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104 community-health-nursing-lec THE FAMILY Concepts of Family The basic unit of society A primary entity of health care Institution responsible for the physical, emotional, and social support of its members Its foundation is marriage, the group which ensures continuity through its...

104 community-health-nursing-lec THE FAMILY Concepts of Family The basic unit of society A primary entity of health care Institution responsible for the physical, emotional, and social support of its members Its foundation is marriage, the group which ensures continuity through its reproductive function and socialization (Burges and Locked) the family is a group of persons united by ties of marriage, blood, birth or adoption. It constitute a single household, which is used to cover a number of family styles and refers to a group of people who share a common dwelling and cooking facilities. Family two or more individuals coming from the same or different kinship groups who are involved in a continuous living arrangement, usually residing in the same household, experiencing common emotional bonds, and sharing certain obligations toward each other and toward others. Family Centered Nursing A condition including the promotion and maintenance of physical, mental, spiritual, and social health for the family unit and for individual family members. Family process the ongoing interaction between family members through which they accomplish their instrumental and expressive tasks. The nursing process considers the family, not the individual, as the unit of care. Family Centered Nursing nursing that considers health of the family as a unit in addition to the health of individual family members. FAMILY CENTERED NURSING APPROACH The four approaches included in the family health nursing care views are: 1. Family as the context 2. Family as the client 3. Family as a system 4. Family as a component of society FAMILY AS THE CONTEXT When the nurse views the family as context, the primary focus is on the health and development of an individual member existing within a specific environment (i.E., The client’s family)  Although the nurse focuses the nursing process on the individual’s health status, the nurse also assesses the extent to which the family provides the individual’s basic needs. These needs vary, depending on the individual’s development level and situation. Because families provide more than just material essentials, their ability to help the client meet psychological needs must also be considered Family members may need direct interventions themselves. FAMILY AS THE CLIENT The family is the foreground and individuals are in the background. The family is seems as the sum of individuals' family members. The focus is concentrated on each and every individual as they affect the whole family. From this perspective, a nurse might ask a family member who has just become ill. Tell me about what has been going on with your own health and how your perceive each family member responding to your mother’s recent diagnosis of liver cancer. FAMILY AS A SYSTEM The focus is on the family as a client and it is viewed as an international system in which the whole is more than the sum of its parts. This approach focuses on the individual and family members become the target for nursing interventions. Eg: the direct interaction between the parent and the child. The system approach to the family always implies that when something happens to one affected. It is important to understand that although theoretical and practical distinctions can be made between the family as context and the family as client, they are not necessarily mutually exclusive, and both are often used simultaneously, such as with the perspective of the family as system. FAMILY AS A COMPONENT OF SOCIETY The family is seen as one of many institutions in society, along with health, educational, religious, or economic institution. The family is a basic or primary unit of society, as are all the other units and they are all a part of the larger system of society. The family as a whole interacts with other institutions to receive exchange or give communications and services. Community health nursing has drawn many of its clients from this perspective as it focuses on the interface between families and communities. Family health nursing practice like any nursing practice begins with the nursing process. By using this process, the nurse practicing with family perspectives is potentially able to effectively intervene at any of the levels. After an assessment of the individuals, family nit, and supra system, the nurse is ready to begin to identify areas of concern or need. THE FILIPINO FAMILY Based on the Philippine Constitution, Family code with focus on religious, legal, and cultural aspects of the definition of family. Section 1 The state recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen its solidarity Section 2 Marriage, as an inviolate social institution, is the foundation of family and shall be protected by the state. Section 3 The state shall defend – 1. The right of spouse to found a family in accordance with their religious convictions and the demands of responsible parenthood 2. The right of children to assistance including proper car, and nutrition, and special protection from all forms of neglect, abuse, cruelty, exploitation, and other conditions prejudicial to their development. 3. The right of the family to a family living wage income 4. The right of families or family associations to participate in the planning and implementation of policies and programs of that affect them in the planning Section 4 The family has the duty to care for its elderly members but the state may also do so through just programs of social security FAMILY ROLE As basic and essential building blocks of societies, families have a crucial role in social development. They bear the primary responsibility for the education and socialization of children as well as instilling values of citizenship and belonging in the society. An expected set of behaviors associated with a particular family position that can be formal or informal 1. Formal roles – recognized by expectations associated with roles 2. Informal roles – are those that are casually acquired within the family - patriarchalism FIVE ESSENTIAL ROLES FOR THE EFFECTIVE FAMILY FUNCTIONING There are many roles within a family; however, researchers have identified the following five roles as being essential for a healthy family. 1. Provision of resources Providing resources, such as money, food, clothing, and shelter, for all family members is one of the most basic, yet important, roles within a family. This is primarily an instrumental role.  0. Nurturance and support Nurturing and supporting other family members is primarily an affective role and includes providing comfort, warmth, and reassurance for family members. Examples of this role are a parent comforting a child after he/she has a bad day at school, or family members supporting one another after the death of a loved one. 0. Life skills development The life skills development role includes the physical emotional, educational, and social development of children and adults. Examples of this role are a parent helping a child make it through school, or a parent helping a young adult child decide on a career path. 0. Maintenance and management of the family system This fourth role involves many tasks, including leadership, decision making, handling family finances, and maintaining appropriate roles with respect to extended family, friends and neighbors. Other responsibilities of this role include maintaining discipline and enforcing behavioral standards. 0. Sexual gratification of marital partners A satisfying sexual relationship is one of the keys to a quality marital relationship. This role involves meeting sexual needs in a manner that is satisfying to both spouses. CHARACTERISTICS OF A FAMILY 1. Commitment: they make their relationships a high priority. This is particularly important in co-parenting families. Reassure your children it is OK to love all of their parents and siblings; don’t make them feel guilty. 2. Appreciation: they let other family know, daily, they were appreciated. Teach and use appreciative language and gestures. Children learn from adult examples. 3. Communication: they talk to each other about big issues as well as small issues. Keep your communication positive, listen to all opinions and don’t forget to lighten the mood with laughter when tensions are running high. 4. Time together: they are deliberate about planning activities. Mealtime is a great place to start. Include family members in menu planning, shopping and food preparation. 5. Spiritual wellness: they believe in a greater power and have shared beliefs. Model acceptance and tolerance. Share your views about your beliefs and why they are important to you. 6. Crisis and stress: they are able to cope with difficulties and crises—they are resilient. Be mindful of how others in the family feel when things are stressful. Encourage family members to work together and share feelings when the going gets tough. TYPES OF FAMILY There are many types of family. They change overtime as a consequence of births, death, migration, separation, and growth of family A. Structure Nuclear – a father, mother with child/ children living together but apart from both sets of parents and other relatives.  Extended – composed of two or more nuclear families economically and socially related to each other. Multigenerational, including married brothers and sisters, and the families Single parent – divorced or separated, unmarried or widowed male or female with at least one child Blended/ Reconstituted – combination of two families with children from both families and sometimes children of the newly married couple. It is also a remarriage with children from previous marriage Compound – one man/ woman with several spouses Communal – more than one monogamous couple sharing resources; choose to live together as an extended family Cohabitation / live- in – unmarried couple living together Dyad – husband and wife or other couple living alone without children Gay/ lesbian – homosexual couple living together with or without children No-kin – a group of at least two people sharing a relationship and exchange support who have no legal or blood tie to each other Foster – substitute family for children whose parents are unable to care for them. FUNCTIONAL TYPE: 1. Family of procreation – refers to the family you yourself created. 2. Family of orientation – refers to the family where you came from. B. Decisions in the Family (AUTHORITY) Patriarchal – full authority on the father or any male member of the family e.g. eldest son, grandfather. Matriarchal – full authority of the mother or any female member of the family, e.g. eldest sister, grandmother. Egalitarian – husband and wife exercise a more or less amount of authority, father and mother decides. Democratic – everybody is involve in decision making Laissez- faire – “ full autonomy” Matricentric – the mother decides / take charge in absence of the father e.g. father is working overseas Patricentric – the father decides takes charge in absence of the mother C. DECENT (Cultural norms, which affiliate a person with a particular group of kinsman for certain social purposes) Patrilineal – affiliate a person with a group of relatives who are related to him through his mother Bilateral – both parents Matrilineal – related through mother D. Residence Patrilocal – family resides / stay with / near domicile of the parents of the husband. Matrilocal – live near the domicile of the parents of wife THE FAMILY HEALTH NURSING PROCESS Definition of Family Health Nursing Focuses on the family as a unit of service As the CHN utilizes the nursing process, he assesses the family as a whole- the individual and family functioning, and establish client-centered goals relevant to the needs of the entire family unit. As the nurse develops a trusting and supportive relationship with the family , he must remember that the family is responsible for their own health. He must form client-focused goals with the family as she extends the needed health service and assistance. FAMILY NURSING PROCESS A client –oriented systematic and dynamic approach to scientific problem solving involving a series of dynamic actions- relating/establishing a good working relationship with the family , assessment, planning, implementing and evaluating- for the purpose of facilitating optimum family functioning. It acknowledges the autonomy of the family and their freedom to make decision regarding their own goals as they actively involve themselves in family care. By including the family as an active participant in the nursing process , the chn will help maintain the family’s control over their life and responsibility for action PURPOSE OF THE FAMILY HEALTH NURSING PROCESS 1. To determine the level of family functioning 2. To clarify family interactions patterns 3. To identify family strengths and weaknesses 4. To describe the health status of the family and its individual members. Initial Assessment/ Data Base for Family Nursing Practice Nursing Assessment- Involves a set of actions by which the nurse measures the status of the family as a client , its ability to maintain itself as a system and functioning unit, and its ability to prevent, control or resolve problems in order to achieve health and well being among its members Data about the present condition or status of the family are compared against norms or standards of personal and social health, system integrity and the ability to resolve system problems. These norms or standards are derived from values, beliefs, principles, rules or expectations. Nursing assessment includes: 1. Data collection 2. Data analysis or interpretation 3. Problem definition or nursing diagnosis Nursing diagnosis is the end result of two major types of nursing assessment in family nursing practice which are:  1. First level assessment- a process whereby existing and potential health conditions or problems of the family are determined. These health conditions or problems are categorized as: 1. Wellness states 2. Health threats 3. Health deficits 4. Stress points or foreseeable crisis situations 0. Second-level assessment- defines the nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem, and the etiology or barriers to the family’s assumption of these tasks. STEPS IN FAMILY NURSING ASSESSMENT 1. Data collection for first level assessment- involves gathering of 5 types of data which will generate the categories of health conditions or problems of the family. These data include: a. Family structure, characteristics and dynamics- include the composition and demographic data of the members of the family /household, their relationship to the head and place of residence; the type of, and family interaction/communication and decision-making patterns and dynamics. a. Socio-economic and cultural characteristics – include occupation, place of work, and income of each working member; educational attainment of each family member; ethnic background and religious affiliation; significant others and other roles they play in the family’s life ; and the relationship of the family to the larger community b. Home and environment- include information on housing and sanitation facilities; kind of neighbourhood and availability of social, health communication and transportation facilities in the community c. Health status of each member – includes current and past significant illness; beliefs and practices conducive to health and illness; nutritional and developmental status; physical assessment findings and significant results of laboratory/diagnostic tests/ screening procedures. d. Values and practices on health promotion/maintenance and disease prevention- include use of preventive services; adequacy of rest/sleep, exercise, relaxation activities, stress management or other healthy lifestyle activities, and immunization status of at-risk family members Family health (Hanson) a dynamic changing relative state of well-being which includes the biological, psychological, spiritual, sociological, and cultural factors of the family system. The bio-psycho-socio-cultural-spiritual approach refers to individual members as well as the family unit as a whole entity and the family within the cmty context.  An individual’s health affects the functioning of the entire family, and in turn the family’s functioning affects the health of individuals Health Tasks of the Family: 1. Recognizing interruptions in health or development 2. Seeking health car 3. Managing health and non-health crisis 4. Providing nursing care to the sick, disabled or dependent members of the family 5. Maintaining a home environment conducive to good health and personal development 6. Maintaining a reciprocal relationship with the community and its health institutions Family Case Load Refers to the number and kind of families a nurse handles at any given time With the use of a suitable family –nurse contact, the community health nurse must first assess all components of family functioning: 1. Family dynamics 2. Health status of each family member 3. Socio-economic –cultural factors 4. Home living and environmental condition 5. Preventive health practices The above components of family functioning can be obtained through:(methods of data gathering) 1. Direct observation 2. Interview 3. Examination 4. Records review Accurate recording should be done by: 1. Narrative 2. Checklist format 3. Summary recording On completion of the data collection, the CHN compares the information to documented norms of health and illness. It is essential to remember that what is acceptable and appropriate in one family may be considered unusual in another. The nurse should make proper allowances for the family’s characteristics and the community of which they are a member. TOOLS USED IN FAMILY ASSESSMENT 1. Genogram 2. Ecomap 3. Initial Database 4. Family Assessment Guide GENOGRAM Displays pertinent family information in a family tree format that shows family members and their relationships over at least 3 generations. Presents the family history and illness patterns for planning interventions which will enhance the nurse’s abilities to make clinical judgment and connect them to family structure and history. For each person on the genogram, the nurse should determine the ff information that is relevant to the issues the family is experiencing. First name Age Date of birth Occupation Health problems Cause of death Date of marriages, divorces, separations, commitments education level ethnic/ religious background The ff areas are essential to note in the family genogram: 1. family structure: nuclear, extended, single-parent household 2. sibling subsystem group: birth order, sex, distance between ages of children 3. patterns of repetition: patterns across the generations related to family structure, behaviors, health problems, relationships, violence, abuse, poverty 4. Life events: repeated similar events across the generations , such as transitions, traumas. Medical History Since the genogram is meant to be an orienting map of the family, there is room to indicate only the most important factors, such as major or chronic illnesses and problems include date in parentheses where possible. Use diagnostic labels where available (ex. Stroke, cancer, diabetes) Other family information of special importance may also be noted: Religion or religion change Education Occupation or unemployment Military service Retirement Trouble with law Physical abuse or incest Obesity Chemical use ( smoking, alcohol, drugs) Dates when family members left home Current location of family members ECOMAP  A visual diagram of the family unit in relation to other units or subsystems in the community. Serves as a tool to organize and present factual information and allows the chn to have a more holistic and integrated perception of the family situation Presents the nature of the relationships among family members, and between families and the community The nature and quality of relationships and the direction of energy flow between the family members and the subsystems are shown by different connecting lines. Serves as a tool to organize and present information allowing the chn to have a more holistic and integrated perception of the family situation. FAMILY APGAR Helps determine The family’s ability to acquire resources and productive use of money or social support The ability to communicate in depth with each other with openness and consensual decision making The presence of encouragement, support, praise, recognition, respect for individuality, and flexibility of family functions and roles, and family unity, loyalty, and cooperation. FAMILY COPING INDEX to provide a basis for estimating the nursing needs of a particular family. Provides a means for indicating the change the nurse expects in the family’s capacity to cope with its problems, as well as their present coping capacity. A family nursing need is present when the family has a health problem in which they are unable to cope , and when there is a reasonable likelihood that nursing will make a difference in the family’s ability to cope. COPING- Defined as dealing with problems associated with health care with reasonable success. It has been selected as an index of nursing need because the particular contribution of nursing to health care is to strengthen or supplement the capacity of the indiv or family as it encounters the stress of illness, or the opportunity to prevent disease and to promote health. Coping Deficit- When the family is unable to cope with one or another aspect of health care The coping index consists of 2 parts: 1. A point on the scale 2. A justification statement The evaluation should be repeated at 3-months interval if the family is supervised for a long period of time. Scaling Cues: The CHN rate the coping capacity of their family case load according to: “1” no competence, “3”moderate competence and “5”complete competence. Family Coping Areas:  1. 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 daily activities 2. Therapeutic Competence: This category includes all the procedures or treatments prescribed for the care of illness, such as giving medication, dressings, exercise and relaxation, special diets. 3. Knowledge of Health Condition: This is concerned with the particular health condition that is the condition for care. 4. Application of the Principles of General Hygiene: This is concerned with the family action in relation to maintaining family nutrition, securing adequate rest and 5. 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. 6. EMOTIONAL COMPETENCE : This category has to do with the maturity and integrity in 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. 7. 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, the degree to which they support one another and do things as a family, the degree of respect and affection they show for one another, the ways in which they manage the family budget, the kind of discipline that prevails. 8. PHYSICAL ENVIRONMENT: this is concerned with the home, the community and the work environment as it affects family health. The condition of the house such as the presence of accident hazards, screening, plumbing system, facilities for cooking and privacy. 9. USE OF COMMUNITY FACILITIES: this has to do with the degree of family’s use and awareness of available cmty facilities for health education and welfare. This includes the ways they would use services of private physicians, clinics, hospitals, schools, welfare organizations and churches. The coping ability does not indicate the level of the need for services but rather the degree to which they can cope when they must seek aid. Analysis, Synthesis and Validation After gathering the essential data to identify the family’s problems and needs, The CHN will now formulate a typology of nursing problem to analyze and synthesize the findings and to determine the family’s perception of its nursing care needs rather than that of a family member. This will delineate the family strengths, needs and anticipatory guidance when the chn is assisting the family reinforce their functioning and capabilities. NURSING DIAGNOSIS: Identifying Family Needs Consists of the identification of actual or potential health problems that are amenable to resolution by nursing actions after the family assessment data have been organized and analyzed. Typology of Nursing Problems in Family Nursing Practice Health Problem – A situation or condition which interferes with the promotion and/or maintenance of health and recovery from illness or injury. Nursing Problem – A situation or condition which interferes with the promotion and/or maintenance of health and recovery from illness or injury, and which is subject to change or modification through a nursing intervention.  Health Threats – Are conditions conducive to disease, accidents or failure to realize one’s health potential. Examples: family history of hereditary diseases ( diabetes, hypertension, cancer, heart disease, blood disorders) , accident hazards, inadequate immunization of children. Health deficit – Are instances of failure in health maintenance and includes illness states, whether diagnosed or undiagnosed, failure to thrive or develop accdg to the expected rate and personality disorders A health deficit occurs when there is a gap between actual and achievable health status. Ex. History of repeated infections, or miscarriages; no regular check-up. Stress point/ Foreseeable crisis Includes anticipated periods of unusual demand on the individual or the family in terms of adjustments of family resources. Types of Crisis Situation: 1. Developmental/maturational crisis situation are conflicts encountered by the family to the biological stages of growth and development, characterized by physical, psychological and social changes ex. Preg, birth, parenting 2. Situational or accidental crisis situations are unavoidable, stressful event or life changes, threatening or causing a disequilibrium on the family’s biological and social integrity. Examples are death of a family member, loss of a job, and accidental injuries 1st Level Assessment: Identify health threats, foreseeable crisis, health deficits & wellness potential/state 2nd Level Assessment: Determining family’s ability to perform the family health tasks on each health threat; health deficit, foreseeable crisis or wellness potential SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES Criteria Highest Score Weight 1.Nature of the problem presented 3 1 Scale: Healthdeficit-3 Health threat-2 Foreseeable crisis- 1  2. Modifiability of the Problem 2 2 Scale: Easily modifiable -2 Partially modifiable -1 Not modifiable -0 3. Preventive Potential 3 1 Scale: High- 3 Moderate – 2 Low -1 4. Salience 2 1 Scale: A serious problem, immediate attention needed-2 A problem but need no immediate attention -1 Not a felt need/problem - 0 Scoring: 1. Decide on a score for each criteria 2. Divide the score by the highest possible score and multiply by the weight Score ÷highest score x weight = score 0. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight. THE FAMILY HEALTH NURSING CARE PLAN The FNCP focuses on actions which designed to solve or minimize existing problem It is a product of deliberate systematic process. The nursing care plan, as with all plans, relates to the future FNCP is based upon identified health and nursing problems Barriers to implementation Family related: Apathy Indecision Nurse related Imposing ideas Negative labeling Overlooking family strength Neglecting cultural and gender implications of family intervention (Friedman, 1998) Categories of Intervention May include: Education programs New or stronger policies Improvement of environment Health promotion campaign Depends on the needs as well as the goals and objectives of the identified family, intervention or interventions may range from simple or immediate to complicated or prolonged 3 categories/types of nursing interventions 1. Supplemental Interventions Actions that the nurse performs on behalf of the family when it is unable to do things for itself (ex. Providing direct nursing care to a sick member of the family 0. Facilitate Interventions Actions that remove barriers to appropriate health action (ex. Assisting the family to avail of maternal and child care services) 0. Developmental Interventions Aim to improve the capacity of the family to provide for its own health need How to help the family perform the health task: 1. Assist or help the family recognize the problem Increase family’s knowledge on nature Help the family see the implication of the situation Relating health needs to the health and non-health goals of the family Encouraging positive emotional attitude toward the problem by affirming the family’s capabilities and providing information on available options 0. Guide the family on how to decide 0. Develop the family;s ability and commitment to provide nursing care to its member 0. Enhance the capability of the family to have a home environment conducive to good health maintenance 0. Facilitate the family’s capability to utilize resources for heahlth care Categories of intervention 1. Promotive Tending or serving to promote measures promotive of good health 0. Preventive A medicine or other treatment designed to stop disease 0. Curative 0. Rehabilitative Health care services that help you keep, get back, or improve skills Evaluation Determining the value of nursing care that has been given to a family The product of this step is used for further decision making, to terminate, continue, or modify the interventions  Well formulated goals and objectives in the nursing care plan serves as the framework for evaluation Evaluation method Direct observation Interview Oral or written tests Health and/or physical examination Record review Types of Evaluation 1. Formative evaluation Judgement made 0. Summative evaluation End results of family nursing care Aspects of evaluation 1. Effectiveness 2. Appropriateness 3. Adequacy 4. Efficiency Documentation The family nursing care plan is a written guide of the nurse and family to ensure a systematic approach Tools on how to set up a record keeping system: 1. The family service and progress record 2. Used of the the family service and progress record Tools of Public Health Nurse 1. Nursing bag or the PHN bag Important tool during home visit Types of Family Nurse Contact 1. The family Clinic visit, hoe visit, group conference, telephone contact, written communication, messagesvia text, messenger, vibed, and other social media text messaging ap Major criteria for selecting the type of family nurse contact Effective Efficient Appropriate CLINIC VISIT  May take place in a private clinic, health center, barangay center or in a mobile clinic GROUP CONFERENCE Provides an opportunity for initial contact between the nurse and target families Gmeet TELEPHONE CONFERENCE Resources are possible, telephone conference via landline or cellphone Afford easy access to data like monitoring of health WRITTEN COMMUNICATION Less time consuming option ofor nurse in instances that there are priority families needed follow up SCHOOL VISIT School conference Provides the opportunity to work with the family and school authorities on how to determine the degree of vulnerability INDUSTRIAL PLANT OR JOB SITE VISIT Health risk in the work place HOME VISIT Professional and purposeful interaction that takes place in the residence of the family When the nurse makes a home visit: Resources Promotes family participation and focuses on the family as a unit Teaching families in their homes is easier Personalized home visits gives the family a sense of self confidence in themselves and the agency Phases of Home visit 1. Pre visit phase Nurse contact family, determines family's willingness for a home visit 0. In home phase Begins as soon the nurse seeks permission to enter the house and ends when the nurse leaves the family's home 0. Post visit When the nurse has returns to the health facility and odes the documentation of the visit Nursing action, time, date, signature Three phases of in home phase 1. Initiation Upon entering the room, the nurse acknowledges the family members with a greeting and introduces and the agency the nurse represents To establish rapport 0. Implementation  Apply nursing process, assess and provide nursing care while teaching the mother 0. Termination 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 such as clinic visit Principles in planning a home visit 1. The home visit should have a purpose - the nurse is the guest in the family and not for social reason and should be therapeutic 2. Use information about the family collected from all possible sources such as records, other personnel and agency/ or previous contacts with the family 3. The home visit plan focuses on identified family needs, particularly needs recognized by the family should actively participate in planning for continuing care 4. The plan should be practical and adaptable Purpose 1. To have more accurate assessment 2. To educate the family about measures 3. To prevent the spread of infection 4. To provide supplemental intervention 5. T provide family with greater access to health Records in family health nursing (Nursing records and reports) All professional person need to be accountable for the perforance Record and Reports Records Permanent written communication that documents information relevant to a clientes health care management Purpose of records Supply data that are essential for programmed planning and evaluation Provide practitioner with data reunited Indicate plans for future Help in research for improvement of nursing care Effective health records Principles of record writing Nurses should develop their own method of expression and form in record writing Written clearly, appropriately, and adequately Records are confidential documents Accurately dated, times, and signs Not included abbreviations, jargons, meaningless phrases Values and uses of the records in hospital or health centers For the individual and family For the doctor  Inguide of diagnosis, treatent, and follow up Indicate progress and continuity of care Help self-evaluation For the nurse Documentation showing health condition of client Enable to judge quality and quantity of work done Indicate plans For Authorities Provide the management with statistical information necessary for decision regarding utilization of record Types of records 1. Cumulative or continuing record Found to be time saving Hospital 0. Family records These are records which relate to members of family, should be placed in a single-famly order 104-community-health-nursing-lab BAG TECHNIQUE Public Health Bag Is an essential and indispensable equipment of a public health nurse which she has to carry along during her home visits. It contains basic medication and articles which are necessary for giving care. BAG TECHNIQUE Definition A tool making use of a public health bag through which the nurse, during his/her home visit, can perform nursing procedures with ease and deftess, saving time and effort with the end in view of rendering effective nursing care. Rationale To render effective nursing care to clients &/or members of the family during home visit. Purpose 1. To carry out nursing procedure in home. 2. To perform minor dressing  3. To conduct delivery in emergency situations 4. To do cord care for a newborn child. 5. To check vital signs 6. To do collection and transportation of sample 7. To treat minor ailments Principles 1. Cleanliness 2. Handwashing 3. Clean of bag 4. Protecting and taking care of bag 5. Keep the instruments after sterilization 6. Protect the bag away from contamination 7. Keep the bag safety from children, animals and other 8. Avoid cross infection from the place 9. Keep the bag always upper surface area The use of the bag technique should minimize if not totally prevent the spread of infection from individuals to families, hence, to the community. Bag technique should save time and effort on the part of the nurse in the performance of nursing procedures BT should not overshadow concern for the patient rather should show the effectiveness of total care given to an individual or family. BT can be performed in a variety of ways depending upon agency policies, actual home situation, etc, as long as principles of avoiding transfer of infection is carried out. Special Considerations in the use of the Bag 1. The bag should contain all necessary articles, supplies, and equipment that may be used to answer emergency needs. 2. The bag and its contents should be cleaned as often as possible, supplies replaced and ready for use any time. 3. The bag and its contents should be well protected from contact with any article in the home of the patients. Consider the bag and its contents clean and/or sterile while any article belonging to the patient as dirty and contaminated 4. The arrangement of the contents of the bag should be the one most convenient to the user to facilitate efficiency and avoid confusion. 5. Handwashing is done as frequently as the situation calls for, helps in minimizing or avoiding contamination of the bag and its contents. 6. The bag when used for a communicable case should be thoroughly cleaned and disinfected before keeping and re-using. Content of the bag  Paper lining Baby’s scale Extra paper for making bag for waste 1 pair of rubber gloves materials (paper bag) 2 test tubes Plastic linen/lining Test tube holder Apron Hand towel in plastic bag Soap in soap dish Medicines/Solutions: Thermometers (one oral and rectal) Betadine 2 pairs of scissors (1 surgical and 1 bandage) 70% alcohol 2 pairs of forceps (curved and straight) Ophthalmic ointment (antibiotic) Syringes (5 ml and 2 ml) Hydrogen peroxide Hypodermic needles (g 19, 22, 23, 25) Spirit of ammonia Sterile dressing (OS, cotton balls) Acetic acid Sterile cord tie Benedict’s solution Adhesive plaster Alcohol lamp Tape measure Arrangement of the Bag A. Front of Bag, Left to Right Thermometer in case Tape measure Adhesive plaster Cotton Applicator B. On Right Rear of Bag Test tubes and holder Medicine Dropper Alcohol Lamp C. On Left Rear of Bag 1. Medicine Glass 2. Baby Scale 3. Bandage scissors 4. Rubber suction  D. Back of Bag, Left to Right 70% Alcohol Betadine solution Hydrogen Peroxide Ophthalmic Ointment 5. Zephiran Solution Spirit of Ammonia acetic Acid Benedict’s Solution Liquid Soap Cotton in Sterile Water E. In the Center of the Bag 2 pairs of forcep ( curved and straight) 1 surgical scissors Sterile Dressing ( OS & cotton balls) Roller Bandage Syringe ( 5 ml, 2 ml) Hypodermic needle (g 19,22,23,25) Sterile cord clamp Kidney basin F. On the top pile, center of bag Hand towel in plastic bag Soap in soap dish Apron Plastic/ linen lining G. Pocket of Bag Surgical Gloves Waste Paper Receptacle Note: Folded paper lining inserted between the flaps and cover of the bag. (BP apparatus and stethoscope are carried separately) Steps in BAG TECHNIQUE 1. Upon arriving at the client’s home, place the bag on the table or any flat surface lined with paper lining, clean side out (folded part touching the table). Put bag’s handles or strap beneath the bag. Rationale: To protect the bag from contamination. 0. Ask for a basin of water and a glass of water if faucet is not available. Place these outside the work area. Rat.: To be used for handwashing 0. Open the bag , take the linen/plastic lining and spread over work field or area. The paper lining, clean side out ( folded part out) Rat.: To protect the work field from being wet. To make a non-contaminated work field or area  0. Take out hand towel, soap dish and apron and place them at one corner of the work area (within the confines of the linen/plastic lining) Rat.: To prepare for handwashing. 0. Do handwashing. Wipe, dry with towel. Leave the plastic wrappers of the towel in soap dish in the bag. Rat.: Handwashing prevents possible infection from care provider to the client. 0. Put on an apron right side out and wrong side with crease touching the body, sliding the head into the neck strap. Neatly tie the straps at the back. Rat.: To protect the nurse’s uniform. Keeping the crease creates aesthetic appearance 0. Put out things most needed for specific case ( thermometer, kidney basin, cb, waste paper bag) and place at one corner of the work area. Rat.: To make them readily accessible 0. Place the waste paper bag outside of work area. Rat.: To prevent contamination of bag and contents 0. Close the bag. Rat.: To give comfort and security, maintain personal hygiene and hasten recovery 0. Proceed to the specific nursing care or treatment Rat.: To prevent contamination of clean area 0. After completing nursing care or treatment, clean and alcoholize the things used. Rat.: To protect caregiver and prevent spread of infection to others. 0. Do handwashing again. 0. Open the bag and put back all articles in their proper places. 0. Remove apron folding away from the body, with soiled side- folded inwards, and the clean side out. Place it in the bag 0. Fold linen/plastic lining, clean; place it in the bag and close the bag. 0. Make post visit conference on matters relevant to health care, taking anecdotal notes preparatory to final reporting. Rat.: To be used as a reference for future visit. 0. Make an appointment for the next visit ( either home or clinic) taking note of the date, time and purpose. Rat.: For follow-up care HERBAL MEDICINES Products made from botanicals, or plants, that are used to treat diseases or to maintain health are called herbal products, botanical products, or phytomedicines. A product made from plants and used solely for internal use is called an herbal supplement. DOH TIPS ON HANDLING MEDICINAL PLANTS / HERBS If possible, buy herbs that are grown organically i.e. without pesticides. Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits or nuts during and after heavy rainfall. Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal substances are found on young parts.  After harvesting, if drying is required, it is advisable to dry the plant parts either in the oven or air-dried on screens above ground and never on concrete floors. Store plant parts in sealed plastic bags or colored bottles in a cool dry place without sunlight preferably with a moisture absorbent material like charcoal. Leaves and other plant parts that are prepared properly, well-dried and stored can be used up to six months. LAGUNDI (VITEX NEGUNDO) A shrub that grows in the Philippines, known in English as the 5 leaved chaste tree. Lagundi contains Chrysoplenol D, a substance with anti- histamine and muscle relaxant properties BENEFITS Relief of rheumatism, dyspepsia, boils, diarrhea Removal of worms, and boils Alleviate symptoms of Chicken Pox Treatment of cough, colds, fever and flu and other bronchopulmonary disorders Relief of asthma & pharyngitis PREPARATION & USAGE Boil half cup of chopped fresh or dried leaves in 2cups of water for 15 minutes. Boil in low heat and do not cover the clay pot. For skin diseases or disorders, apply the decoction of leaves and roots directly on skin. The root is specially good for treating dyspepsia, worms, boils, colic and rheumatism. For treatment of fever, take recommended dosage every four hours. For treatment of asthma and cough divide the boiled concoction in 3 equal parts to be taken in the morning, afternoon and evening. YERBA BUENA Clinopodium Douglasii / Mentha x cordifolia, Opiz ex Fresen a local species of mint, which varies from region to region. It is an aromatic plant that is used as herbal medicine worldwide. Commonly known as peppermint. KNOWN BENEFITS Relieves tooth aches stomach aches Arthritis Headaches Indigestion intestinal gas Used as mouthwash Used as tea for general health purposes PREPARATION wash the leaves and chop measure 2 cups of water and leaves boil in low heat for 15 minutes do not cover the clay pot let it cool and strain TSAANG GUBAT Carmona Retusa / Ehretia Mycrophylla Lam This small tree is abundant in the Philippines. This shrub grows 1 to 5 meters. It is also known as wild tea or Forest tea. KNOWN BENEFITS Relieves stomach ache relieves gastroenteritis relieves dysentery relieves diarrhea or LBM used as a mouthwash used as body wash or body cleanser PREPARATIONS wash the leaves and chop measure 2 cups of water and leaves boil in low heat for 15 minutes, do not cover the claypot let it cool and strain NIYOG-NIYOGAN Quisqualis indica Burma creeper Chinese honey Vine Anti-helminthic No worms repeat after 1 week 2 hrs after meals Not given to