Developing A Family Nursing Care Plan

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

Relates to the future; projects future scenario

A product of deliberate systematic process – data analyses

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

STEPS I.

PRIORITIZATION OF PROBLEMS

III.

SETTING THE GOALS AND OBJECTIVES

V.

PLANNING INTERVENTIONS

VII.

EVALUATION OF CARE

Prioritizing the Health Problems c) Nature of the problem d) Modifiability e) Preventive potential f) Salience

Development of Evaluation Plan •Criteria •Standards •Methods / tools

Selection of Appropriate Nursing Interventions Formulation of Goals and Objectives of Nursing Care

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

I. PRIORITIZATION OF PROBLEMS  



Devised by Maglaya and Bailon Known as SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES Has four (4) criteria for setting priorities

SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES FOUR CRITERIA:

1) NATURE OF THE PROBLEM a) health threat b) health deficit c) foreseeable crisis

2) MODIFIABILITY OF THE PROBLEM - the probability of success in minimizing, alleviating or totally eradicating the problem through intervention 3) PREVENTIVE POTENTIAL - 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 - the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed

SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCDG TO PRIORITIES Criteria

Weight 1) Nature of the Problem scale: Health Deficit Health Threat Foreseeable Crisis 2) Modifiability of the Problem scale: Easily Modifiable Partially modifiable Low 3) Preventive Potential scale:

4) Salience scale:

High Moderate Low

1 3 2 1 2 2 1 0 1 3 2 1 1

Serious px, imm. Attn Px, not needing imm. Attn

2 1

Scoring 1)

2)

3)

Decide on a score for each criteria Divide the score by the highest possible score and multiply by the weight : score/highest score x weight Sum up the scores for all criteria. The highest score is 5, equivalent to the total weight.

Fxs Affecting Priority - Setting 



Greater weight on Health Deficit = needs more immediate attn and felt by the pt over a health threat Foreseeable crisis = lowest score d/t culture-linked variables/factors that provide our ct with adequate support to cope

Fxs in Determining the Modifiability of the Problem 



 

Current knowledge, tech. and interventions to manage the problem Resources of the family – physical, financial, manpower Resources of the N – S, K, time Resources of the community – facilities and community org/support

Fxs Affecting the Scoring of Preventive Potential 

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



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



Current management = appropriateness of intervention instituted



Exposure to any high risk group

SALIENCE OF THE PROBLEM 



Perception of the pt/fam of the problem Family’s concerns and felt needs

II. FORMULATION OF GOALS AND OBJECTIVES OF NURSING CARE GOALS General statement of the condition or state to be brought about by specific courses of action Client outcomes Goals tell where the family is going

OBJECTIVES More specific statements of desired results or outcomes of care Specify the criteria by which the degree of effectiveness of care are to be measured Must be specific in order to facilitate its attainment Milestones to reach the destination

GOALS  Must be set together with the family  Family 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.

B. C. D.

Analyze w/ the Family the Current Situation and Determine Choices and Possibilities based on a Lived Experience of Meanings and Concerns Develop / Enhance Family’s Competencies as Thinker, Doer and Feeler Focus on Interventions to Help Perform the Health Tasks 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