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
2.    Divide the score by the highest possible
problem through intervention
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
• Refers to the nature and magnitude of
prioritize the problem
future problems that can be minimized
or totally prevented if intervention is Criteria 1, 2 & 3 has to be assessed objectively
done on the condition or problem by 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 environment
Introduction and Steps in Developing a Family
- family structure, characteristics
NCP.
- compare families health with these standards
Family Nursing Care Plan
Steps of Assessment Phase:
 Family health nursing process is a
systematic approach to help family to - Plan for data collection
develop and strengthen its capacity to
meet its health needs and solve health - Data collection methods and techniques
problems. - Analysis of data
 It is important to take in mind that
Family Nursing Care Plans are unique - Family profile and diagnosis
since it is continuous in nature. A 1. Plan for data collection
community health nurse must be able
to understand that he or she must keep It includes data regarding:
on updating the nursing care plan as the
- Family structure and characteristics
family is a dynamic unit of the
community. - Lifestyle, culture and socio economic factors

Qualities of Nursing Care Plan - Health and medical history and health
behavior
 It should be based on clear, explicit
definition of the problems. A good - Environmental factors
nursing plan is based on a
Primary source of data collection – obtained
comprehensive analysis of the problem
directly from the client (family members)
situation.
 A good plan is realistic Secondary source of data collection – obtained
 The nursing care plan is prepared jointly through friends, neighbors, colleagues, family
with the family. The nurse involves the records, family team members, investigation
family in determining health needs and reports, reference books etc.
problems in establishing priorities, in
2. Data collection methods and techniques
selecting appropriate courses of action,
implementing them and evaluating - Observation
outcomes. The nursing care plan is most
useful in written form. - Questioning

Steps in Formulating a Family Nursing Care - Conversation and discussion

Plan - Listening
I. Assessment phase (family identification) - Review of family health records
The standards of determining family health - Examination
status can be:
- Investigation
- optimum health of individual member
- Interview
- family life style
Guidelines for data collection -environmental pollution

- Be systematic -incomplete immunization

- Do not force to get information -unbalanced diet

- Explain the reason for data collection c. Foreseeable Crisis - situations anticipated
periods of unusual demands on the individual or
- Ensure confidentiality
the family in terms of adjustment. They are:
- Be polite
- Marriage
- Don’t let the family feel small and
- Pregnancy
embarrassed
- New born
- Make them comfortable
- Developmental stages
- Sympathizes and listen attentively and
meaningfully - New job

- Record the data - Death

3. Analysis of data - Change in residence

 It should be categorized as health  Health threats and foreseeable crisis

deficit, health threats and foreseeable situation are potential problems and
crisis situations. health deficits are actual problems.

a. Health deficits-failure in health maintenance 4. Family profile and diagnosis

and development.
 Family profile implies brief description
- diagnosed illness of family structure and characteristics,
family life cycle and culture, socio
- deviation in growth and development
economic conditions environmental
- personality disorders factors health and medical history etc.
 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
and development and personality disorders. data collected.
The possible health threats are: II. PLANNING PHASE (FAMILY HEALTH AND
-large family size NURSING CARE PLAN FORMULATION)

-lack of education  it is based on the diagnosis.

-immature parents

-broken family Steps of planning phase:

-poor environmental condition -analysis of diagnosed health problems and

assessment of families ability to resolve
-poor sanitation problems (second assessment)
-establish priorities Nurse focused goal- after the nursing
intervention the mother will be able to provide
-setting goals and objectives
need based care to malnourished children
-formulating family health and nursing care plan
Factors influence the goal formulation
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
problems -families felt need

-ability to make decisions for taking appropriate -families perception about seriousness of the
health action problem

-ability to maintain environment conducive to -families ability to face the reality

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 -help family to understand the situation
threats and foreseeable crisis situations
-relate families exiting socio economic
b) Severity of the consequence of the problem
- nature and magnitude of the problem condition to health problem

c) Modifiability of the problem- possibility of -motivate family to implement actions

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
seriousness of the problem IV. EVALUATION PHASE (FAMILY HEALTH AND
NURSING CARE EVALUATION)
e) Preventive potential-whether the problem
can be prevented, eradicated or controlled. QUANTITATIVE EVALUATION - It determine the
extent of services rendered to the family. It
3) Setting goals and objectives accounts the number of visits, clinic visits, no. of
Client focused goal-provide need based care to immunization completed, reduction in mortality
malnourished children and morbidity.

QUALITATIVE EVALUATION - has 3 dimensions

Structure evaluation-it measure the adequacy • Cardinal principle: goals to be set
of resources in terms of manpower, material, jointly with the family = family’s
time etc. commitment and realization.

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
• Goals – broad desired outcome toward condition or problem but is TOO BUSY
which behavior is directed.
 at the moment with other • ***Goals tell where the family is going;
preoccupations. objectives are the milestones to reach
the destination.
• Perceives the existence of the problem
but does not see it serious enough to • Objectives can be stated in various ways
warrant attention. depending upon the focus, level of
generality and time required for their
• Perceives the existence of the problem
realization.
and the need to take action but refuse
to face and do something about the • It can either be nurse-oriented (based
situation due to the following: on activities of the nurse) or client-
oriented (stated in terms of outcomes).
- Fear of consequence of taking
action NURSE-ORIENTED
- Respect for traditions, beliefs or
• Example 1: during the home visit, the
values
nurse will discuss the importance of
- Failure to perceive the benefits of
immunization.
action proposed
- Failure to relate the proposed • Example 2: during the second nurse-
action to the family’s goals family contact, the nurse will show the
different types of fertility-regulating
• A big barrier – failure to develop a
methods.
working relationship between family
and nurse. CLIENT-ORIENTED
• Goals set by the nurse and the family • Example 3: after the nursing
should be realistic or attainable. They intervention, the malnourished pre-
should therefore be set in reasonable school member of the family will
levels. Too high goals and their increase their weights by at least one
subsequent failure frustrate the nurse pound per month.
and the family.
• Example 4: after the nursing
• Goals are best stated in terms of client’s intervention, there will be improved
outcomes, whether at the individual, relationship among family members.
family, or community levels.
• Example 5: after the nurse’s visit, the
FORMULATION OBJECTIVES OF NURSING CARE family will bring the pre-school
members to the well-baby clinic the
Objectives
following day.
• Objectives refer to more specific
Objectives can also be stated in general sense
statements of the desired results or
or specific terms. 
outcomes of care.
GENERAL: after the nursing intervention, the
• They specify the criteria by which the
family will utilize community resources for
degrees of effectiveness of care are to
health care.
be measured.
SPECIFIC: after the nursing intervention,
 • The family will bring the pregnant time to demonstrate (e.g.
member to the health center regularly nature of behavior change) 
for check ups;
Example: NURSING GOAL- the family will cope
• The family will also consult the health effectively with the threat of pulmonary
center on every episode of illness tuberculosis.
among members.
• SHORT-TERM: the infant and preschool
GENERAL: after the nursing intervention, members of the family will be
the family will be able to take care of the immunized with BCG.
mentally challenged child competently.
• MEDIUM-TERM: all members of the
SPECIFIC: After the nursing intervention, family will have a complete physical
check-up to rule out pulmonary
1. The family will be able to feed the
tuberculosis.
mentally challenged prescribed quantity
and quality of food. • LONG-TERM: all members of the family
will participate in the care of the sick
2. They will be able to teach the child simple
members and apply preventive
skills related to activities of daily living and
measures against the spread of
3. The family will be able to apply measures infection.
taught to prevent infection in the mentally
SMART criteria for formulating
challenged child.
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
implementation of the project
resources, outcomes require
whether you are on track?
 (Preferably, this includes specific 4. Catalyze Behavior Change through motivation
numbers) and support

Achievable: Don’t set the bar too high (this will EXPLORE with Family Choices/Possibilities
disappoint stakeholders when you do not based on Lived Experience of
deliver what you aimed for. Don’t set the bar Meanings/Concerns
too low (you don’t want to underestimate your
• Self interacting with others in specific
own project)
situations
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-
term plans? • Phenomological experience
Timely: Your goal/objective should include a • Family and nurse are participants in an active,
certain time frame in order to maximize the mutual, dynamic interchange of realities,
effect of your project by not running it too long concerns and resources.
or too short) By which time do you hope to
achieve your goals/objectives? Develop/Enhance Cognition, Volition and
(weeks/months/years)  Emotion

• The choice contributes to a process of self-

understanding of the family as a system and of
Topic 2: Developing the Intervention Plan each individual member.
• Based on the formulated goals and objectives • Decision making on appropriate actions is
• The nurse decides on the appropriate nursing enhanced.
actions among a set of alternatives, specifying
the most effective or efficient method of nurse- • As a feeler, the family needs to develop or
family contact and the resources needed. strengthen its affective competencies
(understand emotions generated by family life
Ex. of Nurse-family contact- home visit, or health and illness situations.
telephone call, group approach (health class)
Focus on Interventions to Help the Family
Ex. of resources- material (supplies, equipment, Perform the Health Tasks
teaching aids/kits, visual materials)
1. Help the family Recognize the Problem –
GUIDE SELECTION OF APPROPRIATE NURSING
INTERVENTIONS a. increasing the family’s knowledge on the
nature, magnitude and cause of the problem
1. Analyze with the family the current situation
and determine choices and possibilities based b. helping the family see the implications of the
on a lived experience of meanings and concerns situation

2. Develop/enhance family’s competencies as c. relating health needs to the goals of the

Thinker, Doer and Feeler family

3. Focus on interventions to help perform the d. encouraging positive or wholesome

Health tasks emotional attitude toward the problem
2. Guide the family on how to decide on OBJECTIVE CUE (OC): The deep well is
appropriate health actions to take approximately 2 meters from the house with
the diameter of the hole is approximately 1
a. id or exploring with the family the courses of
meter and it is level to the ground. The deep
action available and the resources needed
well has a depth of 6 feet and being used by the
b. discussing the consequences of each course family without the cover.
of action available
FAMILY NURSING DIAGNOSIS
c. analyzing with the family the consequences
 Inability to anticipate risk factors due
of inaction
to lack of knowledge on the identified
3. Develop the family’s ability and problem
commitment to provide nursing care to its
members
GOAL OF CARE
• Can demonstrate the use of medicinal plants
or herbs. • Within 4 hours of nursing interventions,
the family will be able to identify the
4. Enhance the capability of the family to
risk factors on the actual condition and
provide a home environment conducive to
make plans to modify the deep well and
health maintenance and personal
to prevent any accidents.
development
OBJECTIVES
- Home envt through environment
modification, manipulation or Within 4 hours of nursing interventions, the
management to minimize or eliminate family will be able to:
health threats or risks or to install
1. Recognize the possible risk factors with
facilities for nursing care
regards to the condition identified;
- environmental conditions
2. Enumerate various ways on maintaining
conducive to breeding and
safety and to prevent fall hazard;
rehabilitation of vectors of diseases
3. Select a course of action to correct and
5. Facilitate the family’s capability to utilize
solve the problem.
community resources for health care
4. Make plans to choose appropriate ways
- Maximum use of available resources through
and materials necessary to cover the
the coordination, collaboration and team work
deep well to prevent any occurrence of
provided by an effective referral system.
injuries;

5. Identify the positive outcomes upon

Topic 3: Formulation of Family Nursing Care planning the solution to the problem.
Plan
INTERVENTION WITH RATIONALE
SUBJECTIVE AND OBJECTIVE CUES
1. Assess the family’s perceptions with
SUBJECTIVE CUE (SC): “May balon sa likod nang regards to the problems identified.
bahay namin” as verbalized by the mother. Rationale: To acknowledge the family
 concerns and in order to promote • Goal met. After 2 home visits
cooperation. conducted with nursing interventions,
the family was able to identify risk
2. Discuss with the family the possible risk
factors of having an uncovered well and
factors that will result with the
short blocks of the deep-well and
occurrence of the problem. Rationale:
verbalized their plans to modify their
To provide information regarding the
situation as evidenced by one of the
risk factors such as fall.
family member’s verbalization,
3. Emphasize to the family the importance “kailangan nating gawin at takpan ang
of solving the problem and on ating balon upang hindi mapanganib
maintaining an environment which is ang mga bata, baka mahulog sila.”
safety at home. Rationale: To develop
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