HEALTH CARE PROCESS

applied at the FAMILY LEVEL

HEALTH CARE PROCESS

1. Family Assessment 2. Planning for Family Health

Care 3. Implementation 4. Evaluation

FAMILY HEALTH

PROBLEMS Are situations or conditions which interfere with the promotion & maintenance of health, and with recovery from illness and injury

FAMILY HEALTH PROBLEMS

ò 3 Classifications ò Health Threats ò Health Deficits ò Foreseeable Crisis

HEALTH THREATS

Definition: Conditions that are conducive to disease, accidents, or failure to recognize one’s health potential

HEALTH THREATS ò Family history of conditions/

diseases ò Threats of Cross infection from a

communicable disease ò Family size beyond what family

resources can adequately provide

HEALTH THREATS ò Accident hazards ò Faulty/unhealthy eating habits ò Stress-provoking factors ò Poor environmental sanitation ò Unsanitary food handling and

preparation

HEALTH THREATS ò Unhealthy lifestyles ò Inherent personal characteristics ò Health Hx which may induce

occurence of health deficit ò Lack of immunization ò Family disunity

HEALTH DEFICITS

Definition: Instances of failure in health maintenance

HEALTH DEFICITS ò Illness states: diagnosed or

undiagnosed ò Failure to thrive and develop

according to normal rate ò Disability: congenital or from

illness; transient or permanent

FORESEEABLE CRISIS

ò Definition: Anticipated periods of unusual demand on the individual/family in terms of adjustment and resources

FORESEEABLE CRISIS ò Marriage ò Pregnancy, labor and delivery ò Parenthood ò Additional member: newborn or

boarder ò Abortion

FORESEEABLE CRISIS ò School entrance ò Adolescence ò Divorce or separation ò Menopause ò Death of family member ò Loss of job

FORESEEABLE CRISIS ò Hospitalization ò Resettlement ò Illegitimacy

THE  INITIAL  DATABASE  

FAMILY  STRUCTURE  CHARACTERISTICS  AND  DYNAMICS  

SOCIOECONOMIC  AND  CULTURAL  CHARACTERISTICS  

HOME  AND  ENVIRONMENT  ASSESSMENT  

HEALTH  STATUS  OF  EACH  MEMBER  

STATEMENT  OF  FAMILY  HEALTH  CONDITION  

THE  INITIAL  DATABASE  

1. Family Assessment

FAMILY  STRUCTURE  COMPOSITION  AND  DEMOGRAPHIC  DATA  

RELATIONSHIP  TO  THE  HEAD  OF  THE  FAMILY  AND  PLACE  OF  RESIDENCE  

TYPE  OF  FAMILY  

FAMILY  INTERACTION  

DECISION  MAKING  PATTERNS  

EXAMPLE  

INITIAL DATA BASE a. Family Structure

Composition 4 members; father, mother etc.

Demographic data Name: Ali C. Cruz, Lia C. Cruz etc. Age: 55; 51; 20; 10 etc.

Relationship The head of the family is their biological father and they own the residence.

b. Type of family

Nuclear family

c-d. Family interaction/decision making

Family exhibits open communication among its members and decision

making originates from the father. However, members are allowed to voice their concerns to refine a

particular decision.

SOCIOECONOMIC  AND  CULTURAL  CHARACTERISTICS  

INCOME,  OCCUPATION,  PLACE  OF  WORK  

EDUCATIONAL  ATTAINMENT  

ETHNIC  AND  RELIGIOUS  BACKGROUND  

SIGNIFICANT  OTHERS  

FAMILY  RELATIONSHIP  TO  THE  COMMUNITY  

EXAMPLE  

E. SOCIOECONOMIC AND CULTURAL CHARACTERISTICS

Occupation and income

Father works as an architect and mother is employed as a sales clerk both for Ayala land. They earn 40,000-50,000 /month.

Educational attainment

Ali and Lia are both College graduates while sons are both highschool students.

Religious background

All members are roman catholic Significant others

Has grandmother living with them. Family’s relationship to community

Family members only mingle with other community members during christmas parties.

They have very limited knowledge of the community programs.

ò Home and environment ò Housing adequacy ò Sleeping arrangements ò Food storage ò Cooking facilities ò Water supply ò Presence of accident hazards ò Toilet and garbage disposal ò Availability of social, health,

communication, and transportation

HOME  AND  ENVIRONMENT  ASSESSMENT  

Housing  adequacy  

Sleeping  arrangements  

Food  storage  

Cooking  facilities  

Water  supply  

Presence  of  accident  hazards  

Toilet  and  garbage  disposal    

HOME  AND  ENVIRONMENT  ASSESSMENT  

Availability  of  Social,  health,  communication,  and  transportation  services  

EXAMPLE  

F. HOME AND ENVIRONMENT ASSESSMENT

Housing

Lives in a 20 square meter, single detachment, bungalow type of house.

Sleeping arrangments

All members sleep in 1 room while grandmother sleeps on the other.

Food storage/Cooking facilities

Stores their food in a garbage basket and cooks using an electric stove.

F. HOME AND ENVIRONMENT ASSESSMENT

Water supply

Family relies on water delivery. They request every other day to fill their water tank of 1 gallon.

Presence of hazards

House corners present sharp edges of metal that can predispose a member to accidents or injuries. Electrical switches are clogged with faulty wires.

Toilet/garbage disposal

Garbage truck picks it once a year.

HEALTH  STATUS  OF  EACH  MEMBER  

PAST/CURRENT  ILLNESS  

BELIEFS  AND  PRACTICES  

NUTRITIONAL/DEVELOPMENTAL  STATUS  

DECISION  MAKING  

NOTE:*Health Status

Should be individualized for each member

EXAMPLE  

G. HEALTH STATUS OF MEMBERS

Ali C. Cruz

Past/Current illness

ò (+) Diabetes mel l i tus (1999; takes Biguanides once a day up until present)

ò (+) Stage-3 HPN (2002; takes pindolol everytime BP rises up until present)

ò (-) Fractures

ò (-) Osteoporosis

ò Beliefs and practices

Client relies on his wife, Lia C. Cruz, to carry out the family’s medical beliefs and practices.

ò Nutritional status/decision making

Client’s food consists of rice all meals as a source of carbohydrates. Protein source varies from eggs, beef and fish. Client does not eat fruits and vegetables and prefers protein-rich foods.

ò Values and principles on health promotion and maintenance ò Preventive aspects ò Adequate rest, sleep, exercise

and relaxation activites ò Stress management, utilization

of health care facilities

g. Values on health promotion/maintenance

- The family prevents impending illnesses by having a first aid and medicine kit at home. They do not exercise but aims to sleep at least 8 hours/day. They also go to the nearest massage center to relieve stress and does not avail of the barangay health care facilities.

Please  prepare  for  a  mid-­‐lecture  quiz  

2. PLANNING FAMILY HEALTH

CARE

REVIEW: Family Health Tasks

ò Recognizes signs of health and development

ò Manages health and on-health crisis ò Provides health care ò Provides a conducive home environment ò Utilizes community resources for health

care

STATEMENT OF FAMILY HEALTH

CONDITIONS

- A statement of family’s capabilities to maintain health

and prevent illness.

FAMILY  HEALTH  CONDITION  

Ability  to  recognize  signs  of  health  and  development  

Ability  to  manage  health  and  non-­‐health  crisis  

Ability  to  provide  healthcare  

Ability  to  provide  conducive  home  environment  

Ability  to  utilize  healthcare  resources  

Statement of family health conditions

- Based from the family assessment, it is clear that they are unable to recognize most health concerns as well as provide a home conducive to cleanliness and safety. However, the family demonstrated its ability to provide healthcare and manage a health crisis (minor cut) by utilizing their resources such as first aid and medical kits.

Guidelines in Prioritizing Family Health Conditions

ò Familyʼ’s perception ò Significance of the condition ò Urgency of the condition ò Availability of resources

FORMULATING GOALS AND OBJECTIVES

FOR HEALTH PROMOTION AND MAINTENANCE

Problems Goals Plan

1. Inability to provide cleanliness and safety in the home

- For the family members to promote and maintain a clean and safe home after 1 week.

- Removal of metal edges from walls. - Transfer of food to refrigerator. - Additional delivery of water.

3. IMPLEMENTING FAMILY HEALTH

CARE

*NOTE: Practice clinical

decision-making and apply only the

interventions pertinent to a specific family.

ò Assisting Prenatal Care ò History & demographic data ò LMP ò Hx of previous pregnancies:

Nature of delivery ò Age in months

Assisting Prenatal Care

ò SSx of pregnancy

EARLY ò  Missed

menstrual pregnancy

ò  Frequent urination

ò  Weight gain (1kg in the first 3 months)

ò Assisting Prenatal Care ò SSx of pregnancy

ò LATE ò Enlargement of

the abdomen ò Fetal movement ò Fetal heartbeat ò Gain 5 kg by the

2nd trimester

ò Assisting Prenatal Care ò Check-ups during Pregnancy ò 1st 3 mos – every month ò 2nd 3 mos – every 2 weeks ò 3rd 3 mos - weekly

ò Assisting Prenatal Care ò Immunizations

ò TT1 – anytime during pregnancy preferably during 1st 3 mos

ò TT2 - 1 mo. After TT1 ò TT3 – 6 mos after TT2 ò TT4 – 1 yr after TT3/next pregnancy (7

mos) ò TT5 – 1 yr after TT4/next pregnancy (7

mos)

ò Assisting Prenatal Care ò Immunizations

ò Give TT 0.5 cc at the 6th and 7th month to woman who did not receive this before.

ò Avoid exposure to persons who have german measles, influenza, typhoid, and active polio.

ò Assisting Prenatal Care ò Nutrition

ò Eat foods rich in proteins, vitamins and minerals, especially iron and calcium.

ò Drink at least 8 glasses of water/day. ò Avoid too much sweets, as well as

salty foods

ò Assisting Prenatal Care ò Personal Habits

ò Take a bath daily but avoid chilling. ò Wear comfortable loose clothing ò Use low-heeled, comfortable footwear. ò Maintain regular bowel movements. ò Eat plenty of fruits and vegetables. ò Give extra care to teeth. ò No smoking/drinking alcoholic

beverages

ò Assisting Prenatal Care ò Others

ò Sexual Intercourse - not contraindicated ò Travel – Caution against long distance

land travel especially on rugged terrain. ò Medications – Take medicines only when

necesssary and only upon doctorʼ’s advise.

ò Activities – Encourage walking and usual household activities that do not overstrain

ò Care of Newborn ò Breastfeeding ò Advantages

ò  Protects baby against infection ò  Clean ò  Has the right temperature ò  Helps in child spacing ò  Safe-more easily digestes than cowʼ’s

milk ò  Lower risk of getting breats CA (Mother) ò  Economical and convenient

ò Care of Newborn ò Breastfeeding

ò When? ... Immediately after birth until 4-6 months

ò Supplementary feeding ò  When?... As early as 2 mos; should be

gradual to detect allergies (fruit juices) ò  3-4 mos: meat broth, mashed sweet

potatoes, fruits ò  5-7 mos: shredded meat, fish, soft rice ò  9 mos: regular diet

ò Care of Newborn ò Cord Care: care of the umbilical

cord which had been cut after delivery to prevent infection. ò Apply 70% alcohol in a circular motion

from inside to outside. ò Bathing

ò When?... Daily with warm or tepid water in a place where there is no wind to prevent chilling

ò Care of Newborn ò Immunizations

ò Why?... For development of antibodies to fight against diseases

Vaccine   BCG   DPT   OPV   Measles   Heapatitis  

Route   ID   IM   Oral   SQ   IM  

Dose   0.05  mL   0.5  mL   3  drops   0.5  mL   0.5  mL  

Age     Birth/anytime  school  

entrance  

1.5,  2.5,  3.5  months    not  after  5  y/o  

1.5,  2.5,  3.5  

months    not  

after  5  y/o    

9  mos   1.5,  2.5,  3.5  months  

Site   Right  Deltoid  

Thighs   Mouth   Deltoid   Thighs  

ò Parenting Resposibilities ò To each other

ò  love and support, helping in many ways

ò To children ò  love and support, shelter, education

ò To society ò Help in making a good community and

bringing about good and just relationship

ò Environmental Care & Sanitation ò Cleanliness in the home ò Screen to protect food from

insects ò Food containers should be well-

sealed. ò Place stove near window so

smoke gets out of the house. ò Hang pots, pans & ladles on the

wall.

ò Environmental Care & Sanitation ò Cleanliness in the home ò Wash plates and utensils with

soap and water, and if possible, dry under the sun.

ò Keep animals outside the house. ò Collect and dispose garbage. ò Kitchen and bathroom drainage

should be coursed to a covered pit.

ò Environmental Care & Sanitation ò Cleanliness in the home

ò Toilet should at least be 30 meters away from the nearest well.

ò Water for home use must come from clean sources.

ò Backyard Sanitation ò Keep animals tied or inside a pen, &

clean up their manure regularly. ò Plant fruit trees, vegetables &

medicinal plants.

ò Hygiene Measures ò Eye care ò Oral Care ò Care of hands and feet ò Perineal care ò Daily baths

ò Proper Nutrition

ò Balanced Diet (Awareness of the Food groups)

ò Avoid foods high in cholesterol, sugar and salt

ò Proper food handling and preparation

ò Exercise, Rest and Sleep ò Exercise: daily or once to 3x/week ò Rest: daily! ò Sleep: 6-8 hours/day

ò Health Education ò provides information, education

& communication for the improvement of the familyʼ’s health condition

4. EVALUATION

Evaluation

- Measures the effectiveness, efficiency, appropriateness, and adequacy of the entire health care process.

ò Evaluation of Plan: ò The plan may be

evaluated based on standards and/or criteria.

ò Evaluation of Plan: Standards

ò Desired achievable level of performance against which actual practices are compared

ò Evaluation of Plan: Criteria

ò Statement of performance behavior and circumstances that explicitly describe what is implied by the goal

IN SUMMARY

TODAY  WE  HAVE  LEARNED    

..THAT  THE  HEALTHCARE  PROCESS  HAS  4  STEPS  NAMELY:  

   

..THAT  THERE  ARE  3  CLASSIFICATIONS  OF  HEALTH  PROBLEMS  DIFFERENTIATED  BY:  

..OF  THE  VARIOUS  SECTIONS  OF  THE  INITIAL  DATA  BASE  

(SUCH  AS)  

..THAT  IMPLEMENTING  HEALTHCARE  INVOLVES  

PRE-­‐NATAL  CARE,  NEWBORN,  PARENTING  RESPONSIBILITIES,  AND  ENVIRONMENTAL  SANITATION  

…THAT  EVALUATION  MAY  BE  DONE  IN  TWO  

WAYS  VIA?  

PLEASE  PREPARE  FOR  A  POSTLECTURE  QUIZ  

FIELD  WORK  

PLEASE  INTERVIEW  3  FAMILIES  IN  YOUR  AREA  

USING  THE  GIVEN  ASSESSMENT  FORMS  (PLEASE  PHOTOCOPY)  

DOCUMENT  ONE  INTERVIEW  (AMONG  THE  THREE)  THROUGH  

VIDEOGRAPHY  

ACCOMPLISHED  IN  A  CD  LABELED  WITH  NAME  

AND  SECTION,  DEADLINE  ON  NEXT  HEALTHCARE  

MEETING    

THE  COMMUNITY  EXPERIENCE