COMMUNITY HEALTTH NURSING

I. Evolution of Public Health Nursing in the Philippines

Health ​- a state of complete physical, mental and social well being, not merely the absence of disease or infirmity - Is essential to
the achievement of the goals in Public Health Nursing and a major contributor of achieving poverty reduction

WHO Determinants of Health

1. Income and social status
2. Education
3. Physical Environment
4. Employment and working conditions
5. Social support networks
6. Culture
7. Genetics
8. Personal behavior and Coping skills
9. Health services
10. Gender

Public Health ​(WHO)

- the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best
health for the greatest number

Public Health Nursing ​(WHO)

- Special field of nursing that combines the skills of nursing, public health, and some phases of social assistance and
functions as part of the total public health program for the promotion of health, the improvement of
conditions in the social and physical environment, rehabilitation, and the prevention of illness and disability

Community Health Nursing

- The utilization of the nursing process in the different levels of clientele – individuals, families, population groups and
communities concerned with the promotion of health, prevention of disease and disability and rehabilitation

HISTORY OF COMMUNITY HEALTH NURSING

∙ ​CHN in early times was dominated by metaphysical rituals and traditions. These magico-relegious practices were influenced
by colonizers particularly the Spaniards and the Americans

∙ ​Spanish Regime 1521 – 1898 – Spaniards imposed a feudal health care system by establishing religious orders, charitable
hospitals &apostolic centers in various parts of the country to help the poor & care for the sick

∙ ​American Regime 1898 – 1946 –Americans perpetuated the feudal system of health care training. Filipino elites (including
physicians and nurses) & grooming them to serve the American First then the Filipinos

∙ ​Philippine Republic 1946 - 2007 – community health development has not been given priority attention by the government.
Several laws were enacted to organize and establish the various structures and activities of the health agency ( DOH
formerly known as Department of Public Works, Education & Hygiene in 1898) covering the entire country * Three
Important Programs
1. Health Sector Reform Agenda of the Philippines 1999-2004
2. National Objectives for Health 1999 – 2004
3. National Health Planning Committee ( NHPC ) and Establishments of Inter local health zones (ILHZ)

Philosophy of Community Health Nursing Practice

Philosophy - is defined as a system of beliefs that provides a basis for and guides action
- Provides the direction and describes the What’s, Why’s and How’s of the activities within a profession

CHN Practice is guided by the following beliefs :

1. ​H​umanistic values of nursing profession upheld
2. ​U​nique and distinct component of health care
3. ​M​ultiple factors of health considered
4. ​A​ctive participation of clients encouraged
5. ​N​urse considers availability
6. ​I​nterdependence among health team members practiced
7. ​S​cientific and up to date
8. ​T​asks of the community health nurse vary with time and place
9. ​I​ndependence or self reliance of people is the end goal
10. ​C​onnectedness of health and development regarded

1  
Specialized Field of Nursing
1. Community Mental Health Nursing
- a unique clinical process which includes an integration of concepts from nursing, mental health, social psychology,
psychology, community networks and basic sciences
2. Occupational Health Nursing
- The application of nursing principles and procedures in conserving the health of workers in all occupants 3.
School health nursing
- Application of nursing theories and principles in the care of school population

Basic Principles of CHN

- The patient in CHN is the COMMUNITY
- The unit of care is the FAMILY
- Four levels of clientele :
1. INDIVIDUAL
2. FAMILY
3. COMMUNITY – social group determined by geographic boundaries
4. POPULATION GROUP – group of people who share common characteristic, developmental stage and
health problem
- The client is considered the ACTIVE partner not a passive recipient of care
- CHN practice are affected by developments in health technology and changes in the society
- The goal of CHN is achieved through MULTI SECTORAL EFFORTS
- CHN is part of health care system and the larger human services system.

Roles of the Public Health Nurse

1. Clinician or Health Care Provider : Utilizes nursing process in the care of client in the home care setting
Ex. The PHN conducts follow up home visit to families with children who are taking antibiotics
2. Health Educator : Utilizes teaching skills to improve the health knowledge, skills and attitudes of individual, family and
community
Ex. The PHN conducts a lecture on the different vaccines covered in the EPI and its importance to children at the health
center
3. Coordinator and Collaborator : Establishes linkages and collaborative relationships with other health professionals,
government agencies, the private sector, non government organization and people’s organization Ex. The PHN taps
with a local NGO for a joint sponsorship of a one day free circumcision program during summer
4. Supervisor : Monitors and supervises the performance of midwives and other auxiliary health workers, initiates
formulation of staff development
Ex. The PHN assigns midwives under her supervision to attend provincial training on updates regarding IMCI
5. Leader and Change Agent : Influences people to participate in the overall process of community development
Ex. The PHN initiates community wide clean up of the water systems in the area
6. Manager : Organizes the nursing service component of the local health agency or local government unit
Ex. Nursing service plan component of the overall municipal health plan
7. Researcher : Participates in the conduct of research and utilizes research findings to practice
Ex. The PHN conducts disease surveillance or the continuous collection and analysis of data on dengue.

Levels of Clientele
A. INDIVIDUAL
− ​Individuals may be sick or well
− ​Two ways of looking at a man :
1. ​Atomostic Approach ​– proposed by Byrne and Thompson views man as an organism composed of : different
organs – made up of tissues – cells
2. ​Holistic Approach ​– traces the pattern of man’s relationship with other beings in the supra-system of society -
it is how man acts and how man reacts to situational stimuli provide clues in understanding man ​− ​Five dimensions of
man in the Holistic Approach
1. ​Physical Being ​– genetic endowment, sex & physical attributes
2. ​Social Being ​– capable of relating to others
3. ​Spiritual Being ​– capable of virtues such as faith, hope and charity
4. ​Thinking or Intellectual Being ​– capable of perception, cognition and communication
5. ​Psychological Being ​– capable of feeling, rationality and all conscious & unconscious states
B. FAMILY
As defined by Murray & Zentner is a small social system and primary reference group made up of two or more persons living
together who are ​related by blood, marriage, adoption or by arrangement over a period of time

Types of Families Based on Composition

1. ​Nuclear ​– composed of father, mother, child or children
2. ​Extended ​– composed of nuclear family plus relatives (at least three generations)
3. ​Beanpole ​– composed of four or more generations
4. ​Single parent ​– composed of either the father or mother with her biological or adopted child
2  
5. ​Step/ Blended / reconstituted ​– composed of one separated/divorced /widowed adult with his/her children with a new
spouse with his/her children
6. ​Single ​– never married, divorced or widowed individual
7. ​Same sex/ Homosexual ​– composed of gay or lesbian partners living together
8. ​Cohabiting or Communal ​– consists of unrelated individuals or families who live together under one roof for purposes of
companionship and share resources and household management

Types of Families Based on Locus of Power

1. ​Patrifocal ​or Patriarchal – the man has the main authority in decision making
2. ​Matrifocal or Matriarchal ​– the woman has the main authority and decision making power
3. ​Egalitarian ​–the husband & the wife exercise equal amount of authority
4. ​Matricentric ​– the prolonged absence of the father as in the case of families of OFW’s gives the mother dominant
position in the family

Types of Families Based on Place of Residence

1. ​Patrilocal ​– requires the couple to live with or near the residence of the parents/ family of the groom 2. ​Matrilocal ​-
requires the couple to live with or near the residence of the parents/ family of the bride 3. ​Bilocal ​– provides the newly wed
couple the choice of staying with either the groom’s or the bride’s parents depending on factors like the relative wealth,
parents wishes or personal preferences
4. ​Neolocal ​-permits couple to reside independently
5. ​Avunculocal ​– reside with or near the maternal uncle of the groom

Types of Families Based on Descent

1. ​Patrilineal ​– affiliates a person with a group of relatives through his or her father
2. ​Matrilineal ​- affiliates a person with a group of relatives through his or her mother
3. ​Bilateral ​- affiliates a person with a group of his relatives related through both his or her parents

Stages of Family Life Cycle ​by Evelyn Duvall

1. Married Couple – without children
2. Childbearing Family – oldest child at birth up to 30 months
3. Family with Pre School children – oldest child at over 30 months up to 6 years
4. Family with School-age Children – oldest child up to 12 years
5. Family with Teenagers - oldest child at 13 up to 20 years
6. Family Launching young adults – first child to last child gone
7. Family without children – empty nest to retirement
8. Aging Family – retirement to death

C. POPULATION GROUP : ​Is a group of people sharing same :

1. ​Characteristics ​– children, elderly, women , men…
2. ​developmental stage ​– infancy, toddler, pre school, school age….
3. common exposure to environmental factors

D. COMMUNITY : ​Is a group of people sharing common geographic boundaries/ or common values and interests

HEALTH CARE DELIVERY SYSTEM

The totality of all policies, facilities, equipment, products, human resources and services which address the health needs,
problems and concerns of the people
Major Players :
1. ​Public sector ​– National level (DOH); Local level
2. ​Private sector ​– private clinic and laboratories, foundations

Primary Health Care

Essential health care made universally accessible to individuals and families in the community by means of acceptable to
through their full participation and at a cost that the community and country can afford at every stage of development ​5 A’s of
Health Care
1. Accessible
2. Attainable
3. Affordable
4. Acceptable
5. Adequate

Four Cornerstones or Pillars of PHC

1. Use of appropriate technology
2. Support mechanism made available
3. Active community participation
4. Intra and inter sectoral linkage
3  
Sectors most closely related to health
1. Local government
2. Education
3. Agriculture
4. Public Works
5. Population Control
6. Social Welfare

Elements/ Components of PHC

1. Health education
2. Communicable disease control
3. Expanded program on immunization
4. Locally endemic disease treatment
5. Environmental sanitation
6. Maternal & child health and Family Planning
7. Essential drugs provision
8. Nutrition and adequate food provision
9. Treatment of emergency cases and provision of medical care

2 Levels of Health care WORKERS

1. Village or Barangay Health Worker (BHW) - trained community health worker
2. Intermediate Level health Workers
- general medical practitioners, public health nurse, sanitary inspectors & midwives

3 Levels of Health Care Services

1. ​Primary Level of Care ​– health care provided by the health center staff
2. ​Secondary Level of Care ​– rendered by physicians with basic health training in district provincial & city hospitals
3. ​Tertiary Level of Care ​– rendered by specialists in medical centers, regional hospitals & specialized hospitals

Levels of Disease Prevention

1. ​Primary Level ​– Directed towards individuals who are at RISK of developing diseases; deals with the removal of risk
factors or SPECIFIC PROTECTION of individuals
Examples : immunization, vitamins,food supplementation
2. ​Secondary Level ​– directed towards individuals in the subclinical stage, asymptomatic and symptomatic stage of disease,
aims to DIAGNOSE & TREAT existing health problem
Ex. Screening, case finding, surveillance and treatment of communicable diseases
3. ​Tertiary Level ​– directed towards individuals in the pathogenic stage of disease, deals with the REDUCTION of the
magnitude & severity of the residual effects of communicable and non communicable disease
Ex. Rehabilitation of post stroke patient, control of spread of measles during endemic

FAMILY HEALTH NURSING PROCESS

Phases of Family Health Nursing Process
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

1. ASSESSMENT
− ​Deals with collecting, organizing & recording data about clients health status
− ​Identifying assessment priorities determined by the purpose of the assessment & clients condition ​−
Prioritizing types of data to be collected systematically
− ​Establishing data base
− ​Continuous updating of records
− ​Validating data
− ​Communicating data

Two types of Nursing Assessment in Family Nursing Practice p.55

1. ​First level assessment ​– is a process whereby existing and & potential health conditions or problems of the family are
determined
2. ​Second level assessment ​– defines the nature or type of nursing problem that the family encounters in performing the
health tasks

Three Major steps in nursing Assessment

I. Data collection
1​st ​level : data on status/ condition of the family which includes :
a. family structure, characteristic & dynamics
b. Socio economic & cultural characteristics
4  
c. Home & environment
d. Health status of each member
e. Values & practices on health promotion/maintenance & disease prevention

2​nd ​level : data on family’s Assumption of health task on each health condition (describe the family’s realities, perception &
attitude)

II. Data analysis

1​st ​level : IDB Initial Data Base (sample IDB Maglaya p.66)
a. Family structure
b. Socio Economic & Cultural characteristics
c. Home & environment
d. Health status of each member
e. Values & practices
nd ​
2​ level : reflects the extent to which the family can perform the health tasks on each health condition or problem identified

Methods of Gathering Data

a. Observation
b. Physical Examination
c. Interview
d. Record Review
e. Laboratory/ Diagnostic tests
Maglaya p. 64

III. Health conditions/ Problems & Family Nursing Diagnosis

1​st ​level – Define the health condition
Categories of Health Problem ( Maglaya p. 68)
a. Wellness state – a clinical or nursing judgment about a client in transition from a specific level of wellness b.
Health threat – conditions that are conducive to disease, accident, or failure to realize one’s health potential c.
Health deficit – instances of failure in health maintenance
d. Foreseeable crisis – anticipated periods of unusual demand on the individual or family in terms of adjustment or
family resources

2​nd ​level – Define the family nursing problem

5 main types of family nursing problem
a. Inability to recognize the presence of the condition/ problem due to :
b. Inability to make decisions with respect to taking appropriate health action due to :
c. Inability to provide nursing care to the sick, disabled or dependent member of the family due to : d. Inability to
provide home environment which is conducive to health maintenance & personal development due to :
e. Failure to utilize community resources for health care due to :

2. DIAGNOSIS
a. Interpreting and analyzing client data
b. Identifying client strengths and health problems
c. Formulating and validating nursing diagnosis

3. PLANNING
A deliberative systematic phase of the nursing process that involves decision making and problem solving It involves a series of
steps in which the nurse & the client set priorities & goals or expected outcomes to resolve or minimize the identified problems.
It includes the following activities :
a. Establishing priorities
b. Writing goals/otcomes & developing an evaluated strategy
c. Selecting nursing interventions
d. Communicating the plan of nursing care

Goal setting - a cardinal sign in goal setting states that goals must be set jointly with the family
Prioritization of Problem is based on (Maglaya p. 86)
1. Nature of the problem – categorized into wellness state, health threat, health deficit & foreseeable crisis 2. Modifiability –
refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or
totally eradicating the problem through intervention
3. Preventive potential – refers to the nature & magnitude of future problems that can be minimized or totally prevented if
the intervention is done on the problem
4. Salience – refers to the family’s perception & evaluation of the condition or problem in terms of seriousness and urgency
Refer to page 89
5  
4. IMPLEMENTATION
A phase in which the nurse puts the nursing care plan into action. It includes the following activities
: a. carrying out care plan
b. continuous data collection & modification of plan of care as needed
c. Documentation of care
Implementation requires the following skills from the nurse :
− ​Cognitive skills (intellectual) – problem solving, decision making, critical thinking & creative thinking ​−
Interpersonal skills or communication skills
− ​Technical skills (psychomotor) or hands on skills such as skills in manipulating equipment, giving medications and others
Guidelines for implementing nursing activities :
− ​should be based on scientific knowledge, nursing research & professional standards of care
− ​Nurses should understand clearly the orders to be implemented
− ​should be adapted to the individual client
− ​should always be safe
− ​Often require teaching, support & comfort
− ​Should be holistic
− ​Should respect the dignity of the client
− ​should respect the dignity of the client
− ​Clients should be encouraged to participate

5. EVALUATION
A planned, ongoing, purposeful activity in which clients & health care professionals, determines the client’s progress toward
goal achievement, & the effectiveness of the care plan. It includes the following activities :
a. measuring how well the client has achieved desired goals or outcomes
b. Identifying factors contributing to the clients success or failure.
c. Modifying the plan of care as necessary
Types of Evaluation
1. Ongoing evaluation – done while or immediately after implementing an order
2. Intermittent- performed at specified time of interval
3. Terminal – indicates clients condition at the time of discharge

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

First Level Assessment

I. Presence of Wellness ​Condition-stated as potential or Readiness-a clinical or nursing judgment about a client in transition from
a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition
based on client’s performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a
higher level of state or function in a specific area on health promotion and maintenance. Examples of this are the following

A. Potential for Enhanced Capability for:

1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of mystery through harmonious interconnectedness that
comes from inner strength/sacred source/God (NANDA 2001)
6. Others. Specify.
B. Readiness for Enhanced Capability for:
1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.

II. Presence of Health Threats-​conditions that are conducive to disease and accident, or may result to failure to maintain
wellness or realize health potential. Examples of this are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.
6  
E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify.
1. Inadequate food intake both in quality and quantity
2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify.
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.
1. Inadequate living space
2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities
12. Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic areas).
J. Inherent Personal Characteristics-e.g. poor impulse control
K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous history of difficult labor.
L. Inappropriate Role Assumption- e.g. child assuming mother’s role, father not assuming his role. M. Lack of
Immunization/Inadequate Immunization Status Specially of Children
N. Family Disunity-e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits​- instances of failure in health maintenance.

Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner.
B. Failure to thrive/develop according to normal rate
C. C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary paralysis after a
CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles, lameness from polio)

IV. Presence of stress points/foreseeable crisis ​situations-anticipated periods of unusual demand on the individual or family in
terms of adjustment/family resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community

7  
N. Illegitimacy
O. Others, specify.___________

Second-Level Assessment

I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically:
1. Social-stigma, loss of respect of peer/significant others
2. Economic/cost implications
3. Physical consequences
4. Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
D. Others. Specify _________

II. Inability to make decisions with respect to taking appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the situation or
problem, i.e. failure to breakdown problems into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding action to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with rational
decision-making.
J. In accessibility of appropriate resources for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of action
M. Others specify._________

III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and
management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care (i.e.
complex therapeutic regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her
capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.
K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify._________

IV. Inability to provide a home environment conducive to health maintenance and personal developmentdue to:

A. Inadequate family resources specifically:

1. Financial constraints/limited financial resources
2. Limited physical resources-e.i. lack of space to construct facility

8  
B. Failure to see benefits (specifically long term ones) of investments in home environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life which is not conducive to health maintenance and personal development I. I. Lack
of/inadequate competencies in relating to each other for mutual growth and maturation (e.g. reduced ability to meet the
physical and psychological needs of other members as a result of family’s preoccupation with current problem or condition.
J. Others specify._________

V. Failure to utilize community resources for health care due to:

A. Lack of/inadequate knowledge of community resources for health care

B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc. J. Negative
attitude/ philosophy in life which hinders effective/maximum utilization of community resources for health care
K. Others, specify __________

SCALE FOR RANKING HEALTH PROBLEMS ACCORDING TO PRIORITIES

1. Nature of the Problem Presented : Categorized whether a Health Threat, Health Deficit or Foreseeable Crisis 2.
Modifiability of the Problem : Refers to the probability of success in minimizing alleviating or totally eradicating the problem
through health intervention
Factors:
− ​Current knowledge, technology and interventions to manage the problem
− ​Resources of the family (physical, financial, manpower)
− ​Resources of the nurse (knowledge, skills, time)
− ​Resources of the community (facilities & community organization)
3. Preventive Potential : Refers to the nature and magnitude of the future problem that can be
minimized or totally prevented if intervention is done in the problem.
Factors:
− ​Gravity and severity of the problem
− ​Duration of the problem
− ​Current management
− ​Expose of any high risk group
4. Salience : Refers to the family perception & evaluation of the problem in terms seriousness & urgency of attention
needed.
∙ ​To determine the score for Salience, the nurse evaluates the family’s perception of a problem. As a general rule, the
family’s concerns and felt needs require priority attention
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
----------------- X Weight
Highest Score

3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight.
4. The higher the score (near 5 and above) of a given problem, the more likely it is taken as a PRIORITY. 5.
With the available scores, the nurse then RANKS health problems accordingly.

9  
SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES

Criteria Weight

1. Nature of the problem presented

Scale: 1
Health Deficit……………. 3
Health Threat……………. 2
Foreseeable Crisis……… 1
2. Modifiability of the Problem
Scale: 2
Easily modifiable………... 2
Partially modifiable……… 1
Not modifiable…………… 0
3. Prevention Potential
Scale: 1
High…………………….. 3
Moderate………………. 2
Low…………………….. 1
4. Salience
Scale: 1
A serious problem, needs
immediate attention………. 2
A problem but not needing
immediate attention………. 1
Not a felt need / problem….. 0

SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCDG TO PRIORITIES

Criteria Weight
1) Nature of the Problem 1
scale: Health Deficit 3
Health Threat 2
Foreseeable Crisis 1
2) Modifiability of the Problem 2
scale: Easily Modifiable 2
Partially modifiable 1
Low 0
3) Preventive Potential 1
scale: High 3
Moderate 2
Low 1
4) Salience 1
scale: Serious px, imm. Attn 2
Px, not needing imm. Attn 1
Not a felt need 0

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 of FNCP
− ​focuses on actions (designed to solve or alleviate existing problems)….The PLAN is a Blueprint for action. ​−
product of deliberate systematic process
− ​continuous process
Qualities of FNCP
− ​Clear definition of problem
− ​Consistent with the goals & philosophy of the health agency
− ​Realistic
− ​It is drawn with the family…nurse works with the family not for the family
− ​Be kept in written form
Importance of FNCP
− ​Provides individualized care
− ​Helps in setting priorities
− ​Promotes systematic communication
− ​Continuity of care
− ​Facilitate coordination of care

10