DEVELOPING A FAMILY NURSING CARE PLAN

Group 2

MAN_2008

AUL

F N C P : defined

Blueprint of the care that the N designs to systematically minimize or eliminate the identified health and family nsg problems through explicitly formulated outcomes of care and deliberately chosen sets of interventions, resources and evaluation criteria, standards, methods and tools.

CHARACTERISTICS OF FNCP

Focuses on action to solve/minimize existing problems

A product of deliberate systematic process – data analyses

Relates to the future; projects future scenario

Based upon the identified health and nursing problems – problems are starting points

Cont…

It is a means to an end, not an end in itself – deliver the most appropriate care to the ct by eliminating barriers to family health development

A continuous process – must be evaluated for its effectiveness

DESIRABLE QUALITIES OF FNCP

It should be based on clear, explicit definition of the problems.

= Must be based on comprehensive analysis of the problem

A good plan is realistic

Cont…

Prepared jointly with the family.= N works with the family; not works for the family= N involves family in determining the health needs & problems, priorities, appropriate actions, implementation and evaluation of outcomes

A means of communication (within the profession and other professions)

IMPORTANCE OF PLANNING CARE

Individualizes patient care.Sets priorities by providing information abt

the ct; his nature of problems.Promotes systematic communication

involved in care.Continuity of care is facilitated, prevents

gaps and duplication of care.Coordinates care to other health team

members.

THE ASSESSMENT PHASE OF THE THE ASSESSMENT PHASE OF THE NURSING PROCESS GENERATES NURSING PROCESS GENERATES THE HEALTH AND NURSING THE HEALTH AND NURSING PROBLEMS WHICH IS THE BASIS PROBLEMS WHICH IS THE BASIS OF DEVELOPING THE FNCP.OF DEVELOPING THE FNCP.

STEPSSTEPS

I.I. PRIORITIZATION OF PROBLEMSPRIORITIZATION OF PROBLEMS

II.II. SETTING THE GOALS AND SETTING THE GOALS AND OBJECTIVESOBJECTIVES

III.III. PLANNING INTERVENTIONSPLANNING INTERVENTIONS

IV.IV. EVALUATION OF CAREEVALUATION OF CARE

Prioritizing the Health Problemsa) Nature of the problemb) Modifiabilityc) Preventive potentiald) Salience

Formulation of Goals andObjectives of Nursing Care

Selection of Appropriate Nursing Interventions•Consider alternatives•Decide on appropriate measures•Determine methods of nurse-family contact•Specify resources

Development of Evaluation Plan•Criteria

•Standards•Methods / tools

I. PRIORITIZATION OF I. PRIORITIZATION OF PROBLEMS PROBLEMS Devised by Maglaya and BailonDevised by Maglaya and Bailon Known as Known as SCALE FOR RANKING SCALE FOR RANKING

FAMILY HEALTH PROBLEMS FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIESACCORDING TO PRIORITIES

Has four (4) criteria for setting Has four (4) criteria for setting prioritiespriorities

SCALE FOR RANKING SCALE FOR RANKING FAMILY HEALTH FAMILY HEALTH PROBLEMS ACCORDING PROBLEMS ACCORDING TO PRIORITIESTO PRIORITIESFOUR CRITERIA:FOUR CRITERIA:

1) NATURE OF THE PROBLEM1) NATURE OF THE PROBLEM

a) health threata) health threat

b) health deficitb) health deficit

c) foreseeable crisisc) foreseeable crisis

2) MODIFIABILITY OF THE PROBLEM2) MODIFIABILITY OF THE PROBLEM- the - the probability of successprobability of success in in minimizing, minimizing, alleviating or totally eradicating the alleviating or totally eradicating the problemproblem through intervention through intervention

3) PREVENTIVE POTENTIAL 3) PREVENTIVE POTENTIAL - the - the nature and magnitude of future nature and magnitude of future problemsproblems that can be that can be minimized or totally minimized or totally preventedprevented if intervention is done on the if intervention is done on the problem under considerationproblem under consideration

4) SALIENCE 4) SALIENCE - the family’s - the family’s perception and evaluationperception and evaluation of the of the problem in terms of problem in terms of seriousness and urgencyseriousness and urgency of attention neededof attention needed

Scoring Scoring

1)1) Decide on a score for each criteriaDecide on a score for each criteria

2)2) Divide the score by the highest Divide the score by the highest possible score and multiply by the possible score and multiply by the weight : score/highest score x weight : score/highest score x weightweight

3)3) Sum up the scores for all criteria. Sum up the scores for all criteria. The highest score is 5, equivalent The highest score is 5, equivalent to the total weight.to the total weight.

Fxs AffectingFxs AffectingPriority - SettingPriority - Setting

Greater weight on Health Deficit Greater weight on Health Deficit = needs more immediate attn = needs more immediate attn and felt by the pt over a health and felt by the pt over a health threatthreat

Foreseeable crisis = lowest score Foreseeable crisis = lowest score d/t culture-linked variables/factors d/t culture-linked variables/factors that provide our ct with adequate that provide our ct with adequate support to cope support to cope

Fxs in Determining theFxs in Determining the Modifiability of the Modifiability of the

ProblemProblem Current knowledge, tech. and Current knowledge, tech. and

interventions to manage the interventions to manage the problemproblem

Resources of the family – physical, Resources of the family – physical, financial, manpowerfinancial, manpower

Resources of the N – S, K, timeResources of the N – S, K, time Resources of the community – Resources of the community –

facilities and community org/supportfacilities and community org/support

Fxs Affecting the Scoring Fxs Affecting the Scoring ofof Preventive Potential Preventive Potential

Gravity / severity of Gravity / severity of the pxthe px= dse progression, = dse progression, extent, damage on extent, damage on the pt/famthe pt/fam= the more severe = the more severe or advanced, the or advanced, the lower is the lower is the preventive potentialpreventive potential

Duration of the pxDuration of the px= length of time the = length of time the px has been existingpx has been existing

Current managementCurrent management= appropriateness of = appropriateness of intervention intervention institutedinstituted

Exposure to any high Exposure to any high risk grouprisk group

SALIENCE OF THE SALIENCE OF THE PROBLEMPROBLEM

Perception of the pt/fam of the Perception of the pt/fam of the problemproblem

Family’s concerns and felt needsFamily’s concerns and felt needs

II. FORMULATION OF GOALS AND OBJECTIVES OF NURSING CARE

GOALS OBJECTIVES

General statement of the condition or state to be brought about by specific courses of actionClient outcomesGoals tell where the family is going

More specific statements of desired results or outcomes of careSpecify the criteria by which the degree of effectiveness of care are to be measuredMust be specific in order to facilitate its attainmentMilestones to reach the destination

GOALS

Must be set together with the familyFamily must be able to recognize and

accept the presence of existing health needs and problems.

Nurse must ascertain the family’s knowledge and acceptance of the problems and the desire to make actions to resolve them.

BARRIERS TO GOAL-SETTING

1) Failure of the family to perceive the existence of the problem.= family may feel satisfied with the existing situation

2) Family is too busy with other concerns or preoccupations at the moment.

Cont…

3) Family does not see the existence of a problem as serious enough to necessitate attention

4) Family may perceive the problem and the need to take action, but they face to do something about the situation.

Reasons for Not Doing Any Action

1) Fear of consequence of doing action

= social stigma / financial reasons

2) Respect for tradition

3) Failure to perceive the benefits of action proposed

= previous experience

4) Failure to relate the proposed action to the family’s goals

Cont… BARRIERS TO GOAL-SETTING

5) Failure between the nurse and the family to establish a working relationship.

= TRUST AND CONFIDENCE

TIME SPAN OF OBJECTIVES

1) Short Term / Immediate Objectives- immediate att’n; results: can be observed in a period of short time

2) Medium – Term / Intermediate Objectives- required to attain long – term objectives

3) Long – Term or Ultimate Objectives- several N-F contact + more resources- takes time to see the result

III. SELECTION OF APPROPRIATE NURSING INTERVENTIONS

N must choose among set of alternatives N must specify the most effective or

efficient method of N-F contact• Home visit• Clinic conference• Visit in the work, place, school• Telephone call• Group approach• Mail

Cont…

N must specify the most effective or efficient resources Teaching kits – visual aids, handouts,

charts Human – other team members,

community leaders

HOW TO CHOOSE THE APPROPRIATE NURSING INTERVENTION?

A. Analyze w/ the Family the Current Situation and Determine Choices and Possibilities based on a Lived Experience of Meanings and Concerns

B. Develop / Enhance Family’s Competencies as Thinker, Doer and Feeler

C. Focus on Interventions to Help Perform the Health Tasks

D. Catalyze Behavior Change through Motivation and Support

A. EXPLORATION W/ FAMILY CHOICES/POSSIBILITIES BASED ON LIVED

EXPERIENCE OF MEANINGS AND CONCERNS

N.I. is dependent upon lived meaning of the experiences of family member w/ each other and the nurse

FAMILY is the active participant in the applc’n of Nsg. Process

FAMILY & NURSE are participants in active, mutual, dynamic interchange of realities, concerns and resources

They both need to analyze & understand the current health/illness situation

Nurse must explore w/ the F the possibilities and choices presented by current situation Meanings Concerns Social relations Resources

B. DEVELOPING/ENHANCING COGNITION, VOLITION AND EMOTION

Provides the family ways to be THINKER, DOER & FEELER

THINKER – N must be able to share info/knowledge; must be accessible for ease and confidence in understanding current situations and health/illness

DOER – N must enhance confidence to the F in carrying out/initiating and sustaining change for health promotion & maintenance, and accurate dse mgt.

FEELER – N must help the F strengthen its affective competencies in order to appropriately acknowledge & understand emotions generated by family life or health illness situations; so that these emotions will be transformed into growth-promoting actions

C. FOCUSING ON THE INTERVENTIONS TO HELP THE FAMILY PERFORM THE HEALTH

TASKS

1) Help the F recognize the px.- information-giving about the nature, magnitude, cause of the px- help the F see the implications of the px- relate health needs to the goals of the family- help the F recognize its capabilities/qualities and resources

Cont…

2) Guide the F on how to decide on appropriate health actions to take.- identify/explore the courses of action + resources available- discuss the consequences of each courses of action- analyze together w/ the F the consequences of inaction

Cont…

3) Develop the F’s ability and commitment to provide nursing care to its members.- nsg care to sick, disabled, dependent member/s demonstration / practice sessions on procedures/tx, techniques= use of low-cost, available resources

CONTRACTING Maximizes opportunities to develop the

ability & commitment of the family to provide nsg care to its members

N creates a situation in order that the ct learns to achieve a specific health-related behaviour through steps and conditions or elements jointly identified by both parties

Uses positive reinforcement

4) Enhance the capability of the F to provide a home env’t conducive to health maintenance and personal dev’t.- env’t modification, manipulation, management to reduce health threats/risks

5) Facilitate the F’s capability to utilize community resources for health care.- coordination, collaboration, team work referral system

D. CATALYZING BEHAVIOR CHANGE THROUGH MOTIVATION & SUPPORT

There should be an env’t that nurtures change

There should be support from both parties in order to make a change

MOTIVATION & SUPPORT Enhance the F’s knowledge and willingness

to prevent, control health pxs Makes the F skillful, emotionally stable and

creative handling the stresses/issues surrounding them

MOTIVATION: described

Any experience or information that leads the family to desire and agree to undergo the behavior change or proposed measure and takes the initial action to bring about a change

SUPPORT: described

Any experience or information that maintains, restores or enhances the capabilities or resources of the family to sustain these actions and complete the change process feelings of security and in control of the px (family)

DEVELOPING THE EVALUATION PLAN

Specifies how the N will determine achievement of the outcomes of care

Criteria, standards, evaluation methods and sources of data