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CHN Lecture - Module 4 - Family Health Assessment

Bachelor of Science in Nursing (University of Perpetual Help System DALTA)

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MODULE 4: FAMILY
HEALTH ASSESSMENT
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A. FAMILY HEALTH ASSESSMENT

1. TOOLS FOR ASSESSMENT
a. Initial Database
b. Typology of Nursing Problems in Family Nursing Practice
Family Health Assessment
• The first major phase of nursing process in family health nursing
• Involves a set of actions by which the nurse measures the status of the family as a
client. Its ability to maintain wellness, prevent, control, or resolve problems to achieve
health and wellness among its members.
• The family’s status and present condition are gathered and analyzed based on
how family dynamics, realities, possibilities, and vulnerabilities generate the factors
associated with health and illness experiences
• Includes data collection, data analysis, and nursing diagnosis

Two Major Types of Assessment

1. First Level Assessment- a process where the current health status and potential health
condition of an individual, family as a system, and its environment are compared
against the norms and standards of personal, social, and environmental health
2. Second Level Assessment- defines the nature or type of nursing problem that family
encounters in performing health tasks with respect to given health conditions or
problems and etiology or barriers to the family’s assumption of the task

Tools for Assessment

1. Initial Data Base for Family Nursing Practice
a. Family Structure Characteristics and Dynamics
b. Socio-economic and Cultural Characteristics
c. Home Environment
d. Health and Status of Each Family Member
e. Values, Habits, Practices on Health Promotion, Maintenance, and Disease
Prevention
2. Typology of Nursing Problems in Family Nursing Practice- contains 6 main
categories of problems in family nursing care

Typology of Nursing Problems in Family Nursing Practice

1. The first category refers to presence of:
• Wellness Condition
O Stated as potential or readiness
O Is a nursing judgment on condition based on client’s current
competencies
• Health Threats
O Conditions that are conducive to disease or accident
O Examples include:
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▪ Presence of risk factors of specific diseases

▪ Threat of cross infection from communicable disease case
▪ Family size beyond what family resources can adequately
provide
▪ Accident hazards
▪ Faulty/unhealthy nutritional/eating habits or feeding
techniques/practices
▪ Stress provoking factors
▪ Poor home/environmental conditions/sanitation
▪ Unsanitary food handling and preparation
▪ Inherent personal characteristics
▪ Health history, which may participate/induce the occurrence of
health deficit
▪ Inappropriate role assumption
▪ Lack of immunization/inadequate immunization status specially
of children
▪ Family disunity
• Health Deficits
O Instances of failure in health maintenance
O Examples include:
▪ Illness states, regardless of whether it is diagnosed or
undiagnosed by medical practitioner
▪ Failure to thrive/develop according to normal rate
▪ Disability-whether congenital or arising from illness;
transient/temporary or permanent
• Stress points/foreseeable crisis situations
O Marriage
O Abortion
O Divorce
O Loss of Job
O Death of a Member
O Pregnancy
2. Inability to recognize the presence of the condition or problem due to:
• Lack or inadequate knowledge
• Denial about its existence or severity as a result of fear of consequences of
diagnosis of problem
• Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
3. Inability to make decisions with respect to appropriate health action due to:
• Failure to comprehend the nature/magnitude of the problem/condition
• Low salience of the problem/condition
• Feeling of confusion, helplessness and/or resignation brought about by
perceive magnitude/severity of the situation or problem
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• Inability to decide which action to take from among a list of alternatives

• Conflicting opinions among family members/significant others regarding
action to take
• Lack of inadequate knowledge of community resources for care
• Fear of consequences of action
• Negative attitude towards the health condition or problem-by negative attitude
is meant one that interferes with rational decision-making
• Inaccessibility of appropriate resources for care
• Lack of trust/confidence in the health personnel/agency
• Misconceptions or erroneous information about proposed course(s) of action
4. Inability to provide adequate nursing care to the sick, disabled, dependent, or
vulnerable/at risk family member due to:
• Lack of/inadequate knowledge about the disease/health condition
• Lack of/inadequate knowledge about child development and care
• Lack of/inadequate knowledge of the nature or extent of nursing
care needed
• Lack of the necessary facilities, equipment and supplies of care
• Lack of/inadequate knowledge or skill in carrying out the
necessary intervention or treatment/procedure of care
• Inadequate family resources of care
• Significant persons unexpressed feelings which his/her capacities
to provide care.
• Philosophy in life which negates/hinder caring for the sick,
disabled, dependent, vulnerable/at risk member
• Member’s preoccupation with on concerns/interests
• Prolonged disease or disabilities, which exhaust supportive
capacity of family members.
• Altered role performance
5. Inability to provide a home environment conducive to health maintenance and
personal development due to:
• Inadequate family resources
• Failure to see benefits of investments in home environment
improvement
• Lack of/inadequate knowledge of importance of hygiene and
sanitation
• Lack of/inadequate knowledge of preventive measures
• Lack of skill in carrying out measures to improve home
environment
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• Ineffective communication pattern within the family

• Negative attitudes/philosophy in life which is not conducive to
health maintenance and personal development
• Lack of/inadequate competencies in relating to each other for
mutual growth and maturation
6. Failure to utilize community resources for health care due to:
• Lack of/inadequate knowledge of community resources for health
care
• Failure to perceive the benefits of health care/services
• Lack of trust/confidence in the agency/personnel
• Previous unpleasant experience with health worker
• Fear of consequences of action
• Unavailability of required care/services
• Inaccessibility of required services
• Lack of or inadequate family resources
• Feeling of alienation to/lack of support from the community
• Negative attitude/ philosophy in life which hinders
effective/maximum utilization of community resources for health
care
A. FAMILY HEALTH ASSESSMENT
1. TOOLS FOR ASSESSMENT
c. Family Health Task
d. Family Coping Index
Family Health Task
• Health tasks differ from family to family
• Task is a function
• Duvall and Niller identified 8 tasks essential for a family to function as a unit:
1. Physical Maintenance- provides shelter, clothing, and health care to its
members; being certain that a family has ample resources to provide
2. Socialization to Family- involves preparation of children to live in the
community and interact with people outside the family
3. Allocation of Resources- determines which family needs will be met and their
order of priority
4. Maintenance of Order- includes opening in an effective means of
communication between family members, integrating family values, and
enforcing common regulations for all family members
5. Division of Labor- who will fulfill certain roles (e.g., family provider, home
manager, children’s caregiver)
6. Reproduction, recruitment, and release of family member
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7. Placement of members into larger society- consists of selecting community

activities such as church, school, and politics that correlate with the family
beliefs and values
8. Maintenance of motivation and morale- created when members serve as
support people to each other
• In order to achieve wellness among family members and reduce or eliminate family
health problems, the family as a functioning unit performs the following health tasks:
O Recognize the presence of a wellness state or health condition or problem
O Make decisions about taking appropriate health action to maintain wellness or
manage the health problem
O Provide nursing care to the sick, disabled, dependent, or at-risk members
O Maintain the home environment conducive to health maintenance and personal
development
O Utilize community resources for health care
Family Coping Index
• Purpose: provide a basis for estimating the nursing needs of a particular family
• A health care need is present when:
O The family has a health problem with which they are unable to cope
O There is a reasonable likelihood that nursing will make a difference in the
family’s ability to cope
• Coping- dealing with problems associated with health care with reasonable success
• Coping Deficit- when the family is unable to cope with one or another aspect of
health care
• Direction for Scaling:
O 2 Parts of the Coping Index:
1. A point on the scale. The scale enables you to place the family in
relation to their ability to cope with the 9 areas of family nursing at the
time observed and as you would expect it to in 3 months or at the time
of discharge, if nursing care was 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
2. A justification statement. The justification consists of brief statement
or phrases that explain why you have rated the family as you have
• General Considerations
O It is the coping capacity and not the underlying problem that is being rated.
O It is the family and not the individual that is being rated.
O Rating should be done after 2-3 home visits when the nurse is more acquainted
with the family
O The scale is as follows:
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▪ 0-2 or no competence
▪ 3-5 coping in some fashion but poorly
▪ 6-8 moderately competent
▪ 9 fairly competent
O Justifications should be expressed in terms of behavior or observable facts.
O Terminal rating is done at the end of the given period of time. This enables the
nurse to see the 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.
• Areas to be Assessed
1. Physical Independence- concerned with the ability to move about to get out
of bed, to take care of daily grooming, walking and other things which
involves daily activities
2. Therapeutic competence- includes all the procedures or treatment prescribed
for the care of ill, such as giving medications, dressings, exercise and
relaxation, and special diets
3. Knowledge of health condition- concerned with the health particular
condition that is the occasion of care
4. Application of the principles of general hygiene- 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
5. Health attitudes- concerned with the way the family feels about health care in
general, including preventive services, care of illness and public health
measures
6. Emotional competence- concerned 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
7. Family living- concerned largely 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
8. Physical environment- concerned with home, the community, and the work
environment as it affects family health
9. Use of community facilities- generally keeps appointments; follows through
referrals; tells others about Health Department services

Nursing assessment includes data collection, data analysis or interpretation, and problem
definition or nursing diagnosis
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A. FAMILY HEALTH ASSESSMENT

2. FAMILY DATA ANALYIS
a. Socio-economic and Cultural Characteristics
b. Home Environment
Family Data Analysis
• The nurse sorts out and classifies or groups data, generated from the tool
on Assessment Database, by type or nature.
• She relates them with each other and determines patterns or recurring
themes with norms or standards.

Systems of Organizing Family Data (adapted from Nies and McEwen, 2011)
• Socioeconomic Characteristics
O Data on social integration
▪ Ethnic origin
▪ Languages and dialects spoken
▪ Social networks
O Educational experiences and literacy
O Work history
O Financial resources
O Leisure time interests
O Cultural influences
O Spirituality or religious affiliation
• Family Environment- refers to the physical environment inside the
family’s home/residence and its neighborhood
O Type and quality of housing
O Adequacy of living space
O Adequacy of sanitation facilities and resources both in home and the community
O Kind of neighborhood
O Expectations of modes of life which enhance health development and prevent
or control risk factors
O Hazards

A. FAMILY HEALTH ASSESSMENT

2. FAMILY DATA ANALYIS
c. Family Health Status
d. Family Values and Health Practices
Family Structure and Characteristics are reflected in:
• Data on household membership
• Demographic characteristics
• Family members living outside the household
• Family mobility
• Family dynamics
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O Emotional bonding
O Authority and power structure
O Autonomy of members
O Division of labor and pattern of communication
O Decision making
O Problem and conflict resolution
• Data on family structure can be visualized clearly through graphic tools such as:
O Genogram
O Ecomap
O Family tree

Family Health and Behavior

• Family’s activities of daily living
• Self-care
• Risk behaviors
• Health history
• Current health status
• Health care resources (home remedies and health services)

In order to achieve wellness among its members and reduce or eliminate health problems, the
standard or norm of the family as a functioning unit involves the ability to perform the
following health tasks:

1. Recognize the presence of a wellness state of health condition or problem

2. Make decisions about taking appropriate health action to maintain
wellness or manage the health problem
3. Provide nursing care to the sick, disabled, dependent, or at-risk members
4. Maintain a home environment conducive to health maintenance and
personal development
5. Utilize community resources for health care

After relating the family data to clinical/research findings and comparison of patterns with
norms/standard, assessment data, as categorized, are interpreted to draw inferences. The
result of the analysis during the first-level assessment is a conclusion or statement of a health
problem/condition, classified as wellness potential, health threat, health deficit/stress point or
foreseeable crisis. This definition constitutes any of the following:

1. Transition state from a specific level of wellness to a higher level

2. Medical or nursing diagnosis indicating current health status of each family member
3. Condition of home/environment conducive to disease/ illness or accidents
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4. Maturation developmental or situational crisis situation

The second-level of analysis ends with the definition of family nursing problem. To define
this, each wellness state or health condition or problem should be analyzed in terms of how
the family handles it. The process of data gathering has been described. The patterns and
implications of the data reflect explanations and inferences about the family as a functioning
unit in terms of its problems related to performance of family health tasks. The existence of
health problems reflects barriers to the family capabilities to promote and maintain within its
members as it maintains family system integrity.

B. FAMILY DIAGNOSIS
Family Nursing Diagnosis
1. International (NANDA-I, 2011)
• Serve as a common framework of expressing human responses to actual and
potential health problems - Family Coping Index
• This tool is based on premise that nursing action may help a family in
providing for a health need or resolving a health problem by promoting the
family’s coping capacity
i. This may be formulated at several levels:
1. As an individual family member
2. As a family unit
3. As the family in relation to its environment/community

Nine Areas of Assessment of the Family Coping Index

2. Physical Independence
• Family member’s mobility and ability to perform activities of daily living
(personal hygiene)
3. Therapeutic Competence
•
Ability to comply with prescribed or recommended procedures
and treatments to be done at home
4. Knowledge of Health Condition
•Understanding of the health condition or essentials of care
according to the developmental stages of family members
5. Application of Principles and General Hygiene
•Practice of general health promotion and recommended preventive
measures
6. Health Care Attitudes
• Family’s perception of health care in general
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7. Emotional Competence
•Degree of emotional maturity of family members according to
their developmental stage
8. Family Living Patterns
•Interpersonal relationships among family members according to
their developmental stage
9. Physical Environment
• Includes home, school, work, and community environment that
influence the health of family members
10. Use of Community Facilities
• Ability of the family to seek and utilize, as needed, both
environment-run and private health.
C. FORMULATING FAMILY NURSING CARE PLAN
1. Priority Setting
Planning involves:
1. Priority Setting
2. Establishing Goals and Objectives
3. Determining Appropriate Interventions to Achieve Goals and Objectives

The nurse has to remember that:

• The plan is for the family’s benefit
• Never lose sight of the fact that the family has the right to self-determination
• Family decisions regarding health care have to be respected

Nurse’s Role (Stanhope & Lancaster, 2010):

• Offering guidance
• Providing information
• Assisting the family in the planning process

Priority Setting
• Determining the sequence in dealing with identified family needs and
problems.
• Necessary for the nurse to possibly deal with all identified family needs
and concerns all at once.
• Factors:
O Family Safety
▪ Top priority: life-threatening situation
▪ Requires immediate action: occurrence of a communicable disease
• To promote healing
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•To prevent the spread of the communicable disease to the

susceptible members of the household
O Family Perception
▪ Second priority: need that the family recognizes as most urgent and/or
important
▪ In cases where the family fails to recognize issues that may affect
family safety (e.g. communicable diseases), the nurse may strive
towards patient and family education
O Practicality
▪ The nurse, together with the family, looks into existing
resources and constraints (limitations or restrictions).
▪ Guide Questions:
• Are the resources required to address a particular need available
to the nurse and the family?
• Does the nurse have the necessary competence to deal with the
situation?
• If the nurse does not have the necessary competence, how
feasible is referral to another health worker or agency?
• What are the constraints that the family and the nurse have to
deal with?
O Projected Effects
▪ The immediate resolution of a family concern gives the family a sense
of accomplishment and confidence in themselves and the nurse.
▪ Providing a clear-cut intervention during a family-nurse contact raises
the family’s level of trust in the nurse.
▪ Also, the nurse thinks of the prospect of preventing serious problems in
the future by resolving in existing family concern.
C. FORMULATING FAMILY NURSING CARE PLAN
2. Establishing Goals and Objectives
Establishing Goals and Objectives
• Goal: Desired observable family response to planned interventions in response to a
mutually identified family need.
• Objectives
O the desired step by step family responses as they work toward a goal
Workable, well-stated objectives should be SMART:
▪ S: Specific
▪ M: Measurable
▪ A: Attainable
▪ R: Relevant
▪ T: Time Bound
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ESTABLISHING OF GOALS
Goals
• Is a general statement of purpose. It is the end towards which all efforts are directed. It
is the condition or state to be brought about by specific courses of action.
• Example: after nursing intervention, the family will be able to take care of the
premature infant competently.
• Goals established by the nurse with the family usually relate to health matter,
specifically the alleviation of disease conditions. Health problems are however,
intertwined with other problems like socio-economic ones. It is common therefore, for
a community health nurse to find herself setting in non-health goals like:
O Example 1: at the end of nursing intervention, the family will be able to start a
piggery business.
O Example 2: at the end of nursing intervention, the family will be able to start
litigation proceedings against landlord.
• A cardinal principle in goal setting states that goals must be set mutually with the family.
This ensures their acceptance and realization. Unless the family understands and accepts
the goals of nursing care it cannot be expected to participate actively in the
implementation of needed actions.
• Basic to the establishment of mutually acceptable goals in the family’s recognition and
acceptance of existing health needs and problems. The nurse must as certain the family’s
knowledge and acceptance of the problem as well as the desire to take actions
to resolve them. This is done in the assessment phase.
• Goals set by the nurse and the family should be realistic or attainable. They should
therefore be set in reasonable levels. Too high goals and their subsequent failure
frustrate the nurse and the family.
• Goals are best stated in terms of client’s outcomes, whether at the individual, family,
or community levels.

SHORT-TERM AND LONG-TERM GOALS Short-term goals might

be “Client will raise right arm to shoulder height by Friday.”

• Short-term goals are useful for clients who:

O require health care for a short time or
O are frustrated by long-term goals that seem difficult to attain and who
need the satisfaction of achieving a short-term goal
• In an acute care setting, much of the nurse’s time is spent on the client’s
immediate needs, so most goals are short term.
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Long-term goal/outcomes might be “Client will regain full use of right arm in
6 weeks.”
• clients in acute care settings also need long-term goals/outcomes to guide planning for
their discharge to long-term agencies or home care, especially in a managed care
environment
• Outcomes are often set for clients who live at home and have chronic health problems
and for clients in nursing homes, extended care facilities, and rehabilitation centers

When developing goals/desired outcomes, ask the following questions:

1. What is the client’s problem?
2. What is the opposite, healthy response?
3. How will the client look or behave if the healthy response is achieved? (What will I
be able to see, hear, measure, palpate, smell, or otherwise observe with my senses?)
4. What must the client do and how well must the client do it to demonstrate problem
resolution or to demonstrate the capability of resolving the problem?

FORMULATION OF OBJECTIVES IN NURSING

CARE OBJECTIVES
• In contrast to goals, objectives refer to more specific statements of the desired
results or outcomes of care. They specify the criteria by which the degrees of
effectiveness of care are to be measured. Goals tell where the family is going;
objectives are the milestones to reach the destination.
• Objectives can be stated in various ways depending upon the focus, level of
generality and time required for their realization. It can either be nurse-oriented
(based on activities of the nurse) or client-oriented (stated in terms of outcomes).
• NURSE-ORIENTED
O Example 1: during the home visit, the nurse will discuss the importance of
immunization.
O Example 2: during the second nurse-family contact, the nurse will show the
different types of fertility-regulating methods.
• CLIENT-ORIENTED
O Example 3: after the nursing intervention, the malnourished pre-school
member of the family will increase their weights by at least one pound per
month.
O Example 4: after the nursing intervention, there will be improved
relationship among family members.
O Example 5: after the nurse’s visit, the family will bring the pre-school
members to the well-baby clinic the following day.
• Stating objectives in terms of client outcomes will indicate during the evaluation
phase whether the desired changes in the problem situation resulted from the nurse’s
action. Nurse-oriented objectives will not tell if the nurse’s activities produced some
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beneficial results; they only indicate what the nurse did and in qualitative
evaluation, how well she performed them.
• Examples of objectives:
O after the nursing intervention,
a. The family will bring the pregnant member to the health
center regularly for check-ups;
b. The family will also consult the health center on every
episode of illness among members.
c. The family will be able to feed the mentally challenged
prescribed quantity and quality of food every mealtime.
d. They will be able to teach the child simple skills related to
activities of daily living.
e. The family will be able to apply measures taught to
prevent infection in the mentally challenged child.
• The more specific the objective, the easier is the evaluation
of their attainment. Specifically stated objectives define already
the criteria for evaluation.

BARRIERS TO JOINT GOAL SETTING BETWEEN THE NURSE AND THE

FAMILY:

1. Failure on the part of the family to perceive the existence of the problem.
2. The family ay realize the existence of a health problem but is too busy at the moment
with other concerns and preoccupations.
3. Sometimes the family perceives the existence of the problem but does not see it as
serious enough to warrant attention.
4. A big barrier to collaborative goal setting between the nurse and the family is failure
to develop a working relationship.
5. The family may perceive the presence of a problem and the need to take action. It
may, however, refuse to face and do something about the situation, the following
reasons for this kind behavior:
a. FEAR OF CONSEQUENCES OF TAKING ACTION
• diagnosis of a disease condition may mean expenses or social stigma
for the family.
b. RESPECT FOR TRADITION
• in the Philippine culture, elders plays a part in decision making.
• Behaviours which are 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.
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c. FAILURE TO PERCEIVE THE BENEFITS OF ACTION

PROPOSED
• this could be a function of a client’s previous experience with the
health workers and their services.
• Going to the health center, for example, is an advice frequently given
by the nurse. When this does not yield beneficial results from the point
of view of the 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 goal generally occupy a higher position than
health goals in ranking of concerns and priorities.

PURPOSE OF GOALS/DESIRED OUTCOMES If

referenced to Nursing Outcome Classification,
• goals are considered to be met or not met,
• progress toward outcomes can be described along a continuum and
in comparison to previous status.

Goals/desired outcomes serve the following purposes:

1. Provide direction for planning nursing interventions. Ideas for interventions come
more easily if the desired outcomes state clearly and specifically what the
nurse hopes to achieve.
2. Serve as criteria for evaluating client progress. Although developed in the planning
step of the nursing process, desired outcomes serve as the criteria for judging the
effectiveness of nursing interventions and client progress in the evaluation step.
3. Enable the client and nurse to determine when the problem has been
resolved.
4. Help motivate the client and nurse by providing a sense of achievement. As goals
are met, both client and nurse can see that their efforts have been worthwhile. This
provides motivation to continue following the plan, especially when difficult lifestyle
changes need to be made.

COMPONENTS OF GOAL/DESIRED OUTCOME STATEMENTS

Goal/desired outcome statements should have the four components:
1. SUBJECT
• The subject, a noun, is the client, any part of the client, or some attribute of
the client, such as the client’s pulse or urinary output.
• often omitted in goals; it is assumed that the subject is the client
unless indicated otherwise.
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2. VERB
• specifies an action the client is to perform, for example, what the client is to do,
learn, or experience. Verbs that denote directly observable behaviors, such as
administer, show, or walk, must be used. See Box 13–1 for some examples.

Note: Adapted from Berman, A., Kozier, B., Erb, G., Snyder, S., Levett-Jones, T., Dwyer, T.,
. . . Stanley, D. (2016). Kozier and Erb's fundamentals of nursing: Concepts, process
and practice.

1. CONDITIONS OR MODIFIERS
• added to the verb to explain the circumstances under which the behavior is to
be performed. They explain what, where, when, or how
•
Conditions need not be included if the criterion of performance clearly
indicates what is expected.
2. CRITERION OF DESIRED PERFORMANCE.
• indicates the standard by which a performance is evaluated or the level at
which the client will perform the specified behavior.
• specify time or speed, accuracy, distance, and quality.
• To establish a time-achievement criterion, the nurse needs to ask:
O “How long?” To establish an accuracy criterion,
O “How well?”
O “How far?” and “What is the expected standard?” to establish
distance and quality criteria, respectively.
• Examples are: Weighs 75 kg by April (time). Lists five out of six signs of
diabetes (accuracy). Walks one block per day (distance and time). Administers
insulin using aseptic technique (quality).
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Table 13–3 illustrates the format that should be used to write outcomes.

Note: Adapted from Berman, A., Kozier, B., Erb, G., Snyder, S., Levett-Jones, T., Dwyer, T.,
. . . Stanley, D. (2016). Kozier and Erb's fundamentals of nursing: Concepts, process and
practice.

GUIDELINES FOR WRITING GOALS/DESIRED OUTCOMES

guidelines can help nurses write useful goals and desired outcomes:

1. Write goals and outcomes in terms of client responses, not nursing actvities.
Beginning each goal statement with The client will may help focus the goal on client
behaviors and responses. Avoid statements that start with enable, facilitate, allow, let,
permit, or similar verbs followed by the word client. These verbs indicate what the
nurse hopes to accomplish, not what the client will do.
• Correct: The client will drink 100 mL of water per hour (client behavior).
• Incorrect: Maintain client hydration (nursing action).
2. Be sure that desired outcomes are realistic for the client’s capabilities,
limitations, and designated time span, if it is indicated. Limitations refers to finances,
equipment, family support, social services, physical and mental condition, and time.
• the outcome “Measures insulin accurately” may be unrealistic for a client
who has poor vision due to cataracts.
3. Ensure that the goals and desired outcomes are compatible with the therapies of
other professionals.
• the outcome “The client will increase the time spent out of bed by 15
minutes each day” is not compatible with a primary care provider’s
prescribed therapy of bed rest.
4. Make sure that each goal is derived from only one nursing diagnosis.
• the goal “The client will increase the amount of nutrients ingested and show
progress in the ability to feed self” is derived from two nursing diagnoses:
Imbalanced Nutrition: Less Than Body Requirements and Feeding Self-Care
Deficit.
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• Keeping the goal statement related to only one diagnosis facilitates evaluation
of care by ensuring that planned nursing interventions are clearly related to the
diagnosis.
5. Use observable, measurable terms for outcomes. Avoid words that are vague and
require interpretation or judgment by the observer.
• phrases such as increase daily exercise and improve knowledge of nutrition
can mean different things to different people.
• These phrases may be suitable for a broad client goal but are not sufficiently
clear and specific to guide the nurse when evaluating client responses.
6. Make sure the client considers the goals/desired outcomes important and values them.
Some outcomes, such as those for problems related to self-esteem, parenting, and
communication, involve choices that are best made by the client or in collaboration
with the client.
• Some clients may know what they wish to accomplish with regard to their
health problem; others may not know all the possibilities.
• nurse must actively listen to the client to determine personal values,
goals, and desired outcomes in relation to current health concerns.
• Clients will expend the necessary energy to reach goals they
consider important.
• Example:
O NURSING GOAL
▪ Within 3 hours of nursing interventions, the family would be
able to recognize the current home environment and health
practices. They must be able to identify healthy practices and be
able to practice them habitually. These hygienic measure as
follows: proper handwashing, proper waste disposal, and proper
house cleaning.
O OBJECTIVES
▪ Within 3 hours of nursing intervention, the family will be able
to:
a. Recognize the need for proper handwashing before and
after meals as after using the toilet.
b. Enumerate factors that promote unhygienic practices.
c. Be knowledgeable in ways on how to maintain hygiene.
d. Accept the importance of proper hygiene in their daily
activities.
e. Exhibit the desire to change the current unhygienic
practices.
As with goals, objectives should be realistic and attainable considering the
resources of the nurse, the family, and community. In addition, they should be
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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 facts and/or behavior, then the criteria for
evaluation become inherent and evidence.
C. FORMULATING FAMILY NURSING CARE PLAN
3. Selecting Appropriate Family Nursing Interventions/Strategies

Selecting Appropriate Family Nursing Interventions/ Strategies

DEVELOPING THE INTERVENTION PLAN
Developing the intervention plan involves selection of appropriate nursing interventions based on
the formulated goals and objectives. The nurse’s role is to decide which nursing action best
suits the problem. The most effective or efficient method of nurse-family contact and
resources need must be specified to ensure that necessary preparation, coordination and
collaboration are done before the plan will be implemented.
The following general directions for nursing interventions 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.

FAMILY LIFE & NURSING PRACTICE = Phenomenological unified realities of

experiencing the self, interacting with other in specific situations that are affected by
meanings, concerns, emotions, past experiences, and anticipated future.
FAMILY HEALTH NURSING PRACTICE = Phenomenological experience for the family
and nurse
• The FAMILY & NURSE are both participants in an ACTIVE, MUTUAL,
DYNAMIC interchange of realities, concerns, and resources.
• Analyzation and understanding of the current health/illness situation as the family
experiences it is important to create nursing interventions.
• The nurse can select EXPERIENTIAL LEARNING STRATEGIES through
Participatory Approach.
• LOOK THINK ACT CYCLICAL PROCESS – analyzation of antecedents or factors
contributing to or producing specific health process.

2. 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 – contributing to SELF UNDERSTANDING.

Nursing interventions that enhance/maximize the competencies of the family as…

• THINKER
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O Making information/data/knowledge readily available and accessible.

• DOER
O Developing and maximizing the skills and communication
competencies of the family.
• FEELER
O Develop or strengthen affective competencies.

Words to ponder…
“By acknowledging the dwelling in the occasions and meanings of our feelings we can gain
the skill to rehearse and return to positive feelings such as joy, pride, comfort and
contentment…” – Benner and Wrubel (1989)

3. Focus on Interventions to Help the Family Perform the Health Tasks

• Help the Family Recognize the Problem
• Increase the family’s knowledge on the nature, magnitude and
cause of the problem.
• Helping the family see the implications of the situation, or the
consequences of the condition.
• Relating health needs to the goals of the family (both health and
non-health related goals)
• Encouraging positive or wholesome emotional attitude toward the
problem by affirming the family’s capabilities/qualities/resources
and providing information on available options.
• Guide the Family on How to Decide on Appropriate Health
Actions to Take
• Identifying or exploring with the family the courses of action
available and the resources needed for each.
• Discussing the consequences of each course of action available.
• Analyzing with the family the consequences of inaction.
• Develop the Family’s Ability and Commitment to Provide Nursing Care
to its Members
• Demonstration and practice sessions on procedures, treatments
utilizing readily available low-cost materials and equipment.
• CONTRACTING
O Develops the ability and commitment to the family in
providing care
O Focuses on assisting members to act effectively on their
own behalf
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O Intervention where a nurse creates a situation in order for a

client to learn to achieve a specific health-related behavior
following sequentially arrange steps and conditions.
O Uses REINFORCEMENT CONTRACTS- give and take
situation
O Provides a systematic method of increasing desirable client
behavior through use of PRINCIPLE OF POSITIVE
REINFORCEMENT (mutually agree on favorable
reinforcing experiences or consequences as rewards when
the client performs the desired behavior.)
O Necessary elements of desired behavior must be written in
the form of
O an agreement. Must be OBSERVABLE and
MEASURABLE
O The contract should be written, dated, signed by all parties
concerned and a copy is given to each one.
a. The following are elements of a nurse-patient
contract:
b. Names of individuals
c. Roles of nurse and patient
d. Expectations of nurse and patient
e. Purpose of the relationship
f. Meeting location and time
g. Conditions for termination
h. Confidentiality
4. Enhance the Capability of the Family to Provide a Home Environment Conducive
to Health Maintenance and Personal Development.
• Teaching of family specific competencies that allows them to modify the
environment, manipulate or manage to minimize or eliminate health threats
or risks or to install facilities for nursing care.
• Learning how to construct or modify needed facilities inside the home
based on needs
• Nurse needs to work 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.
• Teach the family to maximize the use of available resources in their
community trough coordination collaboration, and teamwork provided by
and effective referral system.
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• Maintenance of an updated file that lists health and socio-economic

resources is a must. List their addresses, telephone numbers and specific
services offered.
• TWO-WAY REFFERAL SYSTEM can facilitate mobilization of
resources for families. It’s between the nurse and the agency establishing
or offering their services. The nurse has an interdependent relationship
with the agencies.
• 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 client’s status or family’s problem/ situation
• Referral system in Level of Health Care:
O Barangay Health Station (BHS) is under the management of the
Rural Health Midwife (RHM)
O Rural Health Unit (RHU) is under the management or supervision of
PHN
O Public Health Nurse (PHN) acts as managers in the implementation
of policies and activities of RHU, directly under supervision.
• INSTRUCTIONS:
O The personnel of the referring agency fill up the first half of the
form providing pertinent data as indicated (i.e., case summary and
reason for referral or services requested.)
O The client/family brings the referral form to the agency where
referral is made to avail of the services needed.
O The personnel of the agency to which referral is made fills up the
second half of the form, specifying the services rendered/findings
and recommendations, and sends back the form to the referring
agency through the client/family.
O The client/family brings back to the referring agency the duly
accomplished second half of the from for decision, action or
information.
O The form is filed with the client’s record. 6.
Catalyze Behavior Change through Motivation and Support
• To bring about self-directed change, people must learn from their
experiences .
• 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 . To catalyze the change process, support is needed.
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• The family as a system needs to achieve

• To catalyze the behavior change towards problem-solving competencies, a

theory of family health nursing intervention was developed by Maglaya
(1988)
Motivation- in the intervention theory, is any experience or information
that leads the family to desire and agre to undergo the behavior change or
proposed measure and take the initial action to bring about the change.
Support- any information that maintains, restores or enhances the
capabilities or resources of the family to sustain these actions and
complete the change process.
End result- the family feels “secured” or “in control of the situation”

4 Major Components of Motivation-Support Intervention by Maglaya et.al.

- used in an intervention research on family empowerment for malaria
prevention and control in rural barangay in Abra Province
1. Visioning or Goal-setting Activities
“What are the reasons for the need for behavior change?”
2. Planning Activities
“What can be done to achieve the specific behavior
changes?” “How can these be carried out?”
3. Implementation of Practice Activities
4. Evaluation Activities “What
happened?” “What were missing?”
“What to do next?”
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REFERENCES:
Berman, A., Kozier, B., Erb, G., Snyder, S., Levett-Jones, T., Dwyer, T., . . .
Stanley, D. (2016). Kozier and Erb's fundamentals of nursing: Concepts,
process and practice.
Family Care Plan. (2017, July 4). RNpedia.
https://www.rnpedia.com/nursing-notes/community-health-
nursing-notes/family-care-pla n/
FamilyCoping Index (n.d.) Retrieved from
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/family-
coping-i ndex/

FamilyHealth Nursing (n.d.) Retrieved from rnpedia.com/nursing-notes/community-health-

nursing-notes/family-health-nursing/

Famorca, Z.U., Siegrist B.C., Abele, C.L., Nies, M.A. (2013). Chapter 6: Family
Health Nursing.
Nursing Care of the Community. Place: Elsevier Mosby

Hope, I. (2020, September 8). Family Nursing Care Plan. Nursing Journal |
RNspeak. https://rnspeak.com/family-nursing-care-plan/
Maglaya, A. S. (2009). Nursing Practice in the Community 5th ed. Marikina City:
Argonauta Corporation.