The family as client: assessment and diagnosis Prepared by Suhail Al Hu moud

1. The family as client: assessment and diagnosis Prepared by Suhail Al Humoud The familyas Client: home visit

2. The family as client: assessment and diagnosis: objective After completion the lecture the students enable to: • Define the FAMILY • Describe the roles and functions of the family • Describe the different types of families • To acknowledge why family is considered as the unit of care • To recognize the developmental tasks and health tasks of the family • Describe the decision making in the family • Enumerate and apply the different steps in Decision Making • Discuss how to prepare for a home health care visit and how to conduct the visit. • Identify personal safety precautions a home care nurse should take when making home visits.

3. The family as client: assessment and diagnosis: Introduction Introduction Working in a community setting generally involves working with families. CHN must there for understand the interactions and dynamics of families so that they can provide appropriate family assessment , planning, intervention and evaluation

4. The family as client: assessment and diagnosis: Introduction Introduction Cont…. Thus an understanding of family dynamics and the context of the community assists the nurse in planning care. When family is the client, the nurse determines the health status of the family and its individual members, the level of family functioning, family interaction family strengths and weakness

5. The family as client: assessment and diagnosis: Definition Definition Family: is two or more persons related by birth, marriage, or adoption who reside together in a household. Family is a structural unit composed of a man and women who are married and have children

6. The family as client: assessment and diagnosis : Characteristics • Characteristics of the family • Every family is a social system • Every family has a it’s own cultural values and rules • It is the first social group to which the individual is exposed • Every family has a structure • Every family have certain basic function • Every family moves through stages in its life cycle

7. The family as client: assessment and diagnosis : types Types of family structure • Nuclear family • Extended family • Commune family • Family of origin • Family of procreation • blended family • single parent family • Legally married or traditionally married. It’s the only form accepted culturally in our regions

8. The family as client: assessment and diagnosis : Introduction Function of the family • Affection, love, care, an emotional support • Security • Identity • Affiliation • Socialization • Control • A sense of belonging and of history and place • Family rituals for rejoicing and grieving • Systems for earning money , supporting partners and children • Sharing of labor, chores required to keep the family running

9. The family as client: assessment and diagnosis : Introduction Characteristics of healthy family • Facilitative interaction among members • Enhancement of individual development • Effective structuring of relationship • Active coping effort • Healthy environment and lifestyle • Regular link with the border comminty

10. The family as client: assessment and diagnosis : Introduction Health tasks of the family • Recognizing interruptions of health or development. • Seeking health care • Managing Health and non- health crises • Providing nursing care to the sick, disabled and dependent member of the family. • Maintaining a home environment conductive to good health and personal development. • Maintaining a reciprocal relationship with the community and health and institutions

11. The family as client: assessment and diagnosis : Introduction Importance of family health • Family as a unit of services • Effect of the family health on individual health • Effect of family on community health

12. The family as client: assessment and diagnosis : Introduction Family health assessment • Assessing family health in a systematic fashion require three tools • Conceptual framework upon which to dbase the assessment • A clearly defined set of assessment categories for data collection • A method for measuring a family’s level of functioning

13. The family as client: assessment and diagnosis : Introduction Conceptual frameworks • A conceptual framework is a set of concepts integrated into meaningful explanation that helps one interpret human behavior or situations. • Three conceptual frameworks are particularly useful in community health nursing:

14. The family as client: assessment and diagnosis : Introduction Interactional framework • Describes the family as: • unit of interacting, • personalities, • emphasize communication, • role, • coping patterns and • decision-making process • ( focus on internal relationship)

15. The family as client: assessment and diagnosis : Introduction The structual-functional framework • Describes the family as a social system relating to other social systems in the external environment, such as: • School • Work • Religion places • Health care system

16. The family as client: assessment and diagnosis : Introduction The developmental framework Studies family from lifecycle perspective by examine members changes roles and tasks in each progressive life cycle

17. The family as client: assessment and diagnosis : Introduction family developmental tasks 1. Beginning family Establishing a mutually satisfying marriage Planning to have or not have children 2. Childbearing family Having and adjusting to infantSupport needs of all three membersRenegotiating marital relationship

18. The family as client: assessment and diagnosis : Introduction 3. Family with pre- school children Adjusting to cost of family life Adapting to needs of pre-school children to stimulate growth and development Coping and parental loss of energy and Privacy 4. Family with school age children Adjusting to the activity of growing children Promoting joint decision making between children and parents. Encouraging and supporting children’s educational achievements

19. The family as client: assessment and diagnosis : Introduction 5. Family with teenagers and young adults  Maintaining open communication among members. Supporting ethical and moral values within the family. Balancing freedom with responsibility of teenagers. Releasing rituals and assistance Strengthening marital relationship. Maintaining supportive home base young adults with appropriate

20. The family as client: assessment and diagnosis : Introduction 6. Post- parental family Preparing for retirement Maintaining ties with younger and older generations. 7. Aging family Adjusting to retirementAdjusting to loss of spouseClosing family house

21. Data collection categories • A list of 12 data collection categories • Family demographic ( composition, socioeconomic) • 2. Physical environment • a. housing and the conditions inside, outside and surrounding it • b. Any existing safety or environmental hazards • c. The amount and quality or services available • d. Geography and climate

22. The family as client: assessment and diagnosis : 3. Psychological and spiritual environment such as: Mutual respect, support, promation and members self-esteam 4. Family structure and roles include: Family organization Division of labor and allocation Use of authority and power 5. Family functions refers to a a family’s ability to carry out apporopriate developmental tasks and provide for it’s members needs 6. family values and beliefs influence all aspects of family life, E.g making and spending money, education, work and religion

23. The family as client: assessment and diagnosis : 7. Family communication pattern include the frequency and quality of communication with a family and between the family and its environment 8. Family decision-making pattern 9. Family problem solving 10. Family coping patterns , family support system, responses to stressors 11. Family health behavior 12. Family social and culture pattern

24. The family as client: assessment and diagnosis : assessment methods • Assessment methods • Ecomap: is diagram of the connection between a family and the other system in its ecological enviroment or its A picture of the family’s patterns. • Nurses can use an ecomap to identify: • Family resources that are present • Family needs • Conflicts • Connections that are present or absent • The balance or lack of balance between a family's needs and the resources available to the family

25. The family as client: assessment and diagnosis • Genogram • A graphic picture of family history, usually used over three or more generation . • The genogram maps such information as/; • Relationships among family members • Important life events • Place of residence • Characteristics such as race, culture and religious affiliations

26. The family as client: assessment and diagnosis • Family assessment tools • Genogram • 65 48 82 • Lung heart car breast • cancer disease accident cancer • 62 60 • diabetes breast • cancer

27. The family as client: assessment and diagnosis • 3. Family Health Tree • a record of diseases that occur in a family. • It can be used to track: • Diseases that have genetic bases • Environmental diseases • Mental health disorders

28. The family as client: assessment and diagnosis • There are two systems of nursing diagnosis • NA NDA system • Uses nursing diagnosis labels • b. Omaha system • Develop for community health nurses, • consist of: • Problem classification • Intervention • Problem rating scale for outcomes

29. The family as client: assessment and diagnosis • Guidelines for family health assessment • Focus on the family as a total unit • Utilize goal-directed question • Allows adequate time for data collection • Combine quantitive data with qualitative data • Exercise professional judgement

30. The family as client: assessment and diagnosis • Remember: • Planning and intervention for families must be in partnership with family members, not imposed from by CHN • Planning and intervention for families by CHN must used the three level of prevention • Work with the family collectively • Start where the family is • Fit nursing intervention to the family stage of development • Recognize the validity of family structural variation • Emphasize family strength

31. The family as client: home visit • The goals of primary health nursing are • often met through providing health care to • families in their home. It can be provided • By: • Visiting nurse association • Hospice • Public health departments • Home health agencies • School districts

32. The family as client: home visit • Advantages of home visits: • These visits cost less than hospital care, with better outcomes, especially when chronic health issues are involved. • Clients have greater control over their health and lives. • The community health nurse gains access to families to provide health education and other prevention strategies. • The nurse can observe family and environment factors that influence health. • Home visits allow for primary intervention, to prevent disease or injury from occurring. • Home visits facilitate family participation and promote family focus.

33. The family as client: home visit • Disadvantages of home visit • The nurses skills, personality, or physical ability may not be compatible with providing home visit. • Home visits are time consuming; travel time is required to get to the persons needing care. • There is no easy access to emergency equipment or consultation with other health professionals if needed. • Home visits may present issues regarding the nurse personal safety in some community or family settings. • The nurse has less control over the care setting (for example, cleanliness, noise, privacy, or distractions).

34. The family as client: home visit The community health nurse develops objectives for primary, secondary, and tertiary prevention levels, in consultation with the family. To accomplish these objectives, the nurse needs to: Assess clients ability or willingness to comply with treatment directions and/ or change certain behaviors. Anticipate family needs, such as the timing of visits, the need to educate family members, respite care, and so on.

35. The family as client: home visit • Community health nurse bag • Requirements include equipment for basic assessment, medical asepsis, and waste disposal. • These precautions must be followed to avoid contamination from blood, body secretions, excretions, or contaminated items. • - Wash hands • - Use gloves. • - Wear eye and face protection • - Wear gown • - Handle client care equipment carefully. • - Clean environmental surfaces. • - Use proper sharps disposal container.

36. The family as client: home visit The community health nurse doing home visits usually works as part of a home health care team that can includes social workers, rehabilitation specialists, and home health nurses or aides. Cooperation and communication with other care providers are essential.

37. The family as client: home visit • The three most common intervention in home health care include: • Helping families deal with stress created by health problems. • Making referrals for community services. • Teaching and educating clients, with the focus on strengths rather than weakness.

38. The family as client: home visit Evaluation is the ongoing process that continually assesses clients progress toward expected outcome. Termination of home visits occurs when both client and nurse are satisfied that goals have been met or that appropriate referrals have made. Telemedicine: which use phone and computer technologies to monitor clients and provide care without the nurse making a home visit.