Community Health Nursing RLE PDF

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Summary

Midterm Lecture...

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a) b) c) d) e) f) g) h) i)

Coverage for Prelim: • Home Visit • Bag technique • Survey Form • Acetic Acid Test • Benedict’s Test • Family Nursing Care Plan HOME VISIT Ppt from Prof. Jocelyn C. Tebrero & Prof. Melania A. Concepcion Discussed by Prof. Donato A. Mirador

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Refers to meeting the health needs of the people at their doorsteps (bahay- bahay). Back bone of the community health services (supporting strength of the CHN) A face-to-face contact made by the public health nurse to the client to render care and services A family – nurse contact which allows the health worker to assess the home and family situation to provide the necessary nursing care and health-related activities Delivery of specialized nursing care services in the home health care setting Services provided is an extension of the health services inside the health center A process of providing nursing care to the patient and his/her family at their doorstep Reasons: • Nagbibigay ng health care services sa bawat family sa komunidad • Para ma check ang health status para ma assess sa mga pangangailangan nila about sa health nila • Kapag na assess malalaman natin ang mga problema makakapagbigay ang nurse’s ng diagnoses and health education • We can discover their problems, learn about it and we are able to help them. Purposes of home visit Protection against diseases. Providing essential treatment. Providing comfort and relief from pain to the patient. Giving a support and empathy to the patient and his family. Using domestic equipment for the nursing care. Providing health education. Giving as much respect as possible to the faiths and beliefs of the family during the procedure. To give care to the sick, to a postpartum mother and her newborn, teach a responsible family member to give the subsequent care To assess the living condition of the patient and his family and their health practices to provide the appropriate health teaching To give health teaching regarding the prevention and control of diseases To establish close relationship between the health agencies and the public for the promotion of health To make use of the inter-referral system and to promote the utilization of community services Programs of Health Services in Health Centers:

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Feeding program Immunization Sanitation Testing of pt that have tuberculosis Family planning Prevention for Communicable Diseases Pre-natal/Post-natal Care Orientation General Check-up Principles of home visit Home visits should be planned with purpose The purpose of home visits should be clear and must meet the needs of the patients Home visits should be regular and flexible Home visits should give educative Home visits should give excellent opportunities for nurses to demonstrate hygienic principles Home visit should be convenient, acceptable, and educative to the patients. The nurse should make an attempt to include each family member while using nursing process The nurse and the family must develop positive interpersonal relationship in their work to achieve the goal. The nurse must respect the patient’s rights Home visits should be recorded in the diary and family folder Steps Establish rapport to the family Identify the client and explain the procedure Take client’s health history. Lay paper on flat surface of table, chest or box. If none use the floor. Place the bag on the left side of the paper lining. Open the bag and take out the towel and soap Wash hands using pouring method instead of running water. Remove apron from the bag and put it on. Observe proper technique Remove from the bag all materials needed for the care. Close the bag. After performing the care, wash all materials used. Dispose soiled materials. Do hand washing. Return all materials in their proper place in the bag. Take off apron and fold properly… Put it back again in the bag. Close the bag. Get the bag. Get the paper lining. Fold it and dispose. Record the visit accurately.

Advantages To study the home environment and the family situation. To clarify doubts on health matters and give accurate personalized (tailor-suit) health education. To implement the nursing process. To render health services to the family members at the convenience and safety of their home.

COMMUNITY HEALTH NURSING 1 RLE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 • • • • • • • • •

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The nurse can observe directly the care given to the family members and also problems when visiting the community. Helps to gain knowledge and solving individuals’ problems. Provides an excellent opportunity to implement the nursing process. Provide an opportunity to study the home and family situation Provide an opportunity to render free service to the family members at their own surroundings Create a good understanding between nurse and family. Clarify doubts raised by the family members

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Contents and Arrangement of Bag Front of the bag Right rear of the bag Left rear of the bag • Medicine glass • 2 test tubes • Baby’s weighing (medium) scale • Test tube holder • Thermometer • Bandage scissor • Medicine dropper • Straight scissor • Penlight • Tourniquet Back of the bag – cleaning Center of the bag Additional contents solutions • Alcohol 70% • Kelly forceps • Rubber suction (curve/straight) • Acetic acid • Kidney basin 5% • Alcohol lamp • Foley catheter • Aromatic • Sterile dressings • Naso gastric tube spirit of (gauze) • Instrument tray ammonia • Tongue depressor • Surgical needle • Liquid soap • Roller bandage • Chromic 2.0 and cotton in • Surgical (mayo) • Medicines sterile water scissor - Lidocaine for cleaning • Cotton applicator - Oxytocin the • Adhesive tape - Vitamin k thermometer • Tape measure - Ky jelly • Benedict’s • Sterile tie or cord • Hot water bag solution clamp • Ice bag • Hydrogen • Syringes (1cc, 3cc, • Breast pump peroxide 5cc) • Nail cutter • Ophthalmic • Hypodermic needles • Instrument ointment (G19, 22, 23, 25, 26) - Needle holder • Disinfectant - Tissue forceps solution - Kelly forcep (chlorox or - Mayo scissors cidex • 10% and 7% betadine solution

Disadvantages Home may be the only sanctuary or safe place for the family or its members to be away from the scrutiny of others The nurse must be highly skilled in communication, specifically setting limits and guiding the interaction, or the visit may have a more social tone and not be efficient or productive. Time consuming No access to emergency equipment Nurse’s personal safety No control over environment Family resent time the visit requires Increase caregiver exhaustion and illness. Public Health Bag An essential and indispensable equipment of the public health nurse which he/she has to carry along when he/she goes out of home visit. Contains basic medications and articles necessary for giving care. Bag technique A tool making use of a public health bag through which the nurse bring during a home visit. Minimize or prevent the spread of any infection. It saves time and effort in performance of nursing procedures. Purpose: • To prevent contamination of bag and equipment, avoid cross infection and establish a clean work area. • Protect client, family members, and health care workers from the spread of infection. • Demonstrate compliance with federal, state, and local laws and regulations, accreditation, standards, infection control principles, and standard precautions. Don’t forget: • Designate two “clean” compartments, one for clean disposables and the other for the client’s record. • Pack the bag with necessary supplies before leaving for visits. • Store the health care bag in a clean storage container. • Do not take the health care bag into infested homes. • Bag soiled reusable items that cannot be cleaned in • the client’s home. • Plan where you discard disposable items ahead of time. • Clean and disinfect the health care bag weekly by wiping down inside of bag with a clean cloth. • Outside of the bag must be washed in mild soap and warm water, air dry on monthly basis.

Nursing considerations Instruct the client on infection control precautions. Consider referring client who have active infectious organisms. Try to visit these clients last or at the end of the day When possible, use disposable equipment or keep needed equipment in the home with these clients.

Top pile center of the bag

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Hand towel in a plastic bag Soap in a soap dish Apron Paper lining Proper waste bag in the pocket of the bag Plastic/linen lining Surgical gloves

Benedict’s test simple and effective method of ascertaining the presence or the amount of glucose in the urine Procedure: 1) Take 5ml of the solution in the test tube. 2) Heat it over a lamp till the benedicts solution boils without overflowing. 3) Drop 8 10 drops of urine into the solution. 4) After again boiling the mixture, let it cool down. 5) While cooling the mixture will change color.

COMMUNITY HEALTH NURSING 1 RLE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

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Acetic Acid test A test that detects the presence of albumin/proteins in the urine. Procedure: 1) Fill the test tube of 3/4th urine and boil the top portion 2) Add 5 drops of acetic acid and reheat. 3) If cloudiness increases the test is positive for albumin.

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Laboratory tests Complete blood count Pap smear Sexually transmitted disease test Hepatitis B screening HIV test Sputum test

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Documentation Any client instructions regarding infection control precautions. Implementation of standard precautions Physician notification, if applicable Other pertinent findings. Update the plan of care Plan for the next visit

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Components Initiative phase the community health nurse should get information from clinical and other records before planning for a visit.

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During visit he has to assess or note for initial visit. A nurse should establish friendly relationship using simple language. Assess physical and environmental status. The family cultural background, occupation, income of the family members, age, educational factors and phycological factors Pre-visit activities a planning Need to coordinate with the health center about the condition of the community that you wanted to adapt together w/ the clinical instructor Coordinate w/ the brgy. Health workers in order for them to accompany the team to home visit. Activities during home visit The relationship starts when the nurse will enter the house The nurse should use effective communication skills implement the nursing process During the home visit the nurse will learn a lot of variety of prones during the interviewing the pt Community nurse will take a role as collaborator, consultant, coordinator, inventor of disease, promoter of health, health educator, and health epidemiologist and take steps to implement nursing process. (kapag may survey form hindi ibig sabihin lahat itatanong mo chill lang dzaiii, ezhan nyo lang, observe2x din hihihii) Provide care, taking temperature (if may fever yung family member), RR, HR (if may abnormalities sabihan na ang guardian or parents na dalhin sa health center para ma check ng maayos, pero first you need to educate the family the nursing intervention) Termination phase Nurse pt goals health is restored the pt functions without actions (ex. After ng sponge bath at least it helps the child lowering the fever, then taking a temperature and it was good) Post-visit activities Evaluation is continuing process every day you go to clients house you have to evaluate, to record what you need. Family Record View Is very important. To obtain a comprehensive clinical picture of the selected family’s need. (pwede makahingi ng record or makahiram sa health center if may napili kang family na re renderan ng care)

Guidelines 1) The physical needs psychological needs and educational needs of the individual and family 2) The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate 3) The policy of a specific agency and the emphasis given towards their health programs 4) Take into account other health agencies and the number of health personnel already involved in the care of a specific family 5) Careful evaluation of past services given to the family and how the family avails of the nursing services 6) The ability of the patient and his family to recognize their needs, their knowledge of available resources and their ability to make use of their resources for their benefits

COMMUNITY HEALTH NURSING 1 RLE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 Survey Form

Types of Family structure: • Nuclear • Extended • Matriarchal • Patriarchal Summary 1. Establish a friendly relationship 2. Make a survey and prepare a map 3. Collection of data and analysis

COMMUNITY HEALTH NURSING 1 RLE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 4. 5. 6. 7. 8. 9.

Establish goals Prepare a plan of action Nursing interventions Interpretation of results Follow up Evaluation

Steps Call the client to obtain permission to visit them at home Schedule the date and time of your visit, and verify address Prepare initial data base survey form, and other pertinent documents needed 4. Bring complete PHN bag 5. Greet the patient and introduce yourself 6. State the purpose of the visit 7. Put the bag in a convenient place and then proceed to perform the bag technique 8. Perform the nursing care needed and give health techniques 9. Record all important date, observation and care rendered 10. Make appointment for a return visit 1. 2. 3.

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Setting up Family Appointments Introduce yourself State the purpose of the request meeting, including who referred the family to the agency Do not apologize for the meeting Be factual about the need for the meeting but do not provide details Offer several possible times off the meeting, including late afternoon or evening Let the family select the most convenient time that allows the majority of the family members to attend Offer services of an interpreter, if required Confirm date, time, place, and directions Family Genogram Interview Data Collection Identify who is in immediate family Identify the person who has the health problem Identify all the people who live with the immediate family Determine how all the people are related (magkaka mag-anak ba, kaptid, pinsan…etc.) Gather the following information on each family member. - Age - Sex - Correct spelling of name - Health problem - Occupation - Dates of relationships: marriage, separation, divorce, living together/committed - Dates and age of death Seek the information for the family members on the same generational level and for those in the preceding generational level Add any additional information relative to the situation, such as geographic location and interaction patterns Family Assessment the process of collecting data about the family structures, and the relationships and interactions among individual members It is a continues process

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Its aim is to generate Nursing diagnoses with goals and interventions for care created in collaboration with the child and caregivers Nursing practice requires the ability to use nursing knowledge and reason through details to make skilled judgements while not losing sight of the whole client picture and desired outcomes of care Nurses determine through which lens the family health problem will be best addressed: form a family-as-context perspective, family-as-client perspective, or family-ascommunity perspective. NANDA Nursing Diagnoses Relevant to Family Nursing Interrupted family processes Readiness for enhanced parenting Impaired parenting Risk for impaired parenting Relocation stress syndrome Ineffective role performance Ineffective family therapeutic regimen management

SUMMARY: 1. Check the family records before home visits 2. Heads up for brgy. That nurse will have a home visit in order to accompany the team 3. Knock on houses (wag basta basta papasok at baka ma habol ka ng aso wala sa oras, char) 4. Always give respect 5. Do not talk in English (te nasa Pilipinas tayo beke nemen char) 6. Always observe 7. Prioritize caring in the household. Remember we have extended family (Pilipinas yan ih) 8. You have to adapt 9. Wag maghahanap ng wala sa bahay 10. You can’t go to the community alone and go to the household by partners 11. HBMR – color pink, used by pregnant woman (dala nya kapag pumupunta ng center para ma record yung kalagayan at malaman kung ilang beses sya nagpapa check) 12. If hindi nakaka intindi ang isang member of the family you can have the interpreter lalo na sa mga galing taga Visayas. Always remember “DO.NOT.USE.ENGLISH.” language. •

Assessment Instruments A genogram is a format for drawing a family tree that records information about family members and their relationships over a period of time, usually three generations.

COMMUNITY HEALTH NURSING 1 RLE – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 •

An ecomap a is a visual representation of a family in relation o the community. It demonstrates the nature and quality of family relationships and what kinds of resources or energies are going in and out of the family.

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The genogram and ecomap are essential components of family assessment. They should be used concurrently with all family assessment approaches. Nursing reasoning Each step of working with families requires a thoughtful deliberate clinical reasoning process. Nurses decide: • what data to collect and how • when and where that data is collected. • the relevance of each new piece of information· • how it fits into the emerging family story. Each "tern of new information must be judged in terms of accuracy, clarity, and relevance.

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Family Nursing Diagnosis Once the data have been clustered, a family nursing diagnosis is determined for each set of data. Nursing diagnoses create the links between collecting information and care planning (Gordon, 1994)

The North American Nurses Diagnosis Association (NANDA; 2003) is the most global nursing classification system. After the keystone family diagnosis has been identified and verified with the family, the next step is determining the present state, the outcome, and the testing evaluation criteria that will be used to determine if the outcomes have been achieved. Outcome statements The nurse works with the family to determine realistic outcomes. Outcome statements should: • Be adjusted for each aspect of the present state; • Need to be based on the ability of the family to successfully adapt to the health issue. • Rely on the given strengths of the family and the patterns of family response in similar situations • Consider the trajectory of the family health care problem. • Should be stated positively and in measurable terms. The type of outcomes possible depends on the frame of the problem for the family. Examples: • Identify realistic perception of role. • Acknowledge problems contributing to inability to carry out usual role in the family. • Describe a decrease in the difficulties of managing medications for family member. • Express feelings and perceptions regarding impacts of illness disability or hospitalization on parental role. • Verbalize internal resources to help deal with the family situation. Testing From experience and information known about the family the nurse predicts what tests or assessment processes will be used to analyze th...