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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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