Ch 4: Health of the Individual, Family, and Community
Nursing Interventions
1. Educate your patients 2. Parenting Skills classes/referrals 3. Healthy food choices 4. Increase activity daily 5. After-school programs 6. Adult and child literacy 7. Anger/stress management 8. Communication strategies 9. Discipline approaches
Family Risk Factors
1. Inadequate knowledge of marital roles, contraception, child safety 2. Child maltreatment, alcohol and other drug abuse/misuse 3. Nutritional deficits 4. Low socioeconomic status 5. Dependence on welfare - sometimes 2 generations within same family 6. Conflict between members 7. Poor or inadequate problem-solving strategies 8. Physical inactivity 9. Chronic illness 10. Depression with aging and death of spouse
Family Functions
1. Physical - Provides safe environment for growth/development 2. Economic - Provides financial support for it's membersEmploymentWelfareWIC 3. Reproductive - Having and raising children Biologic parents Adoptive parents Blended/stepchildren Surrogate parents and children 4. Affective and coping - Provides emotional comfort for well-being 5. Socialization -TeachesValues, beliefs, attitudesCoping mechanisms for times of stress/crisisGuides problem solving
Self-Actualization Needs
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
Developmental Stages of Family Family with older adults
Adjust to retirementLoss of spouse
The nurse is prioritizing nursing care for a patient in a long-term care facility. Which examples of nursing interventions help meet physiologic needs? Select all that apply. a. Preventing falls in the facility b. Changing a patient's oxygen tank c. Providing materials for a patient who likes to draw d. Helping a patient eat his dinner e. Facilitating a visit from a spouse f. Referring a patient to a cancer support group.
B & D Physiologic needs—oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest—must be met at least minimally to maintain life. Providing food and oxygen are examples of interventions to meet these needs. Preventing falls helps meet safety and security needs; providing art supplies may help meet self-actualization needs; facilitating visits from loved ones helps meet self-esteem needs; and referring a patient to a support group helps meet love and belonging needs.
The nurse caring for patients postoperatively uses careful hand hygiene and sterile techniques when handling patients. Which of Maslow's basic human needs is being met by this nurse? a. Physiologic b. Safety and security c. Self-esteem d. Love and belonging
B By carrying out careful hand hygiene and using sterile technique, nurses provide safety from infection. An example of a physiologic need is clearing a patient's airway. Self-esteem needs may be met by allowing an older adult to talk about a past career. An example of helping meet a love and belonging need is contacting a hospitalized patient's family to arrange a visit.
A nurse uses Maslow's hierarchy of basic human needs to direct care for patients on an intensive care unit. For which nursing activities is this approach most useful? a. Making accurate nursing diagnoses b. Establishing priorities of care c. Communicating concerns more concisely d. Integrating science into nursing care
B Maslow's hierarchy of basic human needs is useful for establishing priorities of care.
A COUPLE RECENTLY MARRIED. BOTH THE HUSBAND AND THE WIFE HAVE PREVIOUSLY BEEN MARRIED AND HAD TWO CHILDREN. WHAT NAME IS GIVEN TO THIS TYPE OF FAMILY? •Extended Family•Nuclear Family•Blended Family•Cohabitating Family
Blended Family
two single-parent families joined together to form a new family unit
Blended Family
Family Stage: Family with middle-aged adults Risk Factors & Nursing Interventions
Depression Exposure to environmental or work-related health risks, such as sunlight, asbestos, radiation, coal dust, and air or water pollution Blood pressure screenings Screening for chronic illness
Your assessment reveals the physiologic needs of the family are being met because each member is Dressed appropriately for the weather Go to church regularly Have a reliable car Dinner together
Dressed appropriately for the weather
any group of people who live together and depend on one another for physical, emotional, or financial support
Family
Family Stage: Family with adolescents and young adults Risk Factors & Nursing Interventions
Family of origin Family value of aggressiveness Inadequate problem-solving abilities Conflict between family members Physical or sexual abuse Sexually transmitted diseases Accident prevention programs Sex education Mental health programs Screening for chronic illness
Family Stage: Couple and Family with young children Risk Factors & Nursing Interventions
Inadequate knowledge of contraception and family Inadequate knowledge of sexual and marital roles Lack of knowledge about child safety and health Child abuse and neglect First pregnancy before age 16 Family planning clinics Prenatal classes Well-child clinics Vision and hearing screenings Dental health information Parent support groups Safety in the home, daycare, school, neighborhood, and community
Love and Belonging Needs
Including family and friends in the care of the patient Establishing a nurse-patient relationship based on mutual understanding and trust (by demonstrating care, encouraging communication, and respecting privacy) Referring patients to specific support groups (such as a cancer support group or Alcoholics Anonymous)
THE NURSE IS AWARE WHICH PROBLEM MAY OCCUR IN A SINGLE-PARENT FAMILY? SELECT ALL THAT APPLY Lack of knowledge about child safety Increased financial concerns Child abuse and neglect Conflict between family members. Role shifts
Increased Financial Concerns/Role Shifts
Family Stage: Family with older adults Risk Factors & Nursing Interventions
Increasing age with loss of physical function Chronic illness Depression Death of spouse Screening for chronic illness Home safety information Retirement information Pharmacology information
Developmental Stages of Family Family with middle-aged adults
Maintain family tiesPrepare for retirement
Developmental Stages of a Family Couple and Family with children
Mutually satisfying marriagePlan children (or not to have children)Adjust to infantMeet needs of all family membersIncreased cost of family Increased energy of childrenDecreased energy of parentsLoss of privacy
Community Factors affecting health
Number and availability of health care institutions and services Housing codes Police and fire departments Nutritional services for low-income infants, mothers, school-aged children (e.g., lunch programs), and older adults Zoning regulations separating residential and industrial areas Waste disposal services and locations Air and water pollution Food sanitation Health education services and dissemination Employment opportunities Recreational opportunities Violent crimes or drug use
WHICH OF THE FOLLOWING STATEMENTS ACCURATELY DESCRIBES HOW MASLOW'S THEORY CAN BE APPLIED TO NURSING PRACTICE? Nurses can apply this theory to the nursing process. Nurses can identify met needs as health care needs. Nurses cannot use the theory on infants or children. Nurses use the theory for ill, as opposed to healthy, patients.
Nurses can apply this theory to the nursing process.
Self Esteem Need: Make a person feel good about themselves
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.
Developmental Stages of a Family Family and adolescents/young adults
Open communicationMoral and ethical valuesBalance teenagers freedom and responsibilitySupportive home baseStrengthen marriage
SAFETY AND SECURITY NEEDS OF A COMMUNITY
Police•Fire•Streetlights•Speed limits•Lighting of spaces•Crosswalks•Neighborhood watch•Public transportation•Access to health care
SELF ACTUALIZATION OF FAMILY
Positive Developmental Resolution for each member of the family
YOU HAVE SURVEYED THE COMMUNITY ABOUT THE INCREASE IN CAR VERSUS PEDESTRIAN ACCIDENTS. Your interventions will address which of the following? Self Actualization of the community Love and Belonging of the community Physiologic needs of the community Safety and Security of the community
Safety and Security of the community
LOVE AND BELONGING NEEDS OF A COMMUNITY
Schools•Parks/outdoor spaces•Churches•Places of Worship•After school activities
Safety and Security needs nursing examples
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 & Security: 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.
Family Assessment Risk Factors
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?
A nurse performs an assessment of a family consisting of a single mother, a grandmother, and two children. Which interview questions directed to the single mother could the nurse use to assess the affective and coping family function? Select all that apply. a. Who is the person you depend on for emotional support? b. Who is the breadwinner in your family? c. Do you plan on having any more children? d. Who keeps your family together in times of stress? e. What family traditions do you pass on to your children? f. Do you live in an environment that you consider safe?
a, d. The five major areas of family function are physical, economic, reproductive, affective and coping, and socialization. Asking who provides emotional support in times of stress assesses the affective and coping function. Assessing the breadwinner focuses on the economic function. Inquiring about having more children assesses the reproductive function, asking about family traditions assesses the socialization function, and checking the environment assesses the physical function.
A nurse is practicing community-based nursing in a mobile health clinic. What typically is the central focus of this type of nursing care? a. Individual and family health care needs b. Populations within the community c. Local health care facilities d. Families in crisis
a. In contrast to community health nursing, which focuses on populations within a community, community-based nursing is centered on individual and family health care needs. Community-based nurses may help families in crisis and work in health care facilities, but these are not the focus of community-based nursing.
Define family
any group of people who live together and depend on one another for physical, emotional, or financial support
The nurse caring for families in a free health care clinic identifies psychosocial risk factors for altered family health. Which example describes one of these risk factors? a. The family does not have dental care insurance or resources to pay for it. b. Both parents work and leave a 12-year-old child to care for his younger brother. c. Both parents and their children are considered overweight. d. The youngest member of the family has cerebral palsy and needs assistance from community services.
b. Inadequate childcare resources is a psychosocial risk factor. Not having access to dental care and obese family members are lifestyle risk factors. Having a family member with birth defects is a biologic risk factor.
A nurse caring for patients in a long-term care facility uses available resources to help patients achieve Maslow's highest level of needs: self-actualization needs. Which statements accurately describe these needs? Select all that apply. a. Humans are born with a fully developed sense of self-actualization. b. Self-actualization needs are met by depending on others for help. c. The self-actualization process continues throughout life. d. Loneliness and isolation occur when self-actualization needs are unmet. e. A person achieves self-actualization by focusing on problems outside self. f.Self-actualization needs may be met by creatively solving problems.
c, e, f. Self-actualization, or reaching one's full potential, is a process that continues throughout life. A person achieves self-actualization by focusing on problems outside oneself and using creativity as a guideline for solving problems and pursuing interests. Humans are not born with a fully developed sense of self-actualization, and self-actualization needs are not met specifically by depending on others for help. Loneliness and isolation are not always the result of unmet self-actualization needs.
A visiting nurse working in a new community performs a community assessment. What assessment finding is indicative of a healthy community? a. It meets all the needs of its inhabitants b. It has mixed residential and industrial areas c. It offers access to health care services d. It consists of modern housing and condominiums
c. A healthy community offers access to health care services to treat illness and to promote health. A healthy community does not usually meet all the needs of its residents, but should be able to help with health issues such as nutrition, education, recreation, safety, and zoning regulations to separate residential sections from industrial ones. The age of housing is irrelevant as long as residences are maintained properly according to code.
A nurse works with families in crisis at a community mental health care facility. What is the BEST broad definition of a family? a. A father, a mother, and children b. A group whose members are biologically related c. A unit that includes aunterm-2ts, uncles, and cousins d. A group of people who live together and depend on each other for support
d. Although all the responses may be true, the best definition is a group of people who live together and depend on each other for physical, emotional, or financial support.
A nurse working in an "Aging in Place" facility interviews a married couple in their late seventies. Based on Duvall's Developmental Tasks of Families, which developmental task would the nurse assess for this couple? a. Maintenance of a supportive home base b. Strength of the marital relationship c. Ability to cope with loss of energy and privacy d. Adjustment to retirement years
d. The developmental tasks of the family with older adults are to adjust to retirement and possibly to adjust to the loss of a spouse and loss of independent living. Maintaining a supportive home base and strengthening marital relationships are tasks of the family with adolescents and young adults. Coping with loss of energy and privacy is a task of the family with children.
nuclear family and other related people
extended family
Physiologic needs
for oxygen, water, food, elimination, temperature, sexuality, physical activity, and rest—must be met at least minimally to maintain life.
family unit, family of marriage, parenthood, or procreation, and their immediate children
nuclear family
Tips for providing intervention to family in health crisis
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.
LOVE AND BELONGING FOR FAMILY
•Freedom of Expression•Making friends•Playing together•Discipline•Reasonable responsibilities
PHYSIOLOGICAL NEEDS OF A COMMUNITY
•Housing•Shelter•Electricity•Gas•Clean Water•Grocery stores•Good Air quality•Sanitation
SELF ESTEEM NEEDS OF A COMMUNITY
•Institutions of higher education•Sports•Theaters•Museums•Employment opportunities
SELF ACTUALIZATION NEEDS OF A COMMUNITY
•Opportunities for health and well being potential•Members know each other•Members interact within social structures•Members create norms
SELF ESTEEM FOR FAMILY
•Respectful of each member
SAFETY AND SECURITY FOR FAMILY
•Safe haven•Protection from harm•Parenting Classess
THE NURSE PROVIDES THE MOTHER OF A TODDLER WITH THE PHONE NUMBER FOR THE POISON CONTROL CENTER. WHICH LEVEL OF MASLOW'S HIERARCHY OF NEEDS IS THE NURSE ADDRESSING?
•Safety and security needs
PHYSIOLOGIC NEEDS FOR FAMILY
•Shelter•Clothing•Wellness Check-up's•Food•Clean Environment