The family as client: assessment and diagnosis

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The family as client
assessment and diagnosis
Prepared by Suhail Al Humoud
The family as Client home visit

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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.

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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

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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

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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

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The family as client assessment and diagnosis
Characteristics

• Characteristics of the family
• Every family is a social system
• Every family has a its 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

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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. Its
  the only form accepted culturally in our regions

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The family as client assessment and diagnosis
Introduction
Function of the family

1. Affection, love, care, an emotional support
2. Security
3. Identity
4. Affiliation
5. Socialization
6. Control
7. A sense of belonging and of history and place
8. Family rituals for rejoicing and grieving
9. Systems for earning money , supporting partners
   and children
10. Sharing of labor, chores required to keep the
    family running

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The family as client assessment and diagnosis
Introduction
Characteristics of healthy family

1. Facilitative interaction among members
2. Enhancement of individual development
3. Effective structuring of relationship
4. Active coping effort
5. Healthy environment and lifestyle
6. Regular link with the border comminty

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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

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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

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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 familys level of
  functioning

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The family as client assessment and diagnosis
Introduction
Conceptual frameworks

1. A conceptual framework is a set of concepts
   integrated into meaningful explanation that helps
   one interpret human behavior or situations.
2. Three conceptual frameworks are particularly
   useful in community health nursing

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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)

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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

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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

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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

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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 childrens educational achievements

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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

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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

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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

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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 familys
ability to carry out apporopriate developmental
tasks and provide for its members needs 6.
family values and beliefs influence all aspects
of family life, E.g making and spending money,
education, work and religion

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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

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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 familys
  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

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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

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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

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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

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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

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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

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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

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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

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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.

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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).

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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.

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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.

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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.

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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.

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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.