2. Levels of Clientele Unit 2

3. OUTLINS Introductions on the level of clientele The Individual as a Client Difference between patient and a client Family as a Client Definition of terms (family- family nursing-family health-non-health family) Types of Family Characteristics of health family Functions of Family as a Social System Community as a Client

4. The word “patient” comes, the Greek word pathos, which means “PASSION” or “SUFFERING” and from the stem pathein which means “to suffer” It is most commonly referred to as the person who is waiting for or is undergoing medical treatment and care. A client, on the other hand, is a person who may or may not be sick but who engages the advice or services of a health professional. Introduction

5. Facts of community Health Nursing 1- focus : promotion and preservation of health. 2- area of content: skills and knowledge relevant to both nursing and public health. 3- time: continual, not limited to episodic care. 4- Scope: comprehensive and general, not limited to a particular age or group. 4- clients: general populations (individuals, families, communities)

6. Clients of community health nursing composed of different levels of clientele:  Individual  Family  Population group  Community

7. Individual as a Client The community health nurse deals with the individuals – sick or well – daily Individual consults to the health center and receive health services in different forms. Individuals are also seen as both clients and patients during home visits, school clinic consultation, workplace clinic visits

8. Difference between patient and a client May or may not be sick-Sick -the patient always suffers from an illness Collaborates with the health professionals when it comes to his or her care Dependent on health professionals for decision and health care Assumes an active role in health care Passive receiver of health services Health professionals performs health promotion and disease prevention activities Health professionals generally performs early detection activities, management of illness and prevent complication Client Patient

9. Atomistic Approach According to Byrne and Thompson. They view an Man with the different levels of organization that influence body structure and function 1.Chemical Level 2.Organelle level 3.Cellular level 4.Tissue level 5.Organ Level 6.System Level

10. Holistic Approach The holistic views traces the pattern of Man relationship with other beings in the suprasystem of society. It is how Man reacts in a given situational stimuli. Views Man as a whole organism which interrelated and interdependent parts functioning to produce behavior unacceptable or acceptable to the society

11. Five Dimensions of Man

12. Man as a PHYSICAL BEING Characteristics of a individual as genetic endowment, sex and physical attributes such as structure (anatomy) and functions (physiology)

13. Man a PSYCHOLOGICAL BEING Individual as a psychological BEING is capable of feeling, rationality and all conscious and unconscious mental states. His rational side makes him merciful, kind and compassionate

14. Man as a SOCIAL BEING Man is capable of relating to others. His first agent of socialization is the family where he is nurtured, where he learns his first language and where he first learns to socialize

15. Man as a SPIRITUAL BEING Man is capable of virtues such as faith, hope and charity Faith is the unquestioning belief in someone or something Hope is looking forward to something positive Charity is the outward expression of the love of man for his fellowmen

16. Man as a THINKING or INTELLECTUAL BEING Man capable of perception, cognition and communication Intelligence is simply defined as the “capacity to learn from experience and adapt successfully to one’s environment Perception includes selecting, organizing and interpreting sensory information Communication is a human functions that enables man to relate with other human beings

17. Family as the client Family as the client: family is first, and individuals are second Family as a system: focus is on the family as client, and the family is viewed as an interacting system in which the whole is more than the sum of its parts; simultaneously focuses on individual members and the family as a whole

18. Definitions related to family &family nursing: Family: refers to two or more individuals who depend on one another for emotional, physical, and/or financial support; members of the family are self-defined Another definition: A family is a social unit made up of people related to each other by blood, birth or marriage whose central purpose is to create and maintain a common culture.

19. Family Health Family Health: a dynamic changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors or state of the family system. Family Nursing: means nurses and families working together to ensure the success of the family and its members in adapting to responses to health and illness

20. Family Structure: refers to the characteristics of individual members who make up family units; more specifically, the structure of a family defines the roles and the positions of family members. the composition, membership of the family, the organization and patterning of relationships among individual family members.

21. Three family aspects of family structure can be examined Internal structure. External structure. Context.

22. Refers to the following categories: Family composition, the family member. Gender of members. Subsystem(e.g spouse,parentral) through which the family carries out its function. Rank order or position of family members by age and sex. Boundary.

23. Refers to: The type of family, and larger system  Family types includes: *Traditional family: *Non traditional family Traditional family includes 1- Nuclear family, family consists of two generation (children and parents). 2- Extended family: parent, children and other relatives(e.g: grand father, uncles) living together. 3- Single parent family: family with only one parent(divorced, separated, widowed).

24. Traditional family includes 4- Dyadic unclear family: It consists of husband and wife living together without children. 5- Middle age or aging couple: It consists of husband and wife, children have been left home either for study / career or marriage. 6- Step family: one or both parents have children from a previous marriage.

25.  Non traditional family : includes 1- Adoptive family: family who adopt child. 2- Cohabiting family: family living together without marriage. 3- Unmarried couple with children.  The larger system Larger system: Including work, health and welfare.

26. Family as the context has a traditional focus that places the individual first and the family second including five categories: Ethnicity Race Social class Religion Environment

29. The family tends to communicate well and listen to all members. The family affirms and supports all its member. The family member have a sense of trust. The family shares leisure time together. The family has shared a sense of responsibility. The family has traditions. The family shares religious core.

30. They have healthy home environment and life style. They establish regular links with broader community. Their relationships are structured effectively. There is facilitative process of interaction among family members The family respects the privacy of its member. The family teach a sense of right and wrong

31. Family Theories and Models Family TheoryDescription of FamilyView of Person Family Systems TheoryThe family is viewed as a system in which the family members are interdependent and are working towards specific purpose The person is a member of the family system and is also considered a subsystem Developmental Stage TheoryFamilies are viewed as ever- changing and growing; each family member is expected to accomplish tasks at every stage of development which is to create an environment wherein each family member could master the developmental tasks required of him/her to accomplish at each stage of development The person

32. Family TheoryDescription of FamilyView of Person Structural – Functional Theory The family is seen as a social system passively adapting to external influence, instead of acting a change agent in itself A healthy family functions in harmony and organized and organized its members and resources in achieving family goals The person is seen as fulfilling roles within the social system Interactional TheoryThe family is defined in terms of a unity of interacting personalities with assigned positions and roles, expectations and norms of behavior The person is capable of interacting with other family members and is seen as fulfilling roes within the family

33. Family TheoryDescription of FamilyView of Person Role TheoryFamily life is structured according to the roles that are assumed by the person in interaction with others, Roles are learned through socialization and there is high mutual dependence on division of labor within the family Each family members has specialized roles The person is seen in terms of roles, which are specialized or shared, depending on age, sex, social norms, status and complimentarity. Crisis TheoryThe family is made up of member who individually experience a state of disequilibrium resulting from situational, developmental, or social sources of stress called crises Crisis in a person may take the form of an illness, which may pose as a problem to the entire family

35. reproduce the species. Planning and controlling family size

36.  Providing food, clothing, shelter and medical care. The stability of the family unit also gives members as a sense of security.  Met by the parents as they provide the needs of their love ones like.  protection against danger  Reproduction

37. Placement of offspring into functioning adult, capable of assuming adult family roles of husband – father and wife- mother. Providing social togetherness Fostering self-esteem and personal identity tied to a family identity Providing opportunities for learning social and sexual roles Accepting responsibility for behavior Supporting individual creativity and initiative

38. Maintenance of social control both within the family and between family members and outsiders, through allocation of resources and division of duties and responsibilities

39. Meeting the emotional needs of members and determining types and intensity emotional affectional ties among members and providing means of communication among members. Meeting emotional needs and promoting adaptation and adjustments

40. Family provide protection from hostile forces.

41. Family passing along the culture including religion

42. Health tasks of the family Recognize interruption(deviation) of health development of their member such as illness. Making decisions about seeking health care. Dealing effectively with health and non health problem. Maintaining a home environment which help in health maintenance and personal development. Maintaining relationship with community and its health institution.

43. Community As Client A community-wide group of people as the focus of nursing service – The community directly influences the health of individuals, families, groups, subpopulations, and populations who are a part of it. – Provision of most health services occurs at the community level.

44. Dimensions of Community As Client One perspective: – Status: morbidity & mortality data identifying physical, emotional, and social determinants of health – Structure: services and resources – Process: ability to function effectively

45. Dimensions of Community As a Client (cont.) Another perspective: – Location (community boundaries, location of health services, geographic features, climate, flora, fauna, human- made environment) – Population (size, density, composition, rate of growth or decline, cultural characteristics, social class and educational level, mobility) – Social system (variables, health care delivery system)

46. Question Is the following statement true or false? Most health services occur at the individual level.

47. Answer False – Most health services are provided at the community level.

48. Nursing Process Characteristics & Community Problem-solving process; management process; process for implementing change Characteristics: – Deliberative; adaptable; cyclic – Client-focused; need-oriented – Interaction with community (communication, reciprocal interaction, paving way for helping relationship, aggregate application) – Forming of partnerships and building of coalitions

49. Community Needs Assessment Process of determining real or perceived needs of a defined community Types – Windshield survey (familiarization assessment) – Problem-oriented assessment – Community subsystem assessment – Comprehensive assessment (key informants) – Community assets assessment

50. Community Assessment Methods Surveys Descriptive epidemiologic studies Community forums/town hall meetings Focus groups

51. Sources of Community Data Primary: gathered by talking to the people Secondary: records produced by people who know the community well International National State Local

52. Data Analysis and Diagnosis Validation of data  data interpretation Diagnosis

53. Question Is the following statement true or false? An epidemiologic study is one type of community assessment.

54. Answer False – An epidemiologic study is a method for completing a community assessment.

56. Community Diagnoses Portray a community focus Include community response and related factors that have potential for change via CHN; logically consistent; response and factors logically linked Include statements narrow enough to guide interventions Use a community response instead of a risk, goal, or need statement Include factors within the domain of community health nursing intervention Deficit and wellness diagnoses (include maintenance or potential change responses due to growth and development) when no deficit is present

57. Planning to Meet Community Health Needs; Implementing Plans Planning – Tools for assistance: operational definitions of objectives and activities, conceptual frameworks and models; systematic approach – Health planning process Implementing – Preparation – Activities or actions

58. Evaluating Implemented Community Health Plan Measuring or judging effectiveness of goal or outcome attainment Types of evaluation – Formative: focus on process during actual interventions; development of performance standards – Summative: focus on the outcomes of interventions; effect; impact

59. Community Development Theory Outcome of effective community-level nursing practice Collaboration with community members to assess collective needs and desires for positive change and address these needs through problem solving, use of community experts, and resource development Presumption that all community members participate in all aspects of change Agent of change (nurse) considered a partner, not authority figure responsible for community’s health Outcomes benchmarked against those of other groups

60. Question Is the following statement true or false? A formative evaluation focuses on the outcomes of the interventions.

61. Answer False – A formative evaluation focuses on the process during the actual interventions.

62. PHC is accessible to most people & gives opportunities for health staff to promote health. – Health staff need to be role models and advocates of good health. Well Adult Clinics (WAC) caters for adults and adolescents. – WAC promotes healthy lifestyles and early detection and management of health problems. THANK YOU