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DEVELOPING THE
 INTERVENTION
     PLAN
 This involves
 selection of
 appropriate
 nursing
 interventions
 based on the
 formulated goals
 and objectives.
 Home visit
 Clinic conference
 Visit in the work place
      EXAMPLES OF RESOURCES
A. MATERIAL
 Supplies
 Equipment
 Teaching aids
B. HUMAN
 Other health team members


 Development workers


 Community leaders
1. Analyze with the family the current
  situation and determine choices and
  possibilities based on a lived experience
  of meanings and concerns.

2. Develop/enhance family’s
  competencies as thinker, doer and
  feeler.
3. Focus on interventions to help perform the
   health tasks.

4. Catalyze behaviour change through
   motivation and support.
 The appropriateness of the nursing
  intervention is, therefore, DEPENDENT
  UPON THE LIVED MEANING OF THE
  EXPERIENCES OF FAMILY MEMBERS
  WITH EACH OTHER AND WITH THE
  NURSE, given the current situation and
  possibilities in health and illness realities.
 Nurse is given a choice of
 possibilities that helps her and the
 family gain a clearer understanding
 of the self as a THINKER, DOER and
 a FEELER.
 Developing and maximizing the skills
 and communication competencies of
 the family as DOER enhance confidence
 in carrying out the needed interventions
 to initiate and sustain change for:

  a.) health promotion and maintenance

 b.) accurate disease/problem
 management.
 As a FEELER:
    -affective competencies- be
 developed
    -to acknowledge &
 understand motions generated
 by family life or health-illness
 situations *
 *This positive
 ability may provide
 respite and offer
 perspective during a
 time of negative
 feelings such as fear
 and anxiety.
 The nurse needs to focus her choice
 of interventions on helping the
 family minimize or eliminate the
 possible reasons for or causes of
 the family’s inability to the health
 tasks:
1. HELP THE FAMILY RECOGNIZE THE
  PROBLEM.

Examples of interventions:
 Increasing the family’s knowledge on
  the nature, magnitude and cause of the
  problem.*

 Helping the family see the implications
 of the situation, or the consequences of
 the condition.*
 Encouraging positive or
 wholesome emotional attitude
 toward the problem by affirming
 the family’s
 capabilities/qualities/resources
 and providing information on
 available options.
2. GUIDE THE FAMILY ON HOW TO DECIDE
  ON APPROPRIATE HEALTH ACTIONS TO
  TAKE.

This can be done through:
     a.) identifying or exploring with
 the family
   - courses of action available and the
       needed resources for each.*
b.) discussing the
consequences of each course
of action available

 c.) analyzing with the
family the consequences of
inaction.
3. DEVELOP THE FAMILY’S ABILITY AND
  COMMITMENT TO PROVIDE NURSING
  CARE TO ITS MEMBERS.

 Nurse can increase the family’s confidence
   -   to provide nursing care through
       demonstration and practice sessions on
        procedures, treatments or technique
       utilizing readily available, low-cost
       materials and equipment and other
       resources*
CONTRACTING
- Is creative intervention that can maximize
  opportunities to develop the ability and
  commitment of the family to provide nursing
  care to its members.

- It is an intervention whereby the nurse
  creates a situation in order that the client
  learns to achieve a health-related behaviour.*
-

- Contracting provides a systematic
  method of increasing desirable
  client behaviour through the use
  of the PRINCIPLE OF POSITIVE
  REINFORCEMENT.
- In order to make this intervention effective,
  the necessary elements of the desired
  behaviour must be MADE EXPLICIT AND
  MUST BE WRITTEN IN THE FORM OF AN
  AGREEMENT.

- To make the behaviour consciously reinforced
  it must be observable and measurable.
4. ENHANCE THE CAPABILITY OF THE
    FAMILY TO PROVIDE A HOME
    ENVIRONMENT CONDUCIVE TO HEALTH
    MAINTENANCE AND PERSONAL
    DEVELOPMENT.

   The family can be taught specific competencies to
    ensure such a home environment through:

   Environmental modification
   Manipulation or management to minimize or
    eliminate health threats or risks
   Install facilities for nursing care
5. FACILITATE THE FAMILY’S CAPABILITY TO
    UTILIZE COMMUNITY RESOURCES FOR
    HEALTH CARE

-   involves maximum use of available
    resources through the COORDINATION,
    COLLABORATION AND TEAM WORK
    provided by an effective referral system.

-   Easy access to available health and socio-
    economic resources starts with
    maintaining an updated file that lists such
    resources, their addresses or telephone
    numbers and specific services offered.
A sample format of the file or index of
  community resources
Name of      Office and email      Type of client and   Requirem
agency and   addresses/telephone   specific             ents/proc
person to    number                services/schedule    edures for
contact                                                 referral
 A TWO-WAY REFERRAL SYSTEM can
  facilitate mobilization of resources for
  families.

 An effective two-way referral system
  ensures: a. monitoring of the case, problem
  or situation
 follow-up of required interventions, case or
  services
 evaluation of the client’s status or family’s
  problem/situation.
 To bring about self-directed change, people
  must learn to learn from their experiences.

 In order to help people lower their defenses
  and allow themselves to experience the
  needed change, it is necessary to have a
  learning environment that
  nurtures the change.
 The change agent can help the client put to
   maximum use valid knowledge through
   concern for:
a.) Human needs or the “use-value” of a given
   piece of knowledge

b.) security, trust, self-esteem, self-identity,
  group esteem and group identity

c. Accurate and appropriate preparation and
   transmission of messages
 To catalyze the change, SUPPORT
 IS NEEDED*

 In family health nursing practice,
 the family as a system needs
 OPTIMUM REALITY-ORIENTATION
 in its adaptation to its changing
 internal and external environment.
 To catalyze the behaviour
 change towards problem-solving
 competencies , a THEORY OF
 FAMILY HEALTH NURSING
 INTERVENTION was developed
 by Maglaya.
COMPONENTS
 Motivation
 Support


MOTIVATION
- As conceptualized the intervention theory is any
   experience or information that leads the family
   to desire and agree to undergo the behaviour
   change or proposed measure and take the initial
   action to bring about the change.
SUPPORT
- As an intervention
- any experience or information that:
a. maintains, restores or enhances the
   capabilities
b. resources of the family complete the
   change process.

 The intervention leads the family to feel
  “secured” or “ in control of the situation*
 Was adapted using the
  motivation-support intervention.
 Families were guided through the
  behaviour change process:
1.Constructing the intention to
  initiate/sustain the change
2. Translating the intention inot actions,
  and
3. To integrate the actions/change into
  existing lifestyle

CRITERIA FOR SELECTING THE TYPE OF
  NURSE-FAMILY CONTACT
1. Effectivity
2. Efficiency
3. Appropriateness
 Is an effective and appropriate type of
 nurse-patient contact if the objectives and
 outcomes of care require accurate
 appraisal of family relationships, home
 and environment, and family
 competencies.

 Expensive in terms of time, effort and
 logistics for the nurse
 Less expensive
 Provides opportunity to use equipment
  that cannot be taken to the home
 Other team members in the clinic may be
  consulted or called in to provide additional
  service
 Emphasizes to the family the importance
  of empowerment and assuming
  responsibility for self-help.
 May be effective, efficient and appropriate if :
-objectives and outcomes of care require immediate
  access to data, given problems on distance or travel
  time

 Data include monitoring of health status or progress
  during:
- acute phase of an illness state
- change in schedule of visit or family decision,
- updates on outcomes or responses to care or
  treatment.
 less time-consuming option for the nurse
a. when there are a large number of families
  needing follow-up : problems of distance
  and travel time.

 If the family is motivated enough and
 independent enough- nurse can use the
 advantage of placing responsibility for
 action on the family, a letter, note and
 learning materials are appropriate.
Health    Family     Goals   Objectives Intervention   Method    Resources
Problem   Nursing    of      of Care    Measures       Of        Required
                     Care
          problems                                     Nurse
                                                       Family
                                                       Contact
Fcp intervention

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Fcp intervention

  • 2.  This involves selection of appropriate nursing interventions based on the formulated goals and objectives.
  • 3.
  • 4.  Home visit  Clinic conference  Visit in the work place EXAMPLES OF RESOURCES A. MATERIAL  Supplies  Equipment  Teaching aids
  • 5. B. HUMAN  Other health team members  Development workers  Community leaders
  • 6. 1. Analyze with the family the current situation and determine choices and possibilities based on a lived experience of meanings and concerns. 2. Develop/enhance family’s competencies as thinker, doer and feeler.
  • 7. 3. Focus on interventions to help perform the health tasks. 4. Catalyze behaviour change through motivation and support.
  • 8.  The appropriateness of the nursing intervention is, therefore, DEPENDENT UPON THE LIVED MEANING OF THE EXPERIENCES OF FAMILY MEMBERS WITH EACH OTHER AND WITH THE NURSE, given the current situation and possibilities in health and illness realities.
  • 9.  Nurse is given a choice of possibilities that helps her and the family gain a clearer understanding of the self as a THINKER, DOER and a FEELER.
  • 10.  Developing and maximizing the skills and communication competencies of the family as DOER enhance confidence in carrying out the needed interventions to initiate and sustain change for: a.) health promotion and maintenance b.) accurate disease/problem management.
  • 11.  As a FEELER: -affective competencies- be developed -to acknowledge & understand motions generated by family life or health-illness situations *
  • 12.  *This positive ability may provide respite and offer perspective during a time of negative feelings such as fear and anxiety.
  • 13.  The nurse needs to focus her choice of interventions on helping the family minimize or eliminate the possible reasons for or causes of the family’s inability to the health tasks:
  • 14. 1. HELP THE FAMILY RECOGNIZE THE PROBLEM. Examples of interventions:  Increasing the family’s knowledge on the nature, magnitude and cause of the problem.*  Helping the family see the implications of the situation, or the consequences of the condition.*
  • 15.  Encouraging positive or wholesome emotional attitude toward the problem by affirming the family’s capabilities/qualities/resources and providing information on available options.
  • 16. 2. GUIDE THE FAMILY ON HOW TO DECIDE ON APPROPRIATE HEALTH ACTIONS TO TAKE. This can be done through: a.) identifying or exploring with the family - courses of action available and the needed resources for each.*
  • 17. b.) discussing the consequences of each course of action available c.) analyzing with the family the consequences of inaction.
  • 18. 3. DEVELOP THE FAMILY’S ABILITY AND COMMITMENT TO PROVIDE NURSING CARE TO ITS MEMBERS.  Nurse can increase the family’s confidence - to provide nursing care through demonstration and practice sessions on procedures, treatments or technique utilizing readily available, low-cost materials and equipment and other resources*
  • 19. CONTRACTING - Is creative intervention that can maximize opportunities to develop the ability and commitment of the family to provide nursing care to its members. - It is an intervention whereby the nurse creates a situation in order that the client learns to achieve a health-related behaviour.*
  • 20. - - Contracting provides a systematic method of increasing desirable client behaviour through the use of the PRINCIPLE OF POSITIVE REINFORCEMENT.
  • 21. - In order to make this intervention effective, the necessary elements of the desired behaviour must be MADE EXPLICIT AND MUST BE WRITTEN IN THE FORM OF AN AGREEMENT. - To make the behaviour consciously reinforced it must be observable and measurable.
  • 22. 4. ENHANCE THE CAPABILITY OF THE FAMILY TO PROVIDE A HOME ENVIRONMENT CONDUCIVE TO HEALTH MAINTENANCE AND PERSONAL DEVELOPMENT.  The family can be taught specific competencies to ensure such a home environment through:  Environmental modification  Manipulation or management to minimize or eliminate health threats or risks  Install facilities for nursing care
  • 23. 5. FACILITATE THE FAMILY’S CAPABILITY TO UTILIZE COMMUNITY RESOURCES FOR HEALTH CARE - involves maximum use of available resources through the COORDINATION, COLLABORATION AND TEAM WORK provided by an effective referral system. - Easy access to available health and socio- economic resources starts with maintaining an updated file that lists such resources, their addresses or telephone numbers and specific services offered.
  • 24. A sample format of the file or index of community resources Name of Office and email Type of client and Requirem agency and addresses/telephone specific ents/proc person to number services/schedule edures for contact referral
  • 25.  A TWO-WAY REFERRAL SYSTEM can facilitate mobilization of resources for families.  An effective two-way referral system ensures: a. monitoring of the case, problem or situation  follow-up of required interventions, case or services  evaluation of the client’s status or family’s problem/situation.
  • 26.  To bring about self-directed change, people must learn to learn from their experiences.  In order to help people lower their defenses and allow themselves to experience the needed change, it is necessary to have a learning environment that nurtures the change.
  • 27.  The change agent can help the client put to maximum use valid knowledge through concern for: a.) Human needs or the “use-value” of a given piece of knowledge b.) security, trust, self-esteem, self-identity, group esteem and group identity c. Accurate and appropriate preparation and transmission of messages
  • 28.  To catalyze the change, SUPPORT IS NEEDED*  In family health nursing practice, the family as a system needs OPTIMUM REALITY-ORIENTATION in its adaptation to its changing internal and external environment.
  • 29.  To catalyze the behaviour change towards problem-solving competencies , a THEORY OF FAMILY HEALTH NURSING INTERVENTION was developed by Maglaya.
  • 30. COMPONENTS  Motivation  Support MOTIVATION - As conceptualized the intervention theory is any experience or information that leads the family to desire and agree to undergo the behaviour change or proposed measure and take the initial action to bring about the change.
  • 31. SUPPORT - As an intervention - any experience or information that: a. maintains, restores or enhances the capabilities b. resources of the family complete the change process.  The intervention leads the family to feel “secured” or “ in control of the situation*
  • 32.  Was adapted using the motivation-support intervention.  Families were guided through the behaviour change process: 1.Constructing the intention to initiate/sustain the change
  • 33. 2. Translating the intention inot actions, and 3. To integrate the actions/change into existing lifestyle CRITERIA FOR SELECTING THE TYPE OF NURSE-FAMILY CONTACT 1. Effectivity 2. Efficiency 3. Appropriateness
  • 34.  Is an effective and appropriate type of nurse-patient contact if the objectives and outcomes of care require accurate appraisal of family relationships, home and environment, and family competencies.  Expensive in terms of time, effort and logistics for the nurse
  • 35.  Less expensive  Provides opportunity to use equipment that cannot be taken to the home  Other team members in the clinic may be consulted or called in to provide additional service  Emphasizes to the family the importance of empowerment and assuming responsibility for self-help.
  • 36.  May be effective, efficient and appropriate if : -objectives and outcomes of care require immediate access to data, given problems on distance or travel time  Data include monitoring of health status or progress during: - acute phase of an illness state - change in schedule of visit or family decision, - updates on outcomes or responses to care or treatment.
  • 37.  less time-consuming option for the nurse a. when there are a large number of families needing follow-up : problems of distance and travel time.  If the family is motivated enough and independent enough- nurse can use the advantage of placing responsibility for action on the family, a letter, note and learning materials are appropriate.
  • 38. Health Family Goals Objectives Intervention Method Resources Problem Nursing of of Care Measures Of Required Care problems Nurse Family Contact

Notas do Editor

  1. When you move to the implementation process, you face a lot of challenges which may somehow make you frustrated, to the extent of inaction or may encourage you to try new, creative ways….in this process, it takes a lot of time, of effort, patience for you to carry out effectively the plans you have set… Since there will be a lot of interaction between you and the family membrs, this is the time where you come to know a lot of perceptions, ideas, emotions, concerns towards the family. So what is important is a positive attitude, a dynamic mind and body…and an active and dynamic involvement of both parties: the family and you as their student nurse. The nursing care plan focuses on actions which are designed to solve or minimize existing problem. The plan is a blueprint for action. The core of the plan are the approaches, strategies, activities, methods and materials which the nurse hopes will improve the problem situation. The nursing care plan is based upon identified health and nursing problems. The problems are the starting points for the plan, and the foci of the objectives of care and intervention measures. The nursing care plan is a means to an end, not an end in itself. The goal in planning is to deliver the most appropriate care to the client by eliminating barriers to family health development. Nursing care planning is a continuous process, not a one-shot-deal. The results of the evaluation of the plan’s effectiveness trigger another cycle of the planning process until the health and nursing problems are eliminated.
  2. ………… must be specified in the plan to ensure that necessary preparations, coordination and collaboration are done before the implementation phase. …
  3. methods of nusring family contact: home visits, visit in the workplace, school visit, telephone call, group approach like health classes ……… .reasons- material; supplies, equipment, teachings aids (visual materials, hand outs, charts) -
  4. Appropriateness of the intervention- dependent on the lived experience of family members with each other.. So as what I always reiterate, the active participants are the nurse and the family members…if one of these people fail to do their part, the whole process will put to waste and the goals will not be materialized. Both need to explore, analyze and understand the current health/illness situation as the family experiences it. Hence, there should be what? DYNAMIC,ACTIVE, MutuaL INTERCHANGE OF REALITIES, CONCERS AND RESOURCES----IN OTHER WORDS, MAGTINABANGA
  5. With goal in number 1, as to the lived experience and the appropriateness of the interventions, the nurse has a lot of….CHOICES! These choices will help us understnd the family as a system and its individulaity of the members. As a THINKER: nursing interventions should enhance this competency- outcome: make data readily available and accessible – to understand better the current situations … you make them good or critical thinkers- how? First- identify level of understanding (ask questions to assess if they do undrstand the illness, the causes, from that, make them undertand, and teach them how to solve the given problem, prevention so that the next time around they encounter parallel problems, they know (as good thinker) what to do…. Both need to explore, analyze and understand the current health/illness situation as the family experiences it.
  6. AS doer: nurse must devlop – you help the communication and skills in carrying out the interventions: when you instruct the patient or refer to the hospital, you accompany her first and explain the things she must do- she must communicate clrealy with the physicians,, verbalize the signs and symptoms, how they develop… you intrsuct her as you explore this intervention together…so that the next time she needs to do this, she has the courage and idea what to do, what to say, how to say it… Relate to A and B
  7. … like fear, anger, anxiety, jelousy, guilt…. In other words, pagbati bati…because it is by feeling and recognizing that you feel it that you accept the existing emotion, by that you find ways on how to manage such emotions…prevent further problems, right? After that, there will be growth promoting choices and actions coz you don’t have grudges against othr family member…work relations are better…
  8. The ability of understanding the meanings of our feelings, we can gain the skill to rehearse and rturn to positive felings…you get over it…and be back to the positive feelings of joy, contenment and comfort… Okay, cry ko karon kay sakit kau but after this move on…I have choices…to be happy or not, which is better?
  9. Nature of the problem…is it a health threat, deficit, forseeeable crisis… If dili mareapir and broken stairs, what will happen? … .3 rd one is Relating healt
  10. Example: what the family can do…available resources…..the stairs are broken, faulty eating habits?
  11. Consequence or benefits: if not to repair the stairs or to repair it
  12. What are the available resources…outside the house… Relate sa reapir of stairs Scabies-use of kalatsusi- how to prepare and apply….
  13. Contract_ agreement…..to make this intervention efffective- the necessary elemnts … .. through a sequentially arranged explicit steps and conditions or elements jointly identified by both parties
  14. This behaviour uses reinforcement contracts on a variety of health-related behaviour requiring complex behavioural changes such as: adherence to diet, medications and other treatment regimens to maintain desirable laboratory values, lose weight, and control blood pressure.
  15. People-learned to defend against potential lessons of the experience- when thse threaten potential equilibria…
  16. so that an otherwise insecure, threatened or anxious client who is faced with the stresses of the change process can experience stability to sustain actions and complete the behaviour change. … .. This is done by DEVELOPING AND INSTITUTIONALIZING its own PROBLEM-SOLVING STRUCTURES AND PROCESSES through the performance of the family health tasks.
  17. …… “ in the face of the uncertainties, stresses, blocks or barriers to the solution of the health condition or problem or threats to self-esteem and affection or danger to life. Example with mother whose child has diarrhea…nurse…teach mother : the cyclical relatinship of the diarrhea and malnutrition Cause of diarrhea during oral feeding To develop competency as doer: Teach mother how to administer ORAL rehydration slowly Demonstrate to mother how to prepare easily digested rice with chon like powdered beans, toastd dry small fish What are the support of the nurse to mother? Physical and psychological availabily and accesibilty
  18. REFER TO PAGE EXAPMLE NUTRITION…