Categories of Nsg Inter

7/29/2019 Categories of Nsg Inter.

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Prepared by :

Mrs. Maricris D. Banquilay, R.N.,M.A.N.

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FAMILY NURSING CARE PLAN


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vii. CATEGORIES OF NURSINGINTERVENTIONS

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Just as the self aims to achieve body-mind integration to

achieve wholeness in the experience of being and

becoming, the nurse must engage in full awareness of

being and becoming in expert caring. Unless there is

such a dynamic and active involvement between the nurse

and the family in understanding and making choices in this

meaningful world of coping, aspirations, emotions and skills

the nurse cannot hope to achieve expert caring.3

HUMAN BECOMING


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-A substantive part of the implementation phase which is

directed towards developing the familys competencies to

perform the health tasks

-include the cognitive (knowledge), psychomotor (skills),

and attitudinal or effective (emotions, feelings, values)

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COMPETENCY-BASED TEACHING


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Example : Scabies as a Health Deficit

Health Task: The family recognizes the possibility of cross

infection of scabies to other members

Cognitive competencies:

a. The family explains the cause of scabiesb. The family enumerates ways by which cross-infection

of scabies can occur among the family members

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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 actas a barriers to decision-making

b. Family members acknowledge the existence of these

feelings or emotions6


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EXAMPLES OF LEARNING PRINCIPLES

AND

TEACHING LEARNING METHODS AND

TECHNIQUES THE NURSE CAN USE

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 familys meanings, concerns and

situated possibilities.

3. Learning is an individual matter. Ensure mastery byworking on the familys current capabilities and

potentials

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LEARNING IS AN INDIVIDUAL AND

EMOTIONAL PROCESS

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.

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LEARNING IS FACILITATED WHEN

EXPERIENCES HAVE MEANING TO

THE LEARNER1. 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

teaching- learning based on the health tasks that

members need to perform.

3. Use example or illustrations that the family is familiarwith.

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LEARNING IS AN INDIVIDUAL MATTER:

ENSURE MASTERY OF COMPETENCIES

FOR SUSTAINED ACTION1. 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.

teaching skills :

a. explain why it is important

b. when it should be used.c. the stages and steps in performing the skill and

demonstrate it correctly explaining each step as she

demonstrate and emphasize important points10


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3. Ensure adequate evaluation, feedback, monitoring

and support for sustained action.

a. Explain well how the family is doingb. give the necessary affirmations or reassurances

c. explain how the skill can be improved, and

d. explore with the family how modifications can be

carried out to maximize situated possibilities or

best options available to the family

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To bring about self-directed change, people must learn to

learn from their experiences.

Frequently people have learned to defend against the

potential lessons of experience when these threatenexisting equilibria, whether in the person or in the social

system.

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MOTIVATION-SUPPORT FORBEHAVIOR CHANGE/LIFESTYLE

MODIFICATION


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In order to help people lower their defenses and allow

themselves to experience the needed change, it is

necessary to have learning environment that nurtures thechange. The change agent can help the client put to

maximum use valid knowledge through concern for:

1. human needs or the use-value of a given piece of

knowledge

2. security, trust, self-esteem, self-identify, group esteem

and group identity

3. accurate and appropriate preparation and transmissionof messages

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1. PREVENTIVE

2. CURATIVE

3. REHABILITATIVE

4. FACILITATIVE

5. FACILITATION

6. DIRECT

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VIII. STRATEGIES OF NURSINGINTERVENTIONS


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-that phase which is concerned with the determination ofwhether the objectives set were attained, or to whatdegree they were attained

-also involved decision making. Based on the answer to

the questions, Did nursing makes a difference?, orWhat results came out of the nursing activity?,

decisions have to be made on whether the objectives

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IX. EVALUATION


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have to be formulated, approaches and strategies

modified, resources increased and the like. If evaluation

shows that an objective was not attained, the nurse has

to find out the reasons why: the objectives may be

unrealistic, nursing actions may be inappropriate or

uncontrollable environmental factors may be operative in

the situation


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IMPORTANCE OF EVALUATION

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1. To eliminate or stop the continued performance ofuseless activities and/or interventions

2. To increase the efficiency of nursing interventions

3. To provide documentation of the results of nursing

efforts and justification for the cost of nursing

services

4. To promote growth of the profession and refinement

of nursing practice


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QUANTITATIVE VS QUALITATIVE EVALUATION

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QUANTITATIVE accounting is done in terms of quantity

or number of services or activities performed

e.g. number of prenatal patients attended in the clinic,

number of home visits made, number of

immunizations given or number of school childrenassessed

- the more common type of evaluation done for health

services and understandably because of its relative

ease compared to an evaluation of quality- Taylor contends that this kind of evaluation is

irrelevant in todays complex health care system


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QUANTITATIVEDisadvantage: has one obvious limitation : It

assumes that the more tasks or activities are

done, the better

- a lot of health service activities may be virtual

waste of resources


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QUALITATIVE can be focused on either of the 3dimensions:

1. Structure or Resources this refers to human andmaterial things that are needed to carry out the

desired services or activities, and their supporting

organization

e.g. Nurse Practitioner level the nurse qualifications,

interest and motivation, amount of nursing

time and effort spent, nature and quantity of

equipment and supplies used in the deliveryProgram level covers manpower, (quantity and

quality), supplies and equipment, buildings,

money, statement of philosophy and objectives,


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organization of teams and departments, employeeeducation and training and description of policies andstandard operating procedures

2. Process includes activities done to achieve the

objectives. In nursing, this invariably relates to the

nurses performance or actions

e. g. the quality of anticipatory guidance or health

teaching given to an expectant mother

3. Outcome refer to the end results of care and from the

point of view of the patient can be in terms of

physical condition, psychological or attitudinalstatus and behavior


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EXAMPLE ILLUSTRATION:

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OBJECTIVE : As a result of nursing intervention, the familywill be able to provide adequate care to the malnourished child

EVALUATION OF RESOURCESCriteria : Resources of

the nurse (knowledge of nutrition, normal and therapeutic, interestand motivation in the case and the family), resources of thefamily (income, proportion alloted to food, dietary habits andpractices, knowledge of proper nutrition), and resources of thecommunity (availability of feeding centers, other health personnellike doctors and nutritionists, community interest in nutrition, foodsupply)


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EVAUATION OF PROCESS Criteria : Nature of family-nurse

relationship, method of nurse-family contacts, content

and methods of health teaching, approaches andstrategies used by the nurse

EVALUATION OF OUTCOMECriterion : Childs weight


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1. DIRECT OBSERVATION the most valid method ofdetermining change, that is, if subjective observerinterpretation can be minimized with the use ofprecision instruments and predetermined objective

indices of process or outcomee.g. changes in physical condition of a patient can beenhanced by the use of such devices as weighing scale,

stethoscope, sphygmomanometer and the like

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METHODS AND SOURCES OF

EVALUATIVE DATA


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e.g. Behavioral changes in individual members or of the

whole family as of the a unit, are more objectively

determined by having predetermined criteria onspecific behaviors to look for that suggestive of

successful attainment of the objective

2. RECORD REVIEW - reports of diagnostic tests that are

indicative of a change in health status can be gleaned

from the patients record. Likewise, individual patient

or family behavior and general response to service

delivered may be determined from nursing notes as

well as from entries of other members of the health

team


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3. INTERVIEW OR QUESTIONNAIRE to determine broad

and complex attitudinal and behavioral changes, an

interview or questionnaire may be constructed andadministered to an individual patient or key members of

a family. There are rules for construction and

administration of these instruments which have to be

observed. They also require pretesting for validity and

reliability before actual use

4. SIMULATION EXERCISE this involves presenting real-life

problem situations to the client and asking how he willreact. This is useful for determining success in cognitive

skill development like decision making and problem-

analysis skills

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CLIENT SATISFACTION AS

CRITERION OF SUCCESS

the difficulty with the use of patient/family satisfaction asevidence of good nursing care is the fact that

satisfaction does not always mean good care. Clients

usually have different criteria o what constitute good care.

The criteria used frequently relate to the quality of nurse-patient relationship and seldom consider the technical

elements of good care. Ascertaining the clients

satisfaction with services provided has some uses, though,

because they affect the development and maintenance ofa working relationship between the nurse and the

patient/family. The establishment of a working

relationship is crucial to the successful implementation of

the nursing care plan27


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STEPS IN EVALUATION

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1. Establish a baseline in terms of health problem areas for

an individual patient or the entire family. This means

specifically describing the status at the moment. It isanswering the question: What health problems (health

threats, health deficits and foreseeable crises) exist, and

how is the family coping with these problems?

2. Define the objectives of nursing care specifically and interms of client outcomes.

3. Determine the criteria and standards for evaluation. The

criteria may be in relation to resources, process or

outcomes depending upon the dimension of evaluationdesired.

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4. Decide on the methods/techniques of evaluation and

sources of data.

5. Compare the actual situation (after care was

provided)with the criteria and standard for evaluation)

6. Identify the causes for less than optimum performance.

If the objectives have not been fully attained, analyze

possible reasons, like inadequate assessment, wrong

definition of the problem, unrealistic objectives,

inappropriate approaches and strategies, or family and

community factors beyond the control of the nurse.

7. Redefine the objectives. Based on the conclusionsderived from the evaluation process, the objectives of

care are redefined in the light of new problems

identified

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X. RECORDS IN FAMILY HEALTH

NURSING

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IMPORTANCE:

1. A good information or record system is well-

recognized and very important tool in the provision of

comprehensive health care.

2. Records are specially related to such qualities of care

as adequacy, continuity and patient/familycenteredness.

3. The writing and keeping of good records has become

almost mandatory at this time when the consumers of

care have increasingly high expectations and arebecoming more and more critical of the services they

receive.

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PURPOSES/USES OF RECORDS:

1. They document the care rendered to the patient

and/or family, and show the particular contribution ofeach member of the health team in the health care

effort. Records substantiate claims of achievement by

any one member.

2. They serve as a tool for planning care. Records providethe source for some initial data a health worker seeks

about a patient or family. The public health nurse, for

instance, can identify some health and nursing

problems from a mere review of family health records,and plan the content and conduct of her initial contact

with the family

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3. Records facilitate the delivery of continuous care to the

individual patient or family. They show what has been

done, what transpired in the past and from what point

care should be continued. A record review saves a lot of

time and effort by preventing needless repetition of

activities that have already been done.

4. Records serve as a tool for evaluating care. They indicate

the nature, quantity and quality of care provided to

clients and can thus be used as a measure of personnel

performance. A record audit is a common tool utilized by

nurse supervisors to evaluate performance of their staff.

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5. Good records are very valuable teaching devices for

using students and staff alike. They are a source of

educational materials, and reveal strengths and

weaknesses in staff performance that can serve as a

basis for educational activities.

6.Records are an important source or research data. They

are frequently utilized in epidemiological and evaluative

research studies.

7. Lastly, records are legal documents that are used as

evidence in litigations. Clients of health services are

increasingly using the courts to obtain redress for theirgrievances. For the protection of the health worker he

has to keep adequate records.

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Thank you!36

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