CHN LEC - PRELIM COVERAGE.docx

**CHN** **PRELIMS COVERAGE** FAMILY HEALTH NURSING PROCESS Concept of Family as a Basic Unit of Society A. B. C. D. E. Levels of Prevention in Family Health Family Nursing Care Process A. B. C. D. E. Nurse-Family Contacts **CHAPTER 1** **FAMILY HEALTH NURSING PROCESS** **[Inte...

**CHN** **PRELIMS COVERAGE** FAMILY HEALTH NURSING PROCESS Concept of Family as a Basic Unit of Society A. B. C. D. E. Levels of Prevention in Family Health Family Nursing Care Process A. B. C. D. E. Nurse-Family Contacts **CHAPTER 1** **FAMILY HEALTH NURSING PROCESS** **[Intended Learning Outcomes:]** After studying this chapter, the student is expected to: 1\. Describe the tools used for family assessment. 2\. Differentiate areas of family coping index. 3\. Identify the family health tasks. 4\. Categorize family nursing problem utilizing various family assessment tools. 5\. Develop family nursing care plan based on steps given. 6\. Differentiate various methods of family nurse contacts. 7\. Apply essential principles in home visit and bag technique. 8\. Utilize public health nurse tools in providing family nursing care. 9\. Evaluate nursing care given to family 10\. Create a family health tree from their three-generation family. **KEY TERMS:** bag technique\ blended family\ cohabitation\ compound family\ dyad\ ecomap\ extended family\ evaluation\ family\ family coping index\ family health assessment\ family health tree\ family-nurse contacts\ family nursing care\ genogram\ home visit\ interview\ nuclear **LESSON 1: CONCEPT OF FAMILY AS A BASIC UNIT OF SOCIETY** A. **FAMILY** -U.S census Bureau: a group of people related by blood, marriage, or adoption living together -Allender and Spradley (2004): two or more people who live in the same household (usually) share a common emotional bond, and perform certain interrelated social tasks -primary institution in society that preserves and transmits culture -MAGLAYA: a very important social institution that performs 2 major functions- reproduction and socialization -performs health promoting, health maintaining, and disease preventing activities -family is the locus of decision making on health matters. -it is the source of the most solid support and care to its members, particularly to the young, the elderly, the disabled, and the chronically ill. -FRIEDMAN: two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family \- PHC -family is the basic social institution and the primary group in society -a social group characterized by common residence, economic cooperation and reproduction B. **2 BASIC FAMILY TYPES:** 1. 2\. FAMILY OF PROCREATION -a family one establishes; or oneself, spouse or significant other, and children - - - - - - -*[roles of nurses:]* offer emotional support to members of a remarriage family until the adjustments for mutual living have been made - - -individuals of the same sex live together as partners of companionship, financial security, and sexual fulfilments -offers support in times of crisis comparable to that offered by nuclear or cohabitation family -include children from previous heterosexual marriages through the use of artificial insemination, adoption or surrogate motherhood - -children whose parents can no longer care for them may be placed in a foster or substitute home by a child protection agency -foster parents may or may not have children of their own -they receive remuneration for their care and concern for the foster child -foster home placement is temporary until children can be returned to their own parents -if not possible, children may be raised to adulthood in foster care -when caring for children from foster homes, it is important to determine who has legal responsibility to determine who has legal responsibility to sign for health care (a foster parent may or may not have this responsibility) - -*[methods of adoption:]* 1\. agency adoption -a couple contacts an agency by first attending an informational meeting -if they decide to apply to the agency, they are then put on a waiting list for processing -the process includes extensive interviewing and a home visit by an agency social worker to determine whether the couple can be relied on to provide a safe and nurturing environment for an adopted child. -once approved, the couple is placed on a second waiting list -when a child has been located for them. The agency notifies the parent C. **FAMILY STAGES** 1. - 2. - 3. - 4. - 5. - 6. - 7. - -Closing family house D. *Family Structures and Functions* **FAMILY STRUCTURES** BASED ON INTERNAL ORGANIZATION AND MEMBERSHIP 1. 2. BASED ON PLACE OF RESIDENCE 1. 2. 3. 4. 5. BASED ON DESCENT 1. 2. 3. BASED ON AUTHORITY 1. 2. 3. 4. E. 1. 2. 3. 4. 5. 6. - 1. 2. 3. 4. 5. 6. 7. 8. F. **CHARACTERISTICS OF FAMILY:** 1. 2. 3. 4. 5. 6. 7. 8.  ***[EXERCISE 1.1:]*** *Describe your family according to type, stage, and the different structures. You may also write something for your family. You may include a picture of your family.* **LESSON 2: LEVELS OF PREVENTION IN FAMILY HEALTH** **Primary Prevention** Providing specific protection against disease to prevent its occurrence is the most desirable form of prevention. Primary preventive efforts spare the client the cost, discomfort and the threat to the quality of life that illness poses or at least delay the onset of illness. Preventive measures consist of counseling, education and adoption of specific health practices or changes in lifestyle. Examples: a. b. c. **Secondary Prevention** It consists of organized, direct screening efforts or education of the public to promote early case finding of an individual with disease so that prompt intervention can be instituted to halt pathologic processes and limit disability. Early diagnosis of a health problem can decrease the catastrophic effects that might otherwise result for the individual and the family from advanced illness and its many complications. Examples: a. b. **Tertiary Prevention** It begins early in the period of recovery from illness and consists of such activities as consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility and passive and active exercise to prevent disability. Continuing health supervision during rehabilitation to restore an individual to an optimal level of functioning. Minimizing residual disability and helping the client learn to live productively with limitations are the goals of tertiary prevention. *(Pender, 1987)* Examples: a. b. c. **LESSON 3: THE FAMILY HEALTH NURSING PROCESS** **FAMILY HEALTH NURSING** - **3. A. Conducting Family Health Assessment** ============================================== Assessment of the family helps nurses identify the health status of individual members of the family and aspects of family composition, function and process. The nurse as much information about a familyas is possible and practical. The process of family health assessment does not stop and requires objectivity and professional judgment to attach practical meaning to the information being acquired. The nurse may use a tool called Family Health Assessment Form (Appendix A). or the initial database to be a guide in data collection. Over time and depending on the guidelines of the agency, the tool can be modified or updated. [STEPS IN FAMILY NURSING ASSESSMENT]{.smallcaps} ================================================ Data Collection =============== - **Gathering of five types of data which will generate the categories of health conditions or problems of the family.** ====================================================================================================================== Data Analysis ============= - Sort data --------- - Cluster/group related date -------------------------- - Distinguish relevant from irrelevant data ----------------------------------------- - Identify patterns ----------------- - Compare patterns with norms or standards ---------------------------------------- - Interpret results ----------------- - Make inferences/draw conclusions -------------------------------- **Formulation of Nursing Diagnoses** ------------------------------------ - Identification of Family Nursing Problems. ------------------------------------------ **INITIAL DATA BASE FOR FAMILY NURSING PRACTICE** A. 1. 2. 3. 4. 5. 6. B. 1. a. b. c. 2. 3. 4. 5. C. 1. a. b. c. d. e. f. g. h. i. 2. 3. 4. D. 1. 2. j. - - k. l. 3. 4. 5. 6. E. 1. 2. 3. a. b. c. d. 4. **METHODS OF DATA GATHERING** Observation ----------- - Method of data collection through the use of sensory capacities (sight, hearing, smell and touch). -------------------------------------------------------------------------------------------------- - Data gathered through this method have the advantage of being subjected to validation and reliability testing by other observers. --------------------------------------------------------------------------------------------------------------------------------- 2. - Interview --------- - Completing the health history of each family member. The health history determines current health status based on significant past health history. -------------------------------------------------------------------------------------------------------------------------------------------------- - The second type of interview is collecting data by personally asking significant family members or relatives questions regarding health, family life experiences and home environment to generate data on what wellness condition and health problems exist in the family. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - Productivity of the interview process depends upon the use of effective communication techniques to elicit the needed responses. -------------------------------------------------------------------------------------------------------------------------------- Record Review ------------- - Reviewing existing records and reports pertinent to the client. (individual clinical records of the family members; laboratory & diagnostic reports; immunization records; reports about the home & environmental conditions). ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Laboratory/Diagnostic Tests --------------------------- - performing laboratory tests, diagnostic procedures or other tests of integrity and functions carried out by the nurse herself and/or other health workers. ---------------------------------------------------------------------------------------------------------------------------------------------------------- **TOOLS USED IN FAMILY ASSESSMENT** GENOGRAM -------- - A [[genogram]](http://www.ohiocla.com/Year%205%20Revisions/genogram1.htm#Page%20Start) is a pictorial, multi-generational representation of familial relationships and patterns of behavior. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ##### Purpose: - ECOMAP - Purpose: - FAMILY HEALTH TREE - Purpose: - ***[EXERCISES 1.2:]*** *1. Complete a personal genogram What are the high-risk factors in your family history? What are the current risk factors? Categorize current risk factors as physical, interpersonal, and environmental.* *2. Create a family health tree of your own. Make it creative.* 4. **FIRST LEVEL ASSESSMENT** I. *Wellness potential* - *Readiness for enhanced wellness state* - Examples A. 1. 2. 3. 4. 5. 6. B. 7. 8. 9. 10. 11. 12. II. A. B. C. D. 1. 2. 3. 4. 5. E. 6. 7. 8. 9. 10. F. 11. 12. 13. 14. G. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. H. I. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. J. K. L. M. N. 37. 38. 39. O. III. P. Q. R. IV. S. T. U. V. W. X. Y. Z. A. B. C. D. E. F. G. **SECOND LEVEL ASSESSMENT** I. A. B. 40. 41. 42. 43. C. D. II. E. F. G. H. I. J. K. L. 1. 2. 3. 4. M. N. 5. 6. O. P. Q. III. R. S. T. U. V. W. 7. 8. 9. X. Y. Z. A. B. 1. 2. 3. 4. 5. 6. C. IV. D. 10. 11. E. F. G. H. I. J. K. L. M. V. N. O. P. Q. R. 12. 13. 14. S. T. 15. 16. U. 17. 18. V. W. X. **STATEMENT OF FAMILY NURSING PROBLEM** TWO PARTS: - - Example - **3. C. Family Nursing Care Plan** THE FAMILY CARE PLAN - DESIRABLE QUALITIES OF A NURSING CARE PLAN 1. 2. 3. 4. **THE IMPORTANCE OF PLANNING CARE** 1. 2. 3. 4. 5. **STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN** 1. a. - b. - c. - d. - **Scoring** -- this process will help the nurse in determining which among the family problems or needs be prioritized 1. 2. 0. 3. 4. -------------------------------------------------------- ----------- ------------ **CRITERIA** **SCALE** **WEIGHT** **Nature of the problems Presented** Health deficit / Wellness **3** **1** Health threat **2** Foreseeable crisis **1** **Modifiability of the problem** Easily modifiable **2** **2** Partially modifiable **1** Not modifiable **0** **Preventive potential** High **3** **1** Moderate **2** Low **1** **Salience** A condition / problem needing Immediate attention **2** **1** A condition / problem not needing Immediate attention **1** Not perceived as a problem or condition needing change **0** -------------------------------------------------------- ----------- ------------ **Factors affecting priority setting:** The nurse considers the availability of the following factors in determining the modifiability of a health condition or problem. 1. 2. 3. 4. **Factors in Deciding Appropriate Score for Preventive Potential** 1. 2. 3. 4. **Family Nursing Care Plan** - **Characteristics of Family Nursing Care Plan** 1. 2. 3. 4. 5. 6. **Desirable Qualities of Family Nursing Care Plan** 1. 2. 3. 4. 5. **Setting/ Formulating Goals & Objectives** 0. 1. 2. 1. 2. 3. 4. **Goal** 0. **Cardinal Principle in goal-setting** 1. 2. **Barriers to Joint Goal Setting** 1. Sometimes the family perceives the existence of the problem but does not see it as serious enough to warrant attention **Characteristics of Goals/ Objectives** 1. 2. 3. 4. 5. **Objective** - - **Types of Objective** 1. 0. 1. 2. - 3. - **Plan of Actions/ Interventions** - **It is highly dependent on 2 Major Variables:** 1. 2. **Typology of Interventions** 1. 2. 3. **3. D. Implementation** - - - Barriers to Implementation A. B. **3. E. Evaluation** - - - **According to Alfaro-LeFevre:** - - - - - - - 1. - 2. - - 3. 4. 5. - - 6. **Dimensions of Evaluation** 1. 2. 3. 4. **Tools Being used during Evaluation** Instruments are tools are being used to evaluate the outcome of the nursing interventions: - - - - - - - - **Methods of Evaluation** 1. 2. 3. 4. The goals and objectives of nursing care. **EXPECTED OUTCOMES** - - - - - Cardinal Principle in goal-setting: - Barriers to nurse - patient joint goal setting: - - - - - Reasons: - - - - **[OBJECTIVES]{.smallcaps}** - - [C]{.smallcaps}ategories of Objectives: - - - 1. - - - - - - - 2. - - **Categories of health care strategies and intervention\ **1. Preventive\ 2. Curative\ 3. Rehabilitative\ 4. Facilitative\ 5. Facilitation\ 6. Direct **FAMILY-NURSE CONTACTS** *CLINIC VISIT* Pre-Consultation Conference 1\. Take clinical history after greeting and making client at ease. 2\. Take temperature, blood pressure, height and weight. 3\. Perform a thorough physical assessment. 4\. Do selective laboratory examinations such as urinalysis for sugar and albumin as necessary, sputum exam, stool examination for parasites, vaginal smear for SID screening after taking the necessary training. 5\. Write findings on client\'s record. Medical Examination 1\. Assist client before, during and after examination by physician. 2\. Inform physician of relevant findings gathered in pre-conference. 3\. Work with the physician during the examination. 4\. Ensure privacy, safety and comfort of patient throughout procedure. 5\. Observe confidentiality of examination results. Nursing Intervention 1\. Carry out physician\'s orders as giving medication or injection. 2\. Explain and reinforce physician\'s orders and advises. 3\. Teach patient/client measures designed to promote and maintain health as proper diet, exercise and personal hygiene. 4\. Seek information regarding health status of other family members. Example: immunization status of children, health and problems of elderly if any, health of husband. 3. Counseling Post Consultation Conference 1\. Explain findings and needed care or intervention. 2\. Refer patient/client to other health of related staff/agency if necessary. 3\. Make appointment for next clinic/home visit. 4\. Referral as needed. New: Standard procedures performed during clinic visits 1. 2. 3. a. manage program-based cases b. refer all non-program based cases to the physician c. provide 1^st^ aid treatment to emergency cases 4. 5. 6. 7. 8. *Blood Pressure Measurement* 1. 2. 3. 4. **Home Visit** - **Principles in Preparing for Home Visit** Planning for a home visit is an essential tool in achieving best results. 1\. A home visit should [have a purpose or objective]. 2\. Planning for a home visit should [make use of all available information] about the patient and his/her family [through family health records]; knowledge of the health center personnel, including those from other agencies that may have rendered services to this particular patient or family. 3\. Planning should revolve around the essential needs of the individual and his/her family but ***priority*** should be given to those ***[needs recognized by the family itself.]*** 4\. Planning of a [continuing care] should involve the individual and his/her family. 5\. Planning should be [flexible and practical]. **Factors to be Consider in Determining the Frequency of Home Visit** - - - - - - ------------------------------------------------------------------- --------------------------------- **Advantages** **Disadvantages** First hand assessment of the home situation\ Cost of time and effort\ Nurse is able to seek out previously unidentified needs\ Environmental distractions\ Opportunity to adapt interventions according to family resources\ Nurse's safety may be a concern Promotes family participation\ Focused on the family\ Easier family health education\ Increased sense of confidence to the family and to the agency ------------------------------------------------------------------- --------------------------------- **Phases of Home Visit** Home visit is consisting of three phases: pre-visit, in-home visit, and post-visit phases. A. - - - - Before leaving the health facility:\ - The nurse must ensure the completeness of materials or resources he/she needs.\ - The nurse must comply to safety protocols.\ - Buddy system and a spot map is suggested. B. - **Steps in Home Visit** 1\. **Greet** client or household member and introduce yourself. 2\. Explain **purpose** of home visit. 3\. Inquire about **health and welfare of client/patient and other family members**. Ask about any health and health-related problems. 4\. Place **bag** in a convenient place before doing **bag technique**. 5\. **Wash hands and wear apron** and put out needed articles and/or medicines, dressings from bag 6\. Perform physical assessment and nursing care needed. If more than one member of the family is for health supervision and care, ***[start with the well member to avoid transfer of infection]***. 7\. Give the necessary **health teaching** and advice based on client\'s patient\'s need and condition. 8\. **Wash hands** and **close bag**. 9\. **Record findings** and nursing care given. 10\. Make **appointment** either for a clinic or home visit. 11\. On succeeding home visit and when nurse has gained the family\'s **trust** and confidence, she/he may look into more detailed aspects of the household and surroundings and other health problems/concerns. **The Nursing Bag** - - - **Bag Technique** **Bag technique** - a tool making use of a public health bag through which the nurse, during his/her home visit, can [perform nursing procedures with ease and deftness], [saving time and effort] with the end in view of rendering effective nursing care. **Public health bag** - is an essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out home visiting. It contains basic medications and articles which arc necessary for giving care. Rationale: [To render effective nursing care to clients and/or members of the family during home visit]. *Principles in the use of bag technique* 1\. should **[minimize]** if not totally prevent the **[spread of infection]** from individuals to families, hence, to the community. 2\. should **[save time and effort]** on the part of the nurse in the performance of nursing procedures. 3\. should not overshadow concern for the patient rather **[should show the effectiveness of total care given]** to an individual or family. 4\. can be performed in a [variety of ways] depending upon agency policies, actual home situation, etc., as long as **[principles of avoiding transfer of infection is carried out]**. *Special Considerations in the Use of the Bag* 1\. [contain all necessary articles, supplies and equipment] used to [answer emergency needs]. 2\. be [cleaned] as often as possible, supplies replaced and ready for use at any time. 3\. well protected from contact with any article in the home of the patients. ***Consider the bag and its contents clean and/or sterile while any article belonging to the patient as dirty and contaminated**.* 4\. arrangement of the contents of the bag should be the one most [convenient to the user to facilitate efficiency and avoid confusion]. 5\. **Hand washing** is done as frequently as the situation calls for 6\. bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and re-using. *Contents of the bag* 1. Paper lining 2. Extra paper for making bag for waste materials (paper bag). 3. Plastic/linen lining 4. Apron 5. Hand towel in plastic bag 6. Soap in soap dish 7. Thermometers in case \[one oral and rectal\] 8. 2 pairs of scissors \[1 surgical and 1 bandage\] 9. 2 pairs of forceps \[curved and straight\] 10. Syringes \[5 ml and 2ml\] 11. Hypodermic needles g19,22,23,25 12. Sterile dressings \[OS, C.B\] 13. Sterile Cord Tie 14. Adhesive Plaster 15. Dressing \[OS, cotton ball\] 16. Alcohollamp 17. Tape measure 18. Baby\'s scale 19. 1 pair of rubber gloves 20. 2 test tubes 21. Test tube holder 22. Medicines: a. b. c. d. e. f. g. h. Note: Blood Pressure Apparatus and Stethoscope are carried separately.  **TEACHER'S INSIGHTS:** Community health nurses do not only work with individuals, but work hand in hand at least with a family. Dealing with families is likewise challenging due to its nature, dynamics and traditions within and in the community, they live in. The family remains to be the basic unit of a society and also the unit of care. With this reason, the health status of the families will also dictate the health status of the community. Caring for a family also cares for the community. This section of the learning material provided the different accepts and tools for the application of the nursing care process on the family level. Community health nurses provides nursing care to individual and family which the result will be the health of the community and the larger society.