Chapter 27, 28, 41 Flashcards Preview

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Flashcards in Chapter 27, 28, 41 Deck (52):

Family definition

Is broadening as the numbers of nontraditional families increase


What has happened to the number of households since 1940



single person households

more people living alone, higher life expectancy= more single person households


impact of single person households on healthcare

single indiv may delay seeking care, transportation may be a problem, isolation from other family members



higher age for first marriage, divorce rate for people 50 years or older doubled between 1990-2010


Increased occurance of cohabitation

potential for negative child well-being, parental separation 5 times more likely than for married couple, increase in unstable living conditions, higher rate of poverty in cohabitating families


avg age of mothers birth




in 2010, 20% of all US births were to mothers born outside the country


family caregivers

30% of american adults. most provide care for someone 50 or older. most caregivers are over 50 themselves. *children are becoming caregivers; this affects their school permance and health


four approaches to family nursing

family as context, family as client, family as system, family as component of society


family as context

individual first, family second, family as influence, family as helpers


family as client

family primary, individual secondary, family=sum of its members, response of the family as a whole


family as a system

family as international client, whole is more than the sum of its parts, interactions among family members become the focus, all are effected


family as component of society

one of many institutions, primary unit of society (where do they get community support?)


family systems theory

families are social systems; thus, nurses can learn much from a systems approach (how does the indiv participate in functions of entire family)


family development and life cycle theory

focuses on predicted stresses of families as they change and transition over time (what stressors are most probable to occur)


health of the nation leading cause of death

shift from infectious disease to chronic disease as leading cause of death. link between lifestyle and health; link between heredity and lifestyle/environment


neuman systems model

physiological, psychological, sociocultural, developmental, spiritual


health risk: inherited biological risk

age-related risks, social and physical environment risks


health risk: environmental risks

social aspects, physical aspects


health risk appraisal

assessing for factors associated w/an increased likelihood of an unhealthy event (does this family wear seat belts?)


health risk reduction

based on the assumption that decreased risk (in number or magnitude) lowers probability of an undesired event


family crisis

family lacks or loses the ability to cope w/a specific event or multiple event and becomes disorganized or dysfunctional (demands of the situation exceed the resources of the family)


continuous stress has negative effects on...

physical and mental health, family communication, positive growth-tendency to get "stuck", potential for abuse, child development and education


home health care focus

focus is on the three levels of prevention


home health nursing focus

focus is on empowerment for highest possible levels of function and health


hospice and palliative care focus

focus is on optimizing quality of life for those experiencing life-limiting, progressive illness


cleveland clinic 1987

first comprehensive, integrated palliative care program


medicare and medicaid

recognized importance of home health nursing right away, but didnt reimburse for hospice nursing until 1980s


population focused home care

public health services make home-visits thatre usually related to primary prevention. (tuberculosis directly observed therapy)


transitional care

ensures coordination and continuity of health care as patients transfer between different locations and different levels of care in the same location (hospital to home. prevents further complications of going back into hospital)


home based primary care

(provider goes to pt) offers patients an alternative to receiving services in primary care clinic, community center, or physicians office. serves patients with functional or other health problems that make the trip from their homes to other care sites very difficult


examples of home based primary care

veterans health administration hospital-based home care program, medical home (centralized and accessible)


home health

-provided care at home- focused mostly on tertiary prevention, helps pts and families achieve improved health and independence in a safe environment.
-medi-care certified
-recipients have diverse needs (most common dx is circulatory disease, then neoplasms and endocrine diseases (esp diabetes)
-skilled nursing services
-national and state regulations in place


hospice and palliative care: 4 types of care

routine home care w/intermittent visits, continuous home care when condition is acute and death is near, general inpatient/hospital care for symptom relief, respite care in nursing home of no more then 5 days at a time to relieve family members


four categories of hospice providors

home health agencies, hospital-based facilities, skilled nursing facilities, freestanding facilities


four foci of hospice

1. attention to body, mind, and spirit
2. death is not a taboo topic
3. health care technology used with discretion
4. clients have a right to truthful discussion and participation in treatment decisions

*support family that will be left behind too


problems with communication

incomplete or missing documentation from rushed assessments, low health literacy levels, failure to use current evp


consequences of poor communication

higher risk of readmission, poorer outcomes


involving family in clients care

improves self-management of care, results in fewer medication errors, improves health outcomes


goals of ACA

provide patient protection, ensure availability of affordable health care, decrease overall cost of health care


the remaining uninsured

undocumented immigrants, citizens who choose not to enroll in medicaid, residents of states that opt out of medicaid expansion provision (voluntary program)


five skills for effective home visits

observing, listening, questioning, probing, prompting


before you go: home visit

clarify referral- do you have all the info you need, actual or potential problem identified, possible resources (family, physician, school nurse, caseworker), pre-encounter data (referral source, family, previous needs)


assessment tool qualities

uncomplicated language (fifth-grade level), take 10-15 min to complete, relatively easy and quick to score, renders valid data for decision making, diversity sensitive



assessment instrument. can be as involved or as simple as you want them to be.



family unit in relation to other units or subsystems in the community. close look at family interaction with various groups in the community. (what support systems are available? faith based resources)


interviewing someone in their home

general to specific; save sensitive topics such as religion, sexual partners or similar topics topics until at least the middle of the interview; fill out assessment tool in car so patient more comfortable; ask family what they think of their current situation, and they would identify as their most pressing problems. *write little, listen more. know what information you need before you go in, write down what you will most likely forget and when done w/the visit fill in the blanks


contacting with families

working agreement that is continuously non negotiable and may or may not be written. goals can change over time and be used as building blocks


evaluation of the plan

determine whether- the plan is working, the plan is working fast enough to address the problem, the plan is addressing only part of the problem, the plan needs to be revised based on changes

*if the plan is not working, identify barriers


nurse related barriers to effective goal setting

paternalism, negative labeling, overlooking family strengths, neglecting culture, poor assessment and goal setting at the onset


barriers to effective goal setting family related

poor decision making skills, too many problems-hard to focus