Community Health Nursing

1. Community Health Nursing Family assessment

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. Characteristics of Healthy Family: • Healthy interactions among members : • communication • Interactions • Healthy family use frequent verbal communication • Effective communication is necessary for a family to carry out basic function .

6. Characteristics of Healthy Family: • Enhancement of individual development : • Healthy families are responsive to the needs of individual members and provide the freedom and support necessary to promote each member’s growth. • Pattern for promoting individual member vary from one family to another.

7. Characteristics of Healthy Family: • Effective Structuring of relationship: • Healthy family structure role relationships to meet changing family needs over time. • Changing life cycle stages require alterations in the structure of relation

8. Characteristics of Healthy Family: • Active coping effort: • Healthy family actively attempt to overcome life’s problems and issues. • Coping skills. • Healthy families cope with less dramatic , day-to-day changes.

9. Characteristics of Healthy Family: • Healthy environment and lifestyle : • creates safe and hygienic living conditions for their members • encourages appropriate balance in the lives of its members . • The emotional climate of a healthy family is positive and supportive of growth.

10. Characteristics of Healthy Family: • Regular links with the broader community : • maintain dynamic ties with the community • An unhealthy family has not recognize the values of establishing links because of : • Knowledge Deficit. • Previous negative experience. • A lack of connection because of family expectation or cultural practice.

11. Family Health Practice guidelines • Family Nursing : is a kind of nursing practice in which the family is the unit of services. • Holistic approach

12. Family Health Practice guidelines • Work with the family collectively . • Start where the family is . • Adapt nursing intervention to the family stage of development. • Emphasize family strength

13. Five principle guide and enhance family nursing practice • Work with the family collectively • 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.

14. 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

15. 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.

16. 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.

17. Five principle guide and enhance family nursing practice • Emphasize family strengths • nurse focus on family weaknesses ( Negative emphasis ) • 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.

18. 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.

19. 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.

20. 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 .

21. 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 .

22. 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 .

23. 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.

24. 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.

25. 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)

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

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

28. 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.

29. 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.

30. 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: ________

31. 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 : ________

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

33. 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 ) ________ .

34. 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 ?

35. 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 :

36. 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 : ________

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

38. 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 ?

39. 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.

40. 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 ________ .

41. 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 : ________.

42. 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 ?

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

44. 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 ?

45. 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 :

46. 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 ) :

47. 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 : ------ .

48. 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 :

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

50. 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.