Maternal, Newborn, and Child and utilization of MNCHN core

Health and Nutrition packages of service

The Current Maternal and Child Health and Four key strategies of MNCHN:
Health Nutrition  Ensuring universal access to and
Neonatal Deaths within the 1st week of utilization of an MNCHN core
life are often due to asphyxia, prematurity package of services and
and severe infections, congenital interventions directed not only to
abnormalities, newborn tetanus and other individual women pf reproductive
causes. age and newborns at the different
stages of the life cycle referring to
More than 59% of births take place at the prepregnancy, childbirth,
home, w/ more than 25% of the births postpartum, newborn and childhood
attended by traditional birth attendants/ periods.
hilots  Establishment of a service delivery
This contributes to the three delays that network at all levels of care to
lead to maternal and neonatal deaths: provide the package of serv ices and
interventions.
 Delay in identification of  Organized use of instruments for
complications health systems development to
 Delay in referral and bring all localities to create and
 Delay in management of sustain their service delivery
complications networks, which are crucial for the
The likelihood of maternal and neonatal provision of health services to all
death increases with identified risk factors, and,
namely  Rapid build-up of institutional
capacities of DOH and Philhealth,
 Having mistimed, unplanned, being the lead national agencies that
unwanted , and unsupported provide support to local planning am
pregnancy development through appropriate
 Not securing adequate care during and standards, capacity build-up of
pregnancy implementers and financing
 Delivering without skilled birth mechanisms
attendance, that is , attendance by
skilled midwives, nurses or MNCHN strategy aims to achieve the ff
physicians, and not having access to intermediate results:
emergency obstetric and neonatal  Every pregnancy is wanted, planned,
care, and and supported
 Not having proper postpartum and  Every pregnancy is adequately
postnatal care for the mother and managed throughout its course
the newborn  Every delivery is facility-based and
The Maternal, Newborn and Child Health managed by skilled birth attendants
and Nutrition Strategy or skilled health professionals
 Every mother-and-newborn pair
DOH takes into consideration the secures proper postpartum and
interrelatedness of newborn care with smooth
 Direct threats to the life of mothers transitions to the women’s health
and children that necessitate care package for the mother and
immediate health car5e and child survival package for the
managing risks that tend to in newborn
crease and maternal deaths.
 Underlying socioeconomic
conditions that hinder the provision
The MNCHN core package services of  Adequate Immunization of
package women with TT prevents
tetanus in both the mother
The maternal and newborn package is
and newborn.
characterized by paradigm shift form the
4. Promotion of exclusive
risk approach that focuses on identifying
breastfeeding
pregnant women at risk of such
5. Counseling o on healthy lifestyle
complications
6. Early detection and management of
The MNCHN core package of services complications
consists of interventions for each life stage: 7. Prevention and management of
other conditions where indicated
Pre pregnancy
hypertension, anemia, and diabetes
1. Nutrition 8. Birth planning and promotion of
 Nutritional Counseling facility-based delivery
 Promotion of the use of
Tetanus Toxoid Immunization Schedule:
iodized salt and
 Provision of folate: 60mg
elemental iron/400 ug folic
acid 1 tablet daily fir 3-6b
mos.
 Vitamin A at least 5000 IU
every week
2. Promotion of Healthy lifestyle
including advice relative to smoking
cessation, healthy diet, regular
exercise and moderate alcohol
intake Childbirth Package
3. Advice on Family Planning
1. Skilled birth attendance/ skilled
4. Prevention and management of
health professionals assisted
lifestyle related diseases like
delivery and facility based deliveries
diabetes and cardiovascular diseases
including the use of partograph .
5. Prevention and management of
2. Proper management of pregnancy
infection
and delivery complications.
6. Counseling on HIV/STI/AIDS
3. Access to basic emergency obstetric
7. Adolescent health services
and newborn care (BEmONC) or
8. Provision of oral health services
comprehensive emergency obstetric
Prenatal Package and newborn care (CEmONC)
services
1. Pre natal visits: 4 visits throughout
the course of pregnancy Postpartum Package
2. Micronutrient Supplement
1. Postpartum visits: within 72 hours
 Iron and Folate (60mg/400
2. Micronutrient Supplementation
ug) once a day for 6 mos.
 Iron and Folate (60mg/
or 180 tablet
400uq) once a day for 3
 Vitamin A 10,000 IU twice a
mos. or 90 tablets.
week
 Vitamin A 200,000 IU
 Elemental iodine 200 mg
within 4 weeks after
given once during the
delivery
pregnancy.
3. Counseling on nutrition, child care,
3. Tetanus Toxoid Immunization (TT)
family planning
Immunization
 0.5ml of TT is injected Newborn ( 1st week of life) care package
intramuscularly in the deltoid 1. Interventions within 90 mins.
muscle
  Immediate thorough drying Three levels of care in the MNCHN service
 Skin to skin contact between delivery network:
the mother and the baby
1. Community level service providers
 Cord clamping 1-3 mins. or the community health team
 Early initiation of
 Navigation functions:
breastfeeding means
informing families of health
breastfeeding within an hour risks and assisting families in
after birth
health risks and needs
 Nonseparation of the assessment; assisting families
mother and the baby also to develop and use health
known as rooming-in plans like birthing plans; and
2. Essential newborn care after 90 facilitating access family to
mins. critical health services
 Vitamin K prophylaxis  Basic delivery functions:
 Hepa B and BCG vaccination advocating for birth spacing
 Examination of the baby for and counseling on family
birth injuries, malformations, planning services
and defects. 2. A BEmONC capable facility or
 Additional care for a small provider can perform the following
baby sis signal obstetric functions:
3. Care prior to discharge: after the  Parenteral administration pf
first 90 mins oxytocin in the third stage pf
 Breastfeeding day and night labor
 Ensure warmth of the baby  Anticonvulsants
 Washing and bathing  Antibiotics
 Look for the danger signs and  Performance pf assisted
start resuscitation deliveries
 Perform newborn screening  Removal of retained
 Provide instruction for products
discharge  Manual removal pf retained
Child Care Package placenta

1. Immunization A BEmONC capable facility is also

2. Nutrition able to provide emergency newborn
3. Exclusive breastfeeding up to 6 mos. interventions which includes of the
4. Sustained breastfeeding up to 24 ff:
mos. with complementary feeding  Newborn resuscitation
5. Micronutrient supplement  Treatment of neonatal
6. Integrated management of sepsis/infection
childhood illnesses  Oxygen support
7. Injury prevention
8. Oral health 3. A CEmONC facility or provider can
9. Insecticide-treated-nets for mothers perform the six signal obstetric
and children in molaric endemic functions s in BEmONC, as well as
area provide caesarean delivery
MNCHN service delivery network The Reproductive Health Program
The MNCHN network can be a province- or Reproductive Health (RH) is a state of
city-wide network of public and private complete, physical, mental and social well
health care facilities and providers capable being and not merely the absence of
of giving MNCHN services, including basic disease or infirmity, in all matters relating
and comprehensive emergency obstetric to the reproductive system and to its
and essential newborn care. functions and processes.
The Magna Carta of Women (R.A 9710) FP is a means to prevent high-risk
pregnancies brought about by the ff
- provides that the “state shall, at all times,
conditions:
provide for a comprehensive, culture -
sensitive and gender-responsive health 1. Being too young or too old
services and programs covering all stages of 2. Having had too many pregnancies
a woman’s life cycle and which addresses 3. Having closely spaced pregnancies
the major causes of women’s mortality and 4. Being too ill/too sick or having an
morbidity existing disease.
R.A 10354, Four pillars of the PFPP
- also known as the Responsible Parenthood 1. Responsible parenthood
and the Reproductive Health Act pf 2012, 2. Respect for life
policy that the state recognizes and 3. Birth spacing
guarantees the human rights to sustainable 4. Informed choice
human development , health, education
Client Counseling
and information and the right to choose
and make decisions. Family Planning Counseling is a client-
centered , face to face, interactive
10 elements of reproductive health care:
communication process between the health
1. Family planning service provider and the client that helps
2. Maternal and child health and the latter to make free and informed
nutrition (MCHN) choices regarding one’s fertility intention or
3. Prevention and control of plan.
reproductive tract infections, STIs
Benefits of family planning
and HIV/AIDS.
4. Adolescent reproductive health Benefits to mothers
5. Prevention and management of
1. Enables her to regain her health
abortion and its complications
after delivery
6. Prevention and management of
2. Gives enough time and opportunity
breast and reproductive tract
to love and provide attention to her
cancers and other gynecological
husband and children
conditions
3. Gives more time for her family and
7. Education and counseling on
own personal advancement
sexuality and sexual health
4. When suffering from an illness ,
8. Men’s reproductive health and
gives enough time for treatment and
involvement
recovery
9. Prevention and management of
violence against women and Benefits to children
children
1. Healthy mothers produce healthy
10. Prevention and treatment of
children
infertility
2. Will get all the attention, security,
The Philippine Family Planning Program love and care they deserve
(PPFP)
Benefits to fathers
The Family Planning Program started in the
1. Lightens the burdens and
1970s as a family planning service delivery
responsibility in supporting his
component to achieve fertility reduction.
family
The National Family Planning Policy, 2. Enables him to give his children their
articulated through A.O 50-A, s. 2001 basic needs
asserts that family planning as a health 3. Gives him time for his family and
intervention shall be made available to all own personal advancement
men and women of reproductive age.
 4. When suffering from an illness, give  Responsible for the national testing
enough time for treatment and database and case registries.
recovery Training, technical assistance and
continuing education for laboratory
Natural Family Planning
staff in all Newborn Screening
- refers to methods for planning or avoiding Centers.
pregnancies by observation of the natural
Disorders
signs and symptoms of the fertile and
infertile phase of the menstrual cycle. Congenital Hypothyroidism
Lactational Amenorrhea Method - delay in - inability to produce enough thyroid
the return of fertility after childbirth. hormone
FAB methods are based on the scientific Congenital Adrenal Hyperplasia
analysis of the fertile time in the woman’s
- inability of the adrenal gland to secrete
menstrual cycle
cortisol or aldosterone
FAB methods includes:
Galactosemia
Billing ovulation method (BOM
- unable to metabolize galactose and the
0 also known as cervical mucus methods person is unable to tolerate any form of
fertility management based on cervical milk-human or animal
mucus
Phenylketonuria
Basal body temperature (BBT) refers to
- inability to properly breakdown an amino
one’s body temperature when one is fully at
acid called phenylamine
rest that is upon rising from sleep and
before eating. Glucose-6-phosphate dehydrogenase
(G6PD) deficiency
Symptothermal Method all signs of fertility
are taken note - red blood cells break down when the body
is exposed to certain, drugs, foods, severe
Other signs:
stress, or severe infection.
 Mittleschlemerz
Maple syrup urine disease
 Spinnbarkeit
 Breast Tenderness - Inability to break down the amino acids
 Increased Libido leucine, isoleucine and valine; urine of
 Mood changes such as depression affected persons smells like maple syrup.

Standard days method appropriate for the NBS Procedure

couple where the women’s menstrual cycle
 Law provides that NBS be done after
lasts from 26 to 32 days.
24 hrs of life, but not later than
Two-day method uses cervical secretions as three days from complete delivery
an indicator of fertility of the newborn
 Sample for NBS may be obtained by
Newborn Screening in the Philippines
a physician, nurse, medical
R.A 9288 Newborn Screening Act of 2004 technology or trained midwife
 Normal (negative) NBS results are
- prior to delivery, any health practitioner
available by 7-14 days from the time
who delivers or assists in the delivery in the
samples are received at.
delivery of the newborn in the Philippines
has the obligation to inform the parents or Newborn Hearing Screening
legal guardian of the newborn the
R.A 9709 Universal Newborn Hearing
availability of nature and benefits as
Screening and Intervention Act of 2009
newborn screening establishment at the
(UNHSP) for the early detection of
Newborn Screening Reference Center
(NSRC)
congenital hearing loss nd referral for early Completely immunized children refer to
intervention for infants. children who completed their immunization
schedule at the age of 12-23 months
- Establishment of Hearing Screening
Reference Center at the National Institutes A child protected at birth (CPAB) is a term
of Health used to describe a child whose mother has
received (a) two doses of TT during this
- On any healthcare practitioner who
pregnancy, provided that the second dose
delivers or assists in the delivery of a baby
was given at least a month prior to delivery
in the Philippines the obligation to inform
the parents or legal guardian of the
newborn of the availability, nature and
Infant and young child feeding: The
benefits of hearing, loss screening among
Philippine situation
newborns or infants three for months old
and below.  Executive Order no.51 – also know
as the milk code
Expanded Program on Immunization
 Executive Order NO.382 – provided
- The Expanded Program on Immunization for the observance of the National
was established in 1976 to ensure that Food Fortification Day every
infants/childhood vaccines. November 7
 R.A 7600 – Rooming-In and
 R.A 10152 also known as Mandatory
Breastfeeding Act
Infants and Children Health
 R.A 8172 – also known as ASIN (Act
Immunization Act of 2011 ,
for Salt Iodization Nationwide)
mandates basic immunization
covering the vaccine-preventable  R.A 8976 – Philippine Food
diseases Fortification Act
 R.A 7846 provided for compulsory  R.A 10028 Expanded Breastfeeding
immunization against hepatitis B for Promotion Act
infants and childrens below 8 years  A.0 36, s 2010 – Expanded
old. Garantisadong Pambata (GP)

Specific goals of the program: Nutritional assessment of the infant and

young child
1. Against the most common vaccine-
preventable diseases  Exclusive Breastfeeding
2. To sustain the polio free status if the  Predominant Breastfeeding
Phil.  Complementary Feeding
3. To eliminate measles infection  Bottle feeding
4. To eliminate maternal and neonatal  Early initiation of breastfeeding
tetanus.
Recommended infant and young child
5. To control diptheria, pertussis.
feeding practices
Hepatitis b and German measles
6. To prevent extrapulmonary TB  Early initiation of breastfeeding
among children  Exclusive breastfeeding for the first
6 months
Immunization is an essential health
 Extended breastfeeding up to 2
intervention for eligible children and
years and beyond
women and this service is available in all
 Appropriate complementary feeding
health facilities.
 Micronutrient supplementation
EPI recording and reporting  Universal salt iodization
Fully immunized children (FIC) are those  Food fortification
who were given BCG, three doses of OPV, Promoting Breastfeeding
three doses of DPT and hepatitis B vaccine
or three doses of Pentavalent vaccine - TO promote practice of breastfeeding
providing mothers and families with
adequate, accurate and timely information E- asily established
and opportunities for developing necessary
D – igested easily – with lactobumin
skills for good breastfeeding practices is
essential. I – mmunoglobulin against CD: measles and
chicken pos ( IgA)
- The nurse then makes a health education
plan based on the mother’s needs N – utrition
- Benefits of breastfeeding G – IT disorder is reduced ( ex: diarrhea)
- Techniques of breastfeeding Micronutrient Supplementation
BF contraceptive method – LAM (Lactation  Purpose: add to the vitamins and
Amenorrhea Method) and pituitary gland minerals and provided by a normal
produces PROLACTIN thereby the mother diet
becomes an ovulatory and w/o  Micronutrient supplementation is a
menstruation for 6 mos. short term intervention for
correcting high levels of
To make BF successful contraception 3E’s
micronutrient deficiencies until
contraception 3E’s:
more sustainable food- based
1. Early- start BF as early as possible approaches
NSD- 40 mins after, start BF CS- 3-  Recommended for 0-59 mos. old
4hrs after, start BF children, in addition to pregnant and
2. Exclusive – BF for 6 mos. – never lactating women and other women
alternate w/ supplementary feeding. of reproductive age, or those within
3. Extensive – BF can be extended to 2 the ages 15-49 years old.
yrs
Complementary Feeding Practices
Rooming-in – posterior PG will produce
- Complementary feeding becomes
oxytocin causing uterine muscle contraction
preventing implantation. necessary to fill the energy and nutrient gap
from the age of 6 mos.
Breastfeeding Benefit Children EO51 – milk
code never commercialize any brand of milk Complementary foods should be:

Storage of breastfeeding – keep in ref for 2  Timely – introduced when the need
hrs for energy and nutrients exceeds
what can be provided
Preservation – keep in the freezer minimum  Adequate – provide sufficient
of 3 mos. maximum of 6 mos. energy, proteins and malnutrient
To use: remove from the freezer 2hrs meet a growing child nutritional
before use needs
 Safe – foods are hygienically stored
Colostrum – 1st exposed milk and prepared and fed with cleans
Advantages of Breastfeeding  Proper Fed – foods are given
consistent in child’s signals of
B – “ Breastmilk is best for babies” as appetite and satisfy
mandated by EO51
Deworming
R – educed allergy
- of children age d1 to 12 yrs is done every 6
E – conomical mos
A – lways available - possible adverse affects of the
S – afe: soft stool antihelminthic drugs and their respective
management
T – right temp.
 Local sensitive allergy – give an
F – resh antihistamine
E – motional bonding
  Mild abdominal pain – Extended Family
antispasmodic
- consisting of three generations which may
 Diarrhea – oral rehydrating solution
include married, siblings and their families
 Erratic warm migration – pull out and grandparents
worms from mouth/ nose from
other body orifices Blended Family

Deworming is not advised if the child is - which results for a union where one/both
known to have any of the ff conditions spouses bring a children form a previous
marriage into a new living arrangement
- serious illness, such as an illness that
requires referral to a hospital Composed Family

- abdominal pain - - where a man has more than one spouse

- diarrhea Cohabiting Family

- history of hypersensitivity to the drug - which is commonly described as a “ live-in

arrangement between an unmarried couple
- severe malnutrition who are called common law spouses and
Nursing Care of the Community their children

Definitions of the Family Single Parent

“ The family is a group of persons living - which results from the death of a
together and composed of the head and spouse/both parents
other persons related to the head by blood,
Gay/Lesbian Family
marriage/adoption. It includes both the
nuclear and extended family” – National - made up of cohabiting couple of the same
Statistical Coordination Board, 2008 sex

“ A family w/ two more persons who are Functions of a Family:

joined together by bonds of sharing and
Functions that meet the needs of the
emotional closeness and who identify
society:
themselves as being part of the family” –
Friedman, Bowden and Jones, 2003 o Procreation
o Socialization
 The community health nurse o Status placement
interacts with communities made up o Economic function
of many types of families.
 When faced with great diversity in Functions that meet the needs of
the community. The community individuals:
health nurse must formulate a o Physical maintenance
personal definition of family and be o Welfare and protection
aware of the changing definition or
family held by other discipline, Characteristics of Healthy Families
professionals and family groups. o Members interact with each other
Family Forms they communicate and listen
repeatedly in many contexts
Nuclear Family o Healthy families can establish
- “Family of marriage, priorities
parenthood/procreation: composed of o The members engage in flexible role
husband, wife and immediate children” relationships, share power respond
to change, support the growth and
Dyad autonomy of others
- consisting only of husband and wife, such o The family teaches family and
as newly married couples societal values and beliefs and
shares a spiritual core.
 o Healthy families faster responsibly  Health maintenance
and value service to others  Parenting
o Healthy families have a sense of play  Breastfeeding
and humor and share leisure time  Spiritual being
o Healthy families have the ability to b) Health Threats – conditions that are
cope with stress and crisis and grow conducive to disease/ failure to
from problems. realize one’s health potential
Typology Tool  Accident Hazards
 Communicable Disease
o It is means by which the health care  Family size beyond what
provider addresses the health needs family resources can
and problem of the client adequately provide
o Family nursing care focused on the  Family history of hereditary
individual family members within condition or disease
the context of the family  Stress provoking factors
Family Health Nursing Processes  Poor home environmental
condition and sanitation
1. Assessment – deals with collecting,
 Unsanitary food handling and
organizing, validating and recording
preparation
data about a client’s health
 Unhealthy lifestyle and
condition
personal habits and practices
a) Identifying assessment
 Lack of Immunization
priorities determined by the
c) Health Deficits – instances of failure
purpose of the assessment
in health maintenance
and the client’s condition
 Illness state diagnosed or
b) Prioritizing types of data to
undiagnosed
be called systematically
 Failure to thrive, develop
c) Establishing the database;
according to normal state
1) Nursing History
2) Physical Examination  Disability (congenital or
arising from illness
3) Review of client
d) Stress points/ Foreseeable Crisis –
record and nursing
anticipate periods of unusual
literature
4) Consultation w/ demand on the individual/family.
health professionals  Marriage
and client’s support  Pregnancy, labor,
persons puerperium
 Parenthood
Two types of Assessment:  Additional member
1. First Level Assessment – the process  Hospitalization of a family
of determining existing and member
potential health  Menopause
conditions/problems pf the family  Loss of job
2. Second Level Assessment – type of  Death of member
nursing problems that the family  Abortion
encounters in performing the health  Entrance at school
tasks.  Adolescence
 Divorce or separation
First Level Assessment
 Resettlement of new
a) Wellness Condition – a nursing community
judgment about a client in transition
form a specific level of Second Level Assessment – identifies the
wellness/capability to higher one nature/type of nursing problems the family
experiences on the performance of their
 Healthy lifestyle
health tasks w/ respect to health condition/ o Presence of breeding/reading
problem sites/vectors of diseases
o Water supply – source , ownership
a) Ability to recognize the existence of
sanitary condition
health condition/ a health problems
o Garbage/refuse disposal – type,
b) Ability to make decisions w/ respect
sanitary condition
to taking a appropriate health action
o Drainage system – type, sanitary
c) Ability to provide nursing care to the
condition
sick, disabled/ dependent member
of the family Home and Environment
d) Ability to provide a home
o Kind of neighborhood
environment conducive to health
o Social and health facilities available
maintenance and personal dev.
Health Assessment of each member
2. Diagnosis
- a medical history
3. Planning
o Current. Past significant illness
4. Implementation
o Beliefs and practices conducive to
5. Evaluation health and illness
b) Nutritional Assessment
Steps pf Assessment :
c) Risk factor assessment – presence
1. Data Collection of major and contributing modifiable
2. Data Analysis d) Physical Assessment – presence of
3. Health Condition/Problems illness state
e) Results of lab, diagnostic and other
3 Types of data collection in Family Nursing
screening procedures
Assessment
Value placed on health promotion
1. Family structure, characteristics and
maintenance and disease prevention
dynamics
2. Socio-economic and structural  Immunization status of family
characteristics members
3. Home and environment  Healthy lifestyle practices
 Use of promotive – preventive
Family structure characteristics and
health service
dynamics
 Adequacy of rest and sleep,
a) Members of the household and activities us of protective measures
relationship to the head of the
family Steps of Assessment
b) Demographic data 1. Observation
c) Place of residence each member 2. Physical Environment
Scio-economic and cultural characteristics 3. interview
4. Record Review
a) Income and expenses 5. Laboratory. Diagnostic Tests
b) Educational attainment of each
member Data Analysis
c) Ethnic background and religious Steps
affiliation
d) Significant Others – roles they play a) Sorting of data
in family’s life b) Distinguishing relevant form
irrelevant information
Environmental Factors c) Checking of inconsistence
a) Housing d) Complementing missing information
o Adequacy of living space e) Clustering missing information
o Sleeping Arrangement f) Determining patterns
g) Interpreting results
Second Level Assessment maintenance and personal dev due
to:
1. Inability to recognize the presence
a) Inadequate family resources:
of condition or problem due to:
 Financial constraints,
a) Lack of or inadequate
limited financial
knowledge
resources
b) Denial about its existence or
 Limited physical
severity as a result of fear of
resources
consequences of diagnosis or
b) Lack of inadequate
problem
knowledge of the importance
2. Inability to make decisions with
of hygiene and sanitation
respect to taking appropriate health
c) Lack of or inadequate
action due to:
knowledge of inadequate of
a) Failure to comprehend the
preventive measures
nature/magnitude of the
d) Lack of skills in carrying and
problem or condition
measures to improve home
b) Low salience of the problem
environment
and condition
5. Failure to utilize community
c) Lack of inadequate
resources for health care due to:
knowledge, insight as to
a) Lack of or inadequate
alternative courses of action
knowledge of community
to take
resources for health care
d) Conflicting opinions among
b) Failure to perceive the
family members, significant
benefits of health care and
others regarding action to
service
take
c) Lack of trust, confidence in
e) Negative attitude towards
the agency, personnel
the health problem
d) Previous unpleasant
f) Inaccessibility of appropriate
experience with health
resources for care
worker
g) Lack of trust, confidence in
the health personnel or Family Nursing Care Plan
agency
- It is the blueprint of care that the nurse
3. Inability to provide adequate nursing
designs to systematization eliminate the
care to sick, disabled, dependent or
identified family health problem
vulnerable and at-risk member pf
the family due to: - formulated chosen set of interventions,
a) Lack of the necessary resources and evaluation criteria,
facilities, equipment and standards, methods and tool.
supplies for care
Qualities of Family Nursing Care Plan:
b) Inadequate family resources
for care: 1. Clear definition of the problem
 Absence of 2. It is realistic
responsible member 3. It should be consistent with the
 Financial restraints goals and philosophy
c) Member’s preoccupation 4. IT’s drawn with the family
with own concerns and 5. It’s best kept in written form
interests.
Factors in determining the modifiability of a
d) Prolonged disease/disability
health condition or problem:
progression which exhausts
supportive capacity of family 1. Current knowledge, technology and
members intervention
4. Inability to provide a home 2. Resources of the family
environment conducive to health 3. Resources of the nurse
4. Resources of the community
Types of objective:
1. Short term/ Immediate Objective
2. Medium or Intermediate
3. Long term or Ultimate objectives