Community Health Nursing (RLE) 4.

Salience

Midterm Period • 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
WEEK 1
• High
Topic 1: Prioritizing Family Health Problems
• Moderate
1. The prioritized condition/s or problems
based on: • Low

• Nature of Condition or Problem CRITERIA IN IDENTIFYING THE PROBLEM

• Categorized into:

• Wellness State

• Health deficit

• Health threat

• Foreseeable Crisis

2. Modifiability

• Refers to the probability of success in

Scoring:
enhancing the wellness state,
improving the condition, minimizing, 1. decide on a score for each of the criteria.
alleviating or totally eradicating the
problem through intervention 2. Divide the score by the highest possible
score and multiply by the weight: (score/highest
• – Easily modifiable score) x weight.
• – Partially modifiable 3. Sum up the scores for all the criteria. The
highest score is 5 (equal to total weight).
• – Not modifiable
Interpretation:
3. Preventive Potential
Perfect score=5, if score nearing 5 then prioritize
• Refers to the nature and magnitude of
the problem
future problems that can be minimized
or totally prevented if intervention is Criteria 1, 2 & 3 has to be assessed objectively by
done on the condition or problem the health worker
under consideration
Criteria 4 has to be assessed by the perception
• High of the family
• Moderate

• Low
Example Identified Family Health Problems:

1. Family size beyond what family can

adequately provide

2. Inadequate living space

3. Poor Lighting and Ventilation

Topic 2: Scale for Ranking Health Conditions and

Problems According to Priorities
 Malnutrition

Scoring

• After the score for each criterion has

been decided on, the number is divided
by the highest possible score on the
scale. The quotient is multiplied by the
weight indicated for the criterion being
considered. Then the sum of the scores
for all the criteria is taken. The highest is
five (5), equivalent of the total weight

• The nurse considers as priority those

conditions and problems with total
scores nearer five (5). Thus, the higher
the score of a given condition or
problem the more likely it is taken as
priority. With the available scores, the
nurse then
Ranking and Scoring
Possible Preeclampsia
List of Health Problems Ranked According to
Priorities:
Topic 3: Developing the Nursing Care Plan – - family structure, characteristics
Introduction and Steps in Developing a Family
- compare families health with these standards
NCP.
Steps of Assessment Phase:
Family Nursing Care Plan
- Plan for data collection
 Family health nursing process is a
systematic approach to help family to - Data collection methods and techniques
develop and strengthen its capacity to
meet its health needs and solve health - Analysis of data
problems. - Family profile and diagnosis
 It is important to take in mind that
Family Nursing Care Plans are unique 1. Plan for data collection
since it is continuous in nature. A It includes data regarding:
community health nurse must be able to
understand that he or she must keep on - Family structure and characteristics
updating the nursing care plan as the
- Lifestyle, culture and socio economic factors
family is a dynamic unit of the
community. - Health and medical history and health behavior

Qualities of Nursing Care Plan - Environmental factors

 It should be based on clear, explicit Primary source of data collection – obtained

definition of the problems. A good directly from the client (family members)
nursing plan is based on a
Secondary source of data collection – obtained
comprehensive analysis of the problem
through friends, neighbors, colleagues, family
situation.
records, family team members, investigation
 A good plan is realistic
reports, reference books etc.
 The nursing care plan is prepared jointly
with the family. The nurse involves the 2. Data collection methods and techniques
family in determining health needs and
problems in establishing priorities, in - Observation
selecting appropriate courses of action, - Questioning
implementing them and evaluating
outcomes. The nursing care plan is most - Conversation and discussion
useful in written form. - Listening
Steps in Formulating a Family Nursing Care Plan - Review of family health records
I. Assessment phase (family identification) - Examination
The standards of determining family health - Investigation
status can be:
- Interview
- optimum health of individual member
Guidelines for data collection
- family life style
- Be systematic
- family environment
- Do not force to get information c. Foreseeable Crisis - situations anticipated
periods of unusual demands on the individual or
- Explain the reason for data collection
the family in terms of adjustment. They are:
- Ensure confidentiality
- Marriage
- Be polite
- Pregnancy
- Don’t let the family feel small and embarrassed
- New born
- Make them comfortable
- Developmental stages
- Sympathizes and listen attentively and
- New job
meaningfully
- Death
- Record the data
- Change in residence
3. Analysis of data
 Health threats and foreseeable crisis
 It should be categorized as health
situation are potential problems and
deficit, health threats and foreseeable
health deficits are actual problems.
crisis situations.
4. Family profile and diagnosis
a. Health deficits-failure in health maintenance
and development.  Family profile implies brief description
of family structure and characteristics,
- diagnosed illness
family life cycle and culture, socio
- deviation in growth and development economic conditions environmental
factors health and medical history etc.
- personality disorders  Family health diagnosis is the written
b. Health Threats - condition which predispose statement of family health problems
to disease, accident, poor or retarded growth which are assessed from analysis of data
and development and personality disorders. collected.

The possible health threats are: II. PLANNING PHASE (FAMILY HEALTH AND
NURSING CARE PLAN FORMULATION)
-large family size
 it is based on the diagnosis.
-lack of education

-immature parents
Steps of planning phase:
-broken family
-analysis of diagnosed health problems and
-poor environmental condition assessment of families ability to resolve
-poor sanitation problems (second assessment)

-environmental pollution -establish priorities

-incomplete immunization -setting goals and objectives

-unbalanced diet -formulating family health and nursing care plan

Families ability to resolve health problems can -interpersonal relationship
be assessed on the basis of:
-families perception of the problem
-ability to recognize the presence of health
-families felt need
problems
-families perception about seriousness of the
-ability to make decisions for taking appropriate
problem
health action
-families ability to face the reality
-ability to maintain environment conducive to
health promotion maintenance and personnel
development
III. ACTION PHASE (FAMILY HEALTH AND
- Ability to utilize community for health care NURSING CARE PLAN IMPLEMENTATION
-ability to provide desired care to the sick STEPS:
disabled
-review of plan and mobilization of resources
2) Establish priorities
-implementation and documentation
 means rank ordering of the health
problems CHN required to

Criteria for setting priorities: -give adequate informations

a) Type of problem- health deficit, health threats -help family to understand the situation
and foreseeable crisis situations -relate families exiting socio economic
b) Severity of the consequence of the problem - condition to health problem
nature and magnitude of the problem
-motivate family to implement actions
c) Modifiability of the problem- possibility of
resolving the problem through nursing -utilize the equipments and supplies
interventions within available resources -help family to utilize the community resources
d) Salience - families perception about the IV. EVALUATION PHASE (FAMILY HEALTH AND
seriousness of the problem NURSING CARE EVALUATION)
e) Preventive potential-whether the problem QUANTITATIVE EVALUATION - It determine the
can be prevented, eradicated or controlled. extent of services rendered to the family. It
3) Setting goals and objectives accounts the number of visits, clinic visits, no. of
immunization completed, reduction in mortality
Client focused goal-provide need based care to and morbidity.
malnourished children
QUALITATIVE EVALUATION - has 3 dimensions
Nurse focused goal- after the nursing
intervention the mother will be able to provide Structure evaluation-it measure the adequacy of
need based care to malnourished children resources in terms of manpower, material, time
etc.
Factors influence the goal formulation
Process evaluation-it measure the adequacy of Goals need to be:
nurses actions and activities implementing the
• Realistic and Attainable
nursing process
• Clearly defined problem and accurate
Outcome evaluation- it measure the end result
assessment of available resources
of the care given to the client
• Best stated in terms of client outcomes
Tools of Data collection:
(individual, family or community level)
a. Direct observation
• Tells where the family is going
b. Questioning
• Example: after nursing intervention,
c. Record review the family will be able to take care of
the premature infant competently.

 Goals established by the nurse with the

WEEK 2 family usually relate to health mater,
specifically the alleviation of disease
Topic 1: Formulation of Goals and Objectives of
conditions.
Nursing Care
 Health problems are however,
Steps in Making a Family Nursing Care Plan intertwined with other problems like
(FNCP): socio-economic ones. It is common
therefore, for a community health
nurse to find herself setting in non-
health goals like:
Example 1: at the end of nursing
intervention, the family will be able to
start a piggery business.
Example 2: at the end of nursing
intervention, the family will be able to
start litigation proceedings against
landlord.

Barriers to joint goal setting Between the Nurse

and the Family:

• Failure on the part of the family to

perceive the existence of the problem. –
a problem but just a norm for the family.

Goals: • May realize the existence of health

condition or problem but is TOO BUSY at
• Goals – broad desired outcome toward the moment with other preoccupations.
which behavior is directed.
• Perceives the existence of the problem
• Cardinal principle: goals to be set jointly but does not see it serious enough to
with the family = family’s commitment warrant attention.
and realization.
 • Perceives the existence of the problem • It can either be nurse-oriented (based
and the need to take action but refuse on activities of the nurse) or client-
to face and do something about the oriented (stated in terms of outcomes).
situation due to the following:
NURSE-ORIENTED
- Fear of consequence of taking action
• Example 1: during the home visit, the
- Respect for traditions, beliefs or
nurse will discuss the importance of
values
immunization.
- Failure to perceive the benefits of
action proposed • Example 2: during the second nurse-
- Failure to relate the proposed action family contact, the nurse will show the
to the family’s goals different types of fertility-regulating
methods.
• A big barrier – failure to develop a
working relationship between family CLIENT-ORIENTED
and nurse.
• Example 3: after the nursing
• Goals set by the nurse and the family intervention, the malnourished pre-
should be realistic or attainable. They school member of the family will
should therefore be set in reasonable increase their weights by at least one
levels. Too high goals and their pound per month.
subsequent failure frustrate the nurse
and the family. • Example 4: after the nursing
intervention, there will be improved
• Goals are best stated in terms of client’s relationship among family members.
outcomes, whether at the individual,
family, or community levels. • Example 5: after the nurse’s visit, the
family will bring the pre-school members
FORMULATION OBJECTIVES OF NURSING CARE to the well-baby clinic the following day.
Objectives Objectives can also be stated in general sense
or specific terms.
• Objectives refer to more specific
statements of the desired results or GENERAL: after the nursing intervention, the
outcomes of care. family will utilize community resources for
health care.
• They specify the criteria by which the
degrees of effectiveness of care are to be SPECIFIC: after the nursing intervention,
measured.
• The family will bring the pregnant
• ***Goals tell where the family is going; member to the health center regularly
objectives are the milestones to reach for check ups;
the destination.
• The family will also consult the health
• Objectives can be stated in various ways center on every episode of illness among
depending upon the focus, level of members.
generality and time required for their
realization.
 GENERAL: after the nursing intervention, the • SHORT-TERM: the infant and preschool
family will be able to take care of the members of the family will be
mentally challenged child competently. immunized with BCG.

SPECIFIC: After the nursing intervention, • MEDIUM-TERM: all members of the

family will have a complete physical
1. The family will be able to feed the
check-up to rule out pulmonary
mentally challenged prescribed quantity and
tuberculosis.
quality of food.
• LONG-TERM: all members of the family
2. They will be able to teach the child simple
will participate in the care of the sick
skills related to activities of daily living and
members and apply preventive
3. The family will be able to apply measures measures against the spread of
taught to prevent infection in the mentally infection.
challenged child.
SMART criteria for formulating goal/objectives:
Objectives May be:
Specific: Define your objective as clear, short
• Short-term/immediate objective and simple as possible, covering what you need
to say avoiding unnecessary or complex
– for problem situations needing language.
immediate attention, observe
immediate results, less nurse- This includes the 5-W’s:
family contact, less resources
1. What do we want to accomplish?
used. (e.g. manifests actions to
eventually lead to achievement 2. Who is involved?
the goal)
3. Why are we doing this?
• Medium-term/intermediate objective
4. Where will it be done?
– those not immediately achieved
5. Which resources are needed?
and are required to attain the
long-term ones. (e.g. regular Measurable: Measurability concerns the
check-ups) indicators that measure the success of your
project.
• Long-term/ ultimate objective
- How will you indicate success?
– Require several nurse-family
- How can you measure during the
encounters and more resources,
implementation of the project
outcomes require time to
whether you are on track?
demonstrate (e.g. nature of
(Preferably, this includes specific
behavior change)
numbers)
Example: NURSING GOAL- the family will cope
Achievable: Don’t set the bar too high (this will
effectively with the threat of pulmonary
disappoint stakeholders when you do not deliver
tuberculosis.
what you aimed for. Don’t set the bar too low
(you don’t want to underestimate your own
project)
Relevant: Does this goal/objective fit the other • Dependent upon the lived meaning of the
goals and overall vision of your program. Does experiences of family members with each other
the goal/objective support your short- and long-
• Phenomological experience
term plans?
• Family and nurse are participants in an active,
Timely: Your goal/objective should include a
mutual, dynamic interchange of realities,
certain time frame in order to maximize the
concerns and resources.
effect of your project by not running it too long
or too short) By which time do you hope to Develop/Enhance Cognition, Volition and
achieve your goals/objectives? Emotion
(weeks/months/years)
• The choice contributes to a process of self-
understanding of the family as a system and of
each individual member.
Topic 2: Developing the Intervention Plan
• Decision making on appropriate actions is
• Based on the formulated goals and objectives
enhanced.
• The nurse decides on the appropriate nursing
actions among a set of alternatives, specifying • As a feeler, the family needs to develop or
the most effective or efficient method of nurse- strengthen its affective competencies
family contact and the resources needed. (understand emotions generated by family life or
health and illness situations.
Ex. of Nurse-family contact- home visit,
telephone call, group approach (health class) Focus on Interventions to Help the Family
Perform the Health Tasks
Ex. of resources- material (supplies, equipment,
teaching aids/kits, visual materials) 1. Help the family Recognize the Problem –
GUIDE SELECTION OF APPROPRIATE NURSING a. increasing the family’s knowledge on the
INTERVENTIONS nature, magnitude and cause of the problem
1. Analyze with the family the current situation b. helping the family see the implications of the
and determine choices and possibilities based on situation
a lived experience of meanings and concerns
c. relating health needs to the goals of the family
2. Develop/enhance family’s competencies as
Thinker, Doer and Feeler d. encouraging positive or wholesome emotional
attitude toward the problem
3. Focus on interventions to help perform the
Health tasks 2. Guide the family on how to decide on
appropriate health actions to take
4. Catalyze Behavior Change through motivation
and support a. id or exploring with the family the courses of
action available and the resources needed
EXPLORE with Family Choices/Possibilities
based on Lived Experience of b. discussing the consequences of each course of
Meanings/Concerns action available

• Self interacting with others in specific c. analyzing with the family the consequences of
situations inaction
3. Develop the family’s ability and commitment GOAL OF CARE
to provide nursing care to its members
• Within 4 hours of nursing interventions,
• Can demonstrate the use of medicinal plants or the family will be able to identify the risk
herbs. factors on the actual condition and make
plans to modify the deep well and to
4. Enhance the capability of the family to
prevent any accidents.
provide a home environment conducive to
health maintenance and personal development OBJECTIVES

- Home envt through environment Within 4 hours of nursing interventions, the

modification, manipulation or family will be able to:
management to minimize or eliminate
1. Recognize the possible risk factors with
health threats or risks or to install
regards to the condition identified;
facilities for nursing care
2. Enumerate various ways on maintaining
- environmental conditions conducive
safety and to prevent fall hazard;
to breeding and rehabilitation of
vectors of diseases 3. Select a course of action to correct and
solve the problem.
5. Facilitate the family’s capability to utilize
community resources for health care 4. Make plans to choose appropriate ways
and materials necessary to cover the
- Maximum use of available resources through
deep well to prevent any occurrence of
the coordination, collaboration and team work
injuries;
provided by an effective referral system.
5. Identify the positive outcomes upon
planning the solution to the problem.
Topic 3: Formulation of Family Nursing Care
INTERVENTION WITH RATIONALE
Plan
1. Assess the family’s perceptions with
SUBJECTIVE AND OBJECTIVE CUES
regards to the problems identified.
SUBJECTIVE CUE (SC): “May balon sa likod nang Rationale: To acknowledge the family
bahay namin” as verbalized by the mother. concerns and in order to promote
cooperation.
OBJECTIVE CUE (OC): The deep well is
approximately 2 meters from the house with the 2. Discuss with the family the possible risk
diameter of the hole is approximately 1 meter factors that will result with the
and it is level to the ground. The deep well has a occurrence of the problem. Rationale:
depth of 6 feet and being used by the family To provide information regarding the
without the cover. risk factors such as fall.

FAMILY NURSING DIAGNOSIS 3. Emphasize to the family the importance

of solving the problem and on
 Inability to anticipate risk factors due to
maintaining an environment which is
lack of knowledge on the identified
safety at home. Rationale: To develop
problem
the family’s ability and commitment to
provide nursing care to the members of
 the family and on taking actions to solve
the problems.

4. Provide suggestions about solving the

problem and preventive measures on
fall hazards such as putting a cover made
of wood or plywood, having the sides of
the well cemented, and putting a
wooden fence around the well to guard
the hole and enhance the safety of each
family member. Rationale: To guide the
family on how to decide or select for
appropriate actions to take with regards
to the problem identified.

5. Evaluate the family’s plan or course of

action they are going to make.
Rationale: To enhance the capability of
the family to carry out measures to
provide safe home facilities and personal
development.

RESOURCES REQUIRED

• Home visits

• Assessment

• Discussion

• Time and effort by the student nurse and

the family members

EVALUATION

• Goal met. After 2 home visits conducted

with nursing interventions, the family
was able to identify risk factors of having
an uncovered well and short blocks of
the deep-well and verbalized their plans
to modify their situation as evidenced by
one of the family member’s
verbalization, “kailangan nating gawin at
takpan ang ating balon upang hindi
mapanganib ang mga bata, baka
mahulog sila.”