Module 7
Topic 1: Implementing
Family Nursing Care
Plan
IMPLEMENTING THE NURSING CARE PLAN
During the implementation phase, the nurse encounters the
realities in family nursing practice which can motivate her to
try out creative innovations or overwhelm her to frustration or
inaction.
Meeting the challenges of the implementation phase is the
essence of family nursing practice.
During this phase the nurse experiences with the family a
lived meaningful world of mutual, dynamic interchange of
meanings, concerns, perceptions, biases, emotions and skills.
METHODS AND
POSSIBILITIES
Expert caring in the implementation phase is demonstrated
when the nurse carries out interventions based on the
family's understanding of the lived experience of coping
and being in the world.
Three such major methods and possibilities are discussed
in this chapter for illustration purposes:
1. Performance-focused Learning through Competency-
based Teaching
2. Maximizing Caring Possibilities for Personal and
Professional Development
3. Reflective Practice
COMPETENCY- BASED
TEACHING
A substantive part of the implementation phase is
directed towards developing the family's competencies to
perform the health tasks. This is called competency-
based teaching.
Competencies include the cognitive (knowledge),
psychomotor, (skills), and attitudinal or affective
(emotions, feelings, values).
The following are examples of these family health competencies using the corresponding health
tasks in our case illustration:
Health Task: The family recognizes the possibility of cross-infection of scabies to other
family members.
Cognitive Competencies:
a. The family explains the cause of scabies:
b. The family enumerates ways by which cross-infection of scabies can occur among the
family members.
Health Task: The family provides a home environment conducive to health maintenance and
personal development of its members.
Psychomotor Competency: The family carries out the agreed upon measures to improve home
sanitation and personal hygiene of family members.
Health Task: The family decides to take appropriate health action.
Attitudinal or Affective Competencies
a. Family members express feelings or emotions that solvent act as barriers to decision-
making.
b. Family members acknowledge the existence of these feelings or emotions.
The following are examples of learning principles and teaching-
learning methods and techniques that the nurse can use in
competency-based teaching (Abbatt 1980, pp. 35-73):
1. Learning is both an intellectual and emotional process. Help
the family handle the affective components of learning for
sustained behavior.
2. Learning is facilitated when experience has meaning. Focus
learning on the family's meanings, concerns and situated
possibilities.
3. Learning is an individual matter. Ensure mastery by working
on the family's current capabilities and potentials.
1. Learning is an Intellectual and Emotional Process
Being aware that family members as persons are integrated beings, a
change in how they think about something or in their understanding of
the situation will affect how they feel about that situation and need to
change it.
Five general methods and techniques are discussed here as examples
of how to teach attitudes or help the family handle the affective
components of teaching-learning situations
1. Provide Information to Shape Attitudes.
2. Providing Experiential Learning Activities to Shape Attitudes.
3. Providing Examples or Models to Shape Attitudes.
4. Providing Opportunities for Small Group Discussion to Shape
Attitudes.
5. Role-playing Exercises.
6. Explore the Benefits of Power of Silence.
2. Learning is facilitated when Experiences have meaning to the learner.
Teaching must have meaning so that families learn and remember more easily. Specific
examples of how to do this are suggested:
1. Analyze and process with family members all teaching learning based on their grasp of
the lived experience of the situation in terms of its meaning for the self.
2. Involve the family actively in determining areas for teachng-learning based on the health
tasks that members need to perform. The family must know in advance what
competencies or objectives are to be learned.
3. Use examples or illustrations that the family is familiar with. Analogies that are similar or
congruent with the family's way of organizing its experiences and perceiving the world
(e.g., the family's world view) are effective examples.
3.Learning is an Individual Matter: Ensure Mastery of Competencies for Sustained Actions
Allow for individual differences by letting families learn at their own speed, providing enough time to
practice the behavior and using a variety of teaching methods.
Some techniques to develop mastery are the following:
1. Make the learning active by providing opportunities for the family to do specific activities, answer
questions or apply learning in solving problems.
2. Ensure clarity in teaching. Use words, examples, visual materials and handouts that the family can
understand.
In teaching skills, the nurse must first describe the skill:
(a) explaining why it is important;
(b) when it should be used,
(c) the stages or steps in performing the skill.
3. Ensure adequate evaluation, feedback, monitoring support for sustained action by:
(a) explaining well how the family is doing;
(b) giving the necessary affirmations or assurances;
(c) explaining how the skill can be improved
(d) exploring with the family how modifications can be carried out to maximize situated
possibilities or best option available to the family.
DATA VALIDATION AND PLAN MODIFICATION
During the implementation phase of a family nursing
care plan the nurse continually collects data through the
various methods to determine changes in an individual
client's/patient's condition and/or in the family and home
situation that may require a change in the nursing care
plan.
Commitment to excellence of practice is a lived
experience of being effective in handling the challenges
of working with families.
EXPERTISE THROUGH REFLECTIVE PRACTICE
Through reflective practice, the implementation phase provides the best
opportunities to widen expertise in family health care.
Several authors describe two sets of reflective practice: Reflection-in-action and
Reflection-on- action (Greenwood, 1998).
a. Reflection-in-action means to think what one is doing while one doing it. It
allows the nurse to re-design what she is doing while she is doing it (Schon,
1983, 1987).
b. Reflection-on-action involves reviewing re-evaluating one's actions to:
(1) relate what one has learned from experience to her existing knowledge
structures;
(2) mentally test her new understandings in new contexts;
(3) make the knowledge gained her own tools for critical thinking and expert
caring.
THE NURSING BAG
a tool making use of public health bag through which
the nurse, during his/her home visit, can perform
nursing procedures with ease and deftness, saving time
and effort with the end in view of rendering effective
nursing care.
PUBLIC HEALTH BAG is an essential and indispensable
equipment of the public health nurse which he/she has to
carry along when he/she goes out home visiting. It contains
basic medications and articles which are necessary for
giving care
The nursing bag, frequently called the PHN bag, is a
tool used by the nurse during home and community
visits to be able to provide care safely and efficiently
Rationale
To render effective nursing care to clients
and /or members of the family during
home visit.
The following are the general principles in the use of the nursing bag
(bag technique):
1. Bag technique helps the nurse in infection control.
2. Bag technique allows the nurse to give care efficiently.
3. Bag technique should not take away the nurse's focus on the patient
and the family.
4. Bag technique may be performed in different ways.
Module 7
Topic 2:
Family-Nurse Contacts
TYPES OF FAMILY NURSE CONTACT
The family-nurse relationship through family-nurse
developed through family-nurse contacts, which take the
form of a clinic visit, group conference, telephone
contact, written communication, or home visit (David et
al le 2007). The nurse uses the type of family-nurse
contact that is most suitable to the purpose or e situation
at hand.
1. CLINIC VISIT
The clinic visit takes place in a private clinics health center,
barangay health station, or in g an ambulatory clinic during a
community outreach activity.
The major advantage of a clinic visit is the fact that a family
member takes the initiative of visiting the professional health
worker, usually indicating the family's readiness to participate
in the health care process.
2. GROUP CONFERENCE or FAMILY
DISCUSSION
A group conference, such as a conference of
others in the neighborhood, provides an
opportunity for initial contact between the nurse
and target families of the community.
WRITTEN COMMUNICATION
Written communication is used to give specific
information to families, such as instructions given to
parents through school children. Although there is a
potential for reaching new families, being a one-way
method and requiring literacy and interest, the nurse
cannot be certain that the information will reach the
intended recipient.
4. SCHOOL VISIT
School visit are made to assess the health of school children, teachers, staff and individual
family members in those environment.
Periodic school visit is necessary to monitor the health related attitude, behavior and
practice of the school children.
Child to child school health program can be conducted which is effective in delivering
health education, changing attitude and knowledge and behavior of family and community
through school children.
5. INDUSTRIAL VISIT
Industrial visit is made with the purpose to assess the safety measure as well as spread of
infection or communicable disease in the industrial area.
The major focus od industrial visit is to prevent accident or disease as it affects the daily
living of the whole family
The nurse provide health education or safety measure, monitor health status, refer
appropriately and help in rehabilitation.
6. TELEPHONE CONTACT
If the resources are available, the telephone (landline or mobile/cell)
provides easy access between the nurse/health worker and the family.
The wide reach of mobile/ cell phone communication services in the
country provides the nurse and the family with opportunities to contact
each other through calls or short messaging service (text messaging).
7. HOME VISIT
A home visit is a professional, purposeful interaction that takes place in
the family's residence aimed at promoting, maintaining, or restoring the
health of the family or its members.
It is a family-nurse contact where, instead of the family going to the
nurse, the nurse goes to the family.
Phases of a home visit*
3 PHASES:
1. Previsit
2. In-home
3. Postvisit phases
1. PREVISIT PHASE
During the previsit phase, if possible, the nurse contacts the family,
determines the family's willingness for a home visit, and sets an
appointment with them.
A plan for the home visit is formulated during this phase.
The planning process for a home visit is essentially the same as the
planning phase of the nursing process.
2. IN-HOME PHASE
This phase begins as the nurse seeks permission to enter and lasts until he or she leaves the
family's home.
The in-home phase consists of initiation, implementation, and termination.
a. Initiation: It is customary to knock or F ring the doorbell and, at the same time, in a reasonably
loud but nonthreatening voice say, I "Tao po. Si Jenny po ito, nurse sa health center," or a similar
greeting in the vernacular or some other language common to the nurse and the t family.
b. Implementation: Implementation involves the application of the nursing process assessment,
provision of direct nursing care as needed, and evaluation.
Assessment consists of techniques such as interview, physical examination, and simple diagnostic
examinations that can be done at home, like capillary blood glucose determination.
It includes observation of family dynamics and the family's physical environment.
c. Termination: This consists of summarizing with the family the events during the home visit and
setting a subsequent home visit or another form of family-nurse contact such as a clinic visit. If
necessary, the nurse may also use this time to record findings, such as vital signs of family
members and body weight.
3. POSTVISIT PHASE
The postvisit phase takes place when the nurse has returned to the
health facility.
This involves documentation of the visit during which the nurse
records events that transpired during the visit, including personal
observations and feelings of the nurse about the visit.
This will help the other members of the health team to understand the
family, providing for a more effective intervention. If appropriate, a
referral may be made. If a subsequent visit has been set, planning for
the next visit is done at this time.
THE RURAL HEALTH UNIT
The Rural Health Unit (RHU), commonly known as health center, is a
primary level health facility in the municipality.
The focus of the RHU is preventive and promotive health services and
the supervision of BHSs under its jurisdiction (DOH,2001).
The recommended ratio of RHU to catchment population is
1RHU:20,000 population (DOH,2009).
BHS - is the first-contact health care offers basic services at the
barangay satellite station of the RHU (DOH, 2009).
It is manned by volunteer Barangay Health workers (BHW) under the
supervision Rural Health Midwife (RHM) (DOH,2001).
Rural health unit personnel
The Municipal Health Officer (MHO) or Rural Health Physician heads
the health services at the municipal level and carries out the following roles
and functions:
1. Administrator of the RHU
a. Prepares the municipal health plan and budget
b. Monitors the implementation of basic health services
c. Management of the RHU staff
2. Community physician
a. Conducts epidemiological studies
b. Formulates health education campaigns on disease prevention
c. Prepares and implements control measures or rehabilitation plans
3. Medico-legal officer of the municipality (DOH, 2001)
