CHN: Family Nursing Care Plan - Research Paper Example

?Running head: FAMILY NURSING CARE PLAN CHN: Family Nursing Care Plan (school) CHN Project: Family Nursing Care Plan Assessment Profileof selected family The Smith family (pseudonym) is made up of Mr. and Mrs. Todd (52 years old) and Evelyn (45 years old) Smith, parents to four children: Susan, living at home, (20 years old), Todd, Jr. (17), Adriana (12), and Roger (7 years old). Todd is an office worker at a government agency and Evelyn is a housewife. Todd’s elderly mother, Rose (88 years old), also lives with them. The father is the primary breadwinner, decision-maker, and authority figure in the home. In his absence, the mother Evelyn has more or less similar functions for the family. The family is Caucasian and belongs to the Methodist religion. (Profile - brief - who are the family members & ages and family type (1), other characteristics, e.g. culture (1) Approach to family . a) Description of introduction and how confidentiality was addressed (paper (1), access(1), and consent (1) When I got to the Smith family’s home, I was greeted by the mother. I introduced myself to her, gave my full name, told them that I was a student nurse from George Brown College, and explained my purpose for being there. After they checked my credentials (school ID and letter from the university), I was invited into their home and was introduced to the rest of the family members by the mother. I was welcomed with open arms. During the time I spent with the Smith family, I maintained respect for their home and family at all times by being polite and allowing them to set the tone during each session. I addressed the issue of confidentiality by not using their real names in this project. I also assured the family that their confidentiality would be protected at all times, and that any information gathered would be used for academic purposes only (Bomar, 2004). The family gave their consent through a signed consent form. I assured them that no other individual, aside from me and Gail would have access to this information and that their consent form will be in a separate envelope. 2 b) Identification of 1 non-verbal communication skill (1), with brief evaluation included (1) My non-verbal communication skill was used early in my relationship with the family. The use of facial expressions were used when appropriate such as smiling, or showing indications of sadness, happiness, as well as avoided displays of disgust, anger, or apathy (White, 2009). By smiling, I exuded friendliness and made them feel at ease. I noticed that it was easier for me to break the ice with the family by maintaining a friendly demeanor. This allowed me to develop rapport with and ease the other elements and stages during the interview (White, 2005). During the introductory phase of the relationship, I had the following initial conversation with Mrs. Smith (Bomar, 2005). Student: “Hello, Mrs. Smith. You can call me ____(first name). What would you like me to call you?” Mrs. Smith: “You may call me Evelyn”. Student: “Hello, Evelyn. I like your home, it’s very cozy. And the roses outside are lovely, very colorful”. Mrs. Smith: “Thank you. They do look lovely, don’t they?” Student: “Yes, they do, Evelyn. What beautiful children you have, Evelyn. How old are they?” Mrs. Smith: “Why, thank you ____. Well, Susan is 20, Todd, Jr. is 17, Adriana, is 12, and there’s Roger who’s 7.” Student: “Good spacing too, I might say.” Mrs. Smith: “Thank you, we planned it that way.” (Quotation marks) During this exchange, I made an effort to smile and exude a friendly demeanor. By smiling and by using the appropriate facial expressions, the family saw me as a friendly face, and when coupled with ‘small talk’ provided a gradual process to ease the interview into asking personal questions regarding their health (Williams and Davis, 2005). These efforts are part of the process of building rapport and establishing trust with the family. In any family interaction in the community setting where rapport is gradually built, the family would be more likely to engage in discussions (Williams and Davis, 2005). The family would also feel more in control of the process, about the areas of their life, especially those concerning their health and developing goal concepts to improve it. Family health b) Family developmental stage The family is in its launching stage, specifically the years where the children are about to leave home and pursue their own careers and start their own families (Bomar, 2004). They are an extended family with the grandmother living with them (Rosdahl and Kowalski, 2007). Susan is currently a college student who is single and pregnant. Todd, Jr. is a senior in high school and a talented hockey player. Adriana is in the 6th grade at the elementary school commitments and is starting to have an active social life with her friends. Roger was diagnosed with Attention-deficit Hyperactive Disorder (ADHD) and is currently on Ritalin. Rose, Todd’s elderly mother is arthritic and hypertensive, is mobile, requires minimal supervision and relatively independent. Aside from the above issues, the family did not mention any other health issues and no other health concerns were observed. 3. a) Family definition of health (1)? Family’s comparison with their definition. Do they see themselves as healthy (1). The family defined health as a physical, emotional, mental, and spiritual state of well-being. They believe that in order to be considered healthy in a physical sense, one must be free from disease and must be emotionally well-adjusted; and that one must be mentally stable and spiritually at peace. In comparison with their definition, the family believed that in general, some of them were not physically healthy and emotionally healthy, and some of the family members were concerned with these two aspects. The father believed that he was not physically healthy because of his illnesses, such as, arteriosclerosis and hypercholesterolemia. Past experience with a health issue b) Family’s past experience with health issue, how the family coped (1), summary of coping skills (2) A few months before my visit with the family, the father was hospitalized because of a hypertensive crisis when his BP went up to 180/110, and was later diagnosed with arteriosclerosis and hypercholesterolemia. He fainted at work and was immediately brought to the hospital where he was diagnosed for the above diseases. He was admitted for two days. He was ordered to rest for two weeks and at which time, he was also not able to work. The family subsequently went through a financial crisis due to Todd’s illness and reduced income. The family dealt with the experience by helping each other. Since Evelyn had to be at the hospital most days, Susan and Todd, Jr. took over some responsibilities such as caring for their younger siblings and grandmother. In addition, the children worked together and assumed responsibility for most of the household chores (ex. grocery shopping, cleaning) to relieve Todd and Evelyn of some of the household responsibilities. They also had to borrow money from Todd’s brother in order to stay afloat. They were stressed out at this time because they were very worried about Todd’s health and the effects of his illness on the family, especially as Todd was the sole breadwinner. However, the family knew that they all had to make the necessary adjustments to help manage Todd’s health crisis, as well as the financial and emotional challenges that it brought. Throughout this ordeal, the family tried to maintain a positive outlook towards their future. Family health issues. The family identifies the following (in order of importance) as their health issues/concerns: 3 c) Family’s identified list of health issues/concerns (2). Family’s identified priority health issue (1). 1. Todd’s hypertension/hypercholesterolemia; 2. Roger’s ADHD; 3. Rose’s arthritis/hypertension; 4. Susan’s pregnancy/impending delivery They identified Todd’s hypercholesterolemia and arteriosclerosis (hypertension) as the family’s priority health concern because Todd was having difficulties in making lifestyle changes in his habits. He was a smoker and was overweight with a BMI of 31 which places him in the overweight category; both elements are contributory factors to his deteriorating health. If his blood pressure is not managed, he may suffer complications and other health issues that may progress into an earlier than expected (Benhagen, 2005). Roger’s ADHD is not a major concern because most of the symptoms he experiences are well managed through medication (Lougy and Rosenthal, 2002). Rose’s arthritis and hypertension is also a health issue, but does not rank high in their list of concerns because these issues are well-managed with antihypertensive maintenance medications and Tylenol for occasional arthritic pain. Susan’s pregnancy and impending delivery is a health concern because of the possible additional stress which the child can bring to the family, financially as well as emotionally (Newman and Newman, 2008). This is however not a main problem with them as they are relatively happy about the pregnancy; nevertheless, there are practical financial concerns about the baby which are making them concerned. 5 d) The community health nurse’s (CHN) assessment (2) of the family’s health issues (family history (1), visual assessment (1). (I do not see this part). Is the family’s identified priority consistent with your nursing assessment (1)? As a nurse, I believe that Todd’s hypertension/arteriosclerosis is their main health issue. Arteriosclerosis is a life-threatening condition which has to be managed efficiently (Benhagen, 2005). The fact that Todd is a smoker and is obese is making his situation worse and being constantly stressed about family finances and other family issues makes for a generally unfavorable situation for Todd (Benhagen, 2005). Arteriosclerosis is a condition which places a patient at risk for stroke as it hardens the blood vessels and restricts blood flow (Benhagen, 2005). Potentially, the possibility of suffering a stroke can be fatal to the patient. Smoking a cigarette causes the entry of dangerous chemicals and substances into the lungs, which can then deposit on the lung walls and congest the bronchioles. There is a congruity in my nursing assessment of the priority issue and the family’s identified priority issue. They believe that Todd’s hypertension and arteriosclerosis is a major health problem as I also believe it to be their main health issue. They also believe that Todd’s smoking and obesity is making the situation worse, and such concerns are adding to the emotional stress this family is experiencing. Family health goal. (1) and tasks (1), with brief rationale with supporting data (1) The health goal which the family developed in relation to the priority health issue was on helping Todd reach his ideal BMI within a year. Specifically, they wanted to reduce his meat intake, increase his vegetable and fruit intake, increase his exercise, and reduce his usual food portions. Apparently, Todd loves to eat pork and hardly eats fruits or vegetables. He hardly exercises, and he usually eats huge food portions during his regular meals. Their overall goal is for the long-term, however, for the short-term period, they want to reduce Todd’s intake of meat to once every two days for the first two weeks, and then once every week for the next two months, and then eventually occasionally until the end of the designated year. Simultaneously, they also wish to engage him in daily exercises, for at least 20-30 minutes daily for the first month, then increased to at least 1 hour daily until the end of the year. The expected outcomes for this goal and these changes in the patient’s life relate to the introduction of healthier habits into the patient’s life, as well as the eventual reduction of his weight. As he would lose weight, better blood flow through his arteries would be seen, reducing his risk of hypertension, and possibly stroke or death. Two verbal communication skills. c) Identification of 1 communication skill (1), with verbatim example (1), with brief evaluation (1) included In the assessment phase, active listening is an important communication skill. I applied this by listening to each member of the family as he or she would be talking (Daniels, 2004). Eye contact during this phase was also an important element as it helped ensure that my full attention was with the speaker (Daniels, 2004). I had this conversation with the family, specifically with Mr. Smith, who already asked me to call him Todd. Student: What are your main concerns about your health, Todd? Todd: Well, mostly concerns about my blood pressure which sometimes goes up without any warning at all. Student: Do you have maintenance medications? Todd: Yes, but sometimes, I forget to take them, especially when I’m busy thinking about so many things. And then, I’m told that stress about work and family concerns often increases my blood pressure too. So, it’s a lot of different things adding up really. Student: Oh, I see. What would be some of these family concerns? Todd: Oh, you know, their health, their education, stuff like that. Mostly, their health, I guess. With Susan being pregnant and Roger with his ADHD, and my Mom who’s really getting on in years, I guess, those kinds of stuff. Student: But, I think you’re handling it well, though. Todd: I guess so. Student: How do you think you’re handling all of these things going on? Todd: We support each other mostly, I guess. We make it a point to be there for each other as a family. I made a conscious effort to listen to not only the words which the speaker was saying, but also to the entire message he or she was trying to communicate (Daniels, 2004). I also made sure I would not be distracted by what was happening around me, allowing the speaker to speak without any unnecessary interruptions, inserting a word of encouragement or agreement occasionally or when the speaker would stop talking (Antai-Otong, 2007). This made the assessment process more comfortable for me and for the family. During the working phase of the communication process, I used the open-ended communication skill. By using this communication skill, I was able to allow the family to direct the communication process, to feel free to share what they wanted to share (or not share) (Hitchcock, et.al., 2003). The open-ended questions did not restrict their responses to my questions and they felt less pressure to respond in any particular way to the questions. In posing such open-ended questions, I avoided posing questions like why because I knew that it may too imposing on the family, and may put them on a defensive or argumentative plane. I had this conversation with Mrs. Smith: Student: “What are your main concerns about the family, Evelyn?” Evelyn: “Mostly, health concerns, I guess. And the kids’ education too.” Student: “How are they doing in school?” Evelyn: “They’re doing well, mostly. Susan is in college now, and she’s averaging As and Bs, so that’s good. Todd, Jr. is really a good student and great athlete too. Adriana is also averaging As and Bs. I’m worried about Roger, though.” Student: “What worries you most about Roger?” Evelyn: “Well, with his ADHD, he can hardly concentrate in his lessons. He gets teased by his classmates for being behind with his lessons and it just makes it worse for him. Sometimes, he doesn’t want to go to school because he can’t keep up and because of all the teasing he gets.” Information to share with family to promote self-efficacy. Information I would share with family to support self-efficacy, capacity, and resilience in managing their priority health issue related to diet adjustments they could all make. I would share information to them regarding healthy foods they can eat, healthier food preparations they can make, and activities they can engage in as a family in order to help Todd lose weight (Lundy and Janes, 2009). I would primarily share with Evelyn (who usually prepares the meals) the possible adjustments she can make in the food preparation including the use of meat substitutes and the more appetizing preparations she can make for fruits and vegetables. I can also share with her healthier cooking options for the meats, including grilling instead of frying or broiling instead of boiling. The family can also choose an activity they can all participate in. This may include playing badminton during the weekends, walking in the mornings, jogging during the weekends, and similar activities. Specific health plan. 4. Family goal related to their priority health issue (1). Goal setting theory applied (SMART criteria (2)).(please double check this part) Long-term goal: Todd will reach his ideal BMI within a year of participating in the weight loss program. Specific: Reach ideal BMI (less than 30); Measurable: within a year; Attainable: Weight loss program; Realistic: His ideal BMI; Time: within a year. Short-term goal: Within a month (measurable/time-specific) from the start of the plan, Todd will lose at least 5-10 pounds through diet and exercise. Activity 1: At least 30 minutes to 1 hour of exercise daily (measurable), in the morning or his preferred time. Attainable/Realistic: Todd prefers to walk in the morning with his wife and children for at least 30 minutes (time-bound). Activity 2: Reduce fatty meat/pork intake (specific) to at least once a day (realistic) during his first week (time); to be further reduced to at least three times a week during the second week, and once a week during the fourth week (time-bound). Attainable/Realistic: Todd prefers (realistic) to reduce his meat to two food portions with each day (time-bound). Activity 3: Within a week (time-bound), reduce his food portions for meats/pork, making his food portions more balanced, with a portion allocated for vegetables/fruits and another allocated for carbohydrates. Attainable/Realistic: Todd does not like meat substitutes like tofu, but likes at least one bowl of fruits after each meal Activity 4: Within a week (time-bound), increase his water intake to at least 6-8 glasses daily (measurable). Attainable/Realistic: Todd prefers to drink about 1 liter of water daily. Activity 5: Choosing lean portions of the meat; choosing the chicken breast and other healthier meat options, including tuna, salmon and other heart-healthy food options. Attainable/realistic: Todd prefers chicken to fish. Activity 6: Membership with the Bridgepoint Family Health Team. Joining and signing up Todd for sports activities, like badminton and basketball. There were weekly sports activities which Todd could join and which some of the children could also participate in. Activity 7. In order to enhance their goal achievement, the family indicated that they were choosing self-contract. Their self-contract was based on daily goals achieved with each meal and with every exercise they, especially Todd, would be able to complete. At the end of each week, the goals were to be evaluated based on pounds lost. Challenges encountered in the development of plan of action were mostly on what Todd could enthusiastically and realistically participate in. While we were discussing the plan of action, Todd was very much pessimistic about what he could do, what he could and could not eat, and what exercises he could participate in. In the, end, it was difficult to establish a preferred plan of action which he could really comply with. It was not the ideal plan for him, and would take him longer to lose weight, however, his preferred plan was one that would most likely be sustained for a longer period of time (Falvo, 2010). The family was very much supportive of Todd’s weight loss plan, and they were willing to help him lose weight. This support made the challenges of the planning process easier to resolve and it gave Todd the necessary moral support and encouragement he needed to lose weight (Bomar, 2004). In other words, Todd did not feel alone in facing the challenge of losing weight. Communication skills. During the working phase, I used layman’s terms, avoiding the use of complex medical terms when asking and explaining activities (Hunt, 2008). At one point, I had this discussion with the family: Todd: “How important is it for me to stop smoking?” Answer: “It is important for you to stop smoking because cigarettes have nicotine and nicotine causes the blood pressure to increase. Nicotine can also cause damage to your arteries”. Todd: “Would it be better for me to quit cold turkey or to gradually quit smoking?” Answer: “That would be up to you and what you can realistically do. If you think you can quit cold turkey, then you can try that; but for some, they prefer to gradually wean themselves away from smoking.” I was able to provide a simple correlation between the ingredient of cigarette and his illness in words he could easily understand. I also did not use technical words during the communication process. At the closing phase, I applied the therapeutic communication skill of summarizing (Hunt, 2008). At the closing phase, there is a need to review how the goals of the health plan were covered and to determine which possible needs needed to be addressed by the family. Summarizing also allows both the client and the nurse to review the major points covered during the encounter, establish recommendations, suggestions, and disagreements (Bomar, 2004). It also allows for the parties to reflect on their feelings and to discuss necessary points of interest or concern. The therapeutic conversation applying summarizing skill can be seen in the following exchange: Nurse: “Mr. Smith, so it looks like this has been a difficult year for you.” Todd: “Yes, it has, as I suffered from various health issues and financial setbacks as well.” Nurse: “Your concerns about your health and about what to do about your health issues are certainly understandable. And we were able to establish what we could do to help you lose weight.” Todd: “That is certainly a relief to hear because I am really concerned about my health.” Nurse: “Let’s review some of these things you can do to lose weight. I know you will have a difficult time losing weight, but I know you are also eager to make these changes in your life.” Todd: “Yes, I am very much anxious; and I believe I am now ready to make these changes.” Evaluation. 7. Description of the family’s specific plan (4) consistent with their priority health issue (1). Evidence of use of family strengths (1), (I do not see this part) supports/resources (1), including a specific community agency (1) (I do not see this part) for face-to-face support In assessing how Todd was able to meet the goal of losing at least 5-10 pounds after 1 month of exercise and diet, Todd was able to meet such goal as he lost 7 pounds. I was able to assess his weight loss by asking him to step on the weighing scale. He was able to meet the specific goal of his health plan by reducing his pork intake, reducing his food portions, increasing exercise, and increasing fruit and vegetable intake. He was more energetic and did not tire easily; he also looked happier and less stressed; and he visibly lost some weight. The family was also able to help Todd in meeting his weight loss goal by making the same food adjustments and by joining him during exercise. The family goal was generally met because with Todd’s health improving, they were less worried about his health; moreover, their support for each other helped Todd persist in the weight loss plan (Rosdahl and Kowalski, 2007). They were willing to make the change in their life and in helping Todd make these changes. In the end, this support made the transition easier for Todd (Falvo, 2010). The family was able to modify its food and exercise habits, avoiding fatty foods, eating more fruits and vegetables, and engaging in sports and other activities. I assisted the family planning for the other health issues by using their strengths as a family. Since they were very much supportive of each other, I also used that to help manage Roger’s ADHD. Since Roger was hyperactive, the plan was based on activities which could help redirect and manage Roger’s hyperactivity, focusing these into productive activities he could carry out with his family. Such support helped Roger expend his energy and develop his attentiveness in various (Falvo, 2010). He felt less of a burden to his family when he was aware of their support. Such support was also applied in the plan of care for Rose, the grandmother. She was also eager to participate in the activities of the family, and the planning process was based on activities which Rose could also tolerate (Falvo, 2010). The plan in addressing Susan’s pregnancy and impending birth was based on emotional support, discussing what they could do as a family to welcome the baby. Such support was verbalized to Susan and this made her more eager to welcome the baby and less concerned about the circumstances of her pregnancy. Reflection The issues which arose in the development of the relationship with the Smith family mostly involved the following: trust and short duration of time for the implementation of the health plan. It took several visits for me to gain the family’s trust, however, as I consistently exemplified effective communication skills during my interactions with them, they eventually developed trust in me. The main factor which inhibited the development of trust was mostly on the time pressure I was in. The short duration in the implementation of the plan also made it difficult to gradually ease into the process of implementing the plan; I was prompted to combine some aspects of the plan in order to meet expected outcomes at the soonest possible time. Health promotion and therapeutic relationship in working with families and with individual clients are different on various scores (Bomar, 2004). For one, a health issue affecting one member of the family, usually impacts on the entire family; in effect, a health plan to resolve the health issue must also be based on the entire family, not just on the individual who is sick. Another difference is that family support has a significant impact on the fulfillment of health outcomes (Bomar, 2004). Where family support is strong, health outcomes can easily be met; however where support is weak, health outcomes may be difficult to fulfill. Summary I applied the principles of primary health care, specifically the principles of: health promotion, public participation, and intersectoral cooperation. Health promotion was applied in terms of the weight loss plan I was able to establish with the family, promoting and describing the importance of healthy eating and of exercise in the maintenance of health, in the prevention of diseases, and in the management of chronic illnesses. I was able to apply public participation by engaging the family in the plan of care, discussing with them what changes they can make and what changes they were ready and willing to make in their diet and in their exercise. They chose to set the time they could exercise, and how long they could do it; and what diet adjustments they were also willing to make. Intersectoral cooperation was ensured with the participation of the Bridgepoint Family Health Team in the improvement of their general well-being. Their assistance helped secure the participation of other health agencies in their care and recovery. References Antai-Otong, D. (2008). Nurse-client communication: A life span approach: a life span approach. New York: Jones & Bartlett Publishers. Benhagen, E. (2005). Hypertension: New research. New York: Nova Publishers. Bomar, P. (2004). Promoting health in families: applying family research and theory to nursing practice. Philadelphia: Elsevier Health Sciences. Daniels, R. (2004). Nursing fundamentals: Caring & clinical decision making. California: Cengage Learning. Falvo, D. (2010). Effective patient education: A guide to increased adherence. New York: Jones & Bartlett Publishers. Hitchcock, J., Schubert, P. & Thomas, S. (2003). Community health nursing: Caring in action. California: Cengage Learning. Hunt, R. (2008). Introduction to community-based nursing. Michigan: Lippincott Williams & Wilkins. Lougy, R. & Rosenthal, D. (2002). ADHD: A survival guide for parents and teachers. New York: Hope Press. Lundy, K. & Janes, S. (2009). Community health nursing: Caring for the public's health. New York: Jones & Bartlett Learning. Newman, B. & Newman, P. (2008). Development through life: A psychosocial approach. California: Cengage Learning. White, L. (2004). Foundations of basic nursing. California: Cengage Learning. Williams, C. & Davis, C. (2005). Therapeutic interaction in nursing. New York: Jones & Bartlett Learning. Read More