NCM 104 Community Health Nursing PDF

NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) COURSE OUTLINE: MIDTERMS ○ Burning fossil fuels is the primary cause of air pollution and also a major contri...

NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) COURSE OUTLINE: MIDTERMS ○ Burning fossil fuels is the primary cause of air pollution and also a major contributor to 1. Overview of Public Health Nursing in the climate change that impacts the health of Philippines the people in many ways. 2. The Health Care Delivery System Non-communicable diseases Nen 3. The Family ○ Diabetes, cancer and heart disease are 4. Family Nursing Process the leading causes of death worldwide. 5. Family Records The rise of these diseases has been driven REFERENCE BOOK by five major risk factors: tobacco use, physical inactivity, the harmful use of Philippines. Department Of Health. (1966). Public Health alcohol, unhealthy diets and air pollution. Nursing in the Philippines. Dept. Of Health. ○ Mental health issues are also exacerbated by these five major risk factors. Suicide is the third leading cause of death among OVERVIEW OF PUBLIC f 15-19 years old. Global influenza pandemic ar HEALTH NURSING IN THE ○ The world will face another influenza PHILIPPINES pandemic, the only thing we don’t know is when it will hit and how severe it will be. The continuous monitoring of WHO of the GLOBAL AND NATIONAL HEALTH SITUATIONS circulation of influenza viruses helps prepare the world. HEALTH Fragile and vulnerable settings FUS The World Health Organization (WHO) defined ○ Fragile setting exists in almost all regions health as a state of complete physical, mental and of the world. More than 1.6 billion people social well-being and not merely the absence of live in places where prolonged crises disease or infirmity. (drought, famine, conflict and population The health of all peoples is fundamental to the displacement) and weak health services attainment of peace and security and is leave them without access to basic care. dependent on the fullest cooperation of individuals Antimicrobial resistance ARDR and States. ○ Antimicrobial resistance is the ability of Governments have a responsibility for the health of bacteria, parasites, viruses and fungi to their peoples which can be fulfilled only by the resist the medicines. The threat of going provision of adequate health and social measures. back in time where pneumonia, tuberculosis, gonorrhea and salmonellosis is inevitable. GLOBAL HEALTH ○ Drug resistance is driven by the overuse of Global health is viewed in different ways, as the antimicrobials in people, but also in Institute of Medicine- USA (1997) defined it as animals, especially those used for food health problems, issues and concerns that production, as well as in the environment. transcends national boundaries, which may be influenced by circumstances or experiences in other Ebola and other high threat pathogens HTP E ○ An epidemic of high threat pathogens is countries, and which are best addressed by critical. Watchlist for priority research and cooperative actions and solutions. development includes Ebola, several other Koplan et al. stated it as an area for study, hemorrhagic fevers, Zika, MERS-CoV, research and practice that places a priority on SARS and disease X, which represents improving health and achieving health equity for all the need to prepare for an unknown people worldwide. Moreover, Kickbush defines pathogen that could cause a serious global health as, “those health issues that transcend epidemic. national boundaries and governments and call for actions on the global forces that determine the health of people.” Weak primary health care PAC W ○ Primary health care is usually the first point Global health focuses on people across the of contact people have with their health whole plane rather than concerns of nation. care system, and ideally should provide Global health initiatives consider both medical and comprehensive, affordable, community non-medical disciplines, such as epidemiology, based care throughout life. However, in sociology, economic disparities, public policy, low- and middle-income countries there is environmental factors, cultural studies, etc. an inadequate primary health care facility because of the lack of resources. 10 Threats to Global Health (WHO, 2019) Vaccine hesitancy VA ○ Vaccination is one of the most cost-effective ways of avoiding diseases. Air pollution and climate change Apace However, some people have a complex ○ Air pollution is considered as the greatest reason why they choose not to vaccinate. environmental risk to health. Around ○ Vaccine hesitancy is the reluctance or 90% of these deaths are in low-and refusal to vaccinate despite the availability middle-income countries, with high of vaccines. The unwillingness threatens to volumes of emissions from industry, reverse the progress made in tackling transport and agriculture, as well as dirty vaccine-preventable diseases. cookstoves and fuels in homes. Dengue NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) ○ A high number of cases of this mosquito-borne disease can be lethal and kill up to 20% of those with severe dengue. It has been a growing threat for decades and is spreading to less tropical and more temperate countries that have not traditionally seen the disease. HIV ○ The epidemic continues to rage with nearly a million people every year die of HIV/AIDS despite the progress that has been made against HIV. NATIONAL HEALTH In recent years, the Philippines made significant investments and advances in health. Filipinos have been living longer and healthier due to the rapid economic growth and strong country capacity. intantmortaliterate undertivenortaliterate Death neonatal However, not all the benefits of this growth have reached the most vulnerable groups, and the health system remains fragmented. Achievements have not been even, and challenges Maternal Mortality Rate remain. Inequities persist between regions, rich and Death of a woman while pregnant or within 42 days poor, and different population groups. of termination of pregnancy, irrespective of the Many Filipinos continue to die and suffer from duration and site of the pregnancy, from any cause illnesses. Many people lack enough knowledge to related to or aggravated by the pregnancy or its make informed decisions about their own health. management but not from accidental or incidental Rapid economic development, urbanization, cause. escalating climate change, and widening exposure to diseases and pathogens in an increasingly global world increase the risk associated with disasters, environment threats and emerging and re-emerging infections. HEALTH STATUS STATISTICS - PHILIPPINES Field Health Service Information System (FHSIS 2018) Crude Death Rate – indicates the number of deaths occurring during the year, per 1,000 population estimated at midyear. Crude Birth Rate Is the number of live births occurring among the population of a given geographical area during a given year, per 1,000 mid-year total population of the given geographical area during the same year. Under Five Mortality Rate (UFMR) The probability of a child born in a specific year or period dying before reaching the age of five, expressed per 1,000 live births. Infant Mortality Rate (IMR) Number of deaths per 1,000 live births under one year of age. pundesiranesignysumptoms Perinatal Deaths Morbidity Refers to the number of stillbirths and deaths in the It is the state of being symptomatic or unhealthy for first week of life (early neonatal mortality). a disease or condition. Neonatal Deaths (NT Deaths) Morbidity Rate Deaths among live births during the first 28 The proportion of patients with a disease during a completed days of life. given year per population. NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) prevention of illness, care of the sick at home, and rehabilitation. “ -Ruth B. Freeman “Nursing practice in a wide variety of community lower came respiratory in tea tract on services and consumer advocate areas, and in a variety of roles, at times including independent practice… Community nursing is certainly not confined to public health nursing agencies.” – Jacobson, 1975 “The utilization of the nursing process in the different levels of clientele– individuals, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.” -Maglaya, et al Mortality Rate GOAL!! Is related to the number of deaths caused by the “Raise the level of citizenry by helping communities health event under investigation in a defined and families to cope with the discontinuities in and population during a specified interval. threats to health in such a way as to maximize their potential for high-level wellness” -Nisce, et al STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES The standards differentiated public health nursing from community health nursing only in one area: setting of work as dictated by funding. The government is the employer of Public Health Nurses both at the national and local health agencies. PRINCIPLES OF CHN The community is the patient in CHN, the family is the unit of care. DEFINITION AND FOCUS OF ○ Four levels of clientele: itp Individual COMMUNITY HEALTH Family Population group (those who share NURSING common characteristics, developmental stages and common exposure to health problems – e.g. PUBLIC HEALTH children, elderly) Community “Science and art of preventing disease prolonging The client is considered as an ACTIVE partner NOT life and promoting health and efficiency through PASSIVE recipient of care. organized community effort for the sanitation to CHN practice is affected by developments, in ensure a living adequate for the maintenance of particular, health technology, and in general, health” changes in society - Dr. C.E. Winslow The goal of CHN is achieved through multi-sectoral efforts. PUBLIC HEALTH NURSING CHN is a part of the health care system and the larger human services system. “Special field of nursing that combines the skills of nursing, public health, and some phases of social assistance and functions as part of the total public health program.” RESPONSIBILITIES OF THE COMMUNITY HEALTH COMMUNITY HEALTH NURSING NURSE “Service rendered by a professional nurse to communities, groups, families, and individuals at home, in health centers, in clinics, in schools, and in Participates in developing an overall health plan, its places of work for the promotion of health, implementation and evaluation for communities. NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) Provide quality nursing services to the four levels of 4. Reduce child mortality clientele.individual family particular Group c ommunity 5. Improve maternal health Maintain coordination/linkages with other health 6. Combat HIV/AIDS, malaria, and other team members, NGO/government agencies in the diseases provision of public health services. 7. Ensure environmental sustainability Initiates and conducts research relevant to CHN 8. Global partnership for development services to improve provision of healtH care. Initiates and provides opportunities for professional growth and continuing education for staff development. —————————END of MODULE 1——————— MOD 2: The Health Care Delivery System WORLD HEALTH ORGANIZATION (WHO) Better health for everyone, everywhere SUSTAINABLE DEVELOPMENT GOALS World Health Organization SDGs (Global Goals) the directing and coordinating authority on Formed from The 2030 Agenda for Sustainable international health within the United Nations Development system. Adopted by world leaders in September 2015 widely known in many activities, such as medical Officially came into force on January 1 2016 research, immunization campaigns against fatal Built on the Millennium Development Goals (MDGs) diseases, and improves housing, nutrition, Its 17 Goals and 169 targets are a universal set of sanitation, and working conditions in developing goals and targets that aim to stimulate countries. people-centered and planet-sensitive change. performs charting statistical health trends and Are integrated and indivisible, global in nature, and issues warnings about possible health problems. universally applicable, taking into account different works with agencies, foundations, government, national realities, capacities, and levels of non-governmental organizations, and private sector development and respecting national policies and groups to address the world’s health needs. priorities. Each government is expected to take ownership ★ HEADQUARTERS: Geneva, Switzerland and establish national frameworks, set nationally-owned targets guided by the global level ★ 193 members of ambition but taking into account country-level ★ Governed through representatives within circumstances for the achievement of the 17 goals. World Health Assembly Countries will also decide how these aspirational ★ Supported by: 34 (thirty-four) member and global targets should be incorporated into national planning processes, policies, and Executive Board (elected by World Health strategies. Assembly) The UN recognizes that ending poverty and other ★ 6 (six) regional committees focus on health deprivations must go hand-in-hand with strategies concerns within Southeast Asia, the Eastern that improve health and education, reduce Mediterranean, the Americas, Africa, the inequality, and spur economic growth – all while tackling climate change and working to preserve our Western Pacific, and Europe. oceans and forest ○ Inter-Agency and Expert Group on SDG Indicators (IAEG-SDG) - monitors the MILLENNIUM DEVELOPMENT GOALS SDGs and corresponding targets and developed the 232 unique indicator MDGs framework. Signed on September 2000 by leaders of 189 1. No poverty. “End poverty in all its forms countries gathered at the United Nations everywhere.” headquarters. 2. Zero/no hunger. "End hunger, achieve food security A set of eight measurable goals that range from and improved nutrition, and promote sustainable halving extreme poverty and hunger to promoting agriculture". gender equality and reducing child mortality, by the 3. Good health and well-being. "Ensure healthy lives target date of 2015. and promote well-being for all at all ages". Enormous progress has been made on the MDGs, 4. Quality education. "Ensure inclusive and equitable showing the value of a unifying agenda quality education and promote lifelong learning underpinned by goals and targets opportunities for all". 5. Gender equality. "Achieve gender equality and 1. Eradicate extreme poverty and hunger empower all women and girls" 2. Achieve universal primary education 6. Clean water and sanitation. "Ensure availability and 3. Promote gender equality and empower sustainable management of water and sanitation for women all" NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) 7. Affordable and clean energy. "Ensure access to ○ VISION: affordable, reliable, sustainable, and modern energy - The DOH is the leader, staunch advocate, for all". and model in promoting health for all in the 8. Decent work and economic growth. "Promote Philippines. sustained, inclusive and sustainable economic ○ MISSION: growth, full and productive employment and decent - Guarantee, equitable, sustainable, and work for all". quality health for all Filipinos, especially 9. Industry, innovation, and infrastructure. "Build the poor and shall lead the quest for resilient infrastructure, promote inclusive and excellence in health. sustainable industrialization, and foster innovation". 10. Reduced inequality. "Reduce income inequality within and among countries". 11. Sustainable cities and communities. "Make cities and human settlements inclusive, safe, resilient, and sustainable" 12. Responsible consumption and production. "Ensure sustainable consumption and production patterns". 13. Climate action. "Take urgent action to combat climate change and its impacts by regulating emissions and promoting developments in renewable energy". 14. Life below water. "Conserve and sustainably use the oceans, seas, and marine resources for sustainable development". 15. Life on land. "Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss" 16. Peace, justice, and strong institutions. "Promote peaceful and inclusive societies for sustainable development, provide access to justice for all, and build effective, accountable, and inclusive institutions at all levels" 17. Partnership for the goals. "Strengthen the means of implementation and revitalize the global partnership for sustainable development". DOH Milestones (CLICK ME for full image) LOCAL HEALTH SYSTEM and DEVOLUTION of HEALTH SERVICES Devolution Made local government executives responsible to operate local health care services. ○ RA 7160 Local Government Code - aims to transform local government units into self-reliant communities. PHILIPPINE DEPARTMENT OF HEALTH ○ 1993 - health services were devolved or transferred from the Department of Health DOH to the local government units. The country’s principal health agency. Responsible for ensuring access to basic public health services through the provision of quality healthcare and the regulation of providers of health goods and services. ○ PRIMARY FUNCTION: - the promotion, protection, preservation, or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services. NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) in the 4 major clinical services Isolation Respiratory unit Physical facilities medicine and rehabilitation unit Surgical/Materni General ICU Ambulatory ty facilities surgical clinic Dental clinic High-risk Dialysis clinic pregnancy unit Secondary and NICU Tertiary lab with Fig 1. Simplified overview of the administrative structure of clinical histopathology government health facilities in the Philippines before and laboratory after devolution. CLICK ME Blood station Tertiary clinical Blood bank laboratory Objectives for Local Health Systems 1st Level X-ray Blood station 3rd level x-ray 1 Establish a local health system for effective and efficient delivery of healthcare services. Pharmacy 2nd level x-ray Specialty with mobile unit hospitals 2 Upgrade the health care management and service capabilities of local health care facilities. Trauma capability hospitals 3 Promote inter-LGU linkages. Trauma-capable facility 4 Foster participation of the private sector, NGOs, and Trauma-receiving communities in local health system development. facility 5 Ensure the quality of health service delivery at the local level. CLASSIFICATION OF HEALTH FACILITIES A. Primary ➜ first contact care facility that offers basic CLASSIFICATION OF HEALTH FACILITIES Care Facility services including emergency service and To improve access to health facilities with the provision for normal deliveries. efficient use of government resources and without 1. With in-patient beds - infirmary, compromising the quality of care. birthing home 2. Without beds - medical out-patient CLASSIFICATION OF HOSPITALS clinic, OFW clinic, dental clinic ➔ According to OWNERSHIP ◆ Government - created by law B. Custodial ➜ provides long-term care to patients with ◆ Private - owned and operated with funds Care Facility chronic/mental illness, in need of through donation, principal investment, or rehabilitation, or requiring ongoing health other means by any individual, corporation, and nursing care or organization. 1. Custodial psychiatric care facility ➔ According to SCOPE of SERVICES 2. Substance abuse treatment and ◆ General - services for all kinds of illnesses, rehabilitation center diseases, injuries, or deformities 3. Sanitarium/leprosarium ◆ Specialty - specializes in a particular 4. Nursing home condition or disease ➔ According to FUNCTIONAL CAPACITY C. Diagnostic ➜ examines human body or specimens / Therapeutic from the human body for diagnosis or Care Facility treatment of diseases LEVEL 1 LEVEL 2 LEVEL 3 1. Laboratory facility - clinical lab, HIV testing center, Blood service Consulting Level 1 plus: Level 2 plus: facility, drug testing lab, Newborn specialists in screening lab medicine, 2. Radiologic facility Pediatrics, 3. Nuclear medicine facility OB-Gyne, Surgery D. ➜ with a highly competent and trained staff Specialized that performs highly specialized Emergency and Departmentalized Teaching/training Out-Patient procedures on an out-patient basis out-patient clinical services with accredited Facility 1. Dialysis clinic services residency 2. Ambulatory surgical clinic training program 3. In-vitro fertilization center NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) Increase opportunities for community participation 4. Stem cell facility in local level planning, management, monitoring, 5. Oncology chemotherapeutic and evaluation center Development of intra-sectoral linkages with other 6. Radiation oncology facility government and private agencies 7. Physical medicine and Emphasizing partnership so that the health workers rehabilitation center and the community leaders/members view each other as partners PRIMARY HEALTH CARE (2) Two LEVELS of PHC Types vary Workers depending upon: PHC An essential health care made universally ➔ Village or Barangay ➔ Available accessible to individuals and families in the Health Workers - health community by means acceptable to them to their trained community manpower full participation and at the cost that the community health workers, health resources and country can afford at every stage of auxiliary volunteer, or ➔ Local health development. (WHO) traditional birth needs and attendant/healer problems ➔ Intermediate level ➔ Political and Historical Background health workers - financial - was declared during the First International general medical feasibility Conference on Primary Health Care held in Alma practitioners or their Ata, USSR on September 6-12, 1978 by WHO. assistants. ex. Public - The goal was “Health for All by the year 2000” Health Nurses, Rural this was adopted in the Philippines through Letter Sanitary Inspectors, of Instruction 949 signed by President Marcos on and Midwives October 19, 1979, and has an underlying theme of “Health in the Hands of the People by 2020”. Elements/Components of Primary Health Care PHC TEAM 1. Environmental sanitation 2. Control of Communicable Diseases Physician Nurse auxiliaries 3. Immunization Nurse Locally trained 4. Health Education Midwives community 5. Maternal and Child Health and Family Planning health workers 6. Adequate Food and Proper Nutrition 7. Provision of Medical Care and Emergency Treatment Elements/Components of Primary Health Care 8. Treatment of Locally Endemic Diseases 1. Primary Level of Care 9. Provision of Essential Drugs a. The first contact between the community members and the other levels of health facility (4) FOUR CORNERSTONES/PILLARS 2. Secondary Level of Care a. Given in health facilities either privately Active community Use of owned or government operated. participation appropriate 3. Tertiary Level of Care Intra- and technology a. Rendered by specialists in health inter-sectoral Support facilities. Complicated cases and intensive linkages mechanism care made available LEVELS of PREVENTION STRATEGIES (8) Reorientation and reorganization of the national Primary prevention healthcare systems with the establishment of a functional support mechanism. aims to prevent disease or injury before it ever Effective preparation and enabling process for occurs. health in all levels. ○ Health education about healthy and safe Mobilization of the people to know their measures communities and identifying their basic health ○ Immunization needs with the end in view of providing appropriate ○ Laws to mandate and enforce healthy and solutions. safe practices Develop and utilization of appropriate technology Secondary prevention focusing on local indigenous resources available in aims to reduce the impact of a disease or injury and acceptable in the community. that has already occurred. Organization of communities arising from their ○ Regular exams and screening tests expressed needs ○ Diet and exercise to prevent further attacks Tertiary prevention NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) - aims to soften the impact of an ongoing illness or capacity, to attend to all types of injury that has lasting effects emergencies, and to handle ○ Cardiac or stroke rehabilitation programs non-communicable diseases. The Health ○ Vocation rehabilitation programs Facility Enhancement Program (HFEP) ○ Support groups that allow members to shall provide funds to improve facility share strategies for living well preparedness for trauma and other emergencies. UNIVERSAL HEALTH CARE (UHC) 3. Attainment of health-related Millennium COMPLETE UHC FILE Development Goals (MDGs). a. Further efforts and additional resources also referred to as Kalusugan Pangkalahatan (KP) are to be applied on public health The “provision to every Filipino of the highest programs to reduce maternal and child possible quality of health care that is accessible, mortality, morbidity and mortality from efficient, equitably distributed, adequately funded, Tuberculosis and Malaria, and incidence of fairly financed, and appropriately used by an HIV/AIDS. Localities shall be prepared for informed and empowered public.” emerging disease trends, as well as the It is a government mandate aiming to ensure that prevention and control of every Filipino shall receive affordable and quality non-communicable diseases. health benefits. This involves providing adequate resources – health human resources, health —————————END of MODULE 2——————— facilities, and health financing. The Aquino administration puts it as the availability and MODULE 3: THE FAMILY accessibility of health services and necessities for all Module Content: Filipinos. A: Family as Basic Unit of the Society OBJECTIVES and THRUSTS B: Types of Family C: Functions Developmental Stages Overall Goal D: Family Health task The implementation of Universal Health Care shall E: Characteristic of a Healthy Family be directed towards ensuring the achievement of the health system goals of better health outcomes, sustained health financing, and responsive health FAMILY system by ensuring that all Filipinos, especially the disadvantaged group in the spirit of solidarity, have equitable access to affordable health care. FAMILY AS BASIC UNIT OF SOCIETY General Objective ✓ Genetic transmission unit Universal Health Care is an approach that seeks to ✓ Matrix of personality of development and the improve, streamline, and scale up the reform most intimate strategies in HSRA and Fl in order to address inequities in health outcomes by ensuring that all emotional unit of society Filipinos, especially those belonging to the lowest ✓ Enduring social form in which a person is two income quintiles, have equitable access to incorporated quality health care. ✓ Lifelong involvement This approach shall strengthen the National Health ✓ Shared attributes Insurance Program (NHIP) as the prime mover in improving financial risk protection, generating ✓ Genetics – physical and psychological resources to modernize and sustain health facilities, ✓ Developmental – shared home, lifestyle, social and improve the provision of public health services activities to achieve the Millennium Development Goals ✓ Sense of belonging (MDGs). ✓ Security/defense against a potentially hostile UHC’s Three Thrusts environment To attain UHC, three strategic thrusts are to be pursued, ✓ Companionship namely: ✓ Societal expectations 1. Financial risk protection through expansion in ✓ Sense of responsibility towards members & enrollment and benefit delivery of the National others Health Insurance Program (NHIP) a. attained by making any Filipino eligible to ✓ Basis of affection/care enroll, to know their entitlements and ✓ Built-in problems responsibilities, to avail of health services, ✓ Generation gap and to be reimbursed by PhilHealth with ✓ Dependence of members regard to health care expenditures. ✓ Emotional attachment/involvement 2. Improved access to quality hospitals and health care facilities; ✓ The family endures despite problems a. The quality of government-owned and ✓ Resource utilization operated hospitals and health facilities is to ✓ Authority be upgraded to accommodate larger NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) ✓ Individual sense of responsibility Vary within social context CLASSIFICATION ACCORDING TO COHABITATION/LIVE-IN STRUCTURE Unmarried couple living together NUCLEAR FAMILY NO-KIN A father and mother with/without children living together but apart from both sets of parents and relatives A group of at least two people sharing a relationship and exchange support who have no legal or blood tie to each Separate dwelling not shared with members of the family other of origin/orientation of either spouse FOSTER Economically independent Substitute family for children whose parents are unable to EXTENDED FAMILY care for them Two or more nuclear families economically and socially GAY-LESBIAN related to each other Homosexual couple living together with/without children Unilaterally/ bilaterally extended CLASSIFICATION ACCORDING TO Includes 3 generations FUNCTION Lives together as a group Family of Procreation- refers to the family you yourself created. SINGLE PARENT FAMILY Family of Orientation-refers to the family where you came Children < 17 years of age, living in a family unit with a single parent, another relative or non-relative May result FAMILY AS A UNIT OF CARE from: The family is considered the natural and fundamental unit Loss of spouse by death, divorce, separation of society. Out of wedlock birth of a child The family as a group generates, prevents, tolerates and corrects health problems within its membership. From adoption The health problems of the family members are Migration (OFWs) interlocking. BLENDED-RECONSTITUTED FAMILY The family is the most frequent focus of health decisions and action in personal care. Includes step-parents and step-children The family is an effective and available channel for much Caused by divorce, annulment with remarriage and of the effort of the health worker. separation Compound family TYPES OF FAMILY One woman/ man with several spouses COMMUNAL FAMILY FAMILY AS A CLIENT The family is the foreground and individuals are in the Grouping of individuals which are formed for specific background ideological or societal purposes The focus is concentrated on each and every individual as Considered as an alternative lifestyle for people who feel they affect the whole family alienated from the economically privileged society NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) The focus is concentrated on how the family as a whole is Viewed as an international system in which the whole is reacting to an event when a family member experiences a greater than the sum of its parts health issue Focuses on the individual and family members become the CHARACTERISTICS OF FAMILY AS A target for nursing interventions CLIENT FUNCTIONS & DEVELOPMENTAL STAGES 1. The family is a product of time and place Functions of a Family ▪ A family is different from another family who lives in another location in many ways. Ø- Biologic Reproduction ▪ A family who lived in the past is different from another Ø - Child-rearing/Caring Nutrition family who lives in the present in many ways. Ø - Health maintenance 2. The family develops its own lifestyle Ø - Recreation ▪ Develop its own patterns of behavior and its own style in life. Economic ▪ Develops their own power system which either be: Ø - Provision of adequate financial resources ▪ Balance-the parents and children have their own areas of Ø - Resource allocation decisions and control. Ø - Ensure financial security ▪ Strongly Bias-one member gains dominance over the Educational others. Ø- Teach skills, attitudes and skills relating to other functions 3. The family operates as a group Psychological/ Affection ▪ A family is a unit in which the action of any member may set off a whole series of reactions within a group, and an Ø - Promotes the natural development of personalities entity whose inner strength may be its greatest single supportive factor when one of its members is stricken with Ø - Offer optimum psychological protection illness or death. Ø - Promotes ability to form relationships with people within 4. The family accommodates the needs of the individual the family circle members. Socio-cultural ▪ An individual is unique human being who needs to assert his or herself Ø- Socialization of children in a way that allows him to grow and develop. Ø - Promotion of status and legitimacy ▪ Sometimes, individual needs and group needs seem to find a natural balance; Developmental Stages/ Family Life Cycle 1. The need for self-expression does not overshadow Assess a patient and family developmental consideration for others. concerns Identifies stages of family development that reflect 2. Power is equitably distributed. the biological functions of raising children As the family system moves together through time, 3. Independence is permitted to flourish the individual life cycles intertwines with the life cycles of other family FAMILY AS A SYSTEM members The focus is on the family as a client Families go through different stages for which specific developmental tasks must be accomplished NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) Families who are not able to accomplish these ▪ Adapting to new living circumstances. tasks may develop difficulties with subsequent family development. 7. Empty nest 1. Beginning Family Beginning Family: - From the time the children are gone till the marital couple retires - The couple establishes their home but do not yet have from employment. children. Involves merging of values brought into the Developmental Tasks relationship from families of orientation. Includes ▪ Renewing and redefining the marriage relationship adjustments to each other’s routines (sleeping, eating, ▪ Maintaining ties with children and their families chores, etc.), sexual and economic aspects. ▪ Preparing for retirement years. 8. Aging family ❖ Members work to achieve 3 separate identifiable tasks: From retirement till the death of the surviving marriage 1. Establish a mutually satisfying relationship partner. Developmental Tasks: 2. Learn to relate well to their families of orientation ▪ Adjusting to retirement 3. If applicable, engage in reproductive life planning ▪ Coping with the death of the marriage partner and life alone. 2. Childbearing Family FAMILY HEALTH TASK - From the birth of the first child until that child is 2 1/2 years old. Health task differ in degrees from family to family Developmental Tasks: TASK- is a function, but with work or labor overtures Adjusting to increased family size assigned or demanded of the person Caring for an infant Providing a positive developmental environment Family Health Tasks (Duvall & Niller) 3. Family with Preschoolers 1. Physical maintenance- provides food, shelter, clothing, and healthcare to its members being certain that a family has - When the oldest child is between the ages of 2 1/2 and 6. ample resources to provide Developmental Tasks: ▪ Satisfying the needs and interests of preschool children 2. Socialization of Family- involves preparation of children ▪ Coping with demands on energy and attention with less to live in the community and interact with people outside the privacy at home. family. 4. Family with School Age Children 3. Allocation of Resources- determines which family needs will be met and their order of priority. - When the oldest child is between the ages of 6 and 13. Developmental Tasks: 4. Maintenance of Order- task includes opening an effective ▪ Promoting educational achievement means of communication between family members, ▪ Fitting in with the community of families with school-age integrating family values, and enforcing common regulations children. for all family members. 5. Division of Labor– who will fulfill certain roles e.g., family 5. Family with Teenagers. provider, home manager, children’s caregiver - When the oldest child is between the ages of 13 and 20. 6. Reproduction, Recruitment, and Release of family Developmental Tasks: member ▪ Allowing and helping children to become more independent ▪ Coping with their independence 7. Placement of members into larger society ▪ Developing new interests beyond child care. – consists of selecting community activities such as church, school, politics that correlate with the family beliefs and 6. Launching values - From the time the oldest child leaves the family for 8. Maintenance of motivation and morale independent - created when members serve as support people to each adult life till the time the last child leaves. other Developmental Tasks: ▪ Releasing young adults and accepting new ways of relating Family Health Tasks (Maglaya) to them ▪ Maintaining a supportive home base NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) 1. Recognizing interruptions of health development Two major types in dealing with the assessment of the 2. Making decisions about seeking health care/ to take action family. 3. Dealing effectively health and non-health situations 4. Providing care to all members of the family First Level Assessment 5. Maintaining a home environment conducive to health Second Level Assessment maintenance FIRST LEVEL ASSESSMENT CHARACTERISTICS OF HEALTHY FAMILY The process of determining existing and potential health conditions or problems of the family. These health conditions Able to provide for physical, emotional and spiritual are categorized as: needs of family members Able to be sensitive to the needs of the family members A. WELLNESS CONDITION Able to communicate thoughts and feelings Stated as Potential or Readiness effectively Able to provide support, security and A clinical or nursing judgment about a client in encouragement transition from a specific level of wellness or Able to initiate and maintain growth producing capability to a higher level. relationship Maintain and create constructive and responsible community relationships A. Potential or Capability B. Readiness for Able to grow with and through children for: Enhanced Capability for: Ability to perform family roles flexibly Able to help oneself and to accept help when Healthy Lifestyle Healthy Lifestyle appropriate – e.g. nutrition, Health Demonstrate mutual respect for the individuality of diet, exercise, Maintenance/ family members activity Health Ability to use a crisis experience as a means of Health Management growth Maintenance/ Parenting Demonstrate concern of family unity, loyalty and Health Breastfeeding inter family cooperation Management Spiritual Parenting Well-being —————————END of MODULE 3——————— Breastfeeding Spiritual Others Well-being MODULE 4: FAMILY NURSING Others PROCESS Includes data collection data analysis or interpretation problem definition or nursing diagnosis B. HEALTH THREATS The rationale for adopting these health tasks as the Conditions that are conducive to disease and accident, or framework of the typology is the fact that in community may result in failure to maintain wellness or realize health health nursing practice, one deals mostly with problems potential. within the domain of human behavior or human response to health and illness. A. Presence of risk factors of specific diseases B. Threat of cross infection from a communicable A community health nurse works with and through the family disease case to improve its behavior related to health. C. Family size beyond what family resources can adequately provide ASSESSMENT AND DIAGNOSES IN FAMILY D. Accident/ fire hazards NURSING PRACTICE NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) E. Faulty/ unhealthful nutritional/ eating habits or Data collection for first level assessment includes feeding techniques or Practices gathering the five types of data, namely: F. Stress provoking factors G. Poor home environmental condition/ sanitation H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/practices Family structure and Includes J. Inherent personal characteristics characteristics family composition and K. Health history which may participate/ induce the demographic data occurrence of a health deficit L. Inappropriate role assumption type of family form and M. Lack of immunization/inadequate immunization structure status specially of children decision-making N. Family disunity patterns communication patterns affecting family C. HEALTH DEFICITS relatedness Instances of failure in health maintenance ○ disease - regardless of whether it is diagnosed or undiagnosed by medical Socio-economic and Includes practitioner, disability, developmental cultural factors occupation, place of work, and income of each working member, D. STRESS POINTS/FORESEEABLE CRISIS educational attainment, Anticipated periods of unusual demand on the individual or ethnic background, family in terms of adjustment/family resources. religious affiliation, A. Marriage family traditions B. Pregnancy, labor, Puerperium the relationship of the C. Parenthood family to a larger D. Additional member-e.g. newborn, lodger community E. Abortion F. Entrance at school Home and Environmental Includes G. Adolescence H. Divorce or separation factors information on housing I. Menopause and sanitation facilities; J. Loss of job kind of neighborhood K. Hospitalization of a family memberDeath of a and availability of member social,health, L. Resettlement in a new community communication, M. Illegitimacy transportation facilities in the community. Statement of the Problem Health assessment of Includes P = Problem, E = Etiology (Cause), S = Etiology (Cause), S each member current and past = Signs/Symptoms significant health conditions or illness; Example: beliefs and practices conducive to health and Diarrhea (undiagnosed) as health deficit related to eating of illness; contaminated & unclean food as evidenced by: · nutritional and developmental status; Loose watery stool physical assessment 4X bowel movement/day findings and significant Poor skin turgor body weakness, and as verbalized, results of laboratory/ “symptom kahapon pa sang aga ako naga lupot”. diagnostic tests/ “kag nagakutoy akon tiyan”. screening procedures NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them Value placed on health Includes use of promotive - E. Inability to decide which action to take from among promotions, health preventive services as a list of alternatives maintenance and evidenced by immunization F. Conflicting opinions among family prevention of disease status and use of other healthy members/significant others regarding action to take. lifestyle related services; G. Lack of/inadequate knowledge of community adequacy of rest/sleep resources for care H. Fear of consequences of action, specifically: Social consequences Economic consequences Data gathering methods includes Physical consequences Observation Emotional/psychological consequences Physical examination I. Negative attitude towards the health condition or Interview problem-by negative attitude is meant one that interferes with rational decision-making. Review of records J. In accessibility of appropriate resources for care, Laboratory and Diagnostic procedures specifically: Physical Inaccessibility SECOND LEVEL ASSESSMENT Costs constraints or economic/financial Identifies the nature or type of nursing problems the family inaccessibility experiences in the performance of their health tasks with K. Lack of trust/confidence in the health respect to a certain health condition or health problem. personnel/agency L. Misconceptions or erroneous information about proposed course(s) of action FIVE MAIN TYPES OF FAMILY NURSING PROBLEMS III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk I. Inability to recognize the presence of the condition member of the family due to: or problem due to: A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, A. Lack of or inadequate knowledge complications, prognosis and management) B. Denial about its existence or severity as a result of B. Lack of/inadequate knowledge about child fear of consequences of diagnosis of problem, development and care specifically: C. Lack of/inadequate knowledge of the nature or Social-stigma, loss of respect of extent of nursing care needed peer/significant others D. Lack of the necessary facilities, equipment and Economic/cost implications supplies of care Physical consequences E. Lack of/inadequate knowledge or skill in carrying Emotional/psychological issues/concerns out the necessary intervention or C. Attitude/ Philosophy in life, which hinders treatment/procedure of care (i.e. complex recognition /acceptance of a problem therapeutic regimen or healthy lifestyle program). F. Inadequate family resources of care specifically: Absence of responsible member II. Inability to make decisions with respect to taking Financial constraints appropriate health action due to: Limitation of luck/lack of physical A. Failure to comprehend the nature/magnitude of the G. Significant persons unexpressed feelings (e.g. problem/condition hostility/anger, guilt, fear/anxiety, despair, rejection) B. Low salience of the problem/condition which his/her capacities to provide care. C. Feeling of confusion, helplessness and/or H. Philosophy in life which negates/hinder caring for resignation brought about by perceived the sick, disabled, dependent, vulnerable/at risk magnitude/severity of the situation or problem, i.e. member failure to break down problems into manageable I. Member’s preoccupation with on concerns/interests units of attack. J. Prolonged disease or disabilities, which exhaust the supportive capacity of family members. NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) K. Altered role performance, specify. Financial resources, cost of medicines Role denials or ambivalence prescribe Role strain Feeling of alienation to/lack of support Role dissatisfaction from the community, e.g. stigma due to Role conflict mental illness, AIDS, etc. I. Cost constraints Role confusion Physical inaccessibility Role overload J. Negative attitude/ philosophy in life which hinders effective/maximum utilization of community IV. Inability to provide a home environment resources for health care conducive to health maintenance and personal development due to: ________________________________________________ A. Inadequate family resources specifically: Second Level of Assessment: Financial constraints/limited financial resources Example: Limited physical resources- e.i. lack of space to construct facility Inability to provide adequate nursing care due to: B. Failure to see benefits (specifically long-term ones) of investments in home environment improvement A. Lack of knowledge and skill in treatment of diarrhea C. Lack of/inadequate knowledge of importance of as verbalized by the mother: “Wala ko kabalo kon hygiene and sanitation paano bulngon ang lupot”. D. Lack of/inadequate knowledge of preventive measures Family Health Task E. Lack of skill in carrying out measures to improve home environment In order to achieve wellness among its members and reduce F. Ineffective communication pattern within the family or eliminate health problems, the standard or norm of the G. Lack of supportive relationship among family family as a functioning unit involves the ability to perform the members following health tasks: H. Negative attitudes/philosophy in life which is not conducive to health maintenance and personal A. Recognize the presence of a wellness state or development health condition or problem I. Lack of/inadequate competencies in relating to each B. Make decisions about taking appropriate health other for mutual growth and maturation (e.g. action to maintain wellness or manage the health reduced ability to meet the physical and problem psychological needs of other members as a result C. Provide nursing care to the sick, disabled, of family’s preoccupation with current problem or dependent or at-risk members condition. D. Maintain a home environment conducive to health maintenance and personal development E. Utilize community resources for health care V. Failure to utilize community resources for health care due to: Note: Utilizing the data gathered from the Initial Data Base A. Lack of/inadequate knowledge of community (IDB), the nurse goes through the data analysis. The resources for health care end-result of the analysis during B. Failure to perceive the benefits of health care/services The first-level assessment is a conclusion or a C. Lack of trust/confidence in the agency/personnel statement of a health condition or problem, D. Previous unpleasant experience with health worker classified as a wellness potential, health threat and E. Fear of consequences of action (preventive, health deficit or stress point/ foreseeable crisis. diagnostic, therapeutic, rehabilitative) specifically: The second - level of assessment ends with a Physical/psychological consequences definition of family nursing problems, in terms of Financial consequences how the family handles it. Social consequences F. Unavailability of required care/services PLANNING, IMPLEMENTING AND EVALUATING IN G. Inaccessibility of required services due to: FAMILY NURSING PRACTICE FAMILY NURSING H. Lack of or inadequate family resources, specifically: CARE PLAN Manpower resources, e.g. babysitter NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) Is a blueprint of nursing care designed to systematically Foreseeable crisis enhance the family’s capability to maintain wellness, manage health problems through explicitly formulated goals and objectives of care and deliberately chosen set of 2. Modifiability of the Condition interventions, resources, & evaluation criteria, standards, Probability of success in enhancing wellness, methods/tools. improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. STEPS IN DEVELOPING A FAMILY NURSING CARE Factors to consider in determining modifiability of PLAN the problem: 1. Prioritize Health Conditions or Problems ○ Current knowledge, technology and interventions to enhance wellness state or 1. Goal and Objectives of Nursing Care manage the problem 2. Intervention Plan ○ Resources of the family-physical, financial 3. Evaluation Plan and manpower ○ Resources of the nurse-knowledge, skill Health Problem and time Process whereby existing and potential health conditions or ○ Resources of the community-facilities and problems of the families are determined. They reflect depth community organization or support of data gathering and analysis on what health conditions or problems exist. This is derived from the First Level 3. Preventive Potential Assessment of the Typology of Nursing Problems. Which Nature and magnitude of future problems that can be categorizes the presence of: minimized or totally prevented if interventions are done on the problem. Wellness state Health deficits Factors to consider in determining preventive potential: Health threats Foreseeable crisis or stress points Gravity or severity of the problem – refers to the progress of disease indicating extent of damage on the client. The more severe or advanced the FAMILY NURSING DIAGNOSIS problem, the lower is the preventive potential. Defines the nature or type of nursing problems that Duration of the problem – refers to the length of the family encounters in performing the health tasks time the problem has been existing. Has a direct with respect to a given health condition or problem, relationship to gravity & preventive potential. and the etiology or barriers to the family’s Current Management – refers to the presence and assumption of these tasks. appropriateness of intervention measures instituted This is derived from the Second Level Assessment to enhance the wellness state or remedy the of the Typology of Nursing Problems. problem. The institution of appropriate intervention This includes those that specify or describe the increases the preventive potential. family’s realities, perceptions about and attitudes Exposure of any vulnerable or high-risk group – related to the assumption or performance of family Increases the preventive potential in determining health tasks on each health condition or problem the score for salience. The family’s concerns, felt identified during the first-level assessment. needs, or readiness increases the salience. The nurse should learn to prioritize the numerous family nursing problems considering the available 4. SALIENCE resources of the nurse, the family and the community. Family’s perception & evaluation of the problem in terms of seriousness & urgency of attention needed or family readiness. FOUR CRITERIA IN PRIORITIZING HEALTH CONDITIONS Scale for Ranking Health and Conditions and Problems According to Priorities 1. Nature of the Problem Wellness condition Health deficit Health threat NCM 104 - COMMUNITY HEALTH NURSING 1 (Individual & Family) 2. Long term/ Ultimate objective Require several nurse-family encounters & investment of more resources. Outcomes sought require time to demonstrate. 3. Medium term/ Intermediate objective Those which are not immediately achieved. Components of an objective (ABCD) 1. Actor / Subject – client, any part of the client or some attributes of the client. 2. Behavior / Verb – action of the client to perform. 3. Conditions / Modifiers - explain the circumstances under which the behavior is to be performed, (what, where, when, how) 4. Determinant / Criterion of Desired Performance - SCORING AND PRIORITIZING Level at which the client will perform the specified 1. Decide on a score for each of the criteria. behavior. 2. Divide the score by the highest possible score and multiply by the weight a. Score/Highest Score x Weight HEALTH CARE STRATEGIES 3. Sum up the scores for all the criteria. The highest This involves selection of appropriate nursing interventions/ score is 5, equivalent to the total weight. health care strategies based on the formulated goal and 4. Rank the overall score of each nursing problem. objective. 5. The nursing problem with the highest score will be the priority while the problem with the lowest score Focus on Interventions to Help the Family Performs will be the least priority. Health Tasks Help the family recognize the problem Goal of Care Guide the family on how to decide on appropriate A broad desired outcome toward which behavior is health actions to take. directed. Develop the family’s ability and commitment to The Cardinal Principle: Goals must be jointly set provide nursing care to each member. with the family. This ensures the family's Enhance the capability of the family to provide a commitment to their realization. home environment conducive to health Goals set by the nurse & family should be realistic maintenance and personal development. or attainable. Facilitate the family’s capabil