Family Exam 3 -FINAL- Flashcards by Joshua De Jesus

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

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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

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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

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History of Childbearing:

1960 - 1970 (2)

Sedation questioned

↑ expectation of coaches and physicians

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History of Childbearing:

1980 - Present (2)

↑ Family-Centered Care

Birth Centers and Family Contact promoted

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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

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Family Systems Theory:
Focuses on…
2 Major ▲’s

Balance within/outside family
▲ ↑ reception of outside education
▲ ↑ permeability of family boundaries

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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

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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

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Family Systems Theory 3 Boundaries:
Open
Flexible
Closed

Openly u/resource
Selectively u/resource
Ø u/resource or share, keeps issues w/in family

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Transition Points:

5 Shifts

Planned/Unplanned Pregnancy
Infertility
Pregnancy loss
Adoption
Birth

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Transition Points:

Example Normative vs. Non-normative Family child

Normative has developing child

Non-normative has disabled who never leaves home

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Transition Points:

Situational

Personal relationships ▲ with shifts

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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

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Duvall’s Family Development Theory:

The Basic Premise

All members developing/changing and influencing each other at same time, r/in unexpected results.

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Conflicts:

Childbearing -> CB. Family Nursing

Nurse focus from individual women before birth to whole family once birth occurs

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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.

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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

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Adoption:

US compared to International…

US ↑ cost/length (12 mo - 6 years)

International are cheaper but Ø Hx

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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 ▲ ```