PRIORITIZING

FAMILY’S HEALTH
PROBLEM
HOME VISIT AND
PHN BAG
 PLANNING

The cores of the plan

The nursing care plan are the approaches,
The nursing care plan
focuses on actions, strategies, activities,
is based upon
which are designed to methods and
identified health and
solve or minimize materials, which the
nursing problems.
existing problem. nurse hopes, will
improve the problem.
 PLANNING
FOUR (4) STANDARD STEPS:
• Prioritization – start if there are multiple identified
problems
• Formulation of Objectives – planning a procedure will
start here if there is only one problem
• Developing strategies of Action
• Formulation of Evaluation tools – for the identified
strategy developed.
 PLANNING
A. PRIORITIZATION OF HEALTH
PROBLEMS
• Nature of the condition or problem – categorized
into wellness state/potential, health threat, health
deficit and foreseeable crisis.
• Factors Affecting Nature of the Problem
• The biggest weight is given to the wellness state or
potential because of the premium on client’s effort or desire
to sustain/ maintain high level of wellness.
PLANNING
A. PRIORITIZATION OF HEALTH
PROBLEMS
▪ The same weight is given to health deficit because of its
sense of clinical urgency, which may require immediate
intervention.
▪ Foreseeable crisis is given the least weight because culture
linked variables/factors usually provide our families with
adequate support to cope with developmental or situational
crisis.
 A. PRIORITIZATION OF HEALTH
PROBLEMS
CRITERIA IN IDENTIFYING THE PROBLEM
CRITERIA SCORE WEIGHT
A. Nature of Condition or Problem    
Health deficit 3  
Health threat 2 1
Foreseeable Crisis 1
B. Modifiability    
Easily modifiable 2  
Partially modifiable 1 2
Not modifiable 0
C. Preventive Potential    
High 3  
  Moderate  2 1
  Low 1
D. Salience    
a condition or problem needing immediate attention 2  
a condition or problem not needing immediate attention 1  
not perceived as a problem or condition needing change 0 1
PLANNING
A. PRIORITIZATION OF HEALTH
PROBLEMS
• 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.
 PLANNING
A. PRIORITIZATION OF HEALTH
PROBLEMS

• Modifiability of the condition or problem-

• Factors Affecting Modifiability
▪ Current knowledge, technology and interventions to enhance the wellness state or
manage the problem.
▪ Resources of the family
▪ Resources of the nurse
▪ Resources of the community
 A. PRIORITIZATION OF HEALTH
PROBLEMS
CRITERIA IN IDENTIFYING THE PROBLEM
CRITERIA SCORE WEIGHT
A. Nature of Condition or Problem    
Health deficit 3  
Health threat 2 1
Foreseeable Crisis 1
B. Modifiability    
Easily modifiable 2  
Partially modifiable 1 2
Not modifiable 0
C. Preventive Potential    
High 3  
  Moderate  2 1
  Low 1
D. Salience    
a condition or problem needing immediate attention 2  
a condition or problem not needing immediate attention 1  
not perceived as a problem or condition needing change 0 1
 PLANNING
A. PRIORITIZATION OF HEALTH
PROBLEMS
Preventive potential
Factors Affecting Preventive Potential
▪ 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 the problem is, the lower is the preventive potential of the
problem.
▪ Duration of the problem - refers to the length of time the problem has existed. Generally speaking,
duration of the problem has a direct relationship to gravity; the nature of the problem is variable
that may, however, alter this relationship. Because of this relationship to gravity of the problem,
duration has also a direct relationship to preventive potential.
 PLANNING
A. PRIORITIZATION OF HEALTH
PROBLEMS
Preventive potential
Factors Affecting Preventive Potential
▪ 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 condition’s preventive potential.
▪ Exposure of any vulnerable or high-risk group - increases the preventive potential
of condition or problem
 A. PRIORITIZATION OF HEALTH
PROBLEMS
CRITERIA IN IDENTIFYING THE PROBLEM
CRITERIA SCORE WEIGHT
A. Nature of Condition or Problem    
Health deficit 3  
Health threat 2 1
Foreseeable Crisis 1
B. Modifiability    
Easily modifiable 2  
Partially modifiable 1 2
Not modifiable 0
C. Preventive Potential    
High 3  
  Moderate  2 1
  Low 1
D. Salience    
a condition or problem needing immediate attention 2  
a condition or problem not needing immediate attention 1  
not perceived as a problem or condition needing change 0 1
Scoring:
1. Decide on a score for each of the criteria.
2. Divide the score by the highest possible score and multiply
by the weight: (score/highest score) x weight.
3. Sum up the scores for all the criteria. The highest score is
5 (equal to total weight)
 PLANNING
Establishing Goals and Objectives
Goal – Desired observable family response
to planned interventions in response to a
mutually identified family need.
Objectives – The desired step by step family
responses as they work toward a goal
 PLANNING
Establishing Goals and Objectives
• A cardinal principle in goal setting states that goal must be set jointly with the
family. This ensures family commitment to realization.
• Basic to the establishment of mutually acceptable goals is the family’s
recognition and acceptance of existing health needs and problems.
• Workable, well stated objectives should be SMART:
• S – Specific
• M – Measurable
• A – Attainable
• R – Relevant
• T – Time Bound
 INTERVENTIONS
• This is the capacity to provide
management
• It is the professional phase of nursing
process
• It is the time when the PHN executes the
standard function of a RN ( promotive,
preventive, curative, rehabilitative)
 INTERVENTIONS

Three (3) Standards Functions of RN:

• Dependent – giving of medicines
• Independent – monitor, assess, provide,
educate
• Interdependent - referrals
 INTERVENTIONS
Categories of Nursing Interventions (Freeman and Heinrich)
• Supplemental Interventions – actions that nurse performs on behalf
of the family when it is unable to do things for itself (direct nursing
care)
• Facilitate Interventions – actions that remove barriers to appropriate
health action such as assisting the family to avail of maternal and
early childcare services.
• Developmental Interventions – aim to improve the capacity of the
family to provide for its own health needs such as guiding the family
to make responsible health decisions.
 EVALUATION
• To evaluate is to determine or fix the value
• Formative Evaluation – judgment made about
effectiveness of nursing intervention as they are
implemented.
• Summative Evaluation – determining the end results
of family nursing care and usually involves measuring
outcomes or the degree to which goals have been
achieved.
 EVALUATION
Three (3) Things to be Evaluated: SPO
• Structure of program and activity – measure the adequacy of
articles, equipment, supplies, and manpower utilized
• Process utilized- measures the adequacy of PHN’s actions and
activities.
• Outcome of activity – measures the results of care which can be:
• Desirable – to be implemented, advocated, strengthen
• Undesirable – to be avoided
 EVALUATION
ASPECT OF EVALUATION
Effectiveness – determination of whether goals and
objectives were attained.
Appropriateness – suitability of the goals/objectives and
interventions
Adequacy – degree of sufficiency of goals/objectives and
interventions
Efficiency – relationship of resources used to attain the
desired outcomes
TYPES OF FAMILY-NURSE
CONTACT
CLINIC VISIT
• Takes place in a private clinic health center, barangay health
station
• Advantages – family member takes the initiative of visiting
the professional health worker, usually indicating the family
readiness to participate in the health care process.
• Because the nurse has greater control over the environment,
distractions are lessened, and the family may feel less
confident to discuss family health concerns.
TYPES OF FAMILY-NURSE
CONTACT
Telephone Conference
• Maybe effective, efficient, and appropriate if the
objectives and outcomes are care require immediate
access to data given problems on distance or travel time.
• Such data include monitoring of health status or
progress of an illness state, change in schedule of visit or
family decisions, and updates on outcomes or responses
to care and treatment.
 TYPES OF FAMILY-NURSE
CONTACT
Written Communication
• Less time consuming option for the nurse in
instances when there are large number of families
needing follow-up on top of problems of distance
or travel time.
• Used to give specific information to families, such
as instructions given to parents through school
children.
 TYPES OF FAMILY-NURSE
CONTACT
School Visit
• It is done to work with family and school
authorities on how to appraise the degree of
vulnerability of and worked out
interventions to help children and
adolescence on specific health risks,
hazards or adjustment problems
 TYPES OF FAMILY-NURSE
CONTACT
Industrial or Job Site Visit
• It is done when the nurse and family need to
make an accurate assessment of health
risks or hazards and work with employer or
supervisor on what can be done to improve
on provisions for health and safety of
workers.
 TYPES OF FAMILY-NURSE
CONTACT
Home Visit
• A professional, purposeful interaction that takes place in
the family’s residence aimed at promoting, maintaining and
restoring the health of the family or its members.
• The services provided is an extension of the Health Service
Agency ( Health Center)
• The best opportunity to serve the actual care given by
family members.
 TYPES OF FAMILY-NURSE
CONTACT
PRINCIPLES OF HOME VISIT
• Must have a purpose or objective
• Examples include
• Assessment
• Nursing care
• Treatment
• Health Education
• Referral (if care Fails)
 TYPES OF FAMILY-NURSE
CONTACT
PRINCIPLES OF HOME VISIT
• A home visit must have a purpose or objective.
• Planning for a home visit should make use of all available information
about the patient and his family through family records.
• In planning for a home visit, we should consider and give priority to the
essential needs if the individual and his family.
• Planning and delivery of care should involve the individual and family.
• The plan should be flexible.
• Planning continuing care should involve a responsible family member.
 Advantages of the Home Visit

• It allows firsthand assessment of the home situation

• The nurse can seek out previously unidentified needs
• It gives the nurse an opportunity to adapt interventions according to family
resources
• It promotes family participation and focus on the family as a unit
• Teaching family members in the home is made easier by familiar
environment and the recognition of the need to learn as they are faced by
the actual home situation
• The personalized nature of home visits gives family a sense of confidence
in themselves and in agency
DISADVANTAGES OF HOME
VISIT
• The cost in terms of time and effort
• There are more distractions because the
nurse is unable to control the
environment.
• Nurses safety
PRIORITY PATIENTS FOR
HOME VISIT
• Newborn
• Post-partum
• Pregnant Mothers
• Morbid cases
PHASES OF HOME VISIT
Pre-visit phase ( Planning Phase)
In-home Phase
Initiation (socialization)
Implementing (Activity)
Termination (Summarization)
Post Visit phase
PUBLIC HEALTH BAG
• Frequently called the PHN Bag is an
indispensable tool that should be organized to
save time & effort and to prevent cross infection
and contamination.
• Serves as a reminder of the need for hand
hygiene and other measures to prevent the
spread of infection.
BAG TECHNIQUE
a tool making use of public health bag through which the
nurse, during his/her home visit, can perform nursing
procedures with ease and deftness, saving time and
effort with the end in view of rendering effective nursing
care.
 PRINCIPLES

• The use of the bag technique should minimize if not totally prevent the spread of
infection from individuals to families, hence, to the community.
• Bag technique should save time and effort on the part of the nurse in the performance of
nursing procedures.
• Bag technique should not overshadow concern for the patient rather should show the
effectiveness of total care given to an individual or family.
• Bag technique can be performed in a variety of ways depending upon agency policies,
actual home situation, etc., as long as principles of avoiding transfer of infection is
carried out.
 SPECIAL CONSIDERATIONS IN THE USE OF THE BAG

• The bag should contain all necessary articles, supplies and equipment which may be used to answer emergency
needs.
• The bag and its contents should be cleaned as often as possible, supplies replaced and ready for use at any time.
• The bag and its contents should be well protected from contact with any article in the home of the patients. Consider
the bag and its contents clean and /or sterile while any article belonging to the patient as dirty and contaminated.
• The arrangement of the contents of the bag should be the one most convenient to the user to facilitate the efficiency
and avoid confusion.
• Hand washing is done as frequently as the situation calls for, helps in minimizing or avoiding contamination of the
bag and its contents.
• The bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and
re-using.