CHN WEEK 5 Flashcards
Is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen set of interventions, resources and evaluation criteria, standards, methods and tools.
FAMILY NURSING PROCESS
a problem-solving approach that enables the nurse to provide care in an organize and scientific manner. It is applicable to individuals, families and community groups at any level of health. It is adaptable to any practice setting or specialization and the components may be used sequentially or concurrently.
NURSING PROCESS
Phases of Nursing Process:
● 1. Assessment
● 2. Diagnosis
● 3. Planning
● 4. Implementation
● 5. Evaluation
● 1. Collection of data
● 2. Comparison of data against the standard
or norm
THE NURSING ASSESSMENT PHASE
First source
Health status of the family
Second Source
Family’s status as a
functioning unit
Third Source
Family’s environment
Methods of Gathering Data
- Direct observation
- Interviewing
- Physical Examination
● ◼ A method of data collection which is done through the use of all sensory capacities
● ◼ The nurse gathers information about the
family’s state of being and behavioural
responses.
● ◼ Presence of S/S
Direct observation
● ◼ Encourage verbalization of thought and feelings and offer needed support or reassurance.
Interviewing
◼ Done through inspection, palpation, percussion, auscultation measurement of specific body parts and reviewing the body systems
Physical Examination
● 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. Place of residence of each member - whether living with or elsewhere.
● 4. Type of family structure - matriarchal, patriarchal, nuclear or extended.
● 5. Dominant family members in terms of decision making in matters of health care.
● 6. General family relationship - presence of any obvious/ready observable conflict between members; communication patterns among members.
Family structure and Characteristics
● 1. Income and expense
○ ▪ Occupation, place of work and
income of each working member
○ ▪ Adequacy to meet basic necessities (food, clothing and
shelter)
○ ▪ Who makes decision about money
and how it is spent
● 2. Educational attainment of its members
● 3. Ethnic background and religious affiliation ● 4. Significant others - roles they play in the
family
● 5. Relationship of the family to the larger
community-what is the participation of the family in community activities?
Socio-economic and Cultural Factors
- Housing
○ a. Adequacy of living space
○ b. Sleeping arrangement.
○ c. Presence of insects and rodents.
○ d. Adequacy of the furniture
○ e. Food storage and cooking
facilities
○ f. Presence of accidents hazards
○ g. Water supply-source, ownership,
potability
○ h. Toilet facility-type, ownership,
sanitary condition
○ i. Garbage/refuse disposal- type,
sanitary condition
○ j. Drainage system- type and
sanitary condition - Kind of neighborhood- congested, slum, etc.
- Social and health facilities available
- Communication and transportation
Environmental Factors
● 1. Medical and Nursing History indicating past significant illness, beliefs and practices conducive to illness.
● 2. Nutritional assessment (specifically for vulnerable or at risk members)
○ a. Anthropometric data- weight, height.
○ b. Dietary history indicating quality and quantity of food intake per day
○ c. Eating/feeding habits and practices
● 3. Current health status indicating presence of illness states (diagnosed/undiagnosed by medical practitioner)
Health Assessment of Each Member
● 1. Immunization status of children
● 2. Use of other preventive services
- Value Placed on Preventive Disease
Comparison of the gathered DATA to the STANDARDS OR NORMS
Data Analysis
Is defined as situation or condition which interferes with the promotion and/ or maintenance of health and recovery from illness and injury
Health Problem
Exist when there is a health problem that can be alleviated with medical or social technology.
Health Need
the study or systematic classification of types.
◼ A tool or classification of a family nursing problems that reflects the family status and capabilities as a functioning unit.
Typology of Nursing Practice
- Instances of failure in health maintenance and development
- Occurs when there is a gap between actual and achievable health status.
Health Deficits
- diagnosed/suspected illness states of family members
-Sudden or premature or untimely death illness or disability and failures to adapt reality of life emotional control and stability
Health Deficits
-Deviations in growth and development
-Personality disorders
Health Deficits
Anticipated periods of unusual demand on the individual or family in terms of adjustments/family resources.
Stress Points/ Foreseeable Crisis Situation
● ◼ Marriage
● ◼ Pregnancy, labor, puerperium
● ◼ Parenthood
Stress Points/ Foreseeable Crisis Situation
● ◼ Abortion
● ◼ Entrance at school
● ◼ Adolescence
Stress Points/ Foreseeable Crisis Situation
● ◼ Loss of job
● ◼ Death of a member
● ◼ Resettlement in new community
● ◼ Illegitimacy
Stress Points/ Foreseeable Crisis Situation
Condition that are conducive to diseases, accidents or failure to realize one’s health potential.
Health Threats
● a. Broken stairs
● b. Pointed sharp objects,
poison and medicine
improperly kept
● c. Fire hazards
● d. Fall hazards
Accident Hazards
● a. Inadequate food intake both in quantity and quality
● b. Excessive intake of certain nutrients
● c. Faulty eating habits
Nutritional
a. Strained marital relationship
● b. Strain parent-sibling relationship
● c. Interpersonal conflicts between family members.
Stress Provoking Factors
● ●
● ● ●
● ● ● ● ●
a. Inadequate living space
b. Inadequate personal belongings/utensils
c. Lack of food storage facilities
d. Polluted water supply
e. Presence of breeding places of insects and rodents
f. Improper garbage/refuse disposal g. Unsanitary waste disposal
h. Improper drainage system
i. Noise pollution
j. Air pollution
Poor Environmental Sanitation
● a. Frequent drinking of alcohol
● b. Excessive smoking
● c. Walking barefooted
● d. Eating raw meat/fish
● e. Poor personal hygiene
● f. self-medication
● g. Use of dangerous drugs or
narcotics
● h. Sexual promiscuity
● i. Engaging in dangerous sports
Personal Habits/ Practices
● a. Self-oriented behaviour of members
● b. Unresolved conflicts among members
● c. Intolerable disagreements
Family disunity
the statement of the unhealthful response
General
the statement of factors which are maintaining the undesirable response and preventing the desired change
Specific
is the set of actions the nurse decides to implement to be able to resolve identified family health and nursing problems.
Family Nursing Care Plan
Four Criteria for Determining Priorities
- Nature of condition or problem
- Modifiability of the Problem
- Preventive Potential
- Salience
Four Criteria for Determining Priorities
- Nature of condition or problem
- Modifiability of the Problem
- Preventive Potential
- Salience
Categorized into wellness state/ potential, health threat, health deficit of foreseeable crisis.
Nature of condition or problem
refers to the probability of success in minimizing, alleviation or totally eradicating the problem through nursing intervention
Modifiability of the Problem
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.
Preventive Potential
refers to the family’s perception and evaluation of the problem in terms of seriousness an urgency attention needed.
Salience
▪ Is a general statement of condition or state to be brought about by specific courses of action.
▪ It is the end towards which all efforts are directed.
Goals
refer to more specific statements of the desired results or outcomes of care.
Formulation Objectives of Nursing Care
will not tell if the nurse’s activities produced some beneficial results; they only indicate what the nurse did and in qualitative evaluation, how well she performed them.
Nurse-Oriented
will indicate during the evaluation phase whether the desired changes in the problem situation resulted from the nurse’s action.
Client-Oriented
problem situations which require immediate attention
Results can be observed in a relatively short period of time.
They are accomplished with few nurse-family contacts and relatively less resources.
SHORT-TERM OR IMMEDIATE OBJECTIVES
are those which are not immediate ly achieved and are required to attain the long term ones.
MEDIUM- TERM OR
INTERMEDIATE OBJECTI VES
require several nurse-family encounters
The nature of the outcomes sought requires time to demonstrate
Investment of more resources
LONG-TERM ULTIMATE OR OBJECTIVES
resolve around the family’s assumption of the health tasks.
The nature of the problem
-aimed at minimizing or eliminating the possible reasons for or causes of the family’s inability to do these tasks.
Resource available to solve the problem
Goals and Objectives
S – Specific
M – Measurable
A – Attainable
R – Realistic
T- Time Bound
To stimulate recognition and acceptance of health needs and problems
Principles of Nursing Actions
The nurse can work on the family’s failure to decide on taking appropriate health actions
Principles of Nursing Actions
The nurse can increase the family’s confidence in providing nursing care to its sick, disabled and dependent member through demonstrations on nursing procedures utilizing supplies and equipment’s available in the home
Principles of Nursing Actions
The nurse should involve the patient and family in order to motivate them to assume responsibility for their own care.
Principles of Nursing Actions
The nurse also explains and clarifies doubts thus the role of the nurse shifts direct care giver to that of a teacher.
Principles of Nursing Actions
She can explore the ways to minimize or prevent threats to the maintenance of health and personal development among family members
Principles of Nursing Actions
She can utilize intervention measures involving environmental manipulations through improvements on the physical facilities in the home either by construction of needed ones or modifying existing ones.
Principles of Nursing Actions
To minimize or eliminate psychological threats in the home environment, the nurse can work closely with the family to improve its communication patterns, role assumptions and relationships and interaction patterns
Principles of Nursing Actions
physical and psycho-social strengths and assets of individual members, financial capabilities, physical facilities and the presence of support system provided by relatives and significant others.
FAMILY RESOURCES
knowledge about family health and her skills in helping family manage them. These skills may range from simple nursing procedure to complicated behavioural problems such as marital disharmony. Availability of time and logistical support are also part of resources of the nurse.
NURSE RESOURCES
include existing agencies, programs or activities for health and related needs/problems and community organization for health actions.
COMMUNITY RESOURCES
professional, purposeful interaction that takes place in the family’s residence aimed at promoting, maintaining and restoring the health of the family or its members.
Home-Visit
Major advantage is the fact that a family member takes the initiative of visiting the professional health worker, usually indicating the family readiness to participate in the health care process.
Clinic- Visit
Because the nurse has greater control over the environment, distraction are lessened and the family may feel less confident to discuss family health concerns.
Clinic- Visit
• appropriate for developing cooperation, leadership, self-reliance and or community awareness among group member
Group Approach
• The opportunity to share experiences and practical solutions to common health concerns is a strength of this type of family-nurse contact.
Group Approach
• used to give specific information to families, such as instructions given to parents through school children.
Written Communication
Serves as a reminder of the need for hand hygiene and other measures to prevent the spread of infection.
The Nursing Bag
• Frequently called the PHN bag
The determination of whether the objectives set were attained or to what degree they were attained.
EVALUATION PHASE
always related to objectives.
Evaluation
when address to the result or outcome of care answers the question “did the intended results occur?”
Evaluation
There is always an element of subjectivity in evaluation; the process involves value judgement which is subjective
Evaluation
also involves decision-making
Evaluation
focus is attainment of the
objectives
EFFECTIVENESS
relates to cost whether in terms of money, time, effort, or materials
EFFICIENCY
ability to solve or correct existing problem situation, a question that involves professional judgement.
APPROPRIATENESS
pertains to its comprehensiveness whether all necessary activities were performed in order to realize the intended results.
ADEQUACY
refer to the signs or indicators that tell us if the objective has been achieved. They are names and description of variables that are relevant indicators of having attained the objectives. They are free from any value judgement and are independent to time frame.
CRITERIA
once a value judgement is applied to a criterion; it acquires the status of a standard. It refers to the desired level of performance corresponding with a criterion against which actual performance is compared. It tells us what the acceptable level of performance or state of affairs should be for us to say that the intervention was successful.
STANDARD
are actions performed to accomplish an objective. They are the things the nurse does in order to achieved a desired result or outcome.
ACTIVITIES
is the results produced by activities
OUTCOME
decreased temperature or weight and change in clinical manifestations
PHYSICAL CONDITION
decreased anxiety and favourable attitude towards health care personnel.
PSYCHOLOGICAL OR ATTITUDINAL STATUS-
compliance of the patient with instructions given by the nurse
KNOWLEDGE ON LEARNING BEHAVIOR-
