The family can be defined simply as any group of people who live together. The role of the family is to help meet the basic human needs of society. (LeMone, Lillis, and Taylor 2001, p 27). The family is the social system and the larger biological context within which medical problems arise and are managed over time. Thus, knowledge of the family can be significant for understanding the etiology of illness and therapeutic resources for managing the problem. In total, the family affects the health of the individuals and the family is affected by the health of its members.
Therefore, the family assessment is an essential component of family- centered community health. "Assessment can be viewed as a systematic evaluative process that leads to specific judgments about a given person's current and potential level in variety of setting" (Hanson, 2001). According to Roffman (1998) family assessment is very important as it helps in full understanding and unbiased view of the family; not just its problems; but also its strengths, values, and goals. Nursing practice as focus in the family wellness, solving health related problem, promote health and prevent diseases in the family. Through assessment we can identify the quality of family functioning, know the strength and weakness of the family unit and we will have general view of health status of family members. Furthermore, by identifying the actual and potential health problem we will help the family to manage their own health problems as well as conserve and strength community services for health care and health promotion.
Health promotion is defined as the process of enabling people to increase control over and to improve their health. (Ewles & Simnett, 1999). Also it is defined as the science and art of helping people in changing their life style and to move toward a state of optimal health, .( Edelman C.L & Mandle C.L, 1998).
The fundamental aspect of health promotion is that it aims to empower people to have more control over aspects of their lives which affect their health (social, economic and environmental aspect). It can be offered to all clients regardless of their health and illness status or age. It is more than the avoidance or prevention of disease. It includes primary prevention activities as well as wellness promotion activities. The individual will decide to make the changes that will help to promote a higher level of wellness.
Pender stated that health promotion is directed toward increasing the level of well being and self actualization of a given individual or group. Health promotion focuses on movement toward a positively balanced state of enhanced health and well being. (Pender, 1987).
Nurses need to assess the family's health in order to make them able to adapt more effective attitude in regard to promote their health. In our case we found it easy to contact and approach our client since she is very pleasure, cooperative, and understandable woman. We found Mrs. F.A.A in the mother and child department as she was known case of diabetes and the community health nurses know her so they asked her to be our patient for the assigned project but in the beginning she refused and then she agreed after thinking about that. We talked to her and took appointment to visit her in her house. She welcomed us and opened her heart with thoughts and concerns and we found that attitudes very helpful to complete our project successfully with the benefits to the clients.
General Patient Profile:
F.A. is 53 years Bahraini female house wife, holding file number1/819/734.Has history of many diseases, Diabetes type 2, Rheumatoid Arthritis, Bronchial Asthma, Ischemic Heart Disease and Epilepsy with Depression.
Assessment is the collection of data about the individual's health state. (Carolyn J.4th ed.p 2) and part of assessment is physical examination. Physical examination is the process by which a physician or a nurse examines the patient's body parts for signs or clues of disease.
Mrs. F. is 53 years, young and well developed according to her age. Skin uniformly white in color, soft, warm, moist, and elastic. No edema or lesions. Hair is straight, black and white in color and well distributed. Nails are firm no clubbing, breaking or cyanosis, capillary refill <3sec.
Neck: full range of motion in all direction.
Temporomandibular joint (TMJ): no slipping or crepitation.
Upper extremities (UE): Arms symmetrical, she is able to move her shoulders and elbows, but weak muscle strength. She can perform active ROM in both arms and elbows, but it is slightly limited.
Lower extremities (LE): legs symmetrical, she is able to move her leg and feet, but weak muscle strength. There is crepitation in her both knees.
General: Mrs. F. is alert, oriented to time, place and person, can recall recent and past events.
UE: able to distinguish sharp from dull on face and UE, feel vibration, unable to identify objects that kept in hands.
LE: unable to distinguish sharp from dull, she cannot feel vibration.
All reflexes are present.
Heart and Peripheral Examination of Mrs. F.:
Heart: No lifts, thrills, or abnormal pulsations. P.M.I. palpated between 5th and 6th intercostals space (ICS), (MCL). PMI is 2.5 Cm wide. Apical pulse 99 beat/min, heart sounds S1 and S2 with normal characteristics. No Murmur heard. Internal Jugular Vein present with supine position and absent with sitting. No bruits over carotid artery.
Upper and lower extremities with no edema, warm and all pulses present +3. No varicosities noticed in lower extremities.
Bp: 180/ 100mmHg.
Brows, lids, and lashes intact; no tearing, conjunctiva pink without discharge, Rt.pupil react equally to light and accommodation; Rt. Eye extra ocular movement intact, visual field not equal to examiner, red reflex present. Cornea, lens, and vitreous clear, retina pink, macula present. Snellen test done the result was Rt. Eye 6/18, Lt.6/12 and patient wearing glasses and following up in eye clinic in SMC regularly every 3 months. laser therapy done previously
Symmetrical breasts size, there was no palpable mass or discharge. Axillae were non tender with no lymphadenopathy. She did breast examination two times before in the national breast examination survey. Mrs. F. was instructed to do periodic self breast examination.
Symmetrical, round, no lesions, bowel sounds audible in all four quadrants, no bruit pulsation over aorta. No masses or tenderness. Liver edge was not palpable span of 7.5 cm at MCL. No CVA tenderness. No umbilical hernia.
The Client Community Setting
Mrs. F.A.A is living in A'ali village in an old ministry of housing 2 story unit with an extension of flats built in the back side and second floor of her house for her 4 children whom are living with their families, the setup of the block is very simple and has narrow roads between houses.
There is a small mini compound of few convenient stores (cold store, cafeteria, butchery shop, fruit and vegetable store and a bakery shop) that Mrs. F.A.A can walk to as well as the presence of a safe neighborhood; there is no major health hazard, just a nearby hose reconstruction that may cause noise disturbance.
A'ali health center is a type A health center which is located approximately (0.7) km from her home. A'ali health center was officially opened in June 2000. It is located in the middle governorate. It is located in the middle of the catchments areas which serves approximately 31,000 clients. It provides health services to all the residents and expats.
Mrs. F.A.A. is visiting the health center less frequently for follow up because she is following all of her appointments at Salmaniya Medical Complex, she is well oriented to the health center's facilities such as Diabetic clinic and health educator, but she is not following any of these clinics although the family physician had referred her.
There are so many community facilities surrounds her home such (matams) and a health club in a saloon nearby , she is well oriented also to these places ,but she stated that she do not like to be involved in such activities , moreover she visits the matams ( Al Qae'm Maatam ) only in special occasions such as ashoora .
There are so many recreational places such as a small open public garden near the health center which can be a good walking place as well as A'ali's walking arena that was opened the past few years, and many historical land marks such as the famous A'ali burial tombs and the poetry factories, but she don't have interest to be involved as well.
Primary health care activities in relation to the client's health condition
A'ali health center is type A health center provide many services that contribute and promote Mrs. F. health condition for example Diabetic clinic, eye clinic, Laboratory services, X-ray department, Appointment system and Health Education.
The Health Center has one diabetic clinic only on Thursday, and it gives services from 7am to 2pm. The services of the clinic includes laboratory, diabetic foot care, health education, follow up and evaluation of diabetic patient's status.
Our patient is not following in the diabetic clinic, all her appointment in S.M.C.
The health center provides appointment to patient to follow with the family physician in the health center.
The patient has several appointments to follow in Salmaniya Medical Center referred by the doctors from the health center as follow :
-Regular appointment in health center
Health education department:
Health education is another service available in the health center .There is one health educator in the health center, but Mrs. doesn't like continuing appointment with health educator.
Treatment and medications
She is following regularly the collection of her medications from Salmaniya Medical Center. She is taken (Glucophage 1gm BD, Tegretol 200mg OD, Lipitor 20mg HS, Natrilix 1.5mg OD, Aproval 150 OD, Fersolate 1tab BD, Zertic 10 mg HS, Lisinopril 20mg, Amlodipine 10mg).
The patient doing investigation regularly in health center and with the result she is following with doctors in Salmaniya Medical Center.
The Client Community Setting
F.A.A is living in A'ali village in an old ministry of housing unit in a simple compound with an extension flats built in back side of her house for her 4 children whom are living with their families.
A'ali health center is a type A facility which is located approximately (*****) km from her home.
She is living in a safe neighborhood; there is no major health hazard, just a nearby hose reconstruction that may cause noise disturbance.
F.A.A. is visiting the health center less frequently for follow up because she is following all
Of her disease condition at Salmaniya Medical Complex, she is oriented to the health centers facilities such as Diabetic clinic and health educator, but she is not following any of these although the family physician had referred her.