Family Health Nursing Assessment PDF

FAMILY HEALTH NURSING ASSESSMENT Nursing Lecture DIFFERENT TYPES OF FAMILY Nursing Lecture Family Health Nursing  FAMILY NURSING CARE PLAN PART 3 Nursing Lecture Regie De Jesus, MAN  PRIORITIZING FAMILY’S HEALTH PROBLEM HOME VISITS and PHN BAG PART 4 Nur...

FAMILY HEALTH NURSING ASSESSMENT Nursing Lecture DIFFERENT TYPES OF FAMILY Nursing Lecture Family Health Nursing  FAMILY NURSING CARE PLAN PART 3 Nursing Lecture Regie De Jesus, MAN  PRIORITIZING FAMILY’S HEALTH PROBLEM HOME VISITS and PHN BAG PART 4 Nursing Lecture Regie De Jesus, MAN DEFINITION OF FAMILY 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 Nuclear Family – consists of father, mother and children (either adopted or biological) Extended – consists of father, mother, and children with other relatives Single-Parent – single with children Binuclear/Blended/Reconsituted – extended family consisting of 2 or more separate household from separated or divorced parents with children Step Family –remarriage of a widowed person with children TYPES OF FAMILY IN THE COMMUNITY Compound – one man/woman with several spouses Cohabiting family – lived-in unmarried couple Dyad – husband and wife without children Homosexual family – female-female or male/male, gay/lesbian with or without children Communal family – e.g. bahay-ampunan, Home for the aged, Kumbento No-Kin - have no legal or blood tie to each other FUNCTIONAL FAMILY TYPES FAMILY OF PROCREATION- refers to the family you yourself created. FAMILY OF ORIENTATION -refers to the family where you came from. 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 FAMILY TYPE BASED ON WHO MAKE DECISIONS (AUTHORITY) 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 WELL 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 QUESTIONNAIRE (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.  FAMILY APGAR QUESTIONNAIRE (SMILKESTEIN, 1978) 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. FAMILY APGAR QUESTIONNAIRE (SMILKESTEIN, 1978) 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. FAMILY APGAR QUESTIONNAIRE (SMILKESTEIN, 1978)  FAMILY APGAR QUESTIONNAIRE (SMILKESTEIN, 1978) (Paminsan- (Halos (Palagi) minsan) Hindi) APGAR Assessment (2 PTS.) (1 pt.) (0 PT.) A Ako’y nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng problema. P Ako’y nasisiyahan sa paraang nakikipagtalakayan sa akin ang aking pamilya tungkol sa aking problema G Ako’y nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking ikauunlad. A Ako’y nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot, at pag-ibig/ R Ako’y nasisiyahan na ang aking pamilya at ako ay nagkakaroon ng panahon sa isa’t-isa. FAMILY APGAR QUESTIONNAIRE (SMILKESTEIN, 1978) 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 expectation. 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 II. ASSESSMENT Data Collection Methods: Select Appropriate Method 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) II. ASSESSMENT Data Collection Methods: Select Appropriate Method Interview Productivity of interview process depends upon the use effective communication techniques to elicit needed response PROBLEMS ENCOUNTERED II. ASSESSMENT Data Collection Methods: Select Appropriate Method 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 Data Collection Methods: Select Appropriate Method Questionnaires mostly patronized & used in CHN see the ATTACHED DYCI Family Survey Form II. ASSESSMENT Data Collection Methods: Select Appropriate Method Questionnaires 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, 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  INITIAL DATA BASE FOR FAMILY NURSING PRACTICE Family structure, Characteristics, and Dynamics 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  INITIAL DATA BASE FOR FAMILY NURSING PRACTICE 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 INITIAL DATA BASE FOR FAMILY NURSING PRACTICE Home and Environment Kind of neighborhood, e.g. congested, slum, etc. Social and health facilities available Communication and transportation facilities available Housing Home and Environment Adequacy of living Space 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 Approved TYPE OF WATER FACILITIES 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 Approved TYPE OF WATER FACILITIES 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 I) 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 Pail System Pit Privy / Pit Latrine TYPES OF EXCRETA DISPOSAL (Level I) 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 TYPES OF EXCRETA DISPOSAL (Level I) Level I 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. TYPES OF EXCRETA DISPOSAL (Level I) Level I 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. Overhung Latrine TYPES OF EXCRETA DISPOSAL (Level I) 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 I) 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. TYPES OF EXCRETA DISPOSAL Level II 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. TYPES OF EXCRETA DISPOSAL 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 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. Open Drainage 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.  TYPES OF WASTE DISPOSAL Types of Waste Disposal 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. TYPES OF WASTE DISPOSAL 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. TYPES OF WASTE DISPOSAL Types of Waste Disposal 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. TYPES OF WASTE DISPOSAL Types of Waste Disposal 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 Health Status of each Family Member 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 Health 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 FIRST LEVEL ASSESSMENT 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. FIRST LEVEL ASSESSMENT Presence of Wellness Condition 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 FIRST LEVEL ASSESSMENT Presence of Wellness Condition FIRST LEVEL ASSESSMENT 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) FIRST LEVEL ASSESSMENT Presence of Health Deficits 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 isease isorder isability evelopmental problems FIRST LEVEL ASSESSMENT 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 I – nadequate/ Lack of Immunization C – ross infection E – nvironmental sanitation is poor FIRST LEVEL ASSESSMENT Presence of Health Threats FIRST LEVEL ASSESSMENT Presence of Health Threats FIRST LEVEL ASSESSMENT 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 - llegitimacy FIRST LEVEL ASSESSMENT Presence of Stress Points/ Foreseeable Crisis FAMILY NURSING CARE PLAN SECOND LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT SECOND LEVEL ASSESSMENT FAMILY NURSING CARE PLAN Family Coping Index Provides a basis for estimating the nursing needs of a particular family Health Care Need A family health care need is present when: The family has a health problem with which they are unable to cope. There is a reasonable likelihood that nursing will make a difference in the in the family’s ability to cope. Family Coping Index Relation to Coping Nursing Need: COPING may be defined as dealing with problems associated with health care with reasonable success. When the family is unable to cope with one or another aspect of health care, it may be said to have a “coping deficit” Areas to Be Assessed in FAMILY COPING INDEX Physical independence: This category is concerned with the ability to move about to get out of bed, to take care of daily grooming, walking and other things which involves the daily activities. Therapeutic Competence: This category includes all the procedures or treatment prescribed for the care of ill, such as giving medication, dressings, exercise and relaxation, special diets. Areas to Be Assessed in FAMILY COPING INDEX Knowledge of Health Condition: This system is concerned with the particular health condition that is the occasion of care Application of the Principles of General Hygiene: This is concerned with the family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members, carrying out accepted preventive measures, such as immunization. Areas to Be Assessed in FAMILY COPING INDEX Health Attitudes: This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures. Emotional Competence: This category has to do with the maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living. Areas to Be Assessed in FAMILY COPING INDEX Family Living: This category is concerned largely with the interpersonal or group aspects of family life – how well the members of the family get along with one another, the ways in which they take decisions affecting the family as a whole. Areas to Be Assessed in FAMILY COPING INDEX Physical Environment: This is concerned with the home, the community and the work environment as it affects family health. Use of Community Facilities: generally, keeps appointments. Follows through referrals. Tells others about Health Departments services. Scaling Cues In Family Coping Index The following descriptive statements are “cues” to help you as you rate family coping. They are limited to three points – 1 or no competence, 3 for moderate competence and 5 for complete competence General Considerations in Family Coping Index It is the coping capacity and not the underlying problem that is being rated. It is the family and not the individual that is being rated. Rating should be done after 2-3 home visits when the nurse is more acquainted with the family. General Considerations in Family Coping Index Write a Justification a brief statement that explains why you have rated the family as you have. These statements should be expressed in terms of behavior of observable facts. Example: “Family nutrition includes basic rather than good diet. Terminal rating is done at the end of the given period. This enables the nurse to see progress the family has made in their competence; whether the prognosis was reasonable; and whether the family needs further nursing service and where emphasis should be placed. PLANNING The nursing care plan focuses on actions, which are designed to solve or minimize existing problem. The cores of the plan are the approaches, strategies, activities, methods and materials, which the nurse hopes, will improve the problem. The nursing care plan is based upon identified health and nursing problems. PLANNING The nursing care plan is a means to an end, not an end in itself. The goal in planning is to deliver the most appropriate care to the family by eliminating barriers to the family health development. The nursing care plan is a continuous process not a one-shot deal. PLANNING Four (4) Standard Steps: Prioritization -start if there are multiple identified problems Formulation of objectives -planning a procedure will start here if there is only one problem Developing strategies of action Formulation of evaluation tools for the identified strategy developed PLANNING a. Prioritization of Health Problems Nature of the condition or problem - categorized into wellness state/potential, health threat, health deficit of foreseeable crisis. Factors Affecting Nature of the Problem The biggest weight is given to the wellness state or potential because of the premium on client's effort or desire to sustain/maintain high level of wellness. PLANNING a. Prioritization of Health Problems Nature of the condition or problem - Factors Affecting Nature of the Problem The same weight is given to health deficit because of its sense of clinical urgency, which may require immediate intervention. Foreseeable crisis is given the least weight because culture linked variables/factors usually provide our families with adequate support to cope with developmental or situational crisis.  a. Prioritization of Health Problems CRITERIA IN IDENTIFYING THE PROBLEM Criteria Score Weight I. Nature (assessed by PHW) Health Deficit (HD) 3 1 Health Threat (HT) 2 Foreseeable Crisis (FC) 1 II. Modifiability Easily 2 Intermediate (Moderate) 1 2 Not modifiable (FC) 0 III. Preventive Potential Highly 3 Moderate 2 1 Low 1 IV. Salience Problem Needing Urgent Attention 2 Problem Needing Not Urgent Attention 1 1 Not a Felt Problem 0 PLANNING a. Prioritization of Health Problems Modifiability of the condition or problem – refers to the probability of success in enhancing the wellness state improving the condition minimizing, alleviating or totally eradicating the problem through intervention. PLANNING a. Prioritization of Health Problems Modifiability of the condition or problem – Factors Affecting Modifiability Current knowledge, technology and interventions to enhance the wellness state or manage the problem. Resources of the family Resources of the nurse Resources of the community  a. Prioritization of Health Problems CRITERIA IN IDENTIFYING THE PROBLEM Criteria Score Weight I. Nature (assessed by PHW) Health Deficit (HD) 3 1 Health Threat (HT) 2 Foreseeable Crisis (FC) 1 II. Modifiability Easily 2 Intermediate (Moderate) 1 2 Not modifiable (FC) 0 III. Preventive Potential Highly 3 Moderate 2 1 Low 1 IV. Salience Problem Needing Urgent Attention 2 Problem Needing Not Urgent Attention 1 1 Not a Felt Problem 0 PLANNING a. Prioritization of Health Problems Preventive potential – refers to the nature and magnitude of future problem that can be minimized or totally prevented if interventions are done on the condition or problem under consideration. PLANNING a. Prioritization of Health Problems Preventive potential – Factors Affecting Preventive Potential Gravity or severity of the problem-refers to the progress of the disease/problem indicating extent of damage on the patient/family; also indicates prognosis, reversibility or modifiability of the problem. In general, the more severe the problem is, the lower is the preventive potential of the problem PLANNING a. Prioritization of Health Problems Preventive potential – Factors Affecting Preventive Potential Duration of the problem - refers to the length of time the problem has existed. Generally speaking, duration of the problem has a direct relationship to gravity. Because of this relationship to gravity of the problem, duration has also a direct relationship to preventive potential. PLANNING a. Prioritization of Health Problems Preventive potential – Factors Affecting Preventive Potential Current management - refers to the presence and appropriateness of intervention measures instituted to enhance the wellness state or remedy the problem. The institution of appropriate intervention increases condition's preventive potential. PLANNING a. Prioritization of Health Problems Preventive potential – Factors Affecting Preventive Potential Exposure of any vulnerable or High-risk group - increases the preventive potential of condition or problem  a. Prioritization of Health Problems CRITERIA IN IDENTIFYING THE PROBLEM Criteria Score Weight I. Nature (assessed by PHW) Health Deficit (HD) 3 1 Health Threat (HT) 2 Foreseeable Crisis (FC) 1 II. Modifiability Easily 2 Intermediate (Moderate) 1 2 Not modifiable (FC) 0 III. Preventive Potential Highly 3 Moderate 2 1 Low 1 IV. Salience Problem Needing Urgent Attention 2 Problem Needing Not Urgent Attention 1 1 Not a Felt Problem 0 PLANNING a. Prioritization of Health Problems Sample Prioritization Computation PLANNING a. Prioritization of Health Problems Sample Prioritization Computation PLANNING a. Prioritization of Health Problems Sample Prioritization Computation PLANNING a. Prioritization of Health Problems Sample Prioritization Computation  PLANNING a. Prioritization of Health Problems Sample List of identified Problems No. Problems Identified Score Rank 1 Presence of Pediculosis 4.17 1 2 Presence of Dental Caries 4.10 2 3 Poor Lighting Condition 3.83 3 4 Poor Ventilation Condition 3.80 4.5 Presence of vector of diseases 5 e.g. rodents, mosquitoes, flies, 3.80 4.5 PLANNING Establishing Goals and Objectives Goal – Desired observable family response to planned interventions in response to a mutually identified family need. Objectives – the desired step by step family responses as they work toward a goal. PLANNING Establishing Goals and Objectives *A cardinal principle in goal setting states that goal must be set jointly with the family. This ensures family commitment to realization. * Basic to the establishment of mutually acceptable goals is the family’s recognition and acceptance of existing health needs and problems. Workable, well stated objectives should be SMART: S: Specific M: Measurable A: Attainable R: Relevant T: Time bound PLANNING Establishing Goals and Objectives *A cardinal principle in goal setting states that goal must be set jointly with the family. This ensures family commitment to realization. * Basic to the establishment of mutually acceptable goals is the family’s recognition and acceptance of existing health needs and problems. Workable, well stated objectives should be SMART: S: Specific M: Measurable A: Attainable R: Relevant T: Time bound INTERVENTIONS This is the capacity to provide management It is the professional phase of nursing process It is the time when the PHN executes the standard function of an RN (promotive, preventive, curative, rehabilitative) INTERVENTIONS Three (3) Standard Functions of RN: Dependent-giving of medicines Independent-monitor, assess, provide, educate Interdependent-referrals INTERVENTIONS Categories of Nursing Interventions (Freeman and Heinrich) Supplemental interventions – actions that nurse performs on behalf of the family when it is unable to do things for itself (direct nursing care) Facilitative interventions – actions that remove barriers to appropriate health action such as assisting the family to avail of maternal and early child care services. Developmental interventions – aim to improve the capacity of the family to provide for its own health needs such as guiding the family to make responsible health decisions. EVALUATION To evaluate is to determine or fix the value. Formative evaluation – judgment made about effectiveness of nursing interventions as they are implemented. Summative evaluation – determining the end results of family nursing care and usually involves measuring outcomes or the degree to which goals have been achieved. EVALUATION Three (3) Things to be evaluated: SPO Structure of program & activity – measure the adequacy of articles, equipment, supplies, and manpower utilized Process utilized – measures the adequacy of PHN’s actions and activities Outcome of activity -measures the results of care which can be: Desirable -to be implemented, advocated, strengthen Undesirable -to be avoided EVALUATION Aspects of Evaluation Effectiveness – determination of whether goals and objectives were attained. Appropriateness – suitability of the goals/objectives and interventions Adequacy – degree of sufficiency of goals/objectives and interventions Efficiency – relationship of resources used to attain the desired outcomes TYPES OF FAMILY-NURSE CONTACT Clinic Visit Telephone Conference Written Communication School Visit Industrial or Job Site Visit Home Visit TYPES OF FAMILY-NURSE CONTACT Clinic Visit takes place in a private clinic health center, barangay health station. advantage - family member takes the initiative of visiting the professional health worker, usually indicating the family readiness to participate in the health care process. Because the nurse has greater control over the environment, distractions are lessened and the family may feel less confident to discuss family health concerns. TYPES OF FAMILY-NURSE CONTACT Telephone Conference May be effective, efficient, and appropriate if the objectives and outcomes of care require immediate access to data given problems on distance or travel time. Such data include monitoring of health status or progress of an illness state, change in schedule of visit or family decision, and updates on outcomes or responses to care and treatment. TYPES OF FAMILY-NURSE CONTACT Written Communication less time consuming option for the nurse in instances when there are large number of families needing follow-up on top of problems of distance or travel time. used to give specific information to families, such as instructions given to parents through school children. TYPES OF FAMILY-NURSE CONTACT School Visit It is done to work with family and school authorities on how to appraise the degree of vulnerability of and worked out interventions to help children and adolescence on specific health risks, hazards or adjustment problems. TYPES OF FAMILY-NURSE CONTACT Industrial or Job Site Visit It is done when the nurse and family need to make an accurate assessment of health risks or hazards and work with employer or supervisor on what can be done to improve on provisions for health and safety of workers. TYPES OF FAMILY-NURSE CONTACT HOME VISIT Home visit is a professional, purposeful interaction that takes place in the family’s residence aimed at promoting, maintaining and restoring the health of the family or its members. The services provided is an extension of the Health Service Agency (Health Center) The best opportunity to serve the actual care given by family members. TYPES OF FAMILY-NURSE CONTACT PRINCIPLES OF HOME VISIT Must have a purpose or objective Examples include Assessment Nursing Care Treatment Health Education Referral (if care fails TYPES OF FAMILY-NURSE CONTACT PRINCIPLES OF HOME VISIT Must use every available information about the patient and his family through family records Priority should focus on the essential needs of the individual and his family Should involve the individual and family Plan should be flexible Planning continuing care should involve a responsible family member TYPES OF FAMILY-NURSE CONTACT ADVANTAGES OF HOME VISIT It allows first hand assessment of the home situation. The nurse is able to seek out previously unidentified needs. It gives the nurse an opportunity to adapt interventions according to family resources. It promotes family participation and focuses on the family as a unit. Teaching family members in the home is made easier by the familiar environment and the recognition of the need to learn as they are faced by the actual home situation. The personalized nature of home visit gives family a sense of confidence in themselves and in the agency TYPES OF FAMILY-NURSE CONTACT DISADVANTAGES OF HOME VISIT The cost in terms of time and effort. There are more distractions because the nurse is unable to control the environment. Nurse’s safety. TYPES OF FAMILY-NURSE CONTACT Priority patients for Home Visit Newborn Post-partum Pregnant mothers Morbid cases TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit Pre-visit phase (Planning Phase) Nurse contacts the family, determines the willingness for a home visit, and sets an appointment with them. A plan for the home visit is formulated during this phase. Starts at the health center Makes a study on the status of the family Statement of the problem Formation of objective TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit In-home phase This phase begins as the nurse seeks permission to enter and lasts until he or she leaves the family’s home. It consists of initiation, implementation, and termination.  TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit In-home phase Initiation (Socialization) first activity is to establish rapport & to gain the trust of the family It is customary to knock or ring the doorbell and at the same time, in a reasonably loud but nonthreatening voice say, “Tao po. Si Nurse Regie po ito, nurse po sa health center?.”  TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit In-home phase Initiation (Socialization) On entering the home, the nurse acknowledges the family members with a greeting and introduces himself and the agency he represents. Observes environment for his own safety and sits as the family directs him to sit. Establish rapport by initiating a short conversation. States the purpose of the visit the source of information  TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit In-home phase Implementation (Activity) Intervention/Professional Phase Involves the application of the nursing process, assessment, provision of direct nursing care as needed, and evaluation. Opportunity to provide or extend health services Standard Role of the Nurse: Independent, Dependent and Interdependent To be effective, come in complete uniform (also bring a long umbrella with pointed end which serves as protection)  TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit In-home phase Termination (Summarization) Consists of summarizing with the family the events during the home visit and setting a subsequent home visit or another form of family-nurse contact. Use this time to record findings, such as vital signs of family members and body weight TYPES OF FAMILY-NURSE CONTACT Phases of Home Visit Post-visit phase Takes place when the nurse has returned to the health facility. Involves documentation of the visit. PUBLIC HEALTH BAG (PHN BAG) Frequently called the PHN bag is an indispensable tool that should be organized to save time & effort and to prevent cross infection & contamination Serves as a reminder of the need for hand hygiene and other measures to prevent the spread of infection. PUBLIC HEALTH BAG (PHN BAG) Nursing bag usually has the ff. contents: Articles for infection control Articles for assessment of family members Note that the stethoscope and sphygmomanometer are carried separately. Articles for nursing care Sterile items Clean articles Pieces of paper THE BAG TECHNIQUE Bag technique is performed before and after handling a client in the home to prevent transmission of infection to and from the client Bag technique helps the nurse in infection control. Bag technique allows the nurse to give care efficiently. It saves time and effort by ensuring that the articles needed for nursing care are available. THE BAG TECHNIQUE Bag technique should not take away the nurse’s focus on the patient and the family. Bag technique may be performed in different ways, principles of asepsis are of the essence and should be practiced at all times. FOR INFECTION CONTROL the ff. activities should be practiced during home visits: Remember to proceed from “clean” to “contaminated”. The bag and its contents should be well protected from contact with any article in the patient’s home. Contents should be prepared by the one who will make home visit Note: BP Apparatus is kept separately from PHN bag FOR INFECTION CONTROL the ff. activities should be practiced during home visits: Line the table/flat surface with paper/washable protector on which the bag and all of the articles to be used are placed. The inner part of the bag should be clean & sterile Wash your hands before and after physical assessment and physical care of each family member. FOR INFECTION CONTROL the ff. activities should be practiced during home visits: Bring out only the articles needed. The less one opens the bag, the lesser chance of contamination In general, the bag is open 3x: Putting out materials for hand washing Putting out materials used for nursing care Returning all what have been used FOR INFECTION CONTROL the ff. activities should be practiced during home visits: Do not put any of the family’s articles on your paper lining/washable protector. Wash your articles before putting them back into you bag. Confine the contaminated surface by folding the contaminated side inward. Wash the inner cloth lining of the bag as necessary. FOR INFECTION CONTROL the ff. activities should be practiced during home visits: Care of Communicable Case(s) should be disinfected with the use of 70% isopropyl alcohol or Lysol which should be done at the health center and not at home FAMILY NURSING CARE PLAN It is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care (goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria, standards, methods and tools Desirable Qualities of a Family Nursing Care Plan 1.It should be based on clear, explicit definition of the problems. A good nursing plan is based on a comprehensive analysis of the problem situation. 2.A good plan is realistic. Desirable Qualities of a Family Nursing Care Plan 3.The nursing care plan is prepared jointly with the family. The nurse involves the family in determining health needs and problems, in establishing priorities, in selecting appropriate courses of action, implementing them and evaluating outcomes. 4.The nursing care plan is most useful in written form FAMILY NURSING CARE PLAN