Family health nursing

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Multi-problems families
Family health nursing
• Nurses work with families to promote the health of each family
member and the family as a unit.
• Multiproblems families experience concurrent difficulties (e.g. mental
illness, inability to provide care for each others).
• Multiproblems families types:
1) Experiencing crisis: encounter fear, loss, transition, and/or lack of resources
(e.g. social support, communication, problem-solving abilities)
2) With chronic problems: experiencing long-term stressors or problems (e.g.
generations of poverty, disturbances in internal dynamics
Working with multiproblems families
• Continuity of care
• Be patients
• Help the family identify strengths
• Help the family recognize oppotunities
• Work on smallm pience of problems
• Help family cope
• Organize tangible support
• Empower
• Family needs model:
• Identify the family needs
• Assess family style: adapt interpersonal communication to family style
• Describe family strengths: build family competencies
• Determine family functioning: set goal with family
Family case management
• Outreach to find families
• Focus on prevention
• Rely on health teaching, counseling, referral, and follow up
• Consult with family members
Family assessment
• Each family has communicater and leader
• All family members should be seen to get a sense about the
interaction
• Family can be assessed on levels: assessing individuals within the family,
assessing interactions among subsystems, assessing the family as a unit,
and assessing the family within the environment.
Assessing needs
Individual health needs (for each household family member)
Identified health problems or concerns
Medical diagnosis
Recent surgery or hospitalization
Medication and immunization
Physical assessment, developmental assessment, mental status
assessment
Emotional and cognitive functioning
Coping
Sources of medical and dental care
Health screening practices
Each member of the family might have a health problem, chronic illness that needs
monitoring, or potential problem
Family needs
Developmental
Children and ages
Responsibilities for other members
Recent addition or loss of memebrs
Other major normative transitions occuring now
Transitions that are out of sequence or dealyed
Tasks that need to be accomplished
Daily health promotion practice (nutrition, sleep,
leisure, child care, hygiene, socialization)
Family planning
Loss or illness
Nonnormative events or illnesses
Reactions and perceptions of ability to cope
Coping behaviours used by indivuduals and
family unit
Meaning to the family
Adjustment family has made
Roles and tasks being assumed by members
Any one individual bearing most of
responsibility
Family idea of alternative coping behaviours
available
Level of anxiety
Resource and support
General level of resourcesand economic exchange with
community
External sources of instrumental support (money, home, aides,
transportation)
Internal sources of instrumental support from family members
External sources of affective support (emotional support, help
problem solving)
Internal sources of affective support (who in family is helpful)
Family more open or closed to outside
Family willing to use external support
Assessing family subsystem
• Understand the interactions and functioning
• Subsystem: parent-child, marital pair, and sibling, grandparentgrandchild
• Assess social interaction
Assessing family subsystem
Interpersonal needs
Identified subsystem and dyads
Parent-child interactions
Spousal relationships
Sibling relationship
Concerns about older members
Caring for other dependent
Significant others
Assessing the family as unit
• Family maps:
• understand family hierarchies, roles, and
power
• outline the subsystem
• detail the boundries
• interactive pattern
Assessing the family as unit
• Genogram:
1. Mapping the family structure
2. Recording family information
3. Delineating family relationships
Internal dynamic
Roles of family members defined
Where do authority and decision making rest
Subsystems and members
Hierarchies, coalitions, and boundries
Typical patterns of interaction
Communication (verbal and nonverbal)
Expression of affection, anger, anxiety, support
Problem solving style
Degree of cohesiveness and loyality to family
members
Conflict managment
Assessing the family within the
Enviroment
• Data family physical
environment (e.g. presence of
accident hazards, coocking
facilities)
• Plan care that matches family
resources
• Identify potential health
problem
• Assess physical environment
Assessing the family within the
Enviroment
• Ecomap: pattern of energy flow into and out of the family
Environment
Type of dweling
Number of rooms, bathrooms…
Water and sewage
Type of jobs held by each members
Exposure to hazardous condition at job
Level of safety in the neighborhood
Attitudes toward involvement in community
Compliance with rules and laws of society
Occupational and Environmental Health History
1. Describe the health problem or injury you are currently experiencing. _____________________
2. Are any other members of your family experiencing this problem? Any co-worker? Any acquaintance?
3. Do you smoke? ____________ Use chewing tobacco? ____________ Consume alcohol? ____________
Use any other drugs? __________________
(Packs of cigarettes per day, quantity, frequency, number of years in which cigarettes used)
4. Do you smoke while on the job? __________At home? _____________Do your co-workers smoke on the
job? ____________Do family members smoke while you are in the room? ________________
5. Have you missed work within the last 6 weeks? ____________When did these symptoms begin?
____________Have you stayed in bed since this condition started? ____________Are you distressed by your
disability now? _____________
6. Have you ever worked at a job or other activity that has caused you to have this problem before?
______________If so, describe the pattern of illness or difficulty. __________________
7. Have you ever found yourself short of breath, light headed, dizzy, with a cough, or wheezing at work?
______________ After work? ____________At the beginning of the workweek? ______________At the end
of the workweek? _______________ During the weekend? ______________
8. Have you ever changed jobs, homes, or hobbies because of a health problem?
________________________
9. Have you ever experienced muscle or moving difficulties (back pain, fractures, sore muscles, decreased
ability to move around, joint pain) related to work, home, or play? __________________
10. Name the chemicals and compounds with which you work and the frequency of your contact with each
substance. ____________________________________________________________________
11. Name the chemicals and compounds with which your spouse or other family member works.
__________________________________________________________________________________________
12. Does your skin ever come in contact with any chemicals or substances at work or play?
__________________________________________________________________________________________
3. Describe your neighborhood. Map out the location of industrial areas, waste disposal sites, water sources,
and waste disposal processes.
__________________________________________________________________________________________
14. Have any community environmental problems evolved recently?
__________________________________________________________
15. Have there been any toxic spills, sewage breakage, smog changes, or Occupational Safety and Health
Administration investigations pertinent to your condition?
__________________________________________________________________________________________
16. What types of pesticides, cleaning solutions, glues, solvents, metals, or poisons are used in your home?
__________________________________________________________________________________________
17. What type of heating and cooling system is used in the home?
__________________________________________________________________________________________
18. What is its impact on the illness pattern?
__________________________________________________________________________
Analyzing family data
In th form of writing narrative report:
1. Family health needs
2. Family style
3. Family strengths
4. Family functioning
5. Target of care
6. Nursing’s contribution
7. Priorities of health needs
1. Determing family health needs:
• Nursing diagnosis for individual family members (sleep, rest, elimination,
activity and exercise)
• Interpersonal nursing diagnosis
Breast-Feeding Pattern: Ineffective
Coping: Ineffective
Home Maintenance Management: Impaired
Role Performance: Ineffective
Self-Health Management: Ineffective
Social Interaction: Impaired
Verbal Communication: Impaired
Directed at Others
Caregiver Role Strain
Health Maintenance: Ineffective
Parenting: Impaired
Self-Care Deficit
Sexual Dysfunction
Social Isolation
Violence, Risk for: Self-Directed or
• Family nursing diagnosis
• Family Processes: Dysfunctional
• Psychosocial, spiritual, and physiological functions of the family unit are disorganized
(conflict, ineffective problem solving, and a series of crises).
• Family Processes: Interrupted
• Change in family relationships and/or functioning related to development transitions,
family role shifts, changes in family finances or social status, power shift of family
members, or situational transitions or crises
• Family Coping: Compromised or Disabled
Behavior of a significant person (family member or other primary person) that disables
capacities to effectively address person’s adaptation to the health challenge
• Family Coping: Readiness for Enhanced
Effective management of adaptive tasks by family member who exhibits readiness for
enhanced health and growth
• Family nursing diagnosis for envirnmental issue:
• Income
• Sanitation
• Residence
• Neighborhood and workplace safety
• Family nursing diagnosis for the use of social resources:
• Communication with community resources
• Social contact
2. Determining family style
1) Internal family interaction 2) relationship to the outside world
Receptive
• Is open to suggestions
• Is eager to work with the system
• Will accept part of the responsibility for the problem and solution
Distancing
• Understands the problem but has difficulty making connections with resources
• Is embarrassed or tries to deny the problem’s existence
• Has difficulty dealing with the emotions surrounding the contact
Resistive
• Denies or disagrees with institutional interpretation of the problem or the solutions
• Feels powerless in the face of the larger system
• May play along without really cooperating or following through on suggestions
Disorganized
• Is flexible and experiences frequent and quick changes
• May be extremely adaptive or so disorganized or pressured that this problem is only one of many
• May have difficulty cooperating with planning or solutions because family life is unpredictable and
unstructured
2. Determining family style
Rigid
• Has a fixed way of dealing with things that cannot easily be changed to accommodate new
demands or behaviors
• May see itself as incapable of carrying out new routines, even if the family accepts the solutions
Lopsided
• Power or responsibility lies mostly with one adult member
• Member may be too burdened to accomplish all that needs to be done
• The “doer” may have to struggle with another adult to accomplish the changes
Ordered
• Hierarchy, roles, and lines of communication are clearly spelled out
• The way the family usually works together results in success and accomplishments
Tight
• Family members depend on each other for physical assistance and emotional support
• Talking to one member usually means the rest of the family will receive the information quickly
• The family prefers to look to its own rather than to persons outside the family unit
2. Determining family style
Teeter-totter
• Family members trade the roles of caregiver and care receiver; often occurs when a strong family
member becomes sick or disabled
• Or more than one family member may trade the role of caregiver; often happens when different
family members provide care at different times for the receiver
• Family members need to adjust to new roles as others around them adjust also
Dependent
• The family as a unit prefers to look to others to provide direction and supply their needs; often
happens when no member is available to take a leadership role
• The family may have learned this behavior from previous generations
• Dependency may be accompanied by anger when external systems cannot supply what is needed
3. Determing family strengths
• It could be resources.
• Personal strength: self-respect, protectivness, hope, caring in action,
tolerance, and affection
• Relational strength: respect, reliability, ability to repair
3. Determing family strengths
4. Determining family functioning
It is related family resources and coping.
LEVEL 1: Chaotic family
LEVEL 2: Intermediate family
LEVEL 3: Adolescent family
LEVEL 4: Adult family
5. Determining targets care
Identifying the most functional and most willing member
6. Determining the nurse contribution
What the nurse can do?
7. Determining priorities of identified needs
What is the most crucial? What is the most essential or necessary?
Developing a plan
• Develop short-term and long term plan
• The target might be individual, subsystem, family unit, and/or
interaction with environment
• Consider:
• Mutual goal setting
• Personalization
• Realistic goals
• Determination of level of intervention (individual, small interpersonal groups,
or the family as unit)
Implementing the plan (interventions)
E.g.
• Helping the family coping with illness or loss
• Teaching the family
• Connecting the family to resources
Evaluation
• Formative evaluation
• Summative evaluation

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