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FAMILY HEALTH NURSING PROCESS

FAMILY

• Basic unit in society, and is shaped by all forces surround it.

• Values, beliefs, and customs of society influence the role and function of the family (invades every aspect of the life of the family)

TYPES OF FAMILY IN THE COMMUNITY

a. Nuclear Family- consists of father, mother and children (either adopted or biological)

b. Extended- consists of father, mother, and children with other relatives

c. Single-Parent - single with children

d. Binuclear/Blended/Reconsituted extended- family consisting of 2 or more separate household from separated or divorced parents with children

e. Step Family- remarriage of a widowed person with children

f. Compound- one man/woman with several spouses

g. Cohabiting family- lived-in unmarried couple

h. Dyad- husband and wife without children

i. Homosexual family- female-female or male/male,

gay/lesbian with or without children

j. Communal family- e.g. bahay-ampunan, Home for the aged, Kumbento

k. No-Kin- have no legal or blood tie to each other

FAMILY TYPE BASED ON WHO MAKE DECISIONS (AUTHORITY)

• PATRIARCHAL - full authority on the father or any male member of the family e.g. eldest son, grandfather

• MATRIARCHAL - full authority of the mother or any female member of the family, e.g. eldest sister, grandmother

• EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides

• DEMOCRATIC - everybody is involved in decision

making

• AUTHOCRATIC-

• LAISSEZ-FAIRE- "full autonomy"

• MATRICENTRIC- the mother decides/takes charge

in absence of the father (e.g. father is working overseas)

• PATRICENTIC- the father decides/takes charge in absence of the mother

FAMILY TYPES BASED ON DECENT

• cultural norms, which affiliate a person with a particular group of kinsman for certain social purposes

• PATRILINEAL - Affiliates a person with a group of relatives who are related to him though his father

• BILATERAL- both parents

• MATRILINEAL - related through mother

FAMILY TYPE BASED ON RESIDENCE

• PATRILOCAL - family resides / stays with / near domicile of the parents of the husband

• MATRILOCAL - live near the domicile of the parents of the wife

THE FAMILY AS A UNIT OF CARE

• Rationale for Considering the Family as a Unit of Care:

• The family is considered the natural and fundamental unit of society

• The family as a group generates, prevents, tolerates and corrects health problems within its membership

• The health problems of the family members are interlocking

• The family is the most frequent focus of health decisions and action in personal care

• The family is an effective and available channel for much of the effort of the health worker

12 BEHAVIORS INDICATING A WALL FAMILY

• Able to provide for physical emotional and spiritual needs of family members

• Able to be sensitive to the needs of the family members

• Able to communicate thought and feelings effectively

• Able to provide support, security and encouragement

• Able to initiate and maintain growth producing relationship

• Maintain and create constructive and responsible community relationships

5 FAMILY HEALTH TASKS (Maglaya, A., 2004)

• Recognizing interruptions of health development

• Making decisions about seeking health care/ to take action

• Dealing effectively health and non-health situations

• Providing care to all members of the family

• Maintaining a home environment conducive to health maintenance

FAMILY APGAR QUESTIONNA (SMILKESTEIN, 1978)

• It is a tool that qualitatively measures family functioning.

• It is a 10 to15-minute paper and pencil technique that elicits the patient's perception and level of satisfaction on the current state of her family member's relationships (Smilkstein, 1978)

• This is a 5-item questionnaire serves as a rapid screening instrument for family dysfunction.

APGAR:

A Adaptation The capability of the family to utilize and share inherent resources.

P Partnership Measures the satisfaction attained in solving problems by communication.

G Growth Refers to the freedom of change both physical and emotional growth.

A Affection

It is the intimacy and emotional interaction in the family.

R Resolve

The member's satisfaction with the commitment made by other members of the family.

When to use APGAR

• When the family will be directly involved in caring for the patient.

• When treating a new patient in order to get info to serve as general view of family function.

• When treating a patient whose family is in crisis

• When a patient's behavior makes you suspect a psychosocial problem possibly due to family dysfunction.

SCORING

Check one of the three choices:

Total Score:

• 7-10 = suggests a highly functional family

• 4-6 = moderately dysfunctional family

• 0-3 = severely dysfunctional family

FAMILY HEALTH NURSING PROCESS

• a systematic approach of solving an existing problem/meeting the needs of family

• R apport

• A ssessment

• P lanning

• I ntervention

• E valuation

I. RAPPORT

• Trust building

• Knowing your client

• Adjusting to the situation and environment

• RESPECT

II. ASSESSMENT

• first major phase of nursing process

• Involves a set of action by which the nurse measures the status of the family as a client. Its ability to maintain wellness, prevent, control or resolve problems in order to achieve health and wellness among its members

Data about present condition or status of the family are compared against the norms and standards of personal, social, and environmental health, system integrity and ability to resolve social problems.

• The norms and standards are derived from values, beliefs, principles, rules or expectations.

II. ASSESSMENT

Data Collection Methods: Select Appropriate Method

• Observation

• the family's health status can be inferred from the s/sx of problem areas

•a. communication and interaction patterns expected, used, and tolerated by family members

• b. role perception / task assumption by each member including decision making patterns

• c. conditions in the home and environment

Physical Examination

• significant data about the health status of individual members can be obtained through

direct examination through IPPA,

• Measurement of specific body parts and reviewing the body systems

• data gathered from P.E form substantive part of first level assessment which may indicate presence of health deficits (illness state)

Interview

• Productivity of interview process depends upon the use effective communication techniques to elicit needed response PROBLEMS ENCOUNTERED

Questionnaires / Interview

• mostly patronized & used in CHN

• see the ATTACHED DYCI Family Survey Form

Records Review) (e.g. laboratory or diagnostic tests)

• Gather information through reviewing existing records and reports pertinent to the client

• Individual clinical records of the family members, laboratory and diagnostic reports, immunization records report about home and environmental conditions

II. ASSESSMENT

Typology of Nursing Problems

FIRST LEVEL ASSESSMENT-

• to determine problems of family

• Sources of Problems using IDB

• Family: use of Initial Data Base (IDB)

• Nature: Health Deficit (HD), Health Threat (HT), Foreseeable Crisis (FC)

SECOND LEVEL ASSESSMENT-

defines the nature or type of nursing problem that family encounters in performing health task with respect to given health condition or problem and etiology or barriers to the family's assumption of the task

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

Family structure and Characteristics

Socio-economic and Cultural Factors

Home and Environmental Factors

Health Assessment of Each Member

Value Placed on Prevention of Disease

1. Family structure, Characteristics, and Dynamics

• Members of the household and relationship to the head of the family

• Demographic data - age, sex, civil status, position in the family

• Place of residence of each member - whether living with the family or elsewhere

• Type of family structure - e.g. matriarchal or patriarchal, nuclear or extended

• Dominant family members in terms of decision- making, especially in matters of health care

• General family relationship/dynamics - presence of any readily observable conflict between members; characteristics communication patterns among members

2. Socio-economic and Cultural Characteristics

• Income and Expenses

Occupation, place of work and income of each working members

Adequacy to meet basic necessities

Who makes decisions about money and how it is spent

• Educational attainment of each other

• Ethnic background and religious affiliation

• Significant Others - role(s) they play in family's life

• Relationship of the family to larger community - Nature and extent of participation of the family in community activities

3. Home and Environment

• Kind of neighborhood, e.g. congested, slum, etc.

• Social and health facilities available

• Communication and transportation facilities available

• Housing

Approved TYPE OF WATER FACILITIES

Level 1 (Point Source)

• a protected well or a developed spring with an outlet but without a distribution system

• indicated for rural areas where houses are scattered

• serves 15-25 households; its outreach is not more than 250 m from the farthest user

• yields 40-140 L/min

Level II (Communal Faucet or Stand Posts)

• With a source, reservoir, piped distribution network and communal faucets

• Located at not more than 25 m from the farthest house

• Delivers 40-80 L of water per capital per day to an average of 100 households

• Serves 4 to 6 households per faucet

• Fit for rural areas where houses are densely clustered

Level III (Individual House Connections or Waterworks System)

• With a source, reservoir, piped distributor network and household taps

• One or more faucets per household

• Fit for densely populated urban communities

TYPES OF MATERIALS USED FOR HOUSE

• Light - refers to such materials as bamboo, nipa,

sawali, coconut leaves or card board.

• Strong - refers to a predominantly concrete house. •

• Mixed - refers to a combination of light materials, wood and/or concrete. Typically concrete floor or foundation and light walls, or a concrete 1st floor and light 2nd floor.

LIGHTING FACILITIES

• artificial means of providing light/ illumination. Facilities used already reflect adequacy and safety for the family. (Ex. Electricity, kerosene, candles, or none.)

TYPES OF EXCRETA DISPOSAL

Level I

- Non-water carriage toilet facility - no water necessary to wash the waste into receiving space e.g. pit latrines, bored-hole latrine

-Toilet facilities requiring small amount of water to wash the waste into the receiving space e.g. pour flush toilet & aqua privies

TYPES OF EXCRETA DISPOSAL (Level 1)

• Pail System- a pail or box is used to receive the excreta and disposed later when filled. (Included ballot system where in excreta is wrapped in a piece of paper/plastic and thrown later.)

• Open Pit Privy/Latrine - consist of a pit covered by a platform with a hole is usually not covered. The platform may, in its simplest form consist only of 2 pieces of wood or bamboo.

• Closed Pit Privy/ Latrine- a pit privy in which the hole over the platform or toilet floor is provided with a cover

Types of pit include

• Ventilated Improved Pit or VIP, pit with a vent pipe

• Reed Odorless Earth Closet or ROEC, a pit completely displaced from the superstructure and connected to the squatting plate by a curved chute.

Reed Odorless Earth Closet or ROEC

. A variation of VIP latrine

Pit fully "off-set" from superstructure, and connected to squatting slab with a "curved chute"

Connected with vent pipe to control odor and insect nuisance

It is claimed that the chute, in conjunction with the ventilation stack, encourages vigorous air circulation down the latrine, thereby removing odors and discouraging flies. This type of latrine is common in Southern Africa.

• Antipolo Type- toilet house is elevated and the shallow pit is extended upwards to the platform (toilet floor) by means of a chute or pipe made of metal, clay aluminum or board.

• Bored-Hole Latrine- consists of a deep (usually more than 10 feet) but relatively narrow (less than 2 meters in diameter) hole made with boring equipment.

• Overhung Latrine- toilet house is constructed over a body of water (stream, fake, and river) into which excreta is allowed to fall freely.

Level II

• On site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal.

TYPES OF EXCRETA DISPOSAL (Level 2)

• Flush Type a toilet system where waste is disposed by flushing water through pipes (sewers) into a public sewerage system or into an individual disposal system like an individual septic tank

• Water Sealed Latrine- an Antipolo type of toilet, bored-hole latrine or any pit privy wherein water sealed toilet bowl is placed instead of the simple platform hole(+)septic tank.

• On site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal.

Level III

• Water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant

SEWERAGE SYSTEM

• Blind drainage - waste water flows through a system, of closed pipes to an underground pit or covered canal.

• Open drainage - waste water flows through a system of pipes (could be improvised from bamboo) to an open pit canal.

• None - when no drainage system or container used for garbage. Waste water from the kitchen flows directly to the ground, oftentimes forming a nearly permanent pool. Garbage is not put in a container when disposed.

TYPES OF WASTE DISPOSAL

• Hog feeding - garbage is used as hog feed and also to chicken and other livestock.

• Open Dumping- refuse and/or garbage piled in a dumping place (with or without pit) with no soil covering.

• Open Burning- regularly piles refused/garbage and later burned in open air. This is uncontrolled burning which is usually done for yard and street sweeping. It may be allowed in rural areas where it will not worsen already existing air pollution.

• Burial Pit - refuse/garbage placed in a pit and covered when filled up. There is no intention to dig it up later for use as fertilizer. This should be located 25 meters away from any well used for water supply.

• Composting- involved buying or stacking of alternating layers of organic based refuse/garbage and 'treated soil arranged as to hasted rapid decay and decomposition into compost. This organic mixture can later be used as fertilizer.

• Garbage collection- refuse/garbage collected by garbage truck or any type of garbage collection in the community

Health Status of each Family Member

• Medical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health illness

• Nutritional assessment

• Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio

• Dietary history specifying quality and quantity of food/nutrient intake per day

• Eating/feeding habits/ practices

• Developmental assessments of infants, toddlers, and preschoolers

• Risk factor assessment indicating presence of major and

contributing modifiable risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse

• Physical assessment

indicating presence of illness state/s

• Results of laboratory/diagnostic and other screening procedures supportive of assessment findings

Values, Habits, Practices on He Promotion, Maintenance and Disease Prevention

• Immunization status of family members

• Healthy lifestyle practices. Specify

• Adequacy of:

• rest and sleep

• exercise

use of protective measures- e.g. adequate footwear in parasite-infested areas;

• relaxation and other stress management activities

• Use of Promotive-preventive health services

FIRST LEVEL ASSESSMENT

• Categorize if

• Presence of Wellness Condition

• Presence of Health Threat

• Presence of Health Deficits

• Presence of Stress Points/Foreseeable Crisis

1. Presence of Wellness Condition

• stated as Potential or Readiness

• nursing judgment about a client in transition from a specific level of wellness or capability to a higher level.

• Wellness potential is a nursing judgment on wellness state or condition based on client's performance, current competencies or clinical data but no explicit expression of client desire.

• Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client's current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function

Potential for Enhanced Capability for:

Healthy lifestyle-eg. nutrition/diet, exercise/activity

Health Maintenance

Parenting-

Breastfeeding

Spiritual Well-being-process of a client's unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001)

Others,

Readiness for Enhanced Capability for:

Healthy Lifestyle

Health Maintenance

Parenting

Breastfeeding

Spiritual Well-being

2. Presence of Health Threats

• conditions that are conducive to disease, accident or failure to realize one's health potential.

• Family is healthy but there are risks:

• H-azards

• 1-nadequate/Lack of Immunization

• C-ross infection

• E-nvironmental sanitation is poor

Presence of Health Threats:

• Family history of hereditary.condition, eg diabetes

• Threat of cross infection from a communicable disease case

• Family size beyond what family resources can adequately provide

• Accidental hazards

• Broken stairs

• Sharp objects, poison, and medicines improperly kept

• Fire hazards

• Faulty nutritional habits or feeding practices.

• Inadequate food intake both in quality & quantity

• Excessive intake of certain nutrients

• Faulty eating habits

• Ineffective breastfeeding

• Faulty feeding practices

• Stress-provoking factors-

• Strained marital relationship

• Strained parent-sibling relationship

• Interpersonal conflicts between family members

• Care-giving burden

• Poor home condition

• Inadequate living space

• Lack of food storage facilities

• Polluted water supply

• Presence of breeding sites of vectors of disease

• Improper garbage

• Unsanitary waste disposal

• Improper drainage system

• Poor ventilation

• Noise pollation

• Air pollution

3. Presence of Health Deficits

• instances of failure in health maintenance.

• if identified problem is an abnormality, illness or disease, there's a gap/difference between normal status (ideal, desirable, expected) & actual status (the outcome/result/problem encountered on that actual day)

• illness states, regardless of whether it is diagnosed or by medical practitioner

• Failure to thrive/develop according to normal rate

• Disability - whether congenital or arising from illness; temporary

— D:

Disease

Disorder

Disability

Developmental problems

4. Presence of Stress Points/Foreseeable Crisis

• anticipated periods of unusual demand of the individual or family in terms of family resources.

• anything which is anticipated/ expected to become a problem

• S-chool entance

• P - regnancy

• A - dolescents

• D - eath

• C - ourtships and Marriage

• A - ddiction

• C-ircumcission

• I-Illegitimacy

Presence of Stress Points/Foreseeable Crisis

• Marriage

• Menopause

• Pregnancy

• Loss of job

• Parenthood

• Hospitalization of a family member

• Additional member

• Abortion

• Death of a manner

• Entrance at school in a new community

• Resettlement

• Adolescence

• Divorce

• Illegitimacy

SECOND LEVEL ASSESSMENT

• Inability to recognize the presence of the condition or problem due to:

• Lack of or inadequate knowledge

• Denial about its existence or severity as a result of fear of consequences of • • • • diagnosis of problem, specifically:

• Social-stigma, loss of respect of peer/significant others

• Economic/cost implications

• Physical