THE FAMILY CARE PLAN
It also prospects the future
Formulation of the care plan is the next step in
the nursing process after assessment, when
health and family nursing problems have been
clearly defined.
Definition
A family nursing care plan is the blueprint of the
care that the nurse designs to systematically
minimize or eliminate the identified health and
family nursing problems through explicitly
formulated outcomes of care (goals and
objectives) and deliberately chosen set of
interventions, resources and evaluation criteria,
standards, methods and tools.
Features
The definition above points to specific features
of a nursing care plan.
These characteristics are based on the concept
of planning as a process.
1. 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.
2. The nursing care plan is a product of a
deliberate systematic process. The
planning process is characterized by
logical analyses of data that are put
together to arrive at rational decisions.
The interventions the nurse decides to
implement are chosen from among
alternatives after careful analysis and
weighing of available options.
3. The nursing care plan, as with all other
plans relates to the future. It utilizes
events in the past and what is
happening in the present to determine
patterns.
scenario if the current situation is not
corrected.
4. The nursing care plan is based upon
identified health and nursing problems.
The problems are starting points for
the plan and the foci of the objectives
of care and interventions measures.
5. The nursing care plan is a means to an
end, not and end. The goal in planning
is to deliver the most appropriate care
to the client by eliminating barriers to
family health development.
6. 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.
Desirable Qualities of a Nursing Care Plan
There are specific qualities of a nursing care
plan which help to maximize its effectiveness.
1. It should be based on clear explicit
definition of the problems.
A good nursing plan is based on a
comprehensive analysis of the problem
situation. The main as well as contributory
causes of the health conditions or problem
should be identified.
2. A good plan is realistic. It can be
implemented with reasonable chance
of success. This feasibility of the plan is
related to the quantity and quality of
resources required in its
implementation.
3. The nursing care plan is prepared
jointly with the family. This is
consistent with the principle that the
nurse works with and not for the family.
4. She involves the family in determining
health needs and problems in
 establishing priorities in selecting
appropriate courses of action,
implementing them, and evaluating
outcomes. Through participatory
planning the nurse makes the family
feel that the health of its members is a
family responsibility and commitment.
5. The nursing care plan is most useful in
written form. It is a means of
communication not only among nurses
but also between nurses and other
members of the health team.
Moreover, it is impossible for a nurse to
keep many nursing care plans in her
mind and remember the safest points
of care. Written plans also serve as
useful administrative device for
evaluating staff performance and the
quality.
THE IMPORTANCE OF PLANNING CARE.
Little and Camevali (1969 pp. 2-5) discuss the
importance of nursing care plans.
1. They individualize care to clients
whether an individual patient, the
family or the entire community clients
are different from each other in order
to be appropriate, nursing care should
suit and be unique to a particular
client.
Planning facilitates the delivery of the
most appropriate care by considering
the uniqueness of each client.
2. The nursing care plan helps in setting
priorities by providing information
about the client as well as the nature of
his problems. From the available data
the nurse sets her priorities for care.
3. The nursing care plan promotes
systematic communication among
those involved in the health care effort.
It defines the problems and details of
the nursing interventions to resolve
them.
4. Continuity of care is facilitated using
nursing care plans. Gaps and
duplications of services are bound to
occur in settings where there is
frequent turnover of staff or when
several health workers are providing
care to the same family.
5. Nursing care plans facilitate the
coordination of care by making knowns
to other members of the health team
what the nurse is doing. Coordination of
care prevents fragmentation of services
and increases the efficiency of health
service delivery system.
STEPS IN DEVELOPING A FAMILY NURSING
CARE PLAN
The assessment phase of the nursing process
generates the health and nursing problems
which become the bases for the development
of the nursing care plan. The planning phase
takes off from there.
Developing a family care plan involves many
steps. Generally, a plan consists of the
following:
1. The prioritized conditions or problems
2. The goals and objectives of nursing care
3. Th plan of intervention and
4. The plan for evaluating care
The various steps in developing the family
nursing care plan correspond with the above
components. Figure 2 shows a schematic
presentation of the nursing care planning
process.
It starts with a list of health condition or
problems prioritized according to the nature,
modifiability, preventive potential, and
salience.
The prioritized health condition or problems
and their corresponding nursing problems
become the basis for the next step which is the
formulation of goals and objectives of nursing
care.
The goals and objectives specify the expected
health/ clinical outcomes, family responses,
behavior, or competency outcomes.
The next step is selection of appropriate
nursing interventions. It focuses on alternatives
and decision on appropriate intervention
measures based on the specific objectives
formulated.
The interventions specify the nursing actions to
help the family eliminate the barriers to the
performance of health tasks or the underlying
causes of non- performance of expected health
tasks.
These interventions include family focused
alternatives or strategies to help members
recognize/ detect health problems or
opportunities to enhance wellness state or
condition, monitor, eliminate, control, and
manage health problems or enhance wellness
condition. The method of nurse- family contact
and the resources needed are specified in this
step to ensure that the necessary preparation is
done to achieve the objectives of care.
The last step is the development of the
evaluation plan. It specifies the criteria or
outcomes as explicit measures that determine
achievement of formulated objectives. This
close relationship between the evaluation plan
and the formulated goals and objectives
explains the broken line between the two boxes
in figure 2.
PRIORITIZING HEALTH PROBLEMS
After the assessment phase, the nurse may
realize that the family is faced with number of
health and nursing problems which cannot be
taken up all at the same time considering the
available resources of both the family and the
nurse. Considering the situation, she can rank
the identified health conditions/ problems into
priorities. Balon and Maglaya (1990) devised a
tool called Scale for Ranking Health Conditions
and Problems According to Priorities. This tool
aims to objectivize priority setting. These are
four criteria for determining priorities among
health conditions or problems. These include:
1. Nature of the condition or problem
presented- categorized into wellness
state potential health threat deficit and
foreseeable crisis.
2. Modifiability of the condition or
problem- refers to the probability of
success in enhancing the wellness state,
improving the condition, minimizing,
alleviating, or totally eradicating the
problem through intervention.
3. Preventive potential- refers to the
nature and magnitude of future
problems that can be minimized or
totally prevented if intervention is done
on the condition or problem under
consideration.
4. Salience- refers to the family’s
perception and evaluation of the
condition or problem in terms of
seriousness and urgency of attention
needed or family readiness.
The experienced nurse practitioner can
determine priorities among health condition or
problems utilizing her judgement on all these
four criteria without necessarily going through
the process of scoring.
The arithmetic computations utilized in the
scale can however guide the students or new
practitioners who still need to gain the skill in
deciding which factors have more weight over
others.
The computations help systematize priority
setting by determining a specific score for each
problem on the list. The nurse considers several
factors to be objective in the decision- making
process when setting priorities.
Factors Affecting Priority- Setting
Considering the first criterion- nature of the
condition or problem presented- the biggest
weight is given to wellness state or potential
because of the premium on client’s efforts or
desire to sustain/ maintain high level of
wellness. The same weight is assigned to a
health deficit because of its sense of clinical
urgency which may require immediate
intervention. Foreseeable crisis is given the
least weight because culture- linked variable /
factors usually provide our families with
adequate support to cope with developmental
or situational crisis.
The nurse considers the availability of the
following factors in determining the
modifiability of a health condition or problem:
1. Current knowledge, technology, and
interventions to enhance the wellness
state or manage the problem.
2. Resources of the family- physical,
financial and manpower
3. Resources of the nurse- knowledge,
skills and time
4. Resources of the community- facilities
and community organization or support
To decide on an appropriate score for the
preventive potential of a health condition or
problem, the following factors are considered:
1. Gravity or severity of the problem-
refers to the progress of the disease/
problem indicating extent of damage on
the patient/ family; also indicates
prognosis, reversibility, or modifiability
of the problem. In general, the more
severe or advanced the problem is, the
lower is the preventive potential of the
problem.
2. Duration of the problem- refers to the
length of time the problem has been
existing. Generally speaking, duration of
the problem has a direct relationship to
gravity; the nature of the problem is a
variable that may, however, alter this
relationship. Because of this
relationship to gravity of the problem,
duration also has a direct relationship
to preventive potential.
3. Current management- refers to the
presence and appropriateness of
intervention measures instituted to
enhance the wellness state or remedy
the problem. The institution of
appropriate intervention increases the
condition’s preventive potential.
 4. Exposure of any vulnerable or high-
risk group- increases the preventive
potential of a condition or a problem
Effective health management/ health
maintenance pattern and desire for or
engagement in healthy lifestyle activities
increase in the preventive potential of a
wellness state or condition.
To determine the score for salience, the nurse
evaluates the family’s perception of the
condition or problem. As a general rule, the
family’s concerns, felt needs and/ or readiness
increase the score on salience.
Scoring
After the score for each criterion has been
decided on, the number is divided by the
highest possible score in the scale. The quotient
is multiplied by the weight indicated for the
criterion being considered. Then the sum of the
scores for all the criteria is taken. The highest
score is five (5) equivalent of the total weight.
The nurse considers as priority those conditions
and problems with total scores nearer five (5).
Thus, the higher the score of a given condition
or problems, the more likely is taken as a
priority. With the available scores, the nurse
then ranks health conditions and problems
accordingly.
Case Illustration on Priority Setting
Using the case study discussed in Chapter 2,
priority setting as the first step in the planning
phase is presented here with the scoring for
each health condition or problem identified
during the assessment phase.
Note that the nurse considers specific in
justifying the score given to each criterion for
priority setting. For example, a health deficit
requires more immediate attention and
intervention that is why it is given the presence
of resources of the family, the nurse and the
community increase the modifiability score of a
health condition or problem.
A health condition or problem will also result to
elimination or control of complication,
abnormalities, spread of disease or other future
problems.
A heath condition or problem gets a high score
on salience if it is a family concern, felt need or
the family expresses readiness to work on the
identified problem. As illustrated in this case
study, the problem on family size is an example
of a high score on salience.
 A cardinal principle in goal setting states that
goals must be set jointly with the family. This
ensures the family’s commitment to their
organization. Basic to the establishment of
existing health needs and problems. The nurse
must ascertain the family’s knowledge and
acceptance of the problem as well as the desire
to take actions to resolve them. This is done
during the assessment phase.

Barriers to joint goal setting between the

nurse and the family include the following:

1. Failure on the part of the family to

Given available resources, the first four priority
health condition or problems are going to be
addressed to in the family nursing care plan
which will be developed and illustrated later in
this chapter. These are:
1. Family size beyond what present family
resources can adequately provide:
2. Possible pre- eclampsia.
3. Malnutrition; and,
4. Scabies as a health deficit and a health
threat.
FORMULATION OF GOALS AND OBJECTIVES
A goal is a general statement of the condition or
state to be brought about by specific courses of
action. An example of statement of goal in
family health nursing practice is:
After nursing intervention, the family will be
able to take care of the disabled child
competently.
perceive the existence of the problem.
In many instances the problem is seen
xonly by the nurse while the family is
perfectly satisfied with the existing
situation. An example of this is the
threat posed by improper waste
disposal. Many families especially in the
rural areas have no sanitary toilet
facilities. But to the bush or the river
which can serve the same purpose.
2. The family may realize the existence of
a health condition or problem but is too
busy at the moment with other
concerns and preoccupation for the
children, but her household chores take
precedence over other concerns.
3. Sometimes the family perceives the
existence of a problem but does not see
it as serious enough to warrant
attention. The common cold is a
condition that is all too often taken for
granted. The same is true with
intestinal parasitism which is commonly
regarded as a normal affliction of
childhood.
4. The family may perceive the presence
of the problem and the need to take
action. It may however, refuse to face
and do something about the situation.
Freeman (1957 pp. 126- 128) offers the
 following measures for this kind of
behavior.
a. Fear of consequences of taking action-
For examples, diagnosis of a disease
condition may mean expense or social
stigma for the family.
b. Respect for tradition- In Philippine
culture, elders play a part in decision
making. Behavior which is not
sanctioned by the old folks in the family
are not likely to be adopted. A couple
for instance, may not accept the goal of
limiting family size to just three children
if their parents do not approve of
contraceptive practice.
c. Failure to perceive the benefits of
action proposed- This could be a
function of a client’s previous
experience with health workers and
their services. Going to a health center
for example, is an advice frequently
given by nurses. When this does not
yield beneficial results from the point of
view family it will be ignored the next
time it is offered.
d. Failure to relate the proposed action to
the family’s goals- Families differ in
their prioritizing of their goals.
Economic and social goals, generally
occupy a higher than health goals in
families’ ranking of their concerns and
preoccupations. When proposed
actions to improve health are not
related to the family’s goals of say,
economic stability they are not likely to
be accepted.
5. A big barrier to collaborative goal
setting between the nurse and the
family is failure to develop a working
relationship. Nothing will be
accomplished. As a matter of fact, in a
nurse’s work with families unless the
family sees the nurse as a friend who is
genuinely concerned with its welfare.
The elements of mutual trust and
confidence are crucial to the success of
the nurse- family endeavor towards
better health.
Goals set by the nurse and the family should be
realistic or attainable. They should therefore be
set at reasonable levels. Too high goals and
their consequent failure frustrate both the
family and the nurse.
A clear definition of the problem situation and
an accurate assessment of available resources
facilitate the setting of realistic goals. Both are
functions of the depth and breath of the
assessment process.
Goals like the objectives are best stated in
terms of client outcomes whether at the
individual, family, or community levels.
Objectives in contrast to goals refer to more
specific statements of the desired results or
outcomes of care. They specify the criteria by
which the degree of effectiveness of care are to
be measured. Goals tell where the family is
going objectives are milestones to reach the
destination.
Objectives stated as outcomes of care in the
family health nursing practice specify physical,
psychological states or family behavior (or
competencies) Examples are given below:
Example 1. After nursing intervention, the
malnourished preschool members of the family
will increase their weights by at least one pound
per month.
2. After nursing intervention the family will be
able to:
a. Feed the mentally retarded child according to
prescribed quantity and quality of food.
b. Teach the mentally retarded child csimple
skills related to the activities of daily living.
c. Apply measures taught to prevent infection in
the mentally retarded member.
The more specific objectives, the easier is the
evaluation of their attainment. Specifically
stated objectives define the criteria for
evaluation.
Objectives vary according to the time span
required for their realization. Short- term or
immediate attention and results can be
observed in a relatively short period of time.
They are accomplished with few nurse- family
contacts and with the use of relatively less
resources. Long- term or ultimate objectives on
the other hand, require several nurse- family
encounters and an investment of more
resources. The nature of outcomes sought
require time to demonstrate. Such is the nature
of behavior change which is often the subject of
nursing intervention. Medium- term or
intermediate objectives are those which are not
immediately achieved and are required to
attain long- term ones.
The example on page 99 illustrate the above
categories of objectives.
Nursing goal- The family will manage malaria as
a disease and threat.
• Short- term immediate objective- The
sick members will take the drugs
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 malaria vector is
expected.
• Medium- term/ intermediate objective-
All members will have medical check up
and laboratory confirmation to
diagnose malaria.
• Long- term objective- All members will
carry mosquito vector control
measures.
As with goals, object should be realistic and
attainable considering the resources of the
nurse the family and the community. In
addition, they should be measurable. Specific
statements of objectives facilitate the
evaluation of their attainment. Objectives and
evaluation are directly related. When objectives
are stated in terms of observable fact and/or
behavior, the others for evaluation become
inherent and evident.
DEVELOPING THE INTERVENTION PLAN
The next step in developing the family nursing
care plan is formulating the intervention plan.
This involves selection of appropriate nursing
interventions based on the formulated goals
and objectives. In selecting the interventions,
the nurse decides on appropriate nursing
actions among a set of alternatives, specifying
the most effective or efficient method of nurse-
family contact and the resources needed. Some
examples of methods of nurse- family contact
include the home visit, clinic conference, visit in
the work place, school visit, telephone call,
group approach (like health classes) and the use
of mail or letters. The resources which include
material (e.g supplies, equipment, teaching
aids, visual materials, handouts, charts etc) or
human (other health team members,
development workers, community leaders)
must be specified in the plan to ensure that
necessary preparations, coordination and
collaboration are done before the
implementation phase.
The following general directions for nursing
intervention can guide selection of appropriate
nursing interventions:
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 Behavior Change through
Motivation and Support.
Explore with Family Choices/ Possibilities
based on Lived Experience of Meanings and
Concerns
Family life and nursing practice are both
phenomenological unified realities of
experiencing the self- interacting with others in
specific situations that are affected by
meanings, concerns, emotions, past
experiences, and anticipated future. (Benner
and Wrubel 1089). The appropriateness of the
nursing interventionis, 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.
Because family health nursing practice is a
phenomenological experience for the family
and the nurse, the family becomes an active
participant in the application of the nursing
process. The family and the nurse are
participants in an active, mutual, dynamic,
interchange of realities, concerns and
resources. Both need to analyze and
understand the current health/ illness situation
as the family experiences it. To ensure
appropriateness of nursing intervention, the
nurse by the current situation given the
meanings, concerns, social relation, and
resources (equipment)
Develop/ Enhance Cognition, Volition and
Emotion
To determine the appropriateness of nursing
intervention, the nurse is given a choice of
possibilities that helps her, and the family gain a
clearer understanding of the self as a thinker, a
doer and a feeler. The choice contributes to a
process of self- understanding of the family as a
system and of each individual member. (Allnach
1988)
Nursing interventions that enhance or maximize
the competencies of the family as thinker can
mae information/ data or knowlesge readily
available and accessible for ease of and
confidence in understanding current situations
in health and illness. Decision- making on
appropriate actions to take are likewise
enhanced. 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 health promotion and maintenance
and accurate disease problem management. As
feeler, the family needs to develop or
strengthen its affective competencies in order
to appropriately acknowlesge and understand
emotions generated by family life or health and
illness situations (e.g fear, anxiety, jealousy,
guilt)
3. Develop the Family’s Ability and
Commitment to Provide Nursing Care to its
Members.
The nurse can increase the family’s confidence
in providing nursing care to its sick, disabled
and dependent member through
demonstration and practice sessions on
procedure, treatments or techniques utilizing
readily available, low- cost materials and
equipment and other resources.
Using the case illustration on the health
condition on or problem of scabies, the nurse
can demonstrate the use of medicinal plants or
indigenous herbs suchas Kalatsutsi and
Makabuhay in treating scabies. For example,
the nurse can show the family how to prepare
one cup chopped kalatsutsi bark boiled in one provides a systematic method of increasing
cup of coconut oil. The family can be taught desirable client behavior using the principle of
how to apply the mixture on the affected areas positive reinforcement. Using this principle, the
two or three times daily after the skin area has nurse and the client mutually agree on
been cleaned with warm decoction of guava favorable reinforcing experiences or
leaves. consequences as rewards when the client
performs the desired behavior.
To prepare and use the Makabuhay Lotion, the
family can be taught the following procedure. To make this intervention effective, the
necessary elements of the desired behavior
Prepare an extract of 100 cc using 100 gms. Of
must be made explicit and must be written in
the stem, cut, washed, and macerated evenly
the form of an agreement. To make the
using 25 cc. of how water then an additional
behavior consciously reinforced it must be
amount of 50 cc: The mixture is squeezed using
observable and measurable. The contract
thin, firm cloth. The extract is boiled and mixed
specifies the terminal, intermediate behaviors
with 50 cc. of refined vegetable oil added
and the reinforces as rewards for the client in
gradually to the boiled extract with continuous
return for performing the behaiors. The client
stirring for 10 to 15 minutes until a homogenate
and the nurse jointly identify the terminal
is obtained. The final concentration is 1 part oil
behavior and the component in intermediate
to 2 parts plant material. The Lotion is stored in
behaviors. Steckel used contracting as
a sterile bottle. The family is instructed to shake
intervention in her researchers on patient
the bottle before use, applying the lotion to
adherence to health care prescriptions. She
affected areas after washing with warm
recommends that the contract be written,
decoction of guava leaves.
dated, signed by all parties concerned and a
Contracting is creative intervention that can copy is given to each one. Furthermore, she
maximize opportunities to develop the ability specifies in her contracts the method for
and commitment of the family to provide monitoring the behavior through recording. A
nursing care to its members. It is an sample of a contract which can be used for the
intervention whereby the nurse creates a family case study discussed in this book is
situation in order that the client learns to illustrated on page 109.
achieve a specific health- related behavior
4.Enhance the capability of the Family to
through a sequentially arranged explicit steps
Provide a Home Environment Conducive to
and conditions or elements jointly identified by
Health Maintenance and Personal
both parties. This intervention uses
Development. The family can be taught
reinforcement contracts on a variety of health-
specific competencies to ensure such a
related behavior requiring complex behavioral
home environment through environmental
changes such as the adherence to diet,
modification, manipulation or management
medication, and other treatment regimens to
to minimize or eliminate health threats or
maintain desirable laboratory values, lose
risks or to install facilities for nursing care.
weight and control blood pressure. Such
The family can learn to construct or modify
complex behavioral changes require the
needed facilities in the home such as a
performance of explicit steps (intermediate
commode for the disabled or aged member
behaviors) and each steps requires
who cannot use the family’s toilet because
reinforcement if the seminal new behavior is to
of distance. Environmental conditions
be learned and maintained. Contracting
conducive to breeding and haniation of
vectors of diseases (such as mosquitos) can
likewise be improved by the family if it has
the necessary competencies to carry out
vector control measures. For example, the
nurse can teach specific techniques for
procedures like clearing stream banks of
overhanging vegetation and debris to
expose them to sunlight and speed up
water flow to eliminate breeding sites of
Anopheles flavirostris the primary mosquito
vector of Malaria. Another example is the
need to change water in flower vases at
least every two to three days or not to
allow water to remain stagnant in artificial
containers (like old tires or discarded cans)
in order to eliminate breeding places of
Aedes egypti, mosquito vector of dengue
and Dengue Hemorrhagic Fever.
To minimize or eliminate psycho- social
threats or risks in the home environment,
the nurse can walk closely with the family
to improve its communication patterns, role
assumptions, relationships, and interaction
patterns.
5. Facilitate the Family’s Capability to
Utilize Community Resources for Health
Care.
Another major intervention involves
maximum use of available resources
through the coordination, collaboration and
team work provided by an effective referral
system. Easy access to available 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 resources is shown below:
Name Office and Type of Requirements/
of E-mail Client Procedures for
Agency Address/ and Referral
and Telephone Specific
Person Number Services
to Schedule
Contact
A two- way referral system can facilitate
mobilization resources for families. The
nurse or the agency establishing such a
system can have previous arrangements or
agreements on the referral procedures and
services with agencies or resources
involved.
A sample two- way referral for is shown in
Figure 3. The nurse of the referring agency
accomplishes the first half of the form
providing the necessary information or case
summary and specifying the reasons for
referral or the services requested. She can
let the family bring the form with
information on services done, findings and
recommendations. However, other
alternatives are possible such as
messengerial service that brings the forms
from one agency to the other. Thr nurse can
also do the necessary communication with
the personnel of the agency where referral
is made for follow- up coordination.
An effective two- way referral system
ensures monitoring of the case, problem or
situation, follow up of required
interventions, case or services and
evaluation of the clients’ status or family’s
problem/ situation.
Catalyze Behavior Change Through
Motivation and Support
To bring about self- directed change, people
must learn from their experiences.
According to Chin and Benner (1976)
frequently, people have learned to defend
against the potential lessons of experience
when these threaten existing equilibria,
whether in the person or in the social
system. 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 1.
Human needs for the “use- value” of a given
piece of knowledge; 2. Security, trust, self-
esteem, self- identity, group esteem and
group identity; 3. Accurate and appropriate
preparation and transmission of messages
to catalyze the change, support is needed
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 behavior change.
In family, health nursing practice, the family
as a system needs to achieve optimum
really orientation in tis adaptation to its
changing internal and external
environment. This is done by developing
and institutionalizing its own problem-
solving structures and processes through
performance of the family health tasks. To
catalyze the behavior change towards
problem- solving competencies, a theory of
family health nursing interventions was
developed by Maglaya (1988). Motivation
and support are components of this
intervention. Motivation as conceptualized
the intervention theory is any experience or
information that leads the family to desire
and agree to undergo the behavior change
or proposed measure and take the initial
action to bring about change. Support as an
intervention is any experience or
information that maintains, restores, or
enhances the capabilities or resources of
the family to sustain these actions and
complete the change process. The
intervention leads the family to feel
“secured” or “in control of the situation in
the face of uncertainties, stresses, blocks or
barriers to the solution of the health
condition or problem or threats to self-
esteem and action or danger to life. To
illustrate, a young mother with a severely
malnourished nine- month old baby
suffering from diarrhea can be so
overwhelmed with her child’s condition
that she rejects any advice to do oral
rehydration and continue feeding the child.
Experience taught the mother that such
actions lead to vomiting and more frequent
bouts of diarrhea. Through motivation and
support, the nurse can help the young
mother understand the cyclical relationship
of diarrhea and malnutrition and the causes
of diarrhea during oral feeding. She can
develop the mother’s competencies to
administer oral rehydration slowly through
the cup, spoon, or dropper. She can
demonstrate to the mother how to prepare
and give easily digested rice gruel mixed
with protein concentrates made from
powdered beans and sun dried or toasted
dry small fish or shrimps. During the initial
experiences of the mother in carrying out
such measures to manage diarrhea, the
nurse’s physical and psychological
availability or accessibility are sources of
support especially during experiences of
fear, doubt and helplessness. When the
nurse can not be physically present, the
young mother can be made to feel that the
nurse’s help is readily available through the
clinic visit, telephone or written note.

In an evidence- based intervention research

on family empowerment for malaria
prevention and control in a rural barangay
in Abra Province, motivation support
intervention consisted of four major
components. (Maglaya et. Al)