NCM-104-NOTES-1.docx

NCM 104 Prepared By: April E. Loro, RN, MN COMMUNITY HEALTH NURSING - A synthesis of nursing knowledge and practice and the science and practice of public health, implemented via a systematic use of the nursing process other processes to promote health and prevent illness in populat...

NCM 104 Prepared By: April E. Loro, RN, MN COMMUNITY HEALTH NURSING - A synthesis of nursing knowledge and practice and the science and practice of public health, implemented via a systematic use of the nursing process other processes to promote health and prevent illness in population groups (Clark, 2008). CHARACTERISTICS OF CHN 1. Promotion of health and prevention of illness are the goals of professional practice. 2. CHN practice is comprehensive, general, continual and not episodic. 3. There are different levels of clientele\-- individuals, families, population group and the practitioner recognizes the primacy of the population as a whole. 4. The nurse and the client have greater control in making decisions elated to health care and they collaborate as equals 5. The nurse recognizes the impact of different factors on health and has a greater awareness of his/her clients' live situations. \*The practice of CHN entails active interaction and partnership between the nurse and the client. Such partnership recognizes the autonomy of both parties and the potential of each one in enriching their relationship. Community Health Nurses are in a position to assist in the transition of the Philippine health care system from a disease-oriented system to a health-oriented system. Community health activities focusing on health promotion and disease prevention are therefore of the essence. (Nursing Care of the Community,2013)  Considering the high cost of the care of the sick , to which a considerably large portion of the health budget goes, Philippines health indicators have remained markedly below the health indicators of many other countries. ROLES OF CHNs +-----------------------+-----------------------+-----------------------+ | Client- oriented | Delivery-oriented | Population-oriented | | roles | roles | roles | +=======================+=======================+=======================+ | Caregiver | Coordinator | Case Finder | | | | | | Educator | Collaborator | Leader | | | | | | Counselor | Liaison | Change Agent | | | | | | Referral Resource | | Community Mobilizer | | | | | | Role Model | | Coalition Builder | | | | | | Case Manager | | Policy Advocate | | | | | | | | Social Marketer | | | | | | | | Researcher | +-----------------------+-----------------------+-----------------------+ COMMUNITY - is group of people sharing common geographic boundaries and/commonvalues and interests. The people are different from each other, thus the dynamics in one community differs from that of the other. HEALTH - as "a state of complete *physical, mental, and social well-being* and not merely the absence of disease or infirmity."(WHO,1958) - *Social* means "of or relating to living together in organized groups or similar close aggregates" (American Heritage College Dictionary, 1997) - *"Social health"* connotes community vitality and is a result of positive interaction among groups within the community with an emphasis on health promotion and illness prevention. - a state of a person that is characterized by soundnessor wholeness of developed human structures and of bodily and mental functioning (Orem, 2001). - "realization of human potential through goal-directed behavior,competent self-care, and satisfying relationships with others" (Pender, Murdaugh, and Parsons, 2011). FAMILY NURSING - is the practice of nursing directed towards maximizing the*health and well-being of all individuals within a family system* (Maurer and Smith, 2009) LEVELS OF CLIENTELE 1\. INDIVIDUALS -- people (sick/well) consult at the health center and receive health services (pre-natal supervision, well-child follow-ups and morbidity services)on adaily basis. 2\. FAMILY - is a very important social institution that performs two major functions - reproduction and socialization. 3\. POPULATION GROUP OR AGGREGATE - is a group of people who sharecommon characteristics, developmental stage/common exposure to particular environmental factors and consequently common health problems. 4. COMMUNITY- a group of people sharing common geographic boundaries and/or common values and interest within a specific social system. E.g. rural, urban, rurban, sub-urban FRAMEWORK FOR CHN (4 COMPONENTS) 1. Health Care Delivery System with its CHN subsystem (Housing, Education, Fire and Safety, Politics and Government, Health Facilities and activities, Communication, Economy and Recreational) *Types of Health Care Delivery System/ Levels of Prevention* Primary - Promotive and Preventive Secondary - both Preventive and Curative Tertiary - Rehabilitative and Curative 2. The clients 3. Health which is the goal of the health care delivery system 4. The economic, sociocultural , political and environmental factors that affect the health cared delivery system, the practice of CHN and the people's health. FAMILY - is a *group of persons* usually living together and composed of the head and other persons related to the head by blood , marriage or adoption (National StatisticalCoordination Board, 2008) - It is a social unit interacting with the larger society (Johnson, 2000) - In terms of kinship, marriage and choice: "a family is characterized by people together because of birth, marriage, adoption or choice" (Allen et al., 2000) - It is two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family (Friedman et al., 2003). - The community health nurse interacts with the community made up of different types of families. When faced with great diversity in the community, the community health nurse must *formulate a personal definition of family* and be aware of the changing definition of family held by other disciplines, professionals and family groups. TYPES OF FAMILY 1.NUCLEAR FAMILY -- defined as "the family of marriage, parenthood, or procreation; composed of husband, wife and their immediate children -- natural, adopted or both"(Friedman et al., 2003) 2.DYAD FA M I LY -- consisting only of husband and wife such as newly married couples and "empty nesters" 3.EXTENDED FAMILY -- consisting of three generations which may include married siblings and their families and/or grandparents 4.BLENDED FAMILY/BLENDED/RECONSTITUTED -- results from a union where one or both spouses bring a child or children from a previous marriage into a new livingarrangement 5.COMPOUND FAMILY -- where a man has more than one spouse; approved by Philippine authorities only among Muslims by virtue of Presidential Decree No. 1083 also known as the *Code of Muslim Personal Laws of the Philippines* (Office of the President, 1977) 6.COHABITING FAMILY -- commonly described as a " *live -in"arrangement* between unmarried couple who are called common-law spouses and their child or children from such an arrangement 7\. STEP FAMILY --remarriage of a widowed person with children 8.SINGLE PARENT -- which results from the death of a spouse, separation or pregnancy outside of wedlock. 9\. The gay or lesbian family -- is made up of a cohabiting couple of the same sex in a sexual relationship. The homosexual family *may or may not have children*. Because of the Family Code of the Philippines (Executive Order No. 209) expressly states that marriage is a special contract of permanent union between a man and a woman who entered into in accordance with the law for the establishment of conjugal and family life, same- sex marriage is not legally acceptable. 10\. COMMUNAL FAMILY -- e.g. bahay-ampunan, Home for the aged, Kumbento 11\. No-Kin --have no legal or blood tie to each other 2 PURPOSES OF A FAMILY 1\. To meet the needs of society 2\. To meet the needs of individual family member The family meets the needs of society through: ❑ Procreation. Despite the changing forms of the family, it has remained the universally accepted institution for reproductive function and child bearing. ❑ Socialization of family members. Socialization -- is the process of l e a r n i n g h ow t o b e c o m e productive members of society. It involves transmission of the culture of social group. For children, the family is the "first teacher " instructing the children in societal rules *Status placement*. Society is characterized by a hierarchy of its members into social classes. The family confers its societal rank on the children. Depending on the degree of social mobility in a society, the family and the children's future families may move from one social class to another (Medina, 2001). *Economic function*. Medina (2001) observes that the rural family is a unit of production where the whole family works as a team, participating in farming, fishing or cottage industries. The urban family is more of a unit of consumption where economically productive members work separately to earn salaries/wages. It is also a frequent occurrence that the families may engage in business enterprises thereby serving as units of production. FAMILY BASED ON WHO MAKE DECISIONS (AUTHORITY) PATRIARCHAL -- full authority on the father or any male member of the family e.g. eldest son, grandfather MATRIARCHAL -- full authority of the mother or any female member of the family, e.g. eldest sister, grandmother EGALITARIAN -- husband and wife exercise a more or less amount of authority, father and mother decides. DEMOCRATIC -- everybody is involved in decision making AUTOCRATIC (AUTHORITARIAN) -- one person controls all the decisions LAISSEZ-FAIRE --"full autonomy" MATRICENTRIC -- the mother decides/takes charge in the absence of the father (e.g. father is working overseas) PATRICENTRIC -- the father decides/takes charge in absence of the mother **Specifically, the family meets the needs of individuals through**: Physical maintenance. The family provides for the survival needs (food, shelter, and clothing) of its dependent members like young children and the aged.. Welfare and protection. The family supports spouses/partners by providing forcompanionship and meeting affective, sexual and socioeconomic needs. By developing a sense of love and belonging, the family gives the children emotional gratification and psychological security (Medina, 2001) FAMILY TYPES BASED ON DECENT Cultural norms, which affiliate a person with a particular group of kinsman for certain social purposes PATRILINIAL -- affiliates a person with a group of relatives who are related to him through his father. BILATERAL --both parents MATRILINEAL -- related through mother FAMILY BASED ON RESIDENCE *PATRILOCAL*-- family resides/stays with/ near domicile of the parents of the husband *MATRILOCAL*-- live near the domicile of the parents of the wife - The Filipino having close family ties, in the internal structure has three main points of interaction (Medina, 2001). 1\. Husband-Wife Relations -- wherein there are 3 bonding factors involved: *a. conjugal bond*-- the internal sense of obligation and privilege, respect, affection or sexual attraction existing in the mind and heart of each spouse. *b. Social Pressure* -- couple are expected to be loving and faithful to each other all throughout their marriage. *c. economic cooperation*-- couple together support the family basic needs. The Filipino having close family ties, in the internal structure has three main points of interaction (Medina, 2001). 2\. Parent -- Child Relations -- strong bond exists between parents and children ❖ Filipino parents are loving, caring and protective 3\. Siblings Relations -- Filipino parents train and discipline their children on mutual love, protection and respect. ❖ Other brothers and sisters have the responsibility to take care of younger siblings especially when parents are away. - The family meets individual needs through provision of basic needs ( food, shelter, clothing, affection and education ) the family supports spouses/partners by meeting affective, sexual and socioeconomic needs. - Observing and inquiring about family interaction enables the nurse in the community to assess the influence of family members on each other. Nursing assessment and intervention must not stop with the immediate social context of the family, but it must also consider the broader social context of the community and society. IMPORTANT REASON FOR NURSES TO WORK WITH FAMILIES "The family is a critical resource". The importance of the family in providing care to its members has already been established. In this caregiver role, the family can also improve individual members' health through health promotion and wellness activities.  " In a family unit, any dysfunction (illness, injury, separation) that affects one or more family members will affect the members and unit as a whole. The nurse must assess each individual and the family unit. Case finding is another reason to work with families. While assessing an individual and family, the nurse may identify a health problem that necessitates identifying risks for the entire family. "Improving nursing care". The nurse can provide better and more holistic care by understanding the family and its members. Freeman and Heinrich (1981)point out that the family *provides feedback and influences health services*. When the family informs the nurse that *they do not utilize the services of the nearby health center*, the nurse must find out the reason. The family's *reasons for nonutilization of services*may provide the health center personnel with clues as to how they can make services in keeping with the needs and expectations of the catchment population. Beyond "improving nursing care",the family can help improve public health programs. Decisions for personal care and health actions are usually made in a family setting (Freeman and Heinrich, 1981). THE FAMILY AS A UNIT OF CARE Rationale for considering the Family as a Unit of Care: 1.The family is considered the *natural and fundamental unit of society.* 2.The family as a group*generates, prevents, tolerates and corrects health problems*within its membership. 3\. The health problems of the family members are *interlocking.* 4\. The family is the most frequent *focus of health decisions and action*in personal care. 5\. The family is an*effective and available channel*for much of the effort of the health worker. 6.The family provides a crucial environmental force. ❖ Each individual member constantly interacts with the physical, social and interpersonal milieu created by his family. 7\. The family through its interaction with the larger social system validates and influences health efforts. ❖ The family develops within its members sets of skills necessary for productive membership in a larger social system. THE FAMILY AS A UNIT OF CARE General system theory - is a way to how the family as a unit interacts with larger units outside the family and with smaller units inside the family (Friedman, 1998)  Each member of the system is, to a certain extent, independent of other members, yet, the members are in so many ways dependent on each other. Thus, the family is certainly more than just the sum of its members. The family may be affected by affected by any disrupting force acting on a system outside the family (e.g., suprasystem). The family is embedded in social systems that have an influence on health (e.g., education, employment and housing) just as it is affected by systems within the family (i.e., suprasystems). 3 Subsystems of the family Parent-child subsystem Marital subsystem Sibling-sibling subsystem  Allmond et al. (1979) compared the family as a systemto a piece of a mobile crib toy suspended from the air that is in constant movement with the other pieces of the mobile. At any time, the family like any piece of the mobile may be caught by a gust of air and become unbalanced, moving "chaotically" for a time. However, eventually, the stabilizing force of the other parts of the mobile will reestablish balance. Dunst and Trivette (2009) reviewed 20 years of system theory and the importance to early childhood interventions, adding that systems theory providers can expand family capacity by changing that provides direction inunderstanding how health care parenting and therefore changing childbehaviors. CHARACTERISTICS OF FAMILY AS A PATIENT (Freeman, 1970) 1\. The family is a product of time and place. 2\. The family develops its own lifestyle. Each family develops its own set of values, its own patterns of behavior, and its own style of life. 3\. The family operates as a whole/group. In business of daily living, the family develops its own ways of operating. 4\. The family accommodates the needs of the individual. 5\. The family relates to the community. The family develops a characteristic stance with respect to the community. BASIC REQUIREMENT FOR FAMILY SURVIVAL,CONTINUITY AND GROWTH 1\. Reproduction -- planning and controlling family size 2\. Physical maintenance of family members -- providing food, clothing, shelter and medical care 3\. Socialization of offspring into functioning adults, capable of assuming adult family roles of husband-father, wife-mother. 4\. Allocation of resources and division of duties and responsibilities a\. allocation of authority including prestige and designation of accountability. b\. Allocation of economic income and output. c\. Division of labor d\. Division of time -- scheduling of tasks, responsibilities and Services 5\. Maintenance of order within the family and between the family and outsiders. ❖ Within the family: meeting the emotional needs of members and determining the types and intensity of emotion and affection among members ❖ Between family and outsiders: developing methods of articulating with other groups and the larger social structure. 6\. Maintenance of family morale and motivation to carry out family tasks 7\. Development of methods for orderly recruiting and releasing of group members:incorporating of stepparents, kin, guests and servants into family group; releasing members at adulthood to jobs and marriage. DEVELOPMENTAL STAGES OF THE FAMILY  Nurses are familiar with developmental states of individuals from prenatal through adult. (Duvall and Miller, 1985), a noted sociologist is the forerunner of a focus on familydevelopment.  To assess the family, the community health nurse must comprehend these phases and the struggles that families experience while going through them. FAMILY LIFE CYCLE 1. Beginning family through marriage/commitment as a couple relationship 2. Parenting the first child 3.Living with adolescent(s) 4.Launching family (youngest child leaves home) 5.Middle-aged family (remaining marital dyad to retirement) 6.Aging family (from retirement to death of both spouses) STAGES AND TASKS OF THE FAMILY LIFE CYCLE 1\. Marriage: joining of families a\. Formation of identity as a couple b\. Inclusion of spouse in realignment of relationships with extended families c\. Parenthood: making decision 2\. Families with young children a\. Integration of children into family unit b\. Adjustment of tasks: child rearing, financial and household c\. Accommodation of new parenting and grandparenting role 3\. Families with adolescents a\. Development of increasing autonomy for adolescents b\. Midlife reexamination of marital and career issues c\. Initial shift towards concern for older generation 4\. Families as launching centers a\. Establishment of independent identities for parents and grown children b\. Renegotiation of marital relationship c\. Readjustment of relationships to include in-laws and grandchildren d\. Dealing with disabilities and death of older generation 5\. Aging families a\. Maintaining couple and individual functioning while adapting to the aging process b\. Support role of middle generation c\. Support and autonomy of older generation d\. Preparation of own death and dealing with loss of spouse and/or siblings and other peers