My lecture copy
- 1. Advanced Community Health Nursing for Family and Population Topic: Family at Risk Most.Rozina Begom Id: MSN 190506 Major: Community Health Nursing
- 2. Learning out come 1. Identify the vulnerable Families. 2. Understand the families crisis. 3. Helping families cope with crisis. 4. Know the characteristics of families with disturbances in internal dynamics. 5. Strategies for working with multi problem families.
- 3. Vulnerable Families Vulnerable families are families at increased risk because of the intensity and clustering of stressors associated with life event. Examples of families at high risk for future health problems are families with members who are chronically ill or have Down syndrome or alcoholism.
- 4. Vulnerable families Most vulnerable families can be divided into two general types: (1) Families that are experiencing crisis (2) Families with chronic problems.
- 5. CRISIS and STRESSORS A crisis is any event that is going to lead to an unstable and dangerous situation affecting an individual, group, community, or whole society. A stressor is a chemical or biological,agent, environme ntal condition, external stimulus or an event that causes stress to an organism.
- 6. Family crisis Families experiencing crisis: Family crisis is a continuous disruption, disorganization, or incapacitation of the family social system. Families in crisis may have serious disturbances in family organization and require basic changes in family patterns of functioning to restore stability. Crises come in many forms.
- 7. Family Crisis Examples include cheating on one's partner, feeling suicidal, drinking too much (alcoholism), physical and sexual abuse, drug use and divorce. These behaviors are often symptoms of the family's inability to adapt to change and to solve problems. The family may become so disorganized it is unable to overcome the crisis.
- 8. Common stressors in life Examples of life stresses are: The death of a loved one. Divorce. Loss of a job. Increase in financial obligations. Getting married. Moving to a new home. Chronic illness or injury. Emotional problems (depression, anxiety, anger, grief, guilt, low self-esteem)
- 9. Coping mechanisms Coping mechanisms are the strategies people often use in the face of stress and/or trauma to help manage painful or difficult emotions. Coping mechanisms can help people adjust to stressful events while helping them maintain their emotional well- being.
- 10. Types of coping mechanisms
- 11. Nurses responsibilities Nurse’s responsibilities on helping families cope with crisis 1.Start by recognizing sources of family resilience and strength. 2. Offer hope. 3. Help the family identify and describe the nature of the stressors. 4. Explore the family’s appraisal of the situation, including its meaning to members and their judgment of their ability to respond. 5. Provide information about the nature and demands of the stressor that may not be known to the family.
- 12. Nurses responsibilities 6. Help the family divide the tasks required by the stressor into manageable pieces. 7. Help the family explore current and alternative coping mechanisms. 8. Validate and emphasize the use of internal family resources, including personal and family strengths. 9. Pull in external sources of social support. 10. Arrange for tangible sources of external support such as financial assistance, health care, home visitors, support groups, food assistance, and transportation. 11. Encourage a positive reappraisal of the situation as the family moves from adjustment to adaptation to their new state.
- 13. Families with chronic problems Ever since nurses began visiting in the community, they have encountered families that have had chronic problems and many barriers to achieving optimal health. Some of the families have experienced generations of poverty, as well as problems in many areas of functioning such as physical, psychological, and social.
- 14. Cont. Some families experience multiple situational stressors simultaneously (multi problem families). Some families are vulnerable, some are presented with only negative choices, some struggle with poverty, and some have disturbances in internal dynamics.
- 15. Multi problem families A multi problem family has needs in several areas simultaneously: difficulty in achieving developmental tasks, illness or loss, inadequate resources and support, disturbances in internal dynamics, or environmental stressors.
- 16. Families with negative choices Community health nurses assist families in coping with stress by helping them identify their previous coping style, their resources, and their alternatives for action. For some families, however, coping with stress remains a problem even after nursing intervention because the choices for action are all negative (Wilson, 1989). In some instances, none of the available choices will modify the problem, and sometimes the consequences of the choices are all negative and create more problems.
- 17. Families with poverty The impact of poverty, or living in a resource-depleted, hazardous, or hostile environment, is also a factor that affects family coping. The poor, as individuals and as a group, are continually faced with multiple and chronic stressors, including frustration over employment options, inadequate and unsafe housing conditions, repeated exposure to violence and crime, inadequate child care assistance, and insensitive attitudes and responses of health and social service agencies.
- 18. CONT. Poverty also brings its own set of health problems. Increased incidence of communicable diseases, especially tuberculosis and human immunodeficiency virus (HIV) infection; more episodes of illness; less use of preventive care; and higher rates of chronic disease, premature death, occupational hazards, and unsafe housing.
- 19. Families with Disturbances in Internal Dynamics Some multi problem families have disturbances in internal dynamics. Such families are often unable to provide : 1. Security 2. Physical survival 3. Emotional and social functioning 4. Sexual differentiation 5. Training of children 6. Promotion of growth of individual members.
- 20. Issues and strategies for working with multiple problem families: Foster continuity of care Be patient- do not expect instant solutions. Help the family identify its strengths Work on small pieces of problems. Help the family recognize opportunities for moving forward or doing things differently.
- 21. CONT. When all choices are undesirable, help the family cope more positively with the choice that is made. Ensure that all contacts are characterized by caring and respect. Organize possible sources of tangible support. Encourage use of sources of intangible support. Remember that the ultimate goal is empowerment and resilience of the family and development of individual self esteem.
- 22. Students activity Case study: Bela is a housewife her husband is suffering from cancer ,he was the only man who can earn but now he is a chronic patient. They have three children’s. Younger children’s age is only one year . They need money for surviving and meeting the basic needs. In this circumstances she can not bear the treatment cost because of unemployment. Also she feels exhausted and unable to take care of the family member properly. 1. Identify the 5 stressors the families going through? 2. How will you define the family? 3. As a Community Nurse how will you help to cope them with this situation?