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A focus on the family for community health is vital in promoting the health of the individual as well as:
The health of the community
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The family system is a basic unit within which health behavior- including _______- is developed, organized, and performed
- Health Values
- Health Habits
- Health Risk Perceptions
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Categories of risk factors important to family health:
- Genetics
- Age
- Biological Characteristics
- Personal health habits
- Lifestyle
- Environment
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Early approaches to family health risks:
- Health of families
- Health of nation
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Increased attention has been given to:
improving the health of everyone in the US
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2 things that motivate individuals to participate in health behaviors:
- Desire to promote one's own health
- Desire to protect health
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Directed toward decreasing the chances of a specific illness or dysfunction in individuals, families, and communities, including
active protection against unnecessary stressors
Desire to protect health
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Behaviors directed toward increasing the level of well-being and actualizing the health potential of individuals, families, communities and society
Desire to promote one's own health
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An individual can reduce health risk by:
Engaging in health-protecting/promoting behaviors
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Condition including the promotion and maintenance of physical, mental, spiritual, and social health for the family unit and for individual family members
Family Health
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The factors that determine or influence whether disease or other unhealthy results occur
Family Health Risks
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___ may lead to health risks in the family ((there may be things you may not see once the family leaves the hospital))
Dysfunction/Lack of Support
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Process of identifying and analyzing an individual's prognostic characteristics of health and comparing them with those of a standard age-group providing a prediction of a person's likelihood of prematurely developing health problems that have high morbidity and mortality in this country
Health Risk Appraisal
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Application of selected interventions to control or reduce risk factors and minimize the incidence of associated disease and
premature mortality; is reflected in greater congruity between appraised and achievable ages (apply interventions: stop smoking, wear your seat belt, etc)
Health Risk Reduction
...ask questions! Are you an aggressive driver, do you wear your seat belt, What kind of car do you drive, etc...
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Age-related risks to a person’s health that often occur during transitions from one developmental stage to another (normal life events risk: pregnancy, high-risk behavior for young guys….these become non-normal if
injury occurs)
Life-Event Risk
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Situation whereby the demands of the situation exceed the resources and coping capacity of the family (resilience for a family can be lost….)
Family Crisis
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Example of Life-Event Risk
Pre-Eclampsia
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Family Health Risk Appraisal:
- Get to know family: their strengths and needs
- Assess biological and age-related risks; environmental risks; and behavioral risks (a risk in only one of these areas may not be enough to threaten family health, but a combination of risks from two or more categories could be enough...each individual is different)
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Look for the _____ even in a bad/ugly situation
POSITIVES!!!
ie: new mommy with messy house but bonding well with baby
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One of the foremost prdicators of health problems
Economic risk
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Changes in the steps of the nursing process in community health settings
- NO CHANGES
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Community health nurses must be ____ (ie: meeting pts at their jobs instead of home, child's school, weekends/nights,...at families convenience!)
Creative!
Be aware: confidentiality problems....try to find the most private place possible
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A home visit should be viewed as ____ for the nurse
Privilege (this is the client's "sanctuary"....it takes a lot of trust to open their home to someone. clients are experts; nurses are guests!)
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Examples of viewing home visits as privilege for the nurse:
"would you mind if I wash my hands?" "Is it okay to use your restroom?" "Would you mind if I sit down, etc"....
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Working with Families where they live: Nursing Skills:
- Acute Observation
- Assessment of home environmental conditions
- Assessment of body language/nonverbal clues (be aware of own self while you are assessing client; be prepared for the worst so you don't look so shocked)
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Components of Home Visits:
- Previsit preparation (assessment and planning)
- Actual visit (implementation)
- Documentation and planning for the next visit (evaluation)
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Pre-Home Visit Preparation:
***Referral for the initial visit (formal/and informal)
- Resource directory - "little black book", local phone numbers
- Supplies - bag with hand sanitizer, steth, paper, gloves, etc...
***Contact of family: contact number for family (call before you go and clarify address, etc); Introduction and reason for the visit; Schedule of time for the visit; Directions for where family is staying
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Home visit general guidelines:
- Introductions
- Acute observational skills
- Adaptability, Flexibility, Trust feelings
- Be aware of own personality, level of acuity of client(s)
- Focus on issues; review of important points
- Plan for the next visit
(generally >20minutes but <60minutes)
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Documentation for home visit is done:
on return to agency or when you get in the car... if using computer, make sure there are secure passwords on them
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Focus of Family Health Visits
- Family education and anticipatory guidance
- Family promotion and illness prevention (immunizations!!!)
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Personal safety for home visits:
- Travel safety
- Arrival at the home
- Friction between family members
- Family members under the influence
- Strangers
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Effects of family health on individual:
Adherence to cultural and family patterns of eating, exercise, and communication (find out if they don't eat meat, ask about exercise, etc)
Decisions about health services (who makes decisions...family roles!)
Family health patterns also dictate whether members participate in their own health care, follow through and comply with professional advice
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Characteristics of Health Family
Facilitative process of interaction exists among family members
Individual member development is enhanced
Role relationships are structured effectively
Active attempts are made to cope with problems
There is a healthy home environment and lifestyle
Regular links with the broader community are established
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Family Health Practice Guidelines
- Work with the family collectively
- Start where the family is
- Adapt nursing intervention to the family's stage of development
- Recognize the validity of family structural variations
- Emphasize family strengths
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Family as a unit of interacting personalities; emphasis on communication, roles, conflict, coping patterns, and decision-making processes; neglects interactions with the external environment
Interactional Framework (how the family blends together)
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Family as a social system relating to other social systems in the external environment
Structural-functional framework
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Life-cycle perspective; examination of members’ changing roles and tasks in each progressive life-cycle stage
Developmental framework
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Data collection categories
- Demographics
- Physical environment
- Psychological and Spiritual environment
- Structure/Roles
- Functions
- Values/Beliefs
- Communication Patterns
- Decision-making patterns
- Problem-solving patterns
- Coping patterns
- Health behavior
- Social and Cultural patterns
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Assessment methods:
- Eco-map
- Genogram
- Computerized information management systems
- Self-Care assessment guide
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Guidelines for Family Health Assessment
- Focus on the family as a total unit
- Ask goal-directed questions (build on trust)
- Collect data over time
- Combine quantitative and qualitative
- Exercise professional judgment
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An eco-map displays family information graphically to
Connect between family and ecologic environment
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Types of evaluations to implemented family health plans
- Structure-process (organization, timing, environment, preparation, distractions)
- Outcome (assessment of change)
- Self-Evaluation
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Evaluation of implemented family health plans
- Planning for next visit
- Referrals
- Contact of resources
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Community Resources:
Government resources such as Medicare, Medicaid
Aid to Families With Dependent Children
Supplementary Security Income, Food Stamps, and WIC
Voluntary programs
American Cancer Society
American Heart Association
American Lung Association
Muscular Dystrophy Association
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Nurses work with families to identify community resources; as client advocates, nurses also help families learn to use
resources by:
Sharing information with families
Rehearsing with families what questions to ask
Preparing required materials
Making the initial contact
Arranging transportation
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