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Family Nursing Care Plan Template

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FAMILY NURSING CARE PLAN TEMPLATE

1. Family Profile

 Family Name:
 Address:
 Date:
 Family Members:
o Name, Age, Sex, Occupation, Educational Attainment, Relationship to Family
Head, Immunization Status, Health Conditions (if any)

2. Family Structure and Composition

 Family type (e.g., nuclear, extended, single-parent)


 Social and economic status (e.g., source of income, household income)
 Housing and environmental conditions (e.g., sanitation, living space, neighborhood
conditions)

3. Health and Nutritional Status

 Nutritional Status (e.g., BMI, special dietary requirements, feeding patterns)


 Growth and Development Status (for children)
 Immunization Status (for children, older adults, or vulnerable members)

4. Health Problems/Issues Identified

(Identify health issues for each family member. For example, chronic diseases, disabilities,
mental health issues, poor sanitation, etc.)

Family Member Identified Health Issue/Concern Severity/Impact on Family

5. Family Health History

(Identify past health conditions or hereditary diseases affecting family members)

6. Risk Factors

(Assess factors such as lifestyle, genetic predisposition, environment, occupation, etc.)

Risk Factors Level of Risk Priority

7. Nursing Diagnoses

List specific nursing diagnoses based on the family assessment using the NANDA-I framework.
Example:

 Diagnosis 1: Impaired home maintenance related to environmental hazards as evidenced


by poor sanitation and cluttered living conditions.
 Diagnosis 2: Risk for imbalanced nutrition related to poor food intake, lack of dietary
knowledge, and financial constraints.

8. Goals and Objectives

Short-term Goals: (Specific, measurable, attainable, realistic, and time-bound)

 E.g., "The family will demonstrate proper sanitation practices within 1 month."

Long-term Goals:

 E.g., "The family will maintain a healthy, disease-free environment in the next 6
months."

9. Plan of Action

This includes nursing interventions and their rationale for achieving the identified goals.

Nursing Nursing
Goals/Objectives Rationale Timeline Evaluation
Diagnoses Interventions
- Educate family
members on Education
proper sanitation promotes Family members
methods. awareness and demonstrate
Diagnosis Improve home
- Collaborate with encourages better 1 month improved
1 sanitation practices
community home sanitation
services to provide management techniques.
sanitation practices.
resources.
- Conduct
nutrition
education session.
Family adopts
- Develop a Education
and follows
Diagnosis Improve nutritional budget-friendly, improves food 1-2
meal plan, with
2 intake nutritious meal selection and months
improved
plan. preparation skills.
dietary habits.
- Refer to a
dietitian if
necessary.

10. Implementation
 Documentation of actual interventions carried out (e.g., family counseling, home visits,
educational sessions, referrals).

11. Evaluation

 Evaluate the outcome based on the goals set.


 E.g., "Family now demonstrates proper sanitation, with marked improvement in the home
environment."

Nursing
Goal/Objective Outcome Continue/Revise
Diagnosis
The family has decluttered their living space
Improve home
Diagnosis 1 and follows proper waste disposal methods Continue
sanitation
as instructed.
Family has started to prepare and consume
Improve
Diagnosis 2 more balanced meals, but further education Revise
nutritional intake
is needed to maintain consistency.

12. Recommendations and Follow-up

 Future nursing interventions and follow-up plans to ensure continued care.

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