIONS SHOULD BE ADAPTED TO THE INDIVIDUAL
CLIENT
• SHOULD ALWAYS BE SAFE
• SHOULD BE HOLISTIC
BY ROMMEL LUIS C. ISRAEL III
57
• SHOULD RESPECT THE DIGNITY OF THE CLIENT
• CLIENTS SHOULD BE ENCOURAGED TO PARTICIPATE ACTIVELY
BY ROMMEL LUIS C. ISRAEL III
58
STEPS OF FAMILY NURSING- PROCESS
• Appraisal / audit
ELEMENTS
• S – STRUCTURE – input - resources
• P – PROCESS - methods
• O – OUTCOME – output/results
EVALUATION
BY ROMMEL LUIS C. ISRAEL III
59
TYPES:
• ON-GOING – done while or immediately after implementing
an order
• INTERMITTENT (PROCESS EVALUATION) - performed at a
specified time intervals to show extent of progress toward
the goal and enables the nurse to correct any deficiencies
and modify care plan
• TERMINAL – indicates client condition ; at the time of
discharge; includes status of goal achievement and an
evaluation of the client’s self-care abilities with regard to
follow-up care
BY ROMMEL LUIS C. ISRAEL III
60

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FAMILY HEALTH NURSING- TYPOLOGY OF FAMILY HEALTH PROBLEMS

  • 1. FAMILY HEALTH NURSING BY ROMMEL LUIS C. ISRAEL III BY ROMMEL LUIS C. ISRAEL III 1
  • 2. FAMILY HEALTH NURSING • Level of community health nursing practice directed or focused on the family as the unit of care Goal – HEALTH Medium - NURSING Channel/Provider of care - NURSE BY ROMMEL LUIS C. ISRAEL III 2
  • 3. FAMILY NURSING CARE PLAN • Blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problem through explicitly formulated outcomes of care and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools. BY ROMMEL LUIS C. ISRAEL III 3
  • 4. FEATURES OF NCP Focuses on actions which are designed to solve or minimize existing problem Product of a deliberate systematic process Relates to the future – the future scenario if the current situation is not corrected Based upon identified health and nursing problems Means to an end, not an end by itself - the goal in is to deliver the most appropriate care to the client by eliminating barriers to family health development. BY ROMMEL LUIS C. ISRAEL III 4
  • 5. FEATURES OF NCP • Continuous process, not a one – shot deal – the results of the evaluation of the plan’s effectiveness trigger another cycle of the planning process until the health and nursing problems are eliminated BY ROMMEL LUIS C. ISRAEL III 5
  • 6. STEPS OF FAMILY NURSING PROCESS ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION EVALUATION BY ROMMEL LUIS C. ISRAEL III 6
  • 7. • First major phase of the nursing process • Involves a set of actions by which the nurse measures the status of the family as a client, its ability to maintain itself as a system and functioning unit and its ability to prevent, control or resolve problems in order to achieve health and well – being among its members. STEPS OF FAMILY NURSING- PROCESS ASSESSMENT BY ROMMEL LUIS C. ISRAEL III 7
  • 8. STEPS OF FAMILY NURSING- PROCESS ASSESSMENT Identifying assessment priorities Prioritizing types of data to be collected systematically Establishing the data base - Nursing history - Physical examination - Review of client record - Consultation with health professionals BY ROMMEL LUIS C. ISRAEL III 8
  • 9. STEPS OF FAMILY NURSING- PROCESS ASSESSMENT Continuous updating of records Validating data Communicating data BY ROMMEL LUIS C. ISRAEL III 9
  • 10. • Composition and demographic data of the members of the family and household, their relationship to the head and place of residence • Type of family and family interaction/communication • Decision - making patterns and dynamics TYPES OF DATA IN FAMILY NURSING ASSESSMENT Family structure, characteristics and dynamics BY ROMMEL LUIS C. ISRAEL III 10
  • 11. • Occupation, place of work and income of each working member • Educational attainment of each family member • Ethnic background and religious affiliation • Significant others and the other role/s they play in the family’s life • Relationship of the family to the larger community TYPES OF DATA IN FAMILY NURSING ASSESSMENT Socio – economic and cultural characteristics BY ROMMEL LUIS C. ISRAEL III 11
  • 12. • Housing and sanitation facilities • Kind of neighborhood • Availability of social, health communication • Transportation facilities in the community TYPES OF DATA IN FAMILY NURSING ASSESSMENT Home and environment BY ROMMEL LUIS C. ISRAEL III 12
  • 13. • Preventive services • Adequacy of rest and sleep • Relaxation activities • Stress management or other healthy lifestyle activities • Immunization status of at – risk family members TYPES OF DATA IN FAMILY NURSING ASSESSMENT Values and practices on health promotion/ maintenance and disease prevention BY ROMMEL LUIS C. ISRAEL III 13
  • 14. DATA GATHERING METHODS • Observation • Physical examination • Interview • Record review • Laboratory / diagnostic tests BY ROMMEL LUIS C. ISRAEL III 14
  • 15. DATA GATHERING METHODS OBSERVATION • Use of sensory capacities • sight, hearing, smell, touch BY ROMMEL LUIS C. ISRAEL III 15
  • 16. DATA GATHERING METHODS PHYSICAL EXAMINATION • IPPA – inspection, percussion, palpation, auscultation • IAPP – inspection, auscultation, percussion, palpation • Measurement of specific body parts and reviewing the body systems HEALTH DEFICITS BY ROMMEL LUIS C. ISRAEL III 16
  • 17. DATA GATHERING METHODS INTERVIEW • Another major method of data gathering • Completing health history • Personally asking significant family members or relatives questions regarding health, family life experiences and home environment BY ROMMEL LUIS C. ISRAEL III 17
  • 18. DATA GATHERING METHODS RECORD REVIEW • Reviewing existing records - individual clinical records - laboratory and diagnostic reports - immunization records - home and environment conditions BY ROMMEL LUIS C. ISRAEL III 18
  • 19. DATA GATHERING METHODS LABORATORY / DIAGNOSTIC TESTS •E.g. cbc, x- ray, MRI, CT scan..etc BY ROMMEL LUIS C. ISRAEL III 19
  • 20. TWO MAJOR TYPES OF NURSING ASSESSMENT 1. FIRST LEVEL ASSESSMENT • Is a process whereby existing and potential health conditions or problems of the family are determined. - wellness state - health threats - health deficits - stress points / foreseeable crisis situations BY ROMMEL LUIS C. ISRAEL III 20
  • 21. TYPOLOGY OF NURSING PROBLEMS WELLNESS STATE • A clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level • Opportunity to improve • Stated as POTENTIAL OR READINESS BY ROMMEL LUIS C. ISRAEL III 21
  • 22. TYPOLOGY OF NURSING PROBLEMS Wellness Potential • Nursing judgment on wellness state or condition based on client’s performance, current competencies or clinical data but no explicit expression of client desire. • Eg. Potential for Enhanced Capability for - healthy lifestyle - health maintenance - parenting - breast feeding - spiritual well being BY ROMMEL LUIS C. ISRAEL III 22
  • 23. TYPOLOGY OF NURSING PROBLEMS Readiness for enhanced wellness state • Nursing judgment on wellness state or condition based on client’s current competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance • Eg. Readiness for Enhanced Capability for - healthy lifestyle - health maintenance - parenting - breast feeding - spiritual well being BY ROMMEL LUIS C. ISRAEL III 23
  • 24. TYPOLOGY OF NURSING PROBLEMS HEALTH THREAT • Conditions that are conducive to disease, accident or failure to realize one’s health potential • Factors that leads to disease • Eg. - family hx - threats of cross infection - accident - faulty eating habits - stress - poor home / sanitation - unsanitary food handling and preparation - unhealthful lifestyle BY ROMMEL LUIS C. ISRAEL III 24
  • 25. TYPOLOGY OF NURSING PROBLEMS HEALTH DEFICITS • Instances of failure in health maintenance • Deviation from normal health • Eg. - illness states - failure to thrive/develop according to normal rate - disability BY ROMMEL LUIS C. ISRAEL III 25
  • 26. TYPOLOGY OF NURSING PROBLEMS STRESS POINTS/FORESEEABLE CRISIS SITUATION • Anticipated periods of unusual demand on the individual or family in terms of adjustment / family resources • May arise in the future • Eg. - marriage - pregnancy, labor - parenthood - abortion - menopause - loss of job - hospitalization - entrance at school BY ROMMEL LUIS C. ISRAEL III 26
  • 27. TYPOLOGY OF NURSING PROBLEMS - adolescence - additional member - death of a member - resettlement in a new community BY ROMMEL LUIS C. ISRAEL III 27
  • 28. TWO MAJOR TYPES OF NURSING ASSESSMENT 2. SECOND LEVEL ASSESSMENT • Defines the nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem. BY ROMMEL LUIS C. ISRAEL III 28
  • 29. ABILITIES BASED ON HEALTH TASKS BY RUTH FREEMAN 1. Ability to recognize the existence of a wellness state, health condition or a health problem. 2. Ability to make decisions with respect to taking appropriate health actions 3. Ability to provide nursing care to the affected family member BY ROMMEL LUIS C. ISRAEL III 29
  • 30. 4. Ability to provide a home environment conducive to health maintenance and personal development. 5. Ability to utilize community resources for health care BY ROMMEL LUIS C. ISRAEL III 30
  • 31. 5 MAIN TYPES OF FAMILY NURSING PROBLEMS BY DR. MAGLAYA 1. Inability to recognize the existence of a wellness state, health condition or a health problem. 2. Inability to make decisions with respect to taking appropriate health actions 3. Inability to provide nursing care to the affected family member BY ROMMEL LUIS C. ISRAEL III 31
  • 32. 4. Inability to provide a home environment conducive to health maintenance and personal development. 5. Inability to utilize community resources for health care BY ROMMEL LUIS C. ISRAEL III 32
  • 33. • It is the end result of two major types of nursing assessment in family nursing practice TWO PARTS: • Statement of unhealthful response • Statement of factors which are maintaining the undesirable response and preventing the desired change STEPS OF FAMILY NURSING- PROCESS DIAGNOSIS BY ROMMEL LUIS C. ISRAEL III 33
  • 34. STEPS OF FAMILY NURSING- PROCESS Example • Inability to make decisions with respect to taking appropriate health action due to lack of knowledge as to alternative courses of action open to the family DIAGNOSIS BY ROMMEL LUIS C. ISRAEL III 34
  • 35. STEPS OF FAMILY NURSING- PROCESS DIAGNOSIS data utilization problem identification BY ROMMEL LUIS C. ISRAEL III 35
  • 36. STEPS OF FAMILY NURSING- PROCESS PLANNING prioritization plan formulation identification of resources goal setting BY ROMMEL LUIS C. ISRAEL III 36
  • 37. Components for planning phase 1. prioritized conditions or problems 2. goals and objectives of nursing care 3. plan of interventions 4. plan for evaluating care BY ROMMEL LUIS C. ISRAEL III 37
  • 38. CRITERIA FOR PRIORITIZATION 1. NATURE OF CONDITION/ PROBLEM PRESENTED • Categorized as wellness state/potential, health threat, health deficit, foreseeable crisis 2. MODIFIABILITY OF THE CONDITION/PROBLEM • Probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention 3. PREVENTIVE POTENTIAL • Nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration BY ROMMEL LUIS C. ISRAEL III 38
  • 39. CRITERIA FOR PRIORITIZATION 4. SALIENCE Family’s perception and evaluation of the in terms of seriousness and urgency of attention needed or family BY ROMMEL LUIS C. ISRAEL III 39
  • 40. CRITERIA SCORE WEIGHT NATURE OF THE CONDITION Wellness state Health Deficit Health threat Forseeable crisis 3 3 2 1 1 MODIFIABILITY OF THE CONDITION Easily Modifiable Partially Modifiable Not Modifiable 2 1 0 2 PREVENTIVE POTENTIAL High Moderate Low 3 2 1 1 SALIENCE a condition needing immediate action a condition not needing immediate attention not perceived as a condition needing change 2 1 0 1 BY ROMMEL LUIS C. ISRAEL III 40
  • 41. Ex. The nurse conducted a home visit to the family of Mr. Pedro dela Cruz. The following were the initial data that she was able to gather: Mang Pedro, 42 yrs old has been coughing for 2 weeks now and has hemoptysis. He has a medical history of PTB, underwent treatment,and was declared cured of PTB in 2006. His wife, Aling Linda, recognizes the need for him to undergo sputum microscopy. She verbalized “Ganyan din yung sintomas na ipinakita nya nung sinabi ng Doctor na may TB sya. Natatakot kami na baka maulit yon. Balak naming ipatingin sya sa center sa susunod na linggo.” BY ROMMEL LUIS C. ISRAEL III 41
  • 42.  Pedrito, 4 years old, weighs 12.5 kgs, looks pale and is noticeably underweight, as manifested by the evident bony prominences. Aling Linda verbalized “Naku, mahina lang kumain ang batang yan. Palibhasa nauubos ang oras sa paglalaro. Tsaka naisip ko, nasa lahi naman talaga namin ang hindi tabain kaya siguro payat din si Pedrito.” The nurse observed that Aling Linda gave the child a small pack of fish crackers for his morning snack. Aling Linda is the homemaker, while Mang Pedro earns a net income of Php 250 per day as tricycle driver. BY ROMMEL LUIS C. ISRAEL III 42
  • 43. GOALS AND OBJECTIVES OF CARE • GOAL – a desired outcome or change in the client’s behavior - general/broad statement of the condition ; state to be brought about by specific courses of action • E.g. after nx intervention, the family will be able to take care of the disabled child competently CARDINAL PRINCIPLE IN GOAL SETTING • Goals must be set jointly with the family BY ROMMEL LUIS C. ISRAEL III 43
  • 44. OBJECTIVES • more specific statements about the effects of nursing intervention. BY ROMMEL LUIS C. ISRAEL III 44
  • 45. 1. EXPECTED OUTCOMES • The most specific, measurable criteria used to evaluate whether the goal has been met. BY ROMMEL LUIS C. ISRAEL III 45
  • 46. • CRITERION – an objective, measurable, relevant, and flexible indicator related to performance, behavior or circumstances or clinical status. • STANDARD – the desired and achievable level of performance against which actual practice is compared. BY ROMMEL LUIS C. ISRAEL III 46
  • 47. Ex. Goal – After nursing intervention, the client’s nutritional status will improve. Objective – After nursing intervention, the client will have a weight gain after two weeks BY ROMMEL LUIS C. ISRAEL III 47
  • 48. • Expected Outcome – After nursing intervention, the client will have a weight gain of 4 pounds by Sept. 15 (two weeks after the goal of care has been identified) • Criteria – Weight gain • Standard – 4 pounds BY ROMMEL LUIS C. ISRAEL III 48
  • 49. PURPOSE OF GOALS/EXPECTED OUTCOMES • Provide direction for planning nursing interventions • Provide a time span for planned activities • Serve as a criteria for evaluation of client progress • Enable client and nurse to determine when the problem has been resolved • Help motivate client and nurse by providing a sense of achievement BY ROMMEL LUIS C. ISRAEL III 49
  • 50. BARRIERS TO JOINT GOAL SETTING NURSE - PATIENT • Failure on the part of the family to perceive existence of the problem • The family may realize the existence of a health condition or problem but too busy at the moment with other concerns and preoccupations • Family perceives the existence of problem but does not see it as serious to warrant attention • Family may perceive the presence of the problem and the need to take action • Failure to develop working relationship BY ROMMEL LUIS C. ISRAEL III 50
  • 51. REASONS – REFUSE THE PROBLEM • Fear of consequence • Respect for tradition • Failure to perceive the benefits of action proposed • Failure to relate the proposed action to the family’s goals BY ROMMEL LUIS C. ISRAEL III 51
  • 52. CATEGORIES - OBJECTIVES • LONG TERM/ULTIMATE – require several nurse – family encounters and an investment of more resources • SHORT TERM / IMMEDIATE – require immediate attention and results can be observed in a relatively short period of time • MEDIUM TERM / INTERMEDIATE – not immediately achieved and are required to attain long – term ones BY ROMMEL LUIS C. ISRAEL III 52
  • 53. APPROPRIATE NX INTERVENTIONS • Decide on: MEASURES TO HELP FAMILY ELIMINATE: barriers to performance of health tasks; underlying cause of non – performance of health tasks • FAMILY CENTERED: alternatives to recognize/detect monitor, control for manage health condition or problems • Determine methods of family contact • Specify resources needed BY ROMMEL LUIS C. ISRAEL III 53
  • 54. EVALUATION PLAN Specify • CRITERIA/OUTCOMES BASED ON OBJECTIVES OF CARE • METHODS/TOOLS BY ROMMEL LUIS C. ISRAEL III 54
  • 55. WRITING OF FAMILY NURSING CARE PLAN (DR. MAGLAYA) • Health Problem • Family Nursing Problem • Goal of Care • Objectives of Care • Nursing Interventions • Methods of family-nurse contact • Resources required • Evaluation criteria and standard BY ROMMEL LUIS C. ISRAEL III 55
  • 56. STEPS OF FAMILY NURSING- PROCESS • CARRYING OUT OF INTERVENTIONS • UTILIZATION OF RESOURCES • MONITORING OF PROGRESS • SKILLS: - Cognitive skills - - interpersonal skills or communication skills - - technical skills IMPLEMENTATION BY ROMMEL LUIS C. ISRAEL III 56
  • 57. GUIDELINES: • BASED ON SCIENTIFIC KNOWLEDGE, NURSING RESEARCH AND PROFESSIONAL STANDARDS OF CARE • NURSES SHOULD UNDERSTAND CLEARLY THE ORDERS TO BE IMPLEMENTED • NURSING ACTIONS SHOULD BE ADAPTED TO THE INDIVIDUAL CLIENT • SHOULD ALWAYS BE SAFE • SHOULD BE HOLISTIC BY ROMMEL LUIS C. ISRAEL III 57
  • 58. • SHOULD RESPECT THE DIGNITY OF THE CLIENT • CLIENTS SHOULD BE ENCOURAGED TO PARTICIPATE ACTIVELY BY ROMMEL LUIS C. ISRAEL III 58
  • 59. STEPS OF FAMILY NURSING- PROCESS • Appraisal / audit ELEMENTS • S – STRUCTURE – input - resources • P – PROCESS - methods • O – OUTCOME – output/results EVALUATION BY ROMMEL LUIS C. ISRAEL III 59
  • 60. TYPES: • ON-GOING – done while or immediately after implementing an order • INTERMITTENT (PROCESS EVALUATION) - performed at a specified time intervals to show extent of progress toward the goal and enables the nurse to correct any deficiencies and modify care plan • TERMINAL – indicates client condition ; at the time of discharge; includes status of goal achievement and an evaluation of the client’s self-care abilities with regard to follow-up care BY ROMMEL LUIS C. ISRAEL III 60

Editor's Notes

  1. Sanitation- poor flush or aqua privy; pit latrine; flush type (toilet facilities)
  2. Data gathered from pe forms a substantive part of first level assessment which may indicate health deficits
  3. Outcome of plan formulation is FNCP
  4. Specific, measurable, attainable, time bounded, humane