Community Exposure

ESTABLISHING A GOOD WORKING RELATIONSHIP WITH FAMILIES

LESSON OBJECTIVE:
Using the guide form, establish good working relationships with

families in a community.

INTRODUCTION
Initial attempts to communicate the intention to help and the

nature of the assistance that can be extended to the clients are vital to success in the use of the health process. The Community Health care Nurse (CHN) must first establish good working relationships with his/her clients before he/she can hope to gain their cooperation in educating them on the health process.

DIRECTION
Assess level of accomplishment in establishing a good working relationship with each client family by truthfully filling up the required form. The first one is done for you. Establishing a Working Relationship with the Client Family dela Cruz,Juan Name of Family Head

CRITERIA

CHECK IF DONE (Indicate date) 7/8/04 7/8/04 7/8/04

1. Initiate contact through home visit. 2. Introduce yourself and your agency. 3. Communicate interest in family welfare. 4. Maintain a two-way communication with the family. 5. Show willingness to help with expressed need/s.

7/8/04

7/8/04

CONDUCTING A HOME VISIT

LESSON OBJECTIVE: Using the guide form, perform the duties and responsibilities of a CHN during home visits to 10 families. INTRODUCTION A home visit is a professional face to face contact made by the nurse to the patient or the family to provide necessary health care activities and to further attain an objective of the agency. DIRECTION: Conducting home visits (HV) require accomplishing a specific form. The form below serves as your guide/example. Joseph Santiago Name of Family Head June 22, 2004 Date of Visit

STEPS IN HOME VISIT 1. Greet client or household member and introduce yourself. 2. Explain purpose of home visit. 3.Inquire about health and welfare of client/patient and other family members. Ask about any health-related problems. 4. Place health bag in a convenient place using bag technique. 5. Wash hands, wear apron (PRN) and take out needed articles from bag. 6. Perform physical examination (PE). Administer nursing care. If more than one member has to be health supervised/cared for, start with the well member to avoid transfer of infection. 7. Give necessary health advice or teach basic health care based on clients needs and condition. If patient is weak or is diagnosed with illness during a visit, give health instructions to a responsible well member of the family.

CHECK IF DONE (Indicate date) 6/22/04 6/22/04 6/22/04

6/22/04 6/22/04 6/22/04

6/22/04

8. Wash hands and close bag. 9. Record health status of family members and care administered. 10. Make an appointment for next visit either at the clinic or another home visit.

6/22/04 6/22/04 6/22/04

 Upon earning the familys trust and confidence,

succeeding HVs should include a detailed inspection of household surrounding and a thorough examination of other health problems/concerns.

OTHER MEANS OF CONTACT WITH THE CLIENT/FAMILY

LESSON OBJECTIVE: Using the guide form, perform the duties and responsibilities of a CHN during the clinic visit of 10 clients. INTRODUCTION: Other means of nurse-client contact in CH besides HV include Rural Health Unit (RHU) clinic visits, telephone calls (landline or cellular), school or industrial clinic visits, community meetings or through written messages. Of all these methods, the RHU clinic visits, the school and the industrial clinic visits are the most effective because these involve face to face interaction that helps in accurately determining physical, psychological and educational needs of clients.

DIRECTION:
On your RHU, school or industrial clinic duties, accomplish the following forms for each client. Accomplished form below will serve as your guide
STEPS IN CLINIC VISIT CHECK IF DONE (INITIATE DATE)

Warmly greet and make client feel at ease A. Pre-consultation conference 1. Take medical history and health complaints 2. Take vital signs 3. Perform physical examination 4. Recommend selective laboratory exams, such as stool exam for parasites, urinalysis for sugar, etc., vaginal smear for STD, sputum exam for respiratory infection, and blood smear for Malaria parasite. 5. Record clients findings B. Medical examination 1. Assist client before, during and after examination by the doctor 2. Inform physician of relevant findings gathered on preconference 3. Ensure privacy, safety and comfort of client throughout the procedure 4. Observe confidentiality of exam results

6/22/04 6/22/04 6/22/04 6/22/04 6/22/04 6/22/04

6/22/04 6/22/04 6/22/04 6/22/04 6/22/04 6/22/04

STEPS IN HOME VISIT C.Nursing Intervention 1. 2. Execute doctors orders (i.e., giving oral and injectable medication) Reinforce doctors orders/advice

CHECK IF DONE (INDICATE DATE) 6/22/04 6/22/04 6/22/04 6/22/04

3. Teach the client health measures that are designed to promote and maintain a persons well-being and health such as proper diet, exercise and personal hygiene 4. Seek information regarding health status of other family members (i.e., immunization status, health problems of elderly, spouse, other children) 5. Counseling

6/22/04

6/22/04 6/22/04 6/22/04 6/22/04 6/22/04

D. Post consultation conference 1. 2. 3. Explain findings and needed care or intervention Refer patient/client to another health or health related agency if necessary Make an appointment for next clinic/home visit

CONDUCTING FAMILY HEALTH ASSESMENT

LESSON OBJECTIVE:

Using the family assessment guide forms, students should be able to comprehensively assess 10 families Demographic data Home and home environment details; Health and health practices; and Awareness on community resources and organizations
ASSESMENT PHASE

The family health process involves conducting an initial assessment to determine the presence of any health problem. The assessment phase includes the collection and analysis of relevant factual information regarding the clients current health status, his capacity to solve health problems and his present environment. The following are three sources of data reflecting the family health status: Health status of family members- shows whether there are deviations in the health condition of individual members. Ability and willingness of the family to promote wellness among its membersshows the nature and the extent of the familys performance of specific tasks to meet the physical, social and emotional needs of its members. Family environment- defines the conditions in the home and environment that interfere with the promotion and/or maintenance of the family members health and recovery from illness.

DIRECTION
Within three days, visit and interview 10 families in the community and fill up the family assessment guide forms. The accomplished form below will serve as your guide. FAMILY ASSESSMENT GUIDE
Family name dela Cruz____ Address 24 Calmon st. Bgy. Uno, Sitio Des__

I. Demographic Data Household No.: 1 Barangay House NO.: 1 II. Family Data Length of residency: one year Place of origin: Husband- Cebu Wife- Manila Family size: 5 Religion: Husband- Roman Catholic Wife- Roman Catholic

Family Memberss Chart

FAMILY MEMBERS AGE SEX CIVIL STATUS POSITIO RELATIO EDUCATI OCCUPATI N IN THE NSHIP ONAL ON FAMILY TO ATTAINM FAMILY ENT HEAD Head High Carpenter School level Mother Wife High Housekee School per level Son Eldest Grade1 Student child Daughter Second child Nursery Student

1. Jose

24

1. Juana

23

1. Jose Jr.

1. Jane

1. Jeena

1.8mo

Daughter Youngest child

Family Characteristics
Type of Family Structure A. Extended B. Nuclear C. Matriarchal D. Patriarchal E. Dominant Family Member

General Family Relationship/ Dynamics

CRITERIA STATUS ADDITIONAL INFORMATION Wife beating, frequent quarrelling, child abuses Talks disrespectfully Observable between members Characteristics communication conflicts family of (+)

(-)

Interaction patterns among members

(+)

Hurling insults and swearing noted when talking to each other

FAMILY DIETARY HABITS

What did you eat yesterday? (24 hours dietary recall) Breakfast: pandesal, kape Lunch: kanin, instant noodle, saging Supper: kanin, pritong isda, talbos ng kamote
Monthly Family Income Source Husband: Wife: Others:

Monthly Family Income Total (check bracket) Below P5,000.00 Above P5,000.00- 10,000.00 Above P10,000.00-15,000.00 Above P15,000.00-20,000.00 Above P20,000.00-30,000.00 Above P30,000.00-40,000.00 Above P40,000.00-50,000.00 More than P50,000.00

Family Health Status/Health History Father: normal Mother: pregnant, 6 months Children: Jose, Jr- scabies, cough and cold Jana- first degree malnourished, scabies Jeena- second degree malnourished, scabies Felt Family Needs (Identify and rank according to priority) 1. Dagdag na kita 5. Gamut sa ubo at sipon 2. Wastong tapunan ng basura 6. Gamut sa galis 3. Kawalan ng tubig 7. Kawalan ng sapat at masustansiyang pagkain 4. Kawalan ng kubeta 8. Pagbubuntis ni Juana

IV. Home and Environment

A. Is your lot owned? Yes B. Is your house owned? Yes C. Type of housing materials Wood Concrete No No

mixed
makeshift Other, specify (No)

D. Is the living space adequate? (Yes) E. What are the appliances owned by the family? Radio, kerosene stove, plantsa F. Type of garbage disposal Collected burning Waste segregation burying Feeding to animals throw in the river/sewer Open dumping others, specify

G. Type of waste disposal flush wrap and throw

water-sealed

pit privy
others, specify

H. Type of drainage system I. Source of water supply owned bought

Open

Close

shared others, specify

nakiki-igib (deep well)

J. Drinking water storage refrigerated uncovered K. Containers used Plastic pitchers bottles

covered

jars, clay pots others, specify

pails

L. Food storage/cooking facilities covered refrigerator

uncovered cabinet

stove pots/pans, etc.

M. Common household pests found at home Ipis, daga, chicken

N. Are there breeding sites of insects, rodents, etc. present? (Yes) (No) O. Pets/animals kept in the yard/home Dog, cat, Chicken

P. Are there accident hazards present?

(Yes)

(No)

V. Health and health practices

A. Common illnesses encountered for the last 6 months and the treatment applied.

Scabies- dahon ng bayabas

cough/cold- kalamansi, tsaa

B. Whom do you consult for health-related problems?

manghihilot midwife doctor Barangay Health Worker

albularyo nurse Health Center Others, specify

C. For problems other than health, whom do you consult?

family members Friends Priest relatives Barangay officials others, specify

D. Immunization status of family members All children not yet vaccinated

E. Have you had adequate?

1. Rest and sleep? 2. Exercise? 3. Relaxation activities? 4. Stress management activities? (Yes) (Yes) (Yes) (Yes) (No) (No) (No) (No)

VI. Environment
1. Kind of neighborhood Poor rural

2. Social and health facilities

Bgy. Center, Plaza

3. Communication and transportation facilities

Tricycle

A. Are you aware of existing organizations in the community?

VII. Awareness of community organization

(Yes) (No) B. Name all the organization/s you know. Samahang Magkakapitbahay C. Are you a member of any of these organizations? (Yes) (No) D. Are you aware of its activities and projects? (Yes) (No) E. How are you involved in its activities? Attend meetings give donations planning evaluation implementation others, specify not involved F. Name 5 formal and nonf ormal leaders of the community whom you think can lead the people. 1. Mang Elis (albularyo) 2. Mrs. Cruz 3. Tony 4. Kapitan 5. Kapitana

IDENTIFYING FAMILY HEALTH PROBLEMS

LESSON OBJECTIVES: Using the forms for identifying and ranking health problems, students should be able to: 1. List down the health problems recognized in each family; 2. Categorize each health problem into health threat; health deficit or foreseeable crisis; 3. Prioritize health problems according to nature, modifiability, preventive potential; and salience to the family 4. Justify the scores given to each problem, and 5. Rank health problems according to priorities
After collecting the data, these will be analyzed, sorted out and grouped. The synthesized information will be compared to the norm to determine the nature and source of the data gathered. From the inference made, conclusions are formed. Hence, diagnoses are formulated and priorities set.

FACTORS AFFECTING PRIORITY STATUS

Greater weight is assigned to health deficit over health threat because the former usually demands more immediate intervention than the latter. On the other hand, foreseeable crisis is given the least attention because culturelinked factors usually provide adequate support to cope with developmental/situational crises. The community health manager must consider the some important factors in defining modifiability of a health problem- or probability of success in minimizing, alleviating, or totally eradicating the problem through health intervention. These are:

1. Current knowledge, technology and intervention to manage the problem

2. Resources of the family (physical, financial and man power) 3. Resources of the community (facilities and community organizations) 4. Resources of the community health manager ( knowledge, skill and time)

To decide to an appropriate score for the preventive potential of the health problem- or the nature and magnitude of future problems that can be minimized or prevented if intervention is done, the following factors are considered: 1. Severity of the problem- the more severe or advanced the problem, the lower the preventive potential. 2. Duration of the problem- the longer the problem has existed, the lower the preventive potential. 3. Current management- application of appropriate intervention increases the problems preventive potential. To determine the salience score, evaluate the familys perception and evaluation of the problem in terms of seriousness and urgency of attention is needed. The familys concern and felt needs require priority attention. After the score for each criterion has been finalized, the sum of all scores is determined. The highest possible total score is 5. Priority problems are those with scores nearer 5. The higher the score of a problem, the higher its rank.

LISTING AND CATEGORIZING HEALTH PROBLEMS

DIRECTION: Within 2 days, list down the health problems recognized in each of the 10 families you have visited and interviewed. Compute the score of each problem, justify scores given and rank problems according to priority. The accomplished form below serves as an example. Example: Student Name:

Family No: 1 Name of family Head: Juan dela Cruz Address: 24 Catmon St., Bgy. Uno, Sitio Dos List of Health Problems 1. Cough and cold of Jose, Jr 2. Scabies of Jeena 3. Malnutrition of Jana 4. No potable water 5. Poor environmental sanitation 6. Family conflicts 7. Pregnancy of Juana

Nature of Problem health deficit health deficit health deficit health threat health threat health threat foreseeable crisis

COMPUTING AND JUSTIFYING SCORES OF HEALTH PROBLEMS

Direction: Encircle the actual standard scores & the scores that apply to the familys problems. Justify the scores you gave in the indicated column. Compute for the sum of all the actual scores you have encircled & write them on the space provided. See the example below. Example: Family No.1

Problem: coughs and colds

1. Nature of the problem Health Deficit Health Threat Foreseeable Crisis Removable Partially Modifiable Not modifiable 3/ 2 1 2 1/ 0 1 1/ 2/3 1/3 2 1 0 It is a health deficit

2. Modifiability of the problem

The family & the community has the necessary resources to treat coughs & colds.

3. Preventive Potential

High Moderate Low

3 2 1

1/ 2/3 1/3

4. Salience of the Problem

Needs immediate attention Does not need immediate attention Not a problem

2/ 1 0

1/ 1/2 0

Possibility of transferring infection to other members of the family is high & should therefore be given immediate attention. Mother knows ways of treating coughs & colds & has used herbal medicines. Although there is a possibility of transferring infection to other family members, the infection is not life-threatening

TOTAL SCORE:

Ranking Health Problems According to Priority

Direction: Rank the health Problems of each family. Priority 1 has the highest score, Priority 2 has the second highest, priority 3, the next highest, and so on. The first one has been done for you. Example:

Ranking Health Problems of Family dela Cruz

PRIORITY 1 2 3 4 5 PROBLEM Cough & cold Scabies Malnutrition No PWS Pregnancy of Juana SCORE 4 4 3 2 1

DETERMINING PRIORITIES & HIGH RISK GROUPS

Objectives: Students should be able to list down the top three priority health problems of each family interviewed and; Identify families belonging to high risk groups in the community.
RANKING HEALTH PROBLEMS OF FAMILIES IN THE BARANGAY

Direction: Within one day, list down according to priority the top three health problems of each of the families using the form provided. Then determine which families belong to which high risk group in the community.

Ranking Health Problems of Families in Barangay Uno, Sitio Dos

PRIORITY 1 1 2 3 4 5 6 7 8 9 10 FAMILY NAME Dela Cruz Santos Dacanay Rodolfo Antonio Chan De Leon Balano Ramos Lazaro PROBLEMS Cough & cold Primary complex Scabies Tuberculosis Pneumonia Asthma Third degree malnutrition scabies Second degree malnutrition tuberculosis SCORE 4 5 5 4 3 4 5 5 5 5

FAMILY HEALTH CARE PLANNING

IDENTIFYING PRIORITY FAMILIES FOR FOLLOW-UP

Scope: Identify Priority Families for Follow-up Determining Family Nursing Problems Preparing Health Care Plans for Priority Families Working Out Details of the Plan Together with the Families Concerned

IDENTIFYING PRIORITY FAMILIES FOR FOLLOW-UP LEVELS OF FAMILY FUNCTIONING ACCORDING TO JANE ANTILLA TAPIA

1. Infancy or chaotic Family (dysfunctional)- This level is characterized by disorganization. The family can barely meet its physiological needs, as well as the need for security & safety. 2. Childhood or Intermediate Family (dysfunctional)- is characterized by somewhat lesser amount of disorganization than the first level family. Members are only slightly able to meet their need for security &physical survival.

3. Adolescent or Family with Problems- is an essentially normal family but has more than the healthy & usual amount of conflicts & problems. As a unit, it is more capable of physical survival & of providing security for its members. The members may not be able to control their words & actions, thus they may be branded as troublemakers.
4. Adulthood or family with Solution (functional)- refers to a normal, stable, happy & healthy family with fewer than the usual number of problems or conflicts because family members are able to handle most of them. 5. Maturity or Ideal Family (functional)- the family described as homeostatic with a healthy balance of individual & group goal activities & concerns.

PRIORITY FAMILIES IN BARANGAY ___

Uno________

Family name

Level of Functioning

Justification

1. Santos

Infancy

2. Dacanay

Infancy

3. Rodolfo

Childhood

Presence of scabies, cough & cold, inadequate housing & clothing, hygiene, child abuse, wife beating & lack of other basic needs Distrusts outsiders, neglects child, refuses health care, parents are immature & socially deviant Inadequate housing, alcoholic father, poor hygiene, malnourished children

4. Antonio

Adolescent

One child currently with pneumonia, father lost his job but mother was able to seek help from relatives & the local government

5. Chan

Childhood

Asthmatic & malnourished children, unemployed parents quarrelling incessantly, eldest child working as a domestic helper

DETERMINING FAMILY NURSING PROBLEMS

Direction: Within the day determine the root cause of the priority families health problems as well as their family nursing problems. Example: Family Name ___dela Cruz___
Health Problems 1. Colds & persistent coughs as health deficits

Family Nursing Problems First Level Assessment Second Level Assessment

1. Inability to recognize the existence of a problem 2. Inability to make decisions with respect to taking appropriate health actions 1. Inability to recognize the existence of a problem due to ignorance of facts. 2. Inability to make decisions with respect to taking appropriate health actions due to: a. Failure to comprehend the nature, magnitude or scope of the problem b. Lack of knowledge as to alternative courses of action open to them

2.Scabies

1. Inability to recognize the existence of a problem 2. Inability to provide home environment which is conducive to health maintenance & development 3. Failure to utilize community resources for health care

1. Inability to recognize the existence of a problem due to ignorance of facts. 2. Inability to provide a home environment that is conducive to health maintenance & development due to: a. Inadequate family resources b. Ignorance of preventive measures 3. Failure to utilize community resources for health care due to: a. Lack of appropriate information b. Negative attitude (hiya)

3.Poor Environmental Sanitation a. inadequate potable water supply b. inappropriate waste disposal method c. presence of breeding area for insects & rodents

Inability to provide a home environment that is conducive to health maintenance & personal development

Inability to provide a home environment that is conducive to health maintenance & personal development due to: a. Inadequate family resources (financial, inadequacy,& lack of space to construct facility) b. Ignorance of the importance of hygiene & sanitation c. Ignorance of preventive measures

PREPARING FAMILY HEALTH CARE PLANS FOR PRIORITY FAMILIES

A plan of intervention is designed-up on completion of the

assessment, & the analysis & health diagnosis of the family. The purpose of the plan is to elicit behavioral change in the family that will promote dysfunction. The family is expected to be an active participant in the planning process.

STEPS: 1. Determining the order of priority of existing or potential problems. 2. Identifying problems that can be handled by the community health nurse & the family, & those that may be referred to others for assistance. 3. Setting goals & objectives to resolve the problems 4. Predicting actions & expected outcome.

Direction: Within three to five days, prepare, together with the families concerned, family health care plans for the priority 3 families you have assessed.
HEALTH PROBLEMS Cough & colds FAMILY NURSING PROBLEMS GOALS OBJECTIVES

INTERVENTION METHODS 1.Discuss with the family members the importance of knowing the necessary information about the diseases to prevent spreading them. 2. Provide adequate knowledge on the various ways of maintaining cleanliness in their surroundings. 3. Explain the importance of proper food preparation, exercise & rest in strengthening

METHODS OF NURSING FAMILY CONTACT

RESOURCES REQUIRED

EVALUATION

1.Inability to recognize the existence of a problem due to ignorance of facts. 2.Inability to make decisions with respect to taking appropriate health actions due to: a.Failure to comprehend the nature, magnitude or scope of the problem. b.Lack of knowledge as to alternative courses of action open to them.

After nursing intervention, the following are expected to take place: 1.The chances of spreading communicab le diseases to other family members will be slim 2. The recurrence of coughs & colds among family members will be prevented or minimized

After nursing intervention, the following should be achieved: 1.The family should acquire information about the disease, including signs & symptoms of the disease, immediate health care assistance,& preventive measures. 2.Discuss with the family the consequences of failing to take appropriate health action at

Home Visit Clinical Visit

a.Visual aids b. Time & effort of both the nurse & the family c. Monetary allowance for nurses transport ation expenses

CRITERIA: Cured cough STANDARD : In 3-4 visits, cough will be cured through family care.

the earliest possible time. These include the following: a. covering the mouth when sneezing or coughing. b. properly disposing of oral & nasal discharges. c. eating a wellbalanced diet composed of economica l but nutritious foods. d. maintainin

ones resistance against illness. 4. Provide informatio n on Health centers in the vicinity for immediate health care assistance

Environmental Sanitation a.Inadequate safe water supply b.Improper waste disposal c.Presence of breeding area for insects& rodents

Inability to provide a home environme nt that is conducive to maintaining health & personal developme nt due to: a.Inadequa te family resources (financial, lack of space to construct facility) b.Ignorance on the importance of hygiene & sanitation c. lack of knowledge regarding preventive measures

After nursing intervention, the family will take the necessary action to improve & maintain the sanitation of their immediate surroundings.

After nursing intervention, the family will take the necessary action to improve & maintain the sanitation of their immediate surroundings. 1.The family should know the importance of clean potable water supply & proper waste disposal; 2. Boil drinking water; 3.Throw waste materials properly or use the digburn method;

1.Discuss with the family the importan ce of environm ental sanitatio n to their health. 2. Utilize health measures involving the manipula tion or eliminati on of the following threats:

Home Visit

a.Low cost medical supplies to manage/treat scabies b.Time & effort of the nurse & the family c. Budget for buying materials

CRITERIA: 1.Cleanliness of house & surroundings 2.Construction of sanitary toilet/drainage 3.Use PWS

STANDARD: After 3-5 vitis, the above criteria will be met by the family.

4.Clean surroundin gs to eliminate breeding places of pests; and 3. Take a bath once or twice a day.

a. physical threats to health are eliminated by improving on the facilities in the home either by constructing needed ones or by modifying those already existing. b. psychological threats are manipulated by working closely with the family to improve communicati on, role assumptions & relationships, & interaction

3. Explore

with the family the ways of improving home sanitation considering its limited resources. a. Emphasize to the family the advantages of proper garbage disposal. b. Instruct all family members to prevent accumulatio n of stagnant water around their home since this is a good breeding

Scabies as a Health Deficit

1.Inability to recognize the presence of the problem due to ignorance of facts 2.Inability to provide home that is conducive to maintaining health maintenance& personal development due to: a.Inadequate family resources. b.Lack of information regarding preventive measures. 3.Failure to utilize community resources for health care due to: a.lack of appropriate information. b.negative attitude (hiya)

After nursing intervention, the parents will manage care of the children with scabies.

After nursing intervention, the family members will accomplish the following: 1.Become aware & knowledgeable of the presence of health problems among family members; 2.Be cognizant of the nature & the extent of the illness; 3.Implement the agreed upon health measures in preventing the recurrence of illness by improving personal hygiene & home sanitation despite l4.Be adept in providing in providing nursing care to family members at home.limited resources;

Help family members understan d the nature of the present health problem by intensively explaining & discussing with the family members.

Home Visit

a.Time & effort of both the nurse & the family b. Monetary allowance for nurses transportati on expenses.

CRITERIA: Knowledge on caring for scabies STANDARD: In 2-3 visits, the mother will demonstrate how to care for a child with scabies wounds.

WORKING OUT DETAILS OF THE PLAN TOGETHER WITH THE FAMILIES CONCERNED
Signing a family health-worker contract increases the chances of

developing the familys confidence & ability to give health care to its members. This provides a systematic method of increasing desirable client behavior by rewarding appropriate behavior or task successfully performed. The contract specifies the activity or behavior required & the corresponding rewards in exchange for performing the desired behavior/action.
Direction: Within three to five days, prepare, together with the

families concerned, family-health worker contracts for the Priority families you have assessed.

Name of the Family: _______dela Cruz___________________

FAMILY-HEALTH WORKER CONTRACT We,dela Cruz Family & Mrs.Halilis will increase Janas weight by three kilos within two months by following diet planned & recording food eaten with the aide of food supplements, health information materials & free vitamin syrup.

Fathers Signature __________________________________ Mothers Signature __________________________________ Signature of Other Siblings __________________________________ __________________________________ CNHS Siganture Date ________Julietta Halilis_______________ _________January 24,2000___________________

FAMILY CARE IMPLEMENTATION

Scope: This module consists of the following lessons:

Health Education/Teaching (Demonstration/Return Demonstration)

Visual Aids Making A Referral/Conduction Home Health Care Implementation is putting the family health care plan into action. Implementation phase should be flexible. Family health interventions are geared towards assisting the family in carrying out functions that the members cannot perform on their own. It assists the family in improving their chances of becoming independent.

Promoting health & preventing diseases may not be part of the familys life experiences, if this is the case, the health worker must first educate them before any positive behavioral change may be observed.

4 TYPES OF INTERVENTION 1. Increasing knowledge & Skills

Includes assisting families to make informal choices about helpful lifestyles & behavior that will lessen or totally eliminate harmful environmental influences that adversely affect their health. First step involves creating awareness that is achieved by working together with the community health manager to uncover actual or potential problems. Second step, learning to recognize families at risk. Third step, offers families at risk the benefits of knowing how to motivate & support behavioral changes.

2. Increasing family

strengths

Refers to the factors or forces that contribute to family unity & solidarity, and that fosters the development of inherent family potentials. Physical, emotional & spiritual factors Healthy child rearing practices & discipline Meaningful & clear communication

Support security & encouragement

Growth inducing relationships & experiences Responsible community relationships Growth with & through children Self help & acceptance of help Flexibility to family functions & roles Mutual respect for individuality Crisis as a measure for growth Family unity & loyalty & intra-family cooperation

Adaptability of family strength

Assisting functional families simply involves furnishing them with information that can be easily understood & providing them the opportunity to ask questions & clarify information

3. Decreasing exposure to risk

factors

Includes making parental behavior compliment the childs behavior. The childs well being is influenced by the presence or absence of physical

hazards in his/her surroundings. Physical health hazards present in the home should be removed or replaced for the childs benefit. Raising healthy, well-rounded children requires plenty of patience & vigilance.

4. Decreasing susceptibility Means educating the family on the principles of prevention & the disease control. It is expected that family knows which signs & symptoms need medical attention & how to take care of minor illnesses. Family perception of health risks & their susceptibility will determine how they change their behavior. Health workers who introduce threat as a motivator to action are morally obligated to reduce the threat through meaningful & purposeful interventions.

HEALTH EDUCATION/TEACHING (Demonstration/Return Demonstration)

A major part of the implementation phase is aimed towards developing the familys ability to take care of itself through competency-based teaching
Competencies may fall under knowledge, skills, attitudes, emotions, or values. Competency-based health education is an activity that provides information, promotes skills & enhances communication

It facilitates behavior change for the improvement of the familys health condition.
Health care needs & problems of individuals & families, as well as the promotion of health & prevention of illness, dictate the contents & coverage of health education.

Direction: In five days, review Community management 1 module; then plan & conduct health teaching sessions with family clients & evaluate client learning. Paste pictures documenting health teaching being done. Indicate date & name of client & have it signed below by immediate supervisor.
A mother signs a Family health Contract Health education rendered to families Conducting

health education with families (name supervisor)/sgd. (signature of immediate supervisor)

of

immediate

VISUAL AIDS PREPARATION

Illustrations such as drawings or pictures are essential in health education

because they provide the visual representation of the concepts presented. Visual aids facilitate effective learning as long as they are used as intended Improper use or insufficient visual aids may lead to confusion or misinformation. Various types of visual aids include photographs, drawings, cartoons, crosssections, flow charts 1. Clients must first learn how to interpret the visual aids presented to them 2. Be careful to explain the scale of the pictures 3. Test the client comprehension of the illustrations you presented 4. Keep your illustrations apt & simple 5. Layout is very important
Direction: In the space provided, paste self-cared visual aids for the health teaching on the following topics: 1.Wound care 2. Sanitation 3. Caring for an ill family member 4. Caring for a pregnant mother 5. Caring for a baby

MAKING A REFERRAL/CONDUCTION
Direction: Prepare at least three copies of client referral forms for other health personnel or agencies.
REFERRAL SLIP

Name of Agency to which referral is made _____________________________________________ Address_______________________________ Date______________________ Name of Patient/Family Head_________________________________ Age_____________ Civil Status ______________________________ Occupation_____________________________ Address ______________________________________________________________________ Case Summary _________________________________________________________________ Reasons for Referral/Services Requested______________________________________________

Referring Personnel & Designation ____________________________ Name of referring Agency_______________________________________________________________ Address__________________________________________________ Name of Patient/ family

Head____________________________________________________________
Age __________ Sex _____________

Occupation_______________________________________ Services made/ Findings/ Recommendations_______________________________________________ ________________________ Signature & Designation

HOME HEALTH CARE

Direction: Document yourself and/or any member of your client family while dispensing home health care using the processes enumerated below. Paste these in the spaces provided & write the appropriate captions for the pictures. a. Bag technique b. Thermometer technique c. Wound care d. Isolation technique e. Home delivery

FAMILY HEALTH CARE EVALUATION

The following functioning areas determine the efficacy of the health intervention implemented:
1. Changes in interaction pattern 2. Effective communication/ability to clearly express emotions 3. Acquisition and effective use of new skills that promote health 4. Problem solving ability The criteria for the desired outcome are the basis for evaluation. Once the goals and objectives are reached, the problem no longer exists. If goals and objectives are not achieved, the family and the health worker must review the process to determine if there were gaps in the assessment data, errors in analysis or diagnosis and alternative interventions that might be reviewed to determine the contributing factors that led to the failure of the health intervention employed. Direction: after reviewing the Lesson 2.2 of the module in Family Assessment, evaluate together with the families concerned the health care interventions executed to solve priority family health problems of chosen clients.

Evaluation ___dela Cruz Family______ CRITERION __ability of the family to care for the sick son who has coughs and colds_ Which can be tested through____________________________________________________ STANDARD _family members will answer questions & demonstrate skills that will reflect ____ __degree of knowledge on the nature of the disease, caring for the afflicted member _and preventing illness. Which was demonstrated as On three consecutive visits to the dele Cruz home after undergoing health teaching, Mrs. Dela Cruz successfully (1) gave steam inhalation to her sick son using resources available in their home; (2) demonstrated back tapping, which loosens phlegm; (3) administered the herbal concoction (SLK syrup) made with the CHM, which produced good results; (4) coughing lessened phlegm and breathing became easier. No more rales were found up on auscultation; (5) the eldest daughter helped in caring for the son. She gave him food and frequent sips of fluids; and (6) upon asking the questions Bakit ba nagkakaubo ang tao? Paano ba maiiwasang magkasakit ang bata? At paano ba madaling gagaling ang ubo?, Mrs. Dela Cruz, the eldest daughter and even the boy gave the correct responses. Three days later, the boy had (7) recovered from the illness; and (8) Mrs. Dela Cruz was able to come to the center for her prenatal check-up. Signed: _____Juana dela Cruz______ Family Member ___Dawn Rose Malilio__ Health Worker

SELF-EVALUATION
Is assessment of ones own performance.

It provides a greater sense of responsibility & ultimately

saves time. In self-assessment, the community health manager needs a clear understanding regarding the standards to use & an accurate idea of the task he/she can compare his/her work with to determine his/her level of performance. Direction: Rate your performance in home health care visits using the form.

FAMILY HEALTH CARE EVALUATION FORM Sa pagdalaw ko sa Pamilya _______dela Cruz______ (Pangalan ng Pamilya)
Mga batayan (lagyan ng tsek ang angkop na sagot) 1. Ipinakilala ko ang aking sarili 2. Ipinakilala ko ang aking kasama OO Palagi (10 pts) OO Madalas (8 pts) OO Minsan (5 pts) Hindi (3 pts)

X X

3. Ako ay gumamit ng tamang pananalita sa pakikipag-usap

4. Ako ay nagpakita ng katapatan sa pagtulong

5. Madali kong nakapaglagay ang loob ang mga miyembro ng pamilya 6. Ako ay nagpakita ng ugaling medaling pakitunguha n 7. Ginamit ko ang pagkakataon upang magturo ng kaalamang pangkalusugan 8. Tinitiyak ko na naiintindihan ang aking itinuturo

9. Ipinaliwanag ko amg mga salitang medical

10. Ako ay nagging maayos at mabilis sa paggawa

Total: 75%

20

40

15

Iba pang masasabi kulang ang oras at gmit

______Dawn Rose Malilio______ Pangalan ng CHN at Lagda

CLIENT EVALUATION
Client evaluation serves as feedback to the service

provider regarding services rendered to the client family. It determines their performance level & reflects how much they have learned in the course of their training/immersion. Direction: Within the day, have a member of each priority family where you rendered services rate your performance in home visits using the form.

FAMILY HEALTH CARE EVALUATION FORM

Sa pagdalaw sa aming pamilya ni Mr./Mrs. OO Siya ay (lagyan ng tsek Palagi ang angkop na sagot) (10 pts)
1. Nagpakilala ng sarili 2. Nagpakilala ng kasama 3. Gumamit ng tamang pananalita sa pakikipag-usap X

______Dawn Rose Malilio_____ OO OO Hindi Madalas MInsan (3 pts) (8 pts) (5 pts)

4. Nagpakita ng katapatan sa pagtulong

5.

Nagging madaling makapalagayang loob

6. Nagpakita ng ugaling madaling pakitunguhan

7. Gumamit ng pagkakataon upang magturo ng kaalamang pangkalusugan

8.

Naniniguro naiintindihan itinuro

na ang

9. Nagpaliwanag ng mga salitang medical

10. Nagging maayos at mabilis sa paggawa

Total: 83%

30

48

Iba pang masasabi Mahusay siya. Huwag sana siyang magsawa na kami ay tulungan. _____JUANA DELA CRUZ____ Pangalan ng sumagot at Lagda