Project DIO-MAN-JI

FAMILY – THE CELL OF SOCIETY

What is a family?

How well a family works together and how well it can organize itself against potential threats depend on who its members are and the activities or roles the family members carry out. Recognizing different family structures allows health care providers to focus on family-centered care or provide a family-friendly environment for care.

A family is traditionally defined as a group of people related by blood, marriage, or adoption. However this definition is limited when assessing a family for its health concerns or the support people available because some families are made up of unrelated couples, and at certain points in life not all family members may live together. A broader definition of family is then formulated. A family then is two or more people who live in the same household, share a common emotional bond, and perform certain interrelated social task. This definition addresses the broad range of types of families that health care providers often encounter.  Our chosen family – the “Diomanji” family – worked immensely hard for so long a time to fit this definition.

By context, we define “family client” as a group of people who live in the same household, share a common emotional bond, and perform certain interrelated social tasks to which health care is directed. With the aid of health care providers, the family client is the co-facilitator of its own care.

But such care can only be achieved if health workers dedicate themselves to mastering an organized and dynamic approach towards health. The Family Health Care Process is a deliberate activity where the practice of a health worker is performed in a systematic manner wherein the health worker utilizes comprehensive knowledge as a base to assess the family’s health status. Involving in the health care process entails making judicious statements of health problems and to plan, implement and evaluate the plan of care.

To every successful activity, planning is an essential factor. It is expected of a health worker to be always geared towards achieving optimum health care provision for his/her clients. This can be carried out through having a properly prepared nursing health care plan, where interventions are purposely made for a specific family client.

FAMILY HEALTH CARE
A Family Health Care Plan (FHCP) is the blueprint of care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care and deliberately chosen set of interventions, resources, and evaluation criteria, standards, methods and tools.

The importance of the Family Health Care Plan is as follows:

1. It individualizes care to clients. Planning facilitates the delivery of the most appropriate care by considering the uniqueness of each client.

2. The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his problems. From the available data, the nurse sets his priorities for care.

3. The nursing care plan promotes systematic communication among those involved in the health care effort. Problems are defined and the details to resolve the nursing interventions are present.

4. Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in the services provided are minimized, if not totally eliminated.

5. Nursing care plans facilitate the coordination of care by making known to other members of the health team what the nurse is doing. Coordination of care prevents fragmentation of services and increases the efficiency of health service delivery system.

Developing a Family Health Care Plan involves many steps:

a. the prioritized condition/s or problems based on its nature, modifiability, preventive potential and salience
b. the goals and objectives of nursing care. We should formulate (a) expected outcomes which include conditions to be observed and client response/s or behavior, and (b) specific, measurable client-centered statements.

c. the plan of interventions, where the nurse (a) decides on family-centered alternatives, and measures to help the family eliminate barriers and underlying causes of health tasks; (b) determines methods of nurse-family contact; and (c) identifies specifies resources needed.

d. the plan for evaluating, where we should specify outcomes based on methods and objectives of care.

At the end of the family-health care worker relationship, the family is expected to continue strengthening their health potentials and minimizing, if not totally eliminating, the health risks and problems. The family must have also learned all the teachings on health promotion and disease prevention taught to them by the health care provider/s. Moreover, such teachings should be applied and practiced in their daily living. The outcomes that will result from our family health care plan will be our basis in modifying, changing or terminating our plan of care. We as health care providers should still keep in touch with the family client even after the family health plan implementation so as to establish continuity of care.

KNOWING THIS UNIQUE FAMILY

A single mother, a handicapped son and an aunt – they form the triad of the “Diomanji” family’s humble abode. Situated in the upper fragments of the mountainous terrains of Amgaleyguey, Buguias, Benguet is the brick house of the family, a house that surpassed the bone-chilling cold, blinding fog and treacherous mountain rocks. For more than a decade, it is here where they live; for many years, it is here where they start dreaming of a better life; for almost their entire lifetime, it is here where they think dreams would forever just be dreams.

The event was glorious. Fourteen shivering individuals freed themselves of the red van’s confines. Twelve were college students, one was an instructor, the other was the driver who might have forgotten that the ones riding in his van were people and not Buguias vegetables. These individuals stepped out to the cold and unforgiving atmosphere with only their flimsy jackets and mittens on. They were still nauseated.

Then it happened. A family of twelve and a family of three – two families bound to meet unknowingly at a certain junction in the most highly-elevated highway at a certain hour of a foggy morning on a certain duty day. Was this luck?

Behind the blurry spectacle that the clouds had brought, there lay the silhouette of a woman seemingly waiting outside of a familiar brick house. She seemed to face away, a reason for the twelve to notice a bulk on her back. It was strapped on a white cloth with its ends tied around her left shoulder. The bulk let out an unusual whimper. The bulk was moving.

It was “Baby Manny” – the one whom the community duty instructor was talking about weeks ago. At first, the little child seemed like he was only one-and-a-half years old. But he is not. He is already five years old. He is severely malnourished. As if this little boy’s malady is not enough, he has another handicap that cripples him to his ill bed. He has cerebral palsy.

Then there were more. While the student nurses continued with their history taking and physical assessment of the family, more and more of the family’s dilemma surfaced to dig deep into the students’ hearts, one by one. The father has left them for another family. They have very scarce funds for their daily living. They all have physical ailments… and more… It’s as if the world has forsaken them. It was heartbreaking.

At that time, the role of being community health student nurses dawned upon the twelve individuals as they started providing the care that they can give to this humble family. They have little time left to do the best they can – very little time, indeed.

A single mother, a handicapped son and an aunt – they struggle to fill the gaps of their own living. They struggle to attain a status with which they can be called a family.

KNOWING THE CHALLENGERS
What did Baby Manny and her family do to receive these? An infinitesimal question that knows no answer, just yet… Luck or destiny might have played their roles to this family. But who is to blame? The answer is a needle on a haystack. Cerebral palsy (in severe malnutrition), and stroke are the respective ailments that Baby Manny and Auntie Dionisia were fighting against.

According to Wikipedia website, Cerebral palsy (CP) is an umbrella term encompassing a group of non-progressive, motor, non-contagious conditions that cause physical disability in human development.

Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder most likely involves connections between the cortex and other parts of the brain such as the cerebellum), and palsy refers to disorder of movement. CP is caused by damage to the motor control centers of the developing fetal brain and can occur during pregnancy (about 75 percent), during childbirth (about 5 percent) or after birth (about 15 percent) up to about age three.

It describes a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behavior, by epilepsy, and by secondary musculoskeletal problems.

There is no known cure for CP. Medical intervention is limited to the treatment and prevention of complications arising from CP's effects.

On the other hand, stroke is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or inability to see one side of the visual field. In the past, stroke was referred to as cerebrovascular accident or CVA, but the term "stroke" is now preferred.

A stroke is a medical emergency and can cause permanent neurological damage (as manifested by Auntie Dionisia), complications, and death. It is the number two cause of death worldwide and may soon become the leading cause of death worldwide. Risk factors for stroke include advanced age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol diet, cigarette smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

Now there are many other conditions that restrain the Diomanji family from improving their health state, be it in the physical, emotional, mental and financial level. It is up to us student nurses to try to educate and empower them to live a healthy lifestyle to the best of their abilities.

Impossible? For student nurses who are ever so willing to try, impossible is nothing!