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.

4 Implement with client appropriate interventions for health promotion and health maintenance taking into consideration relevant principles and techniques.3 Plan with client appropriate interventions for health promotion and maintenance of health.2 Identify wellness /at risk nursing diagnosis.1. . 1. 1.

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

interacting and communicating with each other in their respective roles of husband and wife. harmonious manner. constituting a single household. son and daughter. brother.The Family and Family Health Family. blood or a visual image of adults & children living together in a satisfying. - - A social group characterized by common residence. mother and father. economic cooperation and reproduction. As a group of persons united by ties of marriage. sister creating and maintaining a common culture. . ( Potter & Perry.2008) - Is the basic social institution and the primary group in a society.

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

Usually live in a close geographic proximity to members of the extended family who provided a sense of stability and belonging. a mother and their children. these people are married and living together in one house make up the nuclear family. Nuclear family.Family Structure And Functions: Structure:. wife. one or more children. 1.consist of husband.compose of a father. .is the form that a family takes in order to maintain function. - - Traditional Family.

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

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

.1 Nuclear. 1. 1. mother and the children. Classification of Family Structure Based on internal organization and membership 1. Composed of father.composed of two or more nuclear families related to each other economically or socially.2 Extended.also known as primary or elementary family.

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. 2.2 Matrilocal-requires the newly wed couple to live with or near the residence of the bride’s parents. .1. Patrilocal-requires the newly wed couple to live with the family of bridegroom or near the residence of the parents of the bridegroom.

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.3 Bilocal.provides the newly wed couple the choice of staying with either the groom’s parents or the bride’s parents. 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.2.

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

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

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

. 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.the family transmit culture of the group . teaching and indoctrination.3. its patterned ways of living and values through example. Supported by system of reward and punishment. Socialization function.

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

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

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

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

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

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

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

4.Adjusting to the activity of growing children.Family with School Age. -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 children’s educational achievements.

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

Balancing freedom with responsibility of teenagers. 6.-Supporting ethical and moral values within the family.Releasing young adults with appropriate rituals and assistance. 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 children’s lives. . breaking up an already disorganized and non cohesive group.Illness imposed on a family at this stage can be detrimental to the family structure. .Many young adults return home to live with their family after college until they can afford their own apartment or get married. .

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. .  Nurse can serve as an important counselor to such a family .

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

The family in Retirement or older Age-individuals are more apt to suffer .To families at this stage who don’t have children.from chronic and disabling conditions than younger persons. .they remain important because they can offer a great deal of support and advice to young adults who are just beginning their families. -Grandparents care for their children while the parents are at work.8. .

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

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

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

Public education to promote breast self examination . b.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. Screening programs for  .Secondary Prevention .

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

done to prevent relapses in certain diseases. .intensive periodic follow up and treatment. .- - Includes minimizing residual disability and helping the client learn to live productively with limitations. 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, it’s ability to maintain itself as a system and functioning unit, it’s ability to maintain wellness, prevent and control or resolve problems in order to achieve health and well being among it’s 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 it’s membership. -every health problem from it’s causation to it’s resolution is influenced by the family. Family acts as the basic care provider, it’s 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 it’s 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.

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

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

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

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

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

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

Recognizing interruptions of health development. 2. Making decisions about taking appropriate health action. .family’s ability to recognize the presence of health problem. 3. Providing nursing care to the sick.1. disabled and or dependent members of the family.

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

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

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

health deficit. Health condition and threats are: wellness state.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 threats. . stress points or foreseeable crisis situations.

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

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 family’s assumption of these tasks. .2.

. .specify a hierarchy of sets of data and their analyses.First and Second Level of Assessment.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.

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

.Data Collection.elicit data needed to arrive at a measure of the family’s ability to achieve health and well being among it’s members.

include the composition & demographic data of the members of the family/ household. type of and family interaction/ communication & decision making patterns and dynamics. . characteristics & dynamics. Family structure.Data taken during the first level assessment: 1. their relationship to the head & place of residence.

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

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

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

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

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

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

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

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

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

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

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

.done through inspection.elicit data about health status of individual family members. percussion. Physical Examination.2. auscultation. palpation. 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.

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

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

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

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

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

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