1. Advanced Community Health Nursing for
Family and Population
Topic: Family at Risk
Most.Rozina Begom
Id: MSN 190506
Major: Community Health
Nursing
2. Learning out come
1. Identify the vulnerable Families.
2. Understand the families crisis.
3. Helping families cope with crisis.
4. Know the characteristics of families
with disturbances in internal
dynamics.
5. Strategies for working with multi
problem families.
3. Vulnerable Families
Vulnerable families are families at
increased risk because of the intensity
and clustering of stressors associated
with life event.
Examples of families at high risk for
future health problems are families
with members who are chronically ill
or have Down syndrome or
alcoholism.
4. Vulnerable families
Most vulnerable families can be
divided into two general types:
(1) Families that are experiencing
crisis
(2) Families with chronic problems.
5. CRISIS and STRESSORS
A crisis is any event that
is going to lead to an
unstable and dangerous
situation affecting an
individual, group,
community, or whole
society.
A stressor is a chemical or
biological,agent, environme
ntal condition, external
stimulus or an event that
causes stress to
an organism.
6. Family crisis
Families experiencing crisis:
Family crisis is a continuous disruption, disorganization,
or incapacitation of the family social system.
Families in crisis may have serious disturbances in family
organization and require basic changes in family patterns of
functioning to restore stability. Crises come in many forms.
7. Family Crisis
Examples include cheating on one's
partner, feeling suicidal, drinking too
much (alcoholism), physical and
sexual abuse, drug use and divorce.
These behaviors are often symptoms
of the family's inability to adapt to
change and to solve problems.
The family may become so
disorganized it is unable to overcome
the crisis.
8. Common stressors in life
Examples of life stresses are:
The death of a loved one.
Divorce.
Loss of a job.
Increase in financial
obligations.
Getting married.
Moving to a new home.
Chronic illness or injury.
Emotional problems
(depression, anxiety, anger,
grief, guilt, low self-esteem)
9. Coping mechanisms
Coping mechanisms are the strategies people often use in
the face of stress and/or trauma to help manage painful or
difficult emotions.
Coping mechanisms can help people adjust to stressful
events while helping them maintain their emotional well-
being.
11. Nurses responsibilities
Nurse’s responsibilities on helping families cope with
crisis
1.Start by recognizing sources of family resilience and
strength.
2. Offer hope.
3. Help the family identify and describe the nature of the
stressors.
4. Explore the family’s appraisal of the situation, including
its meaning to members and their judgment of their ability
to respond.
5. Provide information about the nature and demands of the
stressor that may not be known to the family.
12. Nurses responsibilities
6. Help the family divide the tasks required by the stressor
into manageable pieces.
7. Help the family explore current and alternative coping
mechanisms.
8. Validate and emphasize the use of internal family
resources, including personal and family strengths.
9. Pull in external sources of social support.
10. Arrange for tangible sources of external support such as
financial assistance, health care, home visitors, support
groups, food assistance, and transportation.
11. Encourage a positive reappraisal of the situation as the
family moves from adjustment to adaptation to their new
state.
13. Families with chronic problems
Ever since nurses began visiting in the community, they have
encountered families that have had chronic problems and
many barriers to achieving optimal health.
Some of the families have experienced generations of
poverty, as well as problems in many areas of functioning
such as physical, psychological, and social.
14. Cont.
Some families experience multiple situational stressors
simultaneously (multi problem families).
Some families are vulnerable, some are presented with
only negative choices, some struggle with poverty, and
some have disturbances in internal dynamics.
15. Multi problem families
A multi problem family has needs in several areas
simultaneously: difficulty in achieving developmental
tasks, illness or loss, inadequate resources and support,
disturbances in internal dynamics, or environmental
stressors.
16. Families with negative choices
Community health nurses assist families in coping with
stress by helping them identify their previous coping style,
their resources, and their alternatives for action.
For some families, however, coping with stress remains a
problem even after nursing intervention because the
choices for action are all negative (Wilson, 1989).
In some instances, none of the available choices will
modify the problem, and sometimes the consequences of
the choices are all negative and create more problems.
17. Families with poverty
The impact of poverty, or living in a resource-depleted,
hazardous, or hostile environment, is also a factor that
affects family coping.
The poor, as individuals and as a group, are continually
faced with multiple and chronic stressors, including
frustration over employment options, inadequate and
unsafe housing conditions, repeated exposure to violence
and crime, inadequate child care assistance, and
insensitive attitudes and responses of health and social
service agencies.
18. CONT.
Poverty also brings its own set of health problems.
Increased incidence of communicable diseases, especially
tuberculosis and human immunodeficiency virus (HIV)
infection; more episodes of illness; less use of preventive
care; and higher rates of chronic disease, premature death,
occupational hazards, and unsafe housing.
19. Families with Disturbances in Internal
Dynamics
Some multi problem families have disturbances in internal
dynamics.
Such families are often unable to provide :
1. Security
2. Physical survival
3. Emotional and social functioning
4. Sexual differentiation
5. Training of children
6. Promotion of growth of individual members.
20. Issues and strategies for working
with multiple problem families:
Foster continuity of care
Be patient- do not expect instant solutions.
Help the family identify its strengths
Work on small pieces of problems.
Help the family recognize opportunities for moving
forward or doing things differently.
21. CONT.
When all choices are undesirable, help the family cope
more positively with the choice that is made.
Ensure that all contacts are characterized by caring
and respect.
Organize possible sources of tangible support.
Encourage use of sources of intangible support.
Remember that the ultimate goal is empowerment and
resilience of the family and development of individual
self esteem.
22. Students activity
Case study:
Bela is a housewife her husband is suffering from cancer
,he was the only man who can earn but now he is a chronic
patient. They have three children’s. Younger children’s age
is only one year . They need money for surviving and
meeting the basic needs. In this circumstances she can not
bear the treatment cost because of unemployment. Also
she feels exhausted and unable to take care of the family
member properly.
1. Identify the 5 stressors the families going through?
2. How will you define the family?
3. As a Community Nurse how will you help to cope them
with this situation?
