NCM 104 LEC REVIEWER.pdf

COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM NCM 104: COMMUNITY HEALTH NURSING (INDIVIDUAL AND FAMILY) Module 3: FAMILY Module Contents: A. Family as Basic Unit of the Society B. Types Family as a Client Family...

COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM NCM 104: COMMUNITY HEALTH NURSING (INDIVIDUAL AND FAMILY) Module 3: FAMILY Module Contents: A. Family as Basic Unit of the Society B. Types Family as a Client Family as a System C. Functions Developmental Stages D. Family Health task E. Characteristics of a Healthy Family FAMILY AS BASIC UNIT OF SOCIETY ✓ Genetic transmission unit ✓ Matrix of personality of development and the most intimate emotional unit of society ✓ Enduring social form in which a person is incorporated ✓ Lifelong involvement ✓ Shared attributes ✓ Genetics – physical and psychological ✓ Developmental – shared home, lifestyle, social activities ✓ Sense of belonging ✓ Security/defense against a potentially hostile environment ✓ Companionship ✓ Societal expectations ✓ Sense of responsibility towards members & others ✓ Basis of affection/care ✓ Built-in problems ✓ Generation gap ✓ Dependence of members ✓ Emotional attachment/involvement ✓ The family endures despite problems ✓ Resource utilization ✓ Authority ✓ Individual sense of responsibility Classification according to structure Nuclear family A father and mother with/without children living together but apart from both sets of parents and relatives 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Separate dwelling not shared with members of the family of origin / orientation of either spouse Economically independent Extended family Two or more nuclear families economically and socially related to each other Unilaterally/ bilaterally extended Includes 3 generations Lives together as a group Single Parent Family Children < 17 years of age, living in a family unit with a single parent, another relative or non-relative May result from: Loss of spouse by death, divorce, separation Out of wedlock birth of a child From adoption Migration (OFWs) Blended/ Reconstituted family Includes step-parents and step-children Caused by divorce, annulment with remarriage and separation Compound family One woman/ man with several spouses Communal family Grouping of individuals which are formed for specific ideological or societal purposes Considered as an alternative lifestyle for people who feel alienated from the economically privileged society Vary within social context Cohabitation/ Live-in Unmarried couple living together 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 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Gay/ lesbian Homosexual couple living together with/without children Classification According to Function Family of Procreation- refers to the family you yourself created. Family of Orientation-refers to the family where you came Family as a Unit of Care The family is considered the natural and fundamental unit of society. The family as a group generates, prevents, tolerates and corrects health problems within its membership. The health problems of the family members are interlocking. The family is the most frequent focus of health decisions and action in personal care. The family is an effective and available channel for much of the effort of the health worker. TYPES OF FAMILY Family as a Client The family is the foreground and individuals are in the background The focus is concentrated on each and every individual as they affect the whole family The focus is concentrated on how the family as a whole is reacting to an event when a family member experiences a health issue Characteristics of Family as a Client 1. The family is a product of time and place ▪ A family is different from other family who lives in another location in many ways. ▪ A family who lived in the past is different from another family who lives at present in many ways. 2. The family develops its own lifestyle ▪ Develop its own patterns of behavior and its own style in life. ▪ Develops their own power system which either be: ▪ Balance-the parents and children have their own areas of decisions and control. ▪ Strongly Bias-one member gains dominance over the others. 3. The family operates as a group ▪ A family is a unit in which the action of any member may set of a whole series of reaction within a group, and entity whose inner strength may be its 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM greatest single supportive factor when one of its members is stricken with illness or death. 4. The family accommodates the needs of the individual members. ▪ An individual is unique human being who needs to assert his or herself in a way that allows him to grow and develop. ▪ Sometimes, individual needs and group needs seem to find a natural balance; 1. The need for self-expression does not overshadow consideration for others. 2. Power is equitably distributed. 3. Independence is permitted to flourish Family as a System The focus is on the family as a client Viewed as an international system in which the whole is greater than the sum of its parts Focuses on the individual and family members become the target for nursing interventions FUNCTIONS & DEVELOPMENTAL STAGES Functions of a Family Biologic ✓ Reproduction ✓ Child-rearing/Caring ✓ Nutrition ✓ Health maintenance ✓ Recreation Economic ✓ Provision of adequate financial resources ✓ Resource allocation ✓ Ensure financial security Educational ✓ Teach skills, attitudes and skills relating to other functions Psychological/ Affection ✓ Promotes the natural development of personalities ✓ Offer optimum psychological protection ✓ Promotes ability to form relationships with people within the family circle 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Socio-cultural ✓ Socialization of children ✓ Promotion of status and legitimacy Developmental Stages/ Family Life Cycle Assess a patient and family developmental concerns Identifies stages of family development that reflect the biological functions of raising children As the family system moves together through time, the individual life cycles intertwines with the life cycles of other family members Families go through different stages for which specific developmental tasks must be accomplished Families who are not able to accomplish these tasks may develop difficulties with subsequent family development. 1. Beginning Family ❖ Beginning Family: The couple establishes their home but do not yet have children. ❖ Involves merging of values brought into the relationship from the families of orientation. ❖ Includes adjustments to each other’s routines (sleeping, eating, chores, etc.), sexual and economic aspects. ❖ Members work to achieve 3 separate identifiable tasks: 1. Establish a mutually satisfying relationship 2. Learn to relate well to their families of orientation 3. If applicable, engage in reproductive life planning 2. Childbearing Family ❖ From the birth of the first child until that child is 2 1/2 years old. ❖ Developmental Tasks: Adjusting to increased family size Caring for an infant Providing a positive developmental environment 3. Family with Preschoolers ❖ When the oldest child is between the ages of 2 1/2 and 6. ❖ Developmental Tasks: ▪ Satisfying the needs and interests of preschool children ▪ Coping with demands on energy and attention with less privacy at home. 4. Family with School Age Children ❖ When the oldest child is between the ages of 6 and 13. ❖ Developmental Tasks: 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM ▪ Promoting educational achievement ▪ Fitting in with the community of families with school-age children. 5. Family with Teenagers ❖ When the oldest child is between the ages of 13 and 20. ❖ Developmental Tasks: ▪ Allowing and helping children to become more independent ▪ Coping with their independence ▪ Developing new interests beyond child care. 6. Launching ❖ From the time the oldest child leaves the family for independent adult life till the time the last child leaves. ❖ Developmental Tasks: ▪ Releasing young adults and accepting new ways of relating to them ▪ Maintaining a supportive home base ▪ Adapting to new living circumstances. 7. Empty nest ❖ From the time the children are gone till the marital couple retires from employment. ❖ Developmental Tasks ▪ Renewing and redefining the marriage relationship ▪ Maintaining ties with children and their families ▪ Preparing for retirement years. 8. Aging family ❖ From retirement till the death of the surviving marriage partner. ❖ Developmental Tasks: ▪ Adjusting to retirement ▪ Coping with the death of the marriage partner and life alone. FAMILY HEALTH TASK Health task differ in degrees from family to family TASK- is a function, but with work or labor overtures assigned or demanded of the person Family Health Tasks (Duvall & Niller) 1. Physical maintenance- provides food, shelter, clothing, and health care to its members being certain that a family has ample resources to provide 2. Socialization of Family- involves preparation of children to live in the community and 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM interact with people outside the family. 3. Allocation of Resources- determines which family needs will be met and their order of priority. 4. Maintenance of Order- task includes opening an effective means of communication between family members, integrating family values and enforcing common regulations for all family members. 5. Division of Labor – who will fulfill certain roles e.g., family provider, home manager, children’s caregiver 6. Reproduction, Recruitment, and Release of family member 7. Placement of members into larger society –consists of selecting community activities such as church, school, politics that correlate with the family beliefs and values 8. Maintenance of motivation and morale- created when members serve as support people to each other Family Health Tasks (Maglaya) 1. Recognizing interruptions of health development 2. Making decisions about seeking health care/ to take action 3. Dealing effectively health and non-health situations 4. Providing care to all members of the family 5. Maintaining a home environment conducive to health maintenance CHARACTERISTICS OF HEALTHY FAMILY 1. Able to provide for physical, emotional and spiritual needs of family members 2. Able to be sensitive to the needs of the family members 3. Able to communicate thoughts and feelings effectively 4. Able to provide support, security and encouragement 5. Able to initiate and maintain growth producing relationship 6. Maintain and create constructive and responsible community relationships 7. Able to grow with and through children 8. Ability to perform family roles flexibly 9. Able to help oneself and to accept help when appropriate 10. Demonstrate mutual respect for the individuality of family members 11. Ability to use a crisis experience as a means of growth 12. Demonstrate concern of family unity, loyalty and interfamily cooperation 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM References: 1. Famorca, Z.V., Nies, M.A. & Mcewan, M. (2013) Nursing Care of the Community a Comprehensive Test on Community & Public Health Nursing in the Philippines, 1st edition, Elsevier 2. https://www.rnpedia.com/nursing-notes/community-health-nursing notes/family-health-nursing/ 3. Maglaya, A. (2007) Nursing Practice in the Community; 5th ed., Argonauta Corp., Marikina City. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM NCM 104: COMMUNITY HEALTH NURSING (INDIVIDUAL AND FAMILY) Module 4: FAMILY NURSING PROCESS Module Content A. Family Health Assessment 1. Tools for Assessment  Initial Data Base Typology of Nursing Problems in Family Nursing Practice   Family Health Task Family Coping Index  2. Family Data Analysis Socio-Economic and Cultural Characteristics  Home Environment  Family Health Status  Family Values and Health Practices  B. Family Nursing Diagnosis C. Formulating Family Nursing Care Plan 1. Priority Setting 2. Establishing Goals and Objectives 3. Selecting Appropriate Family Nursing Interventions / Strategies FAMILY NURSING PROCESS: Includes data collection, data analysis or interpretation and problem definition or nursing diagnosis The rationale for adopting this health tasks as the framework of the typology is the fact that in community health nursing practice, one deals mostly with problems within the domain of human behavior or human response to health and illness. A community health nurse works with and through the family to improve its behavior related to health. ASSESSMENT AND DIAGNOSES IN FAMILY NURSING PRACTICE There are two major types in dealing with the assessment of the family according to nursing practice: 1. FIRST LEVEL ASSESSMENT - the process of determining existing and potential health conditions or problems of the family. These health conditions are categorized as: A. WELLNESS CONDITION 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM - stated as Potential or Readiness - A clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. A. Potential or Capability for: B. Readiness for Enhanced Capability for: Healthy Lifestyle – e.g. nutrition, Healthy Lifestyle diet, exercise, activity Health Maintenance/ Health Health Maintenance/ Health Management Management Parenting Parenting Breastfeeding Breastfeeding Spiritual Well-being Spiritual Well-being Others Others B. HEALTH THREATS - Conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential A. Presence of risk factors of specific diseases B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide D. Accident/ fire hazards E. Faulty/ unhealthful nutritional/ eating habits or feeding techniques or practices F. Stress provoking factors G. Poor home environmental condition/ sanitation H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/practices J. Inherent personal characteristics 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM K. Health history which may participate/ induce the occurrence of a health deficit L. Inappropriate role assumption M. Lack of immunization/ inadequate immunization status specially of children N. Family disunity O. Others C. HEALTH DEFICITS - Instances of failure in health maintenance (disease - regardless of whether it is diagnosed or undiagnosed by medical practitioner, disability, (developmental lag) D. STRESS POINTS / FORESEABLE CRISIS - Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. - Examples of this include: A. Marriage B. Pregnancy, labor, puerperium C. Parenthood D. Additional member-e.g. newborn, lodger E. Abortion F. Entrance at school G. Adolescence H. Divorce or separation I. Menopause 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM J. Loss of job K. Hospitalization of a family member L. Death of a member M. Resettlement in a new community N. Illegitimacy O. Others, specify.__________ Statement of the Problem: P = Problem, E = Etiology (Cause), S = Signs/Symptoms Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food as evidenced by: Loose watery stool 4X bowel movement/day Poor skin turgor body weakness,and as verbalized,”symptom kahapon pa sang aga ako naga lupot”. “kag nagakutoy akon tiyan”. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Data collection for first level assessment includes gathering the five types of data, namely: Family structure and Include family composition and demographic data, type of family, form and structure, decision- characteristics making patterns and communication patterns affecting family relatedness Socio-economic and Include occupation, place of work, and income of each working member, educational attainment, cultural factors ethnic background, religious affiliation, family traditions and the relationship of the family to a larger community Home and Include information on housing and sanitation facilities; kind of neighborhood and availability of Environmental factors social, health, communication, and transportation facilities in the community. Health Assessment of Includes current and past significant health conditions or illness; beliefs and practices each member conducive to health and illness; nutritional and developmental status; physical assessment findings and significant results of laboratory/ diagnostic tests/ screening procedures Value placed on health Include use of Promotive-preventive services as evidenced by immunization status and use of other promotions, health healthy lifestyle related services; adequacy of maintenance and rest/sleep 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM prevention of disease Data gathering methods includes: Observation, physical examination, interview, review of records and laboratory and diagnostic procedures. 2. SECOND LEVEL ASSESSMENT - identifies the nature or type of nursing problems the family experiences in the performance of their health tasks with respect to a certain health condition or health problem. FIVE MAIN TYPES OF FAMILY NURSING PROBLEMS I. Inability to recognize the presence of the condition or problem due to: a. Lack of or inadequate knowledge b. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically: i. Social-stigma, loss of respect of peer/significant others ii. Economic/cost implications iii. Physical consequences 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM iv. Emotional/psychological issues/concerns c. Attitude/ Philosophy in life, which hinders recognition / acceptance of a problem d. Others. Specify _________ II. Inability to make decisions with respect to taking appropriate health action due to: a. Failure to comprehend the nature/magnitude of the problem/condition b. Low salience of the problem/condition c. Feeling of confusion, helplessness and/or resignation brought about by perceive magnitude/severity of the situation or problem, i.e. failure to breakdown problems into manageable units of attack. d. Lack of/inadequate knowledge/insight as to alternative courses of action open to them e. Inability to decide which action to take from among a list of alternatives f. Conflicting opinions among family members/significant others regarding action to take. g. Lack of/inadequate knowledge of community resources for care h. Fear of consequences of action, specifically: i. Social consequences ii. Economic consequences iii. Physical consequences iv. Emotional/psychological consequences i. Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with rational decision-making. j. In accessibility of appropriate resources for care, specifically: i. Physical Inaccessibility 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM ii. Costs constraints or economic/financial inaccessibility k. Lack of trust/confidence in the health personnel/agency l. Misconceptions or erroneous information about proposed course(s) of action m. Others specify._________ III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to: a. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management) b. Lack of/inadequate knowledge about child development and care c. Lack of/inadequate knowledge of the nature or extent of nursing care needed d. Lack of the necessary facilities, equipment and supplies of care e. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle program). f. Inadequate family resources of care specifically: i. Absence of responsible member ii. Financial constraints iii. Limitation of luck/lack of physical resources g. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her capacities to provide care. h. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member i. Member’s preoccupation with on concerns/interests j. Prolonged disease or disabilities, which exhaust supportive capacity of family 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM members. k. Altered role performance, specify. i. Role denials or ambivalence ii. Role strain iii. Role dissatisfaction iv. Role conflict v. Role confusion vi. Role overload vii. Others. Specify._________ IV. Inability to provide a home environment conducive to health maintenance and personal development due to: a. Inadequate family resources specifically: i. Financial constraints/limited financial resources ii. Limited physical resources-e.i. lack of space to construct facility b. Failure to see benefits (specifically long term ones) of investments in home environment improvement c. Lack of/inadequate knowledge of importance of hygiene and sanitation d. Lack of/inadequate knowledge of preventive measures e. Lack of skill in carrying out measures to improve home environment f. Ineffective communication pattern within the family g. Lack of supportive relationship among family members h. Negative attitudes/philosophy in life which is not conducive to health maintenance and personal development 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM i. Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g. reduced ability to meet the physical and psychological needs of other members as a result of family’s preoccupation with current problem or condition. j. Others specify._________ V. Failure to utilize community resources for health care due to: a. Lack of/inadequate knowledge of community resources for health care b. Failure to perceive the benefits of health care/services c. Lack of trust/confidence in the agency/personnel d. Previous unpleasant experience with health worker e. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically : i. Physical/psychological consequences ii. Financial consequences iii. Social consequences f. Unavailability of required care/services g. Inaccessibility of required services due to: i. Cost constrains ii. Physical inaccessibility h. Lack of or inadequate family resources, specifically i. Manpower resources, e.g. baby sitter ii. Financial resources, cost of medicines prescribe i. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM j. Negative attitude/ philosophy in life which hinders effective/maximum utilization of community resources for health care k. Others, specify __________ Second Level of Assessment: Example: Inability to provide adequate nursing care due to: a. Lack of knowledge and skill in treatment of diarrhea as verbalized by the mother: “Wala ko kabalo kon paano bulngon ang lupot”. Family health task In order to achieve wellness among its members and reduce or eliminate health problems, the standard or norm of the family as a functioning unit involves the ability to perform the following health tasks: A. Recognize the presence of a wellness state or health condition or problem B. Make decisions about taking appropriate health action to maintain wellness or manage the health problem C. Provide nursing care to the sick, disabled, dependent or at-risk members D. Maintain a home environment conducive to health maintenance and personal development E. Utilize community resources for health care Note: Utilizing the data gathered from the Initial Data Base (IDB), the nurse goes though the data analysis. The end-result of the analysis during the first-level assessment is a conclusion or a statement of a health condition or problem, 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM classified as a wellness potential, health threat and health deficit or stress point/ foreseeable crisis. The second - level of assessment ends with a definition of family nursing problems, in terms of how the family handles it. PLANNING, IMPLEMENTING AND EVALUATING IN FAMILY NURSING PRACTICE FAMILY NURSING CARE PLAN Is a blueprint of nursing care designed to systematically enhance the family’s capability to maintain wellness, manage health problems through explicitly formulated goals and objectives of care and deliberately chosen set of interventions, resources, & evaluation criteria, standards, methods/tools. STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN 1. Prioritize Health Conditions or Problems 2. Goal and Objectives of Nursing Care 3. Intervention Plan 4. Evaluation Plan HEALTH PROBLEM Process whereby existing and potential health conditions or problem of the families are determined. They reflect depth of data gathering and analysis on what health conditions or problems exists. This is derived from the First Level Assessment of the Typology of Nursing Problems. Which categorizes the presence of: 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Wellness state Health deficits Health threats Foreseeable crisis or stress points FAMILY NURSING DIAGNOSIS 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. This is derived from the Second Level Assessment of the Typology of Nursing Problems. This include those that specify or describe the family’s realities, perceptions about and attitudes related to the assumption or performance of family health tasks on each health condition or problem identified during the first-level assessment. The nurse should learn to prioritize the numerous family nursing problem considering the available resources of the nurse, the family and the community. FOUR CRITERIA IN PRIORITIZNG HEALTH CONDITIONS (Maglaya et. al., 2017) 1. NATURE OF THE PROBLEM - Is the problem a: a. Wellness condition b. Health deficit c. Health threat d. Foreseeable crisis 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM 2. MODIFIABILITY OF THE CONDITION - Probability of success in enhancing wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention. - Factors to consider in determining modifiability of the problem: o Current knowledge, technology and interventions to enhance wellness state or manage the problem o Resources of the family-physical, financial and manpower o Resources of the nurse-knowledge, skill and time o Resources of the community-facilities and community organization or support 3. PREVENTIVE POTENTIAL - Nature and magnitude of future problems that can be minimized or totally prevented if interventions are done on the problem. - Factors to consider in determining preventive potential: o Gravity or severity of the problem – refers to the progress of disease indicating extent of damage on the client. The more severe of advanced the problem, the lower is the preventive potential. o Duration of the problem – refers to the length of time the problem has been existing. Has a direct relationship to gravity & preventive potential. o Current Management – refers to the presence and appropriateness of intervention measures instituted to enhance the wellness state or remedy the problem. The institution of appropriate intervention increase the preventive potential. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM o Exposure of any vulnerable or high-risk group – Increases the preventive potential in determining the score for salience. The family’s concerns, felt needs, or readiness increases the salience. 4. SALIENCE - Family’s perception & evaluation of the problem in terms of seriousness & urgency of attention needed or family readiness. Scale for Ranking Health and Conditions and Problems According to Priorities CRITERIA SCORE WEIGHT Nature of the Condition Wellness State 3 1 Health Deficit 3 Health Threat 2 Forseeable Crisis 1 Modifiability of the Condition Easily modifiable 2 1 Partially modifiable 1 Not modifiable 0 Preventive Potential High 3 1 Moderate 2 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Low 1 Salience A condition needing immediate 2 1 attention 1 A condition needing immediate 0 attention Not perceived as a condition needing change SCORING AND PRIORITIZING 1. Decide on a score for each of the criteria. 2. Divide the score by the highest possible score and multiply by the weight Score x Weight Highest Score 3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight. 4. Rank the overall score of each nursing problem. 5. The nursing problem with the highest score will be the priority while the problem with the lowest score will be the least priority 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food. Criteria Score Weight Computation Nature of the Condition Wellness State 3 1 (3/3) x 1 1 Health Deficit Health Threat Foreseeable Crisis Modifiability of the Condition Easily modifiable 2 2 (2/2) x2 2 Partially modifiable Not modifiable Preventive Potential High 3 1 (3/3) x1 1 Moderate Low Salience A condition needing 2 1 (2/2) x 1 1 immediate attention A condition needing immediate attention Not perceived as a condition needing change 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM TOTAL 5 GOAL OF CARE a broad desired outcome toward which behavior is directed. The Cardinal Principle: Goals must be jointly set with the family. This ensures the family commitment to their realization. Goals set by the nurse & family should be realistic or attainable. Too high goals & their consequent failure frustrate both the family & the nurse. OBJECTIVES OF CARE This refers to a more specific / more precise statements of the desired results or outcome of care. The more specific the objective, the easier is the evaluation of their attainment. Types of objective: 1. Short term/ Immediate objective Formulated for problem which require immediate attention and results observed is short time period with few nurse family contacts, use of less resources. 2. Long term/ Ultimate objective Require several nurse-family encounters & investment of more resources. Outcomes sought require time to demonstrate. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM 3. Medium term/ Intermediate objective Those which are not immediately achieved. Components of an objective (ABCD): 1. Actor / Subject – client, any part of the client or some attributes of the client. 2. Behavior / Verb – action of the client to perform. 3. Conditions / Modifiers - explain the circumstances under which the behavior is to be performed, (what, where, when, how) 4. Determinant / Criterion of Desired Performance - Level at which the client will perform the specified behavior. Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food. Goal After 1 day of effective health care strategies, Rosario’s diarrhea will be lessened from 4x bowel movement to twice/day. Objective Within 2 hours of health education and nursing care, the family will: a. Provide adequate nursing care 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM HEALTH CARE STRATEGIES This involves selection of appropriate nursing interventions/ health car e strategies based on the formulated goal and objective. Focus on Interventions to Help the Family Performs Health Tasks - Help the family recognize the problem - Guide the family on how to decide on appropriate health actions to take. - Develop the family’s ability and commitment to provide nursing care to each member. - Enhance the capability of the family to provide home environment conducive to health maintenance and personal development. - Facilitate the family’s capability to utilize community resources for health care. Guidelines for Implementing Nursing Activities - Nursing actions should be based on scientific knowledge, nursing research and professional standards of care. - Nurse should understand clearly the orders to be implemented and question any that are not understood. - Nursing actions should be adapted to the individual client. - Nursing actions should always be safe. - Nursing actions often require teaching, support and comfort. - Nursing actions should be holistic. - Nursing actions should respect the dignity of the client and enhance the client’s selfesteem 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM - Clients should be encouraged to participate actively in implementing the nursing actions. Implementation requires the following skills from the nurse: - Cognitive Skills – problem solving, decision making, critical thinking and creative thinking. - Interpersonal or communication skills - Technical skills – hands on skills such as manipulating equipment, giving medications and others. Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean food. Health Care Strategies: a. Teach and demonstrate to the mother how to mix and give ORS as follows: 1 L of clean & potable water mix with 8 level tsps. Sugar and 1 level tsp. salt a. Give frequent small sips of ORS over 4hr period. b. Give extra fluid, food-based fluids such as soup, rice water or buko juice c. Continue breast feeding frequently and longer at each feeding. EVALUATION Specifies how the nurse will determine changes in health status, condition and 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM achievement of outcomes of care specified in the objectives of family nursing care plan. Ongoing Evaluation – done while or immediately after implementing an order; enables nurse to make on-the-spot modifications in an intervention. Intermittent Evaluation- performed at specific time intervals to show the extent of progress towards the goal and enables nurse to correct any deficiencies and modify care plan; also called PROCESS Evaluation. Terminal Evaluation – indicates client’s condition at the time of discharge; includes status of goal achievement and an evaluation of the client’s self-care abilities with regard to follow-up care Example: Diarrhea (undiagnosed) as health deficit related to eating of contaminated & unclean Food. Evaluation: After 1 day of Health teaching and Nursing Care, the goal is partially met as evidenced by soft formed stool 2x per day and the parents now provides proper care to Rosario Sample Family Care Plan Sample Matrix 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM Health Problem Goal / Health Care Evaluation Objective Strategies 1st level assessment After 1 day of After 1 day of Health Diarrhea effective health (undiagnosed) as teaching and care strategies, health deficit related Nursing Care, Rosario’s to eating of diarrhea the goal is contaminated & will be lessened partially met unclean food as evidenced by: from 4x bowel as evidenced - Loose watery stool movement to by softformed - 4X bowel twice/day. stool 2x per movement/day day and the - Poor skin turgor parents now body provides weakness,and as proper care to verbalized,”symptom Rosario. kahapon pa sang aga ako naga lupot”. “kag nagakutoy akon tiyan”. 2nd level assessment Within 2 hours a. Teach and of health demonstrate to the Inability to provide education mother how to mix adequate nursing and give ORS as and Nursing care due follows: care, the family to: will: 1 L of clean & potable water mix 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  COLLEGE OF NURSING, NUTRITION AND DIETETICS NURSING PROGRAM a. Lack of knowledge a. Provide with 8 tsps. Sugar and 1tsp. salt and skill in treatment adequate nursing of diarrhea as a. Give frequent care verbalized by the small sips of ORS mother: “Wala ko over 4hr period. kabalo kon paano b. give extra fluid, bulngon ang lupot”. food-based fluids such as soup, rice, water or buko juice c. continue breast feeding frequently and longer at each feeding. 120 YEARS OF AUGUSTINIAN EXCELLENCE IN VIRTUS ET SCIENTIA Contact No.: 0939-278-9080 |Fax No.: (033) 337-4403 Email: [email protected] | Website: www.usa.edu.ph  NCM 104 CHN LEC countries, with high volumes of emissions from industry, transport, and agriculture as well as dirty cookstoves and fuels in home. Module 1 - Burning fossil fuels is the primary cause of air pollution and also a major contributor to Health – (WHO) a state of complete physical, mental climate change that impacts the health of the and social well-being and not merely the absence of people in many ways. disease or infirmity. - Health of all people is fundamental to the attainment of peace and security and is b. Non-communicable Diseases dependent on the fullest cooperation of - Diabetes, Cancer and heart diseases are leading individuals and states cause of death worldwide - Governments have a responsibility for the - Rise of these diseases has been driven by five health of their people which can be fulfilled major risk factors: tobacco use, physical only by the provision of adequate health and inactivity, the harmful use of alcohol, social measures unhealthy diets and air pollution *Mental health issues are also exacerbated by these five major risk factors. Suicide is the third leading cause Global Health – viewed in different ways, as the of death among 15-19 years old. institute of medicine – USA (1997) defined it as health problems, issues and concerns that transcends national boundaries, which may be influenced by circumstances c. Global Influenza Pandemic or experiences in other countries and which are best - World will face another influenza pandemic, the addressed by cooperative actions and solutions. only thing we don’t know is when it will hit and - (Koplan et al) an area for study, research and how severe it will be. The continues monitoring practice that places a priority on improving of WHO of the circulation of influenza viruses health and achieving health equity for all people helps prepare the world. worldwide. - (Kickbush) those health issues that transcends - Focus on people across the whole plane rather d. Fragile and Vulnerable Settings than concerns of nation - Fragile settings exists in almost all regions of the - Global health initiatives consider both medical world. More than 1.6B people love in places and non-medical disciplines such as where prolonged crisis (drought, famine, epidemiology, sociology, economic disparities, conflict, and population displacement) and public policy, environmental factors, cultural weak health services without access to basic studies, etc. care. 10 Threats to Global Health (WHO, 2019) e. Antimicrobial Resistance - The ability of bacteria, parasites, viruses and 1. Air Pollution & Climate Change fungi to resist the medicines. The threat of 2. Non-Communicable diseases going back in time where pneumonia, 3. Global Influenza Pandemic tuberculosis, gonorrhea, and salmonellosis is 4. Fragile and Vulnerable Settings inevitable. 5. Antimicrobial Resistance 6. Ebola and other high threat pathogens 7. Weak primary health care f. Ebola and other high threat pathogens 8. Vaccine Hesitancy - An epidemic of high threat pathogens is critical. 9. Dengue Watchlist for priority research and development 10. HIV includes ebola, several other hemorrhagic fevers, zika, mers-cov, and disease x which a. Air Pollution and Climate Change represents the need to prepare for an unknown - Air pollution is considered as the greatest pathogen that could cause a serious pandemic. environmental risk to health. Around 90% of these deaths are in low and middle-income  g. Weak Primary Health Care - Primary Health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life - In low and middle-income countries, there is an inadequate primary health care facility because of the lack of resources. Health Status (Philippines) h. Vaccine hesitancy - Vaccination is one of the most cost-effective ways of avoiding diseases. However some people have a complex reason why they chose not to vaccinate. - Vaccine Hesitancy is the reluctance or refusal to vaccinate despite the availability of vaccines. The unwillingness threatens to reverse the progress made in tackling vaccine-preventable diseases. i. Dengue - High number of cases of this mosquito-born disease can be lethal and kill up to 20% of those with severe dengue. - Growing threat for decades and is spreading to less tropical and more temperate countries, that have not traditionally seen the disease. j. HIV - Epidemic continues to rage with nearly a million people every year die of HIV/AIDS despite the progress that has been made against HIV National Health – PH made significant investments and advances in health. Filipinos have been living longer and healthier due to the rapid economic growth and strong country capacity. - Achievements have not been even and challenges remains. Inequities persist between regions, rich and poor, and different population groups. - Many Filipinos continue to die and suffer from illnesses. - Many people lack enough knowledge to make informed decisions about their own health.  Goal: To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness (Nisce, et al) Standards of Public Health Nursing in the Philippines - The standards differentiated public health nursing from community health nursing only in one are: setting of work as dictated by funding - Government is the employer of public health nurses both at the national and local health agencies. Mortality Rate Is related to the number of deaths caused by the health event under investigation in a Principles of CHN defined population during a specified interval. - The Community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems eg’ children, elderly) and community - In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care - CHN practice is affected by developments in health technology, - Goal of CHN is achieved through multi-sectoral efforts - CHN is a part of health care system and the larger human services system Responsibilities of the Community Health Nurse PUBLIC HEALTH - Participates in developing overall health plan, Public Health Nursing – special field of nursing that its implementation and evaluation for combines communities Community Health Nursing – (Ruth B. Freeman) service - Provide quality nursing services to the four rendered by a professional nurse to communities, levels of clientele groups, families, and individuals at home, in health - Maintain coordination/linkages with other centers, in clinics, in schools, and in places of work for health team members, NGO/Government the promotion of health, prevention of illness, care of agencies in the provision of Public Health the sick at home and rehabilitation Services. - Initiates and conducts researches relevant to - (Jacobson, 1975) Nursing practice in a wide CHN services to improve provision of health variety of community services and consumer care advocate areas, and in a variety of roles, at - Initiates and provides opportunities for times including independent practices… professional growth and continuing education community nursing Is certainly not confined for staff development. - (Maglaya, et al) The utilization of the nursing process in the different levels of clientele- individuals, population groups and  MODULE 2 hand-in-hand with strategies that improve health and education, reduce inequality, and Health Care Delivery System spur economic growth – all while tackling WHO’S Primary Goal - is to direct and coordinate climate change and working to preserve our international health within the United Nations system oceans and forest - Mission: “is the attainment by all peoples of highest possible level of health” - It is widely known in many activities, such as medical research, immunization campaigns against fatal disease, improves housing, nutrition, sanitation and working conditions in developing countries - It also performs charting statistical health trends and issues warning about possible health problems DEPARTMENT OF HEALTH – PHILIPPINES - The Department of Health (DOH) is the country’s principal health agency. - It is responsible for ensuring access to basic public health services through the provision of quality healthcare and the regulation of providers of health goods and services. - The primary function of the Department is the promotion, protection, preservation or MILLENIUM DEVELOPMENT GOALS restoration of the health of the people through the provision and delivery of health services In September 2000, leaders of 189 countries gathered and through the regulation and encouragement at the United Nations headquarters and signed the of providers of health goods and services historic Millennium Declaration, in which they committed to achieving a set of eight measurable goals that range from halving extreme poverty and hunger to VISION promoting gender equality and reducing child mortality, The DOH is the leader, staunch advocate and model in by the target date of 2015. promoting health for all in the Philippines MISSION Guarantee, equitable, sustainable, and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health LOCAL HEALTH SYSTEM AND DEVOLUTION OF HEALTH SUSTAINABLE DEVELOPMENT GOALS SERVICES - The Sustainable Development Goals build on  Devolution made local government executives the Millennium Development Goals (MDGs), responsible to operate local health care eight anti-poverty targets that the world services. committed to achieving by 2015. Enormous  RA 7160 Local Government Code aims to progress has been made on the MDGs, showing transform local government units into the value of a unifying agenda underpinned by selfreliant communities goals and targets.  1993 health services were devolved or - Formed from The 2030 Agenda for Sustainable transferred from Department of Health to the Development, adopted by all United Nations local government units. Member States in 2015. The UN recognize that ending poverty and other deprivations must go Objectives for Local Health Systems CLASSIFICATION OF OTHER HEALTH FACILITIES 1. Establish local health system for effective and A. Primary Care Facility- first contact care facility that efficient delivery of health care services. offers basic services including emergency service and provision for normal deliveries 2. Upgrade the health care management and service capabilities of local health care facilities. 1. With in-patient beds- Infirmary, birthing home 3. Promote inter-LGU linkages 2. Without beds- medical out-patient clinic, 4. Foster participation of the private sector, NGOs and OFW clinic, dental clinic communities in local health system development. 5. Ensure the quality of health service delivery at the local level B. Custodial care facility-provides long term care to patients with chronic/mental illness, in need of rehabilitation or requiring ongoing health and nursing CLASSIFICATION OF HEALTH FACILITIES care To improve access to health facilities with the efficient 1. Custodial psychiatric care facility use of government resources and without 2. Substance abuse treatment and compromising the quality of care rehabilitation center 3. Sanitarium/leprosarium CLASSIFICATION OF HOSPITALS 4. Nursing home According to ownership ✓ Government- created by law C. Diagnostic/ Therapeutic Care Facility- examines ✓ Private- owned and operated with funds human body or specimens from the human body for through donation, principal investment or other diagnosis or treatment of diseases means by any individual, corporation or 1.Laboratory facility- clinical lab, HIV testing organization. center, Blood service facility, drug testing lab, According to scope of services Newborn screening lab ✓ General- services for all kinds of illnesses, 2.Radiologic facility diseases, injuries or deformities 3.Nuclear medicine facility ✓ Specialty- specializes in particular condition or disease D. Specialized Out-Patient Facility- with highly According to functional capacity competent and trained staff that performs highly specialized procedures on an out-patient basis ✓ General 1. Dialysis clinic 2. Ambulatory surgical clinic 3. In-vitro fertilization center 4. Stem cell facility 5. Oncology chemotherapeutic center 6. Radiation oncology facility 7. Physical medicine and rehabilitation center PRIMARY HEALTH CARE - WHO defines PHC as an essential health care made universally accessible to individuals and  families in the community by means acceptable 7. Development of intra-sectoral linkages with other to them to their full participation and at the government and private agencies cost that the community and country can afford 8. Emphasizing partnership so that the health workers at every stage of development and the community leaders/members view each other Historical Background as partner - PHC was declared during the First International Conference on Primary Health Care held in Primary Health Care Team Alma Ata, USSR on September 6-12, 1978 by WHO. Physician - The goal was “Health for All by the year 2000” Nurse auxiliaries this was adopted in the Philippines through Letter of Instruction 949 signed by President Nurse Marcos on October 19,1979 and has an Locally trained community health workers underlying theme of “Health in the Hands of the People by 2020 Midwives Elements/Components of Primary Health Care LEVELS OF HEALTH CARE REFERRAL SYSTEM 1. Environmental sanitation 1. Primary Level of Care The first contact between the community 2. Control of Communicable Diseases members and the other levels of health facility 3. Immunization 4. Health Education 2. Secondary Level of Care. 5. Maternal and Child Health and Family Planning  Given in health facilities either privately owned or government operated. 6. Adequate Food and Proper Nutrition 7. Provision of Medical Care and Emergency Treatment 3. Tertiary Level of Care Tertiary care is rendered by specialist in 8. Treatment of Locally Endemic Diseases health facilities. Complicated cases and 9. Provision of Essential Drug intensive care STRATEGIES LEVELS OF PREVENTION 1. Reorientation and reorganization of the national Primary prevention- aims to prevent disease or injury health care systems with the establishment of before it ever occurs. functional support mechanism. ✓ Health education about healthy and safe 2. Effective preparation and enabling process for health measures in all levels. ✓ Immunization 3. Mobilization of the people to know their communities and identifying their basic health needs ✓ Laws to mandate and enforce healthy and with the end in view of providing appropriate solutions. safe practices 4. Develop and utilization of appropriate technology Secondary prevention- aims to reduce the impact of a focusing on local indigenous resources available in and disease or injury that has already occurred. acceptable in the community. ✓ Regular exams and screening tests 5. Organization of communities arising from their ✓ Diet and exercise to prevent further attack expressed needs Tertiary prevention- aims to soften the impact of an 6. Increase opportunities for community participation in ongoing illness or injury that has lasting effects. local level planning, management, monitoring and evaluation ✓ Cardiac or stroke rehabilitation programs  ✓ Vocational rehabilitation programs ✓ Support groups that allow members to share strategies for living well UNIVERSAL HEALTH CARE (UHC) - also referred to as Kalusugan Pangkalahatan (KP), is the “provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public.  MODULE 3 Includes 3 generations Lives together as a group FAMILY FAMILY AS BASIC UNIT OF SOCIETY 3. Single Parent Family ✓ Genetic transmission unit Children < 17 years of age, living in a family ✓ Matrix of personality of development and the most unit with a single parent, another relative or intimate emotional unit of society non-relative May result from: Loss of spouse by death, ✓ Enduring social form in which a person is divorce, separation incorporated Out of wedlock birth of a child From adoption ✓ Lifelong involvement Migration (OFWs) ✓ Shared attributes o Genetics – physical and psychological 4. Blended/ Reconstituted family o Developmental – shared home, lifestyle, social Includes step-parents and step-children activities Caused by divorce, annulment with ✓ Sense of belonging remarriage and separation o Security/defense against a potentially hostile environment 5. Compound family o Companionship One woman/ man with several spouses ✓ Societal expectations o Sense of responsibility towards members & 6. Communal family others Grouping of individuals which are formed for o Basis of affection/care specific ideological or societal purposes Considered as an alternative lifestyle for ✓ Built-in problems people who feel alienated from the o Generation gap economically privileged society o Dependence of members Vary within social context o Emotional attachment/involvement ✓ The family endures despite problems 7. Cohabitation/ Live-in o Resource utilization Unmarried couple living together o Authority o Individual sense 8. No-kin A group of at least two people sharing a Classification according to structure relationship and exchange support who have no legal or blood tie to each other 1. Nuclear family A father and mother with/without children living together but apart from both sets of 9. Foster parents and relatives Substitute family for children whose parents Separate dwelling not shared with members are unable to care for them of the family of origin/orientation of either spouse Economically independent 10. Gay/ lesbian Homosexual couple living together with/without children 2. Extended family Two or more nuclear families economically and socially related to each other Unilaterally/ bilaterally extended  11. Dyad ▪ Strongly Bias-one member gains Husband and wife living alone w/out children dominance over the others Classification According to Function c. The family operates as a group ▪ A family is a unit in which the action of any Family of Procreation- refers to the family you member may set of a whole series of reaction yourself created. within a group, and entity whose inner strength Family of Orientation-refers to the family where you may be its greatest single supportive factor came when one of its members is stricken with illness or death. Family as a Unit of Care d. The family accommodates the needs of the The family is considered the natural and fundamental individual members. unit of society. ▪ An individual is unique human being who The family as a group generates, prevents, tolerates needs to assert his or herself in a way that and corrects health problems within its membership. allows him to grow and develop. ▪ Sometimes, individual needs and group needs The health problems of the family members are seem to find a natural balance; interlocking. 1. The need for self-expression does The family is the most frequent focus of health not overshadow consideration for decisions and action in personal care. others. 2. Power is equitably distributed. The family is an effective and available channel for 3. Independence is permitted to much of the effort of the health worker flourish TYPES OF FAMILY e. Family as a System 1. Family as a Client The focus is on the family as a client The family is the foreground and individuals Viewed as an international system in which are in the background the whole is greater than the sum of its parts The focus is concentrated on each and every Focuses on the individual and family members individual as they affect the whole family become the target for nursing intervention The focus is concentrated on how the family as a whole is reacting to an event when a family member experiences a health issue FUNCTIONS & DEVELOPMENTAL STAGE Characteristics of Family as a Client Functions of a Family a. The family is a product of time and place  Biologic Reproduction ▪ A family is different from other family who  Child-rearing/Caring Nutrition lives in another location in many ways. ▪ A family who lived in the past is different from  Health maintenance another family who lives at present in many  Recreation ways. Economic b. The family develops its own lifestyle ▪ Develop its own patterns of behavior and its  Provision of adequate financial resources own style in life. ▪ Develops their own power system which  Resource allocation either be:  Ensure financial security ▪ Balance-the parents and children have their own areas of decisions and control.  Educational  Includes adjustments to each other’s routines (sleeping, eating, chores, etc.), sexual and  Teach skills, attitudes and skills relating to other economic aspects functions Psychological/ Affection ❖ Members work to achieve 3 separate identifiable tasks:  Promotes the natural development of personalities 1. Establish a mutually satisfying relationship  Offer optimum psychological protection 2. Learn to relate well to their families of orientation  Promotes ability to form relationships with people 3. If applicable, engage in reproductive life within the family circle planning Socio-cultural 2. Childbearing Family  Socialization of children  From the birth of the first child until that child  Promotion of status and legitimacy Developmental is 2 1/2 years old. Stages/ Family Life Cycle  Developmental Tasks: Adjusting to increased family size  Assess a patient and family developmental concerns Caring for an infant  Identifies stages of family development that reflect Providing a positive developmental the biological functions of raising children environment  As the family system moves together through time, 3. Family with Preschoolers the individual life cycles  When the oldest child is between the ages of  intertwines with the life cycles of other family 2 1/2 and 6. member  Developmental Tasks: ▪ Satisfying the needs and interests of  Families go through different stages for which specific preschool children developmental tasks must be accomplished ▪ Coping with demands on energy and attention with less privacy at home  Families who are not able to accomplish these tasks may develop difficulties with subsequent family development 4. Family with School Age Children  When the oldest child is between the ages of 6 and 13. DEVELOPMENTAL STAGES  Developmental Tasks: - Assess a patient and family developmental ▪ Promoting educational achievement concerns ▪ Fitting in with the community of - Identifies stages of family development that families with school-age children reflect the biological functions of raising children - As the family system moves together growing 5. Family with Teenagers - Family go through different stages for which  When the oldest child is between the ages of specific developmental tasks must be 13 and 20. accomplished  Developmental Tasks: - Families who are not able to accomplish these ▪ Allowing and helping children to task may develop difficulties with subsequent become more independent family problems ▪ Coping with their independence ▪ Developing new interests beyond child 1. Beginning Family care  Beginning Family: The couple establishes their home but do not yet have children. 6. Launching  Involves merging of values brought into the  From the time the oldest child leaves the relationship from the families of orientation. family for independent adult life till the time the last child leaves.   Developmental Tasks: 5. Division of Labor – who will fulfill certain roles ▪ Releasing young adults and accepting e.g., family provider, home manager, children’s new ways of relating to them caregiver ▪ Maintaining a supportive home base ▪ Adapting to new living circumstances. 6. Reproduction, Recruitment, and Release of family member 7. Empty nest 7. Placement of members into larger society –  From the time the children are gone till the consists of selecting community activities such marital couple retires from employment. as church, school, politics that correlate with  Developmental Tasks the family beliefs and values ▪ Renewing and redefining the marriage relationship 8. Maintenance of motivation and morale- ▪ Maintaining ties with children and created when members serve as support people their families to each other. ▪ Preparing for retirement years Family Health Tasks (Maglaya) 8. Aging family 1. Recognizing interruptions of health development  From retirement till the death of the surviving marriage partner. 2. Making decisions about seeking health care/ to take action  Developmental Tasks: ▪ Adjusting to retirement 3. Dealing effectively health and non-health situations ▪ Coping with the death of the marriage partner and life alone 4. Providing care to all members of the family 5. Maintaining a home environment conducive to health maintenance FAMILY HEALTH TASK Health task differ in degrees from family to family CHARACTERISTICS OF HEALTHY FAMILY TASK- is a function, but with work or labor overtures assigned or demanded of the person o Able to provide for physical, emotional and spiritual needs of family members o Able to be sensitive to the needs of the family Family Health Tasks (Duvall & Niller) members 1. Physical maintenance- provides food, shelter, o Able to communicate thoughts and feelings effectively clothing, and health care to its members being certain that a family has ample resources to o Able to provide support, security and encouragement provide o Able to initiate and maintain growth producing relationship 2. Socialization of Family- involves preparation of children to live in the community and interact o Maintain and create constructive and responsible with people outside the family. community relationships o Able to grow with and through children 3. Allocation of Resources- determines which family needs will be met and their order of o Ability to perform family roles flexibly priority. o Able to help oneself and to accept help when appropriate o Demonstrate mutual respect for the 4. Maintenance of Order- task includes opening individuality of family members an effective means of communication between family members, integrating family values and o Ability to use a crisis experience as a means of growth enforcing common regulations for all family o Demonstrate concern of family unity, loyalty and inter members. family cooperation MODULE 4: FAMILY NURSING CARE PLAN Undiagnosed malnutrition (mild) as health deficit related to inadequate food intake as evidenced by stunted growth ---- weight ---- and verbalization of  ▪ Seeks to thwart the occurrence of insults to health and well-being Curative ▪ To provide treatment ▪ Basic first aid and initial treatment in the community Rehabilitative ▪ Emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic and vocational areas of their lives ▪ Assist to return to former function ▪ Assist clients in adjusting how to perform activities in order to achieve maximum abilities Tools of Public Health Nursing IMPLEMENTING FAMILY CARE PLAN The PHN Bag Promotion of health Bag technique ▪ Behavior motivated by the desire to increase well-being and actualize human health potential Tool by which the nurse, during her visit, will enable her to perform nursing procedure with ease ▪ Not disease oriented and deftness, to save time and effort, with the end ▪ Motivated by personal “approach” to wellness view of rendering effective nursing care to clients. ▪ Seeks to expand positive potential for health Public health bag Prevention of disease/injury ❖Is an essential and indispensable equipment of the public health nurse which he/she has to carry ▪ Also known as health protection along when he/she goes out home visiting. It ▪ Behavior motivated by a desire to actively avoid contains basic medications and articles which are illness, detect it early or maintain necessary for giving care functioning within the constraints of illness ❖Rationale- to render effective nursing care to clients and /or members of the family during home ▪ Illness/injury specific visit ▪ Motivated by avoidance of illness Principles Soap in a soap dish 1. The use of the bag technique should minimize if Thermometers (oral and rectal) not totally prevent the spread of infection from 2 pairs of scissors (surgical and bandage) individuals to families, hence, to the community. 2 pairs of forceps (curved and straight) 2. Bag technique should save time and effort on the part of the nurse in the performance of nursing Disposable syringes with needles (g. 23 & procedures. 25) 3. Bag technique should not overshadow concern Hypodermic needles (g. 19, 22, 23, 25) for the patient rather should show the effectiveness of total care given to an individual or Sterile dressing family. Cotton balls 4. Bag technique can be performed in a variety of Cord clamp ways depending upon agency policies, actual home situation, etc., as long as principles of avoiding Micropore plaster transfer of infection is carried out Tape measure 1 pair of sterile gloves Special Considerations Baby’s scale 1. The bag should contain all necessary articles, Alcohol lamp supplies and equipment which may be used to answer emergency needs. 2 test tubes 2. The bag and its contents should be cleaned as Test tube holders often as possible, supplies replaced and ready for Solutions of: use at any time. Betadine 3. The bag and its contents should be well protected from contact with any article in the 70% alcohol home of the patients. Consider the bag and