Selected Family Health Promotion Assessment and Initiative - Essay Example

?Introduction Numerous studies have synthesized the evidence that points out toward the contributions of nurses toward family and community health. Nurses’ key priorities generally include anticipatory care, reducing health inequalities, reducing patients’ admission to hospitals, enhancing the facilitation of long-term health conditions, as well as improving the outcomes of patients with the use of various resources (Callahan 2003). The integration of family nursing into urgent care settings have become a great challenge due to the high level of patients’ acuity along with the increased demands of service delivery, commonly 7 days each week and 14 hours per day. Nursing practice faces unpredictable circumstances from patient emergencies and personnel changes to therapeutic encounters and patient recoveries, hence, reinforcing the relations of nurses with their patients and families. In most first world countries, health visitors offer spontaneous public health service in accordance to the actions taken by the government to promote health and provide preventive care among families and communities. These health visitors maintain a number of cases to be dealt with, particularly families within a certain area with children of 5 years old and below, to supply health services through specialized home visiting that focuses on individual health care needs, clinic contacts, as well as health-related activities at a community level. Since the early 1990s, the British National Health Service has aimed to implement policies that will address health inequalities (Greater London Authority 2002), reduce all health-related gaps, and improve the living standards of those experiencing the worst health conditions in the society (Department of Health 2001). Initially, the pressure in decreasing the amount of time allocated for home visiting was consequently followed by the increased emphasis on disadvantaged families. Owing to such priorities, major decisions were made with regards to the assessment of health needs when families are first visited by health visitors to identify the appropriate frequency of possible contacts in the future. There is not a single approach that is accepted as the sole tool for assessing health needs; there is also no established agreements regarding the applicability of various approaches with which decisions about the frequency, level, and types of services to be provided are to be made. Elkan, Robinson, Williams, and Blair (2001) asserted that the main decision lies on the judgment of health professionals in ascertaining the frequency of communication and contact with families. There have been an increased number of studies that examine the processes integrated within health visitor needs assessment, especially in settling on the necessary contact frequency between the family and health visitor (Appleton 2002); however, there are fewer studies that highlight the structure the implementation of structured health needs assessment approaches. Nonetheless, majority of health institutions responsible for health visitors have implemented a type of structured guidance that can help make appropriate decisions about service provision in health visiting. The current study, then, focuses on the Developmental Model of Health and Nursing (DMHN) which emphasizes the development of healthy attitudes and behaviors that take place in the family. The DMHN generally pays attention to how family members create the strategies necessary for them to live a healthy life, focusing on the role of the entire family in developing the responses to health-related situations which can generally affect the family at an individual and group level (Ford-Gilboe 2002).Due to the model’s strengths-based direction, the DMHN can be very much applicable for evaluating and gaining insight especially about vulnerable groups of people. The following sections will then examine the application of the Developmental Model of Health and Nursing (DMHN) initially proposed by Alen (1977) to restructure health care systems and make them more consistent with the development of healthful lifestyles along with healthy families and communities. This will be carried out by selecting a family who is willing to participate in the study, identifying their health needs, and developing plans and strategies to achieve realistic health goals. This will allow the researcher to understand collaborative partnership by exploring family health and identifying the subsequent health work that should be taken up. A qualitative approach to research is used in the study. Qualitative research focuses on observing the experiences, behavior, attitudes, and other observable facts such as gender, age, or ethnicity (Boyatzis 1998). Because of its qualitative nature, the study has made use of interviews that were conducted in a single family in an urban community in Canada to look into the family’s health, assess their current needs and potential, identify the appropriate health work that can be taken up, and observe generally how collaborative associations with families can influence their health care management. A family information letter was sent to the family, indicating that the researcher will visit them in three pre-arranged times. The letter was also used to make certain that they are willing to participate in the study; if they do not wish to become involved or continue on with the visits, their decisions are openly accepted. The questions raised in the interviews were based on the health aspects proposed by the McGill Model of Nursing and consequently in the Developmental Model of Health and Nursing (DMHN). Results The following results, in a narrative form, have been attained through the three interviews conducted in one family to assess their needs and strengths in relation to their health care. The questions aimed to explore and clarify the family's health goals and concerns, their current strengths, coping strategies and resource utilization. The use of interviews also aimed to develop a plan with the family that will facilitate developmental, growth seeking behaviors with a realistic goal and the specific strategies that can be put into practice for the family in attaining their capacity for health. First Visit The family which the researcher conducted interviews with consisted of six members- Mr. X, Mrs. X, their two children (one in elementary and one in high school) together with Grandpa X and Grandma X. Grandpa X, aged 75 years old, has experienced heart problems over the past 25 years such as high blood pressure. He was also experienced a minor heart attack just recently during the previous year. “It was a frightening experience for me; I normally am not fearful of health conditions but that unpredictable experience has driven me to start having doubts”, mentioned Grandpa X. Due to such conditions, the couple was asked about Grandpa X’s conditions with which related health concerns were identified and patient assessment was conducted. A number of issues, such as hypertension, angina, and the psychosocial aspects of care were recognized; physical conditions were also examined in detail, including history of hypertension, systolic and diastolic blood pressure, pulses, and breathing sounds. Respiration, blood circulation, pain and discomfort, and social interaction were taken into consideration as well.Even behavioral manifestations were also recognized along with possible attitudes toward illness and financial concerns. By outlining these factors, an effective developmental plan can be established that can address every category of concern. The delivery of health care services should be consistently aligned with the needs of patients and their families to ensure that optimal health and recovery is achieved. Although the family, as a unit, has been considered as the basic social setting in which health attitudes, behaviors, and practices are learned and carried out, many of the theories on health assessment needs are focused on individual behavior. Specific behaviors, such as finding information, making decisions, solving problems, and accomplishing growth and development, however, have received less attention. The promotion of health through families have now been understood and considered as a means of enabling families to function consistently in enhancing and maintain their physical, psychological, social, and spiritual wellbeing (Ford-Gilboe 1997). Moreover, there has also been the crucial need for health needs assessment among families to identify critical health needs and find resources to manage inequalities. An aging population and economic constraints together with increased chronic health conditions, and technological trends for disease treatment have placed increased pressure on families at present. Health care delivery and the changes it has undergone have created certain risks and challenges for families who are in dire need of it. Comprehensive care for the family is necessary for many and families have been carrying out the various aspects of care service that are supposed to be delivered by health care professionals (Dobbins, Davies, Danseco, Edwards, and Virani (2005), such as in the case of the family members who have been interviewed for the study. Nurses have been long known for their traditional role of providing care for families, particularly due to their considerable skill and knowledge applicable for family health. The concept of nursing care that is aimed at families emerged due to the attempts of parents along with health care professionals in bringing a family perspective in caring for children. At present, a family-oriented approach remains to be one of the most important objectives of nursing practice (Holden, Harrison, and Johnson 2002). The conventional framework with which health professionals are regarded as the only individuals who can identify the most appropriate way for caring for family members has been replaced by a nursing approach that emphasizes partnership and active involvement. Families possess an increase in knowledge regarding health and health-related conditions; they also desire to be able to have greater control over such matters and in sharing ideas with health professionals (Leahey, Harper-Jacques, Stout, and Levac 1995). To establish meaningful associations between a family and their health care provider can generate a positive influence on managing their health conditions as well as in improving nurses’ work satisfaction and self-confidence. Providing a report, including specific details, on the family’s health concerns can allow health care providers to deliver services that are appropriate and effective for a certain condition. This way, satisfaction can be attained by all parties involved. Because health care changes, such as its restructuring, has shifted the challenge of caring to family members, there is a need for nurses to efficiently work with these families to help them attain human and financial resources necessary to deliver care for their members. The emphasis of family nursing has transformed, from focusing on problems to utilizing the strengths and assessing the needs of families (Kristjanson 2004). Although the role of nurses is not necessarily to solve all of the families’ issues, it is necessary that they show their determination and willingness in establishing an environment that will support the ability of families to ascertain their problems and come up with their solutions. It has been recognized that family dynamics can significantly influence family members in relation to their health and conditions. In turn, health-related factors can affect the relationships of family members as well as their functioning and performance. Second Visit When asked about their perceptions of Mr. X’s current situation, all the adults had mentioned that is inevitable for them to be doubtful or anxious even if Mr. X is not physically disabled or has not been experiencing heart problem symptoms over the past year. “Having a family member that experiences heart problems can really bring out the stress even in simple situations; still, we try to be hopeful and motivated by taking appropriate actions and believing that it is very much possible for him to reach a very, very old age.” When asked about their strengths, the family claimed that every aspect of Grandpa X’s health is monitored and controlled. For example, his everyday meals are carefully prepared, making sure that it can give him the nutrients necessary for not just his heart but his entire body to function well. His weight and blood pressure is also monitored on a daily basis while his medications are taken on a regular basis. Exercise is also not overlooked as he can conduct physical activities with the assistance of another individual, such as walking or stretching under the early morning sun. The family claimed that “we are just an average family, earning average incomes, sending our kids to public schools and trying to save up on the most important priorities, such as education and health goals. Nonetheless, we are able to sustain his (Grandpa X) medical needs and are prepared for urgent situations that require the assistance of hospitals which we are to pay for.” In addition, they also mentioned that they need human support most of the time as, everyday, Mr. and Mrs. X along with the kids head to their offices and schools. Grandpa X is left with Grandma X who may not be as aware as the younger members during emergencies. Due to such actions, it can be suggested that the family members are completely aware of the strategies to be used in ensuring that Grandpa X achieves optimal health despite heart conditions. In relation to such occurrences, an extension and refined version of the McGill Model of Nursing, the Developmental Model of Health and Nursing (DMHN) focused on families’ potential for achieving effectiveness in healthy living through a number of dimensions. It emphasizes the available resources that can be used to address health concerns and points out the fundamental role that health care professionals play in delivering health care to families. The pattern of family health, as asserted by Ford-Gilboe (2002), is composed of four different but interrelated aspects- (1) health work, (2) health potential, (3) competence in health behavior, and (4) health status. Every dimension has been conceptualized through definitions based on Allen’s (1983) work. First, health work has been assumed as the most important concept in the theory as it is referred to as the process of instigating active participation with which families learn and build up their ways of dealing with health-related situations; they use their strengths and available resources in attaining goals for the family and its members. Health work demonstrates the actions of families as their responses to health conditions; it does not necessarily focus on their status, identities, or the resources they have at hand. According to DeMarco, Ford-Gilboe, Friedman, McCubbin, and McCubbin (2000), health work is a common and collective process that manifests fundamental qualities, such as their intentions of learning from and dealing with life experiences or their desire to develop their potential. Thus, a higher level of health work can be shown through one’s interest and active participation in health-related matters and processes. Furthermore, an emphasis on family strengths and capabilities, adoption of practical approaches to solving problems and managing health situations, and promoting health by getting involved with professionals should all be evident. In the case of the current study, the family members of Grandpa X were shown to be capable of modifying his diet to make sure that nutritional intake is maintained while avoiding unhealthful food products. Moreover, physical activities and other lifestyle changes were facilitated by the family members. Health work can be general and specific; strategies for coping and development which are learned in a particular situation can be incorporated into the family’s manner of living and can also be applied in new situations that may arise. Therefore, when a family’s health work is evaluated in different circumstances, a general style or pattern comes out (Allen 1978). Families improve their means of dealing with health matters as they continue to learn from the life events that they experience. Hence, the health work patterns in families must shift and become more comprehensive and versatile as they encounter more situations over time. Although families tend to be involved in health work by themselves, nurses can also take part in the activity when assistance is required to support the family’s efforts in coping with a certain situation. Allen (1994) also identified several aspects of health potential- strengths, motivation and resources. Health potential has been associated with the family’s possibility to change, as reflected in their readiness as well as capability to undergo positive changes. If necessary changes are to be effectively carried out in the family of Grandpa X, it is of paramount importance that they are willing and ready to accommodate such changes. Through this notion, at present, a family’s health potential can be characterized by external and internal capacities, including strengths, motivation, and resources, which can be utilized to reinforce health work. Strengths refer to internal capabilities which individual qualities and attributes of family interaction are included. In relation to family values, motivation is defined as the general interest of families regarding health matters as expressed by the importance they give to health concerns, their desire and intentions to undergo changes in health behavior due to present needs, and their perceptions about their capability to control health. Resources are described as the external sources that provide assistance to cope with health concerns and can include social support and services from friends, the extended family, or the community, as well as information access and financial sufficiency (Vuchinich, Wood, and Vuchinich 1994). Competence in health behavior was also suggested by Allen (1980) as a reflection of the family’s achievement in developing and dealing with health issues through a proactive manner, with the family’s level of progress being a primary source of their satisfaction. Hence, competence in health behavior has been described as the family’s effectiveness in dealing with health situations and accomplishing health-related goals together with developing and maintaining lifestyle changes which are of great importance to them. The last dimension of the DMHN model is health status, defined as the overall functioning and performance of the family members with which the concepts of quality life, family life satisfaction, and ability for participation in daily activities can all be incorporated. The DMHN suggests that health potential has a positive impact on health work and that it gives families access to resources and capabilities that play a vital role in facilitate assisting the development of health work (Rueter and Conger 1995). On the other hand, as health work supports active involvement and a perspective of occurrences as family concerns instead of individual issues, to participate in health work improves the family’s health potential through the development of new strengths, increase of motivation levels due to their successful experiences, and development of sources for support and information. Moreover, the wider social context in which families are integrated can also affect their levels and patterns of health work (Ward-Griffin and McKeever 2000). Third Visit After gathering relevant information from Grandpa X and his family, a number of measures and strategies were developed to address the health concerns identified during the first visit. Based on the interviews, the researcher has concluded that the family’s strengths are more evident than their health problems expect for their lack of human support, from the maintenance of good nutrition to healthy lifestyle practices (i.e. regular exercise, avoidance of alcohol and tobacco smoking). Because the family perceives that they are capable of allowing these practices to benefit Grandpa X, their commitment to continue providing care and support to this member of the family is relentless. The outcomes of the lifestyle practices which they try to carry out on a regular routine have also enabled the family members to learn how to learn from experiences, do what is better, and avoid those that may create negative consequences. Grandpa X claimed: “I try to learn from my family through the way they do things or talk to me, seeing that they are very much capable of and committed in providing care for me”. Owing to the various practices that the family has been able to successfully carry out over the past years, the researcher has suggested that continue with such activities and consult regularly with their cardiologist for Grandpa X’s check-ups. Beneficial activities for maintaining good circulation and blood pressure, such as light exercise along with a healthful well-balanced diet that consists of more fruits and vegetables, were recommended; this way, ideal weight can be maintained and angina pain be avoided. Implementing activity programs can significantly enhance and strengthen cardiac function even under stress. Weighing daily is important as well with which changes should be recorded for documentation purposes. Furthermore, yearly examinations for levels of cholesterol and blood sugar have also been recommended along with annual electrocardiography procedures to monitor the functioning of his heart. It has also been suggested for them to talk to as many cardiologists and other health care professionals to add to their knowledge of what they can do to maintain a fit and healthy Grandpa X. This way, the family’s active participation along with the involvement of health care professionals can ensure that the patient receives optimum care and increase the likelihood of positive outcomes in the future. Indigent Over time, families’ involvement in health work has also been suggested to have a positive impact on competences in health behavior as it gives family members the opportunity to practice and enhance their skills for problem solving and accomplishment of goals. As they gain experience, they increase their effectiveness in coping with everyday situations. Moreover, when families’ awareness and understanding of health is increased, they become more capable of making consistent and practical decisions about health issues and start to take on healthier practices for daily living, such as allocating time for exercise or improving nutrition (McWilliam et al 2003). A family’s health potential can also play an important function in competence development among families who possess a well-developed set of abilities which they can readily demonstrate as their members may tend to perceive themselves as more capable (Anderson 2000). Health potential can guarantee them that their actions and behavior are constant with such self-perceptions. An increase in families’ competence in health behavior can consequently lead to an improvement in their health status. When health strategies are continued to be developed and put to the test, gradual improvements in both the individual and group functioning can result, although such behaviors may still not be well-established or completely incorporated into the group’s set of health practices (McCubbin and McCubbin 1996). As nurses play a fundamental role in the effective practice of DMHN, it is highly suggested that they provide assistance to families and help them develop healthy living practices through well-structured experiences that can assist family members in actively participating in the health work process. It has also been indicated that determining and establishing families’ health potential through opportunities that can allow them to learn health behaviors by utilizing strengths, motivation, and resources is of paramount importance (Sgarbossa and Ford-Gilboe 2004). Hence, nurses can also promote health work in an indirect manner by guiding the family members in developing their health potential. To make use of a nursing approach is situation-responsive, such as the DMHN, has been theoretically shown to be more efficient and reliable in providing a guide for families to develop their health potential and become involved in health work compared to the application of traditional nursing approaches. Other studies in the current literature for the impact of DMHN on patients and their families have also provided relevant findings. For instance, Bluvol and Ford-Gilboe (2004) aimed to examine the impact of the application of the DMHN on families with members who were stroke survivors. Due to the financial, physical, and emotional challenges that are brought about by the occurrence of stroke in family members, there is an increasing need to examine the ways with which families deal with the outcomes of stroke and its resulting disability. Hence, the researchers opted for the use of DMHN as families who make use of such approach are able to learn ways with which they can regain their health, develop healthy lifestyle practices, and cope with life events. To determine whether health work can be associated with the families’ quality of life, survey questionnaires were distributed among 40 families, with one family member being a stroke survivor. Findings showed that positive attitudes of families highly influenced their achievement of goals, adaptation to their situation, and their motivation levels, hence, increasing their competence for health behavior. Moreover, those who tend to be more confident and hopeful were shown to have more energy and willingness to commit to certain health changes and cope with the current situation. A high level of motivation can also encourage them to actively participate in solving problems and developing behaviors with which they can obtain growth and development. All in all, the most important predictors of the quality of life among stroke survivors were their level of functional independence upon being discharged from the hospital, followed by the positive outlook in life that influenced their take on daily activities, and their spouses’ involvement in providing care. Additionally, Comer (1991) also emphasized the McGill Model of Nursing on older adults, particularly on how continuous learning and development can provide benefits for these individuals. The study made use of a target population comprised of senior citizens aged 60 or above, along with their families, who live in a large, urban residence and required different levels of health assistance when it comes to personal care and daily activities, from minimum assistance to daily nursing care. Findings showed that positive feelings can be produced whereas negative feelings may be decreased when older adults continue to learn the ways through which they can effectively deal with daily activities and life experiences. Their self-esteem is also increased when they are able to attain personal development and meaning through these events. Findings also suggest that despite age, disabilities, or any health condition, continuous learning about how to take care of one’s health can increase the commitment and willingness of family members to deliver care for their older members. Conclusion The involvement of nurses in family health as well as the utilization of information and support sources for the provision of family care has become the main objectives for current nursing approaches that emphasize the importance of the family in managing health. For instance, the McGill Model of Nursing, which has been revised into the Development Model of Health and Nursing (DMHN), highly suggests that nurses demonstrate their support for families by focusing on their strengths and potential, and not only on their concerns and deficiencies. Assessing the families’ needs and the resources available to them which can be used to address their health concerns are also conducted when applying the DMHN. This way, not only the identification of problems is accomplished; more importantly, the solutions to these health-related matters are developed by family members through the assistance of nurses and other health care professionals. Due to the interrelationships established among families and nurses, the understanding of health needs and development of effective strategies can be attained. The results of the interviews demonstrated how the strengths of the selected family have been used as a means of providing efficient care for their affected family member. Their capabilities and knowledge of healthy lifestyle practices have also increased their self-perceptions and their motivation to continue providing care; more importantly, it positively contributed to the improvement of life quality for the affected member. The researcher acknowledged the rightful actions that the family has taken during the past years and, at the same time, proposed suggestions of establishing stronger communication with health care professionals and making use of clinical procedures that can further help the family in identifying possible problems, creating solutions for such potential risks, and delivering care for their affected member. The application of the Development Model of Health and Nursing has allowed the researcher to assess the needs, strengths, and potentials of the selected family, establishing communication with their members, and providing them with assistance with which they may obtain useful health-related benefits References: Allen, M 1978, Framework for the study of nursing practice and outcomes for clients/ families. Unpublished manuscript, McGill University, School of Nursing, Canada. Allen, M 1980, A new perspective on nursing, Proceedings of Nursing Explorations – Learning To Be Healthy: Where Do Nurses Fit? McGill University, Montreal. Allen, M 1983, Primary care nursing: research in action, in Hockey, L (ed.) Recent advances in nursing: primary care nursing, Churchhill-Livingstone, Edinburgh, pp. 32–77. Allen, M 1994, A developmental health model: Nursing as continuous inquiry. Unpublished manuscript. 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