Community Health Nursing

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Community Health
Nursing
Chapter 23
Assessment of Families
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.
Characteristics of Healthy
Family:
1. A facilitative process of interaction
exists among family members.
2. Individual member development is
enhanced.
3. Role relationships are structured
effectively .
4. Active attempts are made to cope
with problems .
Characteristics of Healthy
Family:
5. There is a healthy home environment
and lifestyle .
6. Regular links with the broader
community are established .
Characteristics of Healthy
Family:
1. Healthy interactions among
members :
 Healthy families communicate
 Interactions are frequent and assume
many forms
 Healthy family use frequent verbal
communication
 Effective communication is necessary for a
family to carry out basic function .
Characteristics of Healthy
Family:
2. 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.
Characteristics of Healthy
Family:
3. 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
Characteristics of Healthy
Family:
4. Active coping effort:
 Healthy family actively attempt to
overcome life’s problems and issues.
 Coping skills are needed to deal with
emotional tragedies.
 Healthy families cope with less
dramatic , day-to-day changes.
Characteristics of Healthy
Family:
5. Healthy environment and lifestyle :
 Healthy family creates safe and hygienic
living conditions for their members
 A healthy family lifestyle encourages
appropriate balance in the lives of its
members .
 The emotional climate of a healthy family
is positive and supportive of growth.
Characteristics of Healthy
Family:
6. Regular links with the broader
community :
 Healthy families maintain dynamic ties
with the community
 An unhealthy family has not recognize the
values of establishing links because of :
1. Knowledge Deficit.
2. Previous negative experience.
3. A lack of connection because of family
expectation or cultural practice.
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
Family Health Practice
guidelines
 Five principle guide and enhance
family nursing practice :
1. Work with the family collectively .
2. Start where the family is .
3. Adapt nursing intervention to the
family stage of development.
4. Recognize the validity of family
structural variations.
5. Emphasize family strength
Five principle guide and
enhance family nursing practice
1. 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 nurseclient interaction.
 Encourage everyone’s participation.
Five principle guide and
enhance family nursing practice
2. 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
Five principle guide and
enhance family nursing practice
3. 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.
Five principle guide and
enhance family nursing practice
4. Recognize the validity of family
structural variations:
Two important principles to
remember :
I. What is normal for one family is not
necessarily normal for another .
II. Families are constantly changing.

Five principle guide and
enhance family nursing practice
5. 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.
Family Health Assessment:
 To assess a family’s level in a
systematic three tools are needed :
1. A conceptual framework on which to
base the assessment.
2. A clearly defined set of assessment
categories for data collection.
3. A method for measuring family’s
level of functioning.
Family Health Assessment:
1. 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 :
A. The interactional framework.
B. The structural-functional framework.
C. The developmental framework.
1. Conceptual Framework
A. 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 .
1. Conceptual Framework
B. 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 .
1. Conceptual Framework
C. 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 .
2. Data collection
categories:
 There are 12 categories :
1. Family demography .
2. Physical environment .
3. Psychological and spiritual
environment.
4. Family structure and roles.
5. Family function.
6. Family values and beliefs.
2. Data collection
categories:
7. Family communication pattern
8. Family decision-making patterns
9. Family problem solving patterns
10.Family coping pattern
11.Family health behavior
12.Family social and cultural patterns.
3. Assessment Method:
 Three well-known graphic assessment
tools are :
1. Eco-map: is a diagram of the
connection between the family and
the other system in its ecologic
environment.
Fig. (23 – 1)
3. Assessment Method:
2. The genogram : displays family
information graphically in a way that
provides a quick view of complex
family pattern.
Fig. (23 – 2)
3. Assessment Method:
3. Social network support map
( Grid ):gives details about the
quality of social connection.
Fig. (23 – 3)
Guide lines for family health
assessment :
1.
2.
3.
4.
5.
Focus on the family as total unit.
Ask goal-directed questions.
Collect data over time.
Combine quantitative and qualitative.
Exercise professional judgment.
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.
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: ________
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 : ________
Family care plan:
Communication pattern :
 Expression of feelings ( happiness ,
sadness , fear , anger … )
 Verbal and non-verbal :
 How are message transmitted ?
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 ) ________ .
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 ?
Family care plan:
1. 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 :
Family care plan:
2. 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 : ________
Family care plan:
 Space : Adequate : ________, Inadequate
: ________
 Furniture : Adequate : ________ ,
Inadequate : ________
 Accident hazards : ________
 Neighborhood : ________
 Residential : ________ . Industrial :
________ . Rural : ________ .
 Urban : ________ . Suburban : ________.
Other : ________ .
 Condition of dwellings and streets :
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 ?
Family care plan:
3.
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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.
Family care plan:
4. FAMILY ELIMINATION PATTERN :
 Compliance with garbage regulations ?
Yes ________ . No ________ . If no , explain
?
 Rodents ?
Yes ________ . No ________ .
 Insects ?
Yes ________ . No ________ .
 Toilet facilities ?
Yes ________ . No ________ .
Family care plan:
5. 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
: ________.
Family care plan:
6. 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 ?
Family care plan:
7. FAMILY SEXUALITYREPRODUCTION PATTERN :
 Sexual relationships :
 Family planning :
 Sex education of children :
Family care plan:
8.
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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 ?
Family care plan:
9.
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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 :
Family care plan:
10. 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 ) :
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 : ------ .
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 :
Family care plan:
Financing health care :
 Health insurances : ________ .
 Private insurances : ________ .
 Own finance : ________ .
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.
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.
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