Family Exam 3 -FINAL- Flashcards
History of Childbearing:
Late 1800’s: Industrialization (4)
↑ urban living
↑ care outside of home
Child-bearing still at home for middle class
Euro colonists, A.Slaves, Natives were midwives
History of Childbearing:
First Third of 20th Century (4)
Urban livers had births at home
↑ public HP nursing for moms/babies
Child-bearing at hospital
Nurses thought: Family
History of Childbearing:
1930’s through “Baby Boom” in 1950’s (4)
Infection control begins
Dramatic ↑ child-birth at hospitals, ↓ family involvement
Males forbidden w/ women
Nurseries established
History of Childbearing:
1960 - 1970 (2)
Sedation questioned
↑ expectation of coaches and physicians
History of Childbearing:
1980 - Present (2)
↑ Family-Centered Care
Birth Centers and Family Contact promoted
Childbearing: Focuses on... Nurses position... Theories r/t Nurses... Stress and Acute Conditions Effect...
Family relationships and Health
Powerful influence
Improve understanding of care
Disrupt family functioning, development, and structure
Family Systems Theory:
Focuses on…
2 Major ▲’s
Balance within/outside family
▲ ↑ reception of outside education
▲ ↑ permeability of family boundaries
Family Developmental and Life Cycle Theory: Focuses on... How many Tasks...? What are the Tasks? (AFRAPRME)
Family development through childbearing
9, each of which the family will struggle with..
Arranging Space for Child - identify resource/barriers
Financing Childbearing - HARD + HP insurance ↓ last 10 years
Mutual Responsibility of Care - educate/assist attachment
Role Learning - …
Adjusting ▲’d Communication Patterns - promote + comms.
Planning for +Children - consider culture + resource
Re-Aligning Inter-generational Patterns - support friends and activities
Maintaining Motivation/Morale - ↑ coping strats
Establishing Rituals/Routines - consider rituals r/t children
Family Systems Theory 4 Concepts
Concept 1, 2, 3, and 4
- All parts = interconnected
- Whole > sum of parts
- All systems for boundaries
- Systems can be organized into subsystems
Family Systems Theory 3 Boundaries:
Open
Flexible
Closed
Openly u/resource
Selectively u/resource
Ø u/resource or share, keeps issues w/in family
Transition Points:
5 Shifts
Planned/Unplanned Pregnancy Infertility Pregnancy loss Adoption Birth
Transition Points:
Example Normative vs. Non-normative Family child
Normative has developing child
Non-normative has disabled who never leaves home
Transition Points:
Situational
Personal relationships ▲ with shifts
Duvall’s Family Development Theory:
8 Stages and basis
Marriage - adjustment
Childbearing - establishing home
Pre-School - coping w/ energy depletion/Ø privacy
School-Aged - encouraging education
Adolescents - freedom balance
Launching Yadults - maintaining support
Milddle-Aged Parents (empty nest - retirement) - refocusing marriage/keeping ties to future gens
Aging Parents (retirment - death) - coping with death and living alone
Duvall’s Family Development Theory:
The Basic Premise
All members developing/changing and influencing each other at same time, r/in unexpected results.
Conflicts:
Childbearing -> CB. Family Nursing
Nurse focus from individual women before birth to whole family once birth occurs
Conflicts:
Does RN = OB?
Who is client and what is it NOT?
NO!
Family is client and family or context.
It’s not about procedures/medical tx.
Infertility: Numerical Definition. Female Response... Male response... Common S/S...
Ø conception after > 12 months trying
anxiety, depression, hostility - like to talk about it
Disguise feelings - talking ↑ anxiety
anger and tension
Adoption:
US compared to International…
US ↑ cost/length (12 mo - 6 years)
International are cheaper but Ø Hx
Perinatal Loss:
What is it?
Societal Invisibility r/in…?
How do we talk about it…?
Losing child at during pregnancy - birth
↑ frustration b/c Ø time to mourn
In front of partner to include and share
Nursing Focuses during... Perinatal illness Attachment Feeding Family Relationships PostPartum Depression PPD Statistic for mothers/teen mothers
Maintain regular fx
Assess risk/ss of poor attachment
Include fathers and postdischarge clinics
Empahsize+ and family help
Identify and Tx (ARE YOU SAD?!). If yes, refer to MHP.
10% mothers, 48% Teen mothers exp. PPD.
Family-Centered HPCare: Child primary source of support is...? Opening share...? Form...? Respect...? Support...?
The Family Concerns and resource Partnerships between family and HPcare system Culture Strength, growth, and development
Family Career is…?
a Dynamic process of ▲ that occurs during the lifespan of a “family”
Directive vs. Supportive Behaviors
Acting for family (not if they’re available)
Background support to maintain activity (bills).
Discharge planning:
3 Focuses
Physical Care
Family Adjustment to helping ill
Barrier to Care at home
Families: Progressive Accommodating Maintaining Struggling Floundering
“normal” - manages illness and stays +
“compromised” - illness identified and mnged daily
“burdened” - negative and can’t solve
“conflicted” - ↓ agreement, dz consistently in foreground
“mean well” - hope but don’t act to solve
4 Primary Cultural Differences in Definition
Definition of HP
Definition of illness and Dz
Health Practice
Family Fx
Nurse Role w/ Family After Code (3)
Include Family during ICU stay
Avoid separation
Family Presence during Resuscitation = good
SPICES Assessment Tool of Older Adults
Sleep Disorders Poor Nutrition Incontinence Confusion Evidence of Falling Skin Breakdown
FAMILY Assessment Tool of Older Adults
Family Involvement Assistance Needed Member Needs Integration into Care Plan Links to Community support Your Intervention
Frailty Risk is greatest for (AGE+ than)? and increases chance of (EVENT).
85+ years old
Elder Abuse
Mental Disorder Statistics (6)
1 cause of disability in Canada/US
Common w/ Substance Abuse
1/3 Schizos attempt suicide, 15% successful
2/3 MDD attempt suicide, 10 - 15% successful
Experience before 3 yrs/o r/in expression of genes which may otherwise be unexpressed (neglect, smoking/drinking r/in Ønormal development and ADHD)
Early Assessment/Intervention is best.
What is an Aggregate
Community/Group defined by shared characteristics
What is PTSD and what does it do.
4 Key S/S
Substance abuse % for men/women. Sobriety Fx?
Fx on family violence
Painful memories r/in negative consequence Intrusion of thoughts Discussion avoidance Sensory Sensitivity Negative Cognition/Mood
12 - 34% ♂
30 - 59% ♀
Sobriety DOES NOT CURE
↑% poor relationships, substance abuse, and child abuse
Health Promotion Model:
Focuses on…
Interventions based on…
Specific issues to specific populations
Broad levels to meet needs at community level
12 Core Competencies of a Public Health Nurse
CECH IIE GHECE
Communication Epidemiology/BioStats Community Assessment/PLanning Health Promotion/Risk Reduciton Illness/Dz Managment Infomration/HPCare Technology Environmental HP Global HP Human Diversity Ethics/Social Justice Coordination/Management Emergency Preparedness
3 Health Promotion Frameworks
Alma Ata - health promotion, accessibility, public participation, appropriate technology, intersectoral collaboration
Ottawa Charter - personal skills, supportive environments, healthy public policy, strengthen comm. action, reorient health services.
Population Health Promotion - peoples needs
Gerontological Nurse Roles:
Assessment of Risk Factors (4)
Early Interventions (5)
Who is also at risk for Depression?
ADLs, iADLs, Cognition, sensory impairments
Providing aids (glasses), assessing safety (risk for suicide), supporting physical fx, enhancing autonomy, providing encouragment
CareGivers
GeroStats 20% 85 year olds need... 20% of deaths occur where... 25% older adults have... 25% older adults account for... 50% acute care pts are ...
nursing home care occur in nursing homes chronic dz that fx ADLs trauma admissions in EDs > 65 yrs/o
in 2008, 12% of the population was > 65 yrs/o… expected in 2050 to be…?
20%
WHO HAS THE POOREST HEALTH PAST 85 YEARS
HISPANIC PEOPLE LOL
Resistance vs. Noncompliance
reluctant to recover
unresponsive to intervention
Stages of an Interview and Purpose Engagement Assessment Intervention Termination
Establish therapeutic relationship
Problem identification
Core clinical work to incite ▲
Ending relationship and encouraging solving of own problems in future
Purpose of Therapeutic Communication: Build... Ask... Listen... Inform... Give... Invite...
Trust Questions Confirms they've heard on resource, offered/Ø imposed Feedback (feelings) other family to join
Systems Theory says… ▲ in 1 family member…
influences them all!!
Barriers to Optimal End-Of-Life Care... Lack of... Delayed... Exclusion of... Lack of... Moral...
education on nursing programs referral to hospice family members support distress
Good Death vs. Bad Death (5 ea)
S/S managment Clear decision making Preparation Contribution Affirmation
Ø planning ahead Ø closure of affairs ↑ level of burden Ø goodbyes Poor perception of uncontrollable s/s (pain)
Nurse Pracitioners are… (6)
Client Oriented Delivery Oriented Group Oriented Fillers of positions Providers of Primary Care Active in HP policy ▲
