Chapter 13: Family Case Management

Focusing on families is important for community/public health nurses because improving the health of a family directly contributes to the overall health of the community. Families are the basic unit of society, and their well-being has a significant impact on the well-being of the larger community. By addressing the health needs of families, nurses can prevent the spread of diseases, promote healthy behaviors, and create a healthier environment for everyone. This approach recognizes the interconnectedness of individuals within a family and the ripple effect their health can have on the community as a whole.

The nurse would visit the client's home to include family and environmental conditions in the assessment. This is important because the client's living situation and support system can greatly impact their health and well-being. By assessing the family dynamics and environmental factors, the nurse can better understand the client's overall situation and develop a more comprehensive care plan. Additionally, visiting the home allows the nurse to observe the client's living conditions and identify any potential barriers or challenges that may affect their recovery or ability to follow medical advice.

Observation and interaction with the family members would be the most helpful source of data for a community/public health nurse conducting a family assessment. This is because direct observation and interaction allows the nurse to gather firsthand information about the family's dynamics, relationships, and health behaviors. It also provides an opportunity for the nurse to establish rapport and trust with the family, which can enhance the accuracy and completeness of the data collected. Information from other cooperating health care agencies, input from other professional health care providers, and review of family members' charts and medical record data may provide additional information, but they are not as comprehensive or personal as direct observation and interaction with the family members.

Establishing a relationship with the family should be the priority action for the nurse because it is important to establish trust and rapport with the family in order to provide effective care. By building a relationship, the nurse can gather important information about the family's needs, concerns, and resources, which will guide the nursing interventions. This will also help the nurse to understand the family's dynamics and cultural background, which are crucial for providing culturally sensitive care. Additionally, establishing a relationship will help the nurse to effectively communicate and collaborate with the family in developing a plan of care that meets their specific needs.

The nurse can conclude that the mother is struggling with understanding and managing the baby's behavior, indicating a need for education on growth and development. This suggests that the family would benefit from assistance in learning how to support the baby's development and address any behavioral issues effectively. Referring the family to community resources such as a daycare center or reporting the mother's actions to child protective services may not be necessary or appropriate based on the information provided.

The correct answer is a. Teach the family member with the most resilience and competence to do what must be done to ensure that it gets done. This answer focuses on identifying the family member who is best equipped to take on the responsibility of caring for the ill member. By teaching this family member, the nurse ensures that the necessary care will be provided effectively and efficiently. This approach recognizes the importance of selecting a capable caregiver rather than assigning the responsibility based on gender or perceived weakness.

The nurse should take the next action of confirming the information with the client because it is important to gather accurate and reliable information directly from the client themselves. Even though the wife provided the information, it is necessary to verify it with the client to ensure accuracy and to allow the client to have a voice in their own care. This step also helps to establish a trusting and therapeutic relationship between the nurse and the client.

The nurse agreed to tour the gardens because examining the environment helps identify potential health or safety problems. By taking a tour of the yard and gardens, the nurse can assess the surroundings and identify any potential hazards or risks that may affect the client's health or safety. This allows the nurse to provide appropriate recommendations or interventions to ensure a safe and healthy environment for the client.

The nurse is accomplishing the goal of providing the married couple an opportunity to review how they interact with each other. By reviewing important family events, the nurse can assess the dynamics of their relationship, identify any issues or areas of improvement, and provide guidance or support as needed. This process allows the couple to reflect on their interactions and potentially make positive changes in their relationship.

By asking questions about what each family member did during the day, including school, work, and recreation outside the home, the nurse is creating a picture of the family's relationships with outside agencies and resources. This information can help the nurse understand the family's support system, access to resources, and potential challenges they may be facing. It can also provide insight into the family's social connections and overall well-being.

The most appropriate response is c. Now is when the family may recognize the need for change. This response suggests that during times of crisis, individuals and families may be more open to recognizing and addressing the need for change. It implies that the nurse believes that the family's current state of stress may create an opportunity for them to be receptive to learning better coping mechanisms. This response demonstrates a thoughtful and empathetic approach to supporting the family during their difficult time.

The most appropriate action for the nurse to take is to assure the mother that her feelings are normal and that no one likes being exhausted. This response validates the mother's feelings and provides support and understanding. It acknowledges that being a new parent can be overwhelming and tiring, and reassures the mother that she is not alone in feeling this way. This approach promotes a trusting and empathetic relationship between the nurse and the mother, which can encourage the mother to seek help and support when needed.

The most appropriate action for the nurse in this situation would be to help the family deal with anxiety and uncertainty. The father's belief that the physician looked serious indicates that there may be a potential serious health issue for one of the family members. The nurse should provide emotional support, reassurance, and information to help the family cope with their anxiety and uncertainty during this difficult time. Assisting with recognizing and meeting the children's needs, discussing illness management skills, and sharing literature about hospice would not be the most appropriate actions in this situation.

The most important variable in determining the probable success of the plan is who agreed to implementing the plan. The success of any plan heavily relies on the commitment and willingness of the individuals involved in executing it. If all members of the family are on board and actively participate in implementing the plan, it increases the chances of success. Their agreement indicates their dedication and cooperation, which are crucial factors in achieving the desired outcome. The involvement and commitment of the individuals involved play a significant role in the success of any plan.

The primary goal of case management of families is to work towards maximizing the family's self-care capabilities. This means that the case manager aims to empower the family to take care of themselves and their needs as much as possible, promoting independence and self-sufficiency. This may involve providing resources, support, and education to help the family develop the skills and knowledge necessary to manage their own care effectively. By doing so, the case manager can help the family become more self-reliant and less dependent on external assistance.

The nurse should summarize all the data into five or six categories. This will help the nurse organize and make sense of the overwhelming amount of information gathered. By categorizing the data, the nurse can identify patterns, prioritize the most important information, and create a more manageable plan of action. Meeting with the agency supervisor and reviewing the data together may be helpful, but it does not directly address the issue of feeling overwhelmed. Talking to a colleague and sharing the information may provide some support, but it does not address the need to organize the data. Working with the family at the next visit to draw conclusions is premature without first summarizing and analyzing the data.

The nurse should share with the family the two resources that are the most immediate needs: housing and food. This is the next step because the family is facing a crisis with the father's illness and they need immediate assistance. By providing them with information and resources for housing and food, the nurse can help address their most pressing needs and ensure their basic necessities are met. This will provide stability and support for the family during this difficult time.

The nurse should address the area the family wants to address first because it is important to prioritize the needs and preferences of the family when providing care. This approach ensures that the family feels heard and involved in the decision-making process, which can lead to better outcomes and satisfaction with the care provided. Additionally, addressing the family's immediate concerns can help establish trust and rapport between the nurse and the family, which is essential for effective communication and collaboration throughout the care process.

The nurse should encourage the family to use close friends and neighbors as a source of social support because they are likely to be familiar with the family's situation and can provide emotional support and practical help. They are also readily available and can offer a sense of belonging and connection, which can help alleviate stress. Family service workers from the agency may be helpful, but they may not have the same level of personal connection and understanding as close friends and neighbors. Family self-help groups and mental health counseling centers can also be beneficial, but they may require more time and effort to access compared to close friends and neighbors.

The correct answer is d because quizzing a diabetic client about his current diabetic medications before discharge is an example of summative evaluation. Summative evaluation involves assessing the client's knowledge and understanding of a specific topic or skill at the end of a learning period. In this case, the nurse is evaluating the client's knowledge of his current diabetic medications before he is discharged, which demonstrates the use of summative evaluation.

The correct answer suggests that the lack of response by the family could be attributed to the common tendency of all families to resist change, even if it is beneficial. This implies that the family may have been reluctant to make the suggested changes due to their natural resistance to change, regardless of the potential benefits it may have brought.

The most appropriate intervention for the nurse in this situation is to try to help the family find meaning in their situation. Since the father has been told that his cancer is too advanced for treatment, it is important for the nurse to provide support and assistance to the family in coping with the emotional and existential challenges they may face. Helping the family find meaning in their situation can provide them with a sense of purpose and understanding, which can be valuable in navigating the difficult journey ahead.

After discovering that other family members desperately need health care as well, the nurse's priority assessment should be providing care for the client who has been discharged from the hospital. This is because the nurse's primary responsibility is to ensure the well-being and recovery of the client under their care. While it is important to address the needs of other family members, the immediate focus should be on the client who has just been discharged and requires immediate attention and care.

By emphasizing how many sessions the family may receive, the nurse is redirecting the focus of the family interaction towards the problems that need to be resolved or improved. This intervention helps to keep the family on track and motivated to address the issues at hand.