Module 4 FCP NCM 104 Lecture Notes 23-24 (1)-1.pdf

COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM NCM 104: COMMUNITY HEALTH NURSING (INDIVIDUAL AND FAMILY) Module 4: FAMILY NURSING PROCESS Module Content A. Family Health Asses...

COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM NCM 104: COMMUNITY HEALTH NURSING (INDIVIDUAL AND FAMILY) Module 4: FAMILY NURSING PROCESS Module Content A. Family Health Assessment 1. Tools for Assessment  Initial Data Base  Typology of Nursing Problems in Family Nursing Practice  Family Health Task  Family Coping Index 2. Family Data Analysis  Socio-Economic and Cultural Characteristics  Home Environment  Family Health Status  Family Values and Health Practices B. Family Nursing Diagnosis C. Formulating Family Nursing Care Plan 1. Priority Setting 2. Establishing Goals and Objectives 3. Selecting Appropriate Family Nursing Interventions / Strategies FAMILY NURSING PROCESS: Includes data collection, data analysis or interpretation and problem definition or nursing diagnosis The rationale for adopting this health tasks as the framework of the typology is the fact that in community health nursing practice, one deals mostly with problems within the domain of human behavior or human response to health and illness. A community health nurse works with and through the family to improve its behavior related to health. ASSESSMENT AND DIAGNOSES IN FAMILY NURSING PRACTICE There are two major types in dealing with the assessment of the family according to nursing practice: 1. FIRST LEVEL ASSESSMENT - the process of determining existing and potential health conditions or problems of the family. These health conditions are categorized as: A. WELLNESS CONDITION 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM - 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 level. A. Potential or Capability for: B. Readiness for Enhanced Capability for: Healthy Lifestyle – e.g. nutrition, Healthy Lifestyle diet, exercise, activity Health Maintenance/ Health Health Maintenance/ Health Management Management Parenting Parenting Breastfeeding Breastfeeding Spiritual Well-being Spiritual Well-being Others Others B. HEALTH THREATS - Conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential A. Presence of risk factors of specific diseases B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide D. Accident/ fire hazards E. Faulty/ unhealthful nutritional/ eating habits or feeding techniques or practices F. Stress provoking factors G. Poor home environmental condition/ sanitation H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/practices J. Inherent personal characteristics 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM K. Health history which may participate/ induce the occurrence of a health deficit L. Inappropriate role assumption M. Lack of immunization/ inadequate immunization status specially of children N. Family disunity O. Others C. HEALTH DEFICITS - Instances of failure in health maintenance (disease - regardless of whether it is diagnosed or undiagnosed by medical practitioner, disability, (developmental lag) D. STRESS POINTS / FORESEABLE CRISIS - 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 I. Menopause 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM J. Loss of job K. Hospitalization of a family member L. Death of a member M. Resettlement in a new community N. Illegitimacy O. Others, specify.__________ Statement of the Problem: P = Problem, E = Etiology (Cause), S = Signs/Symptoms Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food as evidenced by: Loose watery stool 4X bowel movement/day Poor skin turgor body weakness,and as verbalized,”symptom kahapon pa sang aga ako naga lupot”. “kag nagakutoy akon tiyan”. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Data collection for first level assessment includes gathering the five types of data, namely: Family structure and Include family composition and demographic data, type of family, form and structure, decision- characteristics making patterns and communication patterns affecting family relatedness Socio-economic and Include occupation, place of work, and income of each working member, educational attainment, cultural factors ethnic background, religious affiliation, family traditions and the relationship of the family to a larger community Home and Include information on housing and sanitation facilities; kind of neighborhood and availability of Environmental factors social, health, communication, and transportation facilities in the community. Health Assessment of Includes current and past significant health conditions or illness; beliefs and practices each member conducive to health and illness; nutritional and developmental status; physical assessment findings and significant results of laboratory/ diagnostic tests/ screening procedures Value placed on health Include use of Promotive-preventive services as evidenced by immunization status and use of other promotions, health healthy lifestyle related services; adequacy of maintenance and rest/sleep 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM prevention of disease Data gathering methods includes: Observation, physical examination, interview, review of records and laboratory and diagnostic procedures. 2. SECOND LEVEL ASSESSMENT - identifies the nature or type of nursing problems the family experiences in the performance of their health tasks with respect to a certain health condition or health problem. FIVE MAIN TYPES OF FAMILY NURSING PROBLEMS 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: i. Social-stigma, loss of respect of peer/significant others ii. Economic/cost implications iii. Physical consequences 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM iv. Emotional/psychological issues/concerns c. Attitude/ Philosophy in life, which hinders recognition / acceptance of a problem d. Others. Specify _________ 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: i. Social consequences ii. Economic consequences iii. Physical consequences iv. 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. In accessibility of appropriate resources for care, specifically: i. Physical Inaccessibility 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM ii. 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 m. Others specify._________ 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 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: i. Absence of responsible member ii. Financial constraints iii. Limitation of luck/lack of physical resources g. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which 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 on concerns/interests j. Prolonged disease or disabilities, which exhaust supportive capacity of family 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM members. k. Altered role performance, specify. i. Role denials or ambivalence ii. Role strain iii. Role dissatisfaction iv. Role conflict v. Role confusion vi. Role overload vii. Others. Specify._________ IV. Inability to provide a home environment conducive to health maintenance and personal development due to: a. Inadequate family resources specifically: i. Financial constraints/limited financial resources ii. Limited physical resources-e.i. 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 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM 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. j. Others specify._________ 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 : i. Physical/psychological consequences ii. Financial consequences iii. Social consequences f. Unavailability of required care/services g. Inaccessibility of required services due to: i. Cost constrains ii. Physical inaccessibility h. Lack of or inadequate family resources, specifically i. Manpower resources, e.g. baby sitter ii. 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. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM j. Negative attitude/ philosophy in life which hinders effective/maximum utilization of community resources for health care k. Others, specify __________ Second Level of Assessment: Example: Inability to provide adequate nursing care due to: a. Lack of knowledge and skill in treatment of diarrhea as verbalized by the mother: “Wala ko kabalo kon paano bulngon ang lupot”. Family health task In order to achieve wellness among its members and reduce or eliminate health problems, the standard or norm of the family as a functioning unit involves the ability to perform the following health tasks: A. Recognize the presence of a wellness state or health condition or problem B. Make decisions about taking appropriate health action to maintain wellness or manage the health problem C. Provide nursing care to the sick, disabled, dependent or at-risk members D. Maintain a home environment conducive to health maintenance and personal development E. Utilize community resources for health care Note: Utilizing the data gathered from the Initial Data Base (IDB), the nurse goes though the data analysis. The end-result of the analysis during the first-level assessment is a conclusion or a statement of a health condition or problem, 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM classified as a wellness potential, health threat and health deficit or stress point/ foreseeable crisis. The second - level of assessment ends with a definition of family nursing problems, in terms of how the family handles it. PLANNING, IMPLEMENTING AND EVALUATING IN FAMILY NURSING PRACTICE FAMILY NURSING CARE PLAN Is a blueprint of nursing care designed to systematically enhance the family’s capability to maintain wellness, manage health problems through explicitly formulated goals and objectives of care and deliberately chosen set of interventions, resources, & evaluation criteria, standards, methods/tools. STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN 1. Prioritize Health Conditions or Problems 2. Goal and Objectives of Nursing Care 3. Intervention Plan 4. Evaluation Plan HEALTH PROBLEM Process whereby existing and potential health conditions or problem of the families are determined. They reflect depth of data gathering and analysis on what health conditions or problems exists. This is derived from the First Level Assessment of the Typology of Nursing Problems. Which categorizes the presence of: 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Wellness state Health deficits Health threats Foreseeable crisis or stress points FAMILY NURSING DIAGNOSIS Defines the nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem, and the etiology or barriers to the family’s assumption of these tasks. This is derived from the Second Level Assessment of the Typology of Nursing Problems. This include those that specify or describe the family’s realities, perceptions about and attitudes related to the assumption or performance of family health tasks on each health condition or problem identified during the first-level assessment. The nurse should learn to prioritize the numerous family nursing problem considering the available resources of the nurse, the family and the community. FOUR CRITERIA IN PRIORITIZNG HEALTH CONDITIONS (Maglaya et. al., 2017) 1. NATURE OF THE PROBLEM - Is the problem a: a. Wellness condition b. Health deficit c. Health threat d. Foreseeable crisis 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM 2. MODIFIABILITY OF THE CONDITION - Probability of success in enhancing wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. - Factors to consider in determining modifiability of the problem: o Current knowledge, technology and interventions to enhance wellness state or manage the problem o Resources of the family-physical, financial and manpower o Resources of the nurse-knowledge, skill and time o Resources of the community-facilities and community organization or support 3. PREVENTIVE POTENTIAL - Nature and magnitude of future problems that can be minimized or totally prevented if interventions are done on the problem. - Factors to consider in determining preventive potential: o Gravity or severity of the problem – refers to the progress of disease indicating extent of damage on the client. The more severe of advanced the problem, the lower is the preventive potential. o Duration of the problem – refers to the length of time the problem has been existing. Has a direct relationship to gravity & preventive potential. o Current Management – refers to the presence and appropriateness of intervention measures instituted to enhance the wellness state or remedy the problem. The institution of appropriate intervention increase the preventive potential. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM o Exposure of any vulnerable or high-risk group – Increases the preventive potential in determining the score for salience. The family’s concerns, felt needs, or readiness increases the salience. 4. SALIENCE - Family’s perception & evaluation of the problem in terms of seriousness & urgency of attention needed or family readiness. Scale for Ranking Health and Conditions and Problems According to Priorities CRITERIA SCORE WEIGHT Nature of the Condition Wellness State 3 1 Health Deficit 3 Health Threat 2 Forseeable Crisis 1 Modifiability of the Condition Easily modifiable 2 1 Partially modifiable 1 Not modifiable 0 Preventive Potential High 3 1 Moderate 2 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Low 1 Salience A condition needing immediate 2 1 attention 1 A condition needing immediate 0 attention Not perceived as a condition needing change SCORING AND PRIORITIZING 1. Decide on a score for each of the criteria. 2. Divide the score by the highest possible score and multiply by the weight Score x Weight Highest Score 3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight. 4. Rank the overall score of each nursing problem. 5. The nursing problem with the highest score will be the priority while the problem with the lowest score will be the least priority 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food. Criteria Score Weight Computation Nature of the Condition Wellness State 3 1 (3/3) x 1 1 Health Deficit Health Threat Foreseeable Crisis Modifiability of the Condition Easily modifiable 2 2 (2/2) x2 2 Partially modifiable Not modifiable Preventive Potential High 3 1 (3/3) x1 1 Moderate Low Salience A condition needing 2 1 (2/2) x 1 1 immediate attention A condition needing immediate attention Not perceived as a condition needing change 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM TOTAL 5 GOAL OF CARE a broad desired outcome toward which behavior is directed. The Cardinal Principle: Goals must be jointly set with the family. This ensures the family commitment to their realization. Goals set by the nurse & family should be realistic or attainable. Too high goals & their consequent failure frustrate both the family & the nurse. OBJECTIVES OF CARE This refers to a more specific / more precise statements of the desired results or outcome of care. The more specific the objective, the easier is the evaluation of their attainment. Types of objective: 1. Short term/ Immediate objective Formulated for problem which require immediate attention and results observed is short time period with few nurse family contacts, use of less resources. 2. Long term/ Ultimate objective Require several nurse-family encounters & investment of more resources. Outcomes sought require time to demonstrate. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM 3. Medium term/ Intermediate objective Those which are not immediately achieved. Components of an objective (ABCD): 1. Actor / Subject – client, any part of the client or some attributes of the client. 2. Behavior / Verb – action of the client to perform. 3. Conditions / Modifiers - explain the circumstances under which the behavior is to be performed, (what, where, when, how) 4. Determinant / Criterion of Desired Performance - Level at which the client will perform the specified behavior. Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food. Goal After 1 day of effective health care strategies, Rosario’s diarrhea will be lessened from 4x bowel movement to twice/day. Objective Within 2 hours of health education and nursing care, the family will: a. Provide adequate nursing care 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM HEALTH CARE STRATEGIES This involves selection of appropriate nursing interventions/ health car e strategies based on the formulated goal and objective. Focus on Interventions to Help the Family Performs Health Tasks - Help the family recognize the problem - Guide the family on how to decide on appropriate health actions to take. - Develop the family’s ability and commitment to provide nursing care to each member. - Enhance the capability of the family to provide home environment conducive to health maintenance and personal development. - Facilitate the family’s capability to utilize community resources for health care. Guidelines for Implementing Nursing Activities - Nursing actions should be based on scientific knowledge, nursing research and professional standards of care. - Nurse should understand clearly the orders to be implemented and question any that are not understood. - Nursing actions should be adapted to the individual client. - Nursing actions should always be safe. - Nursing actions often require teaching, support and comfort. - Nursing actions should be holistic. - Nursing actions should respect the dignity of the client and enhance the client’s selfesteem 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM - Clients should be encouraged to participate actively in implementing the nursing actions. Implementation requires the following skills from the nurse: - Cognitive Skills – problem solving, decision making, critical thinking and creative thinking. - Interpersonal or communication skills - Technical skills – hands on skills such as manipulating equipment, giving medications and others. Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food. Health Care Strategies: a. Teach and demonstrate to the mother how to mix and give ORS as follows: 1 L of clean & potable water mix with 8 level tsps. Sugar and 1 level tsp. salt a. Give frequent small sips of ORS over 4hr period. b. Give extra fluid, food-based fluids such as soup, rice water or buko juice c. Continue breast feeding frequently and longer at each feeding. EVALUATION Specifies how the nurse will determine changes in health status, condition and 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM achievement of outcomes of care specified in the objectives of family nursing care plan. Ongoing Evaluation – done while or immediately after implementing an order; enables nurse to make on-the-spot modifications in an intervention. Intermittent Evaluation- performed at specific time intervals to show the extent of progress towards the goal and enables nurse to correct any deficiencies and modify care plan; also called PROCESS Evaluation. Terminal Evaluation – indicates client’s condition at the time of discharge; includes status of goal achievement and an evaluation of the client’s self-care abilities with regard to follow-up care Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean Food. Evaluation: After 1 day of Health teaching and Nursing Care, the goal is partially met as evidenced by soft formed stool 2x per day and the parents now provides proper care to Rosario Sample Family Care Plan Sample Matrix 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Health Problem Goal / Health Care Evaluation Objective Strategies 1st level assessment After 1 day of After 1 day of Health Diarrhea effective health (undiagnosed) as teaching and care strategies, health deficit related Nursing Care, Rosario’s to eating of diarrhea the goal is contaminated & will be lessened partially met unclean food as evidenced by: from 4x bowel as evidenced - Loose watery stool movement to by softformed - 4X bowel twice/day. stool 2x per movement/day day and the - Poor skin turgor parents now body provides weakness,and as proper care to verbalized,”symptom Rosario. kahapon pa sang aga ako naga lupot”. “kag nagakutoy akon tiyan”. 2nd level assessment Within 2 hours a. Teach and of health demonstrate to the Inability to provide education mother how to mix adequate nursing and give ORS as and Nursing care due follows: care, the family to: will: 1 L of clean & potable water mix 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM a. Lack of knowledge a. Provide with 8 tsps. Sugar and 1tsp. salt and skill in treatment adequate nursing of diarrhea as a. Give frequent care verbalized by the small sips of ORS mother: “Wala ko over 4hr period. kabalo kon paano b. give extra fluid, bulngon ang lupot”. food-based fluids such as soup, rice, water or buko juice c. continue breast feeding frequently and longer at each feeding. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph