Nursing Care Management 101

Minerva de Ala, RN,MAN

NCM 101 Care of Mother, Child and Family

Course Description: Principles and Techniques of caring for the normal mothers, infants, children and family and the application of principles and concepts on family and family health nursing process. Course Credit: 4 units lecture, 72 lecture hours Pre requisite: FNP, Health Assessment, Anatomy and Physiology. Placement: 2nd Year,1st trimester

Course Objectives: At the end of the course, given an actual or simulated situations/ conditions involving the client (normal pregnant woman, mother or newborn baby, children and family), the student will be able to: 1. Utilize nursing process in the holistic care of client for the promotion and maintenance of health. 2. 1.1 Assess with the client his/her health condition and risk factors affecting health.

1.2 Identify wellness /at risk nursing diagnosis. 1.3 Plan with client appropriate interventions for health promotion and maintenance of health. 1.4 Implement with client appropriate interventions for health promotion and health maintenance taking into consideration relevant principles and techniques.

2.Ensure a well organize recording and reporting system. 3. Observe bioethical principles and core values ( love of God, caring, love of country and of people). 4. Relate effectively with clients, members of health team and others in work situations related to nursing and health.

The Family and Family Health

Family- is a visual image of adults & children living together in a satisfying, harmonious manner. ( Potter & Perry,2008)
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Is the basic social institution and the primary group in a society.

A social group characterized by common residence, economic cooperation and reproduction. As a group of persons united by ties of marriage, blood or adoption, constituting a single household, interacting and communicating with each other in their respective roles of husband and wife, mother and father, son and daughter, brother, sister creating and maintaining a common culture.

F- Father A-and M-Mother I-Implying the presence of children L-Love must prevail between me and Y-You.

Family Structure And Functions:

Structure:- is the form that a family takes in order to maintain function.
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Traditional Family- compose of a father, a mother and their children. these people are married and living together in one house make up the nuclear family. Nuclear family- consist of husband, wife, one or more children. Usually live in a close geographic proximity to members of the extended family who provided a sense of stability and belonging.

Single- Parent Families -single parents may be never married, separated, divorced or widowed. - Single parent is formed when 1 or more parent leaves the nuclear family because of death, divorce or desertion or when a single person decides to have or adopt a child.

Alternative Family Structure -relationships include multi adult households, skip generation families ( grandparents caring for grandchildren), communal groups with children.

Classification of Family Structure

Based on internal organization and membership 1.1 Nuclear- also known as primary or elementary family. Composed of father, mother and the children. 1.2 Extended- composed of two or more nuclear families related to each other economically or socially.
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- Extensions may be through the parent child relationships ,when the unmarried children and the married children with their families live with the parents.

2. Based on place of residence 2.1. Patrilocal-requires the newly wed couple to live with the family of bridegroom or near the residence of the parents of the bridegroom. 2.2 Matrilocal-requires the newly wed couple to live with or near the residence of the brides parents.

2.3 Bilocal- provides the newly wed couple the choice of staying with either the grooms parents or the brides parents, depending on factors like the relative wealth of the families or their status, the wishes of their parents or certain personal preferences of the bride or the groom.

2.4 Neolocal-permits the couple to reside independently of their parents. They can decide on their own as far as their residence is concerned.

B. Based on Authority 1. Patriarchal- authority is vested in the oldest male in the family, often the father. 2. Matriarchal- authority is vested in the mother or mothers kin. 3.Egalitarian- the husband and wife exercise a more or less equal amount of authority.

4. Matricentric-prolonged absence of the father gives the mother a dominant position in the family, although the father may also share with decision making.

Functions of Family

1. Regulates sexual behavior and reproduction. It also serves as to provide legitimate children with the status. 2. Biological/physical maintenance function- the human infant is born helpless and parents fills the role of protector, and guardian. They look after the infants physical and material needs , giving its sustenance.

3. Socialization function- the family transmit culture of the group , its patterned ways of living and values through example, teaching and indoctrination. Supported by system of reward and punishment. Children abide the value systems of the society and internalize them , they acquire the basic skills and basic motivations and attitudes toward work essential for their tasks.

4. The family gives its members status . Child who is born into a family which gives him or her a name and lineage.

5. Social control function- the family continually exerts pressure on its members to make them conform to what it considers as desirable behavior. 6. Economic Function- the family provides economic needs of the members. It may likewise perform educational , recreational, religious and political functions.

Universal Characteristics of Families 1.The family as a social group is universal and its significant element in mans social life. 2. It is the first social group to which the individual is exposed. 3.Family contact and relationships are repetitive and continuous. 4.The family is very close and intimate group.

5.It is the setting of the most intense emotional experiences during the life time of the individual birth, childhood, puberty, adolescence, marriage and death. 6. The family has the unique position of serving as a link between the individual and the larger society. 7.The family has the unique position of serving as a link between the individual and the larger society.

8. The family is also unique in providing continuity of social life.

Family Stages and Tasks

Stages 1. Beginning Family Tasks - establishing a mutually satisfying marriage. -Planning to have or not to have children. -learn to live well to their families of orientation. 2. Child Bearing Having and adjusting to infant.

- Supporting the needs of all three members. - renegotiating marital relationships. - Engage in health education about well child care and how to integrate a new member into a family. 3.Family with pre school Adjusting to cost of family life. - adapting to needs of pre coping with parental loss of energy.

4.Family with School Age- Adjusting to the activity of growing children. -Promoting joint decisions between children and parents.

Parents of school age children important responsibility of preparing their children to function in a complex world while at the same time maintaining satisfying marriage relationship. - Encouraging and supporting childrens educational achievements.

5.Family with Teenagers and Young Adults- Maintaining open communication among members. - Family loosen family ties to allow adolescents more freedom and prepare them for life on their own. - violence, accidents, homicide, suicide- are major cause of death in adolescents. - -nurse working c families @ this stage needs to spend time counseling members on safety, safer sex practices, proper care and danger of chemical abuse.

-Supporting ethical and moral values within the family. - Balancing freedom with responsibility of teenagers. - Releasing young adults with appropriate rituals and assistance. 6. The Launching Stage Family: The Family With Young Adult -the stage at which children leave to establish their own householdsconsidered as most difficult stage because it appears to represent the breaking up of the family.( they get married)

-stage that may represent a loss of self esteem for parents who feel themselves being replaced by other people in their childrens lives. - Illness imposed on a family at this stage can be detrimental to the family structure, breaking up an already disorganized and non cohesive group. - Many young adults return home to live with their family after college until they can afford their own apartment or get married.

Nurse can serve as an important counselor to such a family . Can help parents see that what their children are doing is what they spend a long time preparing them to do or that leaving home is a positive , not a negative step in family growth.

7.The family of Middle Years- couple view this stage as prime time of their lives, (an opportunity to travel , economic independence and time to spend on hobby), or as a period of gradual decline( lacking the constant activity and stimulation of children in the home, finding life boring without them or experiencing an empty nest syndrome.

8. The family in Retirement or older Age-individuals are more apt to suffer - from chronic and disabling conditions than younger persons. -Grandparents care for their children while the parents are at work. - To families at this stage who dont have children- they remain important because they can offer a great deal of support and advice to young adults who are just beginning their families.

Levels of Prevention in Family Health 1. Primary Prevention- By measures designed to promote positive general health: - Development of good health habits and hygiene, proper nutrition, proper attitude towards sickness, proper and prompt utilization of available health and medical facilities.

Specific protection: Use of specific measures against specific disease agents like protection of the individual or establishment of barriers against agents in the environment. Includes:

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b.

c.

Control of means of spread of vector control, sanitation of food, milk, water and air, proper sewerage disposal, proper disposal and or disinfection of soiled articles or clothing, eradication or animal reservoir. Increasing resistance of the individual by specific immunization. Hand washing observed strictly.

Secondary Prevention - Consist of early diagnosis and prompt treatment of disease in order to arrest the disease/ problem and to prevent its spread to other people Example of secondary prevention : a. Public education to promote breast self examination . b. Screening programs for

3. Tertiary Prevention- begins in early period of recovery from illness and consist of such activities as consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility and active and passive exercises to prevent disability.

Includes minimizing residual disability and helping the client learn to live productively with limitations. - intensive periodic follow up and treatment- done to prevent relapses in certain diseases, to effect complete cure in disease which have relapse tendency.

Family Health Nursing Process

-involves a set of actions by which the nurse measures the status of the family as a client, its ability to maintain itself as a system and functioning unit, its ability to maintain wellness, prevent and control or resolve problems in order to achieve health and well being among its members.

Family as the Patient and unit of Care Rationale: 1. Family- is considered the natural and fundamental unit of society. 2. Family- as a group generates, prevents, tolerates and corrects health problems within its membership. -every health problem from its causation to its resolution is influenced by the family. Family acts as the basic care provider, its the family rather than individual alone that works to achieve certain health goals.

3. Health of family members are interlocking- illness of one member affects the entire family and its functioning. Familial roles are modified, shifted or totally disrupted in the event of illness of a member. 4.Family- is the most frequent locus of health decisions and action in personal care.

5. Family- is an effective and available channel for much of the community health nursing effort. - Nurse reaches the community through contacts with families. - Improved community health is realized only through improved health of families.

Health as a Goal in Family Health Nursing Practice

Health-is a dynamic state in which life cycle of an individual, family or community. - It has continuous adaptation of the various physical, psychological and social stress in the environment.

Health Problems are categorized into three groups: 1. Heath Threats- conditions conducive to disease , accident or failure to realize ones health potential. Example: hereditary dse. -Threat of cross infection from a communicable dse. or faulty eating habits.

2. Heath Deficits- refer to instances of failure of health maintenance and include illness states, whether diagnosed or undiagnosed, failure to thrive or develop according to the expected rate. 3. Stress points or foreseeable crisis situations- includes anticipated periods of unusual demand on the individual or the family in terms of adjustment or family resources.

Crisis situations are of two types: 1.Developmental or maturational. Ex. Crisis situation during infancy, childhood, adolescence, adulthood to old age and 2.Situational or accidental. Ex. serious illness of head or any member of the family, & death in the family.

Family copes with health problems to maintain wellness. Failure to cope cause diminished family productivity. Effective Coping- ability to perform certain health tasks, identified and described by Freeman namely:

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2. 3.

Recognizing interruptions of health development- familys ability to recognize the presence of health problem. Making decisions about taking appropriate health action. Providing nursing care to the sick, disabled and or dependent members of the family.

4. Maintaining a home environment conducive to health maintenance and personal development. 5. Maintaining a reciprocal relationship with the community and its health institutions. This implies effective utilization of community resources for health care. If able to perform above health task and if face with health problem does not require or may need minimum nursing supervision.

Family Nursing Assessment

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Includes data collection, data analysis or interpretation and problem definition or nursing diagnosis. Nursing diagnosis- is the end result of two major types of nursing assessment in family nursing practice.

Nursing Assessment includes: 1. Data Collection 2. Data Analysis/ interpretation an problem definition or nursing diagnosis.

Two levels of Assessment:

1. First Level of Assessment-is the process whereby existing and potential health conditions or problems of the family are determined. Health condition and threats are: wellness state, health threats, health deficit, stress points or foreseeable crisis situations.

Categories of Health Conditions: 1. Wellness state 2. Health Threats 3. Health Deficits 4. Stress Points or Foreseeable Crisis Situations

2. Second Level assessment- defines the nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem and the etiology or barriers to the familys assumption of these tasks.

First and Second Level of Assessment- specify a hierarchy of sets of data and their analyses. - Reflects depth of data gathering and analysis on what health conditions or problems exist( 1st level assessment) & why each health condition or problem related with maintaining wellness exists.

Steps in Family Nursing Assessment 1. Data Collection 2. Data Analysis 3. Health Conditions/ Problems and Family Nursing Diagnosis

Data Collection- elicit data needed to arrive at a measure of the familys ability to achieve health and well being among its members.

Data taken during the first level assessment:

1. Family structure, characteristics & dynamics- include the composition & demographic data of the members of the family/ household, their relationship to the head & place of residence, type of and family interaction/ communication & decision making patterns and dynamics.

2. Socio- economic & cultural characteristics-include occupation, place of work & income of each working member, educational attainment of each family member, ethnic background & religious affiliation, significant others & other roles they play in familys life & the relationship of the family to the larger community.

3. Home and Environment- include information on housing & sanitation facilities, kind of neighborhood and availability of social, health, communication and transportation facilities in the community.

4. Health Status of Each Memberincludes current and past significant illness, beliefs & practices conducive to health & illness, nutritional and developmental status, physical assessment findings and significant results of laboratory/ diagnostic tests / screening procedures.

5. Values and Practices on health promotion/ maintenance & disease prevention- include use of preventive services; adequacy of rest/ sleep, exercise, relaxation activities, stress management or other healthy lifestyle activities and immunization status of at risk family members.

- Nurses can identify existing and potential wellness state/ health threats, health deficits and stress points/ foreseeable crises in a give family.

Second Level Assessment- reflects the extent to which the family can perform the health tasks on each health condition or problem identified. These include: 1. The familys perception of the problem. 2. Decisions made and appropriateness; if none, reasons and

3. Actions taken and results, if none and 4. Effects of decisions and actions on their members.

Data Gathering Methods and Tools:

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Data gathering methods depends on the availability of resources like material, manpower, time and facilities. Poor quality / inaccurate and inadequate data lead to inaccurately define health and nursing problems- lead to poorly designed family nursing care plan.

Common Methods of Data Gathering about family , its health status and state of functioning: 1. Observation- done through the use of sensory capacities- sight, hearing, smell and touch. - Direct observation, nurse gathers information about familys state of being and behavioral responses.

Familys health status can be inferred from s & s of the problem areas reflected in the following: a. Communication & interaction patterns expected, used & tolerated by family members. b. Role perceptions/ task assumptions by each member including decision making patterns and

c. Conditions in the home and environment. - All data gathered through observation should be subject to validation and reliability testing by other observers.

2. Physical Examination- elicit data about health status of individual family members- done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing body system -data generated from PE form a substantive part of 1st level of assessment which may indicate presence of health deficits.

3. Interview 3.1 Completing history for each family members. Health hx determines current health status of based on the significant past hx history 3.2 Collecting data by personally asking significant family members or relatives regarding health, family life experiences and home environment to generate data on what wellness condition & hx problems exist in the family.

Success of interview process depends on communication technique. 4. Record Review- nurse may gather information through reviewing existing records and reports pertinent to client. - Include the individual clinical records of family members, laboratory and diagnostic reports about home and environmental conditions.

5, Laboratory and diagnostic testthrough performing laboratory test, diagnostic procedures done by nurse or by other health team members.

Data Analysis- sorts out and classifies or groups data by type or nature ( eg which wellness state, threats, deficits or stress points/ foreseeable crisis. - Relates data with each other & determines patterns or re occuring themes with norms or standards

Data analysis 1. Sort data 2. Claster/ group related data 3. Distinguish relevant from irrelevant data. 4. Identify patterns. 5. Compare patterns with norms or standards 6. Interpret results 7. Draw conclusions