DEVELOPING THE INTERVENTION PLAN ● To ensure the appropriateness of nursing

intervention, the nurse needs to explore

This involves selection of appropriate nursing with the family the possibilities and
interventions based on the formulated goals and choices presented by the current
objectives. In selecting the nursing interventions, the situation given the meanings, concerns,
nurse decides on appropriate nursing actions among a set social relations, and resources.
of alternatives, specifying the most effective or efficient ● Through the participatory approach, the
method of nurse-family contact and the resources needed nurse can select experiential learning
strategies to help the family understand
Examples of methods of nurse-family contact:
its behavior in terms of dynamics,
1. Home visit realities, vulnerabilities and possibilities.
2. Clinic conference ● Through the “Look-Think-Act” cyclical
3. Visit in the work place process, the family can be encouraged to
4. School visit analyze antecedents or factors
5. Telephone call contributing to or producing specific
6. Group approach like health classes health problems.
7. Use of mails ● Based on the analysis, the nurse can
catalyze learning processes such that the
The resources which include material (supplies, family can learn to deconstruct mindsets
equipment, teaching aids/kits visual materials, handouts, or current beliefs and be guided on how
charts, etc. or human (other health team members, to re-order patterns and relationships for
development workers, community leaders) must be fresh insights and workable options to
specified in the plan to ensure that necessary preparation, modify and improve family dynamics and
coordination and collaboration are done before the realities.
implementation phase to maximize efficiency. 2. Develop/enhance family’s competencies as
The following are the general directions for nursing thinker, doer and feeler.
Develop/enhance cognition, volition (the power of
interventions can guide selection of nursing interventions:
choosing and deciding oneself), and emotion
1. Analyze with the family the current situation and ● To determine the appropriateness of
determine choices and possibilities based on the nursing interventions, the nurse is given
lived experience of meaning and concerns. a choice of possibilities that helps her
● Family life and nursing practice are both and the family gain a clearer
phenomenological unified realities of understanding of the self as a thinker, a
experiencing the self who is interacting doer, and a feeler.
with others in specific situations that are ● The choice contributes to a process of
affected by meanings, concerns, self-understanding of a family as a
emotions, past experiences, and system and of each individual member.
anticipated future (Benner and Wrubel, ● Nursing interventions that enhance or
1989). maximize the competencies of the family
● The appropriateness of the nursing as thinker include making
intervention is therefore dependent upon information/data or knowledge readily
the lived meaning of the experiences of available and accessible for ease of and
family members with each other and with confidence in understanding current
the nurse, given the current situation and situations in health and illness. Decision-
possibilities in health and illness realities. making on appropriate actions to take are
● Because family health nursing is a likewise, enhanced.
phenomenological experience for the ● Developing and maximizing the skills and
family and the nurse, the family becomes communication competencies of the
an active participant in the application of family as doer enhance confidence in
the nursing process. carrying out the needed interventions to
● The family and the nurse are participants initiate and sustain change for health
in an active, mutual, dynamic promotion and maintenance, and
interchange of realities, concerns and accurate disease/problem management.
resources. Both need to analyze and ● As feeler, the family needs to develop or
understand the current health/illness strengthen its effective competencies in
situation as the family experiences it. order to appropriately acknowledge and
understand emotions generated by
 family life or health and illness situations its members by focusing on
(e.g. fear, anger, anxiety, jealousy, guilt). assisting the members to act
● By doing so, such emotions can be effectively on their own behalf
transformed into growth-promoting ● Enhance the capability of the family to
choices and actions. When the family provide a home environment conducive
realizes that acknowledging feelings and to health maintenance and personal
allowing them to guide understanding of development
the situation and the self, the experience ● Facilitate the family’s capability to utilize
can attain the greatest freedom in moving community resources for health care
into new possibilities. 4. Catalyze behavior change through motivation
3. Focus on interventions to help perform the health and support
tasks. ● To bring about self-directed change,
● Help the family recognize the problem people must learn from their
⮚ Increase the family’s knowledge experiences.
on the nature, magnitude and ● In order to help the people to lower their
cause of the problem defenses and allow themselves to
⮚ Help the family see the experience the needed change, it is
implication of the situation, or the necessary to have a learning
consequences of the condition environment that nurtures for change.
⮚ Relating health needs to the ● The change agent can help the client put
goals of the family (both health to maximum use valid knowledge
and non-health related goals) through concern for:
⮚ Encourage positive or ⮚ Human needs or the “use-value”
wholesome emotional attitude of a given piece of knowledge
toward the problem by affirming ⮚ Security, trust, self-esteem, self-
the family’s identity, group esteem and group
capabilities/qualities/resources identity
and providing information on ⮚ Accurate and appropriate
available options. preparation and transmission of
● Guide the family on how to decide an messages
appropriate health action to take
In family health nursing practice, the family as a system
⮚ Identify or explore with the family
needs to achieve optimum reality-orientation in its
the courses of action available
adaptation to changing internal and external environment.
and the resources of inaction.
This is done by developing and institutionalizing its own
⮚ Discuss the consequences of problem-solving structures and processes through
each course of action available performance of the family health tasks. To catalyze the
⮚ Analyze with the family the behavior-change towards problem-solving competencies,
consequences of inaction. a theory of family health nursing intervention was
● Develop the family’s ability and developed by Maglaya (1988). Motivation and support are
commitment to provide nursing care to its components of this intervention.
member.
Motivation as conceptualized in the intervention theory is
⮚ The nurse can increase the any experience or information that leads the family to
family’s confidence in providing desire and agree to undergo the behavior change or
nursing care to its sick, disabled proposed measure and take the initial action to bring
and dependent member through about the change.
demonstration and practice Support as an intervention is any experience or
sessions on procedures, information that maintains, restores or enhances the
treatments or techniques capabilities or resources of the family to sustain these
utilizing readily available, low- actions and complete the change process.
cost materials and equipment
and other resources. The intervention leads the family to feel “secured” or “in
⮚ Contracting is creative control” of the situation in the face of uncertainties,
intervention that can maximize stresses, blocks or barriers to the solution of the health
opportunities to develop the condition or problem or threats to self-esteem and
ability and commitment of the affection or danger to life.
family to provide nursing care to
 given to wellness state or potential because of the
premium on client’s efforts or desire to sustain/maintain
DEVELOPING THE EVALUATION PLAN high level wellness.

The evaluation plan specifies how the nurse will The same weight is assigned to a health deficit because
determine changes in health status, condition or situation of its sense of clinical urgency which may require
immediate intervention.
and achievement of the outcomes of care specified in the
objectives of the family nursing care plan.
Foreseeable crisis is given the least weight because
The plan includes evaluation criteria/indicators, culture-linked variables/factors usually provide our
standards, methods and tools/evaluation data sources. families with adequate support to cope with
developmental or situational crisis.
As the nurses’ systematic guide to facilitate improvement
in client’s health status, home and environment condition The nurse considers the availability of the following
or situation, behavior or role/task performance, the factors in determining the modifiability of a health
evaluation plan specifies the criteria as objective, condition or problem:
measurable and flexible indicators to determine
1. Current knowledge, technology and interventions
achievement of expected performance, behavior, to enhance the wellness state or manage the
circumstances or clinical status (ICN 1989). problem
An evaluation plan also includes evaluation methods and 2. Resources of the family-physical, financial and
manpower
tools and / or evaluation data sources. Examples of
3. Resources of the nurse-knowledge, skills and
evaluation methods include direct observation, interview, manpower
oral or written tests, record review, health/physical 4. Resources of the community-facilities and
examination (vital signs and anthropometric community organizations or support
measurement-taking, IPPA, etc.).
To decide on an appropriate score for the preventive
Note that these are similar methods used during the potential of a health condition or problem, the following
assessment phase. It must be remembered that because factors are considered:
the cyclical nature of the nursing process, evaluation
ushers in the assessment phase at the next level of 1. Gravity or severity of the problem-refers to the
application of the nursing process. progress of the disease/problem indicating extent
of damage on the patient/family; also indicates
Evaluation tools include performance evaluation prognosis, reversibility or modifiability of the
checklist, rating scale, interview guide, food recall form, problem. In general, the more severe or
food frequency and food record form as examples. advanced the problem is, the lower is the
preventive potential of the problem.
Instruments such as weighing scale, thermometer, blood 2. Duration of the problem-refers to the link of time
pressure apparatus, tape measure and glucometer are the problem has been existing. Generally
examples of evaluation tools too. speaking, duration of the problem is a variable
that may, however alter this relationship.
Evaluation data sources are records and reports which
Because of this relationship to gravity of the
document the data results generated from specific problem, duration has also a direct relationship to
methods and tools to determine achievement of expected preventive potential.
outcomes based on the goals/objectives specified in the 3. Current management-refers to the presence and
family health nursing care plan. appropriateness of intervention measures
instituted to enhance the wellness state or
Documentation remedy the problem. The institution of
The family care plan is a written guide of the nurse and appropriate intervention increases the condition’s
preventive potential.
family to ensure a systematic approach to planned
4. Exposure of any vulnerable or high-risk group-
behavior change. Accurate record-keeping is an increases the preventive potential of a condition
important responsibility of the community health nurse. It or problem.
provides evidence of professional accountability and
quality care. Effective health management/health maintenance pattern
and desire for or engagement in healthy lifestyle activities
increase the preventive potential of a wellness state or
FACTORS AFFECTING PRIORITY SETTING condition.

Considering the first criterion which is the nature of the To determine the score for salience, the nurse evaluates
condition or problem presented, the biggest weight is the family’s perception of the condition or problem. As a
general rule the family’s concerns, felt needs and/or work with families unless the family sees the
readiness increase the score on salience. nurse as someone who is genuinely concerned
with its welfare. The elements of mutual respect,
trust, and confidence are crucial to the success of
Scoring the nurse-family partnership towards better
After the score for each criterion has been health.
decided on, the number is divided by the highest possible
score in the scale. The quotient is multiplied by the weight Goals set by the nurse and the family should be realistic
indicated for the criterion being considered. Then the sum or attainable. They should be set at reasonable levels.
of the scores for all the criteria is taken. The highest score Too high goals and their consequent failure frustrate both
is five (5), equivalent to the total weight. The nurse the family and the nurse.
considers as priority those conditions and problems with
total scores nearer five (5). Thus, the higher the score of A clear definition of the problem situation and an accurate
a given condition or problem, the more likely it is taken as assessment of available resources facilitate the setting of
a priority. With the available scores, the nurse then ranks realistic goals. Both of these are functions of the depth
health condition and problems accordingly. and breath of the assessment process.

Formulation of Goals and Objectives of Care Goals, like objectives, are best stated in terms of client
outcomes, whether at the individual, family or community
A goal is a broad desired outcome toward which levels. Objectives in contrast to goals, refer to more
behavior is directed. An example of statement of goal in specific statements of the desired results or outcomes of
family nursing practice is: care. They specify the criteria by which the degree of
effectiveness of care is to be measured. Goals tell where
After nursing intervention, the family will be able to take the family is going; objectives are the milestones to reach
care of the disabled child completely. the destinations.

A cardinal principle in goal setting states that Objectives stated as outcomes of care in family health
goals must be set jointly with the family. This ensures the nursing practice specify physical, psychosocial states or
family’s commitment to their realization. Basic to the family behavior or competencies. Examples:
establishment of mutually acceptable goals is the family’s
recognition and acceptance of existing health needs and 1. After nursing intervention, the malnourished
problems. The nurse must ascertain the family’s preschool member of the family will increase their
knowledge and acceptance of the problem as well as the weights by at least one pound per month.
desire to take actions to resolve them. This is done during 2. After nursing intervention, the family will be able
the assessment phase. to:
a. Feed the mentally retarded child according to
Barriers to join goal setting between the nurse and prescribed quantity and quality of food.
the family include the following: b. Teach the mentally retarded child simple
skills related to the activities of daily living.
1. Failure on the part of the family to perceive the c. Apply measures taught to prevent infection in
existence of the problem. the mentally retarded member.
2. The family may realize the existence of a health
condition or problem but is too busy at the The more specific the objectives, the easier is the
moment with other concerns and preoccupations. evaluation of their attainment. Specifically stated
3. Sometimes the family perceives the existence of objectives define the criteria for evaluation.
a problem but does not see it as serious enough
to warrant attention. Objectives vary according to the time span required for
4. The family may perceive the presence of the their realization.
problem and the need to take action. However,
refuse to face and do something about the Short-term or immediate objectives are formulated for
situation. The following are reasons of this kind of problem situations which require immediate attention, and
behavior: results can be observed in a relatively short period of time.
a. Fear of consequences of taking action They are accomplished with few nurse-family contacts
b. Respect for tradition/cultural beliefs, values and with the use of relatively less resources.
c. Failure to perceive the benefits of actions
proposed Long-term or ultimate objectives, on the other hand,
d. Failure to relate the proposed action to the require several nurse-family encounters and an
family’s goals investment of more resources. The nature of outcomes
5. A big barrier to collaborative goal setting between sought require time to demonstrate. Such is the nature of
the nurse and the family is failure to develop a behavior change which is often the object of nursing
working relationship. Nothing will be intervention.
accomplished, as a matter of fact, in a nurse’
Medium-term or intermediate objectives are those which effort, minimizing gaps and duplication of services in
are not immediately achieved and are required to attain settings where there is a frequent turn-over of staff or
the long-term ones. when several health workers are providing care to the
same family. This is particularly true in villages or areas
As with goals, objectives should be realistic and attainable as field practicum sites for training in community health
considering the resources of the nurse, the family and the work.
community. In addition, they should be measurable.
Specific statements of objectives facilitate the evaluation STEPS IN DEVELOPING A FAMILY NURSING CARE
of their attainment. Objectives and evaluation are directly PLAN
related. When objectives are stated in terms of
observable fact and/ or behavior, the criteria for The assessment phase of the nursing process
evaluation become inherent and evident. generates the health conditions and corresponding family
nursing problems which become the bases for the
Examples: development of the nursing care plan. Developing a family
care plan involves many steps. Generally, the plan
Nursing goal: The family will manage malaria as a disease consists of the:
and threat in an epidemic area.
Short-term/immediate objective: 1. Prioritized health conditions or problems
The sick member/s will take the drugs accurately 2. Goals and objectives of nursing care
as to dose, frequency, duration and drug combination. All 3. Intervention plan
members will use self-protection measures at night till 4. Evaluation plan
early morning when biting time of the mosquito vector is
expected. The four Criteria in Prioritizing Health Conditions
Medium-term/intermediate objective: 1. Nature of the condition or problem
presented-categorized into wellness
All members will have regular medical check-up state/potential, health threat, health deficit, and
and laboratory confirmation (i.e., blood smear) to monitor
foreseeable crisis or stress point.
presence of malaria.
2. Modifiability of the condition or problem-
Long-term objective: refers to the probability of success in enhancing
the wellness state, improving the condition,
All members will carry out mosquito vector control minimizing, alleviating or totally eradicating the
measures. problem through intervention.
3. Preventive potential-refers to the nature and
DEVELOPING THE FAMILY NURSING magnitude of future problems that can be
minimized or totally prevented if intervention is
CARE PLAN done on the condition.
The family nursing care plan is a blueprint of the 4. Salience-refers to the family’s perception and
nursing care designed to systematically enhance the evaluation of the condition or problem in terms
family’s capability to maintain wellness and or manage of seriousness and urgency of attention needed
health problems through explicitly formulated goals and or family readiness.
objectives of care and deliberately chosen set of
interventions, resources and evaluation criteria, Steps in Developing the Family Nursing Care Plan
standards, methods and tools. As a written guide, the 1. Prioritize the health conditions and problems
family nursing care plan is regularly updated for based on:
modifications or changes based on family responses, o Nature of the condition or problem
realities, behavioral processes and outcomes of care. o Modifiability
There are several reasons for planning nursing o Preventive potential
care. It is a systematic way to guide the nurse on how to o Salience
enhance the family’s capability for health and health care 2. Develop the Evaluation Plan. Specify:
resource generation, allocation, and or utilization to o Criteria, Standards, Outcomes-based on
achieve specific desired outcomes of prioritized health Objectives of care, Methods/Tools
conditions/problems. Planning enhances the nurse’s 3. Define Goals and Objectives of Care:
foresight for teamwork and coordination of services to Formulate:
ensure adequacy and continuity of care. Specifically in o Expected Outcomes
written form, the nursing care plan promotes systematic o Condition which sustains wellness state
communication among those involved in the health care
 o Conditions to be observed to show
problem is prevented, controlled,
resolved or eliminated.
o Client’s response/s or behavior
o Specific, Measurable client-centered
statements/competencies
4. Develop the Intervention Plan:
Decide on:
o Measures to help family eliminate:
o Barriers to performance of health tasks
o Underlying cause/s of non-performance
of health tasks
o Family-centered alternatives to
recognize/detect, monitor, control or
manage health conditions or problems
o Determine methods of nurse –family
contact
o Specify Resources needed

Scoring:

1. Decide on a score for each of the criterion.

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.