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Care of Family at Risk or with Problems

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Course Objectivesy 1. Utilize the nursing process in the holistic care of

client for the promotion and maintenance of health incommunity and hospital settings

y Assess with the client his/her health condition andrisk factors affecting health

y Identify actual/at risk nursing diagnosis

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y

Plan with client appropriate interventions foridentified problems

y Implement with client appropriate interventions for

identified problems

y Evaluate with client the progress of their condition and

outcomes of care

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2. Ensure a well-organized recording and reportingsystem

3. Observe bioethical principles and the core values (loveof God, caring, love of country and of people)

4. Relate effectively with clients, members of the health

team and others in work situations related to nursing

and health.

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Topic Coverage for the Day

I. Introduction to Family Health Nursing

y Definition of Family Health

y Functions of a Family

y The Family Health Tasks

y Difference of Health Problem from Nursing

Problem

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II. Nursing Assessmenty Data Collection

y Methods ofData Gathering

y Data Analysis

y Problem Definition

First Level Assessment

Second Level Assessment

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Objectives for the day:

y At the end of the three-hour class, student nurses will

be able to:

1. Define Family Health,

2. Enumerate functions of a family,

3. Discuss the family health tasks,

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4. Differentiate health problem from nursing problem,

5. Discuss the process involved in data collection andanalysis,

6. Explain activities undertaken during first and second

level assessments.

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y

FAMILY defined as the basic unit of the community

yHEALTH- the state of complete physical, mental and

social well-being and not merely the

absence of disease or infirmity.

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Family Health-a dynamic relative state of well being which

includes the biological, psychological, socio-cultural and spiritual factors of the family system.

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FIVEFAMILY HEALTH TASKS1. Recognize the presence of a wellness state or health

condition/problem.

2. Make decisions about taking appropriate health

actions to maintain wellness or manage the health

problems.

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3. Provide nursing care to the sick, disabled, dependent

or at risk members.

4. Maintain a home environment conducive to health

maintenance and personal development.

5. Utilize community resources for health care.

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yHEALTH PROBLEM

-a situation or condition, which

interferes with the promotion and/or

maintenance of health and recovery

from illness and injury.

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When does it becomea nursing problem?

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Nursing Problem- A health problem that can be modified or

resolved through nursing intervention

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How will we know if there

is presence of a problem?

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yNursing Assessment-is the first major phase of the nursing

process.

y

Nursing Assessment includes the following:1.DATA COLLECTION

a) Family structure, characteristics anddynamics

b) Socio-economic & cultural characteristics

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a) Family structure, characteristics anddynamics

b) Socio-economic & cultural characteristics

c) Home and environment

d) Health Status of each member

e) Values and practices on health promotion /

maintenance and disease prevention

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Methods of data gathering:

1. Observation

2. Laboratory or diagnostic tests

3. Interview

4. Physical Exam5. Record Review

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2.DATA ANALYSIS

1) Sort data2) Cluster/ Group related data

3) Distinguish Relevant from Irrelevant

Data4) Identify Patterns with norms or

standards

5) Interpret results

6) Make Inferences/ Draw Conclusions

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Topic Coverage for the Day

Problem Definition: First & Second Level Assessments

Sequence of Activities in Family Nursing Practice

Categories of Health Problem

Health Threat, Health Deficit, Foreseeable Crisis, Wellness

State

Ranking Health Conditions and Problems according to

Priorities

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Objectives for the Day

At the end of the two-hour class, the students will be able to:

1. Discuss activities conducted during first and second level

assessments;

2. Enumerate and discuss the sequence of activities in family

nursing practice;

3. Categorize health problems correctly; and4. Prioritize health problems through a standardized

computation.

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3. PROBLEM DEFINITION/ NURSING DIAGNOSIS First Level Assessment

Second Level Assessment

y Typology of Nursing Problems

- is a classification system used by nurses andcommunity health practitioner to facilitate the

process of defining family nursing problems.

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FIRST LEVEL ASSESSMENT/ Primary Assessment

- is a process whereby existing and potential healthproblems/ conditions of the family are determined

y I. Presence of wellness condition

Wellness potential

Readiness for enhanced wellness state

y II. Presence of health threats

y

III. Presence of health deficitsy IV. Presence of stress points/foreseeable crisis

situations

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SECOND LEVEL ASSESSMENT/SecondaryAssessment

- defines the nature or the type of nursing problemsthat the family encounters in performing thehealth tasks

y I. Inability to recognize the presence of thecondition or problem.

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y II. Inability to make decisions with respect to

taking appropriate health actions

y III. Inability to provide adequate nursing careto the sick, disabled, dependent orvulnerable/at risk member of the family.

y IV. Inability to provide a home environmentconducive to health maintenance and personaldevelopment.

y V. Failure to utilize community resources forhealth care.

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SEQUENCE OF ACTIVITIES

IN FAMILY NURSING PRACTICE

1. Establishes a working relationship with the family.

2.Conducts an initial assessment to determine the presenceof any health problem

3. Categorizes health problem into:a) Health Threat

b) Health Deficitc) Foreseeable Crisis/ Stress Pointd) Enhanced capability for health promotion

(Wellness State)

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4.D

etermines the nature and extent of thefamilys performance of the health tasks oneach of the health problems, defines thefamily nursing problems

yHealth status problems

y

Health resources problemsyHealth-related problems

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5. Determines priorities among the list ofhealth problems/ Criteria of priority settingamong family health problems

a. Nature of the problem

b. Magnitude of the problem

c. Modifiability of the problem

d. Preventive potential

e. Salience

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6. Ranks health problems according to priorities

SCALE FOR RANKING HEALTH CONDITIONS AND PROBLEMSACCORDING TO PRIORITIES

1. Nature of the condition

or problem presented

Wellness stateHealth deficitHealth threatForeseeable Crisis

3

321

1

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Modifiability of the condition

or problem

Easily modifiablePartially modifiable

Not modifiable

2

1

0

2

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Preventive potentialHighModerateLow

Salience

a condition or problem needingimmediate attentiona condition or problem not needingimmediate attentionnot perceived as a problem orcondition needing change

32

1

2

1

0

1

1

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yScoring:

y 1.) Decide on a score for each of the criteria.

y 2.) Divide the score by the highest possible score andmultiply by the weight: (Score/Highest Score) x weight

y

3.)Sum up the scores for all the criteria. The highestscore is 5 equivalent to the total weight.

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p

Criteria Computation Actual

Score

Justification

1. Nature of the problem

2. Modifiability of the

problem

3. Preventive potential

4. Salience of the problem

3/3 x 1

2/2 x 2

3/3 x 1

0/2 x 1

1

2

1

0

It is a health deficitrequiring more immediate

intervention

The resources and

interventions needed to

solve the problem are

available to the family.The possibility of

complications during labor

and delivery and occurrence

of abnormalities in the

infant are prevented if

preeclampsia is eliminatedas early as possible

The family does not

recognize the existence of

the problem

Total Score 4

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Gathered Datay The Kunsay family is composed of 7 members all in all

y Father is the only one earning income for the family

y Monthly salary is Php 5,ooo

y Eldest child is 12 yrs old; currently in the 5th gradey They are paying monthly for the house, water and

electricity

y Youngest is an infant.

y The mother verbalized, Nahihirapan na kami kasi angdaming gastos pero ang liit lang ng kinikita ni mister.

y Father verbalized, Promise last na si jun-jun (5th child)

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Family size beyond what the family resources can adequately

provideCriteria Computation Actual

Score

Justification

1. ature of the problem

. odifiability of the

problem

. Preventive potential

. Salience of the problem

/ x 1

/ x

/ x 1

/ x 1

/

1

1

This is a health threat

urrent knowledge and

resources are available

vailability of family

resources can be utilize to

encourage growth

promoting experiences for

members

There is an explicit

expression of the couple

that the condition is

considered a problem

Total Score /

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y Karla, 4 years of age weighs 12 kgs; looks pale, weakand lethargic; markedly underweight and

undernoursihed.

y Mother said, Ganyan talaga yan siya maliit na bata

simula nung ipanganak ko pa.

y Family income of P300 a day

y Mother and father are busy working that they could

barely see the needs of the 4 kids.

Gathered Data

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Criteria Computation Actual

Score

Justification

1. Nature of the problem

2. Modifiability of the

problem

3. Preventive potential

4. Salience of the problem

3/3 x 1

2/2 x 2

3/3 x 1

0/2 x 1

1

2

1

0

Health deficit

The knowledge about proper

nutrition can be provided

through health teaching, the

family can also modify theirbudget to ensure that

nutritious foods can be

served.

Other complications like

immunosuppression can beprevented

Mother does not perceive the

childs condition as a health

problem.

Total Score 4

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7. Decides on what problems to tackle in the

order of immediacy/ urgency, based onpriorities set.

8. Defines nursing objectives in realisticmeasurable terms jointly with the family.

9. Plans approaches, strategies of action(intervention), criteria and standards forevaluation.

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10. Implements the plan of care.

11.Evaluates the effectivity of

implemented aspects of the plan.12. Redefines nursing problems and

reformulates objectives accordingto evaluation findings.

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yD

efinition of contributing risk factors Predisposing factors

Enabling factors

Reinforcing factors

The social determinants of health

- They are the economic and social conditions under

which people live which determine their health

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y

Planning of Individual and FamilyHealth Nursing Care

y Family Nursing Care Plan is the blueprint of care that

the nurse designs to systematically minimize oreliminate the identified health and family nursingproblems

a. Characteristics of FNCPb. Desirable Qualities

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c. Steps in developing an FNCP1. The prioritized condition/problem

2. The goals and objectives of nursing

3. The plan of intervention guide in selectingappropriate nursing intervention

4. The plan for evaluating care

Goal - is a general statement of the condition or state to bebrought about by specific courses of action.

Objectives refer to the more specific statements of thedesired results or outcomes of care

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y

Variables affecting choice of nursingintervention:

1. Nature of the problem

2. Resources available to solve the problem

y Types of Resources:

1. Family resources

2. Nurse

3. Community

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y Evaluation determines the effectivity of the nurses

effortsy Types of Evaluation

1. Qualitative

2. Quantitative

y Steps in Evaluating Nursing Care

1. Decide what to evaluate

2. Design the evaluation plan

3. Collect Relevant data4. Analyze data

5. Make decisions

6. Report and give feedbacks

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Methods and tools for evaluation

1. Direct Observation -Rating Scale, Checklist

2. Records and reports review and analyze

3. Questionnaire, Interview, Verbal Reports

4. Surveys

5. Simulation Exercise

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Items Assessed/ Criteria Check if observed

YES NO

Remarks

1. Ti e f r eals - t e c il is fe at

re lar eal rs, ex. a , 12 nn,

7-8

2. Q a

ntity f f - t e c il s eal

and fd intake a ear adeq ate in

q antity

3. Kinds f fd

a. C ntains ve etables and fr its

b. Incl des ilk and t er fd

s le ents

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y Scoring System

y YES = 2, NO=0, Partially yes = 1

y Add the scores

y

Interpretationy 7-8 excellent

y 5-6 very good

y 3-4 good

y 1-2 poor

y O very poor

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Sample FNCPy Problem Identified: Improper Food Handling

y Subjective Cue: Pasensya kaayo mo ha. Gubot kaayo

nang among kusina. Nah! Wala raba nay hugas among

mga kinan-an dinha.Wala pa man gyud nahuman

among kusina mao ang among butangan ug mga platowala puy tabon. as verbalized by Mrs. L.

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y OC: The family kitchen has unwashed plates,

unorganized placements of utensils, their kitchen

utensils are exposed to insects and rodents. Their

cooked foods are being placed on the table covered by

a basin, which they also use for washing their dishes.

During one of the home visits conducted by the group,

while they were preparing their meals for lunch, theyjust leave the food unattended, which is also exposed

to flies.

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y Family Nursing Diagnosis: Inability to decide about

taking appropriate actions due to failure to

comprehend the identified problem as a health threat

y Goal of Care: Within 45 minutes of nursing

interventions, the family will be able to practice the

properways on handling and preparing food.

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y Objectives: Within 45 minutes of nursing

interventions, the family will be able to:

y 1. name risk factors that will contribute to the

identified problems;

y 2. identify different measures to prevent the arousal of

the risk factors of the problem

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y 3. determine the importance of preparing and

handling the food properly;

4. practice and apply the techniques of food handling

and preparation;

5. keep their kitchen clean and free from insects and

rodents.

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y Interventions with Rationale

y Resources

*Methods and Materials used

y Evaluation

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2. Programs and series that focus on primaryand secondary prevention of communicableand non-communicable diseases

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Implementation of Individual

and Family Health Nursing Care

1. Component of care in acute and chronic illness

a. Health Promotion

b.Disease Prevention - Primary and Secondary

c. Restorative

d. Curativee. Rehabilitative care

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2.Bio-behavioral interventions andholistic care for individuals and family

y to improve the health and healthcare of children,

adolescents and their families through behavioralresearch on vulnerable individuals andpopulations, using a multidisciplinary andbiopsychosocial approach.

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yHolistic Nursing Care

- a practice that focuses on healing the whole personthrough the unity of body, mind, emotion, spiritand environment.

1. Awareness

2. Practices

3. Modalities

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3. Referral System

yPartnership and Collaboration

AIM: to get people to work together inorder to address problems or concernsthat affect them .

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yDifferent ways of partnership and

collaboration

1. Networking

2. Coordination

3. Cooperation

4. Collaboration

5. Coalition or multi-sectoral collaboration

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Advocacy

y Is one way of promoting active communityparticipation.

y The nurse helps the people to attain optimal degree ofindependence in decision making in asserting their

rights to a safe and better community

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yAdvocacy work involves:

1. Informing the people about the rightness of thecause

2. Thoroughly discussing with the people the nature ofalternatives, their content and possible consequences

3. Supporting peoples right to make a choice and to acton their choice

4. Influencing public opinion

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yEnsuring a well organized and accuratedocumentation and reporting

1. Standard format

2. Legal principles involved in documentation

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