Family Nursing Process PDF

 FAMILY NURSING PROCESS  Is a systematic approach to assess the health needs, analyze, identify health problems and their solutions by using the Family Nursing Care Plan as applied to the family in the community  Family Nursing Care Plan (FNCP) Is defined as a guide or framework...

 FAMILY NURSING PROCESS  Is a systematic approach to assess the health needs, analyze, identify health problems and their solutions by using the Family Nursing Care Plan as applied to the family in the community  Family Nursing Care Plan (FNCP) Is defined as a guide or framework of nursing care designed to provide ways in solving health-related problems of the family as a whole. STEPS OF FAMILY NURSING CARE PLAN (FNCP) Assessment Diagnosis Planning Implementations/ Interventions Evaluation  Happens on the first and succeeding home visits. Making objective observation can be coupled with subjective statements by each family member. Identify both actual and potential client health problem/s  Prioritization must be applied.  Formulation of goals and objectives.  Encourage and permit client’s to make their own health management decisions.  Objective/s must be the guidelines in making nursing interventions including health teachings, coordinates and uses referrals and resources, provides and monitors all levels of technical care or skills (BP taking and wound care etc.)  Determining step whether the goals EVALUATION and objectives have been met or not.  Documentation of care given and the client’s progress toward goal achievement.  A tool to facilitate the process of defining family health nursing problems, a classification system of family health nursing problems.  it utilizes Family Nursing Assessment   It involves a set of actions FAMILY by which the nurse NURSING determines the status of ASSESSMENT the family as a client, the ability to maintain wellness, prevent, control or resolve problems in order to achieve health and well being among its members.  Includes data collection, data analysis, formulation of family nursing diagnosis.   2 Types of Family Nursing Assessment I. First Level Assessment II. Second Level Assessment  Identifies the nature  The process of or type of nursing determining existing problems the family and potential health experiences in the conditions or problems performance of their of the family. health tasks with respect to a certain health condition or health problem.  It specified the measures that the family did NOT  FIRST LEVEL ASSESSMENT CATEGORIES OF HEALTH CONDITIONS/ NATURE OF THE PROBLEMS: 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 level. Example of Wellness Condition: A. Wellness Potential – is a nursing judgment on wellness state but NO EXPLICIT EXPRESSION of client desire. B. Readiness for enhanced wellness state – is a judgment on wellness state based on current competencies and performance, clinical data and explicit expression of desire to achieve higher level of functioning or state. Health Threats II. Presence of Health Threats Are conditions that are conducive to disease, accident or failure. Examples: Family size beyond family resources can adequately provide, Faulty/Unhealthy Nutritional Habit, Accident/Fire Hazards, Poor Home/environmental Condition/Sanitation, Unsanitary Food Handling and Preparation, Unhealthy Lifestyle and Personal Habits Health Deficits III. Presence of Health Deficits Are instances of failure in health maintenance Examples: Illness states, regardless of whether is diagnosed or undiagnosed, Failure to Thrive/ Develop according to normal rate, Disability Foreseeable Crisis IV. Presence of Stress Points/ Foreseeable Crisis Situations Are anticipated periods of unusual demand on the individual or family in terms of adjustment/ family resources.  Examples: Marriage, Pregnancy, Parenthood, Loss of Job, Entrance at school, Chronic Illness, Hospitalization, Death of a family member, Resettlement in a new community  SECOND LEVEL ASSESSMENT 1. Inability to recognize the presence of the condition or problem 2. Inability to make decisions with respect to taking the appropriate health action 3. Inability to provide nursing care to the sick, disabled, dependent or vulnerable/ at-risk member of the family 4. Inability to provide a home environment conducive to health maintenance and personal development. 5. Inability to utilize community resources for health care. 1. Inability to recognize the presence of the condition or problem related 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: Social-stigma, loss of respect of peer/significant others Economic/cost implications Physical consequences Emotional/psychological issues/concerns C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem D. Others. Specify _________ 2. Inability to make decisions with respect to taking the appropriate health action related 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 break down 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: Social consequences Economic consequences Physical consequences 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: Physical Inaccessibility 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._________ 3. Inability to provide nursing care to the sick, disabled, dependent or vulnerable/ at-risk member of the family related 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: Absence of responsible member Financial constraints 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 members. K. Altered role performance, specify. Role denials or ambivalence, Role strain, Role dissatisfaction, Role conflict, Role confusion, Role overload L. Others. Specify._________ 4. Inability to provide a home environment conducive to health maintenance and personal development related to: A. Inadequate family resources specifically: Financial constraints/limited financial resources 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 I. Lack of adequate competencies in relating to each other for mutual growth and maturation Example: 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._________ 5. Inability to utilize community resources for health care related 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 : Physical/psychological consequences Financial consequences Social consequences F. Unavailability of required care/services G. Inaccessibility of required services due to: Cost constraints Physical inaccessibility H. Lack of or inadequate family resources, specifically Manpower resources, e.g. baby sitter 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 K. Others, specify __________  I. PROBLEM LIST Health Supporting Family Nursing condition/ Data/ Cues Problem problem 1. Presence of Health Spread of scabies Presence of poor Threats: among family lifestyle and Unhealthy lifestyle members that started personal habits as a practices and with one family health threat: personal habits member only 1. Inability specifically to provide a poor personal home environment hygiene. conducive to health maintenance and contracting the disease and treatment.  II. PROBLEM LIST Health Supporting Family Nursing condition/ Data/ Cues Problem problem Presence of scabies as a 2. Presence of health The head of the family health deficit: deficits: Scabies verbalized,“Lima na 1. Inability to decide kabulan na ga antos about making kami sg ka katol bag-o appropriate health na check sg doctor” action due to failure to comprehend the Presence of scabies magnitude of the among all family problem. members 2. Inability to provide adequate nursing care to the sick members of the family due to lack of knowledge about the disease 'nature, severity, complication,  III. PROBLEM LIST Health Supporting Family Nursing condition/ Data/ Cues Problem problem 3. Presence of Health Three family lives Presence of big family Threats: together in one house size as a health Family size a total of members threat: beyond where only members what family are working and are 1. Inability to provide resources. not gaining enough to a home environment meet basic needs conducive to health maintenance and personal development due to a limited financial resources.   FAMILY NURSING CARE PLAN (FNCP) FAMILY GOALS/ NURSING NURSING OBJECTIVES INTERVENTIO EVALUATION DIAGNOSIS OF NURSING N CARE 1. Assess the Goal partially met. Inability to provide After nursing family’s level of After _ weeks of a home understanding nursing environment intervention regarding the intervention the conducive to the family will problem family acquired health be able to: Identified. sufficient maintenance R/T identify the 2.Establish knowledge and lack of knowledge rapport from the understand the about proper different way family. importance of disposal of of proper 3.Demonstrate practicing the garbage disposal of proper ways on proper method of garbage how to segregate waste disposal. Objective Cues: waste  Garbage 4. Encourage scattered family to clean everywhere their surroundings  EXAMPLE OF HEALTH PROBLEMS: Improper Waste Disposal Poor Personal Hygiene Presence of Fire Hazards Alcoholic drinking Cigarette Smoking Nutritional Imbalance Improper Food Handling Poor Water Supply or No Potable Water Supply Poor Toilet Facility Inadequacy of living space Presence of breeding or resting sites of vectors of diseases Family size beyond what family resources SCALE FOR RANKING FAMILY HEALTH CONDITONS/ PROBLEMS ACCORDING TO PRIORITIES:  PRIORITIZING HEALTH PROBLEMS 1. Nature of the Problem  Categorized into HD, HT, FC 2. Modifiability of the  Refers to the probability problem of success in minimizing, alleviating or totally eradicating the problem through intervention. 3. Preventive Potential  Refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration. 4. Salience  Refers to the family’s perception and evaluation  The nurse considers the availability of the following factors in determining the modifiability of a health condition or problem: 1) Current knowledge, technology and interventions to enhance the wellness state or manage the problem. 2) Resources of the family-physical, financial and manpower 3)Resources of the nurse- knowledge, skills and time 4) Resources of the community-facilities and community organization or support. Modifiability of a health condition  To decide on an appropriate score for the preventive potential of a health condition or problem, the following factors are considered: 1)Gravity or severity of the problem—refers to the progress of the disease/problem indicating extent of damage on the patient/family; prognosis, reversibility or modifiability of the problem. 2) Duration of the problem- length of time the problem has been existing. Preventive potential of a health condition or problem  3)Current management—presence of appropriateness of intervention measures instituted. 4)Exposure of any vulnerable or high risk group- increases the preventive potential of a condition or problem Preventive potential of a health condition  Criteria Score Weight I. Nature of the condition  Health Deficit (HD) 3  Health Threat (HT) 2 1  Foreseeable Crisis (FC) 1 II. Modifiability of the condition Easily Modifiable 2 Partially modifiable 1 2  Not modifiable 0 III. Preventive Potential High 3 Moderate 2 1 Low 1 IV. Salience of the Problem Problem needing immediate attention 2 Problem not needing immediate 1 attention 0 1  SCORING: 1. Decide on a score for each of the criteria 2. Divide the score of the highest possible score and multiply by the weight Formula : SCORE/HIGHEST SCORE X WEIGHT 3. Sum up the score for all the criteria the highest score is equivalent to the total weight.  Scale for Ranking Health Conditions According to Priorities: 1. Unhealthy lifestyle practices and personal habits specifically poor personal hygiene Criteria Computation Actual Score Justification Nature of the 2/3X1 0.6 It is a health threat Problem does not demand immediate action Modifiability of 2/2X2 2 The resources and the Problem interventions needed to solve the problem are available to the family. Preventive 3/3X1 1 Occurrence of Potential diseases can be prevented if proper personal hygiene will be practiced Salience 0/2X1 0 The family does not recognize it as a problem. TOTAL 3.6  Scale for Ranking Health Conditions According to Priorities: 2. Presence of Scabies Criteria Computation Actual Score Justification Nature of the 3/3X1 1 It is a health Problem deficit that requires immediate attention & management to minimize transmission Modifiability of 1/2X2 1 The family lack the Problem resources to solve the problem. Preventive 3/3X1 1 Aggravation of Potential scabies can be reduced or eliminated if managed as soon as possible Salience 0/2X1 0 The family does not recognize it as a problem.  Scale for Ranking Health Conditions According to Priorities: 3. Family size beyond what family resources Criteria Computation Actual Score Justification Nature of the 2/3X1 0.6 It is a health Problem threat does not demand immediate action. Modifiability of 1/2X2 1 Problem can be the Problem partially modified due to inadequacy of resources. Preventive 3/3X1 1 Can be Potential moderately prevented by applying family planning. Salience 0/2X1 0 The family does not recognize it as a health threat. TOTAL 2.6 SCALE RANKING RESULT: HEALTH RANK CONDITION/ TOTAL SCORE PROBLEM Unhealthy lifestyle 1 practices and 3.6 personal habits specifically poor personal hygiene 2 Presence of 3 Scabies 3 Family size beyond 2.6  Criteria Incomplete Poor Fair Good 4pts. 6pts. 8pts. 10 pts. Assessment Assessment Does not include Includes all Includes all portion is all pertinent data pertinent data pertinent data incomplete. related to nursing related to nursing related to nursing diagnosis. May diagnosis, but diagnosis and also include data also includes data does not include that does not not related to data that is not relate to nursing nursing diagnosis. related to nursing diagnosis. diagnosis. Diagnosis Diagnosis portion Diagnosis is not Diagnosis is Diagnosis is is incomplete. appropriate for appropriate for appropriate for client and ordinal client and ordinal client and ordinal level (first level. level. and diagnosis, second diagnosis diagnosis etc). also includes all. parts and information is listed in correct part of diagnosis Family Nursing Care Plan Rubric (50 Points)  Criteria Incomplete Poor Fair Good 4pts. 6pts. 8pts. 10 pts. Planning Goal portion is Goal statement is not Goal statement is Goal statement is incomplete. client or family client or family client or family oriented and may not oriented, and oriented, and contains have measurable contains at least one two measurable criteria or a target measurable criteria criteria and a target date or time. or a target date/time. date or time. Implementation Interventions portion Interventions portion Interventions portion Interventions portion is incomplete. does not include contains adequate contains adequate adequate number of number of number of interventions to help interventions to help interventions to help client/family meet client/family meet client/family meet goal. goal. goal. Evaluation Evaluations portion Evaluation portion Evaluation portion Evaluation portion is incomplete. does not contain data does contain data does contain data that that is listed as that is listed as is listed as criteria in criteria in goal criteria in goal goal statement. Does statement. May also statement, but does describe goal as met, not describe goal as not describe goal as partially met, or not met, partially met, or met, partially met, or met. If goal was not met. May also not not met. May also partially met or not Family Nursing Care Plan Rubric include revision or new evaluation not include revision or new evaluation met, includes revision and/or new evaluation date/time. date/time. date/time.