When you move to the implementation process, you face a lot of challenges which may somehow make you frustrated, to the extent of inaction or may encourage you to try new, creative ways….in this process, it takes a lot of time, of effort, patience for you to carry out effectively the plans you have set… Since there will be a lot of interaction between you and the family membrs, this is the time where you come to know a lot of perceptions, ideas, emotions, concerns towards the family. So what is important is a positive attitude, a dynamic mind and body…and an active and dynamic involvement of both parties: the family and you as their student nurse. The nursing care plan focuses on actions which are designed to solve or minimize existing problem. The plan is a blueprint for action. The core of the plan are the approaches, strategies, activities, methods and materials which the nurse hopes will improve the problem situation. The nursing care plan is based upon identified health and nursing problems. The problems are the starting points for the plan, and the foci of the objectives of care and intervention measures. The nursing care plan is a means to an end, not an end in itself. The goal in planning is to deliver the most appropriate care to the client by eliminating barriers to family health development. Nursing care planning is a 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.
………… must be specified in the plan to ensure that necessary preparations, coordination and collaboration are done before the implementation phase. …
methods of nusring family contact: home visits, visit in the workplace, school visit, telephone call, group approach like health classes ……… .reasons- material; supplies, equipment, teachings aids (visual materials, hand outs, charts) -
Appropriateness of the intervention- dependent on the lived experience of family members with each other.. So as what I always reiterate, the active participants are the nurse and the family members…if one of these people fail to do their part, the whole process will put to waste and the goals will not be materialized. Both need to explore, analyze and understand the current health/illness situation as the family experiences it. Hence, there should be what? DYNAMIC,ACTIVE, MutuaL INTERCHANGE OF REALITIES, CONCERS AND RESOURCES----IN OTHER WORDS, MAGTINABANGA
With goal in number 1, as to the lived experience and the appropriateness of the interventions, the nurse has a lot of….CHOICES! These choices will help us understnd the family as a system and its individulaity of the members. As a THINKER: nursing interventions should enhance this competency- outcome: make data readily available and accessible – to understand better the current situations … you make them good or critical thinkers- how? First- identify level of understanding (ask questions to assess if they do undrstand the illness, the causes, from that, make them undertand, and teach them how to solve the given problem, prevention so that the next time around they encounter parallel problems, they know (as good thinker) what to do…. Both need to explore, analyze and understand the current health/illness situation as the family experiences it.
AS doer: nurse must devlop – you help the communication and skills in carrying out the interventions: when you instruct the patient or refer to the hospital, you accompany her first and explain the things she must do- she must communicate clrealy with the physicians,, verbalize the signs and symptoms, how they develop… you intrsuct her as you explore this intervention together…so that the next time she needs to do this, she has the courage and idea what to do, what to say, how to say it… Relate to A and B
… like fear, anger, anxiety, jelousy, guilt…. In other words, pagbati bati…because it is by feeling and recognizing that you feel it that you accept the existing emotion, by that you find ways on how to manage such emotions…prevent further problems, right? After that, there will be growth promoting choices and actions coz you don’t have grudges against othr family member…work relations are better…
The ability of understanding the meanings of our feelings, we can gain the skill to rehearse and rturn to positive felings…you get over it…and be back to the positive feelings of joy, contenment and comfort… Okay, cry ko karon kay sakit kau but after this move on…I have choices…to be happy or not, which is better?
Nature of the problem…is it a health threat, deficit, forseeeable crisis… If dili mareapir and broken stairs, what will happen? … .3 rd one is Relating healt
Example: what the family can do…available resources…..the stairs are broken, faulty eating habits?
Consequence or benefits: if not to repair the stairs or to repair it
What are the available resources…outside the house… Relate sa reapir of stairs Scabies-use of kalatsusi- how to prepare and apply….
Contract_ agreement…..to make this intervention efffective- the necessary elemnts … .. through a sequentially arranged explicit steps and conditions or elements jointly identified by both parties
This behaviour uses reinforcement contracts on a variety of health-related behaviour requiring complex behavioural changes such as: adherence to diet, medications and other treatment regimens to maintain desirable laboratory values, lose weight, and control blood pressure.
People-learned to defend against potential lessons of the experience- when thse threaten potential equilibria…
so that an otherwise insecure, threatened or anxious client who is faced with the stresses of the change process can experience stability to sustain actions and complete the behaviour change. … .. This is done by DEVELOPING AND INSTITUTIONALIZING its own PROBLEM-SOLVING STRUCTURES AND PROCESSES through the performance of the family health tasks.
…… “ in the face of the uncertainties, stresses, blocks or barriers to the solution of the health condition or problem or threats to self-esteem and affection or danger to life. Example with mother whose child has diarrhea…nurse…teach mother : the cyclical relatinship of the diarrhea and malnutrition Cause of diarrhea during oral feeding To develop competency as doer: Teach mother how to administer ORAL rehydration slowly Demonstrate to mother how to prepare easily digested rice with chon like powdered beans, toastd dry small fish What are the support of the nurse to mother? Physical and psychological availabily and accesibilty
REFER TO PAGE EXAPMLE NUTRITION…
DEVELOPING THE INTERVENTION PLAN
This involves selection of appropriate nursing interventions based on the formulated goals and objectives.
Home visit Clinic conference Visit in the work place EXAMPLES OF RESOURCESA. MATERIAL Supplies Equipment Teaching aids
B. HUMAN Other health team members Development workers Community leaders
1. Analyze with the family the current situation and determine choices and possibilities based on a lived experience of meanings and concerns.2. Develop/enhance family’s competencies as thinker, doer and feeler.
3. Focus on interventions to help perform the health tasks.4. Catalyze behaviour change through motivation and support.
The appropriateness of the nursing intervention is, therefore, DEPENDENT UPON THE LIVED MEANING OF THE EXPERIENCES OF FAMILY MEMBERS WITH EACH OTHER AND WITH THE NURSE, given the current situation and possibilities in health and illness realities.
Nurse is given a choice of possibilities that helps her and the family gain a clearer understanding of the self as a THINKER, DOER and a FEELER.
Developing and maximizing the skills and communication competencies of the family as DOER enhance confidence in carrying out the needed interventions to initiate and sustain change for: a.) health promotion and maintenance b.) accurate disease/problem management.
As a FEELER: -affective competencies- be developed -to acknowledge & understand motions generated by family life or health-illness situations *
*This positive ability may provide respite and offer perspective during a time of negative feelings such as fear and anxiety.
The nurse needs to focus her choice of interventions on helping the family minimize or eliminate the possible reasons for or causes of the family’s inability to the health tasks:
1. HELP THE FAMILY RECOGNIZE THE PROBLEM.Examples of interventions: Increasing the family’s knowledge on the nature, magnitude and cause of the problem.* Helping the family see the implications of the situation, or the consequences of the condition.*
Encouraging positive or wholesome emotional attitude toward the problem by affirming the family’s capabilities/qualities/resources and providing information on available options.
2. GUIDE THE FAMILY ON HOW TO DECIDE ON APPROPRIATE HEALTH ACTIONS TO TAKE.This can be done through: a.) identifying or exploring with the family - courses of action available and the needed resources for each.*
b.) discussing theconsequences of each courseof action available c.) analyzing with thefamily the consequences ofinaction.
3. DEVELOP THE FAMILY’S ABILITY AND COMMITMENT TO PROVIDE NURSING CARE TO ITS MEMBERS. Nurse can increase the family’s confidence - to provide nursing care through demonstration and practice sessions on procedures, treatments or technique utilizing readily available, low-cost materials and equipment and other resources*
CONTRACTING- Is creative intervention that can maximize opportunities to develop the ability and commitment of the family to provide nursing care to its members.- It is an intervention whereby the nurse creates a situation in order that the client learns to achieve a health-related behaviour.*
-- Contracting provides a systematic method of increasing desirable client behaviour through the use of the PRINCIPLE OF POSITIVE REINFORCEMENT.
- In order to make this intervention effective, the necessary elements of the desired behaviour must be MADE EXPLICIT AND MUST BE WRITTEN IN THE FORM OF AN AGREEMENT.- To make the behaviour consciously reinforced it must be observable and measurable.
4. ENHANCE THE CAPABILITY OF THE FAMILY TO PROVIDE A HOME ENVIRONMENT CONDUCIVE TO HEALTH MAINTENANCE AND PERSONAL DEVELOPMENT. The family can be taught specific competencies to ensure such a home environment through: Environmental modification Manipulation or management to minimize or eliminate health threats or risks Install facilities for nursing care
5. FACILITATE THE FAMILY’S CAPABILITY TO UTILIZE COMMUNITY RESOURCES FOR HEALTH CARE- involves maximum use of available resources through the COORDINATION, COLLABORATION AND TEAM WORK provided by an effective referral system.- Easy access to available health and socio- economic resources starts with maintaining an updated file that lists such resources, their addresses or telephone numbers and specific services offered.
A sample format of the file or index of community resourcesName of Office and email Type of client and Requiremagency and addresses/telephone specific ents/procperson to number services/schedule edures forcontact referral
A TWO-WAY REFERRAL SYSTEM can facilitate mobilization of resources for families. An effective two-way referral system ensures: a. monitoring of the case, problem or situation follow-up of required interventions, case or services evaluation of the client’s status or family’s problem/situation.
To bring about self-directed change, people must learn to learn from their experiences. In order to help people lower their defenses and allow themselves to experience the needed change, it is necessary to have a learning environment that nurtures the change.
The change agent can help the client put to maximum use valid knowledge through concern for:a.) Human needs or the “use-value” of a given piece of knowledgeb.) security, trust, self-esteem, self-identity, group esteem and group identityc. Accurate and appropriate preparation and transmission of messages
To catalyze the change, SUPPORT IS NEEDED* In family health nursing practice, the family as a system needs OPTIMUM REALITY-ORIENTATION in its adaptation to its changing internal and external environment.
To catalyze the behaviour change towards problem-solving competencies , a THEORY OF FAMILY HEALTH NURSING INTERVENTION was developed by Maglaya.
COMPONENTS Motivation SupportMOTIVATION- As conceptualized the intervention theory is any experience or information that leads the family to desire and agree to undergo the behaviour change or proposed measure and take the initial action to bring about the change.
SUPPORT- As an intervention- any experience or information that:a. maintains, restores or enhances the capabilitiesb. resources of the family complete the change process. The intervention leads the family to feel “secured” or “ in control of the situation*
Was adapted using the motivation-support intervention. Families were guided through the behaviour change process:1.Constructing the intention to initiate/sustain the change
2. Translating the intention inot actions, and3. To integrate the actions/change into existing lifestyleCRITERIA FOR SELECTING THE TYPE OF NURSE-FAMILY CONTACT1. Effectivity2. Efficiency3. Appropriateness
Is an effective and appropriate type of nurse-patient contact if the objectives and outcomes of care require accurate appraisal of family relationships, home and environment, and family competencies. Expensive in terms of time, effort and logistics for the nurse
Less expensive Provides opportunity to use equipment that cannot be taken to the home Other team members in the clinic may be consulted or called in to provide additional service Emphasizes to the family the importance of empowerment and assuming responsibility for self-help.
May be effective, efficient and appropriate if :-objectives and outcomes of care require immediate access to data, given problems on distance or travel time Data include monitoring of health status or progress during:- acute phase of an illness state- change in schedule of visit or family decision,- updates on outcomes or responses to care or treatment.
less time-consuming option for the nursea. when there are a large number of families needing follow-up : problems of distance and travel time. If the family is motivated enough and independent enough- nurse can use the advantage of placing responsibility for action on the family, a letter, note and learning materials are appropriate.
Health Family Goals Objectives Intervention Method ResourcesProblem Nursing of of Care Measures Of Required Care problems Nurse Family Contact