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

3 Classifications
Health Threats Health Deficits Foreseeable Crisis

HEALTH THREATS
Definition: Conditions that are conducive to disease, accidents, or failure to recognize ones health potential

HEALTH THREATS
Family history of conditions/ diseases Threats of Cross infection from a communicable disease Family size beyond what family resources can adequately provide

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

HEALTH THREATS
Unhealthy lifestyles Inherent personal characteristics Health Hx which may induce occurence of health deficit Lack of immunization Family disunity

HEALTH DEFICITS
Definition: Instances of failure in health maintenance

HEALTH DEFICITS
Illness states: diagnosed or undiagnosed Failure to thrive and develop according to normal rate Disability: congenital or from illness; transient or permanent

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

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

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

FORESEEABLE CRISIS
Hospitalization Resettlement Illegitimacy

THE INITIAL DATABASE

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

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. Familys relationship to community Family members only mingle with other community members during christmas parties. They have very limited knowledge of the community programs.

Home and environment Housing adequacy Sleeping arrangements Food storage Cooking facilities Water supply Presence of accident hazards Toilet and garbage disposal 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 ( +) Diabetes mellitus (1999; takes Biguanides once a day up until present) (+) Stage-3 HPN (2002; takes pindolol everytime BP rises up until present) (-) Fractures (-) Osteoporosis

 Beliefs and practices Client relies on his wife, Lia C. Cruz, to carry out the familys medical beliefs and practices. Nutritional status/decision making Clients 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.

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

Recognizes signs of health and development Manages health and on-health crisis Provides health care Provides a conducive home environment Utilizes community resources for health care

STATEMENT OF FAMILY HEALTH CONDITIONS

capabilities to maintain health and prevent illness.
- A statement of familys

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.

Familys perception

Guidelines in Prioritizing Family Health Conditions

Significance of the condition Urgency of the condition Availability of resources

FORMULATING GOALS AND OBJECTIVES FOR HEALTH PROMOTION AND MAINTENANCE

Problems
1. Inability to provide cleanliness and safety in the home

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

Plan
-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.

Assisting Prenatal Care History & demographic data

LMP Hx of previous pregnancies: Nature of delivery Age in months

Assisting Prenatal Care SSx of pregnancy

EARLY
Missed menstrual pregnancy Frequent urination Weight gain (1kg in the first 3 months)

Assisting Prenatal Care SSx of pregnancy

LATE
Enlargement of the abdomen Fetal movement Fetal heartbeat Gain 5 kg by the 2nd trimester

Assisting Prenatal Care Check-ups during Pregnancy

1st 3 mos every month 2nd 3 mos every 2 weeks 3rd 3 mos - weekly

Assisting Prenatal Care Immunizations

TT1 anytime during pregnancy preferably during 1st 3 mos TT2 - 1 mo. After TT1 TT3 6 mos after TT2 TT4 1 yr after TT3/next pregnancy (7 mos) TT5 1 yr after TT4/next pregnancy (7 mos)

Assisting Prenatal Care Immunizations

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

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

Assisting Prenatal Care Nutrition

Eat foods rich in proteins, vitamins and minerals, especially iron and calcium. Drink at least 8 glasses of water/day. Avoid too much sweets, as well as salty foods

Assisting Prenatal Care Personal Habits

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

Assisting Prenatal Care Others

Sexual Intercourse - not contraindicated Travel Caution against long distance land travel especially on rugged terrain. Medications Take medicines only when necesssary and only upon doctors advise. Activities Encourage walking and usual household activities that do not overstrain

Care of Newborn Breastfeeding

Advantages
Protects baby against infection Clean Has the right temperature Helps in child spacing Safe-more easily digestes than cows milk Lower risk of getting breats CA (Mother) Economical and convenient

Care of Newborn
Breastfeeding Supplementary feeding
When? ... Immediately after birth until 4-6 months
When?... As early as 2 mos; should be gradual to detect allergies (fruit juices) 3-4 mos: meat broth, mashed sweet potatoes, fruits 5-7 mos: shredded meat, fish, soft rice 9 mos: regular diet

Care of Newborn Cord Care: care of the umbilical

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

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

Care of Newborn Immunizations

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

Vaccine BCG Route Dose Age ID 0.05 mL

DPT IM 0.5 mL

OPV Oral 3 drops

Measles SQ 0.5 mL 9 mos

Heapatitis IM 0.5 mL 1.5, 2.5, 3.5 months

Birth/ 1.5, 2.5, 3.5 1.5, 2.5, anytime months not 3.5 school after 5 y/o months entrance not after 5 y/o Right Deltoid Thighs Mouth

Site

Deltoid

Thighs

Parenting Resposibilities To each other To children

To society
Help in making a good community and bringing about good and just relationship love and support, helping in many ways love and support, shelter, education

Environmental Care & Sanitation Cleanliness in the home

Screen to protect food from insects Food containers should be wellsealed. Place stove near window so smoke gets out of the house. Hang pots, pans & ladles on the wall.

Environmental Care & Sanitation Cleanliness in the home

Wash plates and utensils with soap and water, and if possible, dry under the sun. Keep animals outside the house. Collect and dispose garbage. Kitchen and bathroom drainage should be coursed to a covered pit.

Environmental Care & Sanitation

Cleanliness in the home
Toilet should at least be 30 meters away from the nearest well. Water for home use must come from clean sources.

Backyard Sanitation
Keep animals tied or inside a pen, & clean up their manure regularly. Plant fruit trees, vegetables & medicinal plants.

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

Proper Nutrition
Balanced Diet (Awareness of the Food groups) Avoid foods high in cholesterol, sugar and salt Proper food handling and preparation

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

Health Education
provides information, education & communication for the improvement of the familys health condition

4. EVALUATION

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

Evaluation of Plan:
The plan may be evaluated based on standards and/or criteria.

Evaluation of Plan:
Standards
Desired achievable level of performance against which actual practices are compared

Evaluation of Plan:
Criteria
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