HEALTH CARE PROCESS AS APPLIED TO FAMILY

REVIEW

Classification of family structure: Based on internal organization and membership

Nuclear – father , mother and the children Extended – composed of two or more families related

to each other economically or socially Based on place of residence

Patrilocal – requires couple to live with the family of the bridegroom

Matrilocal –requires couple to live with or near the residence of the bride’s parents

Bilocal – couple has a choice where to live Neolocal – they can decide on their own Avunculocal- prescribes the newly wed couple to reside

with or near the maternal uncle of the groom

REVIEW

Based on descent . patrilineal – affiliates a person with a group of

relatives through his or her father 2. Matrilineal – affiliates a person with a group of

relatives through his mother 3. Bilateral – affiliates a person with a group of

relatives related through both his or her parents Based on authority

1. patriarchal – oldest male in the family , father 2. matriarchal – mother or mothers kin 3. Egalitarian – husband and wife are equal 4. matricentric – prolonged absence of the father

gives the mother a dominant position.

I. FAMILY ASSESSMENT

Initial Data Base a. Family structure, characteristics and dynamics 1. Members of the household and relationship to

the head of the family 2. Demographic data – age, civil status, position

in the family 3. Place of residence- whether living with the

family or elsewhere 4. Type of family structure 5.Dominant family members in terms of decision

making especially in matters of health care 6. General family relationship /dynamics

b. Socio-economic and cultural characteristics Income, occupation, place of work (of each

member) Educational attainment of each member Ethnic background and religious affiliation Significant others and other roles they play in the

family’s life Relationship of the family to the larger

community (membership in organizations)

c. Home and environment Information on housing and sanitation facilities

which includes: Housing agency, sleeping arrangements, food storage,

cooking facilities, water supply, source, ownership, potability, presence of accident hazards, toilet, garbage disposal

Availability of social, health , communication and transportation facilities in the community.

d. Health status of each member Past /current significant illness Beliefs/practices about health Nutritional and development status Decision – making on which or whom to seek

advice regarding health

e. Values and Practices on Health Promotion and Maintenance Preventive aspects- immunization status Adequate rest and sleep, exercise, relaxation

activities Street management activities, utilization of

health care facilities

TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

First level assessment – is a process whereby existing and potential health conditions or problems of the family are determined. 1. wellness state/s 2. health threats 3.Health deficits 4.Stress points or foreseeable crisis situations

FIRST LEVEL ASSESSMENT

I.Presence of wellness condition Stated as potential or readiness- a clinical

nursing judgment about a client in transition from a specific level of wellness or capability to a higher level . Potential for enhanced capability for 1.healthy lifestyle2. Health maintenance/health management3. Parenting4. Breastfeeding5. Spiritual being6. Others , specify

FIRST LEVEL ASSESSMENT

Wellness potential Is a nursing judgment on wellness state or

condition based on clients performance, current competencies or clinical data but no explicit expression of client desire.

FIRST LEVEL ASSESSMENT

Readiness for enhanced wellness state is a nursing judgment on wellness or state condition

based on client competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance.

1.healthy lifestyle2. Health maintenance/health management3. Parenting4. Breastfeeding5. Spiritual being6. Others , specify

FIRST LEVEL ASSESSMENT

Presence of 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- e.g. Lifestyle diseases, metabolic syndrome

B. Threat of cross infection from a communicable disease case

C. Family size beyond what family resources can provide

FIRST LEVEL ASSESSMENT

D. Accident hazards Broken stairs Pointed sharp objects Fire hazards Fall hazards Others specifyE. Faulty /unhealthful nutritional/ eating habits or feeding

techniques practices. Inadequate food intake both in quality and quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding techniques

FIRST LEVEL ASSESSMENT

F. Stress –provoking factors Strained marital relationship Strained parent – sibling relationship Interpersonal conflict between family members Care giving burdenG. Poor home/environmental condition/sanitation Inadequate living space Lack of food storage Polluted water supply Presence of breeding or resting sites of vectors

of diseases Improper garbage disposal

FIRST LEVEL ASSESSMENT

Unsanitary waste disposal Improper drainage system Poor lighting and ventilation Noise pollution Air pollutionH. Unsanitary food handling and preparationI. Unhealthful lifestyle and personal

habits/practices Alcohol drinking Cigarette /tobacco smoking Walking barefooted or in adequate footwear Eating raw meat or fish Poor personal hygiene

FIRST LEVEL ASSESSMENT

Self medication/substance abuse Sexual promiscuity Engaging in dangerous sports Inadequate rest or sleep Lack of/inadequate exercise/physical activity Lack of/inadequate relaxation activities Non- use of self protection measure( bednets)J. Inherent personal characteristics – e.g. Poor

impulse controlK. Health history which may participate/ induce the

occurrence of a health deficite.g. Previous history of difficult labor

FIRST LEVEL ASSESSMENT

L. Inappropriate role assumption – e.g. Child assuming mother’s role, father not assuming his role

M. Lack of immunization/ inadequate immunization status especially of children

N. Family disunity Self- oriented behavior of member(s) Unresolved conflicts of members Intolerable disagreement others

FIRST LEVEL ASSESSMENT

III. Presence of health deficits- instances of failure in health maintenance.

Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner

Failure to thrive /develop according to normal rate

Disability – wether congenital or arising from illness : transient /temporary ( e.g. Aphasia or temporary paralysis after a CVA) or permanent (e.g leg amputation secondary to diabetes, blindness from measles, lameness from polio)

FIRST LEVEL ASSESSMENT

IV- presence of stress points / froseeable crisis situations – anticipated periods of unusual demand on the individual or family in terms of adjustment/ family resources

Marriage Pregnancy,labor, puerperium Parenthood Additional member Abortion Entrance at school Adolescence Divorce or separation

FIRST LEVEL ASSESSMENT

Menopause Loss of job Hospitalization of a family member Death of a member Resettlement in a new community Illegitimacy Others.

FAMILY HEALTH ASSESSMENT

Second level assessment – 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

2. Family Health Task – Review a. Recognizes signs of health and development b.Manages health and non –health crisis c. Provides health care to its members d. Provides home environment conducive to good

health and personal development e. Utilizes community resources for health care

II. STATEMENT OF FAMILY HEALTH CONDITIONS

Family health Condition – a statement of family’s capabilities to maintain health and prevent illness

a. Ability to recognize the signs of health and development

b. Ability to manage health and non-health crisis c. Ability to provide health care to its members d. Ability to provide a home environment

conducive to good health and personal development

e. Ability to utilize community resources for health care.

III. FORMULATING GOALS AND OBJECTIVES FOR HEALTH PROMOTION AND MAINTENANCE

Goal – general statement of the condition or the state to be brought about by specific course or action. Eg. After 2-3 months the family will be able to

maintain ability to recognize signs of health and development.

Objectives- refer to more specific statements of the desired results or outcomes of care

At the end of 2-3 months the family will be able to: Identify signs of health and development Perform usual activities for health and development

IV. FAMILY HEALTH CARE STRATEGIES

c.Check –ups during pregnancy 1-7 mos – every month 8 mos.- every 2 weeks 9 month - weekly

d. Immunization TT1 – anytime during pregnancy ( preferably 1st

trimester TT2 – 1 mo. After TT1 TT3 – 6 mos.After TT2 TT4 – 1 year .after TT3/or next pregnancy – 7

mos. TT5 – 1 yr. After TT4/ or next pregnancy -7 mos.

QUESTION /ANSWER

What is the importance of tetanus toxoid immunization? Answer – to prevent tetanus in both mother and baby.

When does the baby is protected against neonatal tetanus? when two doses of TT injection is given at one

month interval between each dose during pregnancy.

How many doses of TT injection will provide lifetime immunity? Five doses following the schedule provide

lifetime immunity.

Give TT 0.5cc at the 6th and 7th month to woman who didn’t have this before.

Avoid exposure to persons who have the following diseases; german measles, influenza, typhoid, polio, mumps , measles e. Nutrition – Eat foods rich in CHON, vitamins

and minerals especially iron , and calcium - drink at least 8 glasses of water per day - avoid to much sweet s and salty foods

f- Personal Habits – take a bath daily but avoid chilling Wear comfortable loose clothes Use low-heeled comfortable footwear Maintain regular bowel habits Eat plenty of fruits and vegetables – to avoid

constipation Extra care should be given to the teeth (they

easily decay) No smoking /alcohol

g. Others Sexual intercourse – not contraindicated unless

no vaginal bleeding Travel – caution against long distance land travel

especially on rugged roads Medications – take drugs only when necessary

and upon doctors advice Activities – encourage walking and usual

household activities that does not overstrain

2. CARE OF THE NEWBORN

A. Breastfeeding Advantages : protects baby against infection

Clean and has the right temperature Helps in child spacing Safe – more digestible than cow’s milk Lowers risk of getting breast CA (mother) Economical and convenient

When? – immediately after birth until tolerated but needs to be supplemented with food rich in iron.

How?1. Was the breast with clean water and soap

before breastfeeding2. Hold the breast and see to it that the thumb

is gently pressing the nipple3. Good sucking position:

A. Move areola in baby’s mouth B. Baby’s tounge comes forward over his lower

jaw and up C. Baby is close to the breast, mouth is wide

open D. Baby’s stomach faces mother’s stomach F. Not painful

b. Supplementary feeding Gradual to detect allergies 3-4 mos – meat broth, mashed sweet potatoes, fruits 5-7 mos – shredded meat ,fish, soft rice, fruit juices 9 mos – regular diet

c. Cord care – care of the umbilical cord which had been cut after delivery to prevent infection. Apply 70% alcohol or gentian violet in a circular

motion from inside to outside , Cover will sterilize clothe looosely – less likely to get

infected if exposed to air Apply abdominal binder loosely and change it if it

becomes wet or dirty with urine or feces d. Bathing

Daily with warm or tepid water in a place where there is no wind to prevent chilling

e. Immunization Acquisition of antibodies to fight against

diseases/ illnessVaccine Route Dose Age

BCG Intradermal 0.05 ml -Birth or anytime-School entrants

DPT IM 0.5 ml -1 ½ ,2 ½ ,3 ½ mos don’t after 5 yr

OPV Oral 2 drops depend on instructions

-Same as above

Measles Subcutaneous

0. 5ml -9 mos

Hepatitis IM 0.5 ml -1 ½, 2 ½ , 3 ½ mos.

THE EPI VACCINES AND ITS CHARACTERISTICS

Type/ form of Vaccines

Storage Temperature

Most sensitive to heat

Oral Polio (live attenuated

-15 C TO 25 C (at the freezer)

Less sensitive to heat

DPT/Hep B“D” toxoid which is a weekend toxin“P” killed bacteria“T”toxoid whic is a weekend toxin

+2 C to 8 C ( in the body of the refrigerator

Hep B +2C to 8C in the body of the refrigerator

BCG (freeze dried) - do

Tetanus toxoid - do

3. PARENTING Responsibilities – to each other , for love and

support and helping in many ways To children, for love, support, shelter and

education To society, for helping to make a good community

and bringing about good and just relationship4. Environmental Care and Sanitationa. Cleanliness in the home Screen to protect food from insects Food containers bowls be well sealed Place stove near window- smoke gets out Hang pots, ladles and pans on the wall Wash plates and utensils with soap and water –

dry if possible under the sun

Keep animals outside the house Collect and dispose garbage Kitchen and bathroom drainage should be

coursed to a covered pit Toilet should be at least be 30 meters away from

the nearest well water for home use must come from cleans sources

b. Backyard Sanitation Keep animals in pens or tied , gather their

manure regularly Clean your yard daily Plant fruit trees, vegetables and medicinal plants

5. HEALTH EDUCATION

An activity which provides of information, education and communication for the improvement of the family’s health condition. Content of Health Education depends on the

health care strategies of individual and family that promotes health and prevent illness

V. EVALUATION

Evaluation plan – specifies how the health care provider will determine the achievement of the outcome of care. Evaluation – reflection of objectivesStandards – desired achievable level of

performance against with actual practice is compared. It serves as a guide in the formulation of objectives ( can be the same with goal)

Criteria – statement of performance , behavior and circumstances or a status that describes what is implied