Outline

I......Introduction
II.....Components of Assignment
III....Problems and solutions
IV....Outcomes
V.....Bibliography

I. Introduction

A. Goal of Assignment

Analyze a family's development over the first year of an infant's life, as individuals within the context of family, and as members of a community.

B. Objectives of Assignment

1. Apply family developmental theories to an individual family

2. Apply the nursing process by:

• completing formal individual and family assessments
  
• developing a problem list, plan of care and critical path
  
• identifying community resources
  
• collaborating with families to implement plan
  
• evaluating effectiveness of interventions
  
  

3. Examine the relationship between the family and their community by completion of a/an:

• windshield survey of the community in which the family resides
• environmental home assessment
  
• sociocultural assessment of the family
  
  

C. Definition of family and community in this context

A family is a group of two or more people who have a commitment to each other and live together. These individuals may be related by blood or marriage, but they may also be individuals who care about each other and live together, such as friends.

D. Logistics

1. Packet with full case study assignment with updates at beginning of subsequent courses

2. Introduction to making home visits

• Safety of student and family
  
• Family privacy
  
• Early planning for future visits etc.
  
  

3. Family selected during inpatient Family-Infant Clinical

• Letter of introduction to family

4. Grading

II. Components of Assignment

A. Common components - completed at each visit

1.Family roster and a genogram

2.List of Health Care Providers

3.Narrative assessment in the areas of:

• Family support
  
• Social support
  
• Financial support
  
• Community support
  
• Recreation Activities
  
• Family perception of community problems
  
• Home environment
  
  

4. Analysis of family dynamics

5. Critique and analysis of the home visit

6. Problem List and Planned interventions

7. Evaluation and revision (2nd and 3rd visit)

B. Individual Components

1. Childbearing Family

• In hospital data collection
  

Assessment of pregnancy, childbirth, and early family development
Maternal Postpartum Adaptation (Affonso)
MIST: Mother Infant Screening Tool (Reiser)
Family demographic data

• First Visit 1 - 4 weeks after discharge
  
  
• Home data collection
  

Completion of demographic data collection, initial completion of narrative assessments, assessment of level of preparation for the newborn

• Development of
  
  Family Problem List
  Outcome Statements
  Initial interventions
  
  

2. Childrearing Family

• Second Visit 4 - 6 weeks after first visit
  
  
• Verification of Demographics
  
  
• Update of narrative assessments
  
  
• Data Collection Tools:
  
  HOME Inventory (Bradley & Caldwell)
  Child Safety Home Checklist (Wong)
  Pediatric Health History
  
  
• Revision of the family problem list
  
  
• Development of health promotion critical path
  
  

3. Community Health

• Third Visit 6 - 10 weeks after second visit
  
  
• Verification of Demographics
  
  
• Update of narrative assessments
  
  
• Data Collection Tools:
  
  Community Assessment, Windshield Survey
  Environmental Home Assessment Checklist
  Sociocultural Assessment of the family (Geissler)
  
  
• Revision of the family problem list
  
  
• Summary of Experience with this family
  
  
  

III. Problems and solutions

A. Family Issues

1. Unavailability of the family

• Assistance with finding family if they move
• Choice of family from pediatric clinical
• Choice of family from own community

2. Resistance to student visits

• Student encouragement
• Examination of source of student concerns
• Intervention with family

3. Preterm infants

• No longer used because of variable of discharge date

B. Student Issues

1. Driving Distance

• Selection of family from student's county of residence

2. Student fear

• Expansion of Home Visit Safety Lecture
  
• Sharing of experiences among students
  
• Meeting with faculty
  
• Selection of alternative family

3. Lack of follow-up to verify that the visits were actually completed.

• Faculty make random calls to families

IV. Outcomes

-Increased depth of student understanding of family.
-Less focus on details of paper work on more on dynamics of how the family evolves over time.
-Students helped to see the environment and culture within which they were providing care.
-Relationship of content presented in multiple courses clearer.
-Could be used over entire curriculum with visits in Adult and Mental Health courses.

Return to Outline

V. Bibliography

Affonso, D. (1987). Assessment of maternal postpartum adaptation. Public Health Nursing, 4,
Bradley, R., & Caldwell, Bettye, M. (1988). Using the HOME Inventory to assess the family environment. Pediatric Nursing, 14, 97-102.
Geissler, E. (1994). Pocket guide to cultural assessment. St. Louis: Mosby-Year Book, Inc.
Lotas, M., Penticuff, J., Medoff-Cooper, B., Brooten, D., Brown, L. (1992). The HOME SCALE: The influence of socioeconomic status on the evaluation of the Home Environment. Nursing Research, 41, 338 - 341.
Reiser, S. L. (1981). A tool to facilitate mother-infant attachment. JOGNN, 10, 297.
Stanhope, M. & Lancaster, J. (1996). Community health nursing: Promoting health of aggregates, families, and individuals (4th ed). St. Louis: Mosby-Yearbook, Inc.
Stanhope, M. & Knollmueller, R. (1996). Handbook of community and home health nursing: Tools for assessment, intervention, and education (2nd ed). St. Louis: Mosby-Yearbook, Inc.
Wong, D. (1995). Whaley and Wong's Nursing care of infants and children. St. Louis: Mosby-Year Book, Inc.

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Family Roster

(Note: Formated here for hypertext and simplicity of download.)

Initials--Age--Gender--Ethnicity--Education/Occupation--Family Position

1.

2.

3.

etc.

Return to Common Components

Health Care Providers

(Note: Formated here for hypertext and simplicity of download.)

Primary Care Provider-------Specialty: Family practice, dentist, ob/gyn, peds

1.

2.

3.

etc.

Return to Common Components

Narriative Assessments

(Note: Formated here for hypertext and simplicity of download.)

Family Support

Visit # 1 Visit # 2 Visit # 3

Family support

Visit # 1 Visit # 2 Visit # 3

Social support

Visit # 1 Visit # 2 Visit # 3

Financial support

Visit # 1 Visit # 2 Visit # 3

Community support

Visit # 1 Visit # 2 Visit # 3

Recreation Activities

Visit # 1 Visit # 2 Visit # 3

Family perception of community problems

Visit # 1 Visit # 2 Visit # 3

Home environment

Visit # 1 Visit # 2 Visit # 3

Analysis of family dynamics

Visit # 1 Visit # 2 Visit # 3

Critique and analysis of the home visit

Visit # 1 Visit # 2 Visit # 3

Return to Common Components

Family Problem/Needs List

(Note: Formated here for hypertext and simplicity of download.)

                 Problem/Need # 1   Problem/Need # 2   Problem/Need # 3 etc.
              
Desired Outcome

Intervention @ visit # 1

Evaluation @ Visit # 2

Revised Outcome

Additional Interventions

Evaluation @ Visit # 3
 
Revised Outcomes
 
Additional Interventions
 

Return to Common Components

Sample Letter to Families

To: 	Families agreeeing to visits form UCF Undergraduate Nursing Students
From:	Dr. Ermalynn M. Kiehl, RN, Assistant Professor
	Dr. Diane M. Wink, RN, Associate Professor
Date: 	May 1997

Thank you for agreeing to welcome a UCF nursing student into your home as 
a part of their course requirments. Their goal is to observe the normal 
development of a family after the birth of a baby. The student is required 
to visit a family three tiems: once shortly after giving birth; a second 
time within a month or two; and finally during the Fall when the baby is 
several months old. This assignment allows the student to better understand
the changes and challenges facing you ng families todya. During these visits, 
the student will not be providing direct nursing care but will be asking 
questions, making observations, and providing appropriate teaching and 
referrral. During the second visit, the student will complete a home safety 
inventory which they will share with you.

The student will be giving us a report of their visit. No names will be used i
n the report. We will be asking the students to provide us, on a separate form, 
your name and phone number in case we need to contact you. If you have any 
questions or comments, please do not hesitate o call either of us at the 
following numbers: XXX-XXX-XXXX (Dr. Kiehl) or XXX-XXX-XXXX (Dr. Wink).
Both of these numbers have voice mail on which you can leave a message 
if we are not immediately availalbe. If it is necessary to reach someone 
immediately, please call the main school of Nursing office number 
XXX-XXX-XXXX.

Again, thank you for your contribution to this student's education.

Return to Logistics

Assessment of pregnancy, childbirth, and early family development

A. Prenatal Health Data
	1. Medical History
	2. Gynecological History
	3. Obstetrical History
	4. Current Health Status
	5. Antepartum Period
B. Intrapartum Period
	1. Onset of Labor
	2. Hospital admission
	3. Labor sumamry
	4. Family reactions and coping behaviors
	5. Birth summary
	6. Immediate care o fthe newborn
	7. Family interaction with their newborn
C. Postpartum/newborn period while hospitalized
	1. Mother
	2. Newborn

Return to Childbearing

Grading For Family Case Study





Grading: Childrearing Family

1.	History/Demographics/Narriative Assessments	25%
2.	Analysis of Family Dynamics	20%
3.	Analysis of the Direct Nursing Care	20%
4.	Analysis and Critique of Home Visit	15%
5.	Brief Screening Inventory and MIST	10%
6.	Problem/Needs List	10%





Grading: Childrearing Family

1.	Updated Demographics/Narriative Assessments	20%
2.	Analysis and Critique of Home Visit	10%
3.	Pediatric Health Assessment	20%
4.	HOME Inventory and Child Home Safety Check List	10%
5.	Updated Problem/Needs List	20%
6.	Critical Path	20%





Grading: Community Health

1.	Updated Demographics/Narrative Assessments	15%
2.	Windshield Survey	15%
3.	Environmental Home Assessment Checklist	5%
4.	Sociocultural Assessment of the Family	15%
5.	Updated Critical Path	10%
6.	Updated Problem/Needs List	15%
7.	Summary of Experience	10%
8.	Overall quality of paper	15%


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Community Focused Care
Over Multiple Courses

© 1996 Ermalynn Kiehl and Diane Wink

The "Community Focused Care over Multiple Courses" assignment was developed by Dr. Ermalynn Kiehl and Dr. Diane Wink to be used as an assignment for courses at the University of Central Florida. This assignment was also the basis for a presentation at Nursing Education '97 sponsored by Allegheny University of the Health Sciences in January, 1997. Faculty are welcome to adapt this assignment for course use if full credit is given to the authors. Retransmission or reproduction of this material for other than use in individual courses is not allowed without prior permission from the authors.


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