Community Health Nursing

1. Community Health Nursing Chapter 23 Assessment of Families

2. Effects of family health on individual and community • The health of each family member effects the other members and contributes to the level of family health . • Family Function . • Family health standards . • Healthy family influences community positively and vice versa.

3. Characteristics of Healthy Family: • A facilitative process of interaction exists among family members. • Individual member development is enhanced. • Role relationships are structured effectively . • Active attempts are made to cope with problems .

4. Characteristics of Healthy Family: • There is a healthy home environment and lifestyle . • Regular links with the broader community are established .

5. Family Health Practice guidelines • Family Nursing : is a kind of nursing practice in which the family is the unit of services. • Not merely family oriented • Holistic approach

6. Family Health Practice guidelines • Five principle guide and enhance family nursing practice : • Work with the family collectively . • Start where the family is . • Adapt nursing intervention to the family stage of development. • Recognize the validity of family structural variations. • Emphasize family strength

7. Five principle guide and enhance family nursing practice • Work with the family collectively • Set aside usual focus on individual • View the family as one unit • Community health nurses want to involve all of the family during nurse-client interaction. • Encourage everyone’s participation.

8. Five principle guide and enhance family nursing practice • Start where the family is • Begin at the present level of functioning • Conduct a family assessment to ascertain the members needs and level of health • Determine collective interests, concerns and proprieties

9. Five principle guide and enhance family nursing practice • Adapt nursing intervention to the family’s stage of development : • Awareness of family’s developmental stage enables the nurse to assess the appropriateness of the family’s level of functioning and to tailor intervention accordingly.

10. Five principle guide and enhance family nursing practice • Recognize the validity of family structural variations: • Two important principles to remember : • What is normal for one family is not necessarily normal for another . • Families are constantly changing.

11. Five principle guide and enhance family nursing practice • Emphasize family strengths • Too often, nurse focus on family weaknesses ( Negative emphasis ) this is not truly therapeutic. • Families need their strength reinforced . • Emphasizing a family strength makes people feel better about themselves. • The nurse lists positive points about an otherwise negative situation.

12. Family Health Assessment: • To assess a family’s level in a systematic three tools are needed : • A conceptual framework on which to base the assessment. • A clearly defined set of assessment categories for data collection. • A method for measuring family’s level of functioning.

13. Family Health Assessment: • Conceptual Framework : is a set of concepts integrated into a meaning explanation that helps one interpret human behavior or situation. • Three framework that are particularly useful in community health nursing : • The interactional framework. • The structural-functional framework. • The developmental framework.

14. 1. Conceptual Framework • The Interactional framework: describes the family as a unit of interacting personalities and emphasize communication, roles, conflict, coping pattern, and decision making process. • This framework focuses on the internal relationships but neglect the family interaction with the external environment .

15. 1. Conceptual Framework • The structural framework describes the family as a social system relating to other social system in the external environment. • This framework examine the interacting functions of society and the family (External), consider family structure and analyze how a family’s structure affects its function .

16. 1. Conceptual Framework • The developmental framework studies families from a lifecycle perspective by examining members’ changing roles and tasks in each progressive life-cycle stage. • This framework incorporate elements from interactional and structural-functional approaches so that family structure function, and interaction are viewed in the context of the environment at each stage of family development .

17. 2. Data collection categories: • There are 12 categories : • Family demography . • Physical environment . • Psychological and spiritual environment. • Family structure and roles. • Family function. • Family values and beliefs.

18. 2. Data collection categories: • Family communication pattern • Family decision-making patterns • Family problem solving patterns • Family coping pattern • Family health behavior • Family social and cultural patterns.

19. 3. Assessment Method: • Three well-known graphic assessment tools are : • Eco-map: is a diagram of the connection between the family and the other system in its ecologic environment. Fig. (23 – 1)

20. 3. Assessment Method: • The genogram : displays family information graphically in a way that provides a quick view of complex family pattern. Fig. (23 – 2)

21. 3. Assessment Method: • Social network support map ( Grid ):gives details about the quality of social connection. Fig. (23 – 3)

22. Guide lines for family health assessment : • Focus on the family as total unit. • Ask goal-directed questions. • Collect data over time. • Combine quantitative and qualitative. • Exercise professional judgment.

23. Family care plan: • Family assessment and planning instrument : This is an assessment and planning instrument to help you to organize your data . Its not be taken into a home as an interviewing instrument.

24. Family and care plan: FAMILY ROLE-RELATIONSHIP PATTERN : • Initial of family ________ • surname ________ Persons living in the house hold • Given name only: ________ • Date of birth: ________ • Age : ________ • Sex: ________ • Relation to head of Household: ________ • Occupation: ________

25. Family care plan: FAMILY ROLE-RELATIONSHIP PATTERN : • Identify primary care giver : ________ • Members of family not living in household : • Significant others : ________ • Pets : ________ • Occupation history of each adult member ( Past/Present ) : ________ • Job Identification : ________ • Exposure to health hazards : ________ • Family dynamics : ________

26. Family care plan: Communication pattern : • Expression of feelings ( happiness , sadness , fear , anger … ) • Verbal and non-verbal : • How are message transmitted ?

27. Family care plan: Social relations • Who do the family members interact with outside the immediate family , and what community activities do they participate in ? • Extend family ________ , Neighbors ________ . • Friends ________ , Mosques ________ , Clubs ________ . • Community activities ( list ) ________ .

28. Family care plan: Income • Family income : ________ . • Source : salary ________ , saving ________ , investment ________ . • Others ________ . • Contribution of working members : • Member : ________ , Amount : ________ (JD, $ & SH ) • Are expenses greater , less than or equal to income : ________ • Who plans how the money is spent ?

29. Family care plan: • FAMILY COGNITIVE / PERCEPTION PATTERN : • Educational level , What is the highest grade completed ? • Adults : ________ Children : ________ • Members of the family with learning or developmental disabilities ? • Decision making : Who make the decisions ? Give examples :

30. Family care plan: • FAMILY SELF PERCEPTION / SELF CONCEPT PATTERN : • Family's perception of their ability to maintain their family unit : • Family's pride in their home : Family residence : • Type : Single : ________ , Multifamily : ________ , Own : ________ , Rent : ________ Describe condition of home inside and outside : • Number of rooms : ________

31. Family care plan: • Space : Adequate : ________, Inadequate : ________ • Furniture : Adequate : ________ , Inadequate : ________ • Accident hazards : ________ • Neighborhood : ________ • Residential : ________ . Industrial : ________ . Rural : ________ . • Urban : ________ . Suburban : ________. Other : ________ . • Condition of dwellings and streets :

32. Family care plan: Accessibility of : • Play area : Yes ________ . No ________ • Health facilities ( List ) : Yes ________ . No________ • Mosques , Churches : Yes________ . No ________ • Schools : Yes ________ . No ________ • Public transportation ? Type ? ________ • Family's method of transportation :________ • Neighborhood health hazard : ________ • Family's perception of safety in the neighborhood ?

33. Family care plan: • FAMILY NUTRTIONAL-METABOLIC PATTERN : • Observation about kitchen and mealtimes : • Who does the grocery shopping ? • Who does the cooking ? • Therapeutic diets : • Observation of family member of nutritional 24-hrs food/fluid intake : Break fast , Lunch , Dinner , Snacks • Analyze if diet provides nutrients ? • How is food stored ? • Water supply :Municipal , Well , Other.

34. Family care plan: • FAMILY ELIMINATION PATTERN : • Compliance with garbage regulations ? Yes ________ . No ________ . If no , explain ? • Rodents ? Yes ________ . No ________ . • Insects ? Yes ________ . No ________ . • Toilet facilities ? Yes ________ . No ________ .

35. Family care plan: • FAMILY ACTIVITY-EXERCISE PATTERN : • Adults leisure ________ . Children leisure ________ . • Shared family activities ________ . • Type of activities required for family roles : ________________ . Adults : ________ . Children : ________ . • Describe pace of family life : Fast : ________. Moderate : ________ . Slow : ________.

36. Family care plan: • FAMILY ACTIVITY SLEEP-REST PATTERN : • Which family member sleep alone ? • What type of bed does each have ? • What are the usual hours of sleep ? • Bedtime , arising , rest periods for adult and children ? • Are they any disturbances in family sleep pattern ?

37. Family care plan: • FAMILY SEXUALITY-REPRODUCTION PATTERN : • Sexual relationships : • Family planning : • Sex education of children :

38. Family care plan: • FAMILY VALUE AND BELIEF PATTERN ? • Ethnic background ________ . Influence on health behavior . • Religious affiliation ________ . Degree of family involvement ________ . • Influences on health behavior : • Family's definition of health : • Health beliefs and attitudes : • Folk medicine : • Use of non-traditional healing methods : • Acceptance / non-acceptance of help from community agencies ?

39. Family care plan: • FAMILY COPING STRESS TOLERANCE PATTERN : • How has the family managed in previous situation of illness or crises ? • Own resources ________ . Extended family : ________ . • Other relatives ________ . Friends ________ . Neighborhood ________ . • Significant others ________ . Health professional ________. Other ________ . • Caregiver's perception of their ability to deal with crises : • Client perception of caregiver's / family ability to deal with demands of care :

40. Family care plan: • FAMILY HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN : • Reason for visit : • Family's perception of their level of health : • Medical diagnosis of each family member : • Familial disease ( heart , cancer , stroke , anemia , ….. etc ) • History of past significant illness and accident of each family member : • Risk factors ( tobacco , alcohol , obesity , lack exercise ) :

41. Family care plan: Family health practice : • Immunization status of each family member : • Self exam ( breast , testicular , ….. etc ) • Preventive exams ( dental , colon/rectal ) : • Names of physician / date of last appointment and next scheduled appointment for each family member : • Medication : is any family member taken any medication ? Yes: ------. No : ------ .

42. Family care plan: • If yes ( including over the counter drugs ) : Name of the drug _______ .How often taken : ______. Drug action ________ .Side effects : ________ . Date of prescription : ________ .Number of refills : ___ . Physician : ________ .Pharmacist : ________ . • Treatment prescribed for family members : • Level of compliance with prescribed medication and treatments :

43. Family care plan: Financing health care : • Health insurances : ________ . • Private insurances : ________ . • Own finance : ________ .

44. Family nursing diagnosis: Examples for family nursing diagnosis: • Family Processes, Dysfunctional: Alcoholism ( substance abuse ). • Family Processes, Interrupted. • Family Processes, Readiness for Enhanced. • Family coping, ineffective. • Family coping, potential for growth.

45. Family nursing diagnosis: Examples for family nursing diagnosis: • Parental role conflict. • Parent/infant/child attachment, altered, risk for. • Parenting, altered. • Parenting, altered, risk for. • Role performance, altered • Social interaction, impaired. • Social isolation.