NCM 101 Lecture Notes PRELIMS Handout 2

UNIVERSITY OF THE CORDILLERAS College of Nursing NCM 101n FAMILY HEALTH CARE PROCESS STEP 1.FAMILY HEALTH ASSESSMENT SUB-STEP 1. Establish/ develop rapport SUB-STEP 2. Data Collection Tools: 1. Family Initial Data Base 2. Family and Community Survey Form Guide

A. Family, Structure, Characteristics, and Dynamics

Types of data to be gathered (INITIAL FAMILY DATA BASE) 1. Member of the Household including S/O and Relationship to the head of the family

Importance of Data

Method s of data Gatheri ng ROI

How to fill in the data

Expected Normal Findings

To determine: 1.Family size 2.Type 3. Other sources of support and specific needs given the type of family

Start with the head of the family, then the wife, the children (In order from the first to last), the other relatives or S/O living with the family This portion is presented in TABULAR form

Small, intact family with complete members

Example: FAMILY: Delos Santos

SIZE: 5 persons/ members TYPE: Nuclear NAME: RELATIONSHIP TO THE HEAD OF THE FAMILY Rodolfo Delos Santos Head of the Family Nelia Delos Santos Wife Arwen Delos Santos Eldest Child Anita Delos Santos Second Child Alvin Delos Santos Youngest Child 2.Demographic To determine: 1. date of birth is also preferred for 1. physically and data, age, date of 1.Developmental accuracy purposes; mentally growing birth, gender, civil stage of each 2.possble answers for CS: single, according to stage or marital status, member; married, age position/role in the 2. Specific needs ROI widow/widower/separated/divorced/a 2. proper role family related to gender, nnulled, abandoned, common-law assumptions in civil status, expected wife or husband; 3.roles/position: relation to age, roles and family head/sole or partner in bread gender and civil responsibilities; earning/ housewife/manager of a sari- status 3.fertility and sari store/ dishwasher/ pupil/ not in 3. absence of over or infertility concerns school under tasking of for over or under members in crowding and need household activities for privacy
Example: Name Rodolfo Delos Santos Nelia Delos Santos Arwen Delos Santos 1 Ag e 56 52 29 Date of Birth Aug 5 July 3 March 23 Gend er M F M Civil Status Married Married separated Role in the Family Family head housewife Partner in Bread earning

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Anne D. Balanon

Ms. April

NCM 101 Lecture Notes PRELIMS Handout 2

3. place of residence of each member whether living with the family or elsewhere To determine accessibility, availability of support for the family, be it psychological, financial or other forms of support for its members OI Write complete address (contact no., street, sitio/purok, barangay, city/municipality, province) including permanent landmarks, as necessary Members live in the same household (HH) or may live apart but they consider their HH as their home where every member goes home at certain times of the year 1. separate rooms for males, females and couples 2. ideally, all members live in the same HH if not, each member considers their HH as their home where they always meet other member of the family at appropriate times of the year Democratic

4. type of family structure

OI To determine specific needs according to each type of family Specify type of structure according to size and composition, decision maker and bread winner

5. dominant family members in terms of decision making

To determine head and or dominant decision makers in matters of health care, finances and other major concerns of the family

OI Check available space on the form

Example: Name: Rodolfo Delos Santos Nelia Delos Santos Arwen Delos Santos Anita Delos Santos Place of Residence 45 Sta Scholastica Village Hillside Baguio City 45 Sta Scholastica Village Hillside Baguio City 501 Happy Glen Loop Baguio City 45 Sta Scholastica Village Hillside Baguio City OI To be described in a narrative form Type Of Family Structure Nuclear Nuclear Lives alone Nuclear Decision Making

6. general family relationships and dynamics

To determine the presence or absence of any obvious or readily observable conflict between members and the characteristic communication patterns among members and subsystems

1. good relationship with each other; smooth interaction between the subsystems 2. socially stable; no sibling rivalry nor child favoritism

Example: The delos Santos family manifests strong family ties. They are all able to maintain a harmonious relationship between and among themselves and have no problems in communicating with one another. Maam Nelia especially encourages communication by allotting family time during Sundays. The children show close bonds with each other and

Types of data to be gathered (INITIAL FAMILY DATA BASE)

2

Importance of Data

Methods of How to fill in the data Gathering data

Expected Normal Findings

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Ms. April

NCM 101 Lecture Notes PRELIMS Handout 2

B. Socio Economic and Cultural characteristic 1. income and 1. giving an idea ROI expenses (socio about the capability economic) of the family to a. occupation, place provide basic of work and income of necessities each working member 2. place of work: work b. adequacy to meet related illness and the basic necessities accessibility of c. who makes financial support decisions about system budgeting 3. budgeting: priorities

Income per month or year: try to make some figure close to the data/ average income if family is hesitant to disclose; approximate or actual monthly budget for every necessity like food, clothing, shelter, health, education etc.

1. a family of 6 should earn above 8 thousand pesos 2. democratic decision making in budgeting 3. budget reflects basic necessities as priorities

Example: Name Rodolfo Delos Santos Nelia Delos Santos Arwen Delos Santos Anita Delos Santos Alvin Delos Santos Cultural characteristics 2. education attainment of each member; grade, year or college level reached or completed Ethnic background and religious affiliation

Occupation

Place of work

Income 20,000-25,000 monthly n/a 15,000-18,000 monthly n/a n/a If graduated emphasize the word graduate of whatever level, if not, specify what level of education had been reached Ethnic background: (minority group where an individual belongs/ provincial origin) Religious affiliation (system of faith/ worship/ denomination or sect) Specify the sect the client was baptized and or where they actively participate for services

Govt Camp Allen Baguio Employee City Housewife n/a Call center Sitel agent Student n/a Student n/a To determine: ROI 1. the ability to understand health related information 2. establish level of communication

Adequacy to meet basic needs

Budgeti ng

Functionally literate

To determine some possible sources of conflicts in value systems, practices, etc.

ROI

1. common culture, or may vary but a degree of tolerance and understanding is observable or present among family members involved 2. share religious core with full spirituality and guidance

Example: Name 3 Educational Attainment Ethnic Background Religious Affiliation

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Ms. April

NCM 101 Lecture Notes PRELIMS Handout 2

Rodolfo Delos Santos College Graduate Ilocano

Nelia Delos Santos Arwen Delos Santos Anita Delos Santos Alvin Delos Santos

College Undergraduate College Undergraduate High school Graduate/ College student Elementary student

Pangasinense Ilocanopangasinense Ilocanopangasinense Ilocanopangasinense

Catholic Catholic Born Again Catholic Catholic

Types of data to be gathered (INITIAL FAMILY DATA BASE)

Importance of Data

Method s of data Gatheri ng

How to fill in the data

Expected Normal Findings

C. Home and Environment 1. Housing; a. adequacy of living space To determine possible transfer/ spread of communicable diseases O 1. approximate the size of living space in square meters/ by the number of rooms 1. there should be enough rooms; ideally one person per room except the couple

b. sleeping arrangement

To determine possible transfer/ spread of communicable diseases

2. check or fill in applicable space on the form

2. the house is good that it cannot be destroyed by any natural calamity rainwater can not enter 3. with good lighting and ventilation 4. no dirt is visible in and outside the house 5. all things are properly arranged 6. ideally; owned With minimal to absence of breeding or resting sites of insects, rodents or other vectors

c. presence or absence of breeding or resting sites of insects, rodents or other vectors d. presence or absence of accident hazards

To determine possible sources of diseases or illnesses

Check applicable space on the form

To determine possible sources of injury or home accidents

OI

Check applicable space on the form

With repairable to absence of accident hazards or measures has been initiated 1. food storage facilities has/ have cover/s 2. there is proper ventilation or exhaust Ms. April

e. food storage and cooking facilities

To determine possible sources of accidents in the home and air pollution which may lead to health deficits

Check applicable space on the form

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Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 2

f. water supply g. toilet facility h. garbage/ refuse disposal i. drainage system To determine adequacy and cleanliness because these can enhance the occurrence ROI Specify the sanitary condition Check applicable space on the form Specify control measures done 1. adequate and potable water supply 2. sanitary, owned toilet 3. composting or landfill garbage system; biodegradable segregated from non bio. 4. close or open type of drainage but no stagnation of water is present 1. less dense and a relatively clean rural area is more healthy 2. less populated 3. less complex and commercialized form of living

2. Kind of neighborhood

To determine some possible sources of conflicts, social problems and easy transfer of communicable diseases from one HH to the other

Check applicable space on the form; indicate brief description of sanitary condition

3. Social and health facilities available

To determine availability and accessibility of 4. communication and resources and transportation communication for facilities health care and recreation and better flow of information among its members
Example:

OI

Check applicable space on the form; specify location and manpower

Available and accessible to all

The family lives in a 3 bedroom 1 storey house approximately ________square meters. The master bedroom is occupied by the couple, one bedroom is occupied by Alvin and the other room is where Anita stays. Arwen lives a few minutes away from the house of his parents. The hose appears to be sturdy and able to withstand natural calamities like earthquakes and typhoon. Lighting and ventilation however appears to be inadequate in some of the rooms of the household. The house is fairly clean inside, and all of their belongings are fixed and are properly arranged, but the surrounding area is unkempt. The house where the family lives is owned, but the place where Arwen their eldest son stays in is rented. He pays an approximate of ___________________ for maintenance and rent of his place. Outside the house is the presence of a notable breeding site for mosquitoes. Rodents and other vectors however are not seen to be present inside the house. Absence of accident hazards was also observed, especially since the house is not located near the road. Food storage and cooking facilities appear to be adequate. The family also practices proper storage of food that has not been consumed with the use of plastic containers, and covered storage bins in the refrigerator. Their water supply is delivered every other day, and a tank for their water (approximately 20 drums) is located at the back portion of their home. The water they utilize for drinking is boiled.Their toilet facility is water seal, and the place is kept dry and clean, and free of odors all the time. Their garbage is collected every Thursday, and the family also practices waste segregation. They have an open compost pit beside their house where they dispose of biodegradable wastes. Their barangay is not congested, and houses are adequately spaced from each other. The health center is approximately ___________ meters from their house, their barangay hall is also __________ meters away. There appears to be no problem with communication or transportation in their area of residence. D. Health status of each family member\ 5

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Anne D. Balanon

Ms. April

NCM 101 Lecture Notes PRELIMS Handout 2

Types of data to be gathered (INITIAL FAMILY DATA BASE) Importance of Data Method s of data Gatheri ng ROI PA How to fill in the data Expected Normal Findings 1. physically and mentally stable or fit 2. seldom gets sick 3. eats a balanced diet, refraining from eating junk foods 4. practices Promotive and preventive health practices

1.General health status including observable developmental milestones (eg. General stature, fine or gross motor development, dressing, developmental tasks, cognitive development NARRATIVE 2.Present health history NARRATIVE 3.Physical assessment a.head to toe assessment TABULATE b.nutritional assessment NARRATIVE b1. anthropometric data TABULATE b2. dietary history indicating quality and quantity of food intake per day b3. eating/ feeding habits and practices NARRATIVE 4.Results of laboratory / diagnostic procedures done TABULATE 5.Family history NARRATIVE 6.past health history NARRATIVE 7.obstetric condition or history NARRATIVE 8.psycho-social history NARRATIVE

To determine health Promotive, disease preventive and curative interventions that need to be initiated or conducted

Fill in all data being asked on the form; note for specific details; eg. Name of hospital, order and name of child pertained into: check appropriate spaces as indicated

Types of data to be gathered (INITIAL FAMILY DATA BASE)

Importance of Data

Method s of data Gatheri ng

How to fill in the data

Expected Normal Findings

E. Values and practices on health promotion/ maintenance and disease prevention

The following information is for all items in E (Values) 1. Immunization status (TABULATE:, vaccinations given: type/name, dose, number given) 2. practice of regular check ups NARRATIVE 3. practice of family planning NARRATIVE 4. nutritional beliefs NARRATIVE 5. Practices for rest, sleep. exercise , relaxation and stress management NARRATIVE 6. practice of vices; smoking, drinking alcohol NARRATIVE FIRST LEVEL ASSESSMENT: To determine healthy or non healthy lifestyle, correct or incorrect perceptions and values related to health ROI Fill in all data being asked on the form; note for specific details; check appropriate spaces, as indicated Practices Promotive and preventive health practices

NURSING PROBLEMS:
6

DESCRIPTIONS

SPECIFIC COMPONENTS: Ms. April

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NCM 101 Lecture Notes PRELIMS Handout 2

1. PRESENCE OF WELLNESS CONDITION This is stated as Potential or readiness. A. Potential for enhanced capability for Is a nursing judgment on wellness state based on the clients performance, current competencies, or clinical data ( Observed cues) B. Readiness for enhanced capability for Is a nursing judgment on wellness state based on the clients performance, current competencies, or clinical data (Observed cues) AND the clients VERBALIZATION of desire to achieve a higher level of state or function in specific areas on health promotion or maintenance. 1. Healthy lifestyle 2. Health maintenance and management 3. Parenting 4. Breastfeeding 5. Spiritual well being 1. Healthy lifestyle 2. Health maintenance and management 3. Parenting 4. Breastfeeding 5. Spiritual well being

Example: a. Potential for enhanced capability for parenting b. Potential for enhanced capability for health maintenance and management c. Readiness for enhanced capability for breastfeeding. 2. PRESENCE OF HEALTH THREATS These are conditions that are conducive to disease or accidents These also may be the reason for failure to maintain wellness A. Presence of risk factors of specific diseases B. Threat of cross infection from a communicable disease case C. Family size beyond what the family can adequately provide D. Accident hazards

E. Unhealthy nutritional habits/ feeding techniques and practices F. Stress provoking factors

G. Poor home environment conditions

1.broken stairs 2. Sharp objects on the table 3. Fire hazards 4. Fall hazards 5. medicines kept in cabinets that toddlers can reach 1. Inadequate food intake 2. Faulty eating habits 3. Ineffective breastfeeding 4. Faulty feeding techniques 1. Strained marital relationship 2. Strained parent sibling relationship 3. Interpersonal conflicts between family members 1. Inadequate living space 2. Lack of food storage facilities 3. Polluted water supply 4. Presence of breeding or resting sites of vectors and diseases 5. Improper garbage disposal 6. Poor lighting and ventilation 7. Noise pollution 8. Air pollution

H. Unsanitary food handling and preparation

7

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Anne D. Balanon

Ms. April

NCM 101 Lecture Notes PRELIMS Handout 2

I. Unhealthy lifestyle and personal habits and practices 1. Alcohol drinking 2. Cigarette smoking 3. Poor personal hygiene 4. Substance abuse 5. Inadequate rest and sleep 6. Lack of adequate exercise and physical activity 1. Poor impulse control

J. Inherent personal characteristics K. Inadequate immunization status

Example: 1. Poor home environment conditions related to lack of food storage facilities 2. Stress provoking factors from strained marital relationships 3. Accident hazards related to broken stairs/ house located beside the highway

3.Presence of health Deficits Manifested through: failure in health maintenance

A. Illness States

1. 2. 3. 4.

HPN DM Cholera Dengue

B. Failure to develop according to normal rate and standards C. Disability

1. Aphasia 2. Temporary paralysis 3. Leg amputation

Example: 1. Failure to develop according to normal rate and standards, as evidenced by inability of the child to perform developmental tasks appropriate to his age 2. Disability secondary to leg amputation from motorcycle accident 4. Presence of stress points/ foreseeable crisis situations These are anticipated periods of unusual demand on the individual or family in terms of family resources. A. B. C. D. E. F. G. H. I. Marriage Pregnancy Parenthood Abortion Divorce Adolescence Loss of job Menopause Death of family member

SECOND LEVEL OF ASSESSMENT:

Family Nursing Problem: a. INABILITY TO RECOGNIZE THE PRESENCE OF THE CONDITION OR PROBLEM b. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING APPROPRIATE HEALTH ACTIONS

1. 2. 1. 2. 3. 4. 5. 6.

Related Factors (due to:) Knowledge deficit/ inadequate knowledge Denial about the existence of the problem Failure to comprehend the nature of the problem Low salience of the problem Feeling of confusion, helplessness, or resignation brought about by perceived severity of the situation. Lack of alternative courses of action regarding the problem Inability to decide which course o action to take Conflicting opinions among family members Ms. April

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Anne D. Balanon

NCM 101 Lecture Notes PRELIMS Handout 2

7. Fear of consequences 8. Lack of confidence in hospital personnel 9. Misconceptions/ false beliefs about the proposed actions to solve the problem 1. Lack of adequate knowledge about the health condition 2. Lack of knowledge about the nature and extent of the problem 3. Lack of the necessary facilities and supplies needed for the care of the sick member of the family 4. Inadequate family resources for health care 5. Altered role performance 1. Inadequate family resources 2. Failure to see benefits of investments to the health and well being of the family members 3. Inadequate knowledge about the importance of maintenance of good personal hygiene. 4. Lack of skill in carrying out specific interventions needed for the care of the sick member of the family 1. Lack of knowledge regarding available community resources for health care 2. Failure to perceive health benefits 3. Previous unpleasant experiences with health care personnel 4. Fear of consequences of actions 5. Unavailability of required health care services

c. INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THE SICK, DISABLED, OR VULNERABLE/ AT RISK MEMBERS OF THE FAMILY

d. INABILITY TO PROVIDE A HOME ENVIRONMENT CONDUCIVE TO HEALTH MAINTENANCE AND PERSONAL DEVELOPMENT

e. FAILURE TO UTILIZE COMMUINTY RESOURCES FOR HEALTH CARE

Example: 1. INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THE SICK, DISABLED, OR VULNERABLE/ AT RISK MEMBERS OF THE FAMILY related to Lack of knowledge about the nature and extent of the problem 2. FAILURE TO UTILIZE COMMUINTY RESOURCES FOR HEALTH CARE due to Previous unpleasant experiences with health care personnel 3. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING APPROPRIATE HEALTH ACTIONS related to Feeling of confusion, helplessness, or resignation brought about by perceived severity of the situation.

GreywolfRed
Anne D. Balanon

Ms. April