Community Nursing Process Prepared by: indira tadlas-echeveria,rn The NURSING PROCESS The clients are viewed as a system with each affecting the other and both being affected by the factors within the behavior in the systematic, sys tematic, scientific, dynamic, on-going on-going interpersonal process. The nursing assessment The first major phase in the nursing process. Involves a set of actions by which the nurse measures measures the status of the family fa mily as a client , its ability to maintain itself as a system and functioning unit, and its ability to maintain wellness, prevent, control or resolve problems in order to achieve health and well-being among its members Two types of nursing assessment First level assessment : existing and potential health conditions or problems of the family are determined 1. Health threats actions conducive to illness; not sick 2. Health deficit deficit patient is unable to continue health; sick 3. Foreseeable Foreseeable crisis or stress points when left unmanaged, can lead to crisis 4. Health need - there is a health problem that can be alleviated with medical or social technology. 5. Health problem - there is a demonstrated health need to combine with ctual or potential resources to apply remedial measures and a commitment to act on the part of the provider or the client Second level Assessment: 1. Recognition of problem 2. Decision on appropriate health action 3. Care of affected family member 4. Provision of healthy home environment 5. Utilization of community resources for health care STEPS IN THE FAMILY NURSING ASSESSMENT 1. Data Collection 2. Data Analysis 3. Health Conditions/Problems and family nursing diagnosis D ATA COLLECTION: COLLECTION: Involves the gathering of 5 types of data (first (firs t level assessment) 1. Family structure, characteristics and dynamics 2. Socio-economic and cultural characteristics 3. Home and environment 4. Health status of each family member 5. Values and practices on health promotion/maintenance promotion/maintenance and disease prevention.
Other types of data taken during the second level of assessment: ass essment: 1. The familys perception of the problem 2. Decisions made and appropriateness; if none, reasons 3. Actions taken and results; if none, reasons 4. Effects of decisions and actions on the family members.
DATA GATHERING METHODS AND TOOLS 1. Observation - done through the use of the sensory capacities - sight, hearing, smell and touch. The familys health status can be inferred from the signs and symptoms of problem areas reflected in the following: A. communication and interaction patterns expected, used, and tolerated by family members. B. Role perceptions/ task assumptions by each member, including decision-making patterns C. conditions in the home and environment 2. Physical Examination - done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing body systems. 3. Interview A. First type of interview (Health history of each family member, the health history determines current health status) Past health history. E.g. developmental accomplishments, known or exposures to communicable diseases. Family history e.g. genetic Social history e.g. intrapersonal and inter personal factors affecting the family members social adjustment or vulnerability to stress and crisis. B. Second type of interview Collecting data by personally asking significant family members or relatives questions regarding health, family life experiences and home environment to generate data on what wellness condition and health problems exist in the family. 4. Record review - gathering of information through reviewing existing records and reports pertinent to the client. 5. Laboratory/ diagnostic tests - method of data collection through performing laboratory tests, diagnostic procedures, or other tests of integrity and functions carried out by the nurse herself and/or other health workers. DATA ANALYSIS: Sorting out/Classification of data/Grouping of data by type or nature. Example: Threats Deficits Stress points/foreseeable crisis Three types of standards and norms: 1. Normal health of individual members . - involves the physical, social and emotional wellbeing of each family member. 2. Home and environmental conditi ons conducive t o health and devel opment - quality of housing, adequacy of living space, adequacy of the families both in the home and the community, the kind of neighbourhood, environmental sanitation, psychological or socio-cultural norms, values, expectations or modes of life which enhance health development and prevent or control risk factors and hazards. Three types of standards and norms: 3. Family characteristics, dynamics or level of functi oning conducive t o family development . Healthy family functioning are described as flexible role patterns, responsiveness to needs of individual members, dynamic problem solving mechanisms, ability to accept help, open communication patterns, experience of trust and respect in a warm and caring atmosphere and capacity to maintain and create constructive relationship with the broader neighbourhood and community.
Health tasks 1. Recognize the presence of a wellness state or health condition or problem 2. Make decisions about taking appropriate health action to maintain wellness or manage the health problem. 3. Provide nursing care to the sick, disabled, dependent or at risk members 4. Maintain a home environment conducive to health maintenance and personal development. 5. Utilize community resources for health care. NURSING DIAGNOSES: F AMILY NURSING PROBLEMS A WELLNESS condition is a nursing judgment related with the clients capability for wellness. A Health condition or a problem is a situation, which interferes with the promotion and/or maintenance of health and recovery from illness and injury. THE TYPOLOGY OF NURSING PROBLEMS IN F AMILY HEALTH CARE The organizing principle of the typology is Freemans family health tasks. The rationale for adopting these health tasks as the framework of the typology is the fact that in community health nursing practice, one deals mostly with problems within the domain of human behavior or human response to health and illness. Much of the nurses efforts are directed at effecting change in the behavior of clients to achieve optimum health. A community health nurse works with and through the family to improve behavior related to health. The typology contains six main categories: First category: refers to the presence of wellness states, health threats, health deficits and foreseeable crises or stress points. Second to the fifth category, contain statements of incapabilitys in the assumption of the health tasks: 1. Inability to recognize the presence of the condition/problem due to 2. Inability to make decisions with respect to taking appropriate health action due to 3. Inability to provide nursing care to the s ick, disabled, or dependent member of the family due to 4. Inability to provide a home environment, which is conducive to health maintenance and personal development due to 5. Failure to utilize community resources for health care due to Two parts of the nursing diagnosis 1. The statement of the unhealthful response; and 2. The statement of factors, which are maintaining the undesirable response and preventing the desired change. Example: A family with a prenatal patient who is at the same time the breadwinner of the family and who is not receiving any care or supervision. The nursing problem may be stated as: (General) Inability to utilize community resources for health care due to lack of adequate family resources, specifically: (Specific) A. financial resources B. manpower resources C. time Application of assessment concepts and tools Data analysis procedures:
1. Sorting of data 2. distinguishing relevant from irrelevant information 3. Checking for inconsistencies 4. Completing missing information 5. Clustering or grouping of related data 6. Determining patterns (e.g. nutrition/dietary; growth and development) 7. Comparing patterns with the norms and standards Application of assessment concepts and tools 8. Interpreting results in terms of problem areas associated with performance of family health tasks. 9. Making inferences or drawing conclusions specifying barriers or reasons for non- performance of family health tasks for each health condition or problem identified. Phases in Community Organizing 1. Area or site selection 2. Entry or integration into the community: Aim: build mutual cooperation Integration
*low key approach *participation in direct productive activities w/ the people 1. Community Study 2. Core group formation 3. Formation of community organization 4. Mobilization 5. Evaluation 6. Follow-up and expansion The nursing Care Plan The family nursing care plan is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and f amily 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. Feature of a nursing Care Plan 1. The nursing care plan focuses on actions, which are designed to solve or minimize existing problem. 2. The nursing care plan is a product of a deliberate systematic process. 3. The nursing care plan, as well with other plans relates to the future. 4. The nursing care plan is based upon identified health and nursing problems. 5. The nursing care plan is a means to an end, not an end in itself. The goal planning is to deliver the most appropriate care to the client by the eliminating barriers to family health development. 6. Nursing care planning is a continuous process, not a one shot deal. The results of the evaluation of the plans effectiveness trigger another cycle of the planning process until the health and nursing problems are eliminated. Desirable Qualities of a Nursing Care Plan 1. It should be based on clear, explicit definition of the problems.
2. A good plan is realistic. 3. The nursing care plan is prepared jointly with the family. Through participatory planning, the nurse makes the family feel that the health of its members is a family responsibility and commitment. 4. The nursing care plan is mos t useful in written form. It is a means of communication not only among nurses but also between nurses and other members of the health team The Importance of Planning Care 1. They individualize care to clients. 2.Two/ the nursing care plan helps in setting pri orities by providing information about the client as well as the nature of his problems. 3. The nursing care plan promotes systematic communication among those involved in the health care effort. 4. Continuity of care is facilitated through the use of nursing care plans. Gaps and duplication in the services provided are minimized. 5. Nursing care plan facilitates the coordination of care by making known to other members of the health team what the nurse is doing. Steps in developing the family Nursing Care Plan A plan consists of the following: 1. The prioritized conditions/ or problems 2. The goals and objectives of nursing care 3. The plan of interventions 4. The plan of evaluating care Problem prioritization: Criteria: Nature of problem: prioritize health threat Preventive potential: High, moderate, low Modifiability: easy, partially, non-modifiable Salience (understanding): high, moderate, low Prioritizing Health Problems Four
criteria for determining priorities among health conditions or problems
1. Nature of the condition or problem presented - categorized into wellness state/potential, health threat, health deficit, and foreseeable crisis 2. Modifiability of the condition or problem - refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. Prioritizing Health Problems 3. Preventive potential - refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the condition or problem under consideration. 4. Salience - refers to the family perception and evaluation of the condition or problem in terms of seriousness and urgency of attention needed or family readiness. SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMS ACCORDING TO PRIORITIES (B aylon & Maglaya) Criteria:
1. Nature of the condition or problem presented 2. Modifiability of the condition or problem 3. Preventive potential 4. Salience SCORING: 1. Decide on a score for each of the 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 the criteria. The highest score is 5 equivalent to the total weight. THE GOALS AND OBJECTIVES O F NURSING CARE the goal is a general statement of the condition or state to be brought about by specific courses of action tells the family where they are going Example: after nursing intervention the family will be able to take care of the disabled child competently. Objectives refer to more specific statements of the desired results or outcomes of care. they specify the criteria by which the degree of effectiveness of care are to be measured. milestones to reach the destination. SMART y
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THE PLAN OF INTERVENTIONS GUIDE: A. Analyze with the family the current situation and determine choices and possibilities based on lived experiences of meanings and concerns. > nurse needs to explore with the family the possibilities and choices presented by the current situation given the meanings, concern, social relations and resources. B. develop/enhance the familys competencies as thinker, doer, and feeler cognition, volition and emotion thinker - make information/data readily available makes the family at ease and confident in understanding current situation. doer - maximizing and developing communication and skills that enhance confidence in carrying out the needed interventions. feeler - develop or strengthen its effective competencies in order to appropriately acknowledge and understand emotions generated by family life or health illness situations, can be transformed into growth-promoting choices and actions. C. focus on interventions to help perform the health task help the family recognize the problem guide the family on how to decide on appropriate actions to take develop familys ability and commitment to provide nursing care to its members enhance the capability of the family to provide a home environment conducive to health maintenance and personal development facilitate the familys capability to utilize community resources for health care.
D. catalyze behavior change through motivation and support > motivation - is any experience or information that leads the family to desire and agree to undergo the behavior change or proposed measure and take initial action to bring about change.
> support - any experience or information that maintains, restores or enhances the capabilities or resources of the family to sustain these actions and complete the change. PLAN FOR EVALUATING CARE specifies how the nurse will determine achievement of the outcomes of care ( goals and objectives) evaluation is a distinct process comparing what actually is with what should be > ASSESSMENT - determine whether there are changes in health status - make sure that assessment data are accurate and complete. > DIAGNOSIS - determination if problems requiring nursing care are resolved, improved or controlled. - consider if there are new problems > PLANNING - determine if interventions are appropriate and adequate to achieve client outcomes. - specify client status based on expected outcomes of care. > IMPLEMENTATION - analyze how the plan was implemented. - Determine what factors are related with the success in implementing the plan. - specify what factors created problems or barriers to care. GODBLESS
