IV.

FAMILY NURSING PROCESS

Objectives:
o Assess with the individual and family one’s health status/competence.
o Formulate with the client a plan of care to address the health conditions, needs, problems, and
issues based on priorities.
o Implement safe and quality interventions with the client to address the health needs, problems,
and issues.
o Provide health education using selected planning models to targeted clientele (individuals and
families) in the community.
o Apply principles of partnership and collaboration to improve delivery of health services.
o Evaluate with the client the health status/competence.

A. Family Health Assessment

1. Tools for Assessment

Assessment – this involves a set of actions by which a nurse measures the states of a family as a
client, its ability to maintain itself as a system and functioning unit and its ability to maintain
wellness, prevent, control or resolve problems in order to achieve health and well-being
among its members.
 INITIAL DATA BASE FOR FAMILY NURSING PROCESS (RNPedia, 2019c)
1) Family Structure Characteristics and Dynamics
i. Members of the household and relationship to the head of the family.
ii. Demographic data-age, sex, civil status, position in the family
iii. Place of residence of each member-whether living with the family or elsewhere
iv. Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended
v. Dominant family members in terms of decision making especially on matters of health
care
vi. General family relationship/dynamics-presence of any obvious/readily observable
conflict between members; characteristics, communication/interaction patterns among
members.

2) Socio-economic and Cultural Characteristics

i. 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 decision about money and how it is spent
ii. Educational Attainment of each Member
iii. Ethnic Background and Religious Affiliation
iv. Significant others-role (s) they play in family’s life
v. Relationship of the family to larger community-nature and extent of participation of the
family in community activities

3) Home Environment
i. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes, roaches,
flies, rodents, etc.)
d. Presence of accident hazard
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e. Food storage and cooking facilities

f. Water supply-source, ownership, potability
g. Toilet facilities-type, ownership, sanitary condition
h. Garbage/refuse disposal-type, sanitary condition
ii. Drainage System- type, sanitary condition
iii. Kind of Neighborhood, e.g. congested, slum etc.
iv. Social and Health facilities available
v. Communication and transportation facilities available

4) Health Status of Each Family Member

i. Medical Nursing history indicating current or past significant illnesses or beliefs and
practices conducive to health and illness
ii. Nutritional assessment (especially for vulnerable or at risk members)
 Anthropometric data: measures of nutritional status of children-weight, height,
mid-upper arm circumference; risk assessment measures for obesity : body mass
index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC:
greater than 90 cm. in men and greater than 80 cm. in women), waist hip ration
(WHR=waist circumference in cm. divided by hip circumference in cm.
Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in
women)
 Dietary history specifying quality and quantity of food or nutrient per day
 Eating/ feeding habits/ practices
iii. Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila
Developmental Screening Test (MMDST).
iv. Risk factor assessment indicating presence of major and contributing modifiable risk
factors for specific lifestyle diseases-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.
v. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by
medical practitioners )
vi. Results of laboratory/diagnostic and other screening procedures supportive of
assessment findings.

5) Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention.

Examples include:
i. Immunization status of family members
ii. Healthy lifestyle practices. Specify.
iii. Adequacy of:
 Rest and sleep
 Exercise/activities
 Use of protective measure-e.g. adequate footwear in parasite-infested areas; use
of bed nets and protective clothing in malaria and filariasis endemic areas.
 Relaxation and other stress management activities
iv. Use of promotive-preventive health services (e.g. MCH, healthy life style-related)

 TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE (RNPedia, 2019d)

First Level Assessment

I. Presence of Wellness Condition - stated as potential or Readiness-a clinical or nursing
judgment about a client in transition from a specific level of wellness or capability to a higher
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level. Wellness potential is a nursing judgment on wellness state or condition based on client’s
performance, current competencies, or performance, clinical data or explicit expression of
desire to achieve a higher level of state or function in a specific area on health promotion and
maintenance. Examples of this are the following:

A. Potential for Enhanced Capability for:

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred source/God
(NANDA 2001)
6. Others.
B. Readiness for Enhanced Capability for:
1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others.

II. Presence of Health Threats - conditions that are conducive to disease and accident, or may
result to failure to maintain wellness or realize health potential. Examples of this are the
following:
A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards
1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others
E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices.
1. Inadequate food intake both in quality and quantity
2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors.
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation.
1. Inadequate living space
2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sites of vectors of diseases
5. Improper garbage/refuse disposal
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6. Unsanitary waste disposal

7. Improper drainage system
8. Poor lighting and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices.
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities
12. Non use of self-protection measures (e.g. non use of bed nets in malaria and
filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control
K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g.
previous history of difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not assuming
his role.
M. Lack of Immunization/Inadequate Immunization Status especially of Children
N. Family Disunity-e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement

III. Presence of health deficits - instances of failure in health maintenance.

Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical
practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or
temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes,
blindness from measles, lameness from polio)

IV. Presence of stress points/foreseeable crisis situations - anticipated periods of unusual

demand on the individual or family in terms of adjustment/family resources. Examples of this
include:
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
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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

Second-Level Assessment

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 peer/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
D. Others.

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 about by perceive
magnitude/severity of the situation or problem, i.e. failure to breakdown problems into
manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding action to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or 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. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of action

III. Inability to provide adequate nursing care to the 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 child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of care
 39

E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or

treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle
program).
F. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitations/lack of physical resources- e.g.,isolation room
G. Significant person’s unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair,
rejection) which affect his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
vulnerable/at risk member
I. Member’s preoccupation with own concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.
K. Altered role performance, specifically:
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload

IV. Inability to provide a home environment conducive to health maintenance and personal
development due to:
A. Inadequate family resources specifically:
1. Financial constraints/limited financial resources
2. Limited physical resources-e.g. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments 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 pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/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 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:
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
 40

1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
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

 FAMILY COPING INDEX

Family Coping Index is the best tool used in the community to assess the family’s ability
to take care of the sick member and to maintain an environment conducive to healing. The
purpose of Family Coping Index is to provide a basis for estimating the nursing needs of a
particular family. Coping is defined as dealing with problems associated with health care with
reasonable success. Coping has been selected as an index of nursing need because the particular
contribution of nursing to health care is to strengthen or to supplement the capacity of the
individual or family as it encounters the stress of illness, or the opportunity to prevent disease
and to promote health. When the family is unable to cope with one or another aspect of health
care, it may be said to have a “coping deficit”.
There are nine (9) areas to be evaluated:
1. Physical Independence
2. Therapeutic Independence
3. Knowledge of Health Condition
4. Application of Principles of General Hygiene
5. Health Attitude
6. Emotional Competence
7. Family Living Pattern
8. Physical Environment
9. Use of Community Facility

The coping index is composed of a point on the scale and a justification statement. Coping 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 resources). Check no problem if it is not relevant.

Level of Competence
0 - No Problem
1 - No Competence
3 - Moderate Competence
5 - Complete Competence

The justification consists of statements that explain why you have rated the family as you have
explained in observable facts. General considerations include:

1. It is the coping capacity and not the underlying problem is being rated.
2. It is the family and not the individual that is being rated.

2. Family Data Analysis

Utilizing the data generated from the tool on Initial Data Base in Family Nursing Practice, the
nurse goes through data analysis. The nurse sorts out and classifies or groups data by type or nature
(e.g. which are wellness states, threats, deficits or stress points/foreseeable crises), relates them
 41

with each other and determines patterns or reoccurring themes among the data, and then
compares these data and the patterns or reoccurring themes with norms and standards.
 Socio – Economic and Cultural Characteristics
 Home Environment
 Family Health Status
 Family Values and Health Practices

B. Family Nursing Diagnosis

The end result of the second-level assessment is a set of family nursing problems for each health
condition or problem.
A wellness condition is a nursing judgment related with a client’s capability for wellness. A
health condition or problem is a situation which interferes with the promotion and/or maintenance of
health and recovery from illness or injury. A wellness state or health condition/problem becomes a
nursing problem when it is stated as the family’s failure to perform adequately specific health tasks to
enhance the wellness state or manage the health problem. This is called the nursing diagnosis in family
nursing practice.

C. Formulating Family Nursing Care Plan

Formulation of the care plan is the next step in the nursing process after assessment, when health
and family nursing problems have been clearly defined.

Definition
A family nursing care plan is the blueprint of the care that the nurse designs to systematically
minimize or eliminate the identified health and family nursing problems through explicitly
formulated outcomes of care (goals and objectives) and deliberately chosen set of interventions,
resources and evaluation criteria, standards, methods, and tools.

Features
The definition points to specific features of a nursing care plan. These characteristics are based on
the concept of planning as a process.
1. The nursing care plan focuses on actions which are designed to solve or minimize existing
problem. The plan is a blueprint for action. The core of the plan are the approaches, strategies,
activities, methods, and materials which the nurse hopes will improve the problem situation.
2. The nursing care plan is a product of a deliberate systematic process. The planning process is
characterized by logical analyses of data that are put together to arrive at rational decisions. The
interventions the nurse decides to implement are chosen from among alternatives after careful
analysis and weighing of available options.
3. The nursing care plan, as with all other plans, relates to the future. It utilizes events in the
past and what is happening in the present to determine patterns. It also projects the future
scenario if the current situation is not corrected.
4. The nursing care plan is based upon identified health and nursing problems. The problems are
starting points for the plan, and foci of the objectives of care and intervention measures.
5. The nursing care plan is a means to an end, not an end in itself. The goal in planning is to
deliver the most appropriate care to a client by eliminating barriers to family health
development.
6. Nursing care planning is a continuous process, not a one-shot-deal. The results of the
evaluation of the plan’s effectiveness trigger another cycle of the planning process until the
health and nursing problems are eliminated.
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Desirable Qualities of a Nursing Care Plan

There are specific qualities of a nursing care plan which help to maximize its effectiveness.
1. It should be based on clear, explicit definition of the problem(s). A good nursing plan is based
on comprehensive analysis of the problem situation. The main as well as contributory causes of
the health conditions or problem should be identified.
2. A good plan is realistic. It can be implemented with reasonable chance of success. This
feasibility of the plan is related to the quantity and quality of resources required in its
implementation.
3. The nursing care plan is prepared jointly with the family. This is consistent with the principle
that the nurse works with and not for the family. She involves the family in determining health
needs and problems, in establishing priorities, in selecting appropriate courses of action,
implementing them and evaluating outcomes. Through participatory planning, the nurse makes
the family feel that the health of its members is a family responsibility and commitment.
4. The nursing care plan is most useful in written form. It is a means of communication not only
among nurses but also between nurses and their members of the health team, Moreover, it is
impossible for a nurse to keep many nursing care plans in her mind and remember the salient
points of care. Written plans also serve as useful administrative device for evaluating staff
performance and the quality of care provided to clients.

1. Priority Setting

After the assessment phase, the nurse may realize that the family is faced with a number of
health and nursing problems which cannot be taken up all at the same time considering the
available resources of both the family and the nurse. Considering the situation, she can rank the
identified health conditions/problems into priorities. Bailon and Maglaya (1990) devised a tool
called Scale for Ranking Health Conditions and Problems According to Priorities. This tool aims to
objectivize priority setting. There are four criteria for determining priorities among health
condition/s or problems. These include:
 Nature of the condition or problem presented – categorized into wellness state/potential,
health threat, health deficit and foreseeable crisis:
 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;
 Preventive Potential – refers to the nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on the condition or problem under
consideration;
 Salience – refers to the family’s perception and evaluation of the condition or problem in
terms of seriousness and urgency of attention needed or family readiness.

The experienced nurse practitioner can determine priorities among health condition or
problems utilizing her judgment on all these four criteria without necessarily going through the
process of scoring. The arithmetic computations utilized in the scale can, however, guide the
students or new practitioners who still need to gain the skill in deciding which factors have more
weight over the others. The computations help systematize priority setting by determining a
specific score for each problem on the list. The nurse considers several factors in order to be
objective in the decision-making process when setting priorities.
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2. Establishing Goals and Objectives

A goal is a general statement of the condition or state to be brought about by specific courses of
action. A cardinal principle in goal setting states that goals must be set jointly with the family. This
ensures the family’s commitment to the realization. Basic to the establishment of mutually
accepted goals is the family’s recognition and acceptance of existing health needs and problems.
The nurse must ascertain the family’s knowledge and acceptance of the problem as well as the
desire to take actions to resolve them. This is done during the assessment phase.
Goals set by the nurse and the family should be realistic or attainable. They should, therefore,
be set at reasonable levels. Too high goals and their consequent failure frustrate both the family
and the nurse. A clear definition of the problem situation and an accurate assessment of available
resources facilitate the setting of realistic goals. Both of these are functions of the depth and
breadth of the assessment process.
Goals, like objectives, are best stated in terms of client outcomes, whether at the individual,
family or community levels. Objectives, in contrast to goals, refer to more specific statements of the
desired results or outcomes of care. They specify the criteria by which the degree of effectiveness
of care are to be measured. Goals tell where the family is going; objectives are the milestones to
reach the destination.
Objectives stated as outcomes of care in family health nursing practice specify physical,
psychosocial states or family behavior. Examples are given below:
 After nursing intervention, the malnourished preschool members of the family will increase
their weights by at least one pound per month.
 After nursing intervention, the family will be able to:
a. Feed the mentally retarded child according to prescribed quantity and quality of food.
b. Teach the mentally retarded child simple skills related to the activities of daily living.
c. Apply measures taught to prevent infection in the mentally retarded member.
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3. Selecting Appropriate Family Nursing Interventions/Strategies

The next step in developing the family nursing care plan is formulating the intervention plan.
This involves selection of appropriate nursing interventions based on the formulated goals and
objectives. In selecting the nursing interventions, the nurse decides on appropriate nursing actions
among a set of alternatives, specifying the most effective or efficient method of nurse-family
contact and the resources needed. Some examples of nurse-family contact include the home visit,
clinic conference, visit in the workplace, school visit, telephone call, group approach (like health
classes), and the use of mail. The resources which include material (e.g., supplies, equipment,
teaching aids/kits, visual materials, handouts, charts, etc.) or human (e.g., other health team
members, development workers, community leaders) must be specified in the plan to ensure that
necessary preparations, coordination and collaboration are done before the implementation phase.

D. Implementing Family Care Plan

1. Categories of Intervention (OECD/WHO/Eurostat, 2011)

 PROMOTIVE
- Health Promotion allows individuals to increase control over their own health. Its
extensive range of social and environmental interventions benefits and protects
individual people’s health and quality of life. These interventions address and prevent
the origin of ill health, not just focusing on treatment and cure.
 PREVENTIVE
- Preventive care refers to measures that aim to avoid or reduce injuries and diseases,
their sequelae and complications. Prevention is based on a health promotion strategy
that involves a process to enable people to improve their health through the control
over some of its immediate determinants. This includes a wide range of expected
outcomes, which are covered through a diversity of interventions, organized as primary,
secondary and tertiary prevention levels.
 CURATIVE
- Curative care encompasses health care contacts during which the principal intent is to
relieve symptoms of illness or injury, to reduce the severity of an illness or injury, or to
protect against exacerbation and/or complication of an illness and/or injury that could
threaten life or normal function.
 REHABILITATIVE
- Rehabilitation is an integrative strategy with the purpose of empowering persons with
health conditions who are experiencing or are likely to experience disability so that they
can achieve and maintain optimal functioning, a decent quality of life and inclusion in
the community and society.
- While curative services mainly emphasize the health condition, rehabilitation services
focus on the functioning associated with the health condition. Rehabilitation services
stabilize, improve or restore impaired body functions and structures, compensate for
the absence or loss of body functions and structures, improve activities and
participation, and prevent impairments, medical complications and risks.

2. Tools of Public Health Nurse (Cuevas, 2007)

 THE BAG TECHNIQUE

The bag technique is a tool by which the nurse, during her visit will enable her to
perform a nursing procedure with ease and deftness, to save time and effort, with the end
view of rendering effective nursing care to clients.
 45

The public health bag is an essential and indispensable equipment of a public health
nurse which she/he has to carry along during her home visits. It contains basic medications and
articles which are necessary for giving care.

Principles of bag technique

1. Performing the bag technique will minimize, if not prevent the spread of infection.
2. It saves time and effort in the performance of nursing procedures.
3. The bag technique should show the effectiveness of total care given to an individual or
family.
4. The bag technique can be performed in a variety of ways depending on the agency’s
policy, the home situation, or as long as principles of avoiding transfer of infection is
always observed.

Contents of Public Health Bag

 Paper lining  One pair of sterile gloves
 Extra paper for making waste bag  Baby’s scale
 Plastic/linen lining  Alcohol lamp
 Apron  2 test tubes
 Hand Towel  Test tube holders
 Soap in a soap dish  Solutions of:
 Thermometers (oral and rectal) Betadine
 2 pairs of scissors (surgical and Zephiran Solution
bandage) Spirit of ammonia
 2 pairs of forceps (curved and Acetic Acid
straight) 70% Alcohol
 Disposable syringes with needles (g. Hydrogen peroxide
23 and 25) Ophthalmic ointment
 Hypodermic needles g. 19, 22, 23, 25 Benedict’s solution
 Sterile dressing  Sphygmomanometer and
 Cotton balls (dry and with alcohol) stethoscope are carried separately.
 Cord clamp
 Micropore plaster
 Tape measure

Important points to consider in the use of the bag

1. The bag should contain all the necessary articles, supplies and equipment that will be
used to answer emergency needs.
2. The bag and its contents should be cleaned very often, the supplies replaced, and ready
to use anytime.
3. The bag and its contents should be well protected from contact with any article in the
patient’s home. Consider the bag and its contents clean and sterile, while articles that
belong to the patients as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to the
user, to facilitate efficiency and avoid confusion.

Steps in Performing the Bag Technique/ Actions Rationale

1. Upon arrival at the patient’s home, place the bag on the table To protect the bag from getting
lined with a clean paper. The clean side must be out and the contaminated
folded part, touching the table.

2. Ask for a basin of water or a glass of drinking water if tap To be used for hand washing
water is not available.
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3. Open the bag and take out the towel and soap. To prepare for hand washing

4. Wash hands using soap and water. Wipe to dry. To prevent infection from the care
provider to the client
5. Take out the apron from the bag and put it on with the right To protect the nurse’s uniform
side out.

6. Put out all the necessary articles needed for the specific care. To have them readily accessible

7. Close the bag and put it in one corner of the working area. To prevent contamination

8. Proceed in performing the necessary nursing care and To give comfort and security and
treatment. hasten recovery

9. After giving the treatment, clean all things that were used To protect the caregiver and prevent
and perform hand washing. infection

10. Open the bag and return all things that were used in their
proper places after cleaning them.

11. Remove apron, folding it away from the person, the soiled
side in and the clean side out. Place it in the bag.

12. Fold the lining, place it inside the bag and close the bag.

13. Take the record and have a talk with the Mother. Write For reference in the next visit
down all the necessary data that were gathered, observations,
nursing care and treatment rendered. Give instructions for care
of patients in the absence of the nurse.

14. Make appointment for the next visit (either home or clinic) For follow-up care
taking note of the date and time.

3. Types of Family Nurse Contact

 CLINIC VISIT (Cuevas, 2007)

The patient visits the Health Center/clinic to avail of the services thereto offered by the
facility primarily for consultation on matters that ailed them physically. Nowadays, patients are
becoming aware of the other services that the Health Center offer such as Pre-natal and post-
partum care, well baby checkup, immunization, and free medicines under DOTS and other
health care.
Most often, patients utilized the facility mainly for the said purpose. But with the
changing time, close interaction between health care providers and patients have been
intensified with other health programs prior to the actual nurse-patient contact such as
enhanced health education and promotion on health care of the family and totality. The nurse
plays a very important role in building closer ties with the patient to gain their trust and
confidence and particularly in the implementation and promotion of health care.

Pre-consultation conference
A pre-clinic lecture is usually conducted prior to the admission of patients, which is one
way of providing health education.

Standard procedures performed during clinic visits

I. Registration/Admission
1. Greet the client upon entry and establish rapport.
2. Prepare the family record of new patients or retrieve records of old clients.
3. Elicit and record the client’s chief complaint and clinical history.
4. Perform physical examination on the client and record it accordingly.
 47

II. Waiting time

1. Give priority numbers to clients.
2. Implement the “first come, first served” policy except for emergency/urgent cases.

III. Triaging
1. Manage program-based cases.
(Certain programs of the DOH like the IMCI utilize an acceptable decision to which the
nurse has to follow in the management of a simple case).
Example – for control of diarrheal diseases (CDD), assess if the child has diarrhea
- If he has, for how long – is there a blood in the stool?
- Assess the child’s general condition – sleepy, difficult to awaken, restless and
irritable
- Observe for sunken eyes
- Offer fluid. Is he able to drink or is he drinking regularly, thirsty
- Pinch skin of the abdomen – does it go back very slowly?
2. Refer all non-program based cases to the physician. For all other cases which has no
potential danger, treatment/management is initiated by the nurse and she decides to
do her own nursing diagnosis and then refer to the physician for medical management.
3. Provide first-aid treatment to emergency cases and refer when necessary to the next
level care.

IV. Clinical Evaluation

1. Validate clinical history and physical examination.
2. The nurse arrives at evidence-based diagnosis and provides rational treatment based
on DOH programs.
a. identify the patient’s problem
b. formulate/write the nursing diagnosis and validate
c. give/perform the nursing intervention
d. evaluate the intervention if it has enabled the patient to achieve the desired
outcome.
3. Inform the client on the nature of the illness, the appropriate treatment and
prevention and control measures.

V. Laboratory and other diagnostic examinations

1. Identify a designated referral laboratory when needed.

VI. Referral System

1. Refer the patient if he/she needs further management following the two-way referral
system (BHS to RHU, RHU to RHU, RHU to Hospital)
2. Accompany the patient when an emergency referral is needed.

VII. Prescription/Dispensing
1. Give proper instructions on drug intake

VIII. Health Education

1. Conduct one-on-one counseling with the patient.
2. Reinforce health education and counseling messages.
3. Give appointments for the next visit.

 HOME VISIT (Cuevas, 2007)

The home visit is a family-nurse contact which allows the health worker to assess the
home and family situations in order to provide the necessary nursing care and health related
activities. In performing this activity, it is essential to prepare a plan of visit to meet the needs
of the client and achieve the best results of desired outcomes.

Purpose of home visit

1. To give nursing care to the sick, to a post partum mother and her newborn with the view
to teach a responsible family member to give the subsequent care.
 48

2. To assess the living condition of the patient and his family and their health practices in
order to provide the appropriate health teaching
3. To give health teachings regarding the prevention and control of diseases
4. To establish close relationship between the health agencies and the public for the
promotion of health
5. To make use of the inter-referral system and to promote the utilization of community
services.

Principles involved in preparing for a home visit

When we plan to go on a home visit, it is necessary to assemble the records of the patients
and list the name to be visited, study the case and have a written nursing care plan.
1. A home visit must have a purpose or objective.
2. Planning for a home visit should make use of all available information about the patient
and his family through family records.
3. In planning for a visit, we should consider and give priority to the essential needs of the
individual and his family.
4. Planning and delivery of care should involve the individual and family.
5. The plan should be flexible.

Guidelines to consider regarding the frequency of home visits

There is no definite rule to be followed on the frequency of home visits. The schedule of the
visit may vary according to the need of the patient or family for nursing care, but one has to
consider the following factors:
1. The physical needs, psychological needs and educational needs of the individual and
family
2. The acceptance of the family for the services to be rendered, their interest and the
willingness to cooperate
3. The policy of a specific agency and the emphasis given towards their health programs
4. Take into account other health agencies and the number of health personnel already
involved in the care of a specific family
5. Careful evaluation of past services given to a family and how the family avail of the
nursing services
6. The ability of the patient and his family to recognize their own needs, their knowledge of
available resources and their ability to make use of their resources for their benefits

Steps in conducting home visits

1. Greet the patient and introduce yourself
2. State the purpose of the visit
3. Observe the patient and determine the health needs
4. Put the bag in a convenient place then proceed to perform the bag technique
5. Perform the nursing care needed and give health teachings
6. Record all important data, observation and care rendered
7. Make appointment for a return visit

 GROUP CONFERENCE (EX: HEALTH CLASSES)

The clinic or office conference is less expensive for the nurse and provides the
opportunity to use equipment that cannot be taken to the home. In some cases, the other
team members (group) in the clinic may be consulted or called upon to provide additional
service. The clinic or office conference also emphasizes to the family the importance of
empowerment and assuming responsibility for self-help.

 TELEPHONE CALLS (Maglaya, 2009)

The telephone conference may be effective, efficient and appropriate if the objectives
and outcomes of care require immediate access to data, given problems on distance or travel
time. Such data include monitoring of health status or progress during the acute phase of an
illness state, change in schedule of visit or family decision, and updates on outcomes or
responses to care or treatment.
 49

 WRITTEN COMMUNICATION (MAIL, LETTERS)

The written communication is another less time- consuming option for the nurse in
instances when there are many priority families needing follow-up on top of problems of
distance and travel time. If the family is motivated and independent enough such that the
nurse can use the advantage of placing responsibility for action on the family, sending a letter,
note (as reminder, follow up on medication/treatment or update on progress or referral and
learning materials) are appropriate, effective and efficient options.

 SCHOOL VISIT OR CONFERENCE

A school visit or conference provides an opportunity to work with the family and school
authorities on how to determine the degree of vulnerability of and work out interventions to
help children and adolescents on specific health risks, hazards or adjustment problems.

 INDUSTRIAL PLANT OR JOB SITE VISIT

An industrial plant or job site visit is done when the nurse and the 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.

E. Family Health Care Researches (Examples)

1. Related Studies

Utilization of health services and the poor: deconstructing wealth-based differences in facility-
based delivery in the Philippines

Andrew Hodge, Sonja Firth, Raoul Bermejo, III, Willibald Zeck, and Eliana Jimenez-Soto

Abstract

Background
Despite achieving some success, wealth-related disparities in the utilization of maternal and child
health services persist in the Philippines. The aim of this study is to decompose the principal factors
driving the wealth-based utilization gap.

Methods
Using national representative data from the 2013 Philippines Demographic and Health Survey, we
examine the extent overall differences in the utilization of maternal health services can be explained
by observable factors. We apply nonlinear Blinder-Oaxaca-type decomposition methods to quantify
the effect of differences in measurable characteristics on the wealth-based coverage gap in facility-
based delivery.

Results
The mean coverage of facility-based deliveries was respectively 41.1 % and 74.6 % for poor and non-
poor households. Between 67 and 69 % of the wealth-based coverage gap was explained by
differences in observed characteristics. After controlling for factors characterizing the socioeconomic
status of the household (i.e. the mothers’ and her partners’ education and occupation), the birth
order of the child was the major factor contributing to the disparity. Mothers’ religion and the
subjective distance to the health facility were also noteworthy.

Conclusions
This study has found moderate wealth-based disparities in the utilization of institutional delivery in
the Philippines. The results confirm the importance of recent efforts made by the Philippine
government to implement equitable, pro-poor focused health programs in the most deprived
geographic areas of the country. The importance of addressing the social determinants of health,
particularly education, as well as developing and implementing effective strategies to encourage
institutional delivery for higher order births, should be prioritized.
 50

2. Evidence- Based Practices

Evidence-based practice (EBP) is defined as the integration of best research evidence, clinical
expertise, and patient values. The aim of using evidence-to-guide practice is to support effective
practice by using evidence-based patient management strategies which are known to result in best
patient care. Thus, the concepts of EBP, which include formulating a focused clinical question,
searching and accessing the literature to identify the best research evidence, assessing the validity of
the evidence (critical appraisal), and applying the evidence to actual patient scenarios, have been
introduced and evaluated in the training of health professionals, particularly among medical doctors
in developed countries.

Evidence-based practice training for health professionals in the Philippines

Janine Margarita Dizon, Ryan Joseph Dizon, Jocel Regino, and Alberto Gabriel

Abstract

Evidence-based practice (EBP) is integral in the health care system whether in developed or
developing countries. Thus, all health professionals need to be trained in EBP. An EBP training
program was conducted to health professionals in a developing country, the Philippines. The health
professionals (medical doctors and allied health professionals [physical therapists and occupational
therapists]) were working in hospitals in Manila, Philippines. The program aimed to build capacity in
EBP in terms of knowledge and skills. The EBP training program was conducted as a 1-day face-to-
face training. Pre- and post-test measures of EBP knowledge and skills were taken prior to and
immediately after the 1-day training, using the Fresno test of evidence-based medicine for the
medical doctors and the Adapted Fresno test for the allied health professionals. The EBP training
program resulted in significant improvements in knowledge and skills for both the medical doctors
(change in pre- and post-Fresno test measures, 95% confidence interval [CI]: 14.6–23.5; P≤0.05) and
the allied health professionals (change in pre- and post-Adapted Fresno test measures, 95% CI: 32.7–
38.5; P≤0.05). The EBP training conducted amongst the health professionals is an effective and tested
undertaking in introducing EBP in developing countries such as the Philippines.

F. Interprofessional Care in the Community

1. Rural Health Unit Personnel

Figure 3. Rural Health Unit Personnel

 51

On large rural health units in cities with established structure, the hierarchy is seen below:

The Rural Health Physician answers to the policies and health strategies set by the City Health
Officer. The Kagawad or Councilor on Health is on his/her political side. This person answers to the
Barangay Captain and is the link to providing resources in the barangay level to the health center.
Note that in the city level, there is also a Kagawad/Councilor on Health, which is the advisor on
health for the mayor.

On the health implementation side inside the barangay health unit, the hierarchy is as follows:

The Rural Health Nurse, usually one, has a higher command responsibility than the midwives.
This is because they have knowledge of every aspect in the day-to-day business of the health center.

The Rural Health Midwifes, usually more than one, have the next degree of responsibility. It is
because they are specialized to specific tasks inside the health center.
The Barangay Health Workers are the lowest group but are not paid through the city health
officer. Some are volunteers with only indemnity provided by the local government. Since the
indemnity and its amount is dictated by the Councilor's influence on the barangay budget, they
answer to the Kagawad/Councilor on Health. However, their service is to the health center, where
they do mostly clerical work.

Catchment Rural Health Units

The structure expands horizontally in the left side. If the rural health unit serves 3 barangays,
the rural health physician answers to 3 kagawads/councilors on health.

Additional Services

Should a barangay have budget for a medical technologist or a dentist, they have the same pay-
grade and command responsibility as the rural health nurse and the structure expands horizontally to
the right. Additional Barangay Health Workers are also found below them to serve their needs.

2. Local Government Units

Local governments are political units composed of provinces, cities, municipalities and
barangays. They have long been existing with their own legislative bodies which are endowed with
specific powers as defined in the Revised Administrative Code and individual local government unit
(LGU) charters. These local legislative bodies were then called provincial boards in the case of
provinces, city councils in cities and municipal councils in municipalities. These local legislative bodies
were vested with the power to determine the number of employees that each office should have and
to fix their salary rates as agreed upon by the majority. In exercising such power, however, there
were no specific guidelines nor definite standards used in the creation of positions and the fixing of
salaries. Position titles were not descriptive nor reflective of the duties and responsibilities of the
positions and salaries were fixed arbitrarily. For local officials, however, laws such as Republic Act
(RA) No. 268 as amended, and RA No. 4477 were passed by Congress fixing the salaries of municipal,
provincial and city officials. These salary laws created a wide gap between the salaries of rank-and-
file employees and the officials.

3. Government Organizations

a) DSWD
The Philippines' Department of Social Welfare and Development (Filipino: Kagawaran ng
Kagalingan at Pagpapaunlad Panlipunan, abbreviated as DSWD) is the executive department of
the Philippine Government responsible for the protection of the social welfare of rights of
Filipinos and to promote social development.
 52

History

In 1915, the Public Welfare Board (PWB) was created and was tasked to study,
coordinate and regulate all government and private entities engaged in social services. In 1921,
the PWB was abolished and replaced by the Bureau of Public Welfare under the Department of
Public Instruction.

On November 1, 1939, Commonwealth Act No. 439 created the Department of Health
and Public Welfare and in 1941, the Bureau of Public Welfare officially became a part of the
Department of Health and Public Welfare. In addition to coordinating services of all public and
private social welfare institutions, the Bureau also managed all public child-caring institutions
and the provision of child welfare services.

In 1947, President Manuel Roxas abolished the Bureau of Public Welfare and created
the Social Welfare Commission, under the Office of the President, in its place.

In 1968, Republic Act 5416, known as the Social Welfare Act of 1968, created the
Department of Social Welfare, placing it under the executive branch of government. In 1976, the
Department of Social Welfare was renamed Department of Social Services and Development
(DSSD) through Presidential Decree No. 994. This was signed into law by President Ferdinand E.
Marcos and gave the department an accurate institutional identity. On June 2, 1978, the DSSD
was renamed Ministry of Social Services and Development (MSSD) in line with the change in the
form of government.

In 1987, the MSSD was reorganized and renamed Department of Social Welfare and
Development (DSWD) through Executive Or der 123, which was signed by President Corazon C.
Aquino. Executive Order No. 292, also known as the Revised Administration Code of 1987,
established the name, organizational structure and functional areas of responsibility of DSWD
and further defined its statutory authority. In 1991, the passage of Republic Act No. 7160
otherwise known as the Local Government Code of 1991 effected the devolution of DSWD basic
services to local government units.

Programs and Services of DSWD

 The Pantawid Pamilyang Pilipino Program

o The Pantawid Pamilyang Pilipino Program or "4Ps" (conditional cash transfer) is
a human development program that invests in the health and education of poor
families, primarily those with children aged 0–18.
 Kalahi CIDSS – NCDDP
o The Kapit-Bisig Laban sa Kahirapan – Comprehensive and Integrated Delivery of
Social Services – National Community-Driven Development Program (Kalahi
CIDSS–NCDDP) is the community-driven development program of the Philippine
Government implemented through the Department of Social Welfare and
Development. Supplemented by the government of the Philippines.
 Sustainable Livelihood Program
o The Sustainable Livelihood Program (SLP) is a community-based capacity
building effort that seeks to improve the program participants’ socio-economic
status through two tracks: Micro-enterprise Development and Employment
Facilitation.
 Listahanan
o An information management system that identifies who and where the poor are
in the country. It is being operated by the National Household Targeting System
for Poverty Reduction (NHTS-PR).
 53

 Supplemental Feeding Program

o Provision of food in addition to the regular meals, to target children as part of
the DSWD's ECCD program of the government.
 Disaster Response Operations
o Life-saving emergency relief and long-term response.
 RRPTP
o Recovery and Reintegration Program for Trafficked Persons (RRTP) is a
comprehensive package of programs and services, enhancing the psychosocial
and economic needs of the beneficiaries.
 PAMANA
o Payapa at Masaganang Pamayanan (PAMANA) aims to improve access of poor
communities to basic social services and promote responsive governance.
 Protective Services Program
o Provides a range of interventions to individuals, families, and communities in
crisis or difficult situations and vulnerable or disaster-affected communities.
 ISWSFN
o International Social Welfare Services for Filipino Nationals is a program for
migrant Filipinos and other overseas Filipino nationals who are in crisis situation
and in need of special protection are encouraged to seek assistance in the
Philippine Embassies in their countries of destination.
 Residential and Non-Residential Facilities
o Services rendered in facilities 24-hour that provide alternative family care
arrangement to poor, vulnerable and disadvantaged individuals or families in
crisis.
 Adoption and Foster Care
o The act of adoption, of permanently placing a minor with a parent or parents
other than the birth parents in the Philippines.
 Gender and Development
o Gender is about relations—between men and women, women and women, also
between men and men and boys and girls. The GAD as perspective recognizes
that gender concerns cut across all areas of development and therefore gender
must influence government when it plans, budget for, implements, monitors
and evaluates policies, programs and projects for development.
 BUB
o Pilot tested in 2013 and now on its 3rd cycle, the Bottom-Up Budgeting (BUB)
Process is proposed to ensure implementation of priority poverty reduction
projects.
o
b) Nutrition Council

National Nutrition Council, abbreviated as NNC, is an agency of the Philippine

government under the Department of Health responsible for creating a conducive policy
environment for national and local nutrition planning, implementation, monitoring and
evaluation, and surveillance using state-of the art technology and approaches.

History

The creation of the Philippine Institute of Nutrition (PIN) as a first attempt to

institutionalize a national nutrition program.

In 1958, PIN was reorganized into the Food and Nutrition Research Center (FNRC) under
the Science and Development Board.
 54

In 1960, the National Coordinating Council on Food and Nutrition (NCCFN), a loose
organization of government and nongovernment agencies and organizations involved in
nutrition and related projects, was organized.

In 1971, Executive Order No. 285 was promulgated, mandating the National Food and
Agriculture Council (NFAC) to coordinate nutrition programs in addition to coordinating national
food programs, thus, superseding the NCCFN.

In 1974, Presidential Decree No. 491 (Nutrition Act of the Philippines, June 24, 1974),
which created the National Nutrition Council (NNC) as the highest policy-making and
coordinating body on nutrition, was promulgated.

In 1987, Executive Order No. 234 (Reorganization Act of NNC, July 22, 1987) was
promulgated, reaffirming the need for an intersectoral national policy-making and coordinating
body on nutrition. It expanded the membership of the NNC to include the Departments of
Budget and Management (DBM), Labor and Employment (DOLE), Trade and Industry (DTI), and
National Economic and Development Authority (NEDA). The Department of Social Welfare and
Development was named chair of the NNC Governing Board.

In 1988, Administrative Order No. 88 named the Department of Agriculture as the NNC
Chair of the NNC Governing Board.

In 1995, Republic Act No. 8172, An Act Promoting Salt Iodization Nationwide, designated
the NNC together with the Department of Environment and Natural Resources, and a
representative each from the medical profession and the salt industry, as the Salt Iodization
Advisory Board (SIAB). The SIAB is the policy-making body and coordinating body for the salt
iodization program.

In 2000, Republic Act No. 8976, Food Fortification Act of 2000, designated the NNC as
advisory body on food fortification. As such, the NNC shall set policies on food fortification, i.e.
what foods to be fortified with what micronutrient.

In 2003, NEDA-Social Development Committee through Resolution No. 1 Series 2003,

Expanding the Function and Composition of the Multisectoral Committee on International
Human Development Commitments, designated the NNC as lead agency for fighting hunger and
malnutrition.

In 2005, Executive Order No. 472 named the Department of Health as the chair of the
NNC, with the DA and DILG as vice-chairs. It also called the NNC to re-orient its operations to be
more client-oriented and to prioritize addressing hunger and malnutrition, and authorized NNC
to generate and mobilize resources.

c) Population Commission

History

1967 -Seventeen heads of state including the Philippine President signed the United
Nations Declaration on Population which stressed: The Population problem must be recognized
as a principal element in long-range planning, if governments are to achieve their economic
goals and fulfill the aspirations of their people.

1970-The Philippine Population Program was officially launched through the Executive
Order No. 233. The Commission on Population (POPCOM) was mandated to serve as the central
coordinating and policy making body of the government in the field of population.
 55

1971-Republic Act 6365, known as the Population Act of the Philippines was enacted by
Congress.

1972-Presidential Decree 79 was signed directing public and private sectors to

undertake a National Family Planning Program which respects the religious beliefs and values of
individuals.

1975-Presidential Decree 166 further strengthened the Program. It required the

participation of private organizations and individuals in the formulation and implementation of
population programs and policies.

1986-Executive Order No. 123 attached POPCOM to the Department of Social Welfare
and Development (DSWD), as the planning and coordinating agency.

1987-Policy statement under the Aquino Administration was issued by the POPCOM
Board which states: "the ultimate goal of the Population Program is the improvement of the
quality of human life in a just and humane society... The achievement of this goal requires a
recognition of the close interrelationships among population, resources and environmental
factors."

1990-Executive Order No. 408, was issued placing POPCOM under the Office of the
President in order to "facilitate coordination of policies and programs relative to population."

1991-Executive Order No. 476 was issued making POPCOM an attached agency of the
National Economic and Development Authority.

1993-Adoption of the Philippine Population Management Program and the Population,

Resources and Environment Framework by the Ramos Administration.

1999-The Estrada Administration reformulated the Philippine Population Management

Program with Responsible Parenthood as its lynchpin.

2003-On March 24, 2003, President Gloria Macapagal-Arroyo issued Executive Order
No. 188 attaching POPCOM to the Department of Health.

2005-In a Statement of Support, President Gloria Macapagal-Arroyo joined "the

community of nations in expressing support for the International Conference on Population and
Development (ICPD)."? The statement also reiterated the principles that guide the Philippine
government in the implementation of population program. These principles are based on the
four (4) pillars of Responsible Parenthood, Respect for Life, Birth Spacing, and Informed Choice.
Health services, including Reproductive Health services, are devolved by the Local Government
Code to the local government units. Local Government Units have the responsibility of providing
couples and individuals with information and services to enable them to exercise Responsible
Parenthood.
2006-On October 10, 2006, President Gloria Macapagal-Arroyo issued guidelines and
directive for the DOH, POPCOM, and local government units to take full charge of the
implementation of the Responsible Parenthood and Family Planning Program. The Responsible
Parenthood and Natural Family Planning Program's primary policy objective is to promote
natural family planning, birth spacing (three years birth spacing) and breastfeeding which are
good for the health of the mother, child, family, and community. While LGUs can promote
artificial family planning because of local autonomy, the national government advocates natural
family planning.
 56

4. Non- Government Organizations

a) Socio- Civic Organizations, Religious Organizations, Schools

Commonly referred to as NGOs, are usually non-profit that are active in humanitarian,
educational, health care, public policy, social, human rights, environmental, and other areas to
effect changes. They are a subgroup of all organizations founded by citizens, which include clubs
and other associations that provide services, benefits, and premises only to members.
Sometimes the term is used as a synonym of "civil society organization" to refer to any
association founded by citizens. Task-oriented and driven by people with a common interest,
NGOs perform a variety of service and humanitarian functions, bring citizen concerns to
Governments, advocate and monitor policies and encourage political participation through
provision of information.
NGOs are usually funded by donations, but some avoid formal funding altogether and
are run primarily by volunteers. NGOs are highly diverse groups of organizations engaged in a
wide range of activities, and take different forms in different parts of the world. Some may have
charitable status, while others may be registered for tax exemption based on recognition of
social purposes. Others may be fronts for political, religious, or other interests. Since the end of
World War II, NGOs have had an increasing role in international development, particularly in the
fields of humanitarian assistance and poverty alleviation.

By orientation
 Charitable orientation often involves a top-down effort with little participation or input
by beneficiaries. It includes NGOs with activities directed toward meeting the needs of
the disadvantaged people groups.
 Service orientation includes NGOs with activities such as the provision of health, family
planning or education services in which the programme is designed by the NGO and
people are expected to participate in its I mplementation and in receiving the service.
 Participatory orientation is characterized by self-help projects where local people are
involved particularly in the implementation of a project by contributing cash, tools, land,
materials, labour etc. In the classical community development project, participation
begins with the need definition and continues into the planning and implementation
stages.
 Empowering orientation aims to help poor people develop a clearer understanding of
the social, political and economic factors affecting their lives, and to strengthen their
awareness of their own potential power to control their lives. There is maximum
involvement of the beneficiaries with NGOs acting as facilitators.

By level of operation
 Community-based organizations (CBOs) arise out of people's own initiatives. They can
be responsible for raising the consciousness of the urban poor, helping them to
understand their rights in accessing needed services, and providing such services.
 City-wide organizations include organizations such as chambers of commerce and
industry, coalitions of business, ethnic or educational groups, and associations of
community organizations.
 State NGOs include state-level organizations, associations and groups. Some state NGOs
also work under the guidance of National and International NGOs.
 National NGOs include national organizations such as the YMCA, Rotary, professional
associations and similar groups.
 International NGOs range from secular agencies such as Save the Children, to religiously
motivated groups. They can be responsible for funding local NGOs, institutions and
projects and implementing projects.
 57

b) Religious Organizations (Barkan, 2012)

 Religious organizations are groupings of religious individuals that have a variety of
different goals and purposes.

Major Types of Religious Organization

1. Church - is a large, bureaucratically organized religious organization that is closely
integrated into the larger society.

Two types of Church:

a. Ecclesia – is a formal part of the state and has most or all of a state’s citizens as
its members. As such, the ecclesia is the national or state religion. People do not
normally join an ecclesia; they automatically become members when they are
born.
b. Denomination –is closely integrated into the larger society but is not a formal
part of the state. Most people are members of a specific denomination because
their parents were members.
2. Sect – is a relatively small religious organization that is not closely integrated into the
larger society and that often conflicts with at least some of its norms and values.
Typically a sect has broken away from a larger denomination in an effort to restore what
members of the sect regard as the original views of the denomination. Because sects are
relatively small, they usually lack the bureaucracy of denominations and ecclesiae and
often also lack clergy who have received official training.
3. Cult – is a small religious organization that is at great odds with the norms and values of
the larger society. Cults are similar to sects but differ in at least three respects. First,
they generally have not broken away from a larger denomination and instead originate
outside the mainstream religious tradition. Second, they are often secretive and do not
proselytize as much. Third, they are at least somewhat more likely than sects to rely on
charismatic leadership based on the extraordinary personal qualities of the cult’s leader.

c) School Organizations
 School organizations are created in schools to arrange the resources of time, space and
resources for the benefit of the faculty and students. Some examples are organizations
in student leadership and organizations in specific fields or subject.

G. Evaluation of Family Nursing Care

1. Evaluation Process and Outcomes and Re- assessment

Evaluation phase of the nursing process is a planned, ongoing, purposeful activity in which the
nurse and the client-partner determine the client’s progress toward achievement of goals and
outcomes. It also involves examining the other steps of the nursing process. Evaluation is an
important aspect of the nursing process because conclusions drawn from the evaluation determine
whether the nursing interventions should be terminated, continued or changed/ modified.
Evaluation is continuous. Evaluation done while or immediately after implementing a nursing
intervention enables the nurse and client-partner to make on- the- spot modifications in an
intervention.
The evaluation in the care of individuals focuses on: quality of life, functional status, patient
satisfaction, compliance measures, and impact of educational interventions. These are the broad
areas contained in the objectives of nursing care. In family health nursing, the nurse determines the
extent to which the family could perform its health tasks to maintain wellness or to address specific
health threats, health deficits, foreseeable crisis/ stress points.
In evaluating programs, the evaluator looks into the inputs, processes and/or outcomes. Inputs
are the important resources the program cannot do without (e.g., Iron and Vitamin A for a nutrition
program and vaccines for an immunization program). Processes are important activities of the
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program. The outcomes of a program are outputs, effects and impact. Outputs are the specific
products or services which an activity is expected to produce from its inputs to achieve its objectives.
Effects are the results of the use of project outputs. Impact is the outcome of program effects and is
an expression of broader, long-range program objectives.

References for FAMILY NURSING PROCESS

Barkan, S. E. (2012). Sociology: Comprehensive Edition. Retrieved from

https://2012books.lardbucket.org/books/sociology-comprehensive-edition/s20-04-types-of-
religious-organizatio.html
Cuevas, F. P. (2007). Public health nursing in the Philippines. Philippines.
Maglaya, A. S. (2009). Nursing practice in the community: Fifth Edition. Marikina City, Philippines:
Argonauta Corporation.
OECD/WHO/Eurostat (2011), A System of Health Accounts: 2011 Edition, OECD Publishing, Paris,
https://doi.org/10.1787/9789264116016-en.
RNmedia. (2019c). Initial Data Base for Family Nursing Practice. Retrieved from
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/initial-data-base-
family-nursing-practice/
RNmedia. (2019d). A Typology of Nursing Problems in Family Nursing Practice. Retrieved from
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/typology-nursing-
problems-family-nursing-practice/