Individual, Family and Community Health Promotion Ch 6, 7, 8, 9
Family elimination Pattern
Regularity and control of family's excretory functions Age-specific developmental assessment - Toilet training for kids, incontinence or constipation with elderly - use of laxatives or aids - waste and garbage disposal (including pets) - problems with flies, roaches or rodents
Transtheoretical Model
*Stages of Change* - understand where the individual is so we can meet them and help them navigate to a place where they can take action. Important to consider so interventions are appropriate to stage of readiness *precontemplation* - not considering change. No thoughts of change, unwilling to listen to education *contemplation* - considering change. may have developed some issues related to behavior *planning/preparation* - decided it is time to make a change and they are willing. Ready to seek out help *action* - implementing change, putting plan into place. Know where to get help and are going to do what they need to do *maintenance* - maintaining change. The hardest part. *relapse* - slipping back into prior behavior. Common, nurses have to be supportive to get them to change again.
Diagnosis of the Community
*determination of patterns in data* - organize data in charts, figures, maps - make sure you don't have missing data - find patterns using subjective or objective data - formulate hypotheses - identify at-risk community groups - establish probable causes and relationships *analysis* - apply theoretical perspectives, models of community structure, - identify strengths in the community based on data collected and status of problem in health concern - identify causes/risk factors to plan nursing intervention - make diagnosis of community based on collected data. Use as basis for planning, implementing and evaluating solutions
Nursing Process with the family
*diagnosis* -derived from assessed and validated data (systems or developmental approach) - concise summary of problem or potential problem discussed with family and formulated with cultural competence (spiritualism, beliefs included). - family needs to agree and be respected (use strengths) *interventions need to increase knowledge/skills, increase strengths, decrease exposure and decrease susceptibility* *planning* - planning is done with the family - identify the order and priority of problems, identify things the nurse can help with and things that should be referred out - specify actions and expected outcomes - *the nursing plan provides direction for implementation and a frame work for evaluation* *implementation* - goal is to foster health promotion - dynamic with nurse and family working together - FLEXIBILITY: new info used to adapt and change plan - nurses assist families to improve capacity to act independently *evaluation* - determines effectiveness of intervention - *changes in interaction patterns, effective communication, ability to express emotion, responsiveness to needs of individual members, problem-solving ability*
Mapping family structure and function
*genogram* - highlights structure of family through a map of three generations identifying family health problems/patterns (aka *family history*). Good for looking at genetically inherited or behavioral health issues. - females in circles and males in squares *ecomap* - functional map of family with a pictorial technique to document family organizational patterns. - Shows relationship and flow of energy. - includes parents and children - lines signify strong, tenuous or stressful relationship. More arrows in one direction indicates energy
assessment of the individual
*goals* - promoting health through nursing knowledge, providing a holistic view of the person with data *subjective data* - something the patient or individual reports, their point of view or feelings (Ex. 24 hour diet recall, pain scale, answers to questions) *objective data* - concrete things that a nurse can see, measure and calculate (Ex. dry skin, BMI calculation, weight measurement) - assess as functional (strength/wellness), actually dysfunctional (nursing diagnosis), or potentially dysfunctional (risk), Nurses determine the cause and plan remedial actions *an assessment should have all characteristics:* - examine patterns over time: Maintenance or changes (BP between doctor visits) - environmental influence on patterns - age-developmental issues (on track or delayed) - functional: individual performance tasks (ADL - can they perform activities, duties, self-care? - age is important to consider) - cultural influence on health patterns (impacts health perceptions and wellbeing)
Nursing process for the family
*nurse's role* - ROLE MODEL, collaborator with family, provide info/educator helping to identify risk behaviors and learn new behaviors, assist in growth and development in collaboration with the family, help with decision making and problem solving, helps connect them with resources, learn family attitudes towards HP&DP *Family assessment* - family as a group and member interactions, home visits to assess environment for health promotion, collaborate with family in all phases, recognize patterns and assess potential for change
Methods of Data Collection
*observational data (objective)* - windshield survey uses senses to determine community appearance *interview data and verbal statements* - key informants in community leaders, community residents, health agency personnel *measurement data* - quantified data of population statistics, morbidity/mortality, US census stats, epidemiological and environmental data - census data about what services are needed (most complete source for pop info), project stats and developmental trends of population patterns/dynamics from community agencies and planning commissions - state databases
Developmental Stages: older adults
- adjust to retirement, possibly lower living standards (less income) - adjust to loss of spouse - adapting home for elderly to maintain functioning and quality of life with disability - nurse's role: counselor on safety of home and bereavement, monitor nutrition, exercise, preventative services, medication, referrals for nursing home, facilitator of interpersonal relationships among family members.
Developmental Stages: Toddler/Preschool
- balance home safety with child exploration (cover outlets, permit exploration) - include activities to promote learning - teach and promote good health behaviors through modeling (sleep rituals, dental hygiene) - adjust to costs of family life - cope with energy depletion and lack of privacy as parents - adapt to critical needs and interests of toddlers in stimulating, growth-promoting ways - nursing roles: teach first aid, coordinate pediatric services, counseling for nutrition, exercise, dental hygiene, environmental safety, managing family lifestyle, facilitate child-parent interaction and establishment of healthy lifestyle activities, facilitate parent's role as guidance as the child has experiences outside of home "letting go"
Purpose of Gordon's Functional Framework
- consistent nursing language through collecting, organizing, presenting, and analyzing data to formulate nursing plans - flexible process that allows tailoring content for individuals and situations - suitible for use within diverse practice areas (home, clinic, institution) for assessment of individuals (adult/children), families and communities - supports theoretical components of nursing services, education, and research by organizing clinical knowledge using interventions and outcomes - incorporates medical science data while retaining the focus on nursing knowledge and practice
Developmental Stage: School-aged children
- dichotomy of pursuing parents own interests vs finding fulfillment in producing the next generation - let child explore outside the home (more open to risks but parents can't always manage their child) - health promotion from family and school environment - "letting go" for both parents and children - encouraging and supporting children's educational achievements (extracurriculars) - promoting joint decision making (parents and child) - nursing roles: teach first aid, coordinate pediatric services, counseling for nutrition, exercise, dental hygiene, environmental safety, managing family lifestyle, facilitate child-parent interaction and establishment of healthy lifestyle activities, facilitate parent's role as guidance as the child has experiences outside of home "letting go"
Developmental Stage: Adolescence
- goal is to loosen family ties - promote identity formation, autonomy, responsibility - balance freedom with responsibility as adolescence mature and emancipate - maintain open communication to mitigate risk behaviors, peer pressure and challenging of family values - support ethical and moral values - strengthen marital relationship - Nurse's role: teaching risk factors, teach problem solving (alcohol, smoking, diet, exercise), facilitate balancing of responsibilities and freedom and open communication within family, counselor on mental health issues, puberty, sexual education (STDs, pregnancy, family planning), facilitate parent's interests beyond the family
Developmental Stage: Middle Adults
- if the couple was not successful in making relationship changes, it may falter once the child leaves (secure vs faltering) - empty nest syndrome - preparing for retirement - higher risk for susceptibility/vulnerability to health problems (high risk for heart disease, CVA, cancer especially if risk takers when younger) - maintain ties with older and younger generation (sandwiched and have to take care of problems) - nurse's role: screening for hypertension, pap test, breast examination, mental health, dental care, counselor on menopausal transition
Developmental Stage: Young Adults
- launch children with appropriate rituals and assistance (high school to after college graduation) - reestablish marital relationship as a couple (marital dyad and multigenerational relations) - financial challenges of aging parents and adult children - young adult copes with social and emotional pressures - maintenance of healthy habits from family - reassess life goals for parents and planning for aging process - nurse's role: teach problem solving related to lifestyle habits, participate in community organizations involved in disease and environmental control
Family Sleep Rest Pattern
Family sleeping patterns - usual sleeping/rising habits/hours - suitability for each member (3 yr olds don't put themselves to bed usually) - who decides bedtime (roles/functions) - evidence of sleep disruption (appearance = objective, hours/night subjective) - naps in the afternoon - sufficient sleeping space and quiet
Developmental Perspective of the Family
Stages of family life cycle. Critical family developmental tasks identified by Duvall and Miller - criticized for lack of diversity in family forms (middle class childbearning) - the stages build on each other so failure in one stage leads to difficulties in later stages - regression may occur or tasks may happen simultaneously - each family performs tasks in a unique manner Knowing the stage can help predict family pattern and appropriate tasks. *stages*: married couple, childbearing family, preschool children, school children, teenagers, launching young adults, middle-aged parents, aging family members
Systems Theory Approach
The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem). - individual behaviors and family members' individual responses influence patterns - each family has a unique value structure, culture and history - families process info and exchange energy with the environment through values - the system has boundaries which seperates the family system from the environment and controls info flow - families are a unified whole, living open system so changes in one member (health behavior/problem) affects everyone else - systems theory connects family systems with health providers and the community *family structure* - family composition, roles/relationships (father, sister etc. or who pays bills, who cooks etc.) - measured by genogram *family function* - processes within systems, how energy is exchanged btw family members and the environment - measured by enegram
Risk Factor Perspective
Understands family health based on risk-factors (lifestyle, biological, environmental, sociocultural, and health care system). - habits learned in family develop into individual lifestyle behaviors - developmental stages (teens) can have more risks - peers may influence risk and compete w/ family values *epidemiology* - uses mortality and morbidity as indirect evidence of health *risk estimate* - calculates differences btw group with and without risk
Gordon's Functional Health Patterns
a framework used to gather assessment data to pick the best NANDA nursing diagnosis for patients - based on the notion of individuals having functional health patterns. Their interactions with the patterns depict the overall lifestyle and health of the individual - from perspective of patient and nurse: behaviors, role of environment and developmental influences - philosophical foundation: holistic view of person and how they interact with the environment - the individual is viewed as a whole being using interrelated behavioral areas *11 functional areas* - many are interrelated and influence other areas. A problem in one area could be a clue to dysfunction in other patterns - assessment includes functional strengths, dysfunctional problems and potentially dysfunctional risks and patients level of satisfaction with pattern - health perception/management, nutritional/metabolic, elimination, activity/exercise, sleep/rest, cognitive/perceptual, self-perception/self-concept, roles/relationships, sexual/reproductive, coping/stress tolerance, values/beliefs
Community
a specific group of people that live in a defined geographical area and typically share a common culture, values and norms - usually arranged in social structure according to relationships - communities can be in a variety of settings (workplaces and schools)
Community Coping-Stress Tolerance Pattern
ability of the community to cope or adapt - ability to exchange goods and services (funding exchanges which can foster goals, values, ideals and promote health) - zoning, strict housing codes and waste codes (it would be stressful to live in an old house and worry about lead, asbestos) - what HP services are available/acceptable, what services do they need (are they private/public, do they have funding - how many education facilities available and do they help foster HP (how many drop-outs, may not be able to find a good job and that would be stressful) - what amount of tax money is allocated for health-promotion activities - crime statistics and amount of substance abuse (using to cope with stress) - money dedicated to stress management programs like anger de-escalation or drug addiction recovery? *data sources* - meeting minutes - public documents - health surveys and records - statistics about exchange of goods and services within the community and federal/state funding the community receives from governments
cognitive-perceptual pattern
ability to understand and follow directions, retain info, make decisions, solve problems, use language. Perceptual and sensory patterns (pain/tolerance, sight, audio) - vertigo, temp sensitivity, hallucinations, educational level, preferred method of learning, attention/concentration, problem solving, memory problems - may use pain scales or coma scales or look at appearance, dress, hygeine - ask about assistive devices - assess early in the process bc dysfunctional pattern = individual is unreliable narrorator - must be assessed within the context of the environment, cognitive deficits may require increased env controls to ensure safety and continued independent functioning (may have to go into long term care) - developmental stages impacts the pattern (Piaget's cognitive developmental stages)
Health Perception/Management Pattern
an individual's perceived health and wellbeing and how health is managed/maintained - affected by lifestyle and functionality - perceived health status, meaning of health, skills, health knowledge, ability to access care. *assessment* - current health/safety practices, have they had previous patterns of adherence to good health behaviors, do they use the health care system and have a regular HCP, do they have access to healthcare, what are their health perceptions/beliefs (models of healthcare - clinical, role, adaptive, eudaimonistic, cultural implications) - health beliefs, perceived susceptibility, self-efficacy, health literacy - past health management is a predictor of how this person will believe or percieve interventions in the future - if they didn't seek care before, they probably won't later (identify + address reason for failures of past interventions Ex. health beliefs/perception, knowledge deficit, inability to access care) - five stages of change
Home Assessment
assessment of environmental factors and their possible impact on health - the condition of the home: adequacy of rooms, lighting, water, sanitation, sleeping arrangements, possible infestations - levels of crime, industry or pollution in the neighborhood. Public transportation access for work or school - community resources like schools, church, shopping, park/exercise, health facilities. Do they live in a food desert
Community Sexuality-Reproductive Pattern
birth statistics, mother's age, ethnicity, marital status, prematurity and abortion rates, STD rates - identify high risk groups and mismatches between issues in comm. and services provided (Ex. more women's health clinics needed) *data sources* - meeting minutes - health records - statistics - public documents about crime rates, child abuse reports, mother/newborn death rates, type and size of families, abortion rates, teen pregnancies, male/female ratio, laws and regulations about birth control
Family Roles and Relationships
characteristics of structure (age, sex, education, role) and function (process of achieving tasks) *use of genograms and ecomaps* - varied forms of family structure (increased poverty and divorce patterns), pattern may change over time - family is most enduring link to health for children - focus should be on resilience to strengthen at-risk families. Ex. resources for single parent - is there violence (potential is increased in disadvantaged households, job loss or shift in roles) - is income sufficient for needs - do they feel part of or isolated from the community or do they have support networks - is there role flexibility and distribution of tasks - who were the parents role models and how are problems with children handled
Community Health Nursing
combines nursing practice and public health to promote health of populations (development of relationships within community is essential for achievement and community involvement) *nurse roles* - *independent*: carrying out nursing process by themselves - *interdependent*: working with others in collaboration (epidemiologist, law enforcement, social services, public assistance) - *dependent*: carry out plans someone else has already formulated (mayor) - combine nursing practice and public health to promote health through supplying educational info and developing skills/behaviors, develop essential relationships for achieving health goals - influence health policy by advocating for justice in healthcare delivery, pay attention to policy decisions, lobbying and joining nursing organizations to increase bargaining power (20% in org, ANA wants more membership to support candidates and health promotion) *community health promotion* - community participation, assessment, creation of targeted/measurable objectives, relevant interventions and evaluation
Community Values-Belief Pattern
common values and norms - family values and beliefs - history of community (traditions and how they've changed) - flexibility of rules - family view of spirituality, religion, acceptable cultural/ethnic practices related to health - community priorities and programs - value conflicts within families - effects of values on health - zoning and conservation laws, health budget in relation to total budget (money for homeless shelters, rent/utility bill relief
Community Roles-Relationships Pattern
communication styles in informal and formal relationships - identify roles/relationships which affect community health - patterns of crime - racial incidents - social networks - how is health info transmitted in the community (flyers, newspaper, bulletins, TV PSA's) - public meetings to discuss concerns, communication with available leaders, organizational structure, locus of power, what community systems interact (ex. school and health clinic) - are people friendly - are there enough wages, employment rate, poverty rate - rates of riot, violence, child or elder abuse, divorce rate *data sources* interview key informants: religious leaders, gov officials, media sources dictated what they should tell to the community - formal > informal comm. Success of programs dependent on engaged comm residents (build relationships)
Community Nutrition-Metabolic Pattern
community consumption habits - availability of food stores and subsidized food programs - adequate food intake, presence/absence of kitchen facilities - adequate plumbing (water) - is food, heating and cooling costs manageable (in order to cook their food properly or use their fridge) - water restrictions or ability to test water quality *data sources* - windshield survey (how many grocery stores vs fast food places) - government programs (subsidized programs, SNAP, WIC) - private soup kitchens - food donations in houses of worship
Community Self-perception self-concept pattern
community self worth and identity - do the residents think it is a good place to live (housing conditions, cleanliness) - do they feel supported by friendly neighbors, do they have spirit, block parties or are they reclusive - is there a high crime rate, accidents or injuries, are the school systems adequate - degree of competence with social/political issues - how do they view itself in terms of job loss (less self worth if not enough income) do they feel they have marketable skills *data sources* - observe: do they get out and talk or are they reclusive - interview key people in the community
Community Sleep-Rest Pattern
community's rhythm of sleeping, resting, relaxing - does the city sleep or are businesses 24/7 - is there ongoing activity and noise from open businesses or highway/airplane noise, trucking hubs - are noise ordinances enforced - are residential areas protected from industrial buildings/construction, highway noise *data collection* observation - are people out late at night interviews - businessowners, what are they doing to promote rest?
coping-stress tolerance
depicts general coping and ability to effectively manage stress - necessary part of life bc it promotes growth and effort, but it can hinder growth and function. Exacerbated by accumulation of small stresses - perception of stress related to development, amt of stress, current levels of stress and social support - coping is a learned behavior in response to stress. May problem solve or use defense mechanisms (process incorporating many behaviors) - may have negative coping strategies: avoidance, distraction, withdraw, self-criticism, blaming, wishful thinking and resignation, alcohol or smoking *Assessment* - determine stress tolerance and past coping behavior (style, strategies, variety/flexibility of strategies, coping effectiveness) - encourage positive coping (humor, optimism) - replace unhealthy coping strategies or teach stress management techniques (they have to be ready to change) - time management, cognitive rehearsal, meditation
Family sexual reproductive pattern
describes sexuality and fulfillment and behavioral patterns of reproduction - is there communication of needs (satisfaction, demonstrations of care) - use of family planning and contraceptives - discussion of sexual topics with children - previous pregnancies and plans for more
elimination pattern
excretory function (bowel, bladder and skin: regularity and efficiency in excretion of waste) - normal patterns may vary - affects interpersonal relationship pattern: not controlled won't be accepted and older adults may be put in nursing home - related to nutrition pattern assessment - stage of life and development are relevant *assessment* - changes in elimination (constipation, diarrhea, pain with elimination), skin integrity (dry, cracked from eliminating too much water, cuts, bruises in anus), continence, UTI, wounds, perceptions, self-treatment (are they using cranberry juice, laxitives?)
activity/exercise pattern
exercise, activity, leisure, recreation - movement capability, activity tolerance, ability to perform self-care, limitations to movement, use of assistive devices (Cane), satisfaction/perceived problems with level of function - activity level can have a significant impact on health (self-care, sedentary = obesity, affect of environment) *people place a high value on mobility and independence* - if they can do it themselves, don't do it for them, give them ability to be mobile and function independently. Don't restrict mobility *assessment* - color of skin (circulatory), respiratory (out of breath easily), neuromuscular (coordinate walking, getting up), gait (shaky/tremors, steady, slow, jerky, unbalanced), posture (stooped could lead to fall), muscle tone, range of motion, subjective complaits (ability to walk or exercise), fatigue - exercise patterns: type, frequency, duration, intensity, mode of transportation (wheelchair or car), barriers to exercise (environment), objective measures to assess function - assess infant/toddler development (walking, milestones)
Family coping and stress tolerance pattern
family adaptation to internal and external pressures - have there been major changes (divorce, moving, economics) - how do they cope with stressful situations (discussion or ignore it) - have there been members who used alcohol or substances - do they use community resources - do dysfunctional adaptive strategies impact child development
Family values and beliefs pattern
family values, beliefs, goals, life meaning and spirituality and how they affect behavior - what values and beliefs are important to the family - view of spirituality or religion - cultural or ethnic practices - are there value conflicts within the family - how do their values affect health
Family Health Perception + Health Management
family's perceived health, management and preventative practices - focus on concerns about children health and safety practices (checkups, immunizations, safety practices like helmets or fencing around pools) - lifestyle practices (seatbelts, drinking, chronic disease, drug use) - use of health care and experiences (followed doctor's orders?) - activities important to keeping healthy (folk medicines) - environmental safety
Family Self-Perception Self-Concept Pattern
family's self-worth and feeling states - manifested through shared aspirations, values, expectations, fears, successes - how family percieves themselves compared to others - assets contributed by each family member - tone of family members towards each other (indifferent, secretive, open) - assimilation into community - coping with change and crisis - general mood of family
Community Risk Factor Perspective
focuses on risks affecting community health and illness - age, gender, race, location, poverty, health service availability, education, environmental risks - the goal is health promotion and health protection to control risk factors and make relevant health-related resources available
Community Developmental Perspective
framework based on developmental theory - focus on particular age groups in the community and used to plan health promotion to target certain dysfunctional groups Ex. find a dysfunction, identify the age group, look at developmental stage, target interventions - demographics guide health promotion
Community Elimination Pattern
how is collective waste disposed of? - contaminated air, water, soil, spillage of landfill waste, inadequate collection - business/industry polluting air, water (humidity) - are there lots of bacteria and viruses in the community - are disposal sites and chemical dump sites adequate? - what efforts are being made to control leached materials? - is there deforestation or poisonous plants - is there a pest problem or are dogs running unleashed - are chemicals used to kill mosquitos, are foods contaminated by chemicals? *data sources* - observation: industry in the area, garbage piles, containment of landfills - EPA and CDC order compliance - key informants: managers of industries, council members, mayor
Self-Perception-Self-Concept Pattern
individual's sense of personal identity, goals, emotional patterns, feelings about self care, self-image, self-worth - developmental level is important because delays in self esteem block progress towards further tasks (Erikson's development stages) - impacted by family/relationships and support/lack of it - look for clues to indicate identity confusion, altered body image, low self-esteem, feelings of powerlessness, anxiety or depression states *Assesment* *objective* - posture, eye contact, restlessness, mumbling, foot shuffling *subjective* - Meaning in Life Questionnaire. talking about themselves or family negatively, negative beliefs - sharing may help facilitate process of goal setting
sexuality-reproductive pattern
individual's sexual self-concept, sexual functioning, method of intimacy and reproduction - closely related to self-perception and relationship pattern - body image, self-concept, role and gender identity are all linked to sexual identity - cultural and family norms may contribute to expression of sexuality, consider continuum of sexual identity - important in adolescence + development of genitals, secondary sex characteristics *assessment* - knowledge of functioning and preventative health practices (contraceptives, pap tests, breast exams), level of activity/libido, menstruation, menopause, reproductive stage/pregnancy, performance, infections, discomfort, satisfaction level - discussion may only occur once a trusting relationship has been established - education important for understanding and increased satisfaction
nutritional/metabolic pattern
individual's typical food and fluid consumption in relation to metabolic needs and perceived problems *assessment* - look for indicators of nutritional adequacy or problems - subjective: 24 hr intake - objective: skin quality, mucous membranes, dental, hair, weight - ask about frequency of eating out, home meal preparation, finances, problems with eating, food security, education, time - metabolic demand is variable btw people dependent on level of activity and stress
The Family
interacting individuals related by blood, marriage, cohabitation or adoption - each individual has an expected role/function - family context influences attainment of health behaviors through modeling (diet, activity, hygiene and coping pattern, providing resources, fostering resilience, individualization within family cohesiveness
Community Systems Perspective
interrelated, interacting parts (boundaries) that function via input and output *structure* - systems and subsystems (health agency, school, fire dept, gov bodies) - macrosystem (part of larger system like a state) - exosystem (the microsystems and individual people in the community) - demography study of pop. *function* - the process of dynamic change with adaptation in the system's parts and how community systems and subsystems interact. nursing is part of a subsystem of healthcare - function in the community as advocates for proactive planning, a community liaison for decision making and collaboration to process dynamic change and adaptation
Family Cognitive Perceptual Pattern
language, cognitive skills, perception that influence family activities - how does the family access information about health - how are important decisions made in the family (especially about health) - are they knowledgable about choices/lifestyle, risk factors and developmental milestones (Ex. potty training) - how long do they wake before seeking healthcare - alternative or traditional healthcare use - management of possible visual or hearing problems
Nursing focus on wellness
nursing is focused on wellness and not the presence or absence of disease (medicine). goal of nursing: assist patients to maintain and obtain optimal health *health promotion*: assessment of strengths of patient, not only their deficits. Use strengths to help patient get to optimal health and wellness
Community Health Perception - Health Management Pattern
overall health status (how many are well versus sick), what practices are in place to promote wellness and disease prevention, how do communities perceive health (Ex. substance abuse, STD, unwanted/teen pregnancies) - major health concerns percieved, cultural patterns influencing health practices, are safety programs sufficient *data sources* - key informants: mayor, counselmen, police force (someone to talk for majority) - look at community statistics on morbidity and mortality - public health info from hospotals, state demographic studies, census data (accident statistics, health programs and use rates, drug use/drinking rates, ratio of health professionals/population
sleep/rest pattern
perception of adequacy of individual's sleep and relaxation (most important factor) - may be affected by stress, decreased immune system or unhealthy relationships *assessment* *subjective* - reports of fatigue/energy levels, difficulties they experience when attempting to sleep, interuptions (night terrors) *objective* - look at quality of sleep in a sleep lab *interventions* - counseling, medical referral for pain (cognitive perceptual), bedtime routine (esp for children), relaxation techniques, MEDS NOT FIRST OPTION
Community Activity-Exercise Pattern
physical activities and recreational options within communities *data collection* *observation* - are there gyms, recreational parks for kids, tennis or bball courts - are there joggers and bikers *interviews* - are areas accessable, do they have to drive to get to them, are there green spaces on every block
Family Activity Exercise Pattern
physical activity level, attitudes and beliefs about exercise. - do they set time aside for exercise (type, regularity) - are all members involved and do the kids have a lot of screen time - what leisure activities do they do (trips, park, hiking) - is there a lack of parks preventing them from being active? - are there problems with home maintenence (shopping, cooking, keeping up house, budgeting for costs)
Roles/Relationships Pattern
positions assumed by individual in relationships and the associations engaged in by the individual connected to that position. - vital for health bc we are social beings. Affects the whole person and may manifest in other areas/patterns (sleep, appetite, sexuality) - healthy relationships only possible after self-identity has stabilized *assessment* *subjective data* - perception/satisfaction with relationship, patterns/roles (decision input), family structure, tasks performed/division of labor, social support systems, involvement with neighborhood *objective data* - unavailable unless a home visit is conducted or can observe interactions btw people - loss change and threat produce major problems - assess potential for isolation, impaired communication, dependence, violence, dysfunctional grieving
Planning with the community
prioritize problems, differentiate roles, identify goals and objectives, formalize plans - community nurse interventions should consider health belief models, communicate plans with other professionals and take steps to overcome resistance to change *evaluation* - ask if actions lead to desired outcomes, were goals achieved - continuous process
Community Cognitive Perceptual Pattern
problem solving and decision making within communities - do they set goals for health, are their strategies effective at meeting concerns *assessment* - how do they interact with the environment to support initiatives that promote optimal cognitive or perceptual development (Ex. replacing lead pipes) - are decisions made by a few people or a group of leaders - are residents heard or are they forced to comply - do they feel deceived about health related issues - do businesses and religious groups support health? - are schools seen as good, is adult education available (THIS IS IMPORTANT FOR HAVING BARGAINING SKILLS and negotiation between health services and comm. members - do health-related agencies work together - do most residents speak English - what is the community government structure *data sources* observation: sit on city council meeting to see how decisions get made (teamwork, bargaining, coercion) interviews: see effectiveness of strategies
Nursing Process
systematic approach to reduce or eliminate the individual's health problem *assessment* - systematic technique used to learn as much as possible about the individual. Collecting subjective and objective data (vitals, temperature, questions about experience to gain understanding) *diagnosis* - problem identification. Determine what has caused the actual/potential health problem + contributing ecologic factors. NANDA diagnosis (not medical diagnosis) includes life processes and health promotion. We can act upon the diagnosis without needing a doctor's order *Planning* - collaborates with patient to set goals and create plan of care towards expected outcome or optimal health. Focus on mediating or resolving problem causes - pt goals are basis - assign priority to problems - set times of achievement and expectations for short term and long term results *implementation* - take actions to achieve outcomes and goals in planning phase. Continue collecting data. *evaluation* - analyzing changes experienced by the individual. Analyze relationships between nursing actions and goal achievement. - iterative process: keep evaluating if it is working and change plan if necessary - plans affected by environment, motivation, genetics, relationships, etc.
Gordon's Functional patterns (family assessment)
systems approach with emphasis on developmental stages and risk factors - presence of risk factors predict potential dysfunction - developmental risk increases the whole family's risk (aim interventions to modify influencing factors to promote positive changes)
Family Nutrition Pattern
typical food and fluid consumption - adequate growth and development? - eat meals together, cooking vs fast food, ED, obesity, pregnancy, diabetes - food storage, preparation, purchased, who prepares food, attitude towards food - appetite, dental problems, skin problems - food diary as subjective data assessment (typical food and fluid intake, supplements)
Values-Belief Pattern
values including the individual's spiritual values, beliefs and goals (perceptions of right and wrong) *assessment* - goal is to determine basis for health-related decisions/actions - obtain and verify information about beliefs of self, relationships, society, purpose of life, sources of strength and health expectations - *interventions must be based on value system and health beliefs to be effective and successful* - individual values affect all of the patterns (Ex. latinx hot and cold concept of health impacts nutrition and elimination/dehydration pattern)
Developmental Stage: Couple Family
wife and husband tasks: - adapting to expectations of a partner - establishing mutually satisfying marriage - joint decisions/negotiations - relating to kin network - planning to have or not have children - interventions aimed at integrating good health practices into lifestyle - nurse's role includes family planning and parenting skills support, genetic counseling, sexual counselor, help facilitate interpersonal relationships
Developmental Stage: Childbearing Family
wife/mother, husband/father, infant tasks: - having and adjusting to new roles and responsibilities with infants and supporting needs of all family members - renegotiating marital and extended family relationships (influenced by origin family) risks - insufficient resources, abuse/neglect, immature parents, beliefs about punishment and obedience (support needed from nurse to prevent stress) - nursing roles include monitoring prenatal care, counselor for nutrition, maternal habits, genetic services, breastfeeding, role adjustment, managing limited resources, developmental stimulation, baby engagement, emotional support for amniocenteses and role adjustment, facilitate caregiving and regulatory behaviors, supervise immunizations, refer to social services