COMMUNITY HEALTH NURSING MIDTERM LESSON 1 1

FAMILY CARE PLAN 4. The nursing care plan is most useful in written
form.
Definition
IMPORTANCE OF PLANNING CARE
It is the blueprint of the care that the nurse designs to
systematically minimize or eliminate the identified 1. They individualize care to clients.
health and nursing problem through explicitly 2. The nursing care plan helps in setting priorities by
formulated outcomes of care (goals and objectives) and providing information about the client as well as the
deliberately chosen to set of interventions, resources nature of his problem.
and evaluation criteria, standards, methods and tools. 3. The nursing care plan promotes systematic
communication among those involve in the health
CHARACTERISTICS, WHICH ARE BASED ON THE
care effort.
CONCEPT OF PLANNING AS A PROCESS:
4. Continuity of care is facilitated through the use of
1. The nursing care plan focuses on actions, which are nursing care plans.
designed to solve or minimize existing problem.  Gaps and duplications in the services provided are
minimized, if not totally eliminated.
 The cores of the plan are the approaches,
5. Nursing care plans facilitate the coordination of care
strategies, activities, methods and materials, which
by making known to other members of the health
the nurse hopes will improve the problem.
team what the nurse is doing.
2. The nursing care plan is a product of the liberated
STEPS IN DEVELOPING CARE PLAN
systematic process.
1. The prioritized conditions of the problem
3. The nursing care plan as with all other plans relates to
2. Goals and objectives of the nursing care
the future.
3. The plan of interventions
 It utilizes events in the past and what is happening 4. The plan for evaluating care
in the present to determine patterns. It also PRIORITIZING HEALTH PROBLEMS
projects the future scenario if the situation is not FOUR CRITERIA FOR DETERMINING PRIORITIES:
corrected.

4. The nursing care plan is based upon identified health 1. Nature of the condition or problem – categorized
and nursing problems. into wellness state/potential, health threat, health
5. The nursing care plan is a means to an end, not an deficit of foreseeable crisis.
end in itself. 2. Modifiability of the condition or problem-refers to
 The goal in planning is to deliver the most the probability of success in enhancing the wellness
appropriate care to the client by eliminating barriers state improving the condition minimizing, alleviating or
to the family health development. totally eradicating the problem through intervention.

6. The nursing care plan is a continuous process not a 3. Preventive potential-refers to the nature and
one shot deal. magnitude of future problem that can be minimized or
totally prevented if interventions are done on the
 The results of evaluation of the plan’s effectiveness condition or problem under consideration.
trigger another cycle of the planning process until
the health and nursing problems are eliminated. 4. Salience-refers to the family’s perception and
evaluation of the condition or problem in terms of
DESIRABLE QUALITIES OF A NURSING CARE PLAN seriousness and urgency of attention needed or family
1. It should be based on a clear, explicit definition of readiness.
the problem(s).
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the
family.
 COMMUNITY HEALTH NURSING MIDTERM LESSON 1 2

FACTORS AFFECTING PRIORITY SETTING  OBJECTIVE-refers to a more specific statement of

Nature of the problem the desired results or outcomes of care. They
 The biggest weight is given to the wellness state or specify the criteria by which the degree of
potential because of the premium on the client's effectiveness of care is to be measured.
effort or desire to sustain/maintain a high level of  A cardinal principle in goal setting states that goals
wellness. must be set jointly with the family. This ensures
 The same weight is given to health deficit because family commitment to realization.
of its sense of clinical urgency, which may require  Basic to the establishment of mutually acceptable
immediate intervention. goals is the family’s recognition and acceptance of
 Foreseeable crises are given the least weight existing health needs and problems.
because culture linked variables/factors usually
Barriers to Joint Goal Setting Between the Nurse and
provide our families with adequate support to cope
the Family:
with developmental or situational crises.
1. Failure on the part of the family to perceive the
MODIFIABILITY IF THE PROBLEM
existence of the problem.
 Current knowledge, technology and interventions to 2. The family may realize the existence of the health
enhance the wellness state or manage the problem. condition or problem but is too busy at the
 Resources of the family moment.
 Resources of the nurse 3. Sometimes the family perceives the existence of the
 Resources of the community problem but does not see it as serious enough to
warrant attention.
PREVENTIVE POTENTIAL
4. The family may perceive the presence of the
 Gravity or severity of the problem- refers to the problem and the need to take action. It may
progress of the disease/problem indicating extent however refuse to face and do something about the
of damage on the patient/family; also indicates situation.
prognosis, reversibility or modifiability of the
REASONS TO THIS KIND OF BEHAVIOR:
problem. In general, the more severe the problem
is, the lower is the preventive potential of the 1. Fear of consequences of taking actions.
problem. 2. Respect for tradition.
 Duration of the problem-refers to the length of 3. Failure to perceive the benefits of action.
time the problem has existed. Generally speaking, 4. Failure to relate the proposed action to the
duration of the problem has a direct relationship to family’s goals.
gravity; the nature of the problem is variable that 5. A big barrier to collaborative goal setting between
may, however, alter this relationship. Because of the nurse and the family is the working
this relationship to gravity of the problem, duration relationship.
has also a direct relationship to preventive
FOCUS ON INTERVENTIONS TO HELP THE FAMILY
potential.
PERFORMS HEALTH TASKS:
 Current management-refers to the presence and
appropriateness of intervention measures instituted 1. Help the family recognize the problem
to enhance the wellness state or remedy the
 Increasing the family’s knowledge on the nature,
problem. The institution of appropriate intervention
magnitude and cause of the problem.
increases the condition's preventive potential.
 Helping the family see the implications of the
 Exposure of any vulnerable or high-risk group-
situation or the consequences of the condition.
increases the preventive potential of condition or
problem  Relating the health needs to the goals of the family.
 Encouraging positive or wholesome emotional
FORMULATION OF GOALS AND OBJECTIVES attitude toward the problem by affirming the
family’s capabilities/qualities/resources and
 GOAL-is a general statement of condition or state to
providing information on available actions.
be brought about by specific courses of action.
 COMMUNITY HEALTH NURSING MIDTERM LESSON 1 3

2. Guide the family on how to decide on appropriate  It is less expensive for the nurse and provides the
health actions to take. opportunity to use equipment that can’t be taken to
the home. In some cases, the other team members
 Identifying or exploring with the family courses of
in the clinic may be consulted or called in to provide
action available and the resources needed for each.
additional service.
 Discussing the consequences of action available.
 Analyzing with the family of the consequences of Telephone Conference
inaction.
 May be effective, efficient, and appropriate if the
3. Develop the family’s ability and commitment to objectives and outcomes of care require immediate
provide nursing care to each member. access to data given problems on distance or travel
time. Such data include monitoring of health status
 Contracting-is a creative intervention that can or progress during the acute phase of an illness
maximize the opportunities to develop the ability state, change in schedule of visit or family decision,
and commitment of the family to provide nursing and updates on outcomes or responses to care and
care to its members. treatment.
4. Enhance the capability of the family to provide a Written Communication
home environment conducive to health maintenance
and personal development.  It is another less time consuming option for the
nurse in instances when there are a large number of
 The family can be taught specific competencies to families needing follow-up on top of problems of
ensure such a home environment through distance or travel time.
environmental manipulation or management to
minimize or eliminate health threats or risks or to School Visit or Conference
install facilities of nursing care.  It is done to work with family and school authorities
5. Facilitate the family’s capability to utilize on how to appraise the degree of vulnerability of
community resources for health care. and worked out interventions to help children and
adolescence on specific health risks, hazards or
 Involves maximum use of available resources adjustment problems.
through the coordination, collaboration and
teamwork provided by an effective referral system. Industrial or Job Site Visit

Criteria for Selecting the Type of Nurse Family Contact  It is done when the nurse and family need to make
an accurate assessment of health risks or hazards
1. Effectivity and work with the employer or supervisor on what
2. Efficiency can be done to improve provisions for health and
3. Appropriateness safety of workers.
TYPES OF NURSE FAMILY CONTACT IMPLEMENTING THE NURSING CARE PLAN
Home Visit  During this phase, the nurse encounters the realities
 While it is expensive in terms of time, effort and in family nursing practice that motivates her to try
logistics for the nurse, it is an effective and out creative innovations or overwhelm her to
appropriate type of family nurse contact if the frustration or inaction. A dynamic attitude on
objectives and outcomes of care require accurate personal and professional development is,
appraisal of family relationship, home and therefore, necessary if she has to face up challenges
environment and family competencies. i.e. The best of nursing practice.
opportunity to serve the actual care given by family IMPLEMENTATION PHASE: A
members. PHENOMENOLOGICAL EXPERIENCE
Clinic or Office Conference Meeting the challenges of this phase is the essence of
family nursing practice. During this phase, the nurse
 COMMUNITY HEALTH NURSING MIDTERM LESSON 1 4

experiences with the family a lived meaningful world of 2. Maximizing caring possibilities for personal and
mutual, dynamic interchange of meanings, concerns, professional development
perceptions, biases, emotions and skills. Just as the self
COMPETENCY-BASED TEACHING
aims to achieve body-mind integration to achieve
wholeness in the experience of “being” and “becoming”  A substantive part of the implementation phase is
in expert caring. Unless there is such a dynamic and directed towards developing the family’s
active involvement between the nurse and the family in competencies to perform the health tasks.
understanding and making choices in this meaningful Competencies include the cognitive (knowledge),
world of coping, aspirations, emotions and skills the psychomotor (skills) and attitudinal or
nurse can’t hope to achieve expert caring. affective(emotions, feelings, values). The following
are examples of these family health competencies
EXPERT CARING: METHODS AND
POSSIBILITIES using the corresponding health task in our case
illustration:
 Expert caring in the implementation phase is  Health Task: The family recognizes the possibility of
demonstrated when the nurse carries out cross-infection of scabies to other family members.
interventions based on the family’s understanding
of the lived experience of coping and being in the COGNITIVE COMPETENCY:
world. Expert caring is developing the capability of 1. The family explains the cause of scabies.
the family to “engage care” through the nurse's 2. The family enumerates ways by which cross-
skilled practice, the family learns to choose and infection of scabies can occur among the family
carry out the best possibilities of caring given the members.
meanings, concerns, emotions and resources(skills 3. Health Task: The family provides a home
& equipment) as experienced in the situation. While environment conducive to health maintenance
the challenge for expert caring is a reality, the nurse and personal development of its members.
is enriched as a result of such an experience
(Benner & Wrubel 1989). PSYCHOMOTOR COMPETENCY:
 By being experts in caring, nurses must take over 1. The family carries out the agreed-upon
and transform the notions of expertise. Expert measures to improve home sanitation and
caring has nothing to do with possessing privileged personal hygiene of family members.
information that increases one’s control and 2. Health Task: The family decides to take
domination of another. Rather, expert caring appropriate health action.
unleashes the possibilities inherent in the self and
the situation. Expert caring liberates and facilitates ATTITUDINAL OR AFFECTIVE COMPETENCIES:
in such a way that the one caring is enriched in the
1. Family members express feelings or emotions
process.
that act as barriers to decision-making.
 While expert caring does not happen overnight to
2. Family members acknowledge the existence of
the novice nurse, there are methods and
these feelings or emotions.
possibilities that can enhance learning towards
 In order to systematically work towards
expert caring. Such methods and possibilities need
development of the family’s competencies, such
to be carried out and experienced in real contexts
competencies need to be explicitly defined.
and real relationships to achieve skillful
Cognitive and psychomotor competencies are
comportment and excellence in the current
reflected explicitly as objectives in the family
situation.
nursing care plan. The attitudinal or affective
TWO SUCH MAJOR METHODS AND competencies may also be translated into the
POSSIBILITIES: objective of care as feelings, emotions or
philosophy in life that enhance the family’s desire or
1. Performance-focus learning through
commitment to behavior change and sustain the
competency-based teaching
needed action.
 COMMUNITY HEALTH NURSING MIDTERM LESSON 1 5

LEARNING PRINCIPLES AND TEACHING- LEARNING  Exploring with the family how modifications can be
METHODS AND TECHNIQUES THAT THE NURSE CAN carried out to maximize situated possibilities or best
USE IN COMPETENCY-BASED TEACHING: options.

1. Learning is both an intellectual and emotional

process.
2. Learning is facilitated when experience has
meaning.
3. Learning is an individual matter.

LEARNING IS BOTH INTELLECTUAL AND EMOTIONAL

PROCESS
Criteria Computat Actual Justification
SIX GENERAL METHODS AND TECHNIQUES:
ion Score
1. Nature 2/3 x 1 2/3 Family size beyond what
1. Provide information to shape attitude
of the family can adequately provide
2. Provide experiential learning activities to shape Problem as a Health Threat.
attitudes 1. Inability to make
decisions with respect to
3. Provide examples or models to shape attitudes taking appropriate health
4. Providing opportunities for small group discussion actions due to lack of
1 knowledge as to alternative
5. Role playing exercises 2.Modifiab 1/2 x 2 courses of action open to the
6. Explore the benefits of power of silence ility of the family.
Problem
LEARNING IS FACILITATED WHEN EXPERIENCE HAS 1 The problem can be partially
modified since the client
MEANING
knows some ways on how to
3.Preventiv 3/3 x 1
reduce the increasing size of
1. Analyze and process family members all teaching- e Potential the family but not utilizing it.
learning based on their grasp on the live experience 1
of the situation in terms of the meaning for the self. The possibility of increasing
4. Salience 2/2 x 1 family size is reduced: the
2. Involve the family actively in determining areas for available family resources can
teaching-learning based on the health tasks that be utilized to encourage
growth promoting experience
members made to perform. for members.
3. Used examples or illustrations that the family is
familiar with. The family perceives it as a
problem needing immediate
attention.
LEARNING IS INDIVIDUAL MATTER: ENSURE MASTERY
OF COMPETENCIES FOR SUSTAINED ACTIONS: TOTAL SCORE 3.7
Some Techniques to Develop Mastery:
Criteria Computatio Actual Justification
1. Make the learning active by providing opportunities n Score
for the family to do specific activities, answer 1. Nature of 2/3 x 1 2/3 Inadequate living space
the Problem as a Health Threat.
questions or apply learning in solving problems. 1. Inability to provide a
2. Ensure clarity. Use words, examples, visual home environment
materials and handouts that the family can conducive to health
maintenance and
understand. 2. 0/2 x 2 0 personal development
3. Ensure adequate evaluation, feedback, monitoring Modifiability due to inadequate family
of the resources, specifically
and support for sustained action by:
Problem 3/3 x 1 1 financial constraints.
 Explaining well how the family is doing
 Giving the necessary affirmations or reassurances 3.Preventive The problem can be
Potential lowly modified because
 Explaining how the skill can be improved the family has difficulty
0/2 x 1 0
proving themselves a
bigger place to live.
4. Salience
 COMMUNITY HEALTH NURSING MIDTERM LESSON 1 6

By increasing the living resources from the community

space, it will reduce the and from the family itself
transferability of (income).
communicable diseases;
provide privacy for If the quality and quantity of
members, and bigger food is increased, there will be
space to allow free lesser risk of malnutrition that
movements. can lead to other problems.

The family doesn't see Family views this as a problem

this as a problem as long that needs immediate action.
as they have shelter. TOTAL SCORE
3.3
TOTAL SCORE 1.6

Criteria Computa Actual Justification

Criteria Computation Actual Justification tion Score
Score 1. Nature of 2/3 x 1 2/3 Toddlers walking barefooted
1. Nature of 2/3 x 1 2/3 Poor Lighting and Ventilation the Problem as a Health Threat.
the Problem as a Health Threat. 1. Inability to
1. Inability to recognize the presence of the
provide a home environment condition or problem due to
conducive to health inadequate knowledge.
maintenance due to limited 2. 1/2 x 2 1 2. Inability to
financial resources. Modifiability provide a home environment
2. 1/2 x 2 1 2. Failure to utilize of the conducive to health
Modifiability community resources for Problem maintenance due to
of the Problem health care due to inadequate knowledge.
3/3 x 1 1 inaccessibility of required 3/3 x 1 1
3. Preventive service due to location of Problem is partially
Potential facility. 3. Preventive modifiable because if
Potential adequate knowledge from
1/2 x 1 1/2 The problem can be partially 0/2 x 1 0 the health personnel is
4. Salience modified because families can given, it can lead the family
ask for possible assistance 4. Salience to be aware of the existing
from the community problem which in turn will
resources. take immediate action.

By increasing the lighting and If the family is given

ventilation, family will adequate knowledge, there
experience better home will be lesser risks for the
conducive for individual toddlers to acquire diseases
comfort and growth. from the outside
environment without self
The family perceives it as a protection.
problem not needing
immediate attention. The family does not view
TOTAL SCORE this as a problem.
3.16 TOTAL SCORE
2.7

Criteria Computa Actual Justification

tion Score Criteria Computation Actual Justification
1. Nature of the 2/3 x 1 2/3 Inadequate food Intake both in Score
Problem quality and quantity as a Health 1. Nature of 2/3 x 1 2/3 Inadequate immunization
Threat. the Problem status as a Health Threat.
1. Inability to provide 1. Inability to make
home environment conducive to decisions with respect to
health maintenance due to taking appropriate health
limited financial resources. action due to inadequate
2. Failure to utilize knowledge/ insight as to
2. Modifiability 1/2 x 2 1 community resources for health alternative courses of
of the Problem care due to inadequate 2. 1/2 x 2 1 action open to them.
knowledge of the available Modifiability 2. Failure to
programs of the government of the utilize community
3. Preventive 2/3 x 1 2/3 that aids assistance. Problem resources for health care
Potential due to inaccessibility of
Problem is partially modifiable required service due to
4. Salience 2/2 x 1 1 because family can use the inadequate knowledge.
 COMMUNITY HEALTH NURSING MIDTERM LESSON 1 7

the existing problem

1/3 x 1 1/3 The problem is partially which in turn will make
modifiable upon the immediate action.
3. Preventive consideration of the
Potential following criteria: TOTAL SCORE
-Family manpower 3.6
resources are available;
1/2 x 1 1/2 the family can go to the
Barangay Health Center to
4. Salience avail those vaccines.
Community resources are
available; the Barangay
Health Center offers the
EPI program of the
Department of Health
(DOH).

The problem has a low

preventive potential as
reflected on the following
reasons:
-Many of the
family members are
affected by the problem.
-The family
does not have any
management on this
problem since their
awareness to this problem
is not evident.

The family knows that this

is a problem but perceives
to have no need of
immediate action.
TOTAL SCORE
2.5

Criteria Computation Actual Justification

Score
1. Nature of 2/3 x 1 2/3 Poor Home Sanitation –
the Problem unsanitary toilet
facilities as a Health
Threat.
1. Inability to
recognize the presence
of the condition or
problem due to
inadequate knowledge.
2. 2/2 x 2 2 2. Inability to
Modifiability make decisions with
of the respect to taking
Problem 2/2 x 1 1 appropriate health
action due to low
3. Preventive salience of the problem.
Potential 3. Inability to
0/2 x 1 0 provide a home
environment conducive
4. Salience to health maintenance
due to low salience of
the problem.

The problem is easily

modifiable if adequate
knowledge from the
health personnel is
given. This can lead the
family to be aware of