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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