BACHELOR OF SCIENCE IN NURSING:

COMMUNITY HEALTH NURSING I

COURSE MODULE COURSE UNIT WEEK
1 5 5
OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES
FAMILY NURSING & NURSING PROCESS

 Read course and unit objectives

 Read study guide prior to class attendance
 Read required learning resources; refer to unit
terminologies for jargons
 Proactively participate in classroom/online discussions
 Participate in weekly discussion board (Canvas)
 Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive
 Discuss appropriate health care delivery system and actions holistically and
comprehensively.
 Enumerate the phases of Family Nursing Process
 Enumerate the methods of Gathering Data

Affective
  Integrate relevant principles of social, physical, natural and health sciences and
humanities in a given health and nursing situation in the community.
 Value the importance of the Family Nursing Process in gathering Data
 Relate the importance of Nursing Bag

Psychomotor
 Model professional behavior as a community health nurse.
 Participate actively during class discussions
 Express opinion and thoughts during class
 Be able to perform unit task of creating you own nursing care plan
 Be able to solve your own Family Health Problem Prioritization

NURSING PROCESS

FAMILY NURSING PROCESS

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.

NURSING PROCESS

Nursing Process is 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.

Phases of Nursing Process:

1. Assessment
 2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

THE NURSING ASSESSMENT PHASE

1. Collection of data
2. 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 as a functioning unit
 Third Source - Family's environment

Methods of Gathering Data

1. Direct observation
¡ 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
 Physical make up of each member
 Communication or language patterns expected and
tolerated.
 Role perception/task assumption by each member,
including decision-making patterns.
 Conditions in home and environment
 2. Interviewing
¡ Productivity of interview process depends upon the use of
effective communication techniques to elicit needed
responses.
¡ Encourage verbalization of thought and feelings and offer
needed support or reassurance.

3. Physical Examination
¡ Done through inspection, palpation, percussion, auscultation
measurement of specific body parts and reviewing the body
systems
1. Review of Records
¡ Reviewing existing records and reports pertinent to the client
2. Laboratory/ Diagnostic Tests
¡ Performing laboratory tests, diagnostic procedures or other
test of integrity and function carried out by the nurse herself
and /or health workers.

5 Types of Data use as Initial Data Base for Family Nursing Practice
1. Family structure and Characteristics
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.
Ex.
 Househol Age Sex Civil Position Place of
d Member Status in the Residence
Family

RD 24 Male Live-in Father Living with

JC 23 Female Live-in Mother Living with
AL 3 Male Single Son Living with
OJ 2 Female Single Daughter Living with

2. Socio-economic and Cultural Factors

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?
Ex
Househo Occupati Plac Income Education SO/
ld on e of al Roles
Member Wor Attainmen in the
k t Family
RD Carpente QC P9000/ Highscho Provid
r mo ol Grad er
JC Housewif - - College Keepe
e Grad r
AL Children - - - Memb
er
 OJ Baby - - - Memb
er

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 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
2. Kind of neighborhood- congested, slum, etc.
3. Social and health facilities available
4. Communication and transportation

Ex.
Housing
- The family lives in a small room
- Inadequate living space
- They do not have beds and used to sleep in their floors, in a slanted position
- There is presence of breeding or resting sites of vectors of disease 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 the faucet of their neighbor
- Poor environmental sanitation due to poor drainage
- Poor environmental condition due to dirty toilet bowl and slippery toilet floor
- Poor environmental condition as manifested by pile of garbage found in their
hallway
4. Health Assessment of Each Member
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)

5. Value Placed on Preventive Disease

1. Immunization status of children
2. Use of other preventive services

Data Analysis
¡ Comparison of the gathered DATA to the STANDARDS OR NORMS
Three Types:
1. Normal health of individual members
2. Home and environment conditions conducive to health development
3. Family characteristics, dynamics or level of functioning conducive to family
development

Health Problem
¡ Is defined as situation or condition which interferes with the promotion and/ or
maintenance of health and recovery from illness and injury.
¡ A health problem becomes a nursing problem when it can be modified through nursing
interventions.

Health Need
¡ Exist when there is a health problem that can be alleviated with medical or social
technology.

THE NURSING DIAGNOSIS PHASE

Typology of Nursing Practice

¡ 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.

Health Problems and Family Nursing Diagnosis

Typology of Nursing Problems in Family Nursing Practice

1. First level of assessment
I. Presence of health deficit, health threats, and foreseeable crisis/ stress points
in the family.
A. Health Deficits
- Instances of failure in health maintenance and
development
- Occurs when there is a gap between actual and achievable
health status.
- 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
-Deviations in growth and development
-Personality disorders
Ex.
¡Illness regardless whether it is diagnosed
¡Failure to thrive or inability to develop according to
normal rate.
¡Disability arising from illness, whether
transient/temporary
¡e.g.
TEMPORARY
§ Aphasia or temporary paralysis after
CVA
PERMANENT
 § Leg amputation secondary to DM,
blindness from measles, paralysis from
polio.

B. Stress Points/ Foreseeable Crisis Situation

- Anticipated periods of unusual demand on the individual or
family in terms of adjustments/family resources.
Ex.
¡Marriage
¡Pregnancy, labor, puerperium
¡Parenthood
¡Additional member-newborn, lodger.
¡Abortion
¡Entrance at school
¡Adolescence
¡Loss of job
¡Death of a member
¡Resettlement in new community
¡Illegitimacy

C. Health Threats
- Condition that are conducive to diseases, accidents or
failure to realize one’s health potential.
Ex.
1. Health history of specific condition/disease-
a.family history of DM
2. Threat of dross infection of CD case
3. Family size beyond what resources can adequately
provide
4. Accident Hazards
a. Broken stairs
b. Pointed sharp objects, poison and medicine
improperly kept
 c. Fire hazards
d. Fall hazards.
5. Nutritional
a. Inadequate food intake both in quantity and
quality
b. Excessive intake of certain nutrients
c. Faulty eating habits
6. Stress Provoking Factors
a. Strained marital relationship
b. Strain parent-sibling relationship
c. Interpersonal conflicts between family
members.
7. Poor Environmental Sanitation
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

8. Unsanitary Food Handling and Preparation

9. Personal Habits/ Practices
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
10. Inherent personal characteristics- short temper
11. Health history which may precipitate the occurrence
of health deficit-previous history of difficult labor.
12. Improper role assumption-child assuming mother’s
role, father not assuming his role.
13. Lack of/ inadequate immunization status of children
14. Family disunity
a.Self-oriented behaviour of members
b.Unresolved conflicts among members
c. Intolerable disagreements

II. Inability to recognize presence of problem

III. Inability to make decisions with respect to taking appropriate health action
IV. Inability to provide adequate nursing care to the sick, disabled, dependent or
vulnerable/at risk member of the family.
V. Inability to provide a home which is conducive to health maintenance and
personal development due to:
VI. Failure to utilize community resources for health care

Nursing Diagnosis

Two Parts:
1. General
§ the statement of the unhealthful response
2. 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,
a. Financial
b. Manpower
c. Time

THE NURSING PLANNING PHASE

Family Nursing Care Plan

A Family Nursing Care Plan is the set of actions the nurse decides to implement to be
able to resolve identified family health and nursing problems.

Characteristics Family 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 deliberate systematic process.
3. The nursing care plan, as with all other plans, relates to the future.
4. The nursing care plan is based upon identified health and nursing problems.
5. The nursing care is a means to an end, not an end in itself.
6. Nursing care plan is a continuous process not a one-shot deal.

Desirable Qualities a Nursing Care Plan

1. It should be based on a clear definition of the problems.
2. A good plan is realistic.
3. The nursing care plan should be consistent with the goals and philosophy of the health
agency.
4. The nursing care plan is drawn with the family.
5. The nursing care plan is best kept in a written form.

Importance of Planning Care

 1. They individualized care to clients
2. The nursing care plan helps in setting priorities by providing information about the client
as well as the nature if his problem.
3. The Nursing care plan promotes systematic communication among those involve in the
health care effort.
4. Continuity of care is facilitated through the use of nursing care
5. Nursing care plans facilitate the coordination of care by making known to other
members of the health team what the nurse is doing.

Four Criteria for Determining Priorities

1. Nature of condition or problem
- Categorized into wellness state/ potential, health threat, health deficit of
foreseeable crisis.
2. Modifiability of the Problem
- refers to the probability of success in minimizing, alleviation or totally
eradicating the problem through nursing intervention
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 problem
under consideration.
4. Salience
- refers to the family’s perception and evaluation of the problem in terms
of seriousness an urgency attention needed.

Scale for Ranking Family Health Problems according to Priorities

CRITERIA SCORE WEIGHT
1. NATURE OF THE PROBLEM PRESENTED
SCALE:
 Health Deficit 3
 Health Threat 2 1
 Foreseeable Crisis 1
2. MODIFIABILITY OF THE PROBLEM
SCALE:
 Easily Modifiable 2
 Partially Modifiable 1 2
 Not Modifiable 0
3. PREVENTIVE POTENTIAL
SCALE:
 High 3
 Moderate 2 1
 Low 1
4. SALIENCE
SCALE:
 A serious problem, immediate action needed 2
 A problem but not needing immediate attention 1 1
 Not a felt need/problem 0

TOTAL/HIGHEST SCORE 5

Scoring

a. Decide on a score for each of the criteria.

b. Divide the score by the highest possible score and multiply by the weight.
SCORE/HIGHEST SCORE X WEIGHT
Sum up the scores for all the criteria. The highest score is 5, is equivalent to the total weight.

SCABIES AS A HEALTH DEFICIT TO THREE PRE-SCHOOL MEMBERS OF THE FAMILY

CRITERIA COMPUTATION ACTUAL JUSTIFICATION

SCORE
NATURE OF THE 3/3 X 1 1 A health deficit that requires immediate
PROBLEM attention and adequate management to
 HEALTH reduce likelihood of transfer of the
DEFICIT disease to the rest of the family
members.
MODIFIABILTY ½X2 1 The family does not have adequate
 PARTIALLY resources to solve the problem.
MODIFIABLE Inadequacy of living space and water
supply are barriers to achievement of
good personal hygiene, which is
important in the management and
prevention of scabies.
PREVENTIVE 3/3 X 1 1 Transfer of scabies to other family
POTENTIAL members is reduced or eliminated if the
 HIGH problem is managed adequately as soon
as possible.
SALIENCE 1/1 X 1 1 The family recognized it as a problem. It
 A PROBLEM consulted the health personnel a month
BUT NOT ago, however, it does not see the
NEEDING problem as needing immediate action.
IMMEDIATE
ATTENTION
TOTAL SCORE 4

IMPROPER REFUSE DISPOSAL

CRITERIA COMPUTATION ACTUAL SCORE JUSTIFICATION
NATURE OF THE 2/3 X 1 0.67 It is a health threat
PROBLEM
MODIFIABILITY 2/2 X 2 2 Resources are available and
interventions are feasible
PREVENTIVE 3/3 X 1 1 Communicable disease
POTENTIAL transferred by insects and
rodents can be prevented
SALIENCE 0/2 X 1 0 The family does not perceive
this as a health problem
TOTAL SCORE 3.67

MALNUTRITION

CRITERIA COMPUTATIO ACTUAL JUSTIFICATION

N SCORE
NATURE OF 3/3 X 1 1 It is a health deficit that requires immediate
THE management to eliminate untoward
PROBLEM consequences.
MODIFIABILTY 2/2 X 2 2 The problem is easily modifiable since the
nurse’s resources are available, she can
help the family on effective budgeting of
money and scheduling of time. she can
develop skills of other members to achieve
good nutrition – proper food selection and
preparation, and feeding practices. The
nurse can also educate the family to utilize
the backyard by planting nutritious
vegetables.
PREVENTIVE 3/3 X 1 1 Susceptibility to other diseases and
POTENTIAL infections can be prevented if malnutrition is
eliminated; normal growth and development
can thus be achieved.
SALIENCE 2/2 X 1 1 A serious problem needing immediate action
and attention
TOTAL 5
SCORE

Summary

The list of health problems ranked according to priorities is presented:

A. MALNUTRITION 5
B. SCABIES 4
C. IMPROPER REFUSE DISPOSAL 3.67

Formulation Of Goals And Objectives Of Nursing Care

Establishment of Goals
¡ Goals
§ 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.
Example:
after nursing intervention, the family will be able to take care of the
premature infant competently.
 Goals relate to health mater
 specifically the alleviation of disease conditions.
 And health problems that intertwined with other problems like socio-
economic ones.
Example 1:
at the end of nursing intervention, the family will be able to start a
piggery business.
Example 2:
at the end of nursing intervention, the family will be able to start
litigation proceedings against landlord.
  A cardinal principle in goal setting states that goals must be set mutually with the
family.
 Basic to the establishment of mutually acceptable goals is the family’s recognition
and acceptance of existing health needs and problems.
 Goals set by the nurse and the family should be realistic or attainable.
 Goals are best stated in terms of client’s outcomes, whether at the individual,
family, or community levels.

Barriers to Joint Goal Setting Between the Nurse and the Family
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of the health condition or problem but is too busy
at the moment.
3. Sometimes the family perceives the existence of the problem but does not see it as
serious enough to warrant attention.
4. The family may perceive the presence of the problem and the need to take action. It
may however refuse to face and do something about the situation.
 Reasons to this kind of behavior:
a. Fear of consequences of taking actions.
b. Respect for tradition.
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the family’s goals.
5. A big barrier to collaborative goal setting between the nurse and the family is the
working relationship.

Formulation Objectives of Nursing Care

Objectives -refer to more specific statements of the desired results or outcomes of care.
It can either be nurse-oriented based on activities of the nurse or client-oriented stated in terms
of outcomes.

Nurse Oriented VS, Client Oriented

Nurse-Oriented Client-Oriented
 Nurse-oriented objectives will not tell if the Stating objectives in terms of client
nurse’s activities produced some beneficial outcomes will indicate during the evaluation
results; they only indicate what the nurse phase whether the desired changes in the
did and in qualitative evaluation, how well problem situation resulted from the nurse’s
she performed them. action.

Example: Example:
§ during the home visit, the nurse § after the nursing intervention,
will discuss the importance of the malnourished pre-school
immunization. member of the family will
§ during the second nurse-family increase their weights by at
contact, the nurse will show the least one pound per month.
different types of fertility- § after the nursing intervention,
regulating methods. there will be improved
relationship among family
members.
§ after the nurse’s visit, the family
will bring the pre-school
members to the well-baby clinic
the following day.

General VS. Specific Objective

General Objective Specific Objective

After the nursing intervention, the family will After the nursing intervention, the family will
utilize community resources for health care. bring the pregnant member to the health
center regularly for check ups
After the nursing intervention, the family will
be able to take care of the mentally The family will also consult the health center
challenged child competently. on every episode of illness among members.

Define the criteria for evaluation

 Example:
¡ After the nursing intervention, the
family will be able to feed the mentally
challenged prescribed quantity and
quality of food.
¡ They will be able to teach the child
simple skills related to activities of
daily living and
¡ The family will be able to apply
measures taught to prevent infection
in the mentally challenged child.

Objective Time Frame

SHORT-TERM MEDIUM-TERM LONG-TERM

OR IMMEDIATE OR INTERMMEDIATE OR ULTIMATE
OBJECTIVES OBJECTIVES OBJECTIVES
problem situations which are those which are not require several nurse-
require immediate immediately achieved family encounters
attention and are required to attain
the long term ones.
Results can be observed The nature of the
in a relatively short outcomes sought
period of time. requires time to
demonstrate
They are accomplished Investment of more
with few nurse-family resources
contacts and relatively
 less resources.

Example of Nursing Goal / Objective

The family will cope effectively with the threat of pulmonary tuberculosis.
 Short Term -The infant and preschool members of the family will be immunized with
BCG.
 Medium Term-All members of the family will have a complete physical check-up to rule
out pulmonary tuberculosis.
 Long Term-All members of the family will participate in the care of the sick members
and apply preventive measures against the spread of infection.

THE NURSING IMPLEMENTATION PHASE

Selecting Appropriate Nursing Actions

The choice of nursing intervention is highly dependent on two major variables:

1. The nature of the problem
-resolve around the family’s assumption of the health tasks.
2. Resource available to solve the problem
-aimed at minimizing or eliminating the possible reasons for or causes of the
family’s inability to do these tasks.

Goals and Objectives

S – Specific
M – Measurable
A – Attainable
R – Realistic
T- Time Bound
Principles of Nursing Actions

 To stimulate recognition and acceptance of health needs and problems

 The nurse can work on the family’s failure to decide on taking appropriate health 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.
 The nurse should involve the patient and family in order to motivate them to assume
responsibility for their own care.
 The nurse also explains and clarifies doubts thus the role of the nurse shifts direct care
giver to that of a teacher.
 She can explore the ways to minimize or prevent threats to the maintenance of health
and personal development among family members
 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.
 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.

Types of Resources

1. FAMILY RESOURCES- 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.
2. NURSE 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.
3. COMMUNITY RESOURCES- include existing agencies, programs or activities for
health and related needs/problems and community organization for health actions.

Methods of Intervention
Family-Nurse Contact
 Home-Visit

 Home visit is a 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.

 Clinic- Visit
 takes place in a private clinic health center, barangay health station.
 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.
 Because the nurse has greater control over the environment, distraction are
lessened and the family may feel less confident to discuss family health
concerns.
 Group Approach
 appropriate for developing cooperation, leadership, self-reliance and or
community awareness among group members.
 The opportunity to share experiences and practical solutions to common health
concerns is a strength of this type of family-nurse contact.

 Telephone Conference
 Written Communication
 used to give specific information to families, such as instructions given to parents
through school children.
 School Visit or Conference
 Industrial or Job Site Visit

The Nursing Bag

 Frequently called the PHN bag is a tool used by the nurse during home or community
visits to be able to provide care safely and efficiently.
 Serves as a reminder of the need for hand hygiene and other measures to prevent the
spread of infection.
 Nursing bag usually has the ff. contents:
  Articles for infection control
 Articles for assessment of family members
 Note that the stethoscope and sphygmomanometer are carried separately.
 Articles for nursing care
 Sterile items
 Clean articles
 Pieces of paper

Use of the Nursing Bag

 Bag technique helps the nurse in infection control.

 Bag technique allows the nurse to give care efficiently.
 It saves time and effort by ensuring that the articles needed for nursing care are
available.
 Bag technique should not take away the nurse’s focus on the patient and the family.
 Bag technique may be performed in different ways, principles of asepsis are of the
essence and should be practiced at all times.

THE NURSING EVALUATION PHASE

 The determination of whether the objectives set were attained or to what degree they were
attained.
 Evaluation is always related to objectives.
 Evaluation when address to the result or outcome of care answers the question “did the
intended results occur?”
 There is always an element of subjectivity in evaluation; the process involves value
judgement which is subjective
 Evaluation also involves decision-making

Dimensions of Evaluation
§ EFFECTIVENESS- focus is attainment of the objectives
§ EFFICIENCY- relates to cost whether in terms of money, time, effort, or materials
 § APPROPRIATENESS- ability to solve or correct existing problem situation, a
question that involves professional judgement.
§ ADEQUACY- pertains to its comprehensiveness whether all necessary activities
were performed in order to realize the intended results.

Criteria and Standard

¡ CRITERIA- 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.
¡ STANDARD- 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.

Activity and Outcome

¡ ACTIVITIES- are actions performed to accomplish an objective. They are the
things the nurse does in order to achieved a desired result or outcome. Activities
consume time and resources. Examples are health teachings, demonstration and
referrals.
¡ OUTCOME- is the results produced by activities. Where activity is the cause,
outcome is the effect. They can also be immediate, immediate or ultimate
outcomes. Patient care outcomes can be measured along three broad lines:
¡ PHYSICAL CONDITION- decreased temperature or weight and change in clinical
manifestations
¡ PSYCHOLOGICAL OR ATTITUDINAL STATUS- decreased anxiety and
favourable attitude towards health care personnel.
¡ KNOWLEDGE ON LEARNING BEHAVIOR- compliance of the patient with
instructions given by the nurse.
Submit: Word File
Points: 100 pts

Situation:

Josefina Rivera is a public Health Nurse at the Rural Health Unit. She met 26-year-old
Susan Yap, married, 6 months pregnant with her first child, in a Garantisadong Pambata (outreach
health services) visit at an ambulatory clinic in the barangay where the Yap family was residing.

Josefina found out that Susan never had a prenatal consultation. She also noted that Susan
was underweight, with a weight of only 48kg and a height of 155 cm. When Josefina asked her
where she plans to deliver her baby, she replied that she would probably have a home delivery
under the care of the local “hilot” because professional attendance would be too expensive for
them. Susan explained that she came to the ambulatory clinic upon the prodding of her husband
who heard about the health workers’ visit to the barangay. To assess the Yaps’ home situation and
teach Susan health practices related to her pregnancy, Josefina asked Susan if she could make a
home visit. Seemingly pleased with Josefina’s attention, Susan agreed with Josefina on a home
visit schedule, stating that she wanted to learn more from Josefina to prevent problems with her
pregnancy and delivery.

When Josefina made the home visit, she noted that Susan lived with her 32-year-old
husband Mario, who was at work at the time of the visit. He was the sole breadwinner of his family
– a construction weoker earning the daily minimum wage. Susan described her husband as
hardworking. They lived in a rented shack of mixed materials with a bedroom, a bathroom and
toilet, and a small multipurpose room (living and dining room and kitchen). Susan’s activities
consisted mainly of household chores. Sometimes, Susan would spend time at the homes of some
friends and relatives residing in the neighborhood.

In the course of the interview, Josefina found out that Susan had inadequate knowledge
about community health services, prenatal nutrition, preparation for childbirth, and infant care.
Susan said that she and her friends and relatives sometimes talk about such matters, but the
information given was confusing and conflicting. Aside from palmar pallor and underweight, other
findings during physical examination were normal. When asked about her diet, Susan told Josefina
that she limited her food intake because she did not want to have a caesarian section, which may
be needed if baby grew too big.

Question :

With this given scenario, create the 5 phases of Family Nursing Process.

Famorca, Z., Nies, M., & McEwen, M., (2013). Nursing Care of the Community. ELSEVIER
MOSBY.

Famorca, Z., Nies, M., & McEwen, M., (2013). Nursing Care of the Community. ELSEVIER
MOSBY.

RN. PEDIA, (N/A) Family Nursing Care Plan. June 29, 2020 https://www.rnpedia.com/nursing-
notes/community-health-nursing-notes/family-nursing-care-plan-fncp/