Family Support Assessment

Case management is useful in a variety of settings. You will be using the nursing process to conduct an in-home assessment in Sentinel City® to develop a plan of care for a family. The process of collecting, analyzing, and synthesizing data from a variety of sources can help the nurse to gain an understanding of family strengths, values, and needs related to physical and social determinants of health to promote the health and well-being of the family unit.

Complete the Family Support & Home Assessment virtual simulation activity which can be found by clicking Enter Virtual Simulation.

Once you enter Sentinel Hospital

Click BEGIN
You’ll enter the lobby and be led to the hospital map
Clicking SKIP will take you directly to map
Select Location: Family Services Or SIMPath Competencies: Collaboration for Improving Outcomes

Once you are in the room, the Family Support Assessment Form will be available. Complete the Family Support Assessment Form by asking the client predetermined questions. When the form is completed, click Submit. Develop a Family Support Care Plan to address the needs of this family using your institutions’ care plan template or use this care plan template.

Include a properly formatted community health nursing diagnosis that addresses either preschool age children, single mothers, or pregnant women.
Increased risk of (disability, disease, etc.) among (community or population) related to (disability, disease, etc.) as demonstrated in or by (health status indicator, or etiological/causal statement).
- Example: Increased risk of obesity among school-age children related to lack of safe outdoor play areas for children as demonstrated by elevated BMI rates.

Reading and Resources

Chapter 16 pages 297-316, Chapter 23 pages 395-404, Chapter 20 pages 367-375, Chapter 26 pages 439-447 in Fundamentals of Case Management Practice.

Review clinical guidelines of the AHRQ

Clinical Guidelines and Recommendations

Evidence-based research provides the basis for sound clinical practice guidelines and recommendations. The datab…

Additional Instructions:

All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.

Submission Options:

Choose One:

Instructions:

Paper

4 to 6-page paper. Include title and reference pages.

Collaboration for Improving Outcomes – Family Support Assessment

Description: Identify the determinants of health and illness of individuals and families using

multiple sources of data.

Course Competencies: 2) Develop a holistic case management plan for a specified disease or

population that incorporates the role of insurance, health care finance, and utilization of

community resources. 4) Coordinate the care of individuals across the lifespan utilizing

principles and knowledge of interdisciplinary models of care delivery and case management.

QSEN Competencies: 1) Patient-Centered Care 2) Teamwork and Collaboration 3) Evidence-

Based Practice 5) Safety

BSN Essential VII

Area Gold

Mastery

Silver

Proficient

Bronze

Acceptable

Acceptable

Mastery not

Demonstrated

Data Includes detailed

objective and

subjective data

Lists objective

and subjective

data

Identifies only

subjective or

objective data

Does not

address section

Nursing Diagnosis Develops a

nursing

diagnosis (using

NANDA) for an

individual in the

family unit

Outlines a

nursing

diagnosis (using

NANDA) for an

individual in the

family unit but

some elements

are missing

Defines a

nursing

diagnosis for an

individual in the

family unit but is

not appropriate

for family

member

Does not

address section

Community

Health Nursing

Diagnosis

Develops a

properly

formatted

community

health nursing

diagnosis

Outlines a

community

health nursing

diagnosis but

some elements

are missing

Defines a

community

health nursing

diagnosis that is

not appropriate

Does not

address section

Plan of Care Designs a plan

of care that is

relevant to

identified

problems, issues,

or concerns

Prepares a plan

of care that

addresses some

of the problems,

issues, or

concerns.

Infers a plan of

care that is not

relevant to

identified

problems, issues,

or concerns.

Does not

address section

SMART Goal

Statements

Develops 3 clear

SMART goal

statements

(Specific,

Measurable,

Achievable,

Relevant, Time-

Bound [realistic

deadlines to

Develops 2 clear

SMART goal

statements

(Specific,

Measurable,

Achievable,

Relevant, Time-

Bound [realistic

deadlines to

Develops 1 clear

SMART goal

statement and/or

elements of the

goal statement

are missing or

not clear

Does not

address section
meet

goals/outcomes])

meet

goals/outcomes])

Evidence-based

Rationale

Illustrates

evidence-based

rationale to

support nursing

actions that

address

identified

problem, issues,

or concerns

Lists evidence-

based rationale

with minimal

explanation for

support of

nursing actions

r/t problem,

issues, or

concerns

Mentions

evidence-based

rationale with no

support for

nursing actions

addressing

problem, issues,

or concerns

Does not

address section

Evaluation Plan Designs an

evaluation plan

addressing each

goal statement

Provides an

evaluation plan

addressing some

of the goal

statements

Names an

evaluation plan

that doesn’t

address each

goal statement

Does not

address section

APA, Grammar,

Spelling, and

Punctuation

No errors in

APA, Spelling,

and Punctuation.

One to three

errors in APA,

Spelling, and

Punctuation.

Four to six

errors in APA,

Spelling, and

Punctuation.

Seven or more

errors in APA,

Spelling, and

Punctuation.

References Provides two or

more references.

Provides two

references.

Provides one

references.

Provides no

references.

Visit NRSNG.com/CriticalThinking for additional help with Care Plans and Critical Thinking

Nursing Diagnosis

Patient Goals Intervention: Rationale Implementation

(Yes or No)

Evaluation

Outcome

Visit NRSNG.com/CriticalThinking for additional help with Care Plans and Critical Thinking

EXAMPLE:

Nursing Diagnosis

Patient Goals Intervention:

Rationale

Implementation

(Yes or No)

Evaluation

Outcome

Diagnosis:

High risk for falls related

to confusion as

evidenced by

disorientation to place,

time, situation, unsteady

gait, generalized

weakness

Subjective Data:

Patient asking, “who are

you again?”

Multiple family stated,

“he doesn’t seem right”

Patient stated, “I feel

weak when I get up”

Objective Data: History of dementia

Set off bed alarm

continually during night

Requires walker for

ambulation

Patient will remain free

from injury during this

admission.

Patient will remain free

from falls during this

admission.

Patient will wear non-

skid socks when out of

bed: to provide stability

during ambulation

Patient’s bed alarm will

be on at all times: to

alert staff if patient is

attempting to get out of

bed independently

Patient will be relocated

to a room closer to the

RN station: to enable

staff to visualize patient

on a more frequent

basis

Nurse will increase

frequency of rounding:

to assess needs more

frequently, toilet more

often, reorient.

Yes

Yes

No

Yes

Patient utilized non-skid socks during all periods of ambulation, did need to be

continually reminded, as he does not like socks, per his report. Will continue to promote. Patient’s bed alarm was on consistently throughout shift and patient did set alarm off approximately 4-6 times. Will continue to have bed alarm on. Another confused patient

occupied the room closest to RN station; will move if room becomes available. Patient rounded on q 30 min or q 1 hour. Noted that patient became agitated when he had to use the bathroom during first rounding, therefore offered toileting with each visit and noted decrease in agitation. Will continue to round

frequently. Patient remained injury and fall free during this shift. Goals progressing.
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