DEVELOPING A FAMILY

NURSING CARE PLAN

Group 2
MAN_2008
AUL
F N C P : defined

Blueprint of the care that the N designs to

systematically minimize or eliminate the
identified health and family nsg problems
through explicitly formulated outcomes of
care and deliberately chosen sets of
interventions, resources and evaluation
criteria, standards, methods and tools.
 CHARACTERISTICS OF FNCP
Focuses on action to Relates to the future;
solve/minimize projects future
existing problems scenario

A product of Based upon the

deliberate systematic identified health and
process – data nursing problems –
analyses problems are starting
points
Cont…
It is a means to an A continuous process
end, not an end in – must be evaluated
itself – deliver the for its effectiveness
most appropriate care
to the ct by
eliminating barriers to
family health
development
DESIRABLE QUALITIES OF FNCP

 It should be based on clear, explicit

definition of the problems.
= Must be based on comprehensive
analysis of the problem

 A good plan is realistic

Cont…
 Prepared jointly with the family.
= N works with the family; not works for the
family
= N involves family in determining the health
needs & problems, priorities, appropriate
actions, implementation and evaluation of
outcomes

 A means of communication (within the

profession and other professions)
 IMPORTANCE OF PLANNING CARE

Individualizes patient care.

Sets priorities by providing information abt
the ct; his nature of problems.
Promotes systematic communication
involved in care.
Continuity of care is facilitated, prevents
gaps and duplication of care.
Coordinates care to other health team
members.
 THE ASSESSMENT PHASE OF THE
NURSING PROCESS GENERATES
THE HEALTH AND NURSING
PROBLEMS WHICH IS THE BASIS
OF DEVELOPING THE FNCP.
STEPS

I. PRIORITIZATION OF PROBLEMS

III. SETTING THE GOALS AND

OBJECTIVES

V. PLANNING INTERVENTIONS

VII. EVALUATION OF CARE

Prioritizing the
Health Problems
c) Nature of the problem Development of Evaluation Plan
d) Modifiability •Criteria
e) Preventive potential •Standards
f) Salience •Methods / tools

Selection of Appropriate
Nursing Interventions
•Consider alternatives
Formulation of Goals and •Decide on appropriate
Objectives of Nursing Care measures
•Determine methods of
nurse-family contact
•Specify resources
I. PRIORITIZATION OF
PROBLEMS
 Devised by Maglaya and Bailon
 Known as SCALE FOR RANKING
FAMILY HEALTH PROBLEMS
ACCORDING TO PRIORITIES
 Has four (4) criteria for setting
priorities
SCALE FOR RANKING
FAMILY HEALTH
PROBLEMS ACCORDING
TO PRIORITIES
FOUR CRITERIA:

1) NATURE OF THE PROBLEM

a) health threat
b) health deficit
c) foreseeable crisis
2) MODIFIABILITY OF THE PROBLEM
- the probability of success in minimizing,
alleviating or totally eradicating the
problem through intervention

3) PREVENTIVE POTENTIAL
- 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
- the family’s perception and evaluation of the
problem in terms of seriousness and urgency
of attention needed
 SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCDG
TO PRIORITIES
Criteria
Weight
1) Nature of the Problem 1
scale: Health Deficit 3
Health Threat 2
Foreseeable Crisis 1
2) Modifiability of the Problem 2
scale: Easily Modifiable 2
Partially modifiable 1
Low 0
3) Preventive Potential 1

scale: High 3
Moderate 2
Low 1
4) Salience 1
scale: Serious px, imm. Attn 2
Px, not needing imm. Attn 1
Scoring

1) Decide on a score for each

criteria
2) Divide the score by the highest
possible score and multiply by
the weight : score/highest score
x weight
3) Sum up the scores for all
criteria. The highest score is 5,
equivalent to the total weight.
 Fxs Affecting
Priority - Setting
 Greater weight on Health Deficit
= needs more immediate attn
and felt by the pt over a health
threat
 Foreseeable crisis = lowest score
d/t culture-linked variables/factors
that provide our ct with adequate
support to cope
 Fxs in Determining the
Modifiability of the
Problem
 Current knowledge, tech. and
interventions to manage the
problem
 Resources of the family –
physical, financial, manpower
 Resources of the N – S, K, time
 Resources of the community –
facilities and community
org/support
Fxs Affecting the Scoring
of Preventive Potential
 Gravity / severity of  Duration of the px
the px = length of time the
= dse progression, px has been existing
extent, damage on
the pt/fam  Current
management
= the more severe
or advanced, the = appropriateness
of intervention
lower is the instituted
preventive potential
 Exposure to any
high risk group
 SALIENCE OF THE
PROBLEM
 Perception of the pt/fam of the
problem
 Family’s concerns and felt needs
II. FORMULATION OF GOALS AND
OBJECTIVES OF NURSING CARE
GOALS OBJECTIVES
General statement of More specific statements
the condition or state to of desired results or
be brought about by outcomes of care
specific courses of Specify the criteria by
action which the degree of
effectiveness of care are to
Client outcomes be measured
Goals tell where the Must be specific in order
family is going to facilitate its attainment
Milestones to reach the
destination
GOALS

 Must be set together with the family

 Family must be able to recognize and
accept the presence of existing health
needs and problems.
 Nurse must ascertain the family’s
knowledge and acceptance of the
problems and the desire to make actions
to resolve them.
 BARRIERS TO GOAL-SETTING
1) Failure of the family to perceive the
existence of the problem.
= family may feel satisfied with the
existing situation

2) Family is too busy with other concerns or

preoccupations at the moment.
Cont…

3) Family does not see the existence of a

problem as serious enough to necessitate
attention

4) Family may perceive the problem and the

need to take action, but they face to do
something about the situation.
Reasons for Not Doing Any Action
1) Fear of consequence 3) Failure to perceive
of doing action the benefits of action
proposed
= social stigma /
financial reasons = previous experience

2) Respect for tradition 4) Failure to relate the

proposed action to
the family’s goals
Cont… BARRIERS TO GOAL-SETTING

5) Failure between the nurse and the family

to establish a working relationship.

= TRUST AND CONFIDENCE

 TIME SPAN OF OBJECTIVES
1) Short Term / Immediate Objectives
- immediate att’n; results: can be
observed in a period of short time
2) Medium – Term / Intermediate Objectives
- required to attain long – term objectives
3) Long – Term or Ultimate Objectives
- several N-F contact + more resources
- takes time to see the result
III. SELECTION OF APPROPRIATE
NURSING INTERVENTIONS
 N must choose among set of alternatives
 N must specify the most effective or
efficient method of N-F contact
• Home visit
• Clinic conference
• Visit in the work, place, school
• Telephone call
• Group approach
• Mail
Cont…
 N must specify the most effective or
efficient resources
 Teaching kits – visual aids, handouts,
charts
 Human – other team members,
community leaders
HOW TO CHOOSE THE APPROPRIATE
NURSING INTERVENTION?

A. Analyze w/ the Family the Current Situation

and Determine Choices and Possibilities
based on a Lived Experience of Meanings
and Concerns
B. Develop / Enhance Family’s Competencies
as Thinker, Doer and Feeler
C. Focus on Interventions to Help Perform the
Health Tasks
D. Catalyze Behavior Change through
Motivation and Support
 A. EXPLORATION W/ FAMILY
CHOICES/POSSIBILITIES BASED ON LIVED
EXPERIENCE OF MEANINGS AND CONCERNS

 N.I. is dependent upon lived meaning

of the experiences of family member
w/ each other and the nurse
 FAMILY is the active participant in the
applc’n of Nsg. Process
 FAMILY & NURSE are participants in
active, mutual, dynamic interchange
of realities, concerns and resources
 They both need to analyze & understand
the current health/illness situation
 Nurse must explore w/ the F the
possibilities and choices presented by
current situation
 Meanings
 Concerns
 Social relations
 Resources
B. DEVELOPING/ENHANCING COGNITION,
VOLITION AND EMOTION

 Provides the family ways to be

THINKER, DOER & FEELER

 THINKER – N must be able to share

info/knowledge; must be accessible
for ease and confidence in
understanding current situations and
health/illness
DOER – N must enhance confidence to
the F in carrying out/initiating and
sustaining change for health promotion
& maintenance, and accurate dse mgt.

FEELER – N must help the F strengthen

its affective competencies in order to
appropriately acknowledge &
understand emotions generated by
family life or health illness situations;
so that these emotions will be
transformed into growth-promoting
actions
 C. FOCUSING ON THE INTERVENTIONS TO
HELP THE FAMILY PERFORM THE HEALTH
TASKS
1) Help the F recognize the px.
- information-giving about the nature,
magnitude, cause of the px
- help the F see the implications of the
px
- relate health needs to the goals of
the family
- help the F recognize its
capabilities/qualities and resources
Cont…
2) Guide the F on how to decide on
appropriate health actions to take.
- identify/explore the courses of
action + resources available
- discuss the consequences of each
courses of action
- analyze together w/ the F the
consequences of inaction
Cont…
3) Develop the F’s ability and
commitment to provide nursing care
to its members.
- nsg care to sick, disabled,
dependent member/s 
demonstration / practice sessions on
procedures/tx, techniques
= use of low-cost, available resources
CONTRACTING
 Maximizes opportunities to develop the
ability & commitment of the family to
provide nsg care to its members
 N creates a situation in order that the ct
learns to achieve a specific health-related
behaviour through steps and conditions or
elements jointly identified by both parties
 Uses positive reinforcement
4) Enhance the capability of the F to provide a
home env’t conducive to health maintenance
and personal dev’t.
- env’t modification, manipulation,
management to reduce health threats/risks

5) Facilitate the F’s capability to utilize

community resources for health care.
- coordination, collaboration, team work
 referral system
 D. CATALYZING BEHAVIOR CHANGE
THROUGH MOTIVATION & SUPPORT
 There should be an env’t that nurtures
change
 There should be support from both parties
in order to make a change
 MOTIVATION & SUPPORT
 Enhance the F’s knowledge and willingness
to prevent, control health pxs
 Makes the F skillful, emotionally stable and
creative handling the stresses/issues
surrounding them
MOTIVATION: described
 Any experience or information that
leads the family to desire and agree
to undergo the behavior change or
proposed measure and takes the
initial action to bring about a change
SUPPORT: described
 Any experience or information that
maintains, restores or enhances the
capabilities or resources of the family
to sustain these actions and complete
the change process  feelings of
security and in control of the px
(family)
DEVELOPING THE EVALUATION
PLAN
 Specifies how the N will determine
achievement of the outcomes of care
 Criteria, standards, evaluation
methods and sources of data