Family Health Management

Community Exposure

ESTABLISHING A GOOD WORKING RELATIONSHIPWITH FAMILIES

LESSON OBJECTIVE:Using the guide form, establish good working

relationships with families in a community.

INTRODUCTIONInitial attempts to communicate the intention to help

and the nature of the assistance that can be extended to the clients are vital to success in the use of the health process.

The Community Health care Nurse (CHN) must first establish good working relationships with his/her clients before he/she can hope to gain their cooperation in educating them on the health process.

DIRECTIONAssess level of accomplishment in establishing a

good working relationship with each client family by truthfully filling up the required form. The first one is done for you.

Establishing a Working Relationship with the Client Family dela Cruz,Juan

Name of Family Head

CRITERIA CHECK IF DONE(Indicate date)

1. Initiate contact through home visit. 7/8/04

2. Introduce yourself and your agency. 7/8/04

3. Communicate interest in family welfare.

7/8/04

4. Maintain a two-way communication with the family.

7/8/04

5. Show willingness to help with expressed need/s.

7/8/04

CONDUCTING A HOME VISITLESSON OBJECTIVE:Using the guide form, perform the duties and responsibilities

of a CHN during home visits to 10 families. INTRODUCTIONA home visit is a professional face to face contact made by the

nurse to the patient or the family to provide necessary health care activities and to further attain an objective of the agency.

DIRECTION:Conducting home visits (HV) require accomplishing a specific

form. The form below serves as your guide/example. Joseph Santiago June 22, 2004Name of Family Head Date of Visit

STEPS IN HOME VISIT CHECK IF DONE(Indicate date)

1. Greet client or household member and introduce yourself. 6/22/04

2. Explain purpose of home visit. 6/22/04

3.Inquire about health and welfare of client/patient and other family members.Ask about any health-related problems.

6/22/04

4. Place health bag in a convenient place using bag technique. 6/22/04

5. Wash hands, wear apron (PRN) and take out needed articles from bag. 6/22/04

6. Perform physical examination (PE). Administer nursing care. If more than one member has to be health supervised/cared for, start with the well member to avoid transfer of infection.

6/22/04

7. Give necessary health advice or teach basic health care based on client’s needs and condition. If patient is weak or is diagnosed with illness during a visit, give health instructions to a responsible well member of the family.

6/22/04

8. Wash hands and close bag. 6/22/04

9. Record health status of family members and care administered. 6/22/04

10. Make an appointment for next visit either at the clinic or another home visit.

6/22/04

 Upon earning the family’s trust and confidence,

succeeding HVs should include a detailed inspection of household surrounding and a thorough examination of other health problems/concerns.

OTHER MEANS OF CONTACT WITH THE CLIENT/FAMILY

LESSON OBJECTIVE:Using the guide form, perform the duties and responsibilities

of a CHN during the clinic visit of 10 clients. INTRODUCTION:Other means of nurse-client contact in CH besides HV include

Rural Health Unit (RHU) clinic visits, telephone calls (landline or cellular), school or industrial clinic visits, community meetings or through written messages.

Of all these methods, the RHU clinic visits, the school and the industrial clinic visits are the most effective because these involve face to face interaction that helps in accurately determining physical, psychological and educational needs of clients.

DIRECTION: On your RHU, school or industrial clinic duties, accomplish the following forms for

each client. Accomplished form below will serve as your guideSTEPS IN CLINIC VISIT CHECK IF DONE

(INITIATE DATE)

Warmly greet and make client feel at ease 6/22/04A. Pre-consultation conference 6/22/041. Take medical history and health complaints 6/22/042. Take vital signs 6/22/043. Perform physical examination 6/22/044. Recommend selective laboratory exams, such as

stool exam for parasites, urinalysis for sugar, etc., vaginal smear for STD, sputum exam for respiratory infection, and blood smear for Malaria parasite.

6/22/04

5. Record client’s findings 6/22/04B. Medical examination 6/22/041. Assist client before, during and after examination

by the doctor

6/22/04

2. Inform physician of relevant findings gathered on pre-conference

6/22/04

3. Ensure privacy, safety and comfort of client throughout the procedure

6/22/04

4. Observe confidentiality of exam results 6/22/04

STEPS IN HOME VISIT CHECK IF DONE (INDICATE DATE)

C.Nursing Intervention 6/22/04

1. Execute doctor’s orders (i.e., giving oral and injectable medication)

6/22/04

2. Reinforce doctor’s orders/advice 6/22/04

3. Teach the client health measures that are designed to promote and maintain a person’s well-being and health such as proper diet, exercise and personal hygiene

6/22/04

4. Seek information regarding health status of other family members (i.e., immunization status, health problems of elderly, spouse, other children)

6/22/04

5. Counseling 6/22/04

D. Post consultation conference 6/22/04

1. Explain findings and needed care or intervention 6/22/04

2. Refer patient/client to another health or health related agency if necessary

6/22/04

3. Make an appointment for next clinic/home visit 6/22/04

CONDUCTING FAMILY HEALTH ASSESMENTLESSON OBJECTIVE: Using the family assessment guide forms, students should be able to comprehensively

assess 10 families’ Demographic data Home and home environment details; Health and health practices; and Awareness on community resources and organizations ASSESMENT PHASE The family health process involves conducting an initial assessment to determine the

presence of any health problem. The assessment phase includes the collection and analysis of relevant factual

information regarding the client’s current health status, his capacity to solve health problems and his present environment.

The following are three sources of data reflecting the family health status: Health status of family members- shows whether there are deviations in the health

condition of individual members. Ability and willingness of the family to promote wellness among its members- shows

the nature and the extent of the family’s performance of specific tasks to meet the physical, social and emotional needs of its members.

Family environment- defines the conditions in the home and environment that interfere with the promotion and/or maintenance of the family members’ health and recovery from illness.

DIRECTIONWithin three days, visit and interview 10 families in the community and fill up the family assessment guide forms. The accomplished form below will serve as your guide.

FAMILY ASSESSMENT GUIDE Family name dela Cruz____ Address 24 Calmon st. Bgy. Uno, Sitio Des__ I. Demographic Data

Household No.: 1 Barangay House NO.: 1II. Family Data

Length of residency: one yearPlace of origin: Husband- Cebu

Wife- ManilaFamily size: 5Religion: Husband- Roman Catholic

Wife- Roman Catholic

Family Members’s ChartFAMILY

MEMBERSAGE SEX CIVIL

STATUSPOSITION IN THE FAMILY

RELATIONSHIP

TO FAMILY HEAD

EDUCATIONAL

ATTAINMENT

OCCUPATION

1. Jose 24 M M Head - High School level

Carpenter

1. Juana 23 F M Mother Wife High School level

Housekeeper

1. Jose Jr.

6 M S Son Eldest child

Grade1 Student

1. Jane 4 F S Daughter Second child

Nursery Student

1. Jeena 1.8mo F S Daughter Youngest child

- -

Family Characteristics Type of Family StructureA.Extended B. Nuclear ×C. Matriarchal D. Patriarchal × E. Dominant Family Member

General Family Relationship/ Dynamics

CRITERIA STATUS ADDITIONAL INFORMATION

Observable conflicts between family members

(+) Wife beating, frequent quarrelling, child abuses

Characteristics of communication

(-) Talks disrespectfully

Interaction patterns among members

(+) Hurling insults and swearing noted when talking to each other

FAMILY DIETARY HABITS What did you eat yesterday? (24 hours dietary recall)Breakfast: pandesal, kapeLunch: kanin, instant noodle, sagingSupper: kanin, pritong isda, talbos ng kamote Monthly Family Income Source Husband: ×Wife: Others: Monthly Family IncomeTotal (check bracket)Below P5,000.00 ×Above P5,000.00- 10,000.00 Above P10,000.00-15,000.00 Above P15,000.00-20,000.00 Above P20,000.00-30,000.00 Above P30,000.00-40,000.00 Above P40,000.00-50,000.00 More than P50,000.00  

Family Health Status/Health History Father: normalMother: pregnant, 6 monthsChildren: Jose, Jr- scabies, cough and cold

Jana- first degree malnourished, scabies Jeena- second degree malnourished, scabies

Felt Family Needs (Identify and rank according to priority) 1. Dagdag na kita 5. Gamut sa ubo at sipon2. Wastong tapunan ng basura 6. Gamut sa galis3. Kawalan ng tubig 7. Kawalan ng sapat at

masustansiyang pagkain4. Kawalan ng kubeta 8. Pagbubuntis ni Juana

IV. Home and Environment A. Is your lot owned?

Yes × No B. Is your house owned?

× Yes NoC. Type of housing materials

Wood mixed Concrete × makeshift

Other, specify D. Is the living space adequate? (Yes) × (No)E. What are the appliances owned by the family?                     Radio, kerosene stove, plantsaF. Type of garbage disposal

Collected burningWaste segregation burying Feeding to animals throw in the river/sewer

× Open dumping others, specify  

G. Type of waste disposal flush water-sealed

× wrap and throw pit privy others, specify

H. Type of drainage system × Open Close

I. Source of water supply owned shared

bought × others, specify nakiki-igib (deep well)

J. Drinking water storage refrigerated × covered

uncovered

K. Containers used Plastic pitchers jars, clay pots

bottles × others, specify pails

L. Food storage/cooking facilities × covered uncovered

× stove refrigerator × cabinet

pots/pans, etc.

M. Common household pests found at home Ipis, daga, chicken

N. Are there breeding sites of insects, rodents, etc. present? × (Yes) (No)

O. Pets/animals kept in the yard/home Dog, cat, Chicken P. Are there accident hazards present? × (Yes) (No) 

V. Health and health practices A. Common illnesses encountered for the last 6 months and the treatment

applied.

Scabies- dahon ng bayabas cough/cold- kalamansi, tsaa

B. Whom do you consult for health-related problems?  × manghihilot albularyo

midwife nurse doctor Health Center

× Barangay Health Worker Others, specify

C. For problems other than health, whom do you consult?  family members × relatives × Friends Barangay officials

Priest others, specify

D. Immunization status of family members All children not yet vaccinated E. Have you had adequate?

1. Rest and sleep? × (Yes) (No)2. Exercise? (Yes) × (No)3. Relaxation activities? (Yes) ×

(No)4. Stress management activities? (Yes) ×

(No)  

VI. Environment1. Kind of neighborhood Poor rural

2. Social and health facilities Bgy. Center, Plaza

3. Communication and transportation facilities

Tricycle

VII. Awareness of community organizationA. Are you aware of existing organizations in the community?

× (Yes) (No) B. Name all the organization/s you know. Samahang Magkakapitbahay C. Are you a member of any of these organizations?

(Yes) × (No) D. Are you aware of its activities and projects?

(Yes) × (No)E. How are you involved in its activities? Attend meetings give donations planning evaluation

implementation × others, specify not involved F. Name 5 formal and nonf ormal leaders of the community whom

you think can lead the people.1. Mang Elis (albularyo)2. Mrs. Cruz3. Tony4. Kapitan5. Kapitana 

IDENTIFYING FAMILY HEALTH PROBLEMS LESSON OBJECTIVES:Using the forms for identifying and ranking health

problems, students should be able to:

1. List down the health problems recognized in each family;

2. Categorize each health problem into health threat; health deficit or foreseeable crisis;

3. Prioritize health problems according to nature, modifiability, preventive potential; and salience to the family

4. Justify the scores given to each problem, and 5. Rank health problems according to priorities 

After collecting the data, these will be analyzed, sorted out and grouped. The synthesized information will be compared to the norm to determine the nature and source of the data gathered.

From the inference made, conclusions are formed. Hence, diagnoses are formulated and priorities set.

FACTORS AFFECTING PRIORITY STATUSGreater weight is assigned to health deficit over health

threat because the former usually demands more immediate intervention than the latter. On the other hand, foreseeable crisis is given the least attention because culture-linked factors usually provide adequate support to cope with developmental/situational crises.

 The community health manager must consider the some

important factors in defining modifiability of a health problem- or probability of success in minimizing, alleviating, or totally eradicating the problem through health intervention. These are:

 1. Current knowledge, technology and intervention to manage the

problem

2. Resources of the family (physical, financial and man power)

3. Resources of the community (facilities and community organizations)

4. Resources of the community health manager ( knowledge, skill and time)

To decide to an appropriate score for the preventive potential of the health problem- or the nature and magnitude of future problems that can be minimized or prevented if intervention is done, the following factors are considered:

 1. Severity of the problem- the more severe or advanced the

problem, the lower the preventive potential.2. Duration of the problem- the longer the problem has

existed, the lower the preventive potential.3. Current management- application of appropriate

intervention increases the problem’s preventive potential. 

To determine the salience score, evaluate the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention is needed. The family’s concern and felt needs require priority attention.

After the score for each criterion has been finalized, the sum of all scores is determined. The highest possible total score is 5. Priority problems are those with scores nearer 5. The higher the score of a problem, the higher its rank.

LISTING AND CATEGORIZING HEALTH PROBLEMS

DIRECTION: Within 2 days, list down the health problems recognized in each of the 10 families you have visited and interviewed. Compute the score of each problem, justify scores given and rank problems according to priority. The accomplished form below serves as an example.

Example: Student Name:  

Family No: 1Name of family Head: Juan dela CruzAddress: 24 Catmon St., Bgy. Uno, Sitio Dos

List of Health Problems Nature of Problem

1. Cough and cold of Jose, Jr health deficit

2. Scabies of Jeena health deficit

3. Malnutrition of Jana health deficit

4. No potable water health threat

5. Poor environmental sanitation health threat

6. Family conflicts health threat

7. Pregnancy of Juana foreseeable crisis

COMPUTING AND JUSTIFYING SCORES OF HEALTH PROBLEMSDirection: Encircle the actual standard scores & the scores that

apply to the family’s problems. Justify the scores you gave in the indicated column. Compute for the sum of all the actual scores you have encircled & write them on the space provided. See the example below.

Example:Family No.1

Problem: coughs and colds1. Nature of the

problem

●Health Deficit●Health Threat●Foreseeable Crisis

3/21

11/

2/31/3

It is a health deficit

2. Modifiability of the problem

●Removable●Partially Modifiable●Not modifiable

21/0

2210

The family & the community has the necessary resources to treat coughs & colds.

3. Preventive Potential ●High●Moderate●Low

321

11/

2/31/3

Possibility of transferring infection to other members of the family is high & should therefore be given immediate attention. Mother knows ways of treating coughs & colds & has used herbal medicines.

4. Salience of the Problem ●Needs immediate attention●Does not need immediate attention●Not a problem

2/10

11/

1/20

Although there is a possibility of transferring infection to other family members, the infection is not life-threatening

                                                                                                 TOTAL SCORE: 4⅔

Ranking Health Problems According to PriorityDirection: Rank the health Problems of each family. Priority 1 has

the highest score, Priority 2 has the second highest, priority 3, the next highest, and so on. The first one has been done for you.

 Example: Ranking Health Problems of Family dela CruzPRIORITY PROBLEM SCORE

1 Cough & cold 4⅔

2 Scabies 4

3 Malnutrition 3

4 No PWS 2

5 Pregnancy of Juana 1⅓

DETERMINING PRIORITIES & HIGH RISK GROUPS

Objectives: Students should be able to list down the top three

priority health problems of each family interviewed and;Identify families belonging to high risk groups in the community.

RANKING HEALTH PROBLEMS OF FAMILIES IN THE BARANGAY

Direction:

Within one day, list down according to priority the top three health problems of each of the families using the form provided. Then determine which families belong to which high risk group in the community.

Ranking Health Problems of Families in Barangay Uno, Sitio Dos PRIORITY 1 FAMILY NAME PROBLEMS SCORE

1 Dela Cruz Cough & cold 4⅔

2 Santos Primary complex

5

3 Dacanay Scabies 5

4 Rodolfo Tuberculosis 4

5 Antonio Pneumonia 3⅔

6 Chan Asthma 4⅔

7 De Leon Third degree malnutrition

5

8 Balano scabies 5

9 Ramos Second degree malnutrition

5

10 Lazaro tuberculosis 5

FAMILY HEALTH CARE PLANNINGScope: Identify Priority Families for Follow-upDetermining Family Nursing ProblemsPreparing Health Care Plans for Priority FamiliesWorking Out Details of the Plan Together with the Families Concerned

IDENTIFYING PRIORITY FAMILIES FOR FOLLOW-UPLEVELS OF FAMILY FUNCTIONING ACCORDING TO JANE ANTILLA TAPIA

1. Infancy or chaotic Family (dysfunctional)- This level is characterized by

disorganization. The family can barely meet its physiological needs, as well as the need for security & safety.

2. Childhood or Intermediate Family (dysfunctional)- is characterized by

somewhat lesser amount of disorganization than the first level family. Members are only slightly able to meet their need for security &physical survival.

IDENTIFYING PRIORITY FAMILIES FOR FOLLOW-UPIDENTIFYING PRIORITY FAMILIES FOR FOLLOW-UP

3. Adolescent or Family with Problems- is an essentially normal family but has more than the healthy & usual amount of conflicts & problems. As a unit, it is more capable of physical survival & of providing security for its members. The members may not be able to control their words & actions, thus they may be branded as troublemakers.

4. Adulthood or family with Solution (functional)- refers to a

normal, stable, happy & healthy family with fewer than the usual number of problems or conflicts because family members are able to handle most of them.

5. Maturity or Ideal Family (functional)- the family described as homeostatic with a healthy balance of individual & group goal activities & concerns.

PRIORITY FAMILIES IN BARANGAY ___ Uno________

Family name Level of Functioning Justification

1. Santos Infancy Presence of scabies, cough & cold, inadequate housing & clothing, hygiene, child abuse, wife beating & lack of other basic needs

2. Dacanay Infancy Distrusts outsiders, neglects child, refuses health care, parents are immature & socially deviant

3. Rodolfo Childhood Inadequate housing, alcoholic father, poor hygiene, malnourished children

4. Antonio Adolescent One child currently with pneumonia, father lost his job but mother was able to seek help from relatives & the local government

5. Chan Childhood Asthmatic & malnourished children, unemployed parents quarrelling incessantly, eldest child working as a domestic helper

DETERMINING FAMILY NURSING PROBLEMSDirection: Within the day determine the root cause of the priority

families’ health problems as well as their family nursing problems. Example:

Family Name ___dela Cruz___

  Health Problems

Family Nursing ProblemsFirst Level Assessment Second Level Assessment

1. Colds & persistent coughs as health deficits

1. Inability to recognize the existence of a problem

2. Inability to make decisions with respect to taking appropriate health actions

1. Inability to recognize the existence of a problem due to ignorance of facts.

2. Inability to make decisions with respect to taking appropriate health actions due to:

a. Failure to comprehend the nature, magnitude or scope of the problem

b. Lack of knowledge as to alternative courses of action open to them

2.Scabies 1. Inability to recognize the existence of a problem

2. Inability to provide home environment which is conducive to health maintenance & development

3. Failure to utilize community resources for health care

1. Inability to recognize the existence of a problem due to ignorance of facts.

2. Inability to provide a home environment that is conducive to health maintenance & development due to:

a. Inadequate family resources

b. Ignorance of preventive measures

3. Failure to utilize community resources for health care due to:

a. Lack of appropriate information

b. Negative attitude (hiya)

3.Poor Environmental Sanitationa. inadequate potable water supplyb. inappropriate waste disposal methodc. presence of breeding area for insects & rodents

Inability to provide a home environment that is conducive to health maintenance & personal development

Inability to provide a home environment that is conducive to health maintenance & personal development due to:a.Inadequate family resources (financial, inadequacy,& lack of space to construct facility)b.Ignorance of the importance of hygiene & sanitationc.Ignorance of preventive measures

PREPARING FAMILY HEALTH CARE PLANS FOR PRIORITY FAMILIES

A plan of intervention is designed-up on completion of the assessment, & the analysis & health diagnosis of the family.

The purpose of the plan is to elicit behavioral change in the family that will promote dysfunction.

The family is expected to be an active participant in the planning process.

STEPS: 1. Determining the order of priority of existing or potential

problems.2. Identifying problems that can be handled by the community

health nurse & the family, & those that may be referred to others for assistance.

3. Setting goals & objectives to resolve the problems4. Predicting actions & expected outcome.

Direction: Within three to five days, prepare, together with the families concerned, family health care plans for the priority 3 families you have assessed.

HEALTH PROBLEMS

FAMILY NURSING PROBLEMS

GOALS OBJECTIVES INTERVENTION METHODS

METHODS OF NURSING

FAMILY CONTACT

RESOURCES REQUIRED

EVALUATION

Cough & colds

1.Inability to recognize the existence of a problem due to ignorance of facts.2.Inability to make decisions with respect to taking appropriate health actions due to:a.Failure to comprehend the nature, magnitude or scope of the problem.b.Lack of knowledge as to alternative courses of action open to them.

After nursing intervention, the following are expected to take place:1.The chances of spreading communicable diseases to other family members will be slim2. The recurrence of coughs & colds among family members will be prevented or minimized

After nursing intervention, the following should be achieved:1.The family should acquire information about the disease, including signs & symptoms of the disease, immediate health care assistance,& preventive measures.2.Discuss with the family the consequences of failing to take appropriate health action at

1.Discuss with the family members the importance of knowing the necessary information about the diseases to prevent spreading them.2. Provide adequate knowledge on the various ways of maintaining cleanliness in their surroundings.3. Explain the importance of proper food preparation, exercise & rest in strengthening

Home Visit

Clinical Visit

a.Visual aidsb. Time & effort of both the nurse & the familyc. Monetary allowance for nurse’s transportation expenses

CRITERIA: Cured cough STANDARD: In 3-4 visits, cough will be cured through family care.

the earliest possible time. These include the following:a. covering the mouth when sneezing or coughing.b. properly disposing of oral & nasal discharges.c. eating a well-balanced diet composed of economical but nutritious foods.d. maintaining proper personal environmental hygiene.

one’s resistance against illness.4. Provide information onHealth centers in the vicinity for immediate health care assistance

Environmental Sanitation

a.Inadequate safe water supply

b.Improper waste disposal

c.Presence of breeding area for insects& rodents

Inability to provide a home environment that is conducive to maintaining health & personal development due to:a.Inadequate family resources (financial, lack of space to construct facility)b.Ignorance on the importance of hygiene & sanitationc. lack of knowledge regarding preventive measures

After nursing intervention, the family will take the necessary action to improve & maintain the sanitation of their immediate surroundings.

After nursing intervention, the family will take the necessary action to improve & maintain the sanitation of their immediate surroundings.1.The family should know the importance of clean potable water supply & proper waste disposal;2. Boil drinking water;3.Throw waste materials properly or use the dig-burn method;

1.Discuss with the family the importance of environmental sanitation to their health.2. Utilize health measures involving the manipulation or elimination of the following threats:

Home Visit

a.Low cost medical supplies to manage/treat scabiesb.Time & effort of the nurse & the familyc. Budget for buying materials

CRITERIA:1.Cleanliness of house & surroundings2.Construction of sanitary toilet/drainage3.Use PWS STANDARD:After 3-5 vitis, the above criteria will be met by the family.

4.Clean surroundings to eliminate breeding places of pests; and3. Take a bath once or twice a day.

a. physical threats to health are eliminated by improving on the facilities in the home either by constructing needed ones or by modifying those already existing.b. psychological threats are manipulated by working closely with the family to improve communication, role assumptions & relationships,& interaction patterns.

3. Explore with the family the ways of improving home sanitation considering its limited resources.a. Emphasize to the family the advantages of proper garbage disposal.b. Instruct all family members to prevent accumulation of stagnant water around their home since this is a good breeding place for insects.

Scabies as a Health Deficit

1.Inability to recognize the presence of the problem due to ignorance of facts2.Inability to provide home that is conducive to maintaining health maintenance& personal development due to:a.Inadequate family resources.b.Lack of information regarding preventive measures.3.Failure to utilize community resources for health care due to:a.lack of appropriate information.b.negative attitude (hiya)

After nursing intervention, the parents will manage care of the children with scabies.

After nursing intervention, the family members will accomplish the following:1.Become aware & knowledgeable of the presence of health problems among family members;2.Be cognizant of the nature & the extent of the illness;3.Implement the agreed upon health measures in preventing the recurrence of illness by improving personal hygiene & home sanitation despite l4.Be adept in providing in providing nursing care to family members at home.limited resources;

Help family members understand the nature of the present health problem by intensively explaining & discussing with the family members.

Home Visit

a.Time & effort of both the nurse & the familyb. Monetary allowance for nurse’s transportation expenses.

CRITERIA: Knowledge on caring for scabiesSTANDARD: In 2-3 visits, the mother will demonstrate how to care for a child with scabies wounds.

WORKING OUT DETAILS OF THE PLAN TOGETHER WITH THE FAMILIES CONCERNED

Signing a family health-worker contract increases the chances of developing the family’s confidence & ability to give health care to its members.

This provides a systematic method of increasing desirable client behavior by rewarding appropriate behavior or task successfully performed.

The contract specifies the activity or behavior required & the corresponding rewards in exchange for performing the desired behavior/action.

Direction: Within three to five days, prepare, together with the

families concerned, family-health worker contracts for the Priority families you have assessed.

Name of the Family: _______dela Cruz___________________

FAMILY-HEALTH WORKER CONTRACTWe,dela Cruz Family & Mrs.Halilis will increase Jana’s weight by three kilos within two months by following diet planned & recording food eaten with the aide of food supplements, health information materials & free vitamin syrup.

Father’s Signature __________________________________ Mother’s Signature __________________________________ Signature of Other Siblings __________________________________ __________________________________ CNHS Siganture ________Julietta Halilis_______________ Date _________January 24,2000___________________

FAMILY CARE IMPLEMENTATION Scope: This module consists of the following lessons: Health Education/Teaching (Demonstration/Return Demonstration) Visual Aids Making A Referral/Conduction Home Health Care Implementation is putting the family health care plan into action. Implementation phase should be flexible. Family health interventions are geared towards assisting the family in carrying out functions

that the members cannot perform on their own. It assists the family in improving their chances of becoming independent. Promoting health & preventing diseases may not be part of the family’s life experiences, if

this is the case, the health worker must first educate them before any positive behavioral change may be observed.

4 TYPES OF INTERVENTION1. Increasing knowledge & Skills Includes assisting families to make informal choices about helpful lifestyles & behavior that will lessen or

totally eliminate harmful environmental influences that adversely affect their health. First step involves creating awareness that is achieved by working together with the community health

manager to uncover actual or potential problems. Second step, learning to recognize families at risk. Third step, offers families at risk the benefits of knowing how to motivate & support behavioral changes.

2. Increasing family strengths Refers to the factors or forces that contribute to family unity & solidarity, and that fosters the

development of inherent family potentials. Physical, emotional & spiritual factors Healthy child rearing practices & discipline Meaningful & clear communication Support security & encouragement Growth inducing relationships & experiences Responsible community relationships Growth with & through children Self help & acceptance of help Flexibility to family functions & roles Mutual respect for individuality Crisis as a measure for growth Family unity & loyalty & intra-family cooperation Adaptability of family strength Assisting functional families simply involves furnishing them with information that can be

easily understood & providing them the opportunity to ask questions & clarify information

3. Decreasing exposure to risk factors Includes making parental behavior compliment the child’s

behavior. The child’s well being is influenced by the presence or absence of

physical hazards in his/her surroundings. Physical health hazards present in the home should be removed or

replaced for the child’s benefit. Raising healthy, well-rounded children requires plenty of patience & vigilance.

4. Decreasing susceptibilityMeans educating the family on the principles of prevention & the disease control. It is expected that family knows which signs & symptoms need medical attention &

how to take care of minor illnesses.Family perception of health risks & their susceptibility will determine how they

change their behavior.Health workers who introduce threat as a motivator to action are morally obligated

to reduce the threat through meaningful & purposeful interventions.

HEALTH EDUCATION/TEACHING(Demonstration/Return Demonstration)

A major part of the implementation phase is aimed towards developing

the family’s ability to take care of itself through competency-based teaching

Competencies may fall under knowledge, skills, attitudes, emotions, or values.

Competency-based health education is an activity that provides information, promotes skills & enhances communication

It facilitates behavior change for the improvement of the family’s health condition.

Health care needs & problems of individuals & families, as well as the promotion of health & prevention of illness, dictate the contents & coverage of health education.

 Direction: In five days, review Community management 1 module; then

plan & conduct health teaching sessions with family clients & evaluate client learning. Paste pictures documenting health teaching being done. Indicate date & name of client & have it signed below by immediate supervisor.

  A mother signs a Family health Contract Health education rendered to families Conducting health education with families (name of immediate

supervisor)/sgd. (signature of immediate supervisor)

VISUAL AIDS PREPARATION

Illustrations such as drawings or pictures are essential in health education because they provide the visual representation of the concepts presented.

Visual aids facilitate effective learning as long as they are used as intended

Improper use or insufficient visual aids may lead to confusion or misinformation.

Various types of visual aids include photographs, drawings, cartoons, cross-sections, flow charts 

1. Clients must first learn how to interpret the visual aids presented to them

2. Be careful to explain the scale of the pictures3. Test the client comprehension of the illustrations you presented4. Keep your illustrations apt & simple5. Layout is very important Direction: In the space provided, paste self-cared visual aids for the

health teaching on the following topics:1.Wound care2. Sanitation3. Caring for an ill family member4. Caring for a pregnant mother5. Caring for a baby 

MAKING A REFERRAL/CONDUCTIONDirection: Prepare at least three copies of client referral

forms for other health personnel or agencies.

REFERRAL SLIP

Name of Agency to which referral is made _____________________________________________Address_______________________________ Date______________________Name of Patient/Family Head_________________________________ Age_____________Civil Status ______________________________ Occupation_____________________________Address ______________________________________________________________________Case Summary _________________________________________________________________Reasons for Referral/Services Requested______________________________________________

Referring Personnel & Designation ____________________________

Name of referring

Agency_______________________________________________________________

Address__________________________________________________Name of Patient/ family

Head____________________________________________________________

Age __________ Sex _____________

Occupation_______________________________________Services made/ Findings/ Recommendations_______________________________________________ ________________________ Signature & Designation

HOME HEALTH CARE

Direction: Document yourself and/or any member of your client family while dispensing home health care using the processes enumerated below. Paste these in the spaces provided & write the appropriate captions for the pictures.

 a. Bag techniqueb. Thermometer techniquec. Wound cared. Isolation techniquee. Home delivery 

FAMILY HEALTH CARE EVALUATION

The following functioning areas determine the efficacy of the health intervention implemented:

 1. Changes in interaction pattern2. Effective communication/ability to clearly express emotions3. Acquisition and effective use of new skills that promote health4. Problem solving ability 

The criteria for the desired outcome are the basis for evaluation. Once the goals and objectives are reached, the problem no longer exists. If goals and objectives are not achieved, the family and the health worker must review the process to determine if there were gaps in the assessment data, errors in analysis or diagnosis and alternative interventions that might be reviewed to determine the contributing factors that led to the failure of the health intervention employed.

Direction: after reviewing the Lesson 2.2 of the module in Family Assessment, evaluate together with the families concerned the health care interventions executed to solve priority family health problems of chosen clients.

Evaluation ___dela Cruz Family______CRITERION __ability of the family to care for the sick son who has coughs and colds_

Which can be tested through____________________________________________________

STANDARD _family members will answer questions & demonstrate skills that will reflect ______degree of knowledge on the nature of the disease, caring for the afflicted member _and preventing illness.Which was demonstrated as

On three consecutive visits to the dele Cruz home after undergoing health teaching, Mrs. Dela Cruz successfully (1) gave steam inhalation to her sick son using resources available in their home; (2) demonstrated back tapping, which loosens phlegm; (3) administered the herbal concoction (SLK syrup) made with the CHM, which produced good results; (4) coughing lessened phlegm and breathing became easier. No more rales were found up on auscultation; (5) the eldest daughter helped in caring for the son. She gave him food and frequent sips of fluids; and (6) upon asking the questions “Bakit ba nagkakaubo ang tao? Paano ba maiiwasang magkasakit ang bata? At paano ba madaling gagaling ang ubo?”, Mrs. Dela Cruz, the eldest daughter and even the boy gave the correct responses.Three days later, the boy had (7) recovered from the illness; and (8) Mrs. Dela Cruz was able to come to the center for her prenatal check-up. Signed: _____Juana dela Cruz______ ___Dawn Rose Malilio__ Family Member Health Worker

SELF-EVALUATION 

Is assessment of one’s own performance. It provides a greater sense of responsibility &

ultimately saves time. In self-assessment, the community health

manager needs a clear understanding regarding the standards to use & an accurate idea of the task he/she can compare his/her work with to determine his/her level of performance.

Direction: Rate your performance in home health care visits using the form.

FAMILY HEALTH CARE EVALUATION FORMSa pagdalaw ko sa Pamilya _______dela Cruz______ (Pangalan ng Pamilya)Mga batayan (lagyan ng tsek ang angkop na sagot)

OOPalagi

(10 pts)

OOMadalas(8 pts)

OOMinsan(5 pts)

Hindi 

(3 pts)

1. Ipinakilala ko ang aking sarili

X

2. Ipinakilala ko ang aking kasama

X

3. Ako ay gumamit ng tamang pananalita sa pakikipag-usap

X

4. Ako ay nagpakita ng katapatan sa pagtulong

X

6. Ako ay nagpakita ng ugaling medaling pakitunguhan

X

7. Ginamit ko ang pagkakataon upang magturo ng kaalamang pang-kalusugan

X

8. Tinitiyak ko na naiintindihan ang aking itinuturo

X

5. Madali kong nakapaglagayang loob ang mga miyembro ng pamilya

X

9. Ipinaliwanag ko amg mga salitang medical

X

10. Ako ay nagging maayos at mabilis sa paggawa

X

Total: 75%

20 40 15

Iba pang masasabi kulang ang oras at gmit

______Dawn Rose Malilio______Pangalan ng CHN at Lagda

CLIENT EVALUATION

Client evaluation serves as feedback to the service provider regarding services rendered to the client family.

It determines their performance level & reflects how much they have learned in the course of their training/immersion.

Direction: Within the day, have a member of each priority

family where you rendered services rate your performance in home visits using the form.

FAMILY HEALTH CARE EVALUATION FORM

Sa pagdalaw sa aming pamilya ni Mr./Mrs. ______Dawn Rose Malilio_____

Siya ay (lagyan ng tsek ang angkop na sagot)

OOPalagi

(10 pts)

OOMadalas(8 pts)

OOMInsan(5 pts)

Hindi(3 pts)

1. Nagpakilala ng sarili X

2. Nagpakilala ng kasama

3. Gumamit ng tamang pananalita sa pakikipag-usap

X

4. Nagpakita ng katapatan sa pagtulong

X

5. Nagging madaling makapalagayang loob

X

6. Nagpakita ng ugaling madaling pakitunguhan

X

7. Gumamit ng pagkakataon upang magturo ng kaalamang pang-kalusugan

X

8. Naniniguro na naiintindihan ang itinuro

X

9. Nagpaliwanag ng mga salitang medical

X

10. Nagging maayos at mabilis sa paggawa

X

Total: 83%

30 48 5

Iba pang masasabi Mahusay siya. Huwag sana siyang magsawa na kami ay tulungan.

_____JUANA DELA CRUZ____Pangalan ng sumagot at Lagda