prelim - week 5

- FAMILY HEALTH NURSING

NCM 104 - Community PROCESS
Health Nursing - Phases of Nursing Process

FAMILY NURSING PROCESS

Basic Phases of the Elaboration of the
Nursing Process Nursing Process

Assessment - the Establishing a Working

- COMMUNITY HEALTH NURSING process of collecting & Relationship
DIAGRAM processing data/
information about the
client

Diagnosis - is the
identi cation of the
client’s needs &
problems based on the
analysis of the data
gathered

Planning Outcomes:
(Statement of SMART
objectives or desired
outcomes)
Planning Planning Interventions:
(Responsive to client’s
problems & should
contribute to the
attainment of the
desired outcomes)
- The health of the family a ects the
Implementation (Translation of the care
individual, and the health of the individual plan into concrete
a ects the family. There are di erent levels action)
of clientele in Community Health, the
Evaluation (The process of
family made up of individuals, make up a making judgements as
community together with population to the extent the
groups (population groups are people who objectives were met)
share a speci c characteristic—for
example elderly, pregnant women, etc.

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 - In Assessing… Utilization 5. Values and
- Consider to ask yourself the following of Health Practices on
questions: Services Health
Promotion,
1. What are the data that I should Maintenance
collect? and Disease
2. What do I need these data for? Prevention
3. Should I believe all the things that the
client told me?
STEP 1
4. What made me believe or disbelieve
- 1 ST LEVEL ASSESSMENT
what she/he said?
• Initial Data Base/ Health Problems
5. How did my personal presentation
and manner of asking questions
a ect my interviewee?
- FAMILY
6. How should I have presented myself? • Family Structure
7. Are the data/information adequate to - (Demographics of members, Places
make a diagnosis? If not, what other of residence, Family structure,
data should I have collected? dominant member., general family
relations
8. What methods of data gathering
and tools do I need? • Member’s Health Status
- (Medical /nursing history, nutrition,
developmental assessment, physical
Family assessment lab results
First Level Second Level • Socio-economic And Cultural
Assessment Assessment - (Income & expenses, Educational
Individual A process whereby Family’s incapability
Attainment, religion Ethnic
Health existing and in performing health background)
Assmt. potential health task and the etiology
• Home & Environment
conditions/ or barriers in the
problems of the assumption of these - (Space, sanitation, accident hazards,
family are task water supply, toilets, drainage,)
determined
neighborhood, transportation, social
and health facilities
Medical / 1. Family 1. Family’s
Nursing structure, Perception of • Values & Practices
History characteristics the Problem - (Immunizations, lifestyles, healthy
and Dynamics physiological functions use of
Signs and 2. Socio- 2. Decisions
promotive – preventive services)
Symptoms economic and Made and its
Cultural Appropriateness - De ne/categorize the health
Characteristics conditions/problems
Lifestyle 3. Home and 3. Actions Taken • Presence of Wellness Condition a
Environment and Results clinical Nursing judgment of client’s
Ability to 4. Health 4. E ects of transition from a speci c level of
cope Status of each Decisions and wellness to a higher level
Member Actions on other
Family Members

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 - Potential – based on client’s - Determine if the family encounters
performance, current competencies other problems in implementing the
or clinical data but NO explicit interventions for the wellness state/
expression of client desire potential, health threat, health de cit or
- Readiness – based on client’s current crisis.
competencies or performance, clinical • What were the problems/barriers
data and explicit expression of desire encountered in…?
to achieve a higher level of state on • What do you think are the reasons why
health promotion and maintenance. there is no improvement in the condition
of…?
• Presence of Health Threats conditions
that are conducive to disease and • Why did you not continue doing what
we have discussed regarding…?
accident or may result to failure to
maintain wellness or realize health • How did you do it? How often did you
do it?
potential
- Determine how all the other members
• Presence of Health De cits instances
for failure in health maintenance are a ected by the wellness state/
potential, health threat, health de cit or
• Presence of Foreseeable Crisis
Situations/ Stress Points anticipated stress point.
periods of unusual demand on individual • How are the other members a ected
or family in terms of adjustment / family by…?
resources • How are the other members reacting
to…?
STEP 2
- 2 ND LEVEL OF ASSESSMENT - FAMILY HEALTH TASKS
1. Recognize the presence of a wellness
• Perceptions, Realities and Attitudes
- Going through the following procedures: state or health condition/problem
2. Make decisions about appropriate
health action to maintain wellness or
- Determine if the family recognizes the
manage health problems
existence of the condition or problem. If
3. Providing nursing care to the sick,
not, explore the reasons why. disabled , dependent and at-risk
• What do you think about the condition family member
of your…? 4. Maintaining a home environment
• What do you think is the reason why he conducive to good health and
appears thin/lethargic? personal development
- If the family recognizes the presence of 5. Utilize community resources for
the condition/problem, determine if health care
something has been done to maintain • These health tasks are the bases in
the wellness state/resolve the problem. identifying family problems.
• What have you done to improve the • A family has a nursing problem if a
condition/situation? family cannot e ectively perform its
• What improvements in the condition tasks.
of…have been observed?

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 - The end result of the 2 nd level • decide whether the problem is a (a)
assessment health threat (b) health de cit (c)
• is a set of family nursing problems for foreseeable crisis (d) wellness
each health problems. - Example: Dental Caries as a Health
- A health problem is a situation or De cit
condition which interferes with the - Second Level
promotion and/ or maintenance of • de ne the family nursing problem/family
health and recovery from illness or nursing diagnosis, stated as inability to
injury perform a speci c health task and the
- A HEALTH PROBLEM BECOMES A reason why/etiology as an end-product
NURSING PROBLEM WHEN IT IS of 2nd level of assessment
STATED AS THE FAMILY’S INABILITY • determine which family health task was
TO PERFORM ADEQUATELY not ful lled and identify the reason (due
SPECIFIC HEALTH TASKS FOR A to what). Choose from the 4 family tasks
listed below which task the family is not
PARTICULAR PROBLEM/ NURSING
able to ful ll, hence resulting to the
DIAGNOSIS
presence of a problem
• Family nursing problems are re ected in
statements such as: • STATEMENT: FAMILY’S INABILITY TO
- .Inability to recognize presence of the PERFORM A (SPECIFIC HEALTH TAKS)
condition or problem due to… DUE TO (REASON WHY THE FAMILY
- Inability to make decisions with CANNOT PERFORM SUCH TASKS)
respect to taking appropriate health - Example: Inability to recognize the
actions due to… presence of dental caries as a
- Inability to provide adequate nursing problem due to lack of knowledge
care to the sick, disabled, dependent about it’s e ect on health
or vulnerable/at risk member of the
family due to…
- Inability to provide a home DEVELOPING THE FAMILY
environment conducive to health
maintenance and personal NURSING CARE PLAN
development due to…
- Failure to utilize community resources
for health care due to… - Blueprint of the care that the nurse
designs to systematically minimize or
STEP 3 eliminate the identi ed health and family
- DIAGNOSIS nursing problems through explicitly
formulated outcomes of care (goals and
- First Level objectives) and deliberately chosen
interventions, resources and evaluation
• de nition of wellness state or health
criteria, standards, methods and tools.
problems as an end product of 1st level
After clear de nition of health and family
of assessment
nursing problems
- It is a blueprint of the care that the nurse
designs to systematically minimize or

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 eliminate the identi ed health and family STEP 4
nursing problems through explicitly - PRIORITY SETTING
formulated outcomes of care (goals and
objectives) and deliberately chosen - Priority Problem: How to compute?
interventions, resources and evaluation • Actual Score/ Highest possible score x
criteria, methods and too weight Add scores from all criteria to get
- STEPS IN DEVELOPING FNCP the total score for that problem.
• Higher score makes the problem a
1. Prioritize the health and conditions priority
and problems based on: - For example:
• Nature • Hypertension as a Health De cit
• Modi ability Health de cit 3/3x1= 1
• Preventive potential • Partially modi able (d/t nancial
• Salience cost of medication) ½ x 2= 1
2. De ne GOALS and OBJECTIVES of • High Preventive Potential (may lead
CARE to multi-systemic complications)
• Speci c measurable, client -centered 3/3 x 1= 1
statements/competences • A problem not needing immediate
Formulate EXPECTED OUTCOME attention (the patient knows that
this is a problem but does not
• Conditions to be observed to show
problem is prevented, controlled, manage it) ½ x 1= 1/2 TOTAL: 3 1/2
resolved or eliminated
• Client response/s or behaviors Criteria Weight
3. Develop the Intervention Plan Decide
Nature of the Problem 1
on: - WELLNESS 3
1. Measure to help family eliminate: - HEALTH DEFICIT 3
• Barriers to performance of Health - HEALTH THREAT 2
Tasks - FORESEEABLE CRISIS 1
• Underlying cause/s of non Modi ability 2
performance of health tasks - EASILY 2
2. Family Centered Alternatives to: - PARTIALLY 1
- NOT 0
• Recognize/detect, monitor, control,
or manage health condition or Preventive Potential 1
problems - HIGH 3
3. Determine Methods of Nurses Family - MODERATE 2
- LOW 1
Contact
4. Specify Resources Needed Salience 1
4. Develop the Evaluation Plan Specify - A PROBLEM, IMMEDIATE 2
ATTENTION
the Following - A PROBLEM, NOT NEEDING 1
• Criteria/ outcomes based on objectives - NOT PERCEIVED AS A 0
of care PROBLEM
• Methods/tools

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 STEP 5 STEP 6
- FORMULATION OF GOALS & - DEVELOPING THE INTERVENTION/
OBJECTIVES IMPLEMENTATION PLAN

- Goal: a general statement of the - The nurse needs focus her choice of
condition or state to be brought about by interventions on helping the family
speci c courses of action minimize or eliminate the possible reasons
• Ex. After nursing intervention, the family for or causes of the family’s inability to do
will be able to take care of the disabled it the health tasks
child competently • Help the family recognize the problem
- Cardinal Principle: Goals must be set • Guide the family on how to decide on
jointly with the family to ensure appropriate health actions to take
commitment - Develop the family’s ability and
- Objectives: more speci c statements of commitment to provide
the desired results or outcomes of care • Contracting- creative intervention that
can maximize opportunities to develop
(client-centered)
the ability and commitment of the family
• Ex. After the nursing intervention, the
to providing nursing care to its members
malnourished preschool members of the
family will increase their weights by at
- Enhance the capability of the family to
provide a home environment conducive to
least 1lb./ month
- After nursing intervention, the family health maintenance and personal
development
will be able to:
- Facilitate the family’s capability to utilize
• Feed the mentally retarded child
community resources for health care
according to prescribed quantity
and quality of food
- In implementation, the nurse could either
be motivated or overwhelmed and
• Teach the mentally retarded child
frustrated
simple skills related to the activities
of daily living
- A dynamic attitude is required
- Meeting the challenges is the essence of
• Apply measures taught to prevent
Family Nursing Practice
infection in the mentally retarded
member
- Expert caring is demonstrated when the
nurse carries out interventions based on
- The more speci c the objectives, the
the family’s understanding and lived
easier the evaluation of their attainment,
experiences
speci cally stated objectives de ne the
criteria for evaluation, objectives and
STEP 7
evaluation are directly related. - EVALUATION PLAN
• The evaluation plan speci es how the
nurse will determine changes in health
status, condition, or situation and
achievement of the outcomes of care
(goals and objectives)

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