C. Formulating Family Nursing Care Plan

C.
FORMULATING FAMILY
NURSING CARE PLAN
Family Nursing Care Plan (FNCP) - 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.
Features/Characteristics of FNCP
1. The nursing care plan 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.
2. The nursing care plan 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.
3. The nursing care plan, as with all plans,
relates to the future. It utilizes events in the
past and what is happening in the present to
determine patterns. It also projects the future
scenario if the current situation is not
corrected.
4. The nursing care plan is based upon
identified health and nursing problems. The
problems are the starting points for the plan,
and the foci of the objectives of care and
intervention measures.
5. The nursing care plan is a means to an
end, not an end in itself. The goal in
planning is to deliver the most appropriate
care to the client by eliminating barriers to
family health development.
6. Nursing care planning is a continuous
process, not a one-shot-deal. The results of
the evaluation of the plan’s effectiveness
trigger another cycle of the planning process
until the health and nursing problems are
eliminated.
Desirable Qualities of a Nursing Care
Plan
1. It should be based on clear, explicit
definition of the problem(s).
2. A good plan is realistic.
3. The nursing care plan is prepared
jointly with the family.
4. The nursing care plan is most useful in
written form.
Importance of Planning Care
1. They individualize care to clients.

2. The nursing care plan helps in setting
priorities by providing information about
the client as well as the nature of his
problem.
3. The nursing care plan promotes
systematic communication among those
involve in the health care effort.
4. Continuity of care is facilitated
through the use of nursing care plans.
Gaps and duplications in the services
provided are minimized, if not totally
eliminated.
5. Nursing care plans facilitate the
coordination of care by making known
to other members of the health team
what the nurse is doing.

Steps in Formulating a Family 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. The prioritized condition/s or problems

2. The goals and objectives of nursing care
3. The plan of interventions
4. The plan of evaluating care
• Schematic presentation of the nursing care plan
process. It starts with a list of health condition or
problems prioritized according to the nature,
modifiability, preventive potential and salience.
• The prioritized health condition or problems
and their corresponding nursing problems
become the basis for the next step which is the
formulation of goals
and objectives of
nursing care. The
goals and objectives
specify the expected
health/clinical outcomes,
family response/s,
behavior of
competency
Four Criteria for Determining Priorities
1. Nature of the condition or problem -
categorized into wellness state/potential,
health threat, health deficit of foreseeable
crisis.
2. Modifiability of the condition or
problem -refers to the 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 problem
that can be minimized or totally prevented
if interventions are done on the condition
or problem under consideration.
4. Salience - refers to the family’s

perception and evaluation of the condition
or problem in terms of seriousness and
urgency of attention needed or family
readiness.
Factors Affecting Priority Setting
Nature of the problem
• The biggest weight is given to the wellness state
or potential because of the premium on client’s
effort or desire to sustain/maintain high level of
wellness.
• The same weight is given to health deficit
because of its sense of clinical urgency, which
may require immediate intervention.
• Foreseeable crisis is given the least weight
because culture linked variables/factors usually
provide our families with adequate support to
cope with developmental or situational crisis.
Modifiability of the Problem
• Current knowledge, technology and

interventions to enhance the wellness
state or manage the problem.
• Resources of the family
• Resources of the nurse
• Resources of the community
Preventive Potential
• Gravity or severity of the problem-refers
to the progress of the disease/problem
indicating extent of damage on the
patient/family; also indicates prognosis,
reversibility or modifiability of the
problem.
• In general, the more severe the problem
is, the lower is the preventive potential of
the problem.
Duration of the problem - refers to the
length of time the problem has existed.
Generally speaking, duration of the
problem has a direct relationship to
gravity; the nature of the problem is
variable that may, however, alter this
relationship.
• Because of this relationship to gravity
of the problem, duration has also a direct
relationship to preventive potential.
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
increases condition’s preventive potential.
Exposure of any vulnerable or high risk

group - increases the preventive potential
of condition or problem
Formulation of Goals and Objectives
Goal - is a general statement of condition

or state to be brought about by specific
courses of action.
It is a desired observable family response
to planned interventions in response to a
mutually identified family need.
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.
It defined the desired step by step family
responses as they work toward a goal.
Workable, well stated objectives
should be;
a. Specific - the objective clearly

articulates who is expected to do
what...e.g. a family will manifest a
particular behavior.
Measurable - observable, measurable,
and 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.
Attainable - the objective has to be
realistic and in conformity with available
resources, existing constraints, and
family traits, such as styles and
functioning.
Relevant - the objective is appropriate
for the family need or problem that is
intended to be minimized, alleviated, or
resolved.
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.
* A cardinal principle in goal setting states
that goal must be set jointly with the
family. This ensures family commitment
to realization.
* Basic to the establishment of mutually

acceptable goals is the family’s
recognition and acceptance of existing
health needs and problems.
Barriers to Joint Goal Setting Between
the Nurse and the Family
1. Failure on the part of the family to
perceive the existence of the problem.
2. The family may realize the existence
of the health condition or problem but is
too busy at the moment.
3. Sometimes the family perceives the
existence of the problem but does not see
it as serious enough to warrant attention.
4. The family may perceive the presence of the
problem and the need to take action. It may
however refuse to face and do something about the
situation.
Reasons to this kind of behavior
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the
family’s goals.
5. A big barrier to collaborative goal setting
between the nurse and the family is the working
relationship.
Focus on Interventions to Help the
Family Performs Health Tasks
• 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.

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C.

1. They individualize care to clients.

1. The prioritized condition/s or problems

4. Salience - refers to the family’s

• Current knowledge, technology and

Exposure of any vulnerable or high risk

Goal - is a general statement of condition

a. Specific - the objective clearly

* Basic to the establishment of mutually

• Help the family recognize the problem

• Helping the family see the implications

• Encouraging positive or wholesome

• Contracting - is a creative intervention

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