Community Nursing Discussion Case Management

Chapter 20 Family Health Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Working with Families    Working with families has never been more complex or rewarding than now. Nurses understand the actual and potential impact that families have in changing the health status of individual family members, communities, and society as a whole. Families have challenging health care needs that are not usually addressed by the health care system. . Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 How Do You Define a Family? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Definitions of a Family Historical definitions:  The environment affecting individual clients  Small to large groups of interacting people  A single unit of care with definable boundaries  A unit of care within a specific environment of a community or society Current theorists:  Two or more individuals who depend on one another for emotional, physical, and economic support. Members of family are self-defined. – Hanson & Kaakimen (2005)  The family is who they say they are. – Wright & Leahey (2000) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Inclusive Definitions of Family “Family” means any person(s) playing a significant role in an individual’s life. This may include person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both differentsex and same-sex significant others. “Family” includes a minor patient’s parents, regardless of gender of either parent … without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles. – Human Rights Campaign ( 2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 The Changing Family  Purposes of the family ➢ ➢  To meet the needs of society To meet the needs of individual family members Examples of different family types ➢ Traditional, nuclear family ➢ Multigenerational family household ➢ Cohabitating families ➢ Community Nursing Discussion Case Management

Single-parent families ➢ Grandparent-headed families ➢ Gay or lesbian families ➢ Unmarried teen mothers Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 The “Sandwich” Generation Figure 20-1 From Pew Research Center: Social and Demographic Trends: The Sandwich Generation. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed March 15, 2013. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Why Is It Important for the CHN to Work with Families?     The family is a critical resource. Any dysfunction in a family unit will affect the members and the unit as a whole. Case finding can identify a health problem that leads to risks for the entire family. Nursing care can be improved by providing holistic care to the family and its members. – Friedman, Bowden, & Jones (2003) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Approaches to Meeting the Health Needs of Families Moving from the Individual to the Family Moving from the Family to the Community Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Moving from the Individual to the Family  Family interviewing ➢ Manners ➢ Therapeutic conversations ➢ Genogram and Ecomap ➢ Therapeutic questions ➢ Commending family or individual strengths ➢ Issues in family interviewing • Many locations, family informant, family health portrait, involvement of children  Intervention in cases of chronic illness Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Moving from the Family to the Community       The health of communities is measured by the well-being of its people and families. Families are components of communities. Cross-comparison of communities must include health needs as well as resources. Cross-compare the needs of the families within the community and set priorities. Delegation of scarce resources is essential. A double standard in public health is tolerated. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 Family Theory Approach 1. Any “dysfunction” that affects one member will probably affect others and the family as a whole. 2. The family’s wellness is highly dependent on the role of the family in every aspect of health care. 3. The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12 Family Theory Approach (Cont.) 4. Commonalities in risk factors and diseases shared by family members can lead to case finding within family. 5. Individual is assessed within larger context of family. 6. Family is vital support system to individual member. – Friedman (1994) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13 Systems Theory Approach The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem). – Friedman (1998) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14 Healthy Families     Members interact with each other; listen and communicate repeatedly in many contexts. Healthy families establish priorities. Members understand that family needs are the priority. Healthy families affirm, support, and respect each other. Members engage in flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision making that affects them. – DeFrain (1999) and Montalvo (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15 Healthy Families (Cont.)     The family teaches family and societal values and beliefs and shares a religious core. Healthy families foster responsibility and value service to others. Healthy families have a sense of play and humor and share leisure time. Healthy families have the ability to cope with stress and crisis and grow from problems. Community Nursing Discussion Case Management

They know when to seek help from professionals. – DeFrain (1999) and Montalvo (2004) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16 Structural-Functional Conceptual Framework  Internal structure ➢  External structure ➢ ➢   Family composition, gender, rank order, functional subsystem, and boundaries Extended family and larger systems (work, health, welfare) Context: ethnicity, race, social class, religion, environment Instrumental functioning (routine ADLs) Expressive functioning ➢ Emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17 Developmental Theory  Family life cycle (Duvall & Miller, 1985) ➢ ➢ ➢ ➢ ➢ ➢ ➢ Leaving home Beginning family through marriage or commitment as a couple relationship Parenting the first child Living with adolescent Launching family (youngest child leaves home) Middle-age family (remaining marital dyad to retirement) Aging family (from retirement to death of both spouses) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18 Family Health Assessment Tools  Genogram ➢  Family health tree ➢  A tool that helps the nurse outline the family’s structure Family’s medical and health histories Ecomap ➢ Depicts a family’s linkages to their suprasystems Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 19 Family Health Assessment Tools  Family Health Assessment ➢ Addresses family characteristics, including structure and process and family environment ➢ Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family ➢ Additional information obtained through observation of family and their environment Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 20 Genogram Figure 20-2 Redrawn from Genopro Software: Symbols used in genograms, 2009: www.genopro.com. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 21 Ecomap Figure 20-4 Redrawn from Hartman A: Diagrammatic assessment of family relationships, Soc Casework 59:496, 1978. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 22 Social and Structural Constraints   Identify what prevents families from receiving needed health care or achieving a state of health Usually based on social and economic causes ➢ ➢ ➢ Literacy, education, employment If disadvantaged, often unable to buy health care from private sector Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 23 Family Health Interventions  Institutional context of family therapists ➢ ➢ ➢ Ecological framework: A blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment Social Network Framework: Involves all connections and ties within a group; social support Transactional model: A system that focuses on process as opposed to a linear approach Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 24 Applying the Nursing Process    Knowledge of self, previous life experiences, and values is crucial in planning home visits Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home Flexibility is important in working with families Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 25 Chapter 9 Case Management Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Case Management … “… is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality cost-effective outcomes.” – The Case Management Society of America (2009) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2 Nursing Case Management … … is “a dynamic and systematic collaborative approach to provide and coordinate health care services to a defined population. The framework includes five components: assessment, planning, implementation, evaluation and interaction.” – American Nurses Credentialing Center, ANA Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3 Care Management Overall goal: Improve the coordination of services provided to clients who are enrolled in a care management program.   A collaborative process An emerging concept that is… ➢ evidence based ➢ patient centered ➢ clinical care focused Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4 Care Coordination  Target chronically ill persons at risk for adverse outcomes and expensive care ➢ Community Nursing Discussion Case Management

Identify full range of problems that increase patients’ risk of adverse health events ➢ Educate in self-care, optimization of treatment, and integration of care ➢ Monitor patients for progress and early signs of problems  Hope to raise quality of care, improve health outcomes, and reduce need for costly hospitalizations and medical care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5 Patient-Centered Medical Homes  Seven characteristics: ➢ ➢ ➢ ➢ ➢ ➢ ➢ Patient’s relationship with primary care physician Physician-led, team-based care “Whole persons” require comprehensive care at various stages of life Integration and coordination of care Quality and safety Improved access to care Payment system that accurately reflects the efforts and care provided by the team Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6 Purposes of Case Management  Client centered ➢  Help the client through a complex, fragmented, and often confusing health care delivery system and achieve specific client-centered goals. System-centered ➢ ➢ Recognizes that resources are finite Promote cost-effective, high-quality care Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7 Possible Case Management Functions        Identifying the target population Determining screening and eligibility Arranging services Monitoring and followup Assessing Planning care Reassessing   Helping clients through a complex, fragmented health care system Care coordination and continuity Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8 Case Managers    Must have appropriate educational background A minimum skill level is needed to ensure success in the role Certification as a case manager is available ➢ Case Management Association of America (CMSA) ➢ American Nurses Credentialing Center (ANCC) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9 Role Functions of Case Managers (CMSA, 2002)  Essential activities of case management ➢ Assessment ➢ Planning ➢ Facilitation ➢ Advocacy ➢ Collaboration Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10 Case Management in Community Health     Community case management models Public health clinic settings Occupational health settings High-risk clinic settings ➢ ➢   Clients with chronic diseases Home health and hospice Case management research International settings Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11 • Name DQ Rubric 2019 • • Community Nursing Discussion Case Management

Description Rubric Detail Levels of Achievement Criteria Proficient Competent Novice Introduction and quality of discussion’s Argument Weight 60.00% 100.00 % It is consistent with application in research related to its context. Clarity of ideas. Comprehensive, indepth and wide ranging. 70.00 % The topic has a partially weak association to clarity of ideas and related topic. Relevant but not comprehensive. 15.00 % Unable to address any part of the question and/or topic. Little relevance/some accuracy. Objectivity of Tone, overall quality & Review of Literature in APA 6th format within past 7 years Weight 10.00% 100.00 % Tone is consistent, addressed professionally and objectively. Evidence in literature supports arguments. 70.00 % The tone is not consistently objective. Some observations, some supportive evidence used. 15.00 % No objectivity in tone. No evidence of literature review provided. Lacks evidence of critical analysis, poor to no use of supportive evidence. Grammar / Writing Skills Weight 7.50% 100.00 % Excellent mechanics, sentence structure and organization with no grammatical mistakes. 70.00 % Some grammatical lapses , uses emotional responses in lieu of relevant points. 0.00 % Poor grammar, weak communication, lack of clarity. Peer Reply #1 Weight 7.50% 100.00 % Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions. 70.00 % Some ability to meaningfully comment on other students work and ask meaningful questions. 0.00 % No peer response Peer Reply #2 Weight 7.50% 100.00 % 70.00 % 0.00 % No Peer response Levels of Achievement Criteria Overall APA Use Weight 7.50% Proficient Competent Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions. Some ability to meaningfully comment on other students work and ask meaningful questions. 100.00 % Demonstrates an exceptional ability to apply 6th edition APA standards. 70.00 % Some ability to to apply 6th edition APA standards. i.e. use of in-text citation, reference structure, quoting,etc. Novice 0.00 % No adherence to 6th edition APA standards. …