Family Coping Index Family Coping Index • tool used to assess the coping ability of the family for certain health situation with its purpose of providing a basis for estimating the nursing needs of a particular family • A nursing need is need is present when: The family has a health problem with which they are unable to cope. There is reasonable likelihood that nursing will make a difference in the family’s ability to cope. Features: • Nursing needs can be defined in terms that is in relation to the nursing intervention that is required. • Nursing needs must be based on nursing itself. • The health problem, the attitude and knowledge of the family, the availability to medical and hospital resources will determine in some measure the mix of nursing skills required by a particular time but regardless of the type of problem, the area and the extent of nursing practice required can be analyzed using a single rubric. • Coping • defined as dealing with problems associated with care with reasonable success • Coping deficit • when the family is unable to cope with one and other aspect of health care • To Cope • ability or capacity to deal with health situation; the control with the health competence of the family Direction for Scaling: • A Point of the Scale • Enables you to place the family in relation to their ability to cope with nine areas of the family nursing at the time observed and as you would expect it to be in 3 months or at time of discharged if nursing care were provided. • Coping capacity is rated from • 1--totally unable to manage this aspect of family care • 5--able to handle the aspect of care and help from community sources • Scaling Cues: (limited to 3 points) Scale 1—poor competence or low competence 3—moderate competence 5—high competence (complete) • When each of 9 categories has been rated, the result will be a profile of family coping capacity in relation to the family nursing required and by the changes you expect to occur in the course of nursing service. • • Justification Statement • Consist of brief statements or phrases that explain why you have rated the family as you have • expressed in terms of behavior or observable facts rather than in adjectives General Considerations: It is the coping capacity and not the underlying problem that is being rated. • Example: A person with serious cardiac condition. It is the family and not the individual that is being rated. In rating, it is your own professional judgment that will be needed to make a decision. Nine Areas of Family Nursing Family Coping Index: 1) 2) 3) 4) 5) 6) 7) 8) 9) Physical Competence Therapeutic Competence Knowledge of Health Condition Application of Principle of General Hygiene Health Attitudes Emotional Competence Family Living Physical Environment Use of Community Facilities Physical Competence • Concerned with ability to move about, to get out of bed, to take care of daily grooming, walking, etc. • Note that it is the family competence that is measured even though an individual is dependent, if the family is able to compensate for this, the family may be independent. Physical Competence • Quality and quantity of care is important • if the focus of care is poor • if a mother is giving care to a handicapped child that he could give himself • if a person is giving care that should be shared with other members the independence might be considered incomplete. Physical Competence • The causes of dependence may vary and may be due to: actual physical incapacity the inability of “know-how” to unwillingness; or fear of doing the necessary tasks Physical Competence • Family failing entirely to provide required personal care to one or more of its members. • Examples: • Arthritic patient unable to get out of bed alone, no one available to help • patient “cannot” give his hypodermic medication because of fear Physical Competence • Family providing partially for needs of its members, or providing care for some members but not for others. • Examples • mother may be doing well with own and husband’s care but failing to give daily care efficiently to a newborn baby • daughter may be giving excellent physical care to aged mother but at cost of neglecting children somewhat, or with poor mechanics that place undue strain upon her. Physical Competence • All family members, whether or not there is infirmity or disability in one or more of its members • receiving the necessary care to maintain cleanliness, including skin care • able to get about as far as possible within their physical abilities • receiving assistance when needed without interruption or undue delay Therapeutic Competence • includes all of the procedures or treatments prescribed for the care of illness, such as giving medications, using appliances (including crutches), dressings, exercises and relaxation, special diets, etc. Therapeutic Competence • Family either not carrying out procedure prescribed or doing it unsafely. • giving several medications without being able to distinguish one from the other, or taking them inappropriately, applying braces so they throw the limb out of line, measuring insulin incorrectly; • family resents, rejects, or refuses to give necessary care. Therapeutic Competence • Family carrying out some but not all of the treatments • giving insulin but not adhering strictly to diet • carrying out procedure awkwardly, ineffectively, or with resentment or necessary anxiety • may be giving medication correctly, but not understanding purposes of the drug, or symptom to be observed Therapeutic Competence • Family able to demonstrate that the members can carry out the prescribed procedures safely and efficiently, with the understanding of the principles involved and with a confident and willing attitude. Knowledge of Health Condition • concerned with the particular health condition that is the occasion for care. • knowledge of the disease or inability to understand communicability of disease and modes of transmission • understanding of general pattern of development of a newborn baby, and the basic needs of infants for physical care or tender loving care Knowledge of Health Condition • Totally uninformed or misinformed about the condition. • Examples: • believes tuberculosis is caused by sin • syphilis cured when symptoms subside • believes stroke patient must be bedridden, and that it is cruel to make them do something for themselves • overweight in the school-age child is “healthy.” • Knowledge of Health Condition • Has some general knowledge of the disease or condition, but has not grasped the underlying principles, or is only partially informed. • may recognize need for tender loving care but not relate this to placing the baby’s crib near people when he s awake; or holding him when feeding • may accept fact that patient is dying but not see need to prepare family for this event • may understand dietary and insulin control of diabetes, but not need for special care of feet, etc. Knowledge of Health Condition • Knows the salient facts about the disease well enough to take necessary action at the proper time, understands the rationale of care, able to observe and report significant symptoms. Application of Principles of General Hygiene • concerned with family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members, carrying out accepted preventive measures such as • Immunizations • medical appraisal • safe homemaking habits in relation to storing and preparing foods Application of Principles of General Hygiene • Family diet grossly inadequate or unbalanced, necessary immunization not secured for children • house dirty, food handled in unsanitary way • members of family working beyond reasonable limits • children and adults getting too little sleep • family members unkempt, filthy, • inadequately clothed in relation to weather Application of Principles of General Hygiene • Failing to apply some general principles of hygiene—for instance, • keeping house in excellent condition but expending too much energy and becoming over fatigue as a result • secured initial immunization • general riot and homemaking skills good, but father carrying two full-time jobs Application of Principles of General Hygiene • Household runs smoothly, family meals well selected; habits of sleep and rest adequate to needs. Health Attitudes • concerned with the way the family feels about health care in general, including preventive service, care of illness and public health measures. Health Attitudes • • • • Family resents and resist all health care has no confidence in doctors uses patent medicines and quack nostrums feels illness is unavoidable and to be borne rather than treated • feels community health agencies should not interfere or bother them • practice folk medicine or superstitious rites of illness Health Attitudes • Accepts health care in some degree, but with reservations • may accept need for medical care for illness, but not general preventive measure • may have confidence in doctors generally, but not in the clinic or in “free” doctors • may feel certain illnesses are hopeless (such as cancer), or care unnecessary—for instance dental care for the young child Health Attitudes • Understands and recognizes need for medical care in illness and for the usual preventive services • arranges for periodic physical appraisals and follows through with recommendations • accepts illness calmly and recognizes the limits it imposes while doing all possible to effect recovery and rehabilitation Emotional Competence • This category has to go with the maturity and integrity with which the members of the family are to meet the usual stresses and problems of life, and to plan for happy and fruitful living. • The degree to which individuals accept the necessary disciplines imposed by one’s family and culture • the development and maintenance of individual responsibility and decision • Willingness to meet responsibility and decision • Willingness to meet reasonable obligations, to accept adversity with fortitude, to consider the needs of others as well as one’s own Emotional Competence • Family does not face realities • assumes moribund patient will get well, that an unwanted pregnancy isn’t so • one or more member lacking in any emotional control—uncontrollable rages • irresponsible sexual activities • one or more members are alcoholic • family torn, suspicious of one another • evidence of great insecurity, guilt or anxiety Emotional Competence • Family members usually do fairly well, but one or more members evidence lack of security or maturity. • Thumb sucking in late childhood • Unusual concern with what the neighbors will think • Failure to plan ahead for foreseeable emergencies • Leaving children unattended • “Fighting” in the family on occasion Emotional Competence • All members of the family able to maintain a reasonable degree of emotional clam, face up to illness realistically and hopefully • able to discuss problems and difference with objectivity and reasonable emotional control • do not worry unduly about trivial matters • consider the needs and wishes of other family members, of neighbor and those with whom they work and live in making decisions upon action Family Living • This category is concerned largely with the interpersonal or group aspects of family life • how well the members of the family get along with one another • the ways in which they make decisions affecting the family as a whole • the degree to which they support one another and do the things as a family • the degree of respect and affection they show for one another • the ways in which they manage the family budget • the kind of discipline that prevails Family Living • Family consists of a group of individuals indifferent or hostile to one another, so strongly dominated and controlled by a single family member • no control of children or family to totally dependent on one another that they are being stifled mother developing habits of dependence in sons thereby threatening future capacity for independence in own family life no rational plan for managing available money “battered” child Family Living • Family gets along but has habits or customs that interfered with the unity of the family. • a family fond of one another have many home activities, but is dominated by a father in a kindly way • recreational habits separated members of the family much of the time • children somewhat overprotected • parents’ expectations on their children are sometimes unrealistic—parents expecting children with low academic competence to become successful professionals Family Living • Family does things together, each member acts for the good of the family as a whole children respect parents and vice-versa family tasks shared, evidence of planning Physical Environment • This topic is concerned with the home, the community and the work environment as it affects family health. • The condition of the house such as the • presence of accident hazards, screening, plumbing system, facilities for cooking and privacy • level of community (deteriorated neighborhood, presence of social hazards such as rats), transportation, condition of schools, and availability. Physical Environment • House in poor condition—unsafe, unscreened, poorly ventilated • Neighborhood deteriorated—juvenile and adult delinquency, no recreational space except streets Physical Environment • House needs some repair or painting but fundamentally sound • Neighborhood with some undesirable social elements but possible to protect children from poor social influence through education and other community activities • House crowded but adjustments can be made Physical Environment • house in good repair • provides for privacy and is free of accidents and pest hazards • neighborhood respectable and provided with recreational facilities for children • free from undesirable social elements • opportunities for community Use of Community Facilities • This category has to do with the degree of the family use and awareness of the available community facilities for health education and welfare. • This includes the ways in which they would use services of private physicians, clinics, hospitals, schools, welfare organizations, churches, and so forth. • The coping ability does not indicate the level of the need for services, but rather the degree to which they can cope when they must seek such aid. Use of Community Facilities • Family has obvious and serious social needs, but has not sought or found any help. • A family may be borrowing unreasonable sums of money for medical care, instead of availing of the free hospitals or clinics • Leaving children without any supervision while the mother works • Failing to take steps to register for public housing when available • Using resources inappropriately, for example, calling ambulance or using emergency services for minor injuries Use of Community Facilities • Family is aware of and uses some, but not all of the available community resources that they need. • The family may be under welfare care, and seeks the assistance of the social worker responsible. • But on the other hand, overlooks the help that could be extended them by the school counselors or the spiritual guidance the church can provide. Use of Community Facilities • Uses the facilities they need appropriately and promptly. • Knows when and whom to call for help. • Feels secure in their relationship with community workers such as social workers, teachers, doctors, etc.
