Ch.4 Health of the Individual, Family, & Community
How does social support systems affect individual and family health?
A person's social support systems are made up of all the people who help meet financial, personal, physical, and emotional needs. In most instances, family, friends, and neighbors provide the best social support within a community. To understand the social support systems of a community, it is important to know who and what provide support (such as family, neighbors, friends, church, and organizations).
Describe the level of love and belonging.
All humans have a basic need for love and belonging. Love and belonging needs include the understanding and acceptance of others in both giving and receiving love, and the feeling of belonging to groups such as families, peers, friends, a neighborhood, and a community. People who believe that their love and belonging needs are unmet often feel lonely and isolated. They may withdraw physically and emotionally, or they may become overly demanding and critical. Often, these behaviors signal that the person has unmet love and belonging needs. Nurses should always consider love and belonging needs when developing a plan of care. Including family and friends in the care of the patient. Establishing a nurse-patient relationship based on mutual understanding and trust (by demonstrating caring, encouraging communication, and respecting privacy). Referring patients to specific support groups (such as a cancer support group or Alcoholics Anonymous).
Discuss family functions.
Families have important functions that affect how individual family members meet their basic human needs and maintain their health. The family provides the individual with an environment for development and social interactions. Families also are important to society as a whole because they provide new and socialized members for society. Family functions occur in five major areas. Physically, the family provides a safe, comfortable environment necessary for growth, development, and rest or recuperation. Economically, the family provides financial aid to family members and also helps meet society's needs. The reproductive function of many families is to have and raise children. The affective and coping functions of the family provide emotional comfort to family members and help members establish their identity and maintain it in times of stress. Finally, through socialization, the family teaches; transmits beliefs, values, attitudes, and coping mechanisms; provides feedback; and guides problem solving.
Discuss family risk factors.
Family patterns of behavior, the environment in which the family lives, and genetic factors can all place family members at risk for health problems. Nurses should assess these factors before developing nursing care plans. Typical questions in a family assessment include the following: What is the family's structure? What is the family's socioeconomic status? What are family members' cultural background and religious affiliation? Who cares for children if both parents work? What are the family's health practices (e.g., types of foods eaten, meal times, immunizations, bedtime, exercise)? How does the family define health? What habits are present in the family (e.g., do any family members smoke, drink to excess, or use drugs)? How does the family cope with stress? Is any family member the primary caregiver for another family member? Do close friends or family members live nearby and can they help if necessary?
What are other family structures?
In addition to traditional and single-parent families, cohabiting adults and single adults are other family structures. Cohabiting families are individuals who choose to live together for a variety of reasons, including relationships, financial need, or changing values. Cohabiting families include unmarried adults (of any age, including retired people who choose not to marry because it would impose financial hardship) living together, and communal or group marriages. Other family structures include binuclear (where divorced parents assume joint custody of children) and dyadic nuclear (in which the couple chooses not to have children). Single adults may not be living with others, but they are part of a family of origin, usually have a social network with significant others, or may even regard a pet as family. Most single adults living alone are either young adults who achieve independence and enter the workforce or older adults who never married or are left alone after the death of a spouse. With changes in family structure have come other influences on the basic human needs of family members. Considerations for the family, and for nursing care, include support systems (in our mobile society, family members may live hundreds or thousands of miles away), availability of childcare, time for leisure and recreation, struggles to meet financial commitments, and changing role models.
Discuss family in health and illness.
Individuals learn health care activities, health beliefs, and health values in the family. When patients enter the health care system, they bring their own personal behaviors and needs, but they also bring (in a sense) their family too. Friedman and associates (2003) identified the importance of family-centered nursing care in four ways. First, the family is composed of interdependent members who affect one another. If some form of illness occurs in one member, all other members become involved in the illness. Second, because there is a strong relationship between the family and the health status of its members, the role of the family is essential in every level of nursing care. Third, the level of health of the family and in turn each of its members can be significantly improved through health promotion activities. Finally, illness of one family member may suggest the possibility of the same problem in other members. Through assessment and intervention, the nurse can assist in improving the health status of all family members. Illness may precipitate a health crisis in a family. If an illness is relatively minor, such as a viral infection in a child, changes in family tasks may be minor and brief. But if a family member's injury or illness is serious, the roles and responsibilities, as well as functions, of other family members change. This is especially true if the illness is chronic and long term, results in disability, or decreases the person's time to live. Some families find it difficult to adapt to the stress of changes in financial, social, and caregiving resources, whereas other families experience renewed family closeness and stability. Regardless of how the family adapts, members of the family must constantly adjust roles and responsibilities to manage the needs of the ill family member and the family. Nursing interventions for a family in a health crisis include providing teaching that is honest, open, and respectful; using therapeutic communication skills; applying knowledge of family dynamics; and making referrals to community health care and financial resources to support realistic hope. In addition, it is important to involve family members in planning and implementing care.
What are the 5 levels of Maslow's hierarchy of basic human needs?
Level 1. Physiologic needs Level 2. Safety and security Level 3. Love and belonging Level 4. Self-esteem Level 5. Self-actualization
Explain nursing care necessary to meet the needs of the patient for each level of Maslow's hierarchy.
Nurses can apply Maslow's hierarchy of basic needs in the assessment, planning, implementation, and evaluation of patient care. The hierarchy can be used with patients at any age, in all settings where care is provided, and in both health and illness. It helps the nurse identify unmet needs as they become health care needs. The hierarchy of basic needs allows the nurse to locate the patient on the health-illness continuum and to incorporate the human dimensions and health models into meeting needs.
How does economic resources affect individual and family health?
Personal finances and health care insurance coverage affect a person's access to health care services within a community. As private health insurance costs continue to escalate, fewer citizens have it. Many part-time and unskilled jobs provide no insurance benefits at all, resulting in a substantial number of citizens without any financial assistance for health care screenings or care for illnesses.
Describe the level of physiologic needs.
Physiologic needs—for oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest—must be met at least minimally to maintain life. These needs are the most basic in the hierarchy of needs, are the most essential to life and, therefore, have the highest priority. Most healthy children and adults meet their physiologic needs through self-care, but meeting physiologic needs is often a major part of the nursing care plan for young, old, disabled, and ill people who require assistance in meeting them. Oxygen is the most essential of all needs because all body cells require oxygen for survival. Oxygenation of body cells is carried out primarily by the respiratory and cardiovascular systems, and any alteration in their structure or function can result in an increased need for oxygen. This need may be acute (such as when cardiopulmonary resuscitation is needed) or chronic (requiring special positioning, treatments, and teaching). Nurses evaluate patients' oxygen needs by assessing skin color, vital signs, anxiety levels, responses to activity, restlessness, and mental responsiveness. A balance between the intake and elimination of fluids is also essential to life. Healthy people drink fluids to satisfy thirst, and they maintain fluid balance through various physiologic processes. Disruption in the water balance of the body results in either dehydration or edema (the collection of fluid in body tissues). Dehydration results from conditions such as severe diarrhea or vomiting, whereas edema is caused by diseases of the cardiovascular or renal system, trauma, and other factors. Measuring intake and output, testing the resiliency of the skin, checking the condition of the skin and mucous membranes, and weighing the patient help assess a patient's water balance. Food and elimination are related physiologic needs, with a balance maintained through digestive and metabolic processes. The need for food is manifested through hunger. Insufficient nutrient intake results in nutrient and electrolyte imbalances and weight loss. Waste products are eliminated from the body through the skin, lungs, kidneys, and intestines. A patient's nutritional status is assessed with a variety of indicators, including weight, muscle mass, strength, and laboratory values. The human body functions best within a narrow temperature range, usually considered as plus or minus 98.6°F (37°C). Homeostatic mechanisms and adaptive responses, such as sweating or shivering, help maintain this temperature. Nurses assess body temperature as a vital sign. Sexuality is an integral component of each person and may be affected by physical and emotional illnesses. Sexual practices depend on a variety of factors, such as a person's age, sociocultural background, self-esteem, and level of health. Health care practitioners are increasingly aware that consideration of sexuality is a vital part of holistic care. Physical activity and rest are also basic physiologic needs. Physical activity depends on intact and functioning neuromuscular and skeletal systems. Rest and sleep allow time for the body to rejuvenate and be free of stress. Individual requirements for rest and sleep vary widely, but the adverse health effects of deprivation have been well documented. Factors that influence sleep include age, environment, exercise, stress, and drug use.
Describe the level of safety and security.
Safety and security needs come next in priority and have both physical and emotional components. Physical safety and security means being protected from potential or actual harm. Nurses carry out a wide variety of activities to meet patients' physical safety needs, such as the following: Using proper hand hygiene and sterile techniques to prevent infection. Using electrical equipment properly. Administering medications knowledgeably. Skillfully moving and ambulating patients. Teaching parents about household chemicals that are dangerous to children. Emotional safety and security involves trusting others and being free of fear, anxiety, and apprehension. Patients entering the health care system often fear the unknown and may have significant emotional security needs. Nurses can help meet such needs by encouraging spiritual practices that provide strength and support, by allowing as much independent decision making and control as possible, and by carefully explaining new and unfamiliar procedures and treatments.
What aspects of the community affect individual and family health?
Social support systems, community health care structure, economic resources, environmental factors
How does environmental factors affect individual and family health?
The community environment in which a person lives and works can have either helpful or harmful effects on health. The quality of air and water differs across communities. Large urban areas are often affected by air pollution, whereas many smaller communities are at risk for water pollution from run-off of chemical or livestock wastes. There is also increasing concern about how global warming and a growing potential for natural disasters affects health. Environmental barriers to accessing health care within a community may include lack of transportation, distance to services, and location of the services.
How does community health care structure affect individual and family health?
The health care structure of a community directly affects the health of the people living within it. The size and location of the community often determine what services are available. For example, urban residents may have public transportation to a variety of health care providers, whereas rural residents might need to travel long distances on their own for care. County and state funding for community health care services also determines the type and number of available health care institutions and agencies.
Describe the level of self-actualization.
The highest level on the hierarchy of needs is self-actualization needs, which include the need for individuals to reach their full potential through development of their unique capabilities. In general, each lower level of need must be met to some degree before this need can be satisfied. The process of self-actualization continues throughout life. Maslow lists the following qualities that indicate achievement of one's potential: Acceptance of self and others as they are. Focus of interest on problems outside oneself. Ability to be objective. Feelings of happiness and affection for others. Respect for all people. Ability to discriminate between good and evil. Creativity as a guideline for solving problems and pursuing interests. To help meet patients' self-actualization needs, the nurse focuses on the person's strengths and possibilities rather than on problems.
Describe the level of self-esteem.
The next highest priority on the hierarchy is self-esteem needs, which include the need for a person to feel good about oneself, to feel pride and a sense of accomplishment, and to believe that others also respect and appreciate those accomplishments. Positive self-esteem facilitates the person's confidence and independence. Many factors affect self-esteem. When a person's role changes (e.g., through illness or the death of a spouse), self-esteem can be seriously altered because the person's responsibilities and relationships also change. A change in body image, such as the loss of a breast, an injury, or a growth spurt during puberty, may also affect self-esteem. Nurses must remember that the person's perception of the change—rather than the actual change itself—is what affects that individual's self-esteem (see the Research in Nursing box). Nurses can help meet patients' self-esteem needs by respecting their values and beliefs, encouraging patients to set attainable goals, and facilitating support from family or significant others. These actions promote a sense of worth and self-acceptance.
What is a nuclear family?
The nuclear family, also called the traditional family, is composed of two parents and their children. Contemporary descriptions of a nuclear family vary. One of the more contemporary definitions refers to the great variability in family structure as "postmodern families". The parents might be heterosexual or homosexual and are usually either married or in a committed relationship; family members live together until the children leave home as young adults. The nuclear family may be composed of biologic parents and children, adoptive parents and children, surrogate parents and children, or stepparents and children. This family group often lives in close geographic proximity to relatives, such as aunts, uncles, and grandparents, who are a part of the extended family. Couples without children and couples with grown children who no longer live at home are considered nuclear families as well. The blended family is another form of a nuclear family, formed when parents bring unrelated children from previous relationships together to form a new family.In contemporary nuclear families, one or both parents work, while the other or both share roles in providing physical and emotional safety and security. The two major causes of this change are increased education and career opportunities for women and changes in our economy resulting in a need for additional income to maintain a desired standard of living.
Discuss nursing interventions for the family.
The nurse can help reduce risk factors with activities that promote health for all family members at any level of development. Recall that each person has one's own definition of health, based in part on family beliefs and values about health and illness. The nurse assists both the person and the family to meet their basic human needs. Nurses may carry out such activities themselves or may refer the individual or family to other health care providers. Health promotion activities and nursing actions can reduce the risk for illness and facilitate healthy behaviors at any age within the family life cycle.
What is a single parent family?
ingle parents may be separated, divorced, widowed, or never married. Increasing numbers of never-married men and women are choosing to become parents. More than one fourth of all children in North America are now estimated to live in single-parent families. Many single-parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents), becoming remarried or having new relationships. These problems are important considerations when planning and implementing nursing care.