FNCP > Family Nursing Care Plan

Nursing Problem. A situation or condition which interferes with the promotion and/or maintenance
of health and recovery from illness or injury.

I. ASSESSMENT
FIRST LEVEL ASSESSMENT: Initial data base for Family Nursing Practice/Types of Data in
Family Nursing Assessment:
A. Family Structure, Characteristics and Dynamics
1. Members of the household and relationship to the head of the family.
2. Demographic data: age, sex, civil status, position in the family.
3. Type of family structure (eg. matriarchal, patriarchal, nuclear, or extended).
4. Dominant family members in terms of decision making, especially in matters of healthcare.
5. Family dynamics, communication pattern, interactional processes and interpersonal
relationships

B. Socio-Economic and Cultural Factors

1. Income and Expenses
a. Occupation, place of work, and income of each working member.
b. Adequacy to meet basic necessities
c. Who makes decisions about the money and how is it spent?
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Family traditions, events or practices affecting members’ health or family functioning
5. Significant others
6. Relationship of the family to larger community

C. Home and Environment

1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Adequacy of the furniture
d. Food storage and cooking facilities
e. Toilet facilities: type, ownership, sanitary condition
f. Water supply: source, ownership, potability
g. Presence of insects and rodents
h. Presence of accident hazards
i. Garbage/refuse disposal: type, sanitary condition
j. Drainage system: type sanitary condition

2. Kind of neighborhood
3. Social and health facilities available
4. Communication and transportation facilities available

D.Health Status of Each Family Member

1. Medical history of each family member
a. Past significant illnesses
b. Current illnesses, treatments, and medications taken
2. Nutritional assessment
a. Anthropometric data
b. Dietary history
c. Eating/feeding habits
3. Developmental assessment of infants, toddlers, and preschoolers
 4. Risk factor assessment indicating presence of major and contributing modifiable risk
factors for specific lifestyle diseases.
5. Physical assessment indicating presence of illness state/s
6. Results of laboratory/diagnostic and other screening procedures supportive of
assessment findings

E.Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

1. Immunization status of family members
2. Healthy lifestyle practices. Specify
3. Adequacy of:
a. rest and sleep
b. exercise/activities
c. use of protective measures
d. relaxation and other stress management activities
e. opportunities which enhance feelings of self-worth, self-efficacy and sense of
connectedness to self, others and a higher power
4. Use of promotive-preventive health services and use of healthy life style-related
services

Methods of Gathering Data:

1.Direct Observation >Method of data collection through the use of all sensory capacities.
(Data gathered through this method have the advantage of being subjected to validation and
reliability testing by other family members)
Characteristics:
a. Objective c. Validity
b. Factual d. Based on knowledge of the family
2.Physical Assessment > These are the significant data about the health status of individual family
members that are obtained through direct examination.
3.Interviewing >Productivity of the interview process depends upon the use of effective
communication techniques to elicit the needed responses.
4.Record Review.
5.Laboratory/ Diagnostic Tests.
TYPOLOGY OF NURSING PROBLEMS IN FAMILY HEALTH CARE: FIRST LEVEL
ASSESSMENT
Categories:
A.Presence of Wellness Condition > A clinical or nursing judgment about a client in transition from
a specific level of wellness or capability to a higher level.
1.Potential for enhanced capability for > healthy lifestyle, health maintenance, parenting,
breastfeeding, spiritual well-being, etc.
2.Readiness for enhance capability for > healthy lifestyle, health maintenance, parenting,
breastfeeding, spiritual well-being, etc.
3.Presence of Health Threats > Conditions that are conducive to disease, accident or failure to
realize one’s health potential.
1. Presence of risk factors of specific diseases
2. Threat of cross infection from a communicable disease case
3. Family size beyond what family resources can adequately provide
4. Accident/fire hazards
5. Faulty/unhealthy eating habits or feeding techniques or practices. Specify
6. Stress provoking factors. Specify
7. Poor home/environmental condition/sanitation. Specify
8. Unsanitary food handling and preparation
 9. Unhealthy lifestyle and personal habits/practices. Specify
10. Inherent personal characteristics
11. Health history which may induce the occurrence of a health deficit
12. Inappropriate role assumption
13. Lack of immunization or inadequate immunization status specially of children
14. Family disunity
15. Others; Specify

A. Presence of Health Deficits. Instances of failure in health maintenance.

1. Illness states, regardless of whether it is diagnosed or undiagnosed by a medical
practitioner
2. Failure to thrive/develop according to normal rate
3. Disability: whether congenital or arising from illness; transient or permanent

B. Presence of Foreseeable Crisis Situation/Stress Points. Anticipated periods of unusual

demand on the individual or family in terms of family resources and transitions.
1. Marriage 9. Menopause
2. Pregnancy, labor, puerperium 10. Chronic illness
3. Parenthood 11. Loss of job
4. Additional member 12. Hospitalization of a family member
5. Abortion 13. Death of a member
6. Entrance at school 14. Resettlement in a new community
7. Adolescence 15. Illegitimacy
8. Divorce or separation 16. Others: Specify

For a family to achieve an optimum level of health care the family should be able to possess
the health tasks identified by Ruth Freeman, which are as follows:
1. Ability to recognize the existence of a wellness state, health condition or a health problem.
2. Ability to make decisions with respect to taking appropriate health actions.
3. Ability to provide nursing care to the affected family member.
4. Ability to provide a home environment conducive to health maintenance and personal
development
5. Ability to utilize community resources for health care.

SECOND LEVEL ASSESSMENT:

 Reflects the extent to which the family can perform the health tasks on each of the WC,
HT, HD, and FC identified during the first level assessment.
 Identifies the nature or type or nursing problems of the family experiences in the
performance of their health tasks with respect to a certain health condition or health
problem.
 The nurses’s major concern is to determine the family’s capabilities to assume the
health tasks on each health problem area identified.

TYPOLOGY OF NURSING PROBLEMS IN FAMILY HEALTH CARE: SECOND LEVEL

ASSESSMENT

A. Inability to recognize the presence of the condition or problem due to:

1.Lack of or inadequate knowledge
2. Denial about its existence or severity as a result of fear of consequences or diagnosis
of problem
3. Attitude/philosophy in life which hinders recognition/acceptance of a problem
B.Inability to make decisions with respect to taking appropriate health action due to :
1. Failure to comprehend the nature/magnitude of the problem/condition
2. Low salience of the problem/condition
3. Feeling of confusion, helplessness and/or resignation brought about by perceived
magnitude of the situation/problem.
4. Inadequate knowledge as to alternative courses of action open to them
5. Inability to decide which action to take from among list of alternatives
6. Conflicting opinions among family members regarding action to take
7. Inadequate knowledge of community resources for care
8. Fear of consequences of action
 9. Negative attitude towards the health condition or problem
10. Inaccessibility of appropriate resources of care
11. Lack of trust or confidence in the health personnel or agency
12. Misconceptions or erroneous information about proposed course of action
13. Others. Specify

C.Inability to provide adequate nursing care to sick, disabled, dependent or vulnerable/at risk
member of the family due to:
1. Inadequate knowledge about the disease or health condition
2. Inadequate knowledge about child development and care
3. Inadequate knowledge of the nature and extent of nursing care needed
4. Lack of necessary facilities, equipment and supplies for care
5. Inadequate family resources for care
6. Significant person`s unexpressed feelings which affects his or her capacity to provide
care
7. Philosophy in life which negates caring for the sick, disabled, dependent, vulnerable
member
8. Member`s preoccupation with own concerns or interests
9. Prolonged disease or disability progression which exhausts supportive capacity of
family members
10. Altered role performance
A. role denial or ambivalence D. role conflict
B. role strain E. role confusion
C. role dissatisfaction F. role overload

D.Inability to provide a home environment conducive to health maintenance and personal

development due to:
1. Inadequate family resources: financial constraints or limited physical resources
2. Failure to see benefits of investment in home environment improvement
3. Inadequate knowledge of importance of hygiene and sanitation
4. Inadequate knowledge of preventive measures
5. Lack of skills in carrying out measures to improve home environment
6. Ineffective communication patterns within the family
7. Lack of supportive relationships among family members
8. Negative attitude or philosophy in life which is not conducive to health maintenance and
personal development
9. Inadequate competencies in relating to each other for mutual growth and maturation

E.Failure to utilize community resources for health care due to:

1. Inadequate knowledge of community resources for health care
2. Failure to perceive the benefits of health care
3. Lack of trust or confidence in the agency or personnel
4. Previous unpleasant experience with health worker
5. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative)
6. Unavailability of required care or service
7. Inaccessibility of required care or service
8. Inadequate family resources
9. Feeling of alienation to or lack of support from the community
10. Negative attitude or philosophy in life which hinders effective or maximum utilization of
community resources for health care.

STEPS IN FAMILY HEALTH CARE PLANNING

I.Determine Family Nursing Problems

Direction: Determine the root cause of the family’s health problems as well as their family
nursing problems.

Example:
Health Problems Family Nursing Problems
1st Level 2nd Level Assessment
Assessment
1. Colds and 1. Health Deficit 1. Inability to recognize the existence of a problem
persistent due to ignorance of facts
 coughs as
health deficits 2. Inability to make decision with respect to taking
appropriate health actions due to:
a. Failure to comprehend the nature, magnitude
or scope of the problem
b. Lack of knowledge as to alternative courses of
action open to them
2. Scabies 1. Health Deficit 1. Inability to recognize the existence of a problem
due to ignorance of facts

2. Inability to provide home environment which is

conducive to health maintenance and
development due to:
a. Inadequate family resources
b. Ignorance of preventive measures
3. Failure to utilize community resources for health
care due to:
a. Lack of appropriate information
b. Negative attitude (hiya)

3. Poor 1. Health Threat 1. Inability to provide a home environment that is

environmental conducive to health maintenance and personal
sanitation: development due to:

a. Inadequate a. Inadequate family resources (financial,

potable water inadequacy and lack of space to construct
supply facility)
b. Inappropriate b. Ignorance of the importance of hygiene and
waste disposal sanitation
method c. Ignorance of preventive measures
c. Presence of
breeding area
for insects and
rodents

II. ESTABLISHING PRIORITIES:

Four Criteria for Determining Priorities:

1. Nature of the problem presented – categorized into wellness condition, health

threat, health deficit and forseeable crisis
2. Modifiability of the problem – refers to the probability of success in minimizing,
alleviating or totally eradicating the problem through nursing intervention
3. Preventive potential – refers to the nature and magnitude of future problems that
can be minimized or totally prevented if intervention is done on the problem under
consideration
4. Salience – refers to the family’s perception and evaluation of the problem in terms
of seriousness and urgency of attention needed.

Factors considered in determining the Modifiability of health condition or problem:

a. Current knowledge, technology and interventions to enhance the wellness state or manage the
problem
b. Resources of the family-physical, financial and manpower
c. Resources of the nurse- knowledge, skills and time
d. Resources of the community- facilities and community organization or support

Factors considered for the Preventive Potential of health condition or problem:

a. Gravity or Severity of the Problem

-refers to the progress of the disease/ problem indicating extent of damage on the patient/
family;
-also indicates prognosis, reversibility or modifiability of the problem.
-in general, the more severe or advanced the problem is, the lower is the preventive potential
of the problem
 b. Duration of the Problem
-refers to the length of time of the problem has been existing.
-generally speaking, duration of the problem has a direct relationship to gravity; the nature of
the problem is a variable that may, however, alter this relationship.
-because of this relationship to gravity of the problem, duration has also a direct relationship to
preventive potential.

c. Current Management
-refers to the presence and appropriateness of intervention measures instituted to enhance
the wellness state or remedy of the problem.
-the institution of appropriate intervention increases the condition’s preventive potential.

d. Exposure of any vulnerable or high risk group

-increases the preventive potential of a condition or problem

Scale for Ranking Family Health Problems

Criteria Score Weight Actual Justification for Scoring

Score
1. Nature of the Problem 1
Scale:
 Wellness 3
Condition/Potential
 Health Deficit 3
 Health Threat 2
 Forseeable Crisis 1
2. Modifiability of the 2
Problem
Scale:
 Easily Modifiable 2
 Partially Modifiable 1
 Not Modifiable 0
3. Preventive Potential 1
Scale:
 High 3
 Moderate 2
 Low 1
4. Salience 1
Scale:
 A serious problem that 2
needs immediate attention
 A problem , but does not 1
need immediate attention
 Not a felt need/ problem 0
TOTAL
SCORING:
1. Decide on a score for each of the criteria
2. Divide the score by the highest possible score and multiply by the weight.
3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total
weight.

Example: 5 year old child has Scabies

Criteria Computation Actual Score JUSTIFICATION

1. Nature of the 3/3x1 1 Scabies is a health deficit

Problem
2. Modifiability of 2/2x2 2 Family tells washing the skin with bayabas
the Problem decoction; presence and availability of
 health worker and barangay health station
within the community; family brings their
child for scheduled consultation.
3. Preventive 3/3x1 1 Child frequently goes out to play but is
Potential observed to do hand washing when going
home from play; family weekly changes
bedding and do laundry at least twice a
week with clean water and laundry soap
4. Salience of the 0/2x1 0 Not a felt problem since the family does
Problem attends to the child’s skin preventing it from
spreading to other skin areas.

TOTAL 4

***in establishing priorities, all identified health conditions should be ranked and prioritized***

Types of Family Nurse Contact

Clinic Visit
Home Visit
Group Conferences
Telephone calls
Written communications
Guidelines for Implementing Nursing Activities:
1.Nursing actions should be based on scientific knowledge, nursing research, and professional
standards of care.
2.Nurses should understand clearly the orders to be implemented and any question that are not
understood.
3.Nursing action should be adapted to the individual client.
a.Nursing actions should always be safe.
b.Nursing actions often require teaching, support and comfort.
c.Nursing actions should be holistic.
III. Prepare Family Health Care Plans for Priority Families

Health Family Objectives Interventions Rationale Methods Resources Evaluation

Problems Nursing of N-F Required
Problems Contact
First Level Second Level (Remember Diagnostic (of Manpower Objective are
Assessment Assessment SMART) Therapeutic interventions) Material the ones
Educative Budget evaluated
Write also the Short Term should be
Subjective Objective (May consist actions that can be scientifically if Met give
and Objective independent, rationalized reasons involved
dependent, & or justification
Cues
collaborative)
Long Term
Objective if Not Met give
Modifications

Example:

Health Family Nursing Objectives Interventions Rationale Method Resources Evaluation

Problems Problems s of N-F Required
(2ND LEVEL Contact
ASSESSMENT)
Coughs and 1. Inability to LTG: After 1. Discuss with the (of Home a. Visual aids CRITERION:
colds AS A recognize the nursing family members interventio visit b. Time and Cured
Health deficit existence of a intervention, the the importance of ns) Clinic effort of both cough
problem due following are knowing the visit the nurse and
NOTE: to ignorance expected to take necessary the family STANDARD:
PRESENT of facts place: information about c. Monetary In 3-4
ALSO THE 2. Inability to The chances of the diseases to allowance for visits, cough
SUBJECTIVE make spreading prevent nurse’s will be cured
AND
decision with communicable spreading them. transportation through
OBJECTIVE
DATA
respect to diseases to 2. Provide expenses family care.
taking other family adequate
appropriate members will knowledge on
health actions be slim. the various ways
 due to: of maintaining
STG: After cleanliness in
a. failure to nursing their
comprehend intervention, the surroundings.
the nature, ff. should be 3. Explain the
magnitude or achieved: importance of
scope of the proper food
problem The family preparation,
should acquire exercise and rest
adequate in strengthening
b. lack of information one’s resistance
knowledge about the against illness.
as to disease,
alternative including signs 4. Provide
courses of and symptoms information on
action open of the disease, health centers in
to them immediate the vicinity for
health care immediate health
assistance, and care assistance.
preventive
measures;

LTG: The
recurrence of
coughs and colds
among family
members will be
prevented or
minimized.

STG: Discuss
with the family
the
consequences of
failing to take
appropriate
health action at
 the earliest
possible time.
These include
the following:
a. covering the
mouth when
sneezing or
coughing
b. properly
disposing of
oral and nasal
discharges
c. eating a well-
balanced diet
composed of
economical
but nutritious
foods
d. maintain
proper
personal and
environmental
hygiene
Environment 1. Inability to LTG: After 1. Discuss with the Home a. Low cost CRITERIA:
al sanitation provide a nursing family the visit medical 1.
such as: home intervention, the importance of supplies to Cleanliness
a. environment family will take environmental manage/treat of house and
inadequat that is the necessary sanitation to their scabies surroundings.
e safe conducive to action to improve health. b. Time and 2.
water health and maintain the 2. Utilize health effort of both Construction
supply maintenance sanitation of their measures the nurse and of sanitary
b. improper and personal immediate involving the the family toilet/drainag
waste development surroundings manipulation or c. Budget for e.
disposal due to: elimination of the buying 3. Use of
c. presence a. Inadequate STG: After following threats: materials PWS
of family nursing a. physical
breeding resources intervention, the threats to STANDARD:
area for (financial, following should health are After 3-5
insects / inadequacy be achieved: eliminated by visits, the
rodents and lack of 1. The family improving on above criteria
space to should know the facilities in will be met by
construct the importance the home either family.
facility) of clean by constructing
b. Ignorance potable water needed ones or
of the supply and by modifying
importance of proper waste those already
hygiene and disposal; existing.
sanitation 2. Boil drinking b. psychological
c. Ignorance water; threats are
of preventive 3. Throw waste manipulated by
measures materials working closely
properly or use with the family
the dig-burn to improve
method; communication,
4. Clean role
surroundings to assumptions
eliminate and
breeding relationships,
places of pests; and interaction
and patterns.
5. Take a bath
once or twice a 3. Explore with the
day family the ways
of improving
home sanitation
considering its
limited
resources.
a. emphasize to
the family the
advantages of
proper garbage
disposal.
b. instruct all
 family
members to
prevent
accumulation
of stagnant
water around
their home
since this is a
good breeding
place for
insects.

Scabies 1. Inability to LTG: After Help family Home a. Time and CRITERIA:
recognize the nursing members visit effort of both
existence of a intervention, the understand the the nurse and Knowledge
problem due parents will nature of the the family on caring for
to ignorance manage care of present health b. Monetary scabies
of facts children with problem by allowance for
scabies. intensively nurse’s STANDARD:
2. Inability to explaining and transportation In 2-3
provide home STG: After discussing with the expenses visits, the
environment nursing family members. mother will
which is intervention, the demonstrate
conducive to family members how to care
health will accomplish for a child
maintenance the following: with scabies
and 1. Become aware wounds.
development and
due to: knowledgeable
a. of the presence
Inadequate of health
family problems
resources among family
b. members;
Ignorance of 2. Be cognizant
preventive of the nature
measures and extent of
 illness;
3. Failure to 3. Implement the
utilize agreed upon
community health
resources for measures in
health care preventing the
due to: recurrence of
a. Lack of the illness by
appropriate improving
information personal
b. Negative hygiene and
attitude (hiya) home
sanitation
despite limited
resources; and
4. Be adept in
providing
nursing care to
family
members at
home.