FAMILY ASSESSMENT, EXAM3

Women's Movement

"The problem with no name." *** Betty Friedan described the stifling of women's lives and ambitions by societal expectations. Civil rights movement caused women to question the way things had always been.

What we say may facilitate or hinder communication

"You must be really thrilled with your new family member. He's so cute." VERSUS "A lot of new parents find this transition harder than they expected and have a many different feelings. Everyone is different. How are things going for you?"

Nine Tasks of Childbearing Families

****1. Arrange space for a child, put em in box/basinet. 2. Financing childbearing & childrearing 3. High co-pays & deductibles; raising children if expensive 4. Women often need to deal with career interruptions 5. Men may take on more work to make more $$, which itself causes stress 6. Single and teen parents face more $$ stress****

Wrong motives for adoption (and parenting in general)

***Because everybody is doing it (children should not be a fad) ***To have someone who will love you back (not every child may reciprocate your love & affection) ***Your biological clock is ticking (not good motivation for adoption) ***You want some company (adopt a pet!) Adapted from: Wrong Reason to Adopt http://www.families.com/blog/wrong-reasons-to-adopt Because you feel sorry for the child or want to rescue them (feeling any sense of indebtedness is not fair to a child who did not ask to be where they are) You could really use another person to help out around the house (hire a housekeeping help!) A playmate for your other children (baby-sit or do arrange more play-dates) ***Because children from ______ are so cute (cute is not a good reason to adopt ***If I can't have a child biologically, I guess I'll settle for adoption (adoption is not second best, it's just a different path—and it's not easy) ***Could use some extra $$ (some special needs adoptions provide a subsidy to cover a child's extra care needs but it may not cover all the costs) ***A child will bring my partner and I closer (maybe, but may also cause more tension and less one-on-one time together; not good for a struggling relationship) I'll start the adoption process and hopefully my partner will come around (it takes the full cooperation of both partners to do this, otherwise it is likely to cause great tension in the marriage) ***Love will cure any problem a child may have and I have a lot love to give (no amount of love in this world can help some children, though patience, proper advocacy and empathy can help) I need someone to pass on the family name (Huh?) To have someone to care for you in your old age (children don't always outlive their parents; it's sad to think about this kind of burden being placed on a child) ***You want someone to leave an inheritance to (donate to a worthy charity) You think you'll gain status of sainthood (this is a purely selfish motive) ***A big tax write off (while this is a bonus, your children will cost more than you will get back from your taxes) ***To make me feel complete (you really ought to feel complete before you adopt)

Three kinds of adoption

***Domestic through an agency: Can take from 12 months to 5 years, especially if parents are trying for a white, healthy NB. Process is difficult, emotionally draining, costly, frustrating, and bureaucratic. ***International: Faster; most will be children of color. Little info on family history, prenatal course means adoptive parents run the risk of developmental or behavioral problems ***Private adoption: can range form anonymous to fully open, where the birth mother gets to know the adoptive parents (Think Juno). Adoptive parents may be present at the birth. Adoptive parents risk getting financially burned if the birth mother changes her mind; birth mother can feel pressured by $$ paid for her costs, feel guilty for "selling" her baby. All parties need to consult a lawyer.

What do adoptive parents need form nurses?

***Help them find and use resources, experts on adoption; help with dealing the long, difficult, expensive adoption process Understand their emotional roller coaster; make it OK to express doubts & negative feelings. Provide advice on G&D, getting enough sleep, dealing with crying, feeding, etc. Encourage parenting classes Prepare them for sibling's response ***Strategies to deal with prejudice/comments from others: role play what they will do and say in response

What goes into the decision to bring a child into a family?

***Wishes, hopes, dreams, aspirations Passing on culture and values Quality of relationship among partners; agreement about future family, joint values Feeling ready to take on responsibility Financial consideration: ***rewards vs. cost Whether other ***life goals (education/career) have been met Desire to give other child a sibling Pressure from family & friends

7 Questions for Prospective Adoptive Parents

*What is your motivation for considering adoption? Can you fully love and bond with a child who is not biologically related to you? If you adopt an older child, can you accept the possibility that the child will have health and psychological problems? Will you have the support you need from extended family and friends? Are you willing to help an adopted child integrate her biological and cultural heritage, as far as they're known, into her identity? Do you have the financial resources to adequately care for an adopted child? Does your community have resources available for families with adopted children?

Trauma Informed Care (TIC)

5. Did you often feel that ... You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Yes No If yes enter 1 ________ 6. Were your parents ever separated or divorced? Yes No If yes enter 1 ________ 7. Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife? Yes No If yes enter 1 ________ Nursing strategies: Patient centered communication Understand the health effects of trauma Interprofessional collaboration Understand your own history regarding trauma Perform trauma screening, self report or face to face.

Trauma: Effects on Families

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Adverse Events in Childhood

ABUSE - actually doing something to someone NEGLECT- withholding of affecton , clothes. HOURSEHOLD DYSFUNCTION- DIVORCE tends to happen- it can have a negative impact on the dfamily.

Adoptive mothers

Adoption is just one of the ways by which women become mothers. They have the SAME fears, concerns, needs, emotions as birth mothers, including mixed feelings. Bonding is just and strong & immediate! Nurses should provide similar care &teaching as they give to biological mothers.

Family members' response: disaster

Adults acute response: muscle or abdominal pain; feel helpless, hopeless, spiritual distress, difficulty concentrating and making decisions Older adults response: Similar, also may be angry, depressed, resources drained, difficulty caring for chronic conditions Children's response: use developmental stages in assessment as guide Again, separation is very difficult. After Katrina about 5,000 families were separated for 6 months.

Other Trauma Issues in Nursing(EXAM)

Adverse Childhood Events (ACES) Stunning impact on illnesses later in life. Increase risk for social, emotional and certain conditions (alcoholism, depression, substance abuse, suicide, impaired work)

3. Assuming mutual responsibility for child care & nurturing

Arrival of a child brings ****demands on time & energy, sleep disruptions, additional household tasks Women may be going through this while also dealing with pain, physical recovery from major surgery Nurses are key players in helping them ***learn new parenting tasks; can help them develop realistic plans for sleep, division of work, establishing new priorities

Depression era families

Back early abortion, congress ruking in supreme court - contraceptive prevention is ***pornography. So they made a birth control, 1936- diaphragm and condom

4. Facilitating role learning of family members

Becoming a parent is one of, if not the most, ***dramatic life shift most people ever experience. Nurses can reduce the stress of learning new roles by exploring attitudes & expectations, encourage open communication between partners, teaching skills, putting them in touch with other new parents. **RE INFORCE THE SLEEP

Impact on U.S. families

Challenges: The separation and reunion that occurs; improved communication technology has some positive influence. Loss of a family member Stressors brought on by death, injury, long term disability, long term stress reactions: PEOPLE CAN LIVE LONG NOW THAN BEFORE BECAUSE OF TRAUMATIZE Increase he likelihood of PTSFD Traumatic brain injury; combined with PTSD and depression can be devastating

Trauma and its effect

Common stressors in families experiencing disaster, war and other forms of violence or adverse events. Fear or threat of death or serious injury is usually present. Similar responses due to the trauma: stress, disruption, separation and reunion. Ex. Hurricanes this past three years ago and they have been separation which causes stress. Individual family members didn't have to be present during traumatic event to "experience" it; secondary trauma. EX. Pinful to listen, we cant predict it, and we don't know when it is going to

Women in 1970

Could not get credit in their own names Limited access to professional schools Looked down on if they traveled alone Airlines used sexist slogans to fill planes "Fly me." Were not guaranteed job would be there after maternity leave; employers could ask if woman planned to have children when hiring 1973: Roe vs. Wade strikes down bans on 1st trimester abortion nationwide ***Nursing man- 1 percent Airlines- can get job after maternity leabves

1940s Family

Depression, legalization of birth control led to smaller family size War brought end to the Depression

Nurse's role:Nurse's role:

Enhance communication through use of communication skills, role modeling, posture, Body language Be open, respectful, welcoming Their agenda, not ours: what matters to you? What do you need from me to day? Don't ask loaded questions Allow enough time

The 50s and 60s were not the norm

Established- gets married and not established, social security reasons. see picture

Turn of the century families

FAMILY ON LEFT- wealthier. Healthy FAMILY ON RIGHT-poor, not healthy

Theory guided, evidence-based childbearing nursing

Family Systems Theory Adding a child challenges family stability New subsystems are created in response Disequilibrium exists until the family adapts and re-achieves stability Families with greater flexibility re: role expectations & behaviors have fewer problems Wider range of coping skills & supports =more effective family response External stresses (poverty, demanding job, etc.) make achieving equilibrium harder

Primary Care PTSD Screen https://www.ptsd.va.gov/

In your life, have you ever had any experience that was so frightening, horrible or upsetting that, in the past month you... 1). have had nightmares about it or thought about it when you didn't want to; 2). tried hard not to think about it or went out of your way to avoid situations that reminded you of it? 3). were constantly on guard, watchful or easily startled, 4). felt numb or detached from others, activities, or your surroundings? The screen is positive if the person answers "yes" to three of the questions.

The Pill

Introduced in 1960, available to married women only (and not in all states) until the early 1970s. The ***Pill changed women's lives and society Allowed women to make a commitment to education and a career Altered mores; ***women did not have to sacrifice sexuality or remain unmarried to have a career

Involve Dads and other family members

Invite to prenatal & Peds visits Ask his name and note in chart Say "Sometimes dad are surprised by, worried about, curious about ________" L&D: learn names/relationships of every one in the room Grandma: How have things changed?

Post Traumatic Stress Disorder(PTSD)

Key points, detail in textbook Symptoms must be present for at least a month and cause significant distress, impaired functioning or both Criteria includes; history of trauma, intrusive recollection, avoidant/numbing, hyperarousal, symptom duration, functional impact Study found PTSD as stress reaction in 81% of people who experienced 62 natural disasters Can persist through person's life or re-emerge long after the event Lack of professional follow up over time seems to increase symptoms : NURSE IS TO ASK THEM TO SEEK FOR PROVIDOR Strong relationship to development of physical problems Mental health consequences can be: family violence, substance abuse, problems with family functioning, secondary trauma to other family members; negative impact on parent child relationships LOOK OVER THE DOCUMENT OF THIS FOR EXAM

1980s family life

Late 60- be independent kids, they wanna get up and work at their time.

Teen pregnancy

Leading reason why young women drop out of school ***Less than half graduate from HS ***Only 2% graduate from college ***8 out of 10 relationships with FOB split up; Dad average $800/year in child support Kids born to teen mothers are far more likely to remain poor. Girls are 3x more likely to give birth at teens themselves. Boys are twice as likely to go to prison.

Loss of surrounding community

Loss of access to roads, hospitals, groceries mail, and other essential services. Families who stayed during Katrina compared with those that evacuated showed increased signs of distress i.e., aggression, irritability and increased interpersonal difficulties

Families' experiences: disaster

Loss of significant others, Extensive property loss, Separation from family or injury to self or others Usually get little or no warning Additional stress if family (pets) separated, traumatic

High risk families: Nursing assessment

Member with unidentified and/or untreated PTSD(does not accompanied with war, they tend to have higher rates) THESE ARE THE FACTORS Alcoholism, substance abuse, make likely to be experience Depression Family violence Secondary trauma, someone in family who experience trauma and you experience secondary trauma. 1 in 4 people who commit suicide in the U.S. is a veteran

8. Maintaining family members' motivation & morale

Must learn to cope with new ***demands on time, energy, personal resources, sexual relationship ***Important to address & relive maternal fatigue; linked to postpartum depression The more ***tangible support new parents have from others, the better they do. MANY cultures recognize this and proscribe rest, special diet, assistance from others for weeks after delivery Nurses must teach ways to ***promote rest; SHOW parents how to ***cope with crying; engage them with others; get new Mom to articulate needs to partner,*** make relationship a priority

Role of the nurse

Nurses have an essential role in helping families: Prepare for possible disaster; or in the case of the family member in war, to understand possible emotional/mental after effects To support family during disaster or separation due to war To assist family to recover by providing assessment and resources

Impact on military veterans

One stressor is worrying about family members left behind Anxiety disorders, like PTSD, a response to an extremely disturbing life threatening event Does not happen to all veterans; more to women, national guard members and reservists WHY?: their problem theyre not as close to it. Researchers find that 31% of Vietnam veterans experience PTSD during lifetime(COMPLICATED AS SUPPOSED TO OTHER: They hit their society, massacre, they are not welcome home. AN ISSUE OF DRUG EPIDEMIC IN VIETNAM AND SOME IN USA.

Adjusting to changed communication patterns

Parents must view NB as capable of interaction and learning, and learn how to ***recognize and respond to infant cues, interpret infant behaviors & responses correctly. If this misfires, it can cause major problems ***Demands may strain parent's relationship unless they work hard to keep communication open, sustain their relationship

Tasks of Family Development

Planning for subsequent children 7. Beginning Intergenerational Patterns: ***Expectant parents change from being children of their parents to becoming parents themselves. May signify the ***onset of being an adult for adolescents. Others gain ***status as a result. Also alters relationships with ***other extended family.

Stages of disaster

Prevention, trying to mitigste adamage, doing things, building up levis, Relief, the didsaster hist and recover afterwards, putting life back together again Recovery

Family Development & Life Cycle Theory

Process of predictable development over time, based on unique life circumstances and family interactions Universal sequence, but with wide variations in timing and sequence of phases Addresses ***typical patterns of adaptation to parenthood Explains the ***essential tasks all families need to negotiate to form a healthy unit Nine specific tasks

Impact of TV

Promoted ***consumerism, fed rising expectations ***Reinforced social norms and gender roles, portrayed ideal family as father, stay-at-home mother, several children Despite this, by 1960, about ***40% of married women worked, including some with children

1960s Family

Prosperous and big

What doWhat do teens need from nurses to prevent pregnancies?

Provide ***respectful treatment that meets them where they are. ***Be realistic, open, and accepting about sexuality. Ask about future hopes & plans, help build self-esteem Provide your adolescent patients with confidential, private, and culturally competent services Ask your male and female adolescent patients about their past and current sexual and reproductive history. Counsel teens who are ***not sexually active to wait. Let those who are sexually active know that they can have *** less sex, or decide not to have sex at all. Discuss the skills needed to say "no". Counsel sexually active teens on always using dual methods—such as an IUD, plus a condom—to prevent pregnancy, and STDs including HIV. Help sexually active teens make an informed decision about what contraceptive method is best for them. Counsel them on how to use their contraception correctly and consistently.

9. Establishing family rituals & routines

Rituals are a source of *** comfort to families, and are part of the uniqueness and identity of a family. They help babies & children develop trust and foster family identity. ***Nurses should foster them, and help preserve them during illness.

Families in 2012

Smaller: 3.25 persons per household More likely to be headed by a woman As of 2007, 40.8% of births were to unmarried women 8% decline in birthrate since 2007 Are waiting longer to give birth Families are less wealthy than 10 years ago Economic issues have led to MORE multi-generational families

Dads

Start with something he can relate to Show/praise/point out NB's response to him If family points out resemblance of NB to Dad, go along with it Depends on culture—in some groups, men simply don't care for NBs, change diapers, etc. but may show pride in other ways (buying nice car seat, etc.)

PTSD Reactions of Family Members

Sympathy - may not be welcome Negative feelings "not the person I knew", sometimers they blsme the victim Avoidance - affected one avoid events Depression - lose hope family will "get back to normal" Anger and guilt - family members Health problems - substance abuse Social support - may accept or not

Children as workers

TRANS OF LONGEVITY BEFORE- 19070 - white women whoe doesn't have high school graduates. 1980- divorce, no provided insurance, work the entire adult.-65 medicare-

1950s Family

Teenagers have sex in the back seat of cars

1970-1980

The Bad News, Bad Mood Decade ***Gentlemen is not fair to make women ,,don't step up there, men doing your share.

Families traumatized by war

Very little research on these families The "culture" of war has changed: Used to be clashes between professional soldiers on battlefield, battlefields far from home. More innocent bystanders are being killed; Terrorist attacks in communities

Family Systems Theory

While in the stage of change & readjustment tends to have more ***open boundaries; family needs resources beyond itself. Engaged with more outside systems, including the HC system and nurses Some families are closed or enmeshed and may be suspicious of or hostile to outside influences; nurse may ***need to win trust, but some are not open to nursing care or teaching.

ACES Screen

While you were growing up, during your first 18 years of life: 1. Did a parent or other adult in the household often ... Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid that you might be physically hurt? Yes No If yes enter 1 ________ 2. Did a parent or other adult in the household often ... Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? Yes No If yes enter 1 ________ 3. Did an adult or person at least 5 years older than you ever... Touch or fondle you or have you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex with you? Yes No If yes enter 1 ________ 4. Did you often feel that ... No one in your family loved you or thought you were important or special? or Your family didn't look out for each other, feel close to each other, or support each other? Yes No If yes enter 1 _______ 5. Did you often feel that ... You didn't have enough to eat, had to wear dirty clothes, and had no one to protect you? or Your parents were too drunk or high to take care of you or take you to the doctor if you needed it? Yes No If yes enter 1 ________ 6. Were your parents ever separated or divorced? Yes No If yes enter 1 ________ 7. Was your mother or stepmother: Often pushed, grabbed, slapped, or had something thrown at her? or Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or Ever repeatedly hit over at least a few minutes or threatened with a gun or knife? Yes No If yes enter 1 ________ _ 8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs? Yes No If yes enter 1 ________ 9. Was a household member depressed or mentally ill or did a household member attempt suicide? Yes No If yes enter 1 ________ 10. Did a household member go to prison? Yes No If yes enter 1 ________ Now add up your "Yes" answers: _______ This is your ACE Score

What is behind teen pregnancy?

Young women with*** low self-esteem, poor school performance ***see no future, or see themselves as having few other life options *Desire to have someone to love who will love you back in return Desire to be a better Mom than your own ******Few role models of successful life RT delayed childbearing Lack of knowledge and skills to negotiate sexuality, withstand pressure from others TEACHING- hope, condoms, protection, support

Post War Baby Boom

see picture

Divorce Rates

see pictures

1990s Person: FAMILY

see slide for table