NCM 104 CHN Reviewer Midterms Exam PDF

NCM 104 – REVIEWER MIDTERMS EXAM What is a Family? Definition: A family is a group of people who live together or stay connected by bonds of blood, marriage, adoption, or choice. They often share resources, emotional support, and responsibilities. The National Statistical Coordination Board (NSCB,...

NCM 104 – REVIEWER MIDTERMS EXAM What is a Family? Definition: A family is a group of people who live together or stay connected by bonds of blood, marriage, adoption, or choice. They often share resources, emotional support, and responsibilities. The National Statistical Coordination Board (NSCB, 2008) describes it as a unit led by a head, related to others by blood or marriage. Allan et al. (2000) highlight the idea of family as a unit where people live together by choice, bonded by shared experiences and emotional closeness. Examples and Situations: Imagine a family living under one roof, consisting of a married couple and their children, grandparents, or sometimes other relatives. In the context of community health nursing, this family structure is essential for understanding the various dynamics that affect each member’s health and how they support each other during illness or crisis. Types of Families 1. Nuclear Family: A traditional family setup consisting of parents and their children, either biological or adopted. In the Philippines, nuclear families are quite common. o Example: A household with a mother, father, and two children. o Situational Problem: If one parent becomes ill, the other must balance work and child-rearing, impacting family dynamics and potentially leading to stress. 2. Extended Family: Consists of three generations, including grandparents, parents, children, and sometimes even married siblings. o Example: A family where grandparents live with their children and grandchildren. o Situational Problem: Space and privacy issues might arise in a small house, affecting each member’s well-being. 3. Dyad Family: A family with only a husband and wife, often older couples whose children have left home. These are called “empty nesters.” o Example: An elderly couple whose children are grown and living independently. o Situational Problem: The couple might feel lonely, which can impact their mental health. Nurses should check for signs of depression or isolation. 4. Blended Family: A family where one or both partners bring children from previous relationships. o Example: A man with two children marries a woman with one child from a previous marriage. o Situational Problem: Children from different parents may face conflicts adjusting to new siblings, requiring the nurse to offer guidance on family integration. 1 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM 5. Compound Family: Common among Muslims in the Philippines, this family involves one man with multiple wives, following Presidential Decree 1083 (Muslim Personal Law). 6. Cohabiting Family: A couple living together without formal marriage, often referred to as “live-in partners.” 7. Single-Parent Family: Families led by one parent due to divorce, death, or other circumstances. Single parents often face additional responsibilities and stress. 8. Gay or Lesbian Family: Comprises same-sex couples, with or without children. Although same-sex marriage is not legally recognized in the Philippines, such families exist and require community support. Functions of the Family 1. Procreation and Child-Rearing: Families bring new life into the world and raise children, ensuring continuity of society. 2. Socialization: Family is the first unit where children learn societal norms, values, and skills. Parents teach children basic manners, responsibilities, and cultural beliefs. 3. Status Placement: Families help place members within social classes, giving children a sense of identity and positioning in society. For instance, a child from a wealthy family may have different opportunities than one from a low-income family. 4. Economic Function: In rural areas, families often work together in farming or small businesses, while urban families typically have salaried work. This function provides financial stability and supports members’ basic needs. 5. Physical Maintenance and Protection: The family provides food, shelter, and safety. If a child is sick, parents take them to the doctor and give them care at home. 6. Emotional Support and Companionship: Family members provide love, encouragement, and companionship, helping each other through crises and joyous moments. Developmental Stages of the Family Families go through various stages as they evolve, known as the Family Life Cycle. Nurses should recognize these stages to provide relevant support and health interventions. 1. Beginning Family (Marriage or Partnership): Couples form a new family, setting up their household and establishing their roles. 2 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM 2. Parenting the First Child: Major adjustments occur as the couple takes on child-rearing responsibilities, which may involve learning new skills and balancing financial needs. 3. Living with Adolescents: As children grow into teenagers, they seek independence. Parents may need to adjust their parenting style to support this development. 4. Launching (Children Leaving Home): As children move out, parents experience changes, sometimes facing “empty nest syndrome.” 5. Middle-Aged Family: Couples often face career re-evaluation and prepare for retirement. 6. Aging Family: Couples adapt to aging and often prepare for life changes such as retirement and potential loss of a spouse. Family Health Tasks (According to Freeman and Heinrich) 1. Recognizing Health Interruptions: Families should identify any signs of illness in members, such as a child’s fever or a parent’s unusual fatigue. 2. Seeking Healthcare: Families may seek help when they cannot manage a health issue on their own, such as consulting a doctor for serious conditions. 3. Managing Health and Non-Health Crises: Families face health crises like sudden illnesses and non-health crises like job loss. Their coping mechanisms indicate overall health. 4. Providing Care for Dependent Members: Families take care of dependent members like elderly grandparents or sick children at home. 5. Maintaining a Healthy Home Environment: A safe, clean, and supportive home environment promotes health and well-being. 6. Building Community Relationships: A family engages with the community, benefiting from shared resources like health facilities and social support. Characteristics of a Healthy Family A healthy family shows certain traits that promote members' well-being: 1. Strong Communication: Members talk openly and honestly with one another, sharing feelings and listening carefully. 2. Setting Priorities: Healthy families know how to set and respect priorities, ensuring everyone’s needs are met. 3 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM 3. Mutual Support and Respect: Members respect each other’s opinions, offer encouragement, and recognize each other’s strengths. 4. Flexibility: Families adjust to change, such as shifting roles when a member becomes ill, or children becoming more independent. 5. Valuing Responsibility: Family members understand their duties to each other and to society, fostering cooperation and service. 6. Play and Leisure: Time for fun and relaxation strengthens family bonds and helps members cope with stress. Situational Example: Imagine a single-parent family with two children. The parent, struggling to manage a busy work schedule, notices one child showing signs of illness. They may seek help at a community health clinic, where nurses educate the parent about recognizing symptoms and managing care at home. This family would also benefit from community resources for single parents, like support groups, to cope with financial and emotional pressures. CLASSIFICATION OF FAMILY STRUCTURE Understanding family structures is fundamental for nurses, as it allows for better family- centered care, addressing each type’s unique needs and dynamics. A. Based on Internal Organization and Membership 1. Nuclear Family: Often called the “elementary” or “primary” family, a nuclear family includes only the father, mother, and their children. This is the most common family structure globally, as well as in the Philippines. o Example: A household with two parents and two children. o Situational Problem: If a parent falls ill, the family may struggle with household duties, childcare, and financial stability. 2. Extended Family: This structure involves two or more nuclear families linked economically or socially, often spanning multiple generations living together or near each other. o Example: A family where grandparents, parents, and children live in the same household or neighborhood. o Situational Problem: Living with a large extended family can lead to conflicts over space, privacy, and decision-making. B. Based on Place of Residence 4 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM 1. Patrilocal: The newlywed couple lives with or near the groom’s family. This structure is more common in traditional and rural areas. 2. Matrilocal: The couple lives with or near the bride’s family, often seen in societies where matrilineal traditions are strong. 3. Bilocal: The couple chooses whether to live with the groom’s or the bride’s family, influenced by family wealth, status, or personal preferences. 4. Neolocal: The couple establishes a new, independent household. This setup is common in modern and urban societies. 5. Avunculocal: The couple resides with or near the groom's maternal uncle. This is rare but present in some indigenous cultures. C. Based on Descent 1. Patrilineal: Ancestry and kinship ties are traced through the father’s side, which affects inheritance and family name. 2. Matrilineal: Family lineage is traced through the mother’s side. This is less common but present in some Filipino indigenous cultures. 3. Bilateral: Family connections are acknowledged through both parents’ families, creating balanced relationships with both maternal and paternal relatives. D. Based on Authority 1. Patriarchal: The father or the oldest male holds the primary authority, making major family decisions. 2. Matriarchal: The mother or her kin exercises authority within the family structure. 3. Egalitarian: Both spouses share authority and decision-making, often found in modern, urban households. 4. Matricentric: This arises when the father is absent for extended periods, giving the mother a dominant role. FAMILY SOLIDARITY Definition: Family solidarity, or pakiki-isa in Tagalog, represents the commitment of family members to support and respect one another. In the Philippine Constitution, Article 5 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM XV, Section 1 recognizes the family as the foundation of society, calling for active promotion of family solidarity and development. Importance: Solidarity strengthens the family unit, making it easier to offer help, care, and support to each other, especially during challenging times. CHARACTERISTICS AND TYPES OF FAMILY SOLIDARITY 1. Structural Solidarity: This considers geographical distance and its impact on family interaction. 2. Associational Solidarity: Refers to the frequency of contact and shared activities, such as regular family dinners or celebrations. 3. Affectual Solidarity: Focuses on emotional closeness and affirmation, showing that family members care for each other. 4. Consensual Solidarity: Family members share similar values, beliefs, or opinions, though they may still respect differences. 5. Functional Solidarity: Practical support like financial aid, caregiving, or household help, showing that family members are there for each other’s needs. 6. Normative Solidarity: Reflects the sense of duty and responsibility family members feel toward each other. CORE VALUES FOR A FAMILY 1. Commitment: Family members prioritize each other and demonstrate a strong sense of responsibility. 2. Stability: Family members provide a dependable support system, promoting a sense of security. 3. Respect: Each member values and regards others with kindness and dignity. 4. Appreciation: Family members express gratitude for each other’s efforts and contributions. 5. Conflict Resolution: Families strive to resolve conflicts amicably, focusing on communication and compromise. SOME OF THE FAMILY VALUES 6 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM Filipino families uphold certain values, such as trust, happiness, support, traditions, and respect. These values foster close-knit relationships and support among family members, guiding their behavior and interactions. MOST IMPORTANT FAMILY VALUES 1. Kindness 2. Self-Compassion 3. Integrity 4. Responsibility 5. Mutual Respect 6. Honesty 7. Flexibility 8. Fairness 9. Communication These values serve as the foundation for strong, positive family relationships and contribute to a supportive family environment. INFORMATION: SOLIDARITY IN THE COMMUNITY In community health nursing, understanding family and community solidarity is essential. It builds a collective sense of justice and care within the community, promoting an inclusive environment where families and individuals respect each other’s differences. This mutual support strengthens community health initiatives, as families collaborate with healthcare providers to achieve a common goal: well-being for all. Family Nursing Care Plan (FNCP) The Family Nursing Care Plan (FNCP) is a structured guide that nurses use to help families address and solve health-related problems. This plan is family-centered, focusing on understanding the family's needs, setting goals, and implementing tailored nursing interventions. The FNCP is crucial in community health nursing, where healthcare providers work not only with individuals but with families as a whole to enhance their health and well-being. Characteristics of the Family Nursing Care Plan 1. Action-Oriented: The FNCP is designed to address specific health problems or risk factors within the family. For instance, if a family has members with high blood pressure, the FNCP will include actions like monitoring blood pressure regularly, encouraging a balanced diet, and promoting exercise. 2. Systematic Process: It is based on data collection and analysis, which allows nurses to understand the family’s health status comprehensively. This means 7 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM conducting assessments, gathering data, and interpreting the information to create a personalized care plan. 3. Future-Oriented: FNCP helps anticipate potential health issues, guiding the family toward preventive actions and health improvement. For example, if a family has a history of diabetes, the nurse might focus on preventive steps like regular screening and a diet plan to reduce the risk of diabetes. 4. Problem-Based: It starts by identifying specific health or nursing problems within the family. Problems like malnutrition, poor sanitation, or lack of immunizations are assessed and addressed accordingly. 5. Family-Centered: The FNCP tailors the approach to the family’s needs and dynamics, recognizing that every family is unique. For instance, a plan for a single-parent family might include specific support systems or resources for child care. 6. Means to an End: The FNCP is a tool that helps deliver the most suitable care, rather than being an end goal itself. It removes barriers to healthcare access and provides a step-by-step approach to help families achieve optimal health. 7. Continuous Process: The FNCP is not static; it’s continuously updated based on the family’s changing needs and situations, ensuring it remains relevant and effective. Desirable Qualities of a Family Nursing Care Plan 1. Clear Problem Definition: The plan should begin with a well-defined health issue. For example, if a family is dealing with poor sanitation, the FNCP will outline the specific sanitation issues, such as inadequate toilet facilities or unsafe water sources. 2. Realistic: Goals and actions should be achievable based on the family’s resources and circumstances. If the family has financial constraints, recommending budget-friendly or accessible solutions is essential. 3. Jointly Prepared with Family: The family should participate in the planning process to ensure that they understand and support the plan. This collaborative approach makes it more likely for the family to adhere to the recommended interventions. Importance of Planning Care 1. Individualized Care: Each family is unique, and the FNCP allows nurses to create a tailored plan that addresses specific family dynamics and health concerns. 2. Setting Priorities: The FNCP helps nurses prioritize which health issues to address first based on the severity and urgency of the problems. 3. Improves Communication: By having a clear plan, all healthcare providers involved in the family’s care are on the same page, reducing misunderstandings and ensuring continuity. 4. Ensures Continuity of Care: The FNCP prevents gaps or duplication in services by coordinating all health interventions, allowing for a smoother care process. Nursing Assessment 8 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM The Nursing Assessment is the initial phase of the nursing process, where nurses gather all relevant information about the family. This assessment is critical because it determines the effectiveness of the entire care plan. A comprehensive assessment leads to a more accurate diagnosis and appropriate interventions. Types of Data in Family Nursing Assessment 1. Family Structure, Characteristics, and Dynamics o Family Members: The nurse collects information on who lives in the household, each member’s age, gender, and their relationship to the head of the family. o Type of Family Structure: This includes identifying if the family is nuclear (parents and children only) or extended (includes relatives). o Dominant Family Members: Understanding who makes health decisions in the family is important, as this person’s cooperation is essential in implementing health interventions. 2. Socio-Economic and Cultural Characteristics o Occupation and Income: The nurse assesses the family’s financial resources, which can impact their ability to access healthcare services. o Education and Cultural Beliefs: The family’s educational background and cultural practices may influence their health behaviors and openness to interventions. o Relationship with the Community: This can provide insights into the family’s social support network, which is crucial in managing health. 3. Home and Environment o Living Conditions: The nurse assesses housing conditions, including space adequacy, sleeping arrangements, and cleanliness. o Sanitation Facilities: This includes checking water sources, toilet facilities, waste disposal methods, and presence of health hazards, such as cracks in the stairs or pests. o Community Resources: Knowing the nearby health and social facilities helps the nurse recommend accessible resources. 4. Health Status of Each Family Member o Medical and Nursing History: Past and present health conditions are documented, which helps in understanding current health risks. o Nutritional Status: Nurses assess diet quality and quantity, BMI, and waist-hip ratios to determine if family members are at risk of malnutrition or obesity. 5. Developmental Assessment o For families with infants and young children, developmental milestones are checked. Any delays may indicate a need for early intervention. 6. Risk Factor Assessment o Modifiable Risk Factors: The nurse evaluates lifestyle factors that could lead to health issues, such as smoking, sedentary habits, or unhealthy diet. For instance, if a family member smokes, the nurse would assess their smoking frequency and educate them on quitting. 7. Physical Assessment o This includes examining any signs of illness that may need further medical evaluation or treatment. 8. Laboratory/Diagnostic Results 9 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM o Any lab tests or diagnostic results that are available can help confirm health issues, guiding the nurse in creating a more targeted plan. 9. Values, Habits, and Practices in Health Promotion o Immunization Status: Ensuring family members are up-to-date on vaccines, especially children. o Healthy Lifestyle Practices: Assessing rest, exercise, use of protective measures, and stress management. Data Gathering Methods 1. Interviews: The primary method in community health nursing, where the nurse directly asks questions to understand the family’s situation. 2. Focus Group Interviews: This involves group discussions, often used when assessing community-wide health needs. 3. Questionnaires: Used to collect detailed information in a structured format. 4. Observations: Nurses observe the family’s home and environmental conditions to spot health hazards that might not be mentioned during interviews. Example Scenario: Creating an FNCP Scenario: A nurse assesses a family in a rural area where the father smokes heavily, and the home lacks proper sanitation facilities. FNCP Goals: 1. Smoking Reduction: Educate the father on the health risks of smoking and set small, achievable goals for reducing cigarette use. 2. Sanitation Improvement: Work with the family to identify low-cost sanitation solutions, such as improving garbage disposal and water potability. Conclusion The FNCP is a critical tool in community health nursing that ensures families receive personalized and structured care. By following the FNCP process, nurses can address and prevent health issues more effectively, contributing to healthier communities and empowered families. Assessment in Health Care for the Individual Definition: Assessment is the initial step in the nursing process where nurses collect, verify, and document data. This includes information the patient shares (subjective data) and what the nurse observes (objective data). Assessment is crucial because the quality and depth of this information guide every decision and intervention that follows. 1. Types of Data: o Objective Data: Observable and measurable facts that can be verified by an observer (e.g., temperature, pulse, blood pressure). o Subjective Data: Information given by the client that reflects their personal feelings, perceptions, or thoughts (e.g., "I feel dizzy," "I have no energy"). 2. Sources of Data: 10 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM o Primary Source: The client is the primary source and the main person providing direct information. o Secondary Sources: Information gathered from family, health records, laboratory results, and literature that adds context or history to the patient’s current health. 3. Active Participation of the Client: Nurses encourage patients to share openly about their health issues, habits, and symptoms. This includes using all senses to observe signs beyond words, like nonverbal cues and emotional responses. Components of Individual Health Assessment 1. History Taking Purpose: To structure the data-gathering process around the patient’s needs, using Maslow’s hierarchy of needs to prioritize. Approach: Nurses need a clear list of questions and focus on specific issues before moving to another problem. For example, if a patient has a history of high blood pressure, explore all related aspects before shifting to their eating habits. 2. Physical Assessment Purpose: Provides objective data about the patient’s health through direct examination. Techniques: o Inspection: Visual examination, noting general appearance, body structure, and posture. o Palpation: Using touch to assess skin texture, temperature, or any abnormalities in tissues or organs. o Percussion: Tapping areas like the chest and abdomen to assess vibrations or sounds that indicate normal or abnormal conditions (e.g., tympanic sound over the stomach or resonant sound in the lungs). o Auscultation: Listening to sounds within the body, like heartbeats, lung sounds, or bowel movements using a stethoscope. Levels of Assessment 1. First-Level Assessment The First-Level Assessment is the initial step in the family nursing process. Its main purpose is to identify wellness states and health threats within the family and any existing health deficits that require immediate attention. In this level, the nurse gathers foundational information about the family’s health, identifying potential areas where preventive measures can be taken. Key Aspects of First-Level Assessment 1. Gathering Baseline Data 11 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM o This includes collecting information on the family’s health history, environmental factors, socio-economic status, cultural beliefs, and lifestyle habits. Basic information like age, sex, medical history, and any existing health conditions is documented. o Example: A nurse learns that the family has a history of hypertension and diabetes, which could increase the risk for younger members. 2. Identification of Health Threats o Health threats are factors or conditions that increase the likelihood of developing a health problem. This may include lifestyle habits like smoking or excessive alcohol consumption, environmental hazards, or hereditary diseases. o Example: If family members are exposed to secondhand smoke, it could be identified as a health threat leading to respiratory issues. 3. Determining Health Deficits o Health deficits are existing health conditions or problems that already affect one or more family members. These require immediate intervention to prevent further complications. o Example: A family member with untreated diabetes would be considered a health deficit, as this poses a direct risk to their health. 4. Identifying Wellness States and Potential for Improvement o The nurse assesses each family member’s wellness state, meaning their current health and well-being. This helps determine areas where lifestyle changes or preventive measures can be implemented. o Example: If the family generally eats a balanced diet but has a sedentary lifestyle, the nurse may encourage more physical activity to enhance overall wellness. Tools and Methods for First-Level Assessment Interviews: Nurses interview family members to gather information on health practices, routines, and beliefs. Observation: Observing family interactions and behaviors that might influence health, such as smoking or physical inactivity. Health History Forms: Standardized forms to record medical history, current medications, and known allergies. Outcomes of First-Level Assessment The goal is to obtain a comprehensive understanding of the family’s health baseline and identify areas needing preventive interventions. By completing this level of assessment, nurses can promote health and prevent disease within the family. 2. Second-Level Assessment (Typology of Nursing Problems) The Second-Level Assessment goes deeper by classifying and prioritizing the nursing problems identified in the First-Level Assessment. This level is also known as the Typology of Nursing Problems. Here, the focus is on analyzing specific health 12 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM problems and understanding the family’s ability to manage these issues. The problems are classified into four main categories to guide intervention. Typology of Nursing Problems 1. Wellness Potential: o This refers to the family’s capacity to improve their health and achieve an optimal level of functioning. It may involve strengthening healthy practices or introducing new habits that could enhance well-being. o Example: A family that already eats healthily but does not exercise regularly has a wellness potential in increasing physical activity. The nurse can encourage and help them set achievable goals, like taking daily walks. 2. Health Threats: o Health threats are factors or conditions within the family that, if left unchecked, could lead to health problems. The aim is to mitigate these threats through education, counseling, and preventive measures. o Example: A family living in a heavily polluted area faces a health threat due to potential respiratory issues. The nurse might educate the family on ways to reduce exposure, like using air purifiers or wearing masks. 3. Health Deficits: o Health deficits are actual health issues that are present within the family and require immediate intervention. These can range from untreated conditions to unmet healthcare needs. o Example: If a family member has hypertension but is not managing it with medication or lifestyle changes, this is a health deficit. The nurse would work on helping the family develop a plan to manage this condition. 4. Stress Points/Crises: o Stress points are situations or life events that create stress within the family, potentially affecting health. Crises are more intense events that require immediate support to prevent health deterioration. o Example: The loss of a job for a family breadwinner could be a stress point, affecting mental and emotional health. A serious illness or death in the family could be a crisis, impacting all members. The nurse would provide resources and emotional support to help the family cope. Situational Examples for Each Typology of Nursing Problem 1. Wellness Potential: o Situation: A family that eats well but does not prioritize exercise may benefit from an intervention encouraging regular physical activity. o Nursing Role: Educate the family on the benefits of exercise, provide ideas for family-friendly activities, and set gradual exercise goals. 2. Health Threats: o Situation: A family living in a congested urban area where smoking is common faces a health threat. o Nursing Role: Educate on the dangers of secondhand smoke, offer strategies to reduce exposure, and discuss quitting options for any smokers in the family. 3. Health Deficits: 13 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM o Situation: A family member has asthma but doesn’t have access to proper inhalers or medication. o Nursing Role: Help the family access medical services, educate them on asthma management, and discuss environmental modifications to reduce triggers. 4. Stress Points/Crises: o Situation: A family is dealing with the loss of a loved one. o Nursing Role: Provide emotional support, refer them to counseling services if needed, and suggest coping strategies to handle grief and stress. Assessment Methods for Second-Level Assessment Interviews and Family Meetings: To understand the family’s perspective on health issues and identify stress points. Observation of Coping Mechanisms: Nurses observe how family members respond to stress, support each other, and manage health problems. Use of Tools: Tools like the Family Coping Index or Family APGAR (a quick assessment of family functioning) may be employed to gauge family dynamics and resilience. Goals of Second-Level Assessment The aim is to classify nursing problems, prioritize them based on urgency, and create a family-centered care plan. By understanding which problems are most pressing and which areas have the potential for health improvement, nurses can create interventions that are tailored to the family’s unique needs. Summary Both levels of assessment work together to create a holistic picture of the family’s health. The First-Level Assessment provides a baseline and identifies general health needs, while the Second-Level Assessment classifies specific nursing problems into types (wellness potential, health threats, health deficits, and stress points/crises) to prioritize and target interventions. This framework helps nurses develop individualized, family-focused plans that address the unique health challenges and strengths within the family unit. Nursing Interventions Based on these assessments, the nursing interventions will focus on educating the family, addressing barriers to accessing care, and providing resources to improve their health: For a family with inadequate resources: Connect them with community resources, educate on proper hygiene, and provide referrals for support services. 14 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM For a client with high blood pressure: Educate on the importance of regular follow-up, diet modification, and symptom monitoring. For malnourished children: Provide nutritional counseling to the family, monitor growth, and work with community health workers for supplemental feeding programs. Family Nursing Overview Family Nursing is a field within nursing that focuses on improving the health and well- being of all family members. Unlike individual care, family nursing considers the family as a system, acknowledging how each member influences and affects one another. The aim is to support both individual members and the family as a whole in promoting health and preventing illness. 1. Focus Areas of Family Nursing Care: o Individual Members: Addressing specific health needs of each family member. o Within the Family Context: Viewing an individual's health in relation to family roles and dynamics. o The Family as a Unit: Treating the family as a single entity to strengthen overall health. Example: In a family where one member has diabetes, a nurse might educate everyone on healthy eating habits. This ensures that each person supports the member with diabetes while adopting healthier practices themselves. A fundamental rule in family nursing is respect for the family’s autonomy. Even if services are offered, the family must agree to receive them. If they prefer a different approach (e.g., folk healers like albularyos or magtatawas), nurses must make exhaustive efforts to educate them while respecting their preferences. Family Health Assessment Family Health Assessment is the first step in the nursing process. It involves gathering comprehensive information about the family's health, their preventive practices, and factors affecting their well-being. 1. Why Is Family Health Assessment Important? o Helps practitioners understand the family's physical, mental, and emotional health status. o Assesses health-promoting behaviors and identifies actual or potential health risks. Example: Through family assessment, a nurse may identify that multiple members have high blood pressure. The nurse can then recommend lifestyle changes for the entire family. 15 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM 2. Steps in Data Collection: o Interviewing: Talking to individual members, groups, or the whole family. o Observation: Observing behaviors, interactions, and environment. o Physical Examination: Checking family members for physical health signs. o Record Review: Analyzing past medical records, lab tests, and health screenings. Differentiating Family from Household Family: People sharing values, long-term commitments, and often living together. This may include parents, children, and other close relatives. Household: People who live together and share living arrangements but may not be related, such as a live-in caregiver. Example Problem: A household might include a live-in nanny who helps care for the children but isn’t related by blood or marriage, so they are considered part of the household, not the family. Assessment Tools in Family Nursing 1. Genogram: o A visual family tree showing relationships, hereditary conditions, and patterns. o Helps in tracking family health issues like diabetes, heart disease, etc. Example: A genogram for a family might show that three generations have a history of diabetes, prompting proactive health checks for younger members. 2. Family Health Tree: o A chart of the family’s medical history to identify potential health risks. o Useful for planning healthy lifestyle choices and preventative care. 3. Ecomap: o A diagram illustrating a family’s connections with external systems (community, healthcare, school). o Identifies sources of support or areas of stress, like a family avoiding community health services. Example: An ecomap may show a family has minimal interaction with local health services, signaling the need for nurse-led community awareness. Family Interviewing 16 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM Family Interviewing allows nurses to conduct an assessment and build rapport through structured communication. 1. Components of the Family Interview: o Manners: Respectful behavior to foster trust. o Therapeutic Questions: Key questions focused on health concerns, goals, and challenges. o Therapeutic Conversations: Engaging family members to express themselves openly. o Genogram and Ecomap Usage: Visual tools to discuss family structure and support systems. o Commendations: Recognizing family strengths to build positivity. Example Problem: If a family hesitates to discuss a member’s chronic illness, therapeutic questions help the nurse understand underlying fears and concerns, encouraging open discussion. Family Data Analysis Data Analysis follows assessment. The nurse organizes the data, verifies accuracy, and clusters relevant findings. 1. Family Data Organization Areas: o Family Structure and Characteristics: Household roles, authority, dynamics. o Socioeconomic Characteristics: Financial stability, literacy, cultural values. o Family Environment: Physical home safety and cleanliness. o Health and Health Behaviors: Lifestyle habits, self-care, medical history. Example: If data shows that the family struggles financially, the nurse might suggest affordable health resources like local clinics. Family Nursing Diagnosis A Nursing Diagnosis summarizes the family’s health needs and is categorized at individual, family, and community levels. 1. Common Diagnosis Tools: o NANDA: A standardized list of nursing diagnoses. o Family Coping Index: Focuses on how the family manages health challenges across nine areas, such as therapeutic competence and emotional resilience. Example Problem: A family with limited emotional resilience may struggle with mental health issues. The nurse can help by introducing counseling or stress management programs. 17 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM Formulating the Care Plan Planning involves prioritizing problems, setting achievable goals, and choosing suitable interventions. 1. Priority Setting: o Urgent issues like breathing problems (Airway, Breathing, Circulation, Disalignment) take precedence. o Family perception and practicality of interventions are also essential considerations. 2. Setting Goals and Objectives: o Goals: Desired family response (e.g., improved nutrition). o Objectives: Specific steps toward goals, following SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound). Example: For a family struggling with nutrition, the goal could be to improve meal planning. An objective might be to prepare balanced meals three times a week. 3. Types of Interventions: o Supplemental: When the nurse provides direct care. o Facilitative: Assisting with resources or removing barriers. o Developmental: Empowering the family to manage health independently. Example: A nurse may provide dietary education (facilitative) and organize a support group (developmental) for families coping with diabetes. Key Principles of Effective Care Planning 1. Mutuality: Respecting the family’s choice and involvement. 2. Personalization: Tailoring care to fit unique family needs. 3. Coordination: Collaborating with healthcare providers. 4. Nurse Self-Awareness: Recognizing one’s skills, resources, and limitations. Implementation Phase 18 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM The implementation phase is when the nurse or family executes the plan of action. Without this action, there’s nothing to evaluate later! This phase involves various key activities, including: 1. Reassessing the Client: Continuous assessment helps nurses adjust interventions if necessary. 2. Implementing Nursing Interventions: Nurses carry out interventions, ensuring they align with the family’s needs. 3. Supervising Delegated Care: Delegated tasks are overseen to maintain care quality. To implement the plan: Perform interventions: This includes education, coordination with community resources, and monitoring care levels. Collaborate with other disciplines: Teamwork with health workers and agencies ensures comprehensive care. Advocate for clients' rights: Nurses respect confidentiality and promote self- determination. Implementation often requires home visits and close cooperation with families, leaders, and health workers. Adapting interventions based on the evolving needs of families is critical, as certain strategies might need modification depending on the situation. Remember: The Implementation phase is also known as the Action Phase. It’s an exciting phase for health workers as it directly involves improving family health capacity. Nurses facilitate rather than directly implement, empowering families to take charge. Barriers during Implementation: Family-related barriers: Apathy and indecision may hinder participation. Nurse-related barriers: Imposing ideas, negative labeling, overlooking family strengths, and ignoring cultural differences can reduce the intervention's effectiveness. Establishing trust and considering the family’s unique values is essential. Evaluation Phase Evaluation is about determining the value and effectiveness of nursing care provided to a family. It’s an ongoing process integrated throughout all phases, allowing nurses to: 19 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM Terminate, continue, or modify interventions based on outcomes. Observe changes in family attitudes and adjust the plan if necessary. Types of Evaluation: 1. Formative: Judging the effectiveness of interventions as they’re implemented. 2. Summative: Determining the outcomes or goals achieved by the family. Aspects of Evaluation: Effectiveness: Did we achieve our objectives? Appropriateness: Were the goals suitable for the family’s health needs? Adequacy: Were the interventions sufficient? Efficiency: Were the outcomes worth the resources used? Evaluation Approaches: 1. Structure Evaluation: Examines resources like manpower and physical facilities. 2. Process Evaluation: Looks at how each phase of the nursing process was conducted. 3. Outcome Evaluation: Measures the extent to which goals were achieved. Standards of Evaluation: Utility: How useful were the results? Feasibility: Is the evaluation plan doable? Propriety: Were ethical standards maintained? Accuracy: Ensures reliable and valid results. Types of Family-Nurse Contacts 1. Clinic Visit: Provides greater control over the environment and minimizes distractions. 2. Telephone Contact: Encourages easy communication and helps build the family’s confidence. 3. Written Communication: Useful for delivering specific instructions to families. 4. Home Visit: A key component allowing firsthand assessment and the opportunity to adapt interventions. 20 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM Phases of Home Visit 1. Pre-visit: Contacting the family, setting up the appointment, and planning the visit. 2. In-Home Phase: From entering the home, initiating rapport, implementing care, to summarizing findings. 3. Post-visit Phase: Documentation and reflection at the health facility. Home visits offer personalized care in a familiar environment, building trust and promoting family participation. However, distractions and safety concerns must be managed carefully. Field Health Services Information System (FHSIS) The Field Health Services Information System (FHSIS) is a facility-based recording and reporting system in the Philippines. It serves as the backbone of data collection, providing essential information for decision-making at all levels—local government units (LGUs) and the Department of Health (DOH). This system is a critical component of the public health management framework, enabling evidence-based planning, implementation, and evaluation of health programs. Key Features of FHSIS National Implementation: The FHSIS is implemented nationwide, ensuring uniformity in data collection and reporting from the grassroots to the national level. Policy Basis: Established under Executive Order No. 352, it is recognized as a critical statistical activity for generating health-related data. Evolution: The FHSIS underwent a significant revision in 2018 (from the 2012 version) to address: 1. Harmonization of health indicators. 2. Responsive service delivery. 3. Emerging public health challenges. Purpose of FHSIS 1. Summarization of Health Indicators: FHSIS provides a streamlined system for collecting and reporting essential health statistics, avoiding duplication and ensuring focus on critical indicators. 21 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM o Example: Data on the prevalence of diseases like tuberculosis or hypertension is collected for program monitoring. 2. Defined Processes for Data Management: FHSIS outlines a clear methodology for collecting, recording, and reporting data. o Data Flow: Barangay Health Workers (BHWs) → Midwives → Public Health Nurses (PHNs) → Regional Level → National Level. 3. Guide for Validation and Analysis: It includes tools and methods to ensure data accuracy and usability for decision- making. 4. Defined Roles and Functions: Clarifies responsibilities for DOH and LGU offices to ensure proper resource allocation based on data. o Example: If high cases of childhood malnutrition are reported, resources like feeding programs and supplements are prioritized. General and Specific Objectives General Objective: Enhance the FHSIS to meet evolving public health needs. Specific Objectives: 1. Update Coverage Data: Regular updates ensure timely identification of underserved populations. o Example: Monitoring coverage of immunization programs in remote areas. 2. Public Health Service Availability: Provides accessible data for evaluating health services. 3. Track and Record Health Statistics: Collects demographic, morbidity, and program data quarterly. 4. Annual Reports: Develops comprehensive reports for use in policy-making and health program adjustments. Scope of FHSIS The FHSIS organizes data into three categories: Category I: Health Services 22 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM 1. Family Health Services: Includes family planning, maternal care, and child health. o Example: Monitoring contraceptive use and maternal mortality rates. 2. Infectious Disease Prevention: Covers programs for diseases like tuberculosis, HIV/AIDS, malaria, and leprosy. o Example: TB case finding and treatment adherence are recorded and reported. 3. Non-communicable Diseases (NCD): Tracks cases of hypertension, diabetes, and cancer. o Example: Identifying a high prevalence of hypertension in a barangay guides medicine allocation. 4. Environmental Health: Includes data on sanitation (e.g., households with proper toilets). Category II: Morbidity and Mortality Morbidity: Tracks the number of people with specific illnesses. Mortality: Records the leading causes of death. Category III: Demographic Data Demographic data includes age, sex, and household profiles, which are critical for identifying vulnerable populations. Limitations of FHSIS 1. Incomplete Program Coverage: Excludes some programs like mental health and drug rehabilitation. 2. No Data on Governance, Financing, or Regulation: These are managed by other units outside the FHSIS. FHSIS Forms and Tools 1. Household Profiles: A census-style record of households, listing members and basic details. Purpose: Identifies target clients for health services (e.g., pregnant women, children needing immunization). 2. Master Lists: Lists target clients for specific health interventions. 23 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM Example: A master list for 6-11 month-old children eligible for Vitamin A supplementation. 3. Registries: Contains records of clients with specific diseases undergoing treatment. Example: A TB registry lists patients receiving anti-TB medications. 4. Recording Tools: Individual Treatment Record (ITR): Tracks patient consultations, symptoms, diagnosis, and treatment. Target Client List (TCL): Records services delivered to specific client groups (e.g., family planning users, malnourished children). 5. Reporting Forms: Monthly (M1 and M2): Includes program accomplishments and morbidity data. Quarterly (Q1 and Q2): Consolidates three months of data. Annual (A1, A2, A3): Comprehensive reports covering demographics, morbidity, and mortality. Data Flow 1. Barangay Health Workers (BHWs): Collect household-level data. 2. Midwives: Consolidate BHW data and prepare monthly reports. 3. Public Health Nurses (PHNs): Compile midwife reports into quarterly and annual summaries for submission to higher levels. FHSIS in Action: Examples and Situational Problems 1. Example: o A barangay reports an increase in diarrhea cases in children under five. This triggers the local health unit to implement water sanitation programs and distribute oral rehydration salts. 2. Problem: o Issue: A barangay reports incorrect data on vaccination coverage (e.g., overreporting). o Impact: The regional office allocates fewer vaccines than needed, leaving children unprotected. 24 | CHN by CJAA NCM 104 – REVIEWER MIDTERMS EXAM o Solution: Training on accurate data recording and validation at the barangay level. 3. Example: o FHSIS data shows a low contraceptive prevalence rate in a municipality. This prompts the RHU to conduct an awareness campaign on family planning. Significance of FHSIS in Community Health Nursing Guides Health Services: Helps nurses prioritize interventions based on reported data. Ensures Accountability: Encourages accurate documentation for transparency and effective resource allocation. Improves Program Efficiency: Facilitates monitoring and evaluation to refine health programs continuously. In summary, the Field Health Services Information System (FHSIS) is an indispensable tool for public health management in the Philippines, enabling data-driven decisions to improve the health and well-being of communities. 25 | CHN by CJAA