LEVELS OF CLIENTELE IN CHN 1

Objectives:

1. Assess with the individual and family one’s health

status/competence.
2. Formulate with the client a plan of care to address the
health conditions, needs, problems and issues based on
priorities.
3. Implement safe and quality interventions with the
health needs, problems and issues.
4. Provide health education using selected planning
models to targeted clientele (individuals and families)
INDIVIDUAL AS CLIENT
 1. Individual - an open system composed of subsystem
 a. Atomistic –the basic constituents of an individual, use
concepts of biology w/c in turn refers to essentialism—
behavior—psychological---human behavior is dictated by
experience
 b. Holistic-suprasystems—sociological in nature—social
constructionism—nurture--behavior Sex---a biological concept
(male/female)
 a sociological concept—gender—masculinity or femininity—
based on culture on
 sexual orientation: attracted to opposite sex---heterosexual
same sex ---homosexual both ---bisexual
FAMILY AS A CLIENT

 2. Family - 2 or more individuals who commit to

live together for an extended period of time not
necessarily w/ marital affinity or blood relations
FAMILY

 A unity of interacting persons related by TIES of marriage,

birth or adoption, whose central purpose is to create and
maintain a common culture which promotes the physical,
mental, emotional, and social development of each of his
member (Duvall, 1971).
 Composed of two or more people who are emotionally
involved with each other and live in close geographical
proximity (Friedman, 1981)
8 STAGES OF FAMILY DEVELOPMENT

 Stage 1- Beginning family -Concern: marital &

sexual adjustment, fxnal, communication, adjustment
to roles, pre-natal educ.

 Stage 2- Early Childbearing Family -Concern:

Changing roles, parenting

 tage 3- Families with preschool children -

Concern: Child discipline, childbearing, accidents,
poisoning, CD
8 STAGES OF FAMILY DEVELOPMENT

 Stage 4- Families with school age children -Concern: Balancing

time & energy to meet demands of work, children’s needs & activities,
adults social interests, harmony in marital & in-laws relations.

 Stage 5- Families with teenagers -Concern: Open

communication., continuing intimacy in marital relation, peer
pressure, sex educ.

 Stage 6- Family as Launching Center -Concern: Releasing

children as adults, reestablishing marital dyad, identifying post
parental interest, grandchildren, divorce/ separatx, menopause
8 STAGES OF FAMILY DEVELOPMENT

 Stage 7- Middle-Aged Families -Concern:

Rebuilding marriage & maintaining satisfying
relationship with aging parents children with their
families, retirement plans, health, new career.

 Stage 8 – Aging Family ( retirement & old

age) Concern: Continuous maintenance of family
relations, income changes & living arrangements
physiologic aspects of aging, death of spouse.
TRADITIONAL FAMILY STRUCTURE
 Traditional – composed of a  Reconstituted
father, a mother and their nuclear/Blended –
children made up of family units
 Nuclear – a married couple who join together to form
with children living together a new family structure
in a common household  Single parent family –
 Dyadic nuclear – childless may never be married,
couple separated, divorced, or
 Extended – extended family widowed.
with 3 or more generations
 Single adults- a single
such as aunts, uncles,
cousins, and grandparents person not living with
who may and may not live others. (pet as a family)
with the nuclear family.
NON-TRADITIONAL FAMILY
STRUCTURE
  Voluntary childless nuclear –
Binuclear – co-
parenting and joint a married couple chooses not to
have children
custody family system  Heterosexual – unmarried
in w/c the child is part couple living together
of two nuclear  Commune – household of more
households than one monogamous couple
 Unmarried single – with children, sharing common
facilities
one-parent not married
 Cohabiting – includes those
 Unmarried couple individuals who to choose to live
with children – together for a variety of reasons
usually a common law (gay/lesbian, unmarried adults,
group marriages)
marriage
IMPORTANCE OF FAMILY-CENTERED
NURSING CARE
 The role of the family is essential in every level of nursing care –
there is a strong relationship between the family and the health
status of its members.

 The level of wellness of the family, and in turn each member

can significantly improved through health promotion activities.

 Nursing assessment and interventions must consider the whole

family to be holistic – the family is made up of inter-dependent
members who affect each other. If some form of illness occurs
in one member, all other members become part of the illness.
FAMILY NURSING PROCESS

 “the blueprint of the care that the nurse designs top

systematically minimize or eliminate the identified health
and family nursing problems through explicitly formulated
outcomes of the care and deliberately chosen set”

 A problem solving approach that enables the nurse to

provide care in an organize and scientific manner. It is
applicable to individuals, family and community groups at
any levels of health.
Nursing Assessment Phase

Data collection
- involves gathering of 5 types of data which generate the
categories of health conditions or problems of the family:

• 1) Family structure and characteristics,

• 2) Socio-economic and cultural factors,
• 3) Environmental factors.,
• 4) Health assessment of each member, and
• 5) Value placed on the prevention of disease.
FIRST LEVEL OF ASSESSMENT
1. HEALTH THREAT- conditions conducive to disease, accidents or
failure to realize one’s health potential, healthy people
● Ex. Family hx of illness- hereditary like DM, HPN
■ nutritional problems- eating salty foods
■ personal behavior- smoking, self-medication, sexual practices,
drugs, excessive drinking
■ inherent personality char- short temperedness, short attn span
■ short cross infectx
■ poor home env’t.
■ lack/inadequate immunization
■ hazards- fire, falls, or accidents
FIRST LEVEL OF ASSESSMENT

2. HEALTH DEFICIT-instances of failure in health maintenance (

disease, disability, dev’tl lag) 3 Types:

a. Disease/ illness- URTI, marasmus, scabies, edema

b. Disabilities- blindness, polio, colorblindness, deafness
c. Developmental Problems like mental retardatx, gigantism,
hormonal, dwarfism
FIRST LEVEL OF ASSESSMENT

3. STRESS POINTS/ FORESEEABLE CRISIS SITUATIONS -

anticipated periods of unusual demand on individual or family
in terms of adjustment or family resources ( nature situations)
● Ex. Entrance in school
■ adolescents (circumcision, menarche, puberty
■ courtship (falling in love, breaking up)
■ marriage, pregnancy, abortion, puerperium
■ death, unemployment, transfer or relocation,
graduation, board exam
SECOND LEVEL ASSESSMENT
(FAMILY TASKS INVOLVED)
Family tasks that can’t be performed
■ Recognition of the problem
■ Decision on appropriate health action
■ Care to affected family member
■ Provision of healthy home environment
■ Utilization of comm. resources for health care
FAMILY HEALTH NURSING DIAGNOSIS

 Combination of health problems and health

Ex. Inability of the family to recognize the health threats of

a poor home environment r/t knowledge deficit
PROBLEM PRIORITIZATION
CRITERIA SCALE WEIGHT
Nature of the problem
Health deficit
Health threat Foreseeable crisis 3 1 pt
2
1
Preventive potential (ability)
High
Moderate 3
Low 2 1 pt
1
Modifiability Easily
Modifiable 2
Partially modifiable 1 2 pts
Not modifiable 0
Salience
High (serious- immediate action) 2
Moderate (serious not immediate) 1 1 pt
Low (not felt) 0
Ex. A. Inability of the family to recognize the health threats of a
poor home environment r/t knowledge deficit.
B. Inability to provide care to a pregnant member with anemia
as a health deficit r/t knowledge deficit.
Score= add all ( the higher the score, the higher the problem)

 FORMULA: _________given score_______ x weight

THANK YOU!