Health Care for the Nation
9. The pediatric nurse is aware that “race” as a concept is best defi ned as how persons _______ one another
and _______ one another.
10. The clinic nurse is aware of the effects of poverty on the families seen in the clinic as the poverty rate has ________ yearly since the year 2000. At present, the most impoverished group is _________.
See Answers to End of Chapter Review Questions on the Electronic Study Guide or DavisPlus.
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chapter 2 Contemporary Issues in Women’s, Families’, and Children’s Health Care 45
Intervention Wheel Professional Nursing Role:
Change Agent Healthy People 2010
Contemporary Issues In Women’s, Families’, and Children’s Health Care
Factors/Trends Influencing Health Issues
Current Health Status/
Health Issues
• US: 27th in life expectancy
• Major national health problems:
- AIDS; homelessness: drug abuse;
domestic violence
• Increased need for chronic illness management in the aged
• Increasing need for delivering culturally competent health care
• Disparities in HC: access; treatment;
role discrimination
• Childbirth trends: increased maternal age at birth; more elective C-sections
• Physical inactivity/obesity
• “Class” gap = shorter, less healthy lives for “lower” class
Infants/Children:
• Infant mortality rate falling
• Leading causes of death:
- SIDS; accidents/violence;
malignant neoplasms;
homicidal assaults; suicide
• Health issues/trends - Obesity/Type II diabetes - Lead exposure - Asthma
- Rise in ADHD/autism - Self-image issues - Sexuality/pregnancy - Substance abuse
• Assesses epidemiology of population’s health
• Uses broad determinants of health
• Encompasses three intervention “levels” and 17 intervention categories
• Comprehensive focus on prevention
• Know how to access current/accurate knowledge
• Implement community-based programs for screening/
prevention/education
• Be aware of alternative HC delivery systems & nursing role
• Develop an ethical framework for practice
Families:
• Environmental hazards
• Natural disasters
• Poverty-related concerns asthma & waste sources
• Increased rates of uninsured/
under-insured
Women:
• Causes of death: heart disease, cancer, stroke
• Nutritional deficits
• Lack of exercise
• Increased smoking
• No decline in # of pregnancy-associated deaths in 20 years
• 1/2 of all pregnancies unintended/unwanted
• US Dept. HHS
• Blueprint for national health goals - Increase quality/years of healthy life - Eliminate health disparities within
the US population
• 28 focus areas
• 467 disease prevention/health promotion objectives Politics:
• How & where $$$ is spent
• How health care is delivered
• Public programs/policies Socioeconomics:
• Poverty rates: women most impoverished
• Male-female wage-gap
• Digital divide: have/have not
• Increasing vulnerable populations Personal/cultural trends:
• Increased use of technology
• Cultural/language barriers
• Degree of patient autonomy/self-care
• Trend toward early discharges
• Increased use of CAM therapies Societal Health Trends
Guided by Guided by
Collaboration In Caring:
• Bioethical committees
Now Can You:
• Discuss the Intervention Wheel and Healthy People 2010 goals
• Identify population trends that relate to health, including identifying vulnerable populations
• Describe nursing actions that improve children’s health in the US
• Discuss influences that impact the nation’s health
Across Care Settings:
• Parish nurse serving the church community Nursing Insight:
• Critical to listen to young patients’ illness stories
• Develop awareness of relevant statistics
• Understand implications of genetic research
• Holistic nursing = addressing needs of mind/body/spirit
Complementary Care:
• Blogging to facilitate healing: promote sense of community
CONCEPT MAP
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46
chapter chapter
The Evolving Family
Q
uestion of FamilyWhat is a family but a collection of beings dwelling together?
But it is more than that
One person might see a refuge from the storms of society…
Another, a prison to prevent help from the outside world.
It can be both and more.
We draw our fi rst breath in the presence of our family and hopefully
… we are held in family’s arms when we sigh our last.
We learn all that is good in its caring boundaries or keep secrets of terror locked in its heart.
The difference between knowing love and trust and learning never to love or trust is in what passes between members of the family and what is passed on through members to their families.
What have you learned from your family?
What will you pass to your family?
— Brian Fonnesbeck, 2006
L E A R N I N G T A R G E T S At the completion of this chapter, the student will be able to:
◆ Identify different structures of the modern American family.
◆ Describe theoretical concepts that apply to the family.
◆ Assess the family using selected family assessment tools during an interview.
◆ Apply specifi c family nursing diagnoses and interventions to the family.
◆ Discuss special family problems that often require nursing intervention.
◆ Compare various family cultural characteristics that may impact nursing care.
◆ Expand patient care to include and involve the family in every nursing setting.
3 3
moving toward evidence-based practice: Parenting Concepts Among Culturally Diverse Cultures
McEvoy, M., Lee, C., O’Neill, A., Groisman, A., Roberts-Butelman, K., Dinghra, K., & Porder, K. (2005). Are there universal parenting concepts among culturally diverse families in an inner-city pediatric clinic? Journal of Pediatric Nursing, 19(3), 142–150.
The purpose of this study was to examine universal concepts in parenting philosophies and practices, which are in common across multiple cultures. The researchers used a grounded theory approach with ethnographic interviews of 46 English-speaking families representing 27 countries. All participants were from families of well children in an inner city hospital clinic in the Bronx, New York. The children’s ages ranged from 7 days to 15 years of age. The researchers stated that New York City has
long established immigrant neighborhoods, tolerance, and plen- tiful jobs, factors that have been instrumental in attracting diverse cultures during the past century.
Interviews were completed using a question guide com- posed of open-ended questions, which were developed by the research team. The purpose of the questions was to elicit stories or examples from parents regarding the everyday care of their children. From transcribed interviews, 22 thematic categories (continued)
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chapter 3 The Evolving Family 47
moving toward evidence based practice (continued) were identifi ed, which were condensed into 11 common themes.
The themes were subdivided into three broad headings: parent- ing philosophies; infl uence of American culture and perceived opportunities for children; and parenting practices. Similarities were identifi ed among families in all categories.
Findings from the study indicated that a sense of commu- nity, family, and spirituality or religion was strong among all cultures, as was the importance of teaching values, respect, and the need for strict discipline. Television was considered to be an educational infl uence and parents believed that opportunities existed for jobs and higher education for their children. Parents expressed concern for child safety when playing alone outside
and mistrusted nonfamily babysitters. Parents also indicated a preference for medical treatment rather than home remedies during episodes of acute illness. They expressed concern regard- ing the desire for preserving individual cultural heritage versus becoming assimilated into American society.
1. Based on this research, do you believe that suffi cient evi- dence exists to generalize the study fi ndings to all culturally diverse populations?
2. How useful is this information to clinical nursing practice?
See Suggested Responses for Moving Toward Evidence-Based Practice on the Electronic Study Guide or DavisPlus.
Introduction
This chapter addresses the assessment of families and highlights interventions for families encountered in a vari- ety of nursing settings. Viewed through the lens of the media, actual and perceived changes that have taken place in the American family since the 1940s are explored.
Modern-day family structures and challenges are described and various theories from psychology, sociology, and nursing are presented to provide a reference point for fam- ily assessments and interventions. A nursing diagnosis is presented and described in detail to illustrate the possible goals, interventions, and evaluation criteria that could be used with a family that is experiencing problems with daily functioning.
Concepts such as developmental and group stages of the family, communication, roles and relationships, and special need families are presented to assist with the planning and implementation of family centered care. Cultural character- istics and comparisons of American family orientation with families from various ethnic backgrounds provide the nurse with a starting point for the delivery of culturally sensitive care for American and international families.