Family Nursing Care Plan Template
Family Nursing Care Plan Template
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)
(Identify health issues for each family member. For example, chronic diseases, disabilities,
mental health issues, poor sanitation, etc.)
6. Risk Factors
7. Nursing Diagnoses
List specific nursing diagnoses based on the family assessment using the NANDA-I framework.
Example:
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
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.