# Situation: The public health nurse of a Rural Health Unit (RHU) makes home visits to registered families in a coastal barangay. A healthy family asked for help with meal planning. The objective set with them was: "Within 6 weeks, the mother will serve meals with all three food groups every day." The nurse's home visit record shows: Week 0: food groups taught; the mother planned a 3-day menu with the nurse's help Week 3: menu log shows all three food groups on 5 of 7 days; she asked for low-cost protein ideas Week 6: menu log shows all three food groups on 7 of 7 days; she planned next week's menu alone At the week-6 visit, the father, 45, asks the nurse why his blood pressure was 150/95 mmHg when it was checked at a pharmacy last week. He has no symptoms and takes no medicines. Which action BEST follows the principles of family nursing care?

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> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse of a Rural Health Unit (RHU) makes home visits to registered families in a coastal barangay.

A healthy family asked for help with meal planning. The objective set with them was: "Within 6 weeks, the mother will serve meals with all three food groups every day." The nurse's home visit record shows:
Week 0: food groups taught; the mother planned a 3-day menu with the nurse's help
Week 3: menu log shows all three food groups on 5 of 7 days; she asked for low-cost protein ideas
Week 6: menu log shows all three food groups on 7 of 7 days; she planned next week's menu alone
At the week-6 visit, the father, 45, asks the nurse why his blood pressure was 150/95 mmHg when it was checked at a pharmacy last week. He has no symptoms and takes no medicines. Which action BEST follows the principles of family nursing care?

## 보기

1. Continue the meal-planning visits until the father's worry is settled
2. Close the meal objective and set a new one with them on his concern **✔ 정답**
3. End the visits, as the meal objective is met and she plans on her own
4. Refer the father to the RHU physician and end the family's home visits

**정답: 2**

## 해설

Two rules apply at once. First, an objective is evaluated against its criterion and closed when met: by week 6 the mother served all three food groups daily and planned menus without help. Second, the family remains the client, and care ends only when the family has no remaining need it cannot manage; the father's single high reading is a new health concern that the family has raised. The nurse therefore closes the meal objective and, with the family, sets a new objective for the father's blood pressure (starting with confirming it by repeat measurement), rather than ending care or stretching the old objective.

## 심화 해설

Step 1 — Evaluate the original objective against its criterion

The meal-planning objective was written with a clear, measurable criterion: “the mother will serve meals with all three food groups every day.” At week 3, the log showed only 5 of 7 days meeting the standard, so the objective was not yet met. By week 6, the log showed 7 of 7 days with all three food groups, and the mother planned the next week’s menu independently. The criterion is satisfied, and the objective should be closed rather than extended. Continuing the meal-planning visits would keep the family in a dependent role after they have demonstrated self-management, which is not consistent with family nursing care.

Step 2 — Recognize that the family, not the meal objective, remains the client

In family nursing care, the unit of service is the family system. A completed objective does not automatically mean the end of the nurse–family relationship. The father’s report of a pharmacy reading of 150/95 mmHg is a new health concern raised by the family during the visit. According to the 2024 ESC guideline, a reading of ≥140/90 mmHg falls into the hypertension category, for which prompt confirmation and further evaluation are recommended [1]. A single elevated reading at a pharmacy does not establish a diagnosis, but it is a signal that cannot be ignored.

Step 3 — Distinguish between closing an objective and ending care

The nurse must separate two decisions that are easy to confuse. The first decision is whether the meal objective is met — it is, so it is closed. The second decision is whether the family still has a health need requiring nursing follow-up — it does, because the father’s elevated blood pressure has not been assessed, confirmed, or managed. Key point! Ending home visits solely because one objective was achieved would abandon a newly identified family health concern. Referring the father to the RHU physician is a possible component of care, but referral alone does not address the family’s need for continued nursing support, education, and follow-up coordination.

Step 4 — Apply the principle of collaborative goal setting

The correct action is to close the meal objective and, together with the family, set a new objective centered on the father’s blood pressure. The first step in that new objective is confirming the elevated reading through repeat measurement, because a single pharmacy value is not sufficient for a diagnosis. The 2024 ESC guideline emphasizes that hypertension requires confirmation before treatment decisions are made [1]. The 2025 AHA/ACC guideline similarly frames blood pressure management as a process of detection, evaluation, and ongoing management rather than a one-time event . The nurse can facilitate repeat measurement, assess cardiovascular risk factors, and coordinate with the RHU physician if the elevation is confirmed.

Step 5 — Compare the options using family nursing principles

| Option | Problem with the approach |
| --- | --- |
| 1 Continue meal-planning visits | Keeps the family dependent after the objective is met; delays addressing the new concern |
| 2 Close meal objective and set a new one | Correct — respects the completed criterion while keeping the family as the ongoing client |
| 3 End the visits | Ignores the father’s newly raised health need; premature termination of care |
| 4 Refer and end visits | Fragments care; referral is appropriate but does not replace nursing follow-up and family support |

Step 6 — Link the decision to blood pressure classification

The father’s reading of 150/95 mmHg places him in the hypertension range under the 2024 ESC classification, where the threshold is ≥140/90 mmHg [1]. This does not mean he needs immediate medication; it means the reading must be confirmed and the family needs a plan. The nurse’s role is to help the family understand what the number means, arrange repeat measurement under proper conditions, and support them in navigating the next steps. This is a classic application of the nursing process: assessment (repeat BP), diagnosis (confirm elevated BP or hypertension), planning (set a new objective with the family), implementation (education, referral coordination), and evaluation (follow-up readings and family response). The meal objective is closed because its criterion is met, but the family remains the client because a new need has emerged.References (research sources)

- [1]What Is New and Different in the 2024 European Society of Cardiology Guidelines for the Management of Elevated Blood Pressure and Hypertension?GuidelineMcCarthy CP, Bruno RM, Rahimi K, Touyz RM, McEvoy JW (2025) · DOI: 10.1161/HYPERTENSIONAHA.124.24173

## 임상 시나리오

Family Nursing: Closing Objectives and Addressing New ConcernsEvaluating the meal objective and responding to an elevated BP reading
Evaluate the objective against its measurable criterion. By week 6, the mother served all three food groups on 7 of 7 days and planned the menu independently, so the meal objective is met and should be closed.

The family remains the client even after an objective is closed. The father's pharmacy reading of 150/95 mmHg is a new health concern that requires attention, not dismissal.

The correct action is to close the meal objective and set a new objective with the family for the father's blood pressure, beginning with repeat measurement to confirm the elevated reading.

CautionA single elevated pharmacy reading does not establish a hypertension diagnosis, but a value of ≥140/90 mmHg requires prompt confirmation and further evaluation. Do not end care or refer without first engaging the family in a new plan.

## 핵심 개념

- **Family as client** — The family system is the unit of care; a completed objective does not end the nurse-family relationship if new needs arise.
- **Objective criterion** — A measurable standard used to evaluate whether a family nursing objective has been met and can be closed.
- **Hypertension category** — A blood pressure reading of ≥140/90 mmHg, which requires confirmation and further evaluation per guidelines.
- **Self-management** — The family's demonstrated ability to plan and carry out care independently, signaling readiness to close an objective.

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