Reviewer in

ACTION RATIONALE
Upon arrival at To protect the bag
the patient’s from getting
CHNN (RLE) home, place the
bag on the table
contaminated.

lined with a
“BAG TECHNIQUE” clean paper.The
clean side must
be out and the
Bag technique- is a tool by which folder part,
the nurse, during her visit will touching the
enable her to perform a nursing table
procedure with ease and deftness, Ask for a To be used for
to save time and effort with the basing of water hand washing.
end view of rendering effective or a glass of
drinking water
nursing care to clients. if tap waster is
not available.
Public health bag- an essential
and indispensable equipment for a Open the bag Wash hands using
public health nurse which she has and take out the soap and
to carry along during her home towel and soap water, wipe to
dry.
visits.
-It contains basic medication and Wash hands Take out the
articles which are necessary for using soap and apron from the
giving care. water, wipe to bag
dry. and put it on with
Purpose of bag technique: the right side
 To prevent contamination of Take out the To protect the
bag and equipment, avoid apron from the nurse’s uniform.
cross infection, and establish a bag
clean work area. and put it on
 Protect patients, family with the right
members, and healthcare side
workers from the spread of Put out all the Close the bag and
infection. necessary put it in one
 Demonstrate compliance with articles corner of the
standards, infection control needed for the working area.
principles, and standard specific care
precautions
Close the bag To prevent
THE FOLLOWING ARE STEPS IN
and put it in one contamination
PERFORMING
corner of the
BAG TECHNIQUE AND
working area.
RATIONALE FOR EACH
ACTION:
Proceed in After giving the
performing the treatment, clean Make For follow-up care
necessary all appointment for
nursing care things that were the next
treatment used and perform visit (either home
or clinic)
hand washing.
taking note of the
date and time.
After giving the To protect the
treatment, clean caregiver and
all prevent infection
things that were Standard contents
used and  Hand sanitizer
perform  Hand Lotion
hand washing.  Barrier
 Stethoscope
Open the bag and
return all things  Sphygmomanometer
that were used in  Digital Thermometer /Sheaths
their proper  Gloves: Latex-free /Non-
places after Sterile
cleaning them.
 Goggles
Remove apron, Fold the lining,  Alcohol Swabs
folding it away place it inside the  Mask: CPR / N95 Respirator
from the person, bag and close the
the soiled side bag
 Impermeable plastic trash bag
in and the clean  Flashlight
side out. Place  Tape Measure
it in the bag.  Tape
 Gown
Fold the lining,  Penlight
place it inside the  Bandage
bag and close the  Scissors
bag
 Sharps Container
Take the record
and have a talk BAG TECHNIQUE:
with the mother. CONSIDERATIONS
Write down all 1. Staff is responsible for
the
necessary data maintaining the
that were cleanliness and completeness of
gathered, the bag.
observations, 2. As homes differ greatly, staff
nursing care and
treatment will need to use judgment in
rendered. Give selecting an appropriate work area.
instructions for
care of patients in
the
Considerations include:
absence of the cleanliness of home,
nurse.
adequate lighting, low traffic area, guiding the interaction or the
away from direct currents from visit may have a more social
windows, heat or air conditioning tone and not be efficient or
vents, safe area for bag away from productive.
pets and children.
3. Bag must be thoroughly cleaned SETTING UP FAMILY
if soiled and periodically as APPOINTMENTS:
needed.
- Reusable equipment is cleaned 1. Introduce yourself
with soap and water in the 2. State the purpose of the
presence of bodily requested meeting including who
secretions,dried, then wiped with referred the family to the agency
alcohol and allowed to air dry. 3. Do not apologize for the
4. Disposable equipment is used meeting
whenever possible. 4. Be factual of the need about for
5. Patient’s equipment (e.g. the meeting but do not provide
thermometer, BP unit) is used details
whenever possible. 5.Offer several possible times for
6. The inside and contents of the the meeting including late
bag are always considered clean. afternoon
orevening
“HOME VISIT” 6. Let the family select the most
convenient time that allows the
majority of
Advantages: the family members to attend
7. Offer services of interpreter, if
 Opportunity to see family required
environment everyday 8. Confirm date, time, place and
 Observe family interactions directions
 More family members are able
to attend the meeting FAMILY DATA GEBOGRAM
 Emphasizes that the problem is DATA COLLECTION:
the responsibility and not one
family member 1. Identify who is in the immediate
family
Disadvantages: 2. Identify the person who has the
health problem
 Home maybe the the family 3. Identify all the people who live
only sanctuary or safe place with the immediate family
for the family 4. Determine how all the people
 The nurse must be highly are related
skilled in communication
specifically setting limits and
5. Gather all the necessary
information on each family - can be used as a research tool for
member all patients. It has a high research
▪ Age potential, facilitating nursing
▪ Sex diagnosis and the choice of the
▪ Correct spelling of the name optimum care procedure.
▪ Health problems
▪ Occupation
▪ Dates of relationships (marriage,
separation, divorce)
▪ Dates and age of death

6. Seek the same information from

the family members on
the same general level and for
those in the preceding
generational level Ecomap - is a structural diagram
7. Add any additional information of a client's most important
relative to the situation relationships with people,
such as geographic location and groups, and organizations; and
interaction patterns identifies resources available
in clients’ community.
Family assessment

- Is the process of collecting data

about the family structure,
and the relationships and
interactions among individual
members.
- It is a continuous process
- It aims to generate nursing
diagnoses with goals and “ACETIC ACID &
interventions for care created in BENEDICTS TEST”
collaboration with the
child and care givers Urine analysis
-It can be used to screen patient
Assessment Instrument for kidney and urinary tract
disease
Genogram - is a graphic - can help to detect metabolic or
representation of a family tree that systematic disease
displays detailed data on
relationships among individuals.
During course of a urine Acetic acid test
analysis, you’ll:
▪ Evaluate color, odor, and In a community setting, urinalysis
opacity of urine using the acetic acid is a good tool
▪ Determine urine’s specific for nurses to have an idea about
gravity and PH the albumin (protein) in the urine.
▪ Examine urine sediment for
blood cells, casts, and crystals. -This is done for people with
history of hypertension.
Urine Sample
contamination can be reduced by Materials:
collecting a
clean-catch, midstream urine
-1 test tube
1. CLEAN CATCH- refers to the - 10% acetic acid
fact that the area around the - Urine specimen (early morning
external opening of the urethra is urine, midstream flow)
cleansed by washing with soap - Alcohol lamp
and rinsing with water before - Dropper (2 pieces)
urinating - Test tube holder Match
2. MIDSTREAM- refers to the
fact that the initial portion of the Procedure:
urine stream is directed into a
toilet or bedpan, and then the urine 1. Place the paper lining on a table
stream is directed into a container. or any clean, flat surface from the
client. (clean side out)
Color: Pale yellow 2. Place the plastic lining (clean
Odor: Aromatic odor side in) over the paper thing.
Turbidity: Clear 3. Place the CHN bag over the
Specific gravity: 1.016 to 1.022 plastic lining, tucking the handles
pH: 4.5 to 7.8 beneath the bag.
4. Open the bag, take out the
Protein: Negative apron, soap in dish and towel.
Ketones: Negative 5. Do thorough hand washing.
Bilirubin: Negative 6. Put on your apron.
Glucose: Negative 7. Take out 2 droppers and place
Red blood cells: < 3 cells/HPF them in the kidney basin, same
White blood cells: < or = with the test tube and test tube
4cells/HPF holder.
Bacteria: None to Few 8. Take out the match, alcohol
Casts: None to Few lamp, acetic acid and place them
Crystals: None near the kidney basin.
10. Place the waste receptacle at
one of the work area.
11. Light the lamp.
12. Fill the test tube about 2/3 full
of urine.
13. Heat the upper portion of the
test tube to boiling point. (Mouth
of the tube should not face
the examiner and client) Urineanalysis: abnormal
urine
Water bath- is used to Proteinuria - or too
heat samples in the lab high levels of protein
in the urine, can affect kidney
function.
▪ It may be caused by a
variety of conditions.

UPPER PORTION of Benedict’s method

the test tube
-Using the urine specimen in a
14. Add 5 drops of 10% acetic
community health setting can be
acid one drop at a time. Heat
beneficial in determining the
again.
sugar level.
Used droppers should be placed
- This is done using the Benedict’s
near the waste receptacle)
Method for those with history of
16. Put off the flame.
diabetes.
Acetic acid test: Interpretation
Materials:
▪ No turbidity- à negative
▪ Faint turbidity- à+ 1. Benedict’s qualities
▪ Heavy Turbidity- à++ reagent
▪ Solid (opaque)- à +++ 3. Test tube
3. Alcohol lamp
4.Droppers (2pieces)
5. Urine (Early morning,
mid stream flow) Benedict’s method:
6. Match Interpretation
Procedure:
1. Place the paper lining clean side
out on a table or any clean, flat
surface away from the client.
2. Spread the plastic lining over
the paper lining, clean side in.
3. Place the bag in the area away
from the client, tucking handles
beneath the bag. Urineanalysis: abnormal
4. Open the bag; take out soap in urine
dish, towel and apron.
5. Do thorough hand washing. Dry
hands, place soap/dish and towel Positive Glucose
near the bag ▪ Present (Glucosuria)
6. Put on apron, right side out. Nursing Considerations:
7. Take out 2 droppers, a test tube ▪ Glucose in the urine indicates
and holder, and place these in the high blood glucose levels (greater
kidney basin. than 180 mg/dL)
8. Take out the alcohol lamp, ▪ may be indicative of
match, Benedict’s sol’n and place undiagnosed or uncontrolled
them on the work area. diabetes mellitus.
9. Place the waste receptacle at
one corner of the work area. “primary health care
10. Light the lamp (herbal med)”
11. Place 6-8 drops of urine in the
test tube.
12. Add 3-5 ml. of Benedict’s Brief History and Legal
sol’n to the urine Basis:
13. Used droppers should be
placed near the waste receptacle. ● May 1977 -30th World Health
14. Pass the test tube with mixture Assembly decided that the main
over the flame, mouth of the TT health target of
should be away from you and the the government and WHO is the
client. attainment of a level of health that
15. Remove from flame and stand would
for one minute. permit them to lead a socially and
16. Put off flame. economically productive life by
the year 2000.
● September 6-12, 1978 – First - an approach to health
International Conference on PHC development, which is carried out
in Alma Ata, Russia through a set of activities and
(USSR) The Alma Ata Declaration whose ultimate aim is the
stated that PHC was the key to continuous improvement
attain the and maintenance of health status
“health for all” goal
● October 19, 1979 – Letter of Goal of Primary Health
Instruction (LOI) 949, the legal Care -HEALTH FOR ALL
basis of PHC was FILIPINOS by the year 2000
signed by Pres. Ferdinand E. AND HEALTH IN THE HANDS
Marcos, which adopted PHC as an OF THE PEOPLE by the year
approach towards 2020.
the design, development and - An improved state of health and
implementation of programs quality of life for all people
focusing on health attained through SELF
development at community level. RELIANCE

Rationale for Adopting Key Strategy to Achieve

Primary Health Care:
the Goal:
1. Magnitude of Health Problems
2. Inadequate and unequal Partnership with and
distribution of health resources Empowerment of the people –
3. Increasing cost of medical care permeate as the core strategy in
4. Isolation of health care activities the effective provision of essential
from other development health services that are community
activities based, accessible, acceptable, and
sustainable, at a cost, which the
community and the government
Primary Health Care can afford.
- Is the essential health care made
universally accessible to Objectives of Primary
individuals and families in the
community by means of
Health Care
acceptable to them, through their ➢Improvement in the level of
full participation and at cost that health care of the
the community can afford at every community
stage of development. ➢Favorable population growth
structure
- a practical approach to making ➢Reduction in the prevalence of
health benefits within the reach of preventable,
all people. communicable and other disease.
➢Reduction in morbidity and 2. to refer to specialist & hospital
mortality rates especially services
among infants and children. 3. to co-ordinate health service
➢Extension of essential health for the patient
services with priority 4. to provide the best possible
given to the underserved sectors. health & social services in
➢Improvement in Basic he light of economic
Sanitation
consideration.
➢Development of the capability
5. to provide the best possible
of the community
aimed at self- reliance. health & social services in the light
➢Maximizing the contribution of of economic consideration.
the other sectors for
the social and economic 5 KEY ELEMENTS
development of the community
1. Reducing exclusion and social
Mission disparities in health (universal
- To strengthen the health care coverage).
system by increasing opportunities 2. Organizing health services
and supporting the conditions around people’s needs and
wherein people will manage their expectations (health service
own health care. reforms).
3. Integrating health into all
Two Levels of Primary sectors (public policy reforms).
Health Care Workers 4. Pursuing collaborative models
of policy dialogue (leadership
1. Barangay Health Workers- reforms).
trained community health 5. Increasing stakeholder
workers or health auxiliary
participation
volunteers or traditional
birth attendants or healers.
2. Intermediate level health Principles of Primary
workers-include the Public Health Health Care:
Nurse, Rural Sanitary Inspector
and Midwives. 1, social equity
2. Nation wide coverage
3. self-reliance
Function of primary health 4. inter-sectoral coordination
care: 5. people’s involvement
1. to provide continuous & in the planning & implementation
comprehensive care of health programs
6. 4 A’s:
 Accessibility
 Availability, Lack of motivation:
 Affordability Acceptability
 Appropriateness of health  Attitude
services.  Resistance to change
- The health services should be  Dependence on the part of
present where the supposed community people
recipients are. They should make  Lack of managerial skills
use of the available resources
within the community, wherein the
focus would be more on health
Elements of Primary
promotion and prevention of Health Care:
illness.
7. Recognition of 8 Essential Health Services
interrelationship between the E-Education for health
health and development L-Locally endemic disease control
Health- is a dynamic state of E-Expanded program for
complete physical, mental, social immunization
& spiritual well being, not merely M- Maternal and child health
the absence of disease & infirmity including responsible
(weakness) parenthood
Development- is the quest for an E-Essential drugs
improved quality of life for all. N - Nutrition
8. Social mobilization- It T- Treatment of communicable
enhances people participation or and noncommunicable
governance, support system diseases
provided by the Government, S - Safe water and sanitation
networking and developing
secondary leaders. Elements of Primary Health
9. Decentralization- This ensures Care
empowerment and that
empowerment can only be 1. Education for Health- Is one
facilitated if the administrative of the potent methodologies for
structure provides local level information dissemination. It
political structures with more promotes the partnership of both
substantive responsibilities for the family members and health
development initiators. This also workers in the promotion of health
facilities proper allocation of as well as prevention of illness.
budgetary resources. 2. Locally Endemic Disease
Control- The control of endemic
Barriers of Community disease focuses on the prevention
Involvement of its occurrence to reduce
morbidity rate. Example Malaria
Control and Schistosomiasis family. There are many food
Control. resources found in the
3.Expanded Program on communities but because of faulty
Immunization- This program preparation and lack
exists to control the occurrence of of knowledge regarding proper
preventable illnesses especially of food planning, Malnutrition is one
children below 6 years old. of the problems that we have in
Immunizations on poliomyelitis, the
measles, tetanus, diphtheria and country.
other preventable disease are given 7. Treatment of Communicable
for free by the government and Diseases and Common Illness -
ongoing program of the The diseases spread through direct
DOH. contact pose a great risk to those
4. Maternal and Child Health who can be infected. Tuberculosis
and Family Planning- The is one of the communicable
mother and child are the most diseases continuously occupies the
delicate members of top ten causes of death. Most
thecommunity. So the protection communicable diseases are also
of the mother and child to illness preventable. The Government
and other risks would ensure good focuses on the prevention, control
health for the community. The and treatment of these
goal of Family Planning includes illnesses.
spacing of children and 8. Supply of Essential Drugs -
responsible parenthood. This focuses on the information
5. Environmental Sanitation and campaign on the utilization and
Promotion of Safe Water acquisition of drugs. In response to
Supply- Environmental Sanitation this campaign, the GENERIC
is defined as the study of all ACT of the Philippines is enacted.
factors in the man’s environment, It includes the following drugs:
which exercise or may exercise Cotrimoxazole, Paracetamol,
deleterious effect on his well- Amoxycillin, Oresol, Nifedipine,
being and survival. Water is a Rifampicin, INH (isoniazid) and
basic need for life and one factor Pyrazinamide,Ethambutol,
in man’s environment. Water is Streptomycin,Albendazole,Quinin
necessary for the maintenance of e.
healthy lifestyle. Safe Water and Major Strategies of Primary
Sanitation is necessary for basic Health Care
promotion of health. 1.Elevating Health to a
6. Nutrition and Promotion of Comprehensive and Sustained
Adequate Food Supply- One National Effort
basic need of the family is food. - Attaining Health for all Filipino
And if food is properly prepared will require expanding
then, one may be assured healthy
participation in health and health relevant curricula and
related development of standard teaching
programs whether as service materials.
provider or beneficiary. 4. Advancing Essential National
Empowerment to parents, families Health Research
and - Essential National Health
communities to make decisions of Research (ENHR) is an integrated
their health is really the desired strategy for organizing
outcome. and managing research using
- Advocacy must be directed to intersectoral, multi-disciplinary
National and Local policy making and scientific approach
to elicit support and commitment to health programming and
to major health concerns through delivery.
legislations, budgetary and
logistical considerations. Four Cornerstones/Pillars in
2. Promoting and Supporting Primary Health Care
Community Managed Health
Care 1. Active Community Participation
-The health in the hands of the 2. Intra and Inter-sectoral
people brings the government Linkages
closest to the people. It 3. Use of Appropriate Technology
necessitates a process of capacity 4. Support mechanism made
building of communities and available
organization to plan,
implement and evaluate health
programs at their levels.
3. Increasing Efficiencies in the
Health Sector
- Using appropriate technology
will make services and resources
required for their delivery,
effective, affordable, accessible
and culturally acceptable. The
development of human resources
must correspond to the actual
needs of the nation and the
policies it upholds such as PHC.
The DOH will continue to support EQUITABLE
and assist both public and private DISTRIBUTION OF
institutions particularly in faculty HEALTH RESOURCES
development, enhancement of - 2 DOH programs to ensure
equitable distribution
1. Doctor to the Barrio (DTTB)
Program R. A. 8423 | Traditional and
- the deployment of doctors to Alternative Medicine Act of 1997
municipalities that are w/o
doctors. Medicinal Plant Preparation
- deployed to unserved,
economically depressed 5th or 6th 1.DECOCTION -boiling the plant
class municipalities for 2 years. material in water for 20 min.
2. Registered Nurses Health 2. INFUSION -plant material is
Enhancement and Local Service soaked in hot water for 10 - 15
(RN HEALS) minutes.
- training and program for 3. POULTRICE- directly apply
unemployed nurse plant material on the affected part,
- deployed to unserved, usually in bruises, wounds and
economically depressed rashes.
municipalities for 1 year. 4. TINCTURE - mix the plant
material in alcohol
“Appropriate
Technology”
Health technology includes:
• tools
• drugs
• methods
• procedures and technique
• people’s technology
• indigenous technology

Criteria for Appropriate

Health
Technology:

•Safety
• Effectiveness
• Affordability
• Simplicity
• Acceptability
• Feasibility and Reliability
• Ecological effects
• Potential to contribute to
individual and
community development
ALTERNATIVE HEALTH
CARE MODALITIES

●Acupressure- application of
pressure on acupuncture pts. w/o
puncturing the skin
● Acupuncture- use special
needles to puncture and stimulate
specific part of the
body
● Aromatherapy- combines
essential aromatic oils to then
applied to the body Health Promotion and
● Nutritional therapy-
“nutritional healing”, this
Levels of Prevention:
improves health by enhancing the
nutritional value to reduce the risk Health promotion - activities
of the disease enhance resources directed at
● Pranic Healing- follows the improving well-being.
principle of balancing energy
● Reflexology- application of Disease prevention - activities
pressure on the body’s reflex protect people from disease and
joints to enhance body’s effects of disease.
natural healing.
Three levels of prevention:
PRIMARY CARE
Includes:

- health promotion
- disease prevention
- health maintenance
- Counselling
- patient education
- diagnosis and treatment of acute
and chronic illness in different
health settings
- refers to the first contact of a
person with a professional a
model of nursing care that
emphasizes continuity of care
nursing care is directed towards
meeting all the patient’s need
 disadvantaged group, have
equitable access to affordable
HEALTH SECTOR health care
REFORM: UNIVERSAL
HEALTH CARE: STRATEGIC THRUSTS
The attainment of the goal of
● Universal Health Care (UHC), UHC is through the pursuit of
also referred to as Kalusugan three strategic thrusts:
Pangkalahatan (KP), is the 1. Financial risk protection
“provision to every Filipino of the through expansion in NHIP
highest possible quality of health enrolment and benefit
care that is accessible, delivery (National Health
efficient, equitably distributed, Insurance Program)
adequately funded, fairly financed, 2. Improved access to quality
and appropriately used hospitals and health care facilities
by an informed and empowered 3. attainment of the health-related
public” MDGs.
● The Aquino administration puts
it as the availability and
To achieve the three
accessibility of health services and
necessities for all Filipinos. strategic thrusts: Six
● It is a government mandate strategic instruments shall
aiming to ensure that every be optimized
Filipino shall receive affordable
and quality health benefits. This 1. Health financing -
involves providing adequate instrument to increase resources
resources – health human for health that will be effectively
resources, health facilities, and allocated and utilized to improve
health financing. the financial protection of the poor
● UHC was built upon strategies and the vulnerable
of two previous platforms of sectors.
reform: the initial Health Sector 2. Service delivery – instrument
Reform Agenda and FOURmula to transform the health service
One for health delivery structure to
address variations in health service
GOALS AND OBJECTIVES utilization and health outcomes
➢ Better health outcomes across
➢ Sustained health financing, and socioeconomic variables.
➢ A responsive health system by 3. Policy, standards, and
ensuring that all Filipinos, regulation – instrument to ensure
especially the equitable access to health services,
essential medicines, and
technologies of assured quality, • is defined as a guide or
availability and safety. framework of nursing care
4. Governance for health – designed to provide ways in
instrument to establish the solving health-related problems of
mechanisms for efficiency, the family as
transparency, and a whole.
5. accountability, and prevent • is the set of actions the nurse
opportunities for fraud. decides to implement to be able to
6. Human resources for health – resolve identified family health
instrument to ensure that all and nursing problems.
Filipinos have access to
professional health care providers Characteristics Family Nursing
the appropriate level of care. Care Plan
7. Health information –
instrument to establish a modern 1. The nursing care plan focuses
information system that shall: on actions which are designed to
solve or minimize existing
 Provide evidence for policy problem.
and program development; 2. The nursing care plan is a
 Support for immediate and product of deliberate systematic
efficient provision of health process.
care and management of 3. The nursing care plan, as with
province-wide health systems. all other plans, relates to the
future.
4. The nursing care plan is based
upon identified health and nursing
problems.
“Developing Family 5. The nursing care is a means to
Nursing Care Plan” an end, not an end in itself.
6. Nursing care plan is a
Family Nursing Care Plan continuous process not a one-shot
• Is the blueprint of the care that deal.
the nurse designs to
systematically minimize or Desirable Qualities a Nursing
eliminate the identified health and Care Plan
family nursing problems through
explicitly formulated 1. It should be based on a clear
outcomes of care (goals and definition of the
objectives) and deliberately problems.
chosen set of interventions, 2. A good plan is realistic.
resources and evaluation criteria, 3. The nursing care plan should be
standards, methods and tools. consistent with
the goals and philosophy of the responses behavior or competency
health agency. outcomes.
4.The nursing care plan is drawn
with the family. Goals
5.The nursing care plan is best -general statement of the condition
kept in a written or state to be brought about by
form. specific
courses of action
Importance of Planning Care Objectives
1. They individualized care to -more specific statements of the
clients desired results or out
2. The nursing care plan helps in 3.) Selection of appropriate
setting priorities by nursing interventions
providing information about the • Focuses on alternatives and
client as well as the decisions on appropriate solutions
nature if his problem. based on the specific objectives
3. The Nursing care plan promotes formulated.
systematic • Emphasized nurse-family contact
communication among those and resources needed to ensure
involve in the health care that the necessary preparation is
effort. done to achieve the objective of
4. Continuity of care is facilitated care
through the use of nursing 4.) Development of Evaluation
care Plan
5. Nursing care plans facilitate the • Elaborates the criteria or
coordination of care by outcomes as explicit measures that
making known to other members determine achievement of
of the health team what the nurse formulated objectives.
is doing.
Steps in developing FNCP:
Steps in Developing a Family
Nursing Care Plans:

1.) The prioritized condition/s or

problems
• It is based on the nature
modifiability preventive potential
and salience.
2.) Formulation of goals and
objectives
• Specifies the expected
health/clinical outcomes, family
 the problem in terms of
seriousness an urgency attention
needed.

Factors Affecting Priority

Setting
1.) Nature of the condition or
problem presented
• Wellness state
-premium on client’s efforts or
desire to sustain or
maintain high level of wellness.
• Health deficit
-sense of clinical urgency which
may require immediate
Scale for Ranking Health intervention.
Conditions and Problems • Health threat
• Foreseeable crisis
According to Priorities - culture linked variables/factors
-a tool that aims in priority setting. usually provide our families with
adequate support to cope with
Four Criteria for Determining developmental or situational crisis.
Priorities
1. Nature of condition or 2.) Modifiability of the condition
problem -Categorized into or problem
wellness • Current knowledge, technology,
state/ potential, health threat, and interventions
health deficit of foreseeable to enhance the wellness state or
crisis manage the
2. Modifiability of the Problem- problem.
refers to the probability of • Resources of the family
success in minimizing, alleviation (physical, financial and
or totally eradicating the manpower)
problem through nursing • Resources of the nurse
intervention (knowledge, skills and
3. Preventive Potential- refers to time)
the nature and magnitude of • Resources of the community
future problems that can be (facilities and
minimized or totally prevented community organization or
if intervention is done on the support).
problem under consideration.
4. Salience- refers to the family’s 3.) Preventive Potential
perception and evaluation of
• Gravity or severity of the
problem
-refers to the progress of the
disease/problem indicating extent
of damage on the patient/family
and indicates prognosis,
reversibility or modifiability
of the problem.
• Duration of the problem
-refers to the length of time the
problem has been existing
• Current Management
-refers to the presence and
appropriateness of intervention
measures
instituted to enhance the wellness
state or remedy the problem. Scoring
• exposure of any vulnerable or a. Decide on a score for each of
high-risk group the criteria.
-increases the preventive potential b. Divide the score by the highest
of a condition or problem. possible score and multiply by the
4.) Salience weight.
•Family’s perception of the SCORE/HIGHEST SCORE X
condition or problem WEIGHT
Sum up the scores for all the
Scale for Ranking Family criteria. The highest score is 5, is
equivalent to the
Health Problems
total weight.
according to Priorities
Example:
• Mrs. A, a 37 y/o patient, on her
2nd trimester of her
pregnancy,
• G8P7
• AOG: 21weeks
• BP: 140/90 mmHg
• Weight: 118lbs.
• Abdominal Palpation: Breech
presentation
• Fundic height: 14cm
• FHT: 135 bpm RUQ.
• With slight bipedal edema
Example:
Other Findings: (other members of
the
family)
•
B1:
•
3 y/o, diagnosed with
bronchopneumonia 3 months ago
• Weight 10kgs.
• B2:
• 4 ½ y/o
• Brought at clinic a month ago
due to scabies
• B3:
• 6 y/o
• Also brought in the clinic a
month ago due to scabies
Malnutrition
Example:
(Housing, Environment)
• Dimensions of each room is 3
meters by 3 meters
• Small screened cabinet for food
storage
• One-burner gas stove for cooking
• Earthen jar with cover for
drinking water
• Dining table with 2 benches
• Lighting: electricity
• Toilet facility: closed pit privy
type situated beside the Given available resources, the
garbage pit, foul smelling and with first 4 priority health condition
plenty of flies or problems are going to be
• Garbage disposal: dumping in addressed to in the
open pit situated at the back family nursing care plan.
of the house 2 meters away, with
plenty of flies. Barriers to Joint Goal Setting
Between the Nurse and the
Possible pre eclampsia Family
1. Failure on the part of the family
to
perceive the existence of the Example of Nursing Goal /
problem Objective
2. The family may realize the The family will cope effectively
existence of the with the threat of
health condition or problem but is pulmonary tuberculosis.
too • Short Term -The infant and
busy at the moment. preschool members of the
3. Sometimes the family perceives family will be immunized with
the BCG.
existence of the problem but does • Medium Term-All members of
not see the family will have a
it as serious enough to warrant complete physical check-up to rule
attention. out pulmonary
4. The family may perceive the tuberculosis.
presence of the • Long Term-All members of the
problem and the need to take family will participate
action. It may however in the care of the sick members
refuse to face and do something and apply preventive
about the situation. measures against the spread of
Reasons to this kind of infection.
behavior:
a. Fear of consequences of taking THE NURSING
actions. IMPLEMENTATION
b. Respect for tradition. PHASE
c. Failure to perceive the benefits
of action.
Selecting Appropriate
d. Failure to relate the proposed Nursing Actions
action to the family’s goals. The choice of nursing intervention
5. A big barrier to collaborative is highly dependent on
goal setting between two major variables:
the nurse and the family is the 1. The nature of the problem -
working relationship. resolve around the family’s
assumption of the health tasks.
Formulation Objectives of 2. Resource available to solve the
Nursing Care problem - aimed at
Objectives minimizing or eliminating the
•refer to more specific statements possible reasons for or
of the desired results or outcomes causes of the family’s inability to
of care. It can either be nurse do these task.
oriented based on activities of the
nurse or client-oriented stated in Principles of Nursing
terms of outcomes Actions
• To stimulate recognition and its communication patterns, role
acceptance of health assumptions and relationships and
needs and problems interaction patterns.
• The nurse can work on the
family’s failure to decide on Methods of Intervention
taking appropriate health actions • Family-Nurse Contact
• The nurse can increase the Home-Visit
family’s confidence in Clinic- Visit
providing nursing care to its sick, • Major advantage is the fact that a
disabled and family member takes the initiative
dependent member through of visiting the professional health
demonstrations on nursing worker, usually indicating the
procedures utilizing supplies and family readiness to participate in
equipment’s available the health care process.
in the home. • Because the nurse has greater
• The nurse should involve the control over the environment,
patient and family in order distraction are
to motivate them to assume lessened and the family may feel
responsibility for their own less confident to discuss family
care. health concerns.
• The nurse also explains and Group Approach
clarifies doubts thus the role of the • appropriate for developing
nurse shifts direct care giver to cooperation, leadership, self-
that of a teacher. reliance and or
• She can explore the ways to community awareness among
minimize or prevent threats to the group members.
maintenance of health and • The opportunity to share
personal development among experiences and practical solutions
family to common health concerns is a
members strength of this type of family-
• She can utilize intervention nurse contact.
measures involving environmental
manipulations through
improvements on the physical
Family-Nurse Contact
facilities in the Telephone Conference
home either by construction of Written Communication
needed ones or modifying existing • used to give specific information
ones. to families, such as instructions
• To minimize or eliminate given to parents through school
psychological threats in the home children.
environment, the nurse can work • School Visit or Conference
closely with the family to improve Industrial or Job Site Visit
THE NURSING objective has been achieved. They
EVALUATION PHASE are names and description of
• The determination of whether the variables that are relevant
objectives set were indicators of having attained the
attained or to what degree they objectives. They are free from any
were attained. value judgement and are
• Evaluation is always related to independent to time
objectives. frame.
• Evaluation when address to the • STANDARD- once a value
result or outcome of judgement is applied to a criterion;
care answers the question “did the it acquires the status of a standard.
intended results It refers to the desired level of
occur?” performance corresponding with a
• There is always an element of criterion against which actual
subjectivity in performance is compared. It tells
evaluation; the process involves us what the acceptable level of
value judgement performance or state of affairs
which is subjective should be for us to say that the
• Evaluation also involves intervention was successful.
decision-making
Activity and Outcome
Dimensions of Evaluation
• EFFECTIVENESS- focus is • ACTIVITIES- are actions
attainment of the objectives performed to accomplish an
• EFFICIENCY- relates to cost objective. They are
whether in terms of the things the nurse does in order
money, time, effort, or materials to achieved a desired result or
• APPROPRIATENESS- ability outcome. Activities consume time
to solve or correct existing and resources. Examples are
problem situation, a question that health teachings, demonstration
involves and referrals.
professional judgement. • OUTCOME- is the results
• ADEQUACY- pertains to its produced by activities. Where
comprehensiveness activity is the cause, outcome is
whether all necessary activities the effect. They can also be
were performed in immediate, immediate or ultimate
order to realize the intended outcomes. Patient care outcomes
results. can be measured along three broad
lines:
Criteria and Standard • PHYSICAL CONDITION-
• CRITERIA- refer to the signs or decreased temperature or weight
indicators that tell us if the and change in
clinical manifestations
• PSYCHOLOGICAL OR  
ATTITUDINAL STATUS- Phases of Nursing Process:
decreased anxiety and  Assessment
favourable attitude towards health  Diagnosis
care personnel.  Planning
• KNOWLEDGE ON  Implementation
LEARNING BEHAVIOR-  Evaluation
compliance of the patient with  Collection of data
instructions given by the nurse.
 Comparison of data against the
standard or norm
 
Family Nursing Assessment:
 Data Collection

Three Sources Of Data

First source - Health status of the
family
Second Source - Family’s status
FAMILY NURSING PROCESS
as a functioning unit
Third Source - Family's
Is the blueprint of the care that the
environment
nurse designs to systematically
minimize or eliminate the
Methods of Gathering Data
identified health and family
1. Direct observation
nursing problems through
explicitly formulated outcomes of  A method of data collection
care (goals and objectives) and which is done through the
deliberately chosen set of use of all sensory capacities
interventions, resources and  The nurse gathers
evaluation criteria, standards, information about the
methods and tools. family’s state of being and
  behavioural responses.
Nursing Process is a problem-  Presence of S/S
solving approach that enables the  Physical make up of
nurse to provide care in an each member
organize and scientific manner. It  Communication or
is applicable to individuals, language patterns
families and community groups at expected and tolerated.
any level of health. It is adaptable  Role perception/task
to any practice setting or assumption by each
specialization and the components member, including
may be used sequentially or decision-making
concurrently. patterns.
  Conditions in home and  Demographic data- age,sex,
environment civil status, position in the
family
2. Interviewing  Place of residence of each
 Productivity of interview member - whether living with
process depends upon the or elsewhere.
use of effective  Type of family structure -
communication techniques matriarchal, patriarchal, nuclear
to elicit needed responses. or extended.
 Encourage verbalization of  Dominant family members in
thought and feelings and terms of decision making in
offer needed support or matters of health care.
reassurance.  General family relationship -
presence of any obvious/ready
3. Physical Examination observable conflict between
 Done through inspection, members; communication
palpation, percussion, patterns among members.
auscultation measurement
of specific body parts and ◦ Matriarchal - the mother or
reviewing the body systems a female elder has absolute
1. Review of Records authority over the family
2. Reviewing existing records group
and reports pertinent to the client ◦ Patriarchal - the father or a
 Laboratory/ Diagnostic male elder has absolute
Tests authority over the family
 Performing laboratory group
tests, diagnostic ◦ Nuclear - a family group
procedures or other test that consists only of parents
of integrity and function and children.
carried out by the nurse ◦ Extended - a family that
herself and /or health extends beyond the nuclear
workers. family, including
grandparents, aunts, uncles,
5 Types of Data use as Initial and other relatives, who all
Data Base for Family live nearby or in one
Nursing Practice household.
Ex:
1. Family structure and
Characteristics
 Members of the household and
relationship to the head of the
family.
 3. Environmental Factors

1. 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
2. Socio-economic and Cultural facilities
Factors f. Presence of accidents hazards
g. Water supply-source,
 Income and expense ownership, potability
 Occupation, place of work h. Toilet facility-type, ownership,
and income of each working sanitary condition
member i. Garbage/refuse disposal- type,
 Adequacy to meet basic sanitary condition
necessities (food, clothing j. Drainage system- type and
and shelter) sanitary condition
 Who makes decision about
money and how it is spent 2. Kind of neighborhood-
congested, slum, etc.
3. Social and health facilities
available
 Ethnic background and 4. Communication and
religious affiliation transportation
 Educational attainment of its  
members Ex:
 Significant others - roles they Housing
play in the family - The family lives in a small room
- Inadequate living space
 Relationship of the family to
- They do not have beds and used
the larger community-what is
to sleep in their floors, in a slanted
the participation of the family
position
in community activities?
- There is presence of breeding or
resting sites of vectors of disease
Ex:
as manifested by an open-canal
found outside their house.
- Presence of fire hazards due to
the used of candle during
night/sleep time
- Presence of fall hazards due to
dark surroundings and un railed
stairs
- They used to fetch water from  Normal health of individual
the faucet of their neighbor members
- Poor environmental sanitation  Home and environment
due to poor drainage conditions conducive to health
- Poor environmental condition development
due to dirty toilet bowl and  Family characteristics,
slippery toilet floor dynamics or level of
- Poor environmental condition as functioning conducive to
manifested by pile of garbage family development
found in their hallway
  Health Problem
4. Health Assessment of Each Is defined as situation or
Member condition which interferes with the
 Medical and Nursing History promotion and/ or maintenance of
indicating past significant health and recovery from illness
illness, beliefs and practices and injury.
conducive to illness. A health problem becomes a
 Nutritional assessment nursing problem when it can be
(specifically for vulnerable or modified through nursing
at risk members) interventions.
 Anthropometric data-
weight, height. Health Need
 Dietary history indicating  Exist when there is a health
quality and quantity of food problem that can be alleviated
intake per day with medical or social
 Eating/feeding habits and technology.
practices
 Current health status indicating THE NURSING DIAGNOSIS
presence of illness states PHASE
(diagnosed/undiagnosed by
medical practitioner) Typology of Nursing Practice
 the study or systematic
5. Value Placed on Preventive classification of types.
Disease  A tool or classification of a
 Immunization status of children family nursing problems that
 Use of other preventive reflects the family status and
services capabilities as a functioning
unit.
Data Analysis
Comparison of the gathered Typology of Nursing Problems
DATA to the STANDARDS OR in Family Nursing Practice
NORMS
Three Types:
First level of assessment - Anticipated periods of unusual
I. Presence of health deficit, demand on the individual or
health threats, and foreseeable family in terms of
crisis/ stress points in the family. adjustments/family resources.
Ex.
A. Health Deficits  Marriage
- Instances of failure in health  Pregnancy, labor, puerperium
maintenance and development  Parenthood
- Occurs when there is a gap  Additional member-newborn,
between actual and achievable lodger.
health status.  Abortion
- diagnosed/suspected illness  Entrance at school
states of family members
 Adolescence
-Sudden or premature or untimely
 Loss of job
death illness or disability and
failures to adapt reality of life  Death of a member
emotional control and stability  Resettlement in new
-Deviations in growth and community
development  Illegitimacy
-Personality disorders

Ex:
C. Health Threats
 Illness regardless whether it is - Condition that are
diagnosed conducive to diseases, accidents or
 Failure to thrive or inability to failure to realize one’s health
develop according to normal potential.
rate.
Ex.
 Disability arising from illness,
1. Health history of specific
whether transient/temporary
condition/disease-
e.g.
family history of DM
TEMPORARY
2. Threat of dross infection of
Aphasia or temporary paralysis
CD case
after CVA
3. Family size beyond what
PERMANENT
resources can adequately
Leg amputation secondary to DM,
provide
blindness from measles, paralysis
4. Accident Hazards
from polio.
 Broken stairs
B. Stress Points/ Foreseeable  Pointed sharp objects,
Crisis Situation poison and medicine
improperly kept
  Fire hazards  Engaging in dangerous
 Fall hazards sports
5. Nutritional 10. Inherent personal
 Inadequate food intake both characteristics- short temper
in quantity and quality 11. Health history which may
 Excessive intake of certain precipitate the occurrence of
nutrients health deficit-previous history of
 Faulty eating habits difficult labor.
6. Stress Provoking Factors 12. Improper role assumption-
 Strained marital relationship child assuming mother’s role,
 Strain parent-sibling father not assuming his role.
relationship 13. Lack of/ inadequate
immunization status of children
 Interpersonal conflicts
14. Family disunity
between family members.
7. Poor Environmental  Self-oriented behaviour
Sanitation of members
a. Inadequate living space  Unresolved conflicts
b. Inadequate personal among members
belongings/utensils  Intolerable
c. Lack of food storage disagreements
facilities
d. Polluted water supply
e. Presence of breeding places II. Inability to recognize
of insects and rodents presence of problem
f. Improper garbage/refuse III. Inability to make decisions
disposal with respect to taking
g. Unsanitary waste disposal appropriate health action
h. Improper drainage system IV. Inability to provide adequate
i. Noise pollution nursing care to the sick,
j. Air pollution disabled, dependent or
8. Unsanitary Food Handling vulnerable/at risk member of the
and Preparation family.
9. Personal Habits/ Practices V. Inability to provide a home
 Frequent drinking of alcohol which is conducive to health
 Excessive smoking maintenance and personal
development due to:
 Walking barefooted
VI. Failure to utilize community
 Eating raw meat/fish
resources for health care
 Poor personal hygiene  
 self-medication Nursing Diagnosis
 Use of dangerous drugs or ◦ Two Parts:
narcotics ◦ General
 Sexual promiscuity
 ◦ the statement of the
unhealthful response
◦ Specific
◦ the statement of
factors which are
maintaining the
undesirable response
and preventing the
desired change
◦ Ex:
◦ GENERAL:
◦ Inability to utilized
the community
resources for health
care due to
◦ SPECIFIC
◦ Lack of adequate family
resources, specifically,
◦ Financial
◦ Manpower
◦ Time

SCORING:
Decide on score for each criteria
Drive the score by the highest
possible score and
multiply by weight

Score X Weight
---------------------
Highest Score

Sum up the scores for all criteria.

The highest score is 5, equivalent
to the total weight