DOMINICA STATE COLLEGE Faculty of Health Sciences

ASSOCIATE SCIENCE GENERAL NURSING

COMMUNITY NURSING HSC 121

FAMILY NEEDS ASSESSMENT
Presented to MS. LAURENT By MONETTE LAURENT REBEKAH ROBERTS 0498 CAROL TELEMACQUE 0692

29. 11.11

CONTENTS

ACKNOWLEDGEMENTS INTRODUCTION INTERVIEW FINDINGS FROM INTERVIEW PLANS FOR MEETING PRIORITY NEED GROUP¶S ASSESSMENT OF THE PROCESS CONCLUSION BIBLIOGRAPHY

3 4 5 17 18 19 21 22

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ACKNOWLEDGEMENTS
The group wishes to thank all those who, by way of any direct or indirect assistance helped make this process a smooth one and this project a reality. God, first and foremost for all that we are and produce, as it is a manifestation of his numerous blessings, his guidance and mercy. Gratitude is extended to the family on whom this assignment was based, for their patience, team work and cooperation with our group. Their willingness to learn and their willingness to collaborate with us on this endeavour has undoubtedly assured that education and improvement has taken place in their household and will bring forth lasting and positive change in their hygiene habits. We also wish to thank our esteemed lecturer for this unique opportunity that has afforded us a very meaningful glimpse into community nursing. This aspect of nursing, as we have first-handedly seen, is one than can bring great rewards in prevention and management of disease and collaboration and connection with individuals in the community. We would also wish to thank our fellow classmates and others persons in the community and elsewhere from whom we have gained insight, increased understanding and assistance throughout this entire process.

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INTRODUCTION

This project allowed us as a group, to gain a very interesting, insightful and helpful experience of community nursing. It allowed us the opportunity to collaborate with other medical personnel, individuals from the community and family members. This collaboration afforded us the opportunity to ensure proper assessment and holistic care to the family, allowing us to meet the priority need adequately and effectively. Community nursing is a branch of nursing that allows nurses the unique opportunity to connect and collaborate with individuals, families, groups and organisations to promote health and wellness in the community, and to prevent, early diagnose and treat diseases that may occur. To ensure all of these, stated above occur, the nurse must have a great knowledge of all the families under his or her care and must maintain regular meetings and a great communication level with them and all individual members. This project allowed us the opportunity to gain a large amount of knowledge on a family in the community, allowing us to pinpoint their health needs, risk behaviours and their susceptibility to diseases. Using this information we were able to address the priority need for the family, ensuring that in meeting the need, whatever our plan of action was, it was sustainable by the family. This entire process allowed our collaborative and creative skills to come through in the group and with other individuals. It is our hope that by assisting this one family we will indirectly increase the health of the surrounding families and community. 4

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FAMILY HEALTH ASSESSMENT
Family Surname: Gabriel and Victor

Household members (name, age, and relationship to head of household):

Ignis Victor ± 32 years (Head of Household) Jess Victor ± 6 Years (daughter) Nelton Victor- 2 years (Son) Family composition: 3 Males 2 Females

Merle Gabriel- 24 years (Girlfriend) Naheim Victor- 5 years (son)

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Genogram:

Family health tree (include health problems of individual members): Christina Valmond Pierre Emma Gabriel Durand Tina Gabriel Unavailable

Angela Valmond

Zando

Ignis Merle Gabriel Valmond

Damian Victor

Nelton Victor

Naheim Victor

Jess Victor

y

The family was unable to identify any known health problems for the members.

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Family characteristics Common law family Extended family Relatives living outside household: Damian Victor (Oldest son) Location of relatives: Castle Bruce and Sineku

Source(s) of information Family Interview

Date 17/10/11

Frequency and duration of contact: Weekly (Castle Bruce) Hour Visits and monthly (Sineku) Day visits Means of communication: Phone calls and Visitation Family mobility Length of time living in residence:

11/2 year Location of previous residence: Castle Bruce Frequency of geographic moves: 3 times in 10 year period Country /area of origin:

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Dominica, Castle Bruce and Kalinago Territory Family structure Educational experiences: Primary school completion- both parents, high school (1st form drop out)- mother, 2nd and 3rd children are in primary school at present.

Family characteristics Common law family

Source(s) of information Family Interview

Date 17/10/11

Employment history: Father- Fishing and farming and mother- has never been employed Financial resources: Money obtained from father¶s fishing and farming as well as assistance from Christian Children Fund for all the children in household. Leisure time interest: Family visits to the beach, river and play time at the park Division of labour: Mother- care of the household and children Father- Financial income Allocation of roles: Father- is in charge of most decisions and Mother accepts what is decided by father concerning household. Distribution of authority and power:

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Father ±is head of household and makes most of the crucial decisions and Motherallowed decisions making relating to household if father is absent. Family cohesion Emotional bonding of family members: Consistent interaction occurs within the family through continuous family oriented activities and family cohesion. Degree of individual autonomy: Individuals are allowed to have clear options when decisions are made mainly by the father but mother choose to allow whatever decisions that are made by father to be established and children due to age abides as well.

Family adaptation Flexibility in role change: Regular exchange of authority between parents occurs in the event of absence of one in the household Flexibility in power structures: Father is in charge of household and mother is allowed to take charge in the absence of father.

Family Processes How members communicate: Regular cohesion between parents and limited discussion among 2 older children with mother are carried out.

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How decisions are made: The father is mainly the decision maker of the household. How problems are solved: The father and mother discuss and from whatever is discussed and both thinks are best then that is the route followed. How conflict is handled: Discussions are held between parents Family social integration Language(s) and /or dialect (s) spoken, where: English and Creole Literacy, ability to read or write in English language(s): Both parents are able to read and write, and first 2 children are able to read at age appropriate level. Degree of racial or cultural identity: Father is blended (Negro and Kalinago), mother is Kalinago, and all 4 children are blended. Degree of social networks with neighbors, friends, and other family members: The family is integrated into the community and interacts with neighbors and friends and the entire family members. Neighbors, friends and family members all visit and are visited by family members with exchange of produce and other items. Network with religious organizations: The family is Roman Catholic and attends church sometimes. Network with social organizations:

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The children are provided with food and school supplies by Christian Children Fund. Degrees of stress experienced by the family Combinations of stressors: 1. The house lacks piped water and water has to be carried in buckets from the public pipe. 2. The house lack electricity making it difficult to sometimes cope with care of the children. 3. It is sometimes difficult to plan meals because children do not eat provisions.

Family characteristics Common law family

Source(s) of information Family Interview

Date 17/10/11

Family health behavior Activities of daily (how family spends typical day): Father: Wakes up and goes off to fish at sea or goes off to the farm based on the weather and season of both farming and fishing. He returns at the end of the day to the household. Mother: Wakes up and prepares breakfast, feeds children and organize them for school, then drops them off at school. She returns home with the last child, cleans up and cooks lunch. Later she picks up both children from school and returns home. She assists with homework and at the end of the day put all the children to bed. Health history: Mother- 4 pregnancies, No surgical interventions. Father- No know medical interventions

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Children: 2nd, 3rd and 4th children all suffered from infantile jaundice

Health status (i.e., problems and priorities): Presently there are none. Risk behaviors: Poor hygiene practices in environment, food preparation and home. Self care (health promotion and prevention): Mother and children are presently all receive regular screening at the health center Father is too busy to get screening. Health care resources: Presently no one in the household is on any medication, all the children are presently up to date with vaccines and receive regular screening, and the mother also receives regular screenings.

Professionals and lay healers: The family believes in the use of both medical and herbal medications for healing. Working with the family and agencies: The family only has interactions with the Christian Children Fund. Family strengths: The parents are able to discuss the family problems despite the father being the head of the household; the family is also able to adjust to the role changes when one parent is absent. The family is also able to cope financially despite only one parent being the sole provider to the household.

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Family priorities: The children are first priorities in the household; the provision of food is second in line, then the household maintenance and finally the parents. Family ± nurse contract(s): Nurse Peltier and Nurse Seraphine Family cultural influences Values, attitudes, and beliefs about; Spirituality: The family believes in God as the almighty and attends church Rituals (holidays and celebrations): The recognition of holidays such as Christmas, birthdays, independence, lent and other catholic celebrations by all the members of the family. Customs: The usual customs that are followed by the family are based on religious beliefs. Dietary habits: Both parents do not eat chicken or drinks milk but the children are allowed to eat both chicken and milk. Child ±rearing practices: None of the children in the household eat provision and thus other food sources have to be provided for them. Health: Regular screenings are done for the children at the local health center. Folk diseases and folk medicine: The use of herbal medicine for both parents and children are practiced in the family. Cultural healers: The parents believe in the practice of healers and herbal medicines. Care of ill family member: The care of ill family members are handled by the use of medical and herbal medication.

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Role of spiritual leader in care of ill family member: Provides advice on illness and use of herbal medications Family characteristics Common law family Family residence Adequacy of size: source(s of information) Family Interview Date 17/10/11

The house has 1 porch and 3 rooms, they are divided as follows; 1 is the kitchen, 1 is the living room and the other is the bed room with 2 beds. Structurally safe: The house is set on a concrete foundation at the base of a small hill with structurally sound design. Sanitation water, sewerage and garbage: The water is collected from the public pipe on the street across from the household, garbage is collected in container and put out for collection by the garbage truck, and the use of pit latrine is used in the disposal of sewage. Adequacy of sleeping arrangement: The first 2 children sleep in one bed and the last child sleeps in another bed with the parents. Modes of transportation: The use of public transportation is the main source for the family. Walking is also done to get to the school and to the father¶s farm.

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Resources: The Incomes is from the father jobs and assistance from Christian Children Fund. Grocery shopping: The father does most of the household shopping Pharmacy: The health center pharmacy is the main source of the family medicine supply and if the medication cannot be given is runs out; it is purchased at the private pharmacies. Recreational (e.g parks): The family visits the local park, the beach, river and other community activities such as children parties. Educational: The both father and mother completed primary school, the mother dropped out in 1st form, the 2nd and 3rd children are in primary school. Religious: The family is Roman Catholic. Emergency (i.e fire and hospital): The emergency numbers are all written down on a chart on the living room and phone directories are present in the household. Neighbourhood interaction: The family is in contact with all the neighbors, and close interaction is maintained among all, with visits to each other and sharing of supplies such as food. Family environment Common law family Family community Industry and business: The sale of ground provision and fish by the father provides income to the family. Leadership: The father is the head of the household. Source(s of information Family Interview Date 17/10/11

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Government: The parents in the family choose not to comment on the present day government. Migration (i.e., in and out of community): No one in the immediate family is presently out of state, the family visits the mothers family in Sineku via public transportation every 2 months. Community memberships/interaction: The family is not involved in any groups in the community but participates in community activities particularly on holidays such as beach days and children parties.

Social services: The family uses the basic services provided by the government to the public for the health maintenance of the family e.g. Vaccination programs, pharmacy services and screening for adults Health services:

Most of the family keeps abreast with the changes of the health services provides by the community nurses in the health center. Primary care: The use of relevant health care services within the health care setting is utilized by the family for health maintenance and prevention of diseases.

Institutions (e.g., hospital or nursing home): There are no known family members in nursing home or hospital care at present.

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FINDINGS FROM INTERVIEW
Based on the interview done, we as a group have ascertained that the needs of the family are hygienic and nutritional. During our assessment we visualized that the surroundings inside and around the home were in quite a disarray and in desperate need of cleaning. We viewed several areas that could harbour microorganisms that could potentially cause serious diseases especially in children, of which there are three in the family. We were also told that the children do not like ground provisions and as such mostly eat refined starchy foods such as macaroni and rice. It was also a cause for concern to as well since, nutrition is important especially for children in the early stage of development. We then therefore concluded that the priority need was hygiene around the home for the family. We also, based on our findings, decided to focus some of our efforts and teachings on nutrition to ensure a healthier diet for the parents and children, one that would be cost effective and sustainable. We concluded from our interview that the parents have poor educational background, which pointed out to us that we especially needed to make any teaching or learning materials simple and easy to understand.

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PLANS FOR MEETING PRIORITY NEEDS
NEEDS TO BE MET 1. KNOWLEDGE ABOUT ENVIRONMENTAL HYGIENE AND FOOD PREPARATION HYGIENE IN AND AROUND THE HOME. 2. KNOWLEDGE OF NUTRITIONAL MANAGEMENT HOW TO MEET THOSE NEEDS KNOWLEDGE ABOUT ENVIRONMENTAL HYGIENE AND FOOD PREPARATION HYGIENE IN THE HOME Demonstrate cleaning methods and techniques for different areas of the home Teach to include children in household chores Teach to cover drums and other sources of water Teach parents to burn, bury and dispose of garbage properly Prepare posters on cleaning around the house Donate proper and necessary cleaning supplies to the family

y y y y y y

KNOWLEDGE OF NUTRITIONAL MANAGEMENT develop charts and posters showing food pyramid and how to combine foods from six foods groups and include recipes y y Demonstrate how to combine foods to prepare a health meal. Teach parents to include children in food preparation

y

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GROUP¶S ASSESSMENT OF THE PROCESS

The assignment process for us was very exciting as it gave us a chance to get into the community and have one-on-one interaction with a family. We therefore placed a great deal of emphasis on this assignment and spent a considerable amount of time planning our intervention for the family. We ensured that we developed a great rapport with the family members to ensure that we got full and correct information from the members. We acquainted ourselves with the neighbourhood and the resources available to the family. Garbage disposing areas, water sources, drainage, toiletry facilities and road networks were assessed and taken into consideration along with the family¶s relationship with their neighbours and friends. We gathered as much information on the family as possible to ensure that whatever care was given was priority for the family and was done in a way that would be most beneficial. On the day of the intervention we were slightly nervous but knowing that we had laid enough ground work with the family and had planned carefully our intervention, we pushed our anxiety aside. The day as it turned out was very fruitful and enjoyable for all of us and the family, as we were able to accomplish all of our goals and left knowing great satisfaction for a job well done. There is always room for improvement, but because of the level of dedication and seriousness we placed into doing this project the improvement to be made is small. Overall, the opportunity to do this was one we relished and as such ran with it. We are 20

very grateful for the opportunity to put what we have learnt, in the courses of community nursing, health assessment, health promotion and others to make this a most fruitful and rewarding enterprise.

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CONCLUSION
Personal experience is one of the greatest ways to gain knowledge and this assignment has given us the opportunity to do so. Community nursing is a very important and sometimes neglected aspect of the nursing practice. If taken seriously and practiced with the importance and fervour for which it deserves, this area will serve to limit the prevalence and occurrence of preventable, communicable and non communicable diseases and will ensure early diagnosis of diseases. Community nursing should be focused on the family as this group is the cornerstone and the foundation of communities. This very integral group is why it is very important that proper assessment of this group and communication and collaboration with its members occur.

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BIBLIOGRAPHY
Aguilar, I. Gables, H. (2006). Disease Prevention in Encyclopaedia of health and education for the family, (vol. 4, pp. 72-94). Toledo: Education and Health Library Howse K., Dunton H., Marshall D. (1998). Family Matters; a Guide to Family Life, (pp. 163-170) Grantham: Stanborough Press Ltd. Snyder, B. (2008). Kozier & Erb¶s fundamentals of nursing, concepts process & practice. Julie Levin Alexander.

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