FIRST LEVEL ASSESSMENT

SECOND LEVEL ASSESSMENT

FNCP (FAMILY NURSING CARE PLAN)
 Focus on actions
 Systematic process
 Relates to future plans
 Based on identified health plan
 Goal is to delivery the most appropriate care
 Plan is a continuous process

QUALITIES
 Clear and explicit definition of the problem
 Realistic
 Prepared with then family/ jointly made with family member
 Written form

STEPS IN DEVELOPING FAMILY NURSING CARE PLAN

1. Prioritized condition/s or problems
2. Goals and objectives
3. Plan of interventions
4. Plan for evaluating care

A. PRIORITIZING HEALTH PROBLEMS

1. Nature of the Condition or problem presented- wellness states, health threat, heath deficit and
foreseeable crisis
2. Modifiability of the Condition/ problem- probability of success in enhancing the wellness state,
improving the condition, minimizing, alleviating or totally eradicating the problem through intervention
3. Preventive Potential- refers to the nature and magnitude of future problems that can minimize or
totally prevented if intervention is done on the condition or problem under consideration
4. Salience- family’s perception and evaluation of the condition or problems in terms of seriousness and
urgency of attention needed or family readiness

ACCORDING TO PRIORITIES

Criteria Weight

1. Nature of the condition or problem presented 1

Scale: wellness state 3
health deficit 3
health threat 2
foreseeable crisis 1

2. Modifiability of the condition or problem 2

Scale: easily modifiable 2
partially modifiable 1
not modifiable 0

3. Preventive Potential 1
Scale: high 3
moderate 2
not modifiable 1

4. Salience 1
Scale: A condition/ problem needing immediate attention 2
A condition or problem not needing immediate attention 1
Not perceived as a problem or condition needing change 0
SCORING
1. Decide on score for each criteria
2. Divide the score by the highest possible score and multiply by the weight
(score/highest score x weight)
3. Sum up the scores for all criteria. The highest score is 5 equivalent to the total weight

POSSIBLE PRE-ECLAMPSIA

Criteria Computation Actual Justification

score

1. Nature of the problem 3/3 x 1 1 The problem is a health deficit and

requires more immediate intervention.

2. Modifiability of the problem 2/2 x 2 2 The resources and interventions

needed to solve the problem are
available.

3. Preventive potential 3/3 x 1 1 The possibility of complications is

prevented if preeclampsia is eliminated
as early as possible.

4. Salience of the problem 0/2 x 1 0 The family does not recognize the
existence of the problem.

Total 4

IMPROPER WASTE DISPOSAL

Criteria Computation Actual Justification

score

1. Nature of the problem 2/3 x 1 2/3 It is a health threat

2. Modifiability of the problem 2/2 x 2 2 Resources are available and

interventions are feasible

3. Preventive potential 3/3 x 1 1 Communicable diseases transferred by

insects and rodents can be prevented

4. Salience of the problem No data No data

available available

Total 3 2/3
PRIORITIZED HEALTH PROBLEMS
• Possible preeclampsia – 4
• Improper waste disposal - 3 2/3

Health Family Goal of care Objective Nursing Method of Resources

Problem Nursing of Interventions Nursing Required
Problem Care Family
Contact
Possible 1. Inability to After the After the 1.Broaden Home visit Material
Pre recognize the nursing Nursing Mrs x Clinic/ resources:
eclampsia presence of a intervention, intervention knowledge by prenatal visit Visual aids
possible the family the patient discussing the Time and
complication will be able will: ff: effort of the
of pregnancy to take a. ………… nurse
due to lack of necessary a. Ensure b. ........... Transportati
knowledge. measures to Mrs. X that c. ………… on expenses
prevent or she will of the nurse
2. Inability to properly have a 2.Discuss with and the
provide manage pre regular family family
adequate care eclampsia prenatal visit the courses
to a pregnant of action and
member due b. the need for
to: Implement a hospital
laboratory delivery
a. Lack of work up,
knowledge nutrition,
and diet, rest
management and sleep
of health
condition c. Decide on
a hospital
b. Lack of delivery
knowledge on
the nature
and extent of
the care
needed

FAMILY NURSING PROCESS

A. Family Data Analysis
1. The nurse organizes data into clusters (data synthesis)
2. sets aside data that may be considered irrelevant at this point.
3. seemingly inaccurate or conflicting data are validated with the family respondent(s).
 Data analysis is done by comparing findings with accepted standards for individual family
members and for the family unit.
 Current information should be compared with previous information if available.
  In addition, the nurse correlates findings in the different data categories and checks for
significant gaps in the information or the need for more details related to a finding.

 Systems of Organizing a Family Data (Nies and McEwen, 2011)

1. Family Structure and Characteristics
 are reflected in data on household membership
 demographic characteristics,
 family members living outside the household,
 family mobility,
 and family dynamics :
a. emotional bonding,
b. authority and power structure,
c. autonomy of members,
d. division of labor,
patterns of communication, decision making, and problem and conflict resolution).
d. Data on family structure can be visualized clearly through graphic tools such as genogram, ecomap,
and/or family health tree.
2. Socioeconomic characteristics
a. include data on social integration (ethnic origin, languages and/or dialects spoken, and social
networks)
b. educational experiences and literacy,
c. work history,
d. financial resources,
e. leisure time interests,
f. cultural influences,
g. including spirituality or religious affiliation.
3. Family environment – refers to the physical environment inside the family’s home/residence and its
neighborhood.
4. Family health and health behavior take into account the family’s activities of daily living, self-care, risk
behaviors, health history, current health status, and health care resources (home remedies and health
services).

B. Family Nursing Diagnosis

 Nursing diagnoses may be formulated at several levels:

a. as individual family members,

b. as a family unit, or as the family in relation to its environment/community.
 Specific diagnoses as proposed by NANDA – International (NANDA-I, 2011) serve as a common
framework of expressing human responses to actual and potential health problems.

 An alternative tool for nursing diagnosis is the Family Coping Index. This tool is based on the 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.

C. Formulating Family Nursing Care Plan

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.

 FNCP FEATURES
● focuses on actions which are designed to solve or minimize existing problem.
● The plan is a blueprint for action.
● The cores of the plan are the approaches, strategies, activities, methods and materials which
the nurse hopes will improve the problem situation.
● 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.

 Steps in Making Family Nursing Care Plan

 The assessment phase of the nursing process generates the health and nursing problems which
become the bases for the development of nursing care plan. The planning phase takes off from
there.

1. Assessment Phase – Happens on the first and succeeding home visits. Making objective
observation can be coupled with subjective statements by each family member.
2. Identification of the Problem/s – Make a list of the problems sited. Prioritization of the needs
must be applied.
3. Formulation of Goals and Objectives – Referring on the problems, goals and objectives must
be measurable, attainable, realistic and time-oriented.
4. Plot Nursing Interventions – The objectives must be the guidelines in making nursing
interventions. Nursing interventions must be rational enough.
5. Evaluate the outcomes – This stage will be the determining stage whether the goals and
objectives have been met or not. Nursing interventions can be modified at this stage.

Formulation of Goals and Objectives

GOAL - is a general statement of condition or state to be brought about by specific courses of

action.

OBJECTIVE - refers to a more specific statement of the desired results or outcomes of care. They
specify the criteria by which the degree of effectiveness of care is to be measured.
  Characteristics of a workable, well-stated objectives

1. Specific: the objective clearly articulates who is expected to do what. Example: the family or a
target family member will manifest a particular behaviour.
2. Measurable: Observable, measurable, and whenever possible, quantifiable indications of the
family’s achievement as a result of their efforts toward a goal provide a concrete basis for
monitoring and evaluation.
3. Attainable: The objective has to be realistic and in conformity with available resources, existing
constraints, and family traits, such as style and functioning.
4. Relevant: The objective is appropriate for the family need or problem that is intended to be
minimized, alleviated, or resolved.
5. Time-bound: Having a specified target time or date helps the family and the nurse in focusing
their attention and efforts toward the attainment of the objective (Doran, 1981).

Selecting Appropriate Family Nursing Interventions/Strategies

 Focus on Interventions to Help The Family Performs Health Tasks:
1. Help the family recognize the problem
 Increasing 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 the health needs to the goals of the family.
 Encouraging positive or wholesome emotional attitude toward the problem by affirming
the family’s capabilities/qualities/resources and providing information on available
actions.
2. Guide the family on how to decide on appropriate health actions to take.
 Identifying or exploring with the family courses of action available and the resources
needed for each.
 Discussing the consequences of action available.
 Analyzing with the family of the consequences of inaction.
3. Develop the family’s ability and commitment to provide nursing care to each member.
 Contracting-is a creative intervention that can maximize the opportunities to develop
the ability and commitment of the family to provide nursing care to its members.
4. Enhance the capability of the family to provide home environment conducive to health
maintenance and personal development.
 The family can be taught specific competencies to ensure such home environment
through environmental manipulation or management to minimize or eliminate health
threats or risks or to install facilities of nursing care.
5. Facilitate the family’s capability to utilize community resources for health care.
 Involves maximum use of available resources through the coordination, collaboration
and teamwork provided by effective referral system.

 Criteria for Selecting the Type of Nurse Family Contact

1. Effectivity
2. Efficiency
3. Appropriateness

D. Implementing Family Care Plan

1. Categories of Intervention
 Depending on identified family needs and the goals and objectives, interventions may range
from the simple or immediate such as offering information about health resources available to
the family, to the complicated or prolonged, such as providing care to a family with a member
newly diagnosed with a pulmonary tuberculosis (PTB).

 Three Types of Nursing Interventions ( Freeman and Heinrich, 1981)

a. Supplemental interventions – are actions that the nurse performs on behalf of the family when
it is unable to do things for itself. Example: providing direct nursing care to a sick or disabled
family member.
 b. Facilitative interventions – refer to actions that remove barriers to appropriate health action.
Example: assisting the family to avail of maternal and early child health care services.
c. Developmental interventions – aim to improve the capacity of the family to provide for its own
health needs. This is directed toward family empowerment. Example: guiding the family to make
responsible health decisions.

 Interventions may be a mix of two or all three of these categories, with the nurse making sure
that they are appropriate to the family situation.

2. Tools of Public Health Nurse

● PHN Bag and Contents

● Principles and Techniques in the Use of PHN Bag

3. Types of Nurse Family Contact

a. Clinic Visit or Office Conference
 It is less expensive for the nurse and provides the opportunity to use equipment
that can’t be taken to the home. In some cases, the other team members in the
clinic may be consulted or called in to provide additional service.
b. Home Visit
 While it is expensive in terms of time, effort and logistics for the nurse, it is an
effective and appropriate type of family nurse contact if the objectives and
outcomes of care require accurate appraisal of family relationship, home and
environment and family competencies. i.e. The best opportunity to serve the
actual care given by family members.
c. Group Conference
 Conference of mothers in the neighborhood, provides an opportunity for initial
contact between the nurse and target families of the community that may take
place at a health facility or in the community.
 Appropriate for developing cooperation, leadership, self-reliance, and/or community
awareness among group members.
 Attendance usually requires motivation and availability of target family members.

d. Telephone Calls
 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 and treatment.

e. Written Communications
● It is another less time consuming option for the nurse in instances when there are large
number of families needing follow-up on top of problems of distance or travel time.
● Is used to give specific information to families, such as instructions given to parents
through school children.
● It’s a one-way method and requiring literacy and interest, and the nurse cannot be
certain that the information will reach the intended recipient.

E. Evaluating of Family Nursing Care

 in family nursing, evaluation is determining the value of nursing care that has been given to
a family.
 the product of this step is used for further decision making: to terminate, continue, or
modify the intervention (s). well-formulated goals and objectives in the nursing care plan
serve as the framework for evaluation.
 Formative evaluation is judgment made about effectiveness of nursing
interventions as they are implemented (Maurer and Smith, 2009). This is
ongoing and continuing while family nursing care is being implemented and
family-nurse interaction are taking place.
 Summative evaluation is determining the end results of family nursing care and
usually involves measuring outcomes or the degree to which goals have been
achieved (Maurer and Smith, 2009).