FNCP, Bag technique, Leopolds

FNCP = Blueprint of the care that the N designs to systematically minimize or eliminate the identified
health and family nsg problems through explicitly formulated outcomes of care and deliberately chosen
sets of interventions, resources and evaluation criteria, standards, methods and tools.

CHARACTERISTICS OF FNCP

 Focuses on action to solve/minimize existing problems

 A product of deliberate systematic process – data analysis
 Relates to the future; projects future scenario
 Based upon the identified health and nursing problems – problems are starting points
 It is a means to an end, not an end in itself – deliver the most appropriate care to the ct by
eliminating barriers to family health development
 A continuous process – must be evaluated for its effectiveness
DESIRABLE QUALITIES OF FNCP
 It should be based on clear, explicit definition of the problems.Must be based on comprehensive
analysis of the problem
 A good plan is realistic
 Prepared jointly with the family.
= N works with the family; not works for the family
= N involves family in determining the health needs & problems, priorities, appropriate
actions, implementation and evaluation of outcomes
 A means of communication (within the profession and other professions)
Importance of planning care
 Individualizes patient care.
 Sets priorities by providing information abt the ct; his nature of problems.
 Promotes systematic communication involved in care.
 Continuity of care is facilitated, prevents gaps and duplication of care.
 Coordinates care to other health team members.
STEPS
1. PRIORITIZATION OF PROBLEMS

2. SETTING THE GOALS AND OBJECTIVES

3. PLANNING INTERVENTIONS

4. EVALUATION OF CARE

Criteria in Different 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 that affects modifiability

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 that affect Preventive potential

1. Gravity and severity of the problem
2. Duration of the problem
3. Current management
 4. 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
----------------- XWeight
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

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

FORMULATION OF GOALS AND OBJECTIVES OF NURSING CARE

Goal :
 general statement of the condition or state to be brought about by specific courses of
action Client Outcomes Goals tell where the family is going.
 Must be set together with the family
 Family must be able to recognize and accept the presence of existing health needs and
problems.
 Nurse must ascertain the family’s knowledge and acceptance of the problems and the
desire to make actions to resolve them.

Objectives:
 More specific statements of desired results or outcomes of care
 Specify the criteria by which the degree of effectiveness of care are to be measured
 Must be specific in order to facilitate its attainment
  Milestones to reach the destination
SMART OBJECTIVES;
 Specific: Concrete, detailed, and well defined so that you know where you are going and what
to expect when you arrive
 Measureable: Numbers and quantities provide means of measurement and comparison
 Achievable: feasible and easy to put into action
 Realistic: Considers constraints such as resources, personnel, cost, and time frame
 Time-Bound: A time frame helps to set boundaries around the objective

BARRIERS TO GOAL-SETTING
1. Failure of the family to perceive the existence of the problem.
= family may feel satisfied with the existing situation
2. Family is too busy with other concerns or preoccupations at the moment.
3. Family does not see the existence of a problem as serious enough to necessitate attention
4. Family may perceive the problem and the need to take action, but they face to do something about
the situation.
5. Failure between the nurse and the family to establish a working relationship.

= TRUST AND CONFIDENCE

What is a nursing intervention?

Nursing interventions are a vital service for patients as nurses care for them in every aspect,
including physically, mentally, emotionally and socially.

Types of nursing interventions

Behavioral nursing interventions include actions that help a patient change their behavior, such
as offering support to quit smoking.

Community nursing interventions are those that focus on public health initiatives, such as
implementing a diabetes education program.

Family nursing interventions are those that impact a patient’s entire family, such as offering a
nursing woman support in breastfeeding her new baby, or reducing the threat of illness
spreading when one family member is diagnosed with a communicable disease.
Health system nursing interventions are actions nurses take as part of a healthcare team to
provide a safe medical facility for all patients, such as following procedures to reduce the risk of
infection for patients during hospital stays.

Physiological nursing interventions are related to a patient’s physical health. These nursing
interventions come in two categories: basic and complex. An example of a physiological nursing
intervention would be providing IV fluids to a patient who is dehydrated

Safety nursing interventions include actions that maintain a patient’s safety and prevent
injuries. These include educating a patient about how to call for assistance if they are not able to
safely move around on their own.

SELECTION OF APPROPRIATE NURSING INTERVENTIONS

N must choose among set of alternatives

N must specify the most effective or efficient method of N-F contact such as;
Home visit
Clinic conference
Visit in the work, place, school
Telephone call
Group approach

HOW TO CHOOSE THE APPROPRIATE NURSING INTERVENTION

1. Analyze w/ 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 Behavior Change through Motivation and Support

DEVELOPING THE EVALUATION PLAN

Specifies how the N will determine achievement of the outcomes of care.

Criteria, standards, evaluation methods and sources of data.

Leopold’s Maneuvers
Leopold's maneuvers are a common and systematic way to determine the position of a fetus inside the
woman's uterus, named after the gynecologist Christian Gerhard Leopold.

Purpose of L maneuver
To determine the following;
 is done to determine the attitude
 fetal presentation lie,
 presenting part,
 degree of descent,
 an estimate of the size, and
 number of fetuses,
 position,
 fetal back & fetal heart tone

Difficulties in performing the maneuvers

1. When client is obese.
2. When client has hydramnios
3. Palpation can be uncomfortable if client is not relaxed and adequately positioned.

Procedure:
Preparation:
 Explain the procedure and its purpose to the client.
 Instruct client to empty her bladder first.
 Provides the client with privacy appropriate to the procedure.
 Place client in, supine with knees slightly flexed . Place a small pillow or rolled towel on
the right side of the client.
 Wash hands with warm water( keep the hands rubbing together). (Cold hands can
stimulate uterine contractions).
 Observe the clients abdomen determining the longest diameter and where the fetal
movement is apparent;
1St Maneuver FUNDAL GRIP
Purpose: To determine fetal part lying in the fundus. To determine presentation.

Procedure:
Stand beside the patient/client
Places both hands flat on the client’s abdomen
Palpates the superior surface of the fundus determining the abdomen’s consistency and
shape
Findings: Head is more firm, hard and round that moves independently of the
body. Breech is less well defined that moves only in conjunction with the body. The first
maneuver aims to determine the gestational age and the fetal lie.

2nd Maneuver UMBILICAL GRIP

Purpose: To identify location of fetal back. To determine position.
Procedure:
Places the palms of each hand on either side of the abdomen
Palpates the side of the uterus by keeping the left hand stationary on the left side of the
uterus while the right hand palpates the left side of the uterus from top to bottom
Repeats palpitation by keeping the right hand stationary on the right side of the uterus
while the left hand palpates the left side of the uterus from top to bottom
Findings: Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus
feel with a number of angular nodulation
 3rd Maneuver PAWLIK’S GRIP
The third maneuver was modified by Karel Pawlík (1849–1914), a Czech gynecologist
and obstetrician, and is referred to as the Pawlik grips. This maneuver aids in the
confirmation of fetal presentation.
Purpose: To determine engagement of presenting part.
Procedure:
Using the thumb and index finger, gently grasp the lower portion of the abdomen (just
above the symphysis pubis) and gently presses fingers together
Determines the fetal presentation by noting any movement and whether the part is firm
or soft
Findings: The presenting part is not engaged if it is not movable. It is not yet engaged if
it is still movable.

4th Maneuver PELVIC GRIP

Purpose: To determine the degree of flexion of fetal head. To determine attitude or
habitus.
Procedure:
Stands on one side of the client facing towards the foot of the client
Places fingers on both sides of the uterus (approximately 2 inches above the inguinal
ligaments)
Presses fingers downward and inward in the direction of the birth canal allowing the
fingers to be carried downward
Provides the client with a brief description of findings
Assists the client to sit up and stand
Performs complete aftercare
Findings: Good attitude – if brow correspond to the side (2nd maneuver) that contained
the elbows and knees. Poor attitude – if examining fingers will meet an obstruction on
the same side as fetal back (hyperextended head)Also palpates infant’s anteroposterior
position. If brow is very easily palpated, fetus is at posterior position (occiput pointing
towards woman’s back)

Note please follow RD tool

Introduction
Home Visit
 It is a family-nurse contact which allows the health worker to assess the home
and family situations in order to provide the necessary nursing care and health related
activities
 It is a professional face to face contact made by a nurse to a client or family to provide
necessary health care activities and to further attain an objective of the health agency.
 Is a professional contact between the community health nurse and the family
 The services provided is an extension of the health services agency ( Health center)

Different Types of FNC

1. Home Visit
- health caregiver visits a home in the community.
2.. Clinic Visit
- clients visit the health clinics to inquire or to seek health center consultation, check-
ups or treatments of health problem.
3. Industrial Clinic Visit
- nurses are hired by agencies or companies to do a medical assessment on their
employees for pre- employment check-up and treatment on health problems.
4. School Clinic Visit
- it’s where students seek health care services from their school.

Types of load that we need to visit;

1. Morbid - for the diagnosed/ undiagnosed diseases.
2. Antepartum
 3. Postpartum
4. Health supervision
- used for children under 6 years old

Purpose of home visit

1. To give care to the sick, to a postpartum mother and her newborn with the view teach a
responsible family member to give the subsequent care.
2. To assess the living condition of the patient and his family and their health practices in
order to provide the appropriate health teaching.
3. To give health teachings regarding the prevention and control of diseases.
4. To detect, help prevent the spread of communicable disease.
5. To establish close relationship between the health agencies and the public for the
promotion of health.
6. To make use of the inter-referral system and to promote the utilization of community
services
Principles involved in preparing for a home visit
: Components of home visit
1. Planning
Principles in planning home visit
a)A home visit should have a purpose or objective.
b)Making use of available information about the client and his family, through family records,
information from the health center personnel and other existing agencies that have given
services to the particular family.
c)It should revolve around the essential needs of the individual and his family but priority
should be given to those needs recognized by the family itself.
d)Planning of continuing care should involve the individual and his family.
e)Planning should be flexible and practical.

Guidelines in planning for a home visit

a) Study records, referrals from other agency and available information.
b) Appraise needs of total family and individual members. Consider the recognized and
unrecognized needs of the family.
c) Review new or forgotten content materials related to the health needs of the family.
d) Contact health and social agencies, which have provided services to the family as
recorded.
e) Decide on methods and materials to be used.
f) Consider other possible ways of meeting the family’s needs.

.2. Implementation
Phases of Approach:
a) Socialization phase – establish rapport with the client and family.
b) Working/Professional phase – apply problem solving techniques to situations found in
the home and plan with the family to resolve health problem situations.
c) Summary phase – documentation of significant findings.

2. Evaluation
Effective program evaluation is a systematic way to improve and account for public health
actions by involving procedures that are useful, feasible, ethical, and accurate. The Framework
for Evaluation in Public Health guides public health professionals in their use of program
evaluation. It is a practical, nonprescriptive tool, designed to summarize and organize essential
elements of program evaluation.
Guidelines to consider regarding the frequency of home visit

 The physical needs, psychological needs, and educational needs of the individual and
family.
 The acceptance of the family for the services to be rendered, their interest and the
willingness to cooperate.
  Take into account other health agencies and the number of health personnel already
involved in the care of a specific family.

Steps in conducting home visits

 Greet the client and introduce yourself.
 State the purpose of the visit
 Observe the patient and determine the health needs.
 Put the bag in a convenient place.
 Perform the nursing care needed and give health teachings.
 Record all important date, observation and care rendered.
 Make appointment for a return visit.

Advantages of home visit;

o Opportunity to assess the family and home situation
o Opportunity to seek out new health problems
o The nurse can assist and supervise the family on how to render nursing care to
the sick family member.’
o Permits teaching in the actual situation.
o Family is more at ease in discovering their problems ✓ Family is more confident
in a personalized service.
Disadvantages of home visits:

Home visits are time consuming; travel time is required to get to the persons needing
care.
 There is no easy access to emergency equipment or consultation with other health
professionals if needed.
 No opportunity for the families to share experiences with others.
 Distractions at home may make instructions difficult.

Bag technique
PUBLIC HEALTH BAG
- an essential & indispensable equipment for the public health nurse which he/she has to carry
along during her/ his home visits.
- It contains basic medications which are needed for giving care.

BAG TECHNIQUE
a tool by which the nurse during her home visit will enable her to perform a nursing procedure
with ease and deftness, to save time and effort, with the end view of rendering effective
nursing care to clients.

PURPOSE
To describe the procedure for maintaining a clean nursing bag and preventing cross-
contamination.

Principles of Bag Technique

1. Performing the bag technique will minimize, if not prevent the spread of any infection.
2. It saves time and effort in the performance of nursing procedure.
3. The bag technique should show the effectiveness of total care given to an individual or
family.
4. The bag technique can be performed in a variety of ways depending on the agency’s
policy, the home situation or as long as principles of avoiding transfer of infection is
always observed.
Important points
1. The bag should contain all the necessary articles, supplies and equipments that will be
used to answer emergency needs.
2. The bag and its contents should be cleaned very often, the supplies replaced and ready
for use anytime.
 3. The bag and its contents should be well protected from contact with any article in the
patient’s home. Consider the bag and its contents clean and sterile while articles that
belong to the patients as dirty and contaminated.
4. The arrangement of the contents of the bag should be the one most convenient to the
user, to facilitate efficiency and avoid confusion
5. Hand hygiene is done as frequently as the situation calls for, helps in minimizing or
avoiding contamination of the bag and its contents.
6. The bag when used for a communicable case should be thoroughly cleaned and
disinfected before keeping and re-using.

NOTE: Follow RD tool