MODULE 4

FAMILY NURSING PROCESS

INTRODUCTION
Assessing, planning, implementing, and evaluating nursing care are steps used to deliver
care to clients in acute care settings and in the extensive clinic system. These same steps are
used with families and aggregates in community health settings. The steps do not change, but
the context and client focus are different, and external variables that have not been
encountered in other contexts must now be considered.
LEARNING OUTCOME
Upon completion of this module, the students will be able to:

● Describe the components of the nursing process as they apply to enhancing family
health.

LEARNING CONTENT

A. What Family Nursing Process?

B. Family Health Assessment
C. Family Nursing Diagnosis
D. Formulating Family Nursing Care Plan
E. Implementing Family Care Plan
F. Evaluation of Family Nursing Care

LESSON 1: FAMILY NURSING PROCESS

FAMILY NURSING PROCESS
• It is a means by which the health care provider addresses the health needs and
problems of the client.
• It is a logical and systematic, way of processing information gathered from different
source and translating into meaningful actions or interventions.

 a systematic approach of solving an existing problem/meeting the needs of family

LESSON 2: FAMILY HEALTH ASSESSMENT

NURSING ASSESSMENT
- Involves a set of actions by which the nurse measure the status of the family as a
client, their ability to maintain wellness, prevent and control or resolve problems in order to
achieve health and well-being among its members.
1. Tools for Assessment
1.1 Initial Data Base’
A. Family Structure, Characteristics and Dynamics
1. Members of the household and relationship to the head of the family
2. Demographic data - age, sex, civil status, position in the family
3. Place of residence of each member - whether living with the family or elsewhere.
4. Type of family structure - e.g. matriarchal or patriarchal, nuclear or extended
5. Dominant family members in terms of decision-making, especially in matters of health
care.
6. General family relationship / dynamics - presence of any obvious / readily observable
conflict between members; characteristic, communication / interaction pattern among
members
B. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant Others - role(s) they play in family's life
5. Relationship of the family to larger community - Nature and extent of participation of
the family in community activities.
C. Home and Environment
1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of disease (e.g. mosquitoes, roaches,
flies, rodents, etc)
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply - source, ownership, sanitary condition
g. Garbage/ refuse disposal - type, sanitary condition
h. Drainage system - type, sanitary condition
2. Kind of neighbourhood, e.g. congested, slum
3. Social and health facilities available
4. Communication and transportation facilities available
D. Health Status of each Family Member
1. Medical and nursing history indicating current or past significant illnesses or beliefs and
practices conducive to health and illness.
2. Nutritional assessment ( specially for vulnerable or risk at-risk members)
a. Anthropometric data : Measures of nutritional status of children- weight, height,
mid-upper arm circumference.
 b. Dietary history specifying quality and quantity of food/ nutrient intake per day
c. Eating/feeding habits /practices
3. Developmental assessment of infants, toddlers, and preschoolers - e.g., Metro Manila
Developmental Screening Test (MMDST)
4. Risk factor assessment indicating presence of major and contributing modifiable risk
factors for - e.g. hypertension¸ physical inactivity, sedentary lifestyle, cigarette/ tobacco
smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber
intake, stress, alcohol drinking and other substance abuse.
5. Physical assessment indicating presence of illness state/s (diagnosed or undiagnosed by
medical practitioners.
6. Results of laboratory / diagnostic and other screening procedures supportive of
assessment findings

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention Such
as:
1. Immunization status of family members.
2. Healthy lifestyle practices.
3. Adequacy of :
a. rest and sleep
b. exercise / activities
c. Use of protective measures - e.g. adequate footwear in parasite- infested areas;
use of bednets and protective clothing in malaria and filariasis endemic areas.
d. Use of relaxation and other stress management activities
4. Use of promotive-preventive health services.

1.2 TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

1. First Level of Assessment – process whereby existing potential health conditions/problems

of the family are determined.

A. Presence of Wellness Condition – states as potential or readiness – a clinical or nursing

judgement about a client in transition from a specific level of wellness or capability to a
higher level.

B. Presence of Health Deficits - Instances of failure in health maintenance.

 Illness States, regardless of whether it is diagnosed or undiagnosed by medical

practitioner
 Failure to thrive/ develop according to normal rate
 Disability - whether (1) congenital or (2) arising from illness

C. Presence of Health Threats - Conditions that are conducive to disease, accident or
failure to realize one's health potential.
  Family history of hereditary condition / disease
 Threat of cross infection from a communicable disease case
 Family size beyond what family resources can adequately provide
 Accident hazards
 broken stairs
 pointed /sharp objects, poisons, & medicines improperly kept
 fire hazards
 fall hazards
 Faulty / unhealthy nutritional / eating habits or feeding techniques / practices.
 inadequate food intake both in quality and quantity
 excessive intake of certain nutrients
 faulty eating habits
 ineffective breastfeeding
 faulty feeding techniques
 Stress-provoking factors
 strained marital relationship
 strained parent-sibling relationship
 interpersonal conflicts between family members
 care-giving burden
 Poor home / environmental condition/ sanitation
 inadequate living space
 lack of food storage facilities
 polluted water supply
 presence of breeding or resting sites of vectors of diseases
 improper garbage / refuse disposal
 unsanitary waste disposal
 poor lightning and ventilation
 noise pollution
 air pollution
 Unsanitary food handling and preparation
 Unhealthy lifestyle and personal habits /practices
 alcohol drinking
 cigarette / tobacco smoking
 walking barefooted or inadequate footwear
 eating raw meat or fish
 poor personal hygiene
 self-medication/ substance abuse
 sexual promiscuity
 engaging in dangerous sports
 inadequate rest or sleep
 lack of / inadequate exercise / physical activity
 lack of / inadequate activities
  non-use of self-protection measures (e.g. non-use of bednets in Malaria
and Filariasis endemic areas)
 inherent personal characteristics - such as poor impulses control
 Health history which may precipitate / induce the occurrence of a health deficit, e.g.
previous history of difficult labor.
 Inappropriate role assumption - e.g. child assuming mother's role, father not assuming
his role
 Lack of immunization / inadequate immunization status specially of children
 Family disunity - e.g. self-oriented behavior of members (s), unresolved conflicts of
members(s), intolerable disagreement

D. Presence of Stress Points / Foreseeable Crisis - Anticipated periods of unusual demand

on the individual or family in terms of adjustment / family resources.
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member - e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of Job
K. Hospitalization of a family member
L. Death of a Member
M. Resettlement in a new community
N. Illegitimacy
O. Other, Specify ______________

2. Second Level of Assessment – defines the nature or type of nursing problems that the
family encounters in performing health.

I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequences of diagnosis
of problem, specifically :
1. social-stigma, loss of respect of peers / significant others
2. economic / cost implications
3. physical consequences
4. emotional / psychological issues / concerns
C. Attitude / philosophy in life which hinders recognition / acceptance of a problem
II. Inability to make decisions with respect to taking appropriate health action due to :
A. Failure to comprehend the nature/ magnitude of the problem / condition
B. Low salience of the problem / condition
C. Feeling of confusion, helplessness and / or resignation brought by perceived
magnitudes / severity of the situation or problem, i.e., failure to break down
problems into manageable units of attacks
D. Lack of / or inadequate knowledge / insight as to alternative courses of action to
take
E. Inability to decide which action to take among the list of alternatives
F. Conflicting opinions among family members / significant others regarding action to
take
G. Lack of / or inadequate knowledge of community resources for care
H. Fear of consequence of action, specially:
 social consequences
 economic consequences
 physical / psychological consequences
I. Negative attitude towards the health problem – By negative attitude is meant one
that interferes with rational decision making
J. Inaccessibility of appropriate resources for care, specifically:
1. physical inaccessibility
2. cost constraints or economic / financial inaccessibility
K. Lack of trust / confidence in the health personnel / agency

III. Inability to provide adequate nursing care to sick, disabled, dependent or vulnerable at-
risk member of the family due to:
A. Lack of / inadequate knowledge about the disease / health condition (nature,
severity, complications, prognosis and management );
B. Lack of / inadequate knowledge about the child development and care;
Lack of / inadequate knowledge of the nature and extent of nursing care needed;
C. Lack of the necessary facilities, equipment and supplies for care;
D. Lack of or inadequate knowledge and skill in carrying out the necessary
interventions / treatment / procedure / care (e.g., complex therapeutic regimen or
healthy lifestyle program);
E. Inadequate family resources for care, specifically:
 Absence of responsible member
 Financial constraints
 Limitations / lack of physical resources – e.g. isolation room
F. Significant person’s unexpressed feelings (e.g. hostility / anger, guilt, fear / anxiety,
despair, rejection) which disable his / her capacities to provide care.
G. Philosophy in life which negates / hinder caring the sick, disabled, dependent,
vulnerable / At – risk member
H. Member’s preoccupation with own concerns / interests
 I. Prolonged disease or disability progression which exhausts supportive capacity of
family members
J. Altered role performance – specify :
a. role denial or ambivalence
b. role strain
c. role dissatisfaction
d. role conflict
e. role confusion
f. role overload

IV. Inability to provide a home environment conducive to health maintenance and personal
development due to :
A. Inadequate family resources, specifically:
a. financial constraints / limited financial resources
b. limited physical resources – e.g. lack of space to construct facility
B. Failure to see benefits (specifically long-term ones) of investment in home
environment improvement
C. Lack of / inadequate knowledge of importance of hygiene and sanitation
D. Lack of / inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude / philosophy in life which is not conducive to health maintenance
and personal development
I. Lack of / inadequate competencies in relating to each other for mutual growth and
maturation (e.g. reduced ability to meet the physical and psychological needs of
other members as a result of
J. family’s preoccupation with current problem or condition)

V. Failure to utilize community resources for health care due to :

A. Lack of / inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care / services
C. Lack of trust / confidence in the agency / personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic. Rehabilitative ),
specifically :
a. physical / psychological consequences
b. financial consequences
b. social consequences – e.g. , loss of esteem of peer / significant others
F. Unavailability of required care / service
G. Inaccessibility of required care / service due to:
a. cost constraints
 b. physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically ;
a.manpower resources – e.g. baby sitter
b. financial resources – e.g., cost of medicine prescribed
I. Feeling of alienation to / lack of support from the community, e.g., stigma due to
mental illness, AIDS, etc.
J. Negative attitude / philosophy in life which hinders effective / maximum utilization
of community resources for health care

1.3. FAMILY HEALTH TASK

To achieve wellness among family members and to reduce, eliminate and prevent health
problems, the family should have the ability to perform the ff. health tasks according to
Maglaya et al.,2003:
1. Recognize the presence of a wellness state and health condition problem
2. Make decisions about taking an appropriate health action to maintain wellness or
manage the health problem
3. Provide nursing care to the sick, disabled, dependent, or at risk member
4. Maintain a home environment conducive to health maintenance and personal
development
5. Utilize community resources for health care

It is the nurse’s responsibility to assess if the family is able to attend to these tasks or not.
Failure to attend to these family health tasks constitutes the family nursing problems.
1.4 FAMILY COPING INDEX

Purpose:
 To provide a basis for estimating the nursing needs of a particular family.
Health Care Need
A family health care need is present when:

1. The family has a health problem with which they are unable to cope.
2. There is a reasonable likelihood that nursing will make a difference in the in the family’s
ability to cope.

Relation to Coping Nursing Need:

 COPING may be defined as dealing with problems associated with health care with
reasonable success.
 When the family is unable to cope with one or another aspect of health care, it may be
said to have a “coping deficit”
Direction for Scaling
 Two parts of the Coping index:
1. A point on the scale
2. A justification statement
 The scale enables you to place the family in relation to their ability to cope with the nine
areas of family nursing at the time observed and as you would expect it to be in 3 months
or at the time of discharge if nursing care were provided. Coping capacity is rated from 1
(totally unable to manage this aspect of family care) to 5 (able to handle this aspect of care
without help from community sources). Check “no problem” if the particular category is
not relevant to the situation.
 The justification consists of brief statement or phrases that explain why you have rated
the family as you have.

General Considerations:
1. It is the coping capacity and not the underlying problem that is being rated.
2. It is the family and not the individual that is being rated.
3. Rating should be done after 2-3 home visits when the nurse is more acquainted with the
family.
The scale is as follows:

 0-2 or no competence
 3-5 coping in some fashion but poorly
 6-8 moderately competent
 9 fairly competent

 Justification- a brief statement that explains why you have rated the family as you have.
These statements should be expressed in terms of behavior of observable facts. Example:
“Family nutrition includes basic 4 rather than good diet.
 Terminal rating is done at the end of the given period of time. This enables the nurse to see
progress the family has made in their competence; whether the prognosis was reasonable;
and whether the family needs further nursing service and where emphasis should be
placed.
Scaling Cues
The following descriptive statements are “cues” to help you as you rate family coping. They are
limited to three points – 1 or no competence, 3 for moderate competence and 5 for complete
competence.
Areas to Be Assessed
Physical independence: This category is concerned with the ability to move about to get out of
bed, to take care of daily grooming, walking and other things which involves the daily activities.
Therapeutic Competence: This category includes all the procedures or treatment prescribed for
the care of ill, such as giving medication, dressings, exercise and relaxation, special diets.
Knowledge of Health Condition: This system is concerned with the particular health condition
that is the occasion of care
Application of the Principles of General Hygiene: This is concerned with the family action in
relation to maintaining family nutrition, securing adequate rest and relaxation for family
members, carrying out accepted preventive measures, such as immunization.
Health Attitudes: This category is concerned with the way the family feels about health care in
general, including preventive services, care of illness and public health measures.
Emotional Competence: This category has to do with the maturity and integrity with which the
members of the family are able to meet the usual stresses and problems of life, and to plan for
happy and fruitful living.
Family Living: This category is concerned largely with the interpersonal with the interpersonal
or group aspects of family life – how well the members of the family get along with one
another, the ways in which they take decisions affecting the family as a whole.
Physical Environment: This is concerned with the home, the community and the work
environment as it affects family health.
Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells
others about Health Departments services

2. FAMILY DATA ANALYSIS

Steps:
1. Sorting of data for broad categories (such as those related with health status or
practices – about home and environment).
2. Clustering of related cues to determine relationship among data.
3. Distinguishing relevant form irrelevant data. This will help in deciding what information
is pertinent to the situation at hand and what information is immaterial.
4. Identifying patterns such as physiologic function, developmental, nutritional/dietary,
coping/adaptation or communication patterns.
5. Compare patterns with norms or standards of health, family functioning and assumption
of health tasks.
 6. Interpreting results of comparisons to determine signs and symptoms or cues of specific
wellness state/s, health deficit/s, health threat/s, foreseeable crises/stress point/s and
their underlying causes or associated factors.
7. Making conclusions about the reasons for the existence of the health condition or
problem, or risk for non-maintenance of wellness state/s which can be attributed to
non-performance of family tasks.

LESSON 3: FAMILY NURSING DIAGNOSIS

Problem Definition/Nursing Diagnosis
 End result of 2 major types of assessment.

Family Nursing Problem - Stated as an inability to perform specific health task and the
reasons / etiology) why the family cannot perform such task.

 Consists of 2 parts: main category of problem (coming from unattained health task) and
specific problems (statement of factors contributory for the existence of the main
problem.
 Example: (general): Inability to utilize resources for health care due to lack of adequate
family resources, specifically: (specific)
a. financial resources
b. manpower resources
c. time
 The more specific the problem definition, the more useful is the nursing diagnosis in
determining the nursing intervention. Therefore, as many as three or four levels of
problem definition can be stated.
 SEE MORE IN THE TYPOLOGY OF NURSING PROBLEMS

LESSON 4: FORMULATING FAMILY NURSING CARE PLAN

The step in the process w/c answers the following questions:
 What is to be done?
 How is it to be done?
 When it is to be done?
It is actually the phase wherein the health care provider formulates a care plan.
Steps in developing a Family Nursing Care Plan
1. Prioritized problems
2. Establishing goals and objectives of the nursing care
3. Selecting appropriate Family Nursing intervention/strategies
 4. Plan for evaluating care

1. Prioritizing Health Problems

 Nature of the Problem Presented - Categorized into wellness state, health threat,
health deficit and foreseeable crisis.
 Modifiability of the Problem/Condition - Refers to the probability of success in
enhancing, improving, minimizing, alleviating or totally eradicating the problem through
intervention.
 Preventive Potentials - Refers to the nature and magnitude of future problems that can
be minimized or totally prevented if intervention is done on the problem under
consideration.
 Salience - Refers to the family's perception and evaluation of the problem in terms of
seriousness and urgency of attention needed or family readiness.
Scoring
1. Decide a score for each of the criteria
2. Divide the score by the highest possible & multiply by the weight
Score x weight
Highest score
3. Sum up the score of all criteria. The highest score is 5 equivalent to the total weight.
lowest 2 or 3
4. Rank
5. The nursing problem with highest score will be the first priority
 CRITERIA Weight
1. Nature of the problems Presented 1
Scale:
-Health deficit / Wellness 3
-Health threat 2
- Foreseeable crisis 1
2.Modifiability of the problem 2
Scale:
-easily modifiable 2
-Partially modifiable 1
-Not modifiable 0
3. Preventive potential 1
Scale:
 High 3
 Moderate 2
 Low 1
4. Salience 1
Scale:
 A condition / problem needing 2
Immediate attention
 A condition / problem not 1
needing Immediate attention
 Not perceived as a problem or 0
condition needing change
Sample :
SCENARIO 1: Mang pedro, 42 years old, coughing for 4 weeks now and with presence of
hemoptysis. He has a medical history of PTB and underwent treatment and declared cured in
2006. His wife recognizes the need for sputum microscopy. His wife linda said
“Parang ganyan yung nangyari sakanya nun. Gusto ko siyang ipakonsulta sa doctor sa linggo
kasi natatakot akong bumalik yung sakit niya”.
SCENARIO 2: Pedrito, 3 years ols weighs 10kg, looks pale, weak and noticeably underweight and
manifested by the evident of bony prominences. Her mother linda said “Hay naku ang hina niya
kasi kumain, palibahasa puro laro ang inaatupag. Saka lahi kasi talaga naming ang mapapayat. “

CRITERIA Mang pedro Pedrito

PTB malnutrition
 NATURE OF THE CONDITION (3/3)x1=1 (3/3)x1=1
Wellness state
Health deficit
Health threat
Foreseeable crisis

MODIFIABILITY OF THE CONDITION (2/2)x2=2 (2/2)x2=2

Easily modifiable
Partially modifiable
Not modifiable
PREVENTIVE POTENTIAL (3/3)x1=1 (3/3)x1=1
High
Moderate
Low
SALIENCE (2/2)x1=1 (0/2)X1=0
A condition needing immediate attention
A condition not needing immediate
attention
Not perceived as a condition needing
change

SUM TOTAL 5 4

Factors affecting priority setting:

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
2. Resources of the family - physical, financial & manpower
3. Resources of the nurse - knowledge, skills and time
Resources of the community - facilities and community organization or support
Factors in Deciding Appropriate Score for Preventive Potential
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 the prognosis,
reversibility of the problem
2. Duration of the problem - refers to the length of time the problem has been existing
 3. Current Management - refers to the presence and appropriateness of intervention
4. Exposure of any high risk group

Family Nursing Care Plan

 It is the blueprint of care that the nurse designs to systematically minimize or eliminate
the identified family health problem through explicitly formulated outcomes of care
(goal and objectives) and deliberately chosen set of interventions/resources and
evaluation criteria, standards, methods and tools.

Characteristics of Family Nursing Care Plan

1. It focuses on actions w/c are designed to solve or alleviate & existing problem.
2. It is a product of deliberate systematic process.
3. The FNCP as with other plans relates to the future.
4. It revolves around identified health problems.
5. It is a mean to an end and not a end to itself.
6. It is a continuous process, not one shot deal.
Desirable Qualities of Family Nursing Care Plan
1. It should be based on a clear definition of the problem.
2. A good plan is realistic, meaning it can be implemented w/ reasonable chance of success
3. It should be consistent w/ the goals & philosophy of the health agency.
4. It’s drawn w/ the family.
5. It’s best kept in written form.

Setting/ Formulating Goals & Objectives

 This will set direction of the plan.
 This should be stated in terms of client outcomes whether at the individual, family or
community level.
 The mutual setting of goals w/c is the cornerstone of effective planning consists of:
1. Identifying possible resources.
2. Delineating alternative approaches to meet goals.
3. Selecting specific interventions.
4. Operationalizing the plan - setting of priorities.
5.
GOAL – A broad statement about the effects of the nursing intervention
After nursing intervention, the client’s nutritional status will improve.
Cardinal Principle in Goal setting

 It must be set jointly with the family. This ensures family commitment to their
realization.
  Basic to the establishment of mutually acceptable goal in the family’s recognition and
acceptance of existing health needs and problems.

Barriers to Joint Goal Setting
1. Failure in the part of the family to perceive the existence of the problem.
Sometimes the family perceives the existence of the problem but does not see it as serious
enough to warrant attention
Characteristics of Goals/ Objectives
1. Specific
2. Measurable
3. Attainable
4. Realistic
5. Time bound

Objective

 Refers to a more specific statement of desired outcome of care.

 They specify the criteria by which the degree of effectiveness of care is to be measured.

After nursing intervention, the client will have a weight gain after two weeks

Types of Objective
1. Short term or Immediate Objective
 Formulated for problem situation w/c require immediate attention & results can be
observed in a relatively short period of time.
 They are accomplished w/ few HCP-family contacts & relatively less resources.
2. Medium or Intermediate objective
 Objectives w/c is not immediately achieved & is required to attain the long ones.
3. Long Term or Ultimate Objective
 This requires several HCP-family contacts & an investment of more resources.

EXPECTED OUTCOMES –the most specific, measurable criteria used to evaluate whether the
goal has been met
After nursing intervention, the client will have a weight gain of 4 pounds by
November 15 (2 weeks after the goal of care has been identified
CRITERION: an objective, measurable, relevant, and flexible indicator related to performance,
behaviour, circumstances or clinical status
weight gain
 STANDARD- the desired and achievable level of performance against which actual practice is
compared
4 pounds

Plan of Actions/ Interventions

 Its aim is to minimize all the possible reasons for causes of the family’s inability to do
certain tasks.
HEALTH FAMILY GOAL OF OBJECTIVE NURSING METHOD RESOURCES EVALUATION
PROBLEM NURSING CARE OF CARE INTERVENTIONS OF REQUIRED CRITERIA AND
PROBLEM FAMILY STANDARD
NURSE-
CONTACT

MALNUTRITION INABILITY After nursing After nursing -HEALTH -Home - Pen The client
RECOGNIZED intervention, intervention, EDUCATION visit verbalized
THE HEALTH the client will the client will ABOUT: - Cart understanding
PROBLEM be able to be able to olina on
recognize the have a Malnutrition-Signs malnutrition
and symptoms - pict
health knowledge ures
problem about signs
and symptoms
of malnutrition

It is highly dependent on 2 Major Variables:

1. nature of the problem
2. the resources available to solve the problem

WRITING THE FAMILY NURSING CARE PLAN

LESSON 5: IMPLEMENTING FAMILY CARE PLAN

 Actual doing of interventions to solve health problems.
 Continuous data collection and modification of plan of care if necessary
 Documentation of care
 NURSES MUST HAVE:
o COGNITIVE SKILLS- problem solving, decision making, critical thinking
o INTERPERSONAL SKILLS
 o TECHNICAL SKILLS –manipulating machines, drug admin

1. CATEGORIES OF INTERVENTION

1. PROMOTIVE  is an activity and / or a series of health service activities that prioritize

health promotion activity. example is dental and oral health education.
2. PREVENTIVE  is a preventive activity against a health problem / illness.
example is topical application on the teeth.
3. CURATIVE  is an activity and / or a series of treatment activities aimed at healing of
disease, the reduction of suffering from the disease, disease control, or disability control
example is dental fillings.
4. REHABILITATIVE  is an activity and / or a series of activities to return the former patients
into the community, so that they can take part again as the useful members of society
for themselves and for the community as much as possible according to their ability.
example is the manufacture or installation of dentures.
GUIDELINES FOR IMPLEMENTING NURSING ACTIVITIES
 Nursing actions should be based on scientific knowledge, nursing research, and
professional standards of care.
 Nurses should understand clearly the orders to be implemented and question any that
are not understood.
 Nursing actions should be adapted to the individual client.
 Nursing actions should always be safe
 Nursing actions often require teaching, support, and comfort.
 Nursing actions should be holistic.
 Nursing actions should respect the dignity of the client and enhance the client's self-
esteem.
 Clients should be encouraged to participate actively in implementing the nursing
actions.
Typology of Interventions
1. Supplemental - the HCP is the direct provider of care.
2. Facilitative - HCP removes barriers to needed services.
3. Developmental - improves client’s capacity.

2. TOOLS OF PUBLIC HEALTH NURSE PHN BAG AND CONTENTS

THE NURSING BAG

 Also called as PHN BAG
 A tool used by the nurse during home and community visit to be able to provide care
safely and efficiently.
  Indispensable tool that should be organize to save time & effort and to prevent cross
infection & contamination
 Contents depends on agency policies and type of services to render
 A receptacle for items needed for nursing care
 Serves a reminder for prevention of spread of infection
 A nurse is prepared for variety of situation while in the field

CONTENTS OF THE PHN BAG

1. ARTICLES FOR INFECTION CONTROL: soap in a covered dish and linen or disposable paper
towel for hand washing, apron, bottles for antiseptics and hand sanitizer
2. ARTICLES FOR ASSESSMENT OF FAMILY MEMBERS: thermometer, measuring tape, weighing
scale, glucometer, benedict’s test- benedict’s sol’n, medicine dropper, test tube and holder,
alcohol lamp
NOTE: STETHOSCOPE AND SPHYGMOMANOMETER ARE CARRIED SEPARATELY
3. ARTICLES FOR NURSING CARE:
• STERILE ITEMS: dressings, cotton balls, cotton tip applicator, syringe (2 and 5 cc),
surgical gloves, cord clamp, surgical scissors, sterile pack with kidney basin, 2
pairs of forcep- straight and curved
• CLEAN ARTICLES: adhesive tape, bandage scissors
• PIECES OF PAPER: for lining the soap dish if the home sink is used and for lining
the bag and folded paper to be used as waste receptacle if needed

PRINCIPLES IN USING NURSING BAG/ BAG TECHNIQUE

1.Bag technique helps the nurse in infection control.
2. Bag technique allows the nurse to care efficiently.
- saves time and effort
- the nurse check the contents of bag for completeness and for proper
functioning before leaving the health facility for home visit.
-articles/contents must be arranged according to use
3. Bag technique should not take away the nurse’s focus on the patient and the family
- simple a tool in providing care
4. Bag technique may be performed in different ways.
-depends on agency policies and home situation
 principles of asepsis are of the essence and should be practice at all times

ACTIVITIES THAT SHOULD BE PRACTICED DURING HOME VISITS AS PART OF BAG TECHNIQUE

1. Remember to proceed from “CLEAN” to “CONTAMINATED”.

2. The bag and its content should be well protected from contact with any article in the
patient’s home. Consider the bag and its content as clean or sterile, while articles that belong to
the patients as dirty and contaminated.
3. Line the table/flat surface with paper or washable protector on which the bag and all the
articles to be used are placed
4. Wash your hands before and after physical assessment and physical care of each family
member
5. Bring out only the articles needed for the care of the family. Those that will not be used
should remain in the bag. This practice is facilitated when the contents of the bag are arranged
according to the nurse’s convenience to avoid confusion and promote efficiency.
6. Do not put any family’s articles on your paper lining/washable protector
. Whenever possible and as necessary, wash your articles before putting them back into the
bag. If this is not possible, wrap them properly to prevent contaminating the bag and its
contents
8. After using an article such as apron or washable protector, confine the contaminated surface
by folding the contaminated side inward.
9. Wash the inner cloth lining of the bag as necessary.
3. TYPES OF FAMILY NURSE CONTACT

 CLINIC VISIT
-takes place in a PRIVATE CLINIC, HEALTH CENTER, BHS, or IN AN AMBULATORY CLINIC
STRENGTH
 the family member takes initiative of visiting the prof’l health workers
 Allows the nurse to maximize the resources available(time, material resources,referral
to other hcp)
 Distractions is lessened since the nurse has greater control in the environment
WEAKNESS
 Obvious hardship of the family like transporting sick family member
 The family member feel less confident to discuss family health concern due to lesser
environment control

 GROUP CONFERENCE
-takes place in a HEALTH FACILITY OR COMMUNITY
-appropriate in developing cooperation, leadership, self-reliance, and community
awareness among group members
-E.G. conference of mothers in the neighbourhood
STRENGTH:
 opportunity to share experiences and practical solutions to common health
concerns.
WEAKNESS:
 Attendance requires motivation and availability of target family members
the nurse may not be able to reach the families in greatest need of help

 TELEPHONE CALLS
-takes place through TELEPHONE OR MOBILE PHONE
-Provides easy access between the nurse/health worker and the family
 Encouraging the family to communicate with the clinic or health center
when they feel the need for it CULTIVATES FAMILY CONFIDENCE IN THE
HEALTH AGENCY
WEAKNESS:
 Information transmitted is limited
 Accurate assessment of family conditions requires face-to-face contact

 WRITTEN COMMUNICATION
-Used to give specific information to families
Ex: instructions given to parents through school children
STRENGTH:
 Potential for reaching many families
WEAKNESS:
 Requires literacy and interest, the nurse cannot certain that the information will reach
the intended recipient

 HOME VISIT
-A professional, purposeful interaction that takes place in the family’s residence
-aimed at promoting, maintaining, or restoring the health of the family or its
members.
- a set up where in the nurse goes to the family

 The nurse makes home visit when:

1. Upon the family’s request
2. As a result of case finding
3. In response to referral
4. To follow up clients
5.
ADVANTAGES OF HOME VISIT
1. It allows firsthand assessment of the home situation: family dynamics, environmental
factors affecting health and resources within the home
2. The nurse is able to seek out previously unidentified needs
3. It gives the nurse an opportunity to adapt interventions according to family resources
4. It promotes family participation and focuses on the family as a unit
5. Teaching family members in the home is made easier by the familiar environment and
the recognition of the need to learn as they are faced by the actual home situation
6. The personalized nature of home visit gives the family the sense of confidence in
themselves and in agency.
WEAKNESS OF HOME VISIT
RELATES TO EFFICIENCY :
1. The cost in terms of time and effort
2. The nurse unable to control the environment more distractions
3. Nurse’s safety may also be a concern

PHASES OF HOME VISIT

1. PREVISIT PHASE
-nurse contacts the family
  Determines the family’s willingness for a home visit
 Set an appointment
 A plan for home visit is formulated this phase
 The PLANNING PROCESS for a home visit is essentially the same as the PLANNING PHASE
OF NURSING PROCESS

SPECIFIC PRINCIPLES IN PLANNING FOR HOME VISIT

1. Being a professional contact with the family, the home visit should have a purpose.
- not for social reason; should be THERAPEUTIC!
PURPOSES:
 To have a more accurate assessment of the family’s living conditions and adapt
interventions accordingly
 To educate the family about measures for health promotion, disease prevention and
control of health problems
 To prevent the spread of infection among family members and within the community
 To provide supplemental intervention for the sick, disabled or dependent family
member and guide the family on how to give care in the future
 To provide family with greater access to health resources in the community

2. Use information about the family collected from all possible sources (records)
3. The home visit plan focuses on identified family needs, particularly needs recognized by the
family as requiring urgent attention.
4. Continuing care for a client who needs it will be provided by the client or family member
( client and family member should actively participate in planning for cont. of care )
5. The should be practical and adaptable

 Before leaving the health facility, the nurse should check the contents of the Nursing
bag and other articles
 carry out home visit efficiently and safety
 The nurse comply with practices and policies for personnel safety
 Informing other personnel of his/her itinerary
 “BUDDY SYSTEM” Nursing students/new personnel

2. IN-HOME PHASE
-begins as the nurse seeks permission to enter and lasts until she/he leaves the family’s
home
INITIATION
 Acknowledging family members through greetings and introducing oneself and
agency he/she represents.
 Observe the environment for own safety
  Sits as the family directs him/her to sit.
 ESTABLISH RAPPORT
- NURSE initiates a short social conversation
-states the purpose of the visit and the source of information
IMPLEMENTATION
 Application of nursing process
 ASSESSMENT- Interview/PA/diagnostic exam that can be done at home
 FAMILY ASSESSMENT FORM is used as a guide for this purpose
 Physical care, health teachings and counselling is provided to the family
 Nurse observes aseptic practices (handwashing before and after)
 Opportunity for demonstration of practical methods in preventing spread of
infection
TERMINATION
-summarizing with the family the events during the home visit and setting subsequent
home visit or another form of family-nurse contact
-Use this time to record findings- vital signs and body weight

3. POST-VISIT PHASE
- Takes place when the nurse has returned to the health facility
-involves documentation of the visit
-personal observations and feelings

LESSON 6: EVALUATION OF FAMILY NURSING CARE

 Determination whether goals / objectives are met.
 Determination whether nursing care rendered to the family are effective.
 Determines the resolution of the problem or the need to reassess, and re-plan and
re-implement nursing interventions.

According to Alfaro-LeFevre:
Evaluation is being applied through the steps of the nursing process:

 Assessment – changes in health status.

 Diagnosis – if identified family nursing problems were resolved, improved or
controlled.
 Planning – are the interventions appropriate & adequate enough to resolve
identified problems.
 Implementation – determine how the plan was implemented, what factors aid in the
success and determine barriers to the care.
CATEGORIES:
 ONGOING EVALUATION- done while or immediately after implementing an order;
enables nurse to make on the spot modification in an intervention
 INTERMITTENT EVALUATION- performed at specific time intervals
 Process evaluation
 TERMINAL EVALUATION – indicates Client’s condition at the time of discharge; status
goal achievement, and evaluation of the client’s self care abilities as regard to follow up
care
Steps in Evaluation:
1. Decide what to Evaluate.
 Determine relevance, progress, effectiveness, impact and efficiency
2. Design the Evaluation Plan
 Quantitative – a quantifiable means of evaluation which can be done through
numerical counting of the evaluation source.
 Qualitative – descriptive transcription of the outcome conducted through
interview to acquire an in-depth understanding of the outcome.
3. Collect Relevant Data that will support the outcome
4. Analyze Data - What does the data mean?
5. Make Decisions
 If interventions are effective, interventions done can be applied to other client /
group with the similar circumstances
 If ineffective, give recommendations
6. Report / Give Feedbacks

Dimensions of Evaluation
1. Effectiveness – focused on the attainment of the objectives.
2. Efficiency – related to cost whether in terms on money, effort or materials.
3. Appropriateness – refer its ability to solve or correct the existing problem, a
question which involves professional judgment.
4. Adequacy – pertains to its comprehensiveness.

Tools Being used during Evaluation

 Instruments are tools are being used to evaluate the outcome of the nursing
interventions:
 Thermometer
 Tape measure
 Ruler
  BP apparatus
 Weighing scale
 Checklist
 Key Guide Questionnaires
 Return Demonstrations
Methods of Evaluation
1. Direct observation
2. Records review
3. Review of questionnaire
4. Simulation exercises

Teaching and Learning Activities

ACTIVITY #1
1. Identify at least 5 existing problems or potential health problems of your family. Following
the family nursing process, formulate a family nursing care plan appropriate to each problem
of 25 points)

Learning materials
Handouts/Lecture notes
Flexible Teaching Learning Modality (FTLM) adopted
Online: Edmodo, Facebook Messenger and Zoom
Remote: Module, Exercises, Individual Activity
Assessment Task