DEVELOPING A FAMILY

NURSING CARE PLAN

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

1. Focuses on action to 3. Relates to the future;

solve/minimize existing projects future scenario
problems
4. Based upon the identified
2. A product of deliberate health and nursing problems
systematic process
Cont…

5. It is a means to an end, 6. A continuous process –

not an end in itself –
DESIRABLE QUALITIES OF FNCP

 It should be based on clear, explicit definition of

the problems.

 A good plan is realistic

Cont…
 Prepared jointly with the family.

 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

II. SETTING THE GOALS AND OBJECTIVES

III. PLANNING INTERVENTIONS

IV. EVALUATION OF CARE

Prioritizing the
Health Problems
a) Nature of the problem
b) Modifiability
c) Preventive potential
d) Salience
Formulation of Goals and
Objectives of Nursing Care
Development of Evaluation Plan
•Criteria
•Standards
•Methods / tools
Selection of Appropriate
Nursing Interventions
•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
 4 Main criteria (with sub-criteria) for prioritization,
scoring and justification

NATURE 
MODIFIABILITY 
PREVENTIVE POTENTIAL 
SALIENCE 
Process of Scoring

1) Decide on a score for each criteria base on the

given sub-criteria.
2) Divide the score by the highest possible score and
multiply by the weight : score/highest score x
weight
3) Sum up the scores for all criteria. The highest
score is 5, equivalent to the total weight.
 NATURE of condition or problem
 Classification of the family health condition / problem
 Given a weight of 1 in a total score of 5

 Sub-criteria and specific scores

A. Wellness state (readiness or potential) – given a score of 3

(highest)
B. Health deficit – also given a score of 3 (highest)
C. Health threat  - given a score of 2
D. Stress points or foreseeable crisis situations – given a score of 1
(lowest)
 MODIFIABILITY
PROBABILITY OF SUCCESS in enhancing the wellness state,
improving the condition, minimizing/alleviating/totally eradicating the
problems through RESOURCES & INTERVENTIONS.

Given a weight of 2 from a total of 5 (it has highest weight)

Guidelines:
This criterion has 4 sets of resources that need to be considered in
prioritization.
Highest possible score for this criterion = 2
In order to be objective and accurate in prioritization, this score of 2 is
divided to the 4 resources required.
Absence of 1 set of resource will mean a decrease in scoring and will
affect the score of the problem, hence will also affect the priority and
capability of the family and health worker to resolve the problem. This
will justify the .5 given to each sub-criterion.
When JUSTIFYING, state all the resources that are present and that
are not.
 Sub-criteria
a. Current knowledge, technology and interventions
available (.5) –
b. Resources of the community (where family lives) (.5) –
c. Resources of the family (.5) –
d. Resources of the health worker / nurse (.5) –
 INTERPRETATION:
Give a score of 2, interpreted as EASILY MODIFIABLE , if all
the 4 sets of resources are present.
Give a partial score of 1 or 1.5, interpreted as PARTIALLY
MODIFIABLE , if 2 or 3 sets of resources are not available.
Give a score of 0 to .5, interpreted as NOT MODIFIABLE ,
because the presence of only 1 set of resource or no resource
at all makes it difficult to resolve a problem or enhance a
wellness condition.
Guideline in JUSTIFICATION:
Always enumerate or state the resources that are present and
that are not present.
 PREVENTIVE POTENTIAL

 Nature and magnitude of FUTURE PROBLEMS (not the

problem being scored) that can be minimized or totally
prevented if intervention is done on the condition or
problem under consideration.

 Weight = 1; highest possible score = 3

 Guidelines:
This criterion has 4 sub-criteria that need to be
considered.
In order to be objective and accurate, the score of 3
is divided to the 4 sub-criteria.
When scoring, interpreting and justifying, always
specify the sub-criterion / criteria that is / are compromised
or not compromised
 Sub-criteria:
 Gravity or severity of the problem  (.75) –
Guidelines:
The more severe or advanced the problem is, the lower is
its PP. No score will be given.
The less severe or less advanced the problem is, the higher
is its preventive potential. Give .75 score.
b. Duration of the problem (.75) –
Guidelines:
The longer the duration, the lower will be its PP.
No score.
The shorter the duration, the higher will be its PP.
Give .75.
c. Presence and appropriateness of current management initiated by
family (.75) 
Guidelines:
If the family instituted appropriate interventions, a .75 score is
given.
If no appropriate intervention was done or if there was but it is
not appropriate, no score will be given.
d. Exposure of any vulnerable or high risk group (.75) 
Guidelines:
If there are other family members who are vulnerable or at risk of
being exposed of developing the disease but such can be prevented
if the problem under consideration is resolved, then give a score
to this criterion.
If none, then no score is given to this sub-criterion.
 INTERPRETATION
Give the highest possible score of 3 and interpret it as HIGH PP if:
The problem is not grave or severe.
The problem is of short duration.
The fam instituted an appropriate intervention measure.
There are at risk or vulnerable fam members exposed to the
problem.
Give a score of 1.5 – 2.25 and is interpreted as having a MODERATE
PP if 1 or 2 of the above sub-criteria are compromised.
Give a score of 0 to .75 and interpret it as LOW PP if 3 or all of the
sub-criteria are compromised.
 SALIENCE

 Family’s perception  and evaluation of the of the

condition or problem in terms of seriousness and
urgency of attention needed or family readiness = 2
points

 Weight = 1; highest possible score = 2

Guideline:
 If the family perceives as problem and NEEDS
URGENT attention, a score of 2 is given
 If the family perceives as problem but not needing
IMMEDIATE ATTENTION, a score of 1 is given
 If the family DOES NOT perceive it as a problem, no
score is given.
II. FORMULATION OF GOALS AND OBJECTIVES
OF NURSING CARE
GOALS OBJECTIVES
General statement of the More specific statements of desired
condition or state to be brought results or outcomes of care
about by specific courses of Specify the criteria by which the
action degree of effectiveness of care are to
be measured
Client outcomes
Must be specific in order to facilitate
Goals tell where the family is its attainment
going 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.

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 reject to do something about
the situation.
Reasons for Not Doing Any Action

1) Fear of consequence of 3) Failure to perceive the

doing action benefits of action proposed

2) Respect for tradition 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.
 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 action

 N must specify the most effective or efficient method of N-F
contact
• Home visit
• Clinic conference
• Visit in the workplace, 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

 Nsg Intervention is dependent upon lived meaning

of the experiences of family member w/ each other
and the nurse
 FAMILY is the active participant in the applcation 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