FAMILY HEALTH NURSING- that level of CHN practice directed to the FAMILY

as the unit of care with HEALTH as the goal and NURSING as the medium, channel
or provider of care.
Family Case Load - the no. and kind of families a nurse handles at any given
time.
-variable for cases are added or dropped based on the need for
nursing care and supervision.
Family - is defined by the US Census Bureau (2005) as ‘group of people related by

blood, marriage, or adoption, living together’.

- is defined by Allender and Spradley (2004) as ‘two or more people who live in the
same household (usually), share a common emotional bond, and perform certain
interrelated social tasks.
- a group of persons of common ancestry

Types of Families

1. Nuclear-is composed of a husband, wife and children and it is the most common
structure seen worldwide and throughout the history
2. Extended(multigenerational)- includes not only the nuclear family but also the
other family members such as grandmothers, grandfathers, aunts, uncles, cousins
and grandchildren
3. Three generational
4. Dyad-consists of two people living together, usually a woman and a man, without
children
5. Single- Parent-has the advantage of offering a child a special parent-child
relationship and increased opportunities for self-reliance and independence.
6. Step- Parent
7. Blended or reconstituted-a remarried or reconstituted family, a divorced or
widowed person with children marries someone who also has children
8. Single adult living alone
9. Cohabiting/ Living –in-are composed of heterosexual peoples who live together
like a nuclear family but remain unmarried.
10. No- kin
11. Compound
12. Gay or Lesbian-where individuals of same sex live together as partners for
companionship, financial security and sexual fulfillment
14. Communal-their relationship to each other is motivated by social or religious
values rather than kinship
Stages of Family Life Cycle
1. Newly married couple
2. Childbearing
3. Preschool age
4. Schoolage
5. Teenage
6. Launching
7. Middle-aged ( empty nest –retirement)
8. Period from retirement to Death of both spouses

HEALTH TASKS OF THE FAMILY( Freeman, 1981)

1. recognizing interruptions of health or development

2. seeking health care
3. managing health and non-health crises
4. providing nursing care to the sick, disabled and dependent member of the family
5. maintaining a home environment conducive to good health and personal
development
6. maintaining a reciprocal relationship with the community and health institutions

Family Nursing Problem-arises when the family cannot effectively perform its
health tasks.
Nurse’s Roles in Family Health Nursing

1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK FAMILY MEMBER
3. COORDINATOR OF FAMILY SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR

An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a
fetus or embryo, resulting in or caused by its death.

Causes of Abortion

Abortion may be occur due to various factors such as fetal, placental, or maternal.
 1. Fetal Causes – The most common cause of early spontaneous abortion is abnormal
development of the zygote, embryo or fetus. These abnormalities are incompatible with
life and would have resulted in severe congenital anomalies had pregnancy not been
aborted spontaneously.
2. Maternal Factors – These are congenital or acquired conditions of the mother and
environmental factors that had adversely affected pregnancy outcome and led to abortion.
Such conditions include diabetes mellitus, incomplete cervix, exposure to radiation and
infection.
3. Placental Factors – Placental factors usually cause abortion around the 14th week of
gestation. These factors includes premature separation of the normally implanted placenta
and abnormal placental implantation.

Abortion Types Characteristics Management

• occurring before the 1. Bedrest
Threatened 20th week of
Abortion gestation 2. No coitus up to 2
• characterized by weeks after bleeding
cramping and stopped
vaginal bleeding
with no cervical
dilation.

• it may subside or an
incomplete abortion
may follow.
Imminent or • membranes rupture 1. Hospitalization
Inevitable and the cervix 2. D and C
Abortion dilates 3. Oxytocin after D and
C
• characterized by 4. Sympathetic
lower abdominal
cramping and 5. Understanding and
bleeding. emotional support
Incomplete • is characterized by 1. D and C
Abortion expulsion of only 2. Oxytocin after D and
part of the products C
of conception 3. Sympathetic
(usually the fetus).
• severe uterine 4. Understanding and
cramping emotional support

• bleeding occur with

cervical dilation.
• characterized by 1. There is no
Complete complete expulsion
Abortion of all products of
conception
• light bleeding 2. All of the tissues
• mild uterine
cramping
• passage of tissue
• closed cervix
treatment other than
rest is usually
needed.
that came out should
be saved for
examination by a
doctor to make sure
that the abortion is
complete.

3. The laboratory
examination of the
saved tissue may
determine the cause
of abortion.
Missed Abortion • intrauterine 1. Usually treated by
pregnancy is present induction of labor by
but is no longer dilation (or
developing normally dilatation) and
• the cervix is closed, curettage (D & C).
and the client may
report dark brown
vaginal discharge.

• pregnancy test
findings are
negative.
Recurrent or • characterized by 1. Trace the cause of
Habitual spontaneous recurrent abortion
Abortion abortion of three or
more consecutive
pregnancies
Septic Abortion • abortion 1. Antibiotics as
complicated by prescribed by your
infection Obstetrician
• foul smelling
vaginal discharge
• uterine cramping

• fever
Euthanasia (from the Greek ευθανασία meaning "good death": ευ-, eu- (well or good) + θάνατος,
thanatos (death)) refers to the practice of ending a life in a manner which relieves pain and
suffering.

Classification of euthanasia
Euthanasia may be classified according to whether a person gives informed consent into three
types: voluntary, non-voluntary and involuntary.[8][9]

There is a debate within the medical and bioethics literature about whether or not the non-
voluntary (and by extension, involuntary) killing of patients can be regarded as euthanasia,
irrespective of intent or the patient's circumstances. In the definitions offered by Beauchamp &
Davidson and, later, by Wreen, consent on the part of the patient was not considered to be one of
their criteria.[10][11] However, others see consent as essential. For example, in a discussion of
euthanasia presented in 2003 by the European Association of Palliative Care (EPAC) Ethics
Task Force, the authors offered the unambiguous statement:

Medicalized killing of a person without the person's consent, whether nonvoluntary

“ (where the person in unable to consent) or involuntary (against the person's will) is not
euthanasia: it is murder. Hence, euthanasia can be voluntary only.[12] ”
This displays a strong stance on the part of the task force members.

Voluntary euthanasia

Main article: Voluntary euthanasia

Euthanasia conducted with the consent of the patient is termed voluntary euthanasia. Voluntary
euthanasia is legal in Belgium, Luxembourg, the Netherlands, Switzerland, and the U.S. states of
Oregon and Washington. When the patient brings about his or her own death with the assistance
of a physician, the term assisted suicide is often used instead.

Non-voluntary euthanasia

Main article: Non-voluntary euthanasia

Euthanasia conducted where the consent of the patient is unavailable is termed non-voluntary
euthanasia. Examples include child euthanasia, which is illegal worldwide but decriminalised
under certain specific circumstances in the Netherlands under the Groningen Protocol.

Involuntary euthanasia

Main article: Involuntary euthanasia

 Euthanasia conducted against the will of the patient is termed involuntary euthanasia.

Procedural decision
Voluntary, non-voluntary and involuntary euthanasia can all be further divided into passive or
active variants.[13] A number of authors consider these terms to be misleading and unhelpful.[1]

Passive euthanasia

Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary
for the continuance of life. Whether the administration of increasingly necessary, albeit toxic
doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral
interpretation, but in order to pacify doctors' consciences, it is usually regarded as a passive
measure.[1]

Active euthanasia

Active euthanasia entails the use of lethal substances or forces to kill and is the most
controversial means. An individual may use a euthanasia device to perform active voluntary
euthanasia on himself / herself.

Suicide (Latin suicidium, from sui caedere, "to kill oneself") is the term used for the deliberate
self-destruction of a human being, by causing their body to cease life function. Such actions are
typically characterised as being made out of despair, or attributed to some underlying mental
disorder which includes depression, bipolar disorder, schizophrenia, alcoholism and drug abuse

DETERMINATION of DEATH
The determination of death of a patient in the field must be done by strictly following the Guidelines. If
there is any
doubt as to the status of the patient, life saving interventions must be started immediately.
GENERAL
• even if CPR has been initiated, death may be determined in the field in the following circumstances:
• the patient has been assessed and found to have
• absence of respirations
and
• absence of a pulse
and
• any one of the following
• decapitation
• transection
• evidence of tissue decomposition, including rigor mortis and/or lividity
• absence of vital signs on both first EMS assessment and after extrication greater that 10 minutes
• resuscitation may also be stopped
• when the patient's vital signs return (e.g. pulse and respiration)
• when instructed to stop by appropriate medical practitioner (physician) licensed to practice in Manitoba
• EMS personnel must be able to confirm the physician's identity and credentials
 • when performing CPR would place the EMS personnel at personal risk (e.g. inside a burning building)
• CPR may be interrupted when it is necessary to move a patient but the interruption should be for as
short a time as possible
• when the EMS personnel are exhausted and cannot continue
• when specifically outlined in a Health Care Directive
• if EMS personnel are trained and certified in discontinuing resuscitation, as outlined in the appropriate
treatment protocol
SPECIAL CONSIDERATIONS
• if there are any doubts as to whether a patient meets the Determination of Death Guideline, begin
resuscitation
efforts and initiate load and go as early as possible and as appropriate
• the earliest evidence of decomposition that can be used to decide to withhold patient care is if lividity
and/or
rigor mortis are present in a pulseless, non-breathing patient
• if either of these two signs are not obvious, then EMS personnel are obligated to initiate immediate
resuscitation efforts and initiate load and go as early as possible and as appropriate
multiple casualty incidents
EMS personnel may withhold patient care for a pulseless, apneic patient in a multiple casualty
situation
for the period of time when resources are required for the stabilization of living patients (see
Triage
Guideline)

stillborn infants
• incidents involving critically ill infants are often difficult emotional situations
• EMS personnel must proceed in a calm and professional manner
• back up should be called for as there are usually two patients to care for, i.e. the infant and the mother
• assess the new born for the criteria for an obvious death (see attached table)
• assess for the presence or absence of a pulse and respirations
• assess for dependent lividity and rigor mortis
• these signs may not be evident in a newborn or may be difficult to assess
• if the newborn infant does not meet the criteria for an obvious death, resuscitation should be started
(as per the CPR Guideline and Obstetrical Emergencies Guideline)
• document all actions and decisions fully
health care directives
• also referred to as “advance directives” or “living wills”
• EMS personnel must be familiar with current legislation governing Health Care Directives (see
Appendix – Health Care Directives Act, Response to an Expected Death at Home Guideline and End
of Life Directive)
• when attending a call and a Health Care Directive form is presented or the patient’s proxy informs the
EMS personnel of the existence of Health Care Directive
• ensure the form and the information provided clearly identifies the person to whom the Health Care
Directive applies
• ensure the patient is the person referred to in the Health Care Directive
• identify what, if any, procedures are authorized or prohibited by the patient in the Health Care
Directive
• follow the instructions outlined in the Health Care Directive including the discontinuation of
resuscitation if required
• certain procedures that are permitted under the Health Care Directive should be initiated, if
appropriate
• document who provided the Health Care Directive or the information on the Health Care Directive
and their relationship to the patient
• document the circumstances fully, including patient assessments, vital signs assessments, and
any treatments initiated
 • assist the patient’s representative to contact the appropriate local authorities
• provide emotional support
NOTE
• patients who are hypothermic should be assessed for longer time frames (45 seconds or longer) to
determine if
a pulse and respirations are present
• if there are any doubts whether a hypothermic patient meets the criteria for determination of death in
the
field, EMS personnel must initiate full resuscitation efforts and transport the patient to a health care facility
• certain patients who are hypothermic may qualify for defibrillation (see Environmental Emergencies -
Cold
Related Guideline)
• careful and thorough assessments of the patient are required both prior to and following defibrillation
• any hypothermic patient who has been defibrillated should have full resuscitation measures initiated
and be transported to nearest appropriate health care facility
• lividity is harder to detect on a person with dark skin pigmentation
• lividity may be absent if death was preceded by large blood loss

• a cold environment will usually delay the onset of rigor mortis while a hot environment may accelerate
the
process
• rigor mortis may be more difficult to detect on obese individuals but may be rapidly evident in infants
• if a patient meets the criteria for the Determination of Death Guideline, it is essential that the body and
scene
not be disturbed until the police or medical examiner authorizes the removal of the body
• when an EMS response results in a determination of death, the person ceases to be a “patient” and
EMS
responsibility should shift to caring for the family or other close contacts of the deceased
• although an out of hospital death may appear to be of natural causes, any such death requires
notification of
legal authorities
• until such authorities arrive, the scene should be protected as much as possible to avoid disturbance
• in an apparently natural death, it may be appropriate to cover the body to avoid unnecessary observers
• EMS personnel should, when possible, provide advice and assistance to distraught family by assisting
in
notification of family members, friends, or others to provide comfort
• notification of police or family physician may also be undertaken
• if work load permits, it may be appropriate to remain on the scene until a support person arrives
• when a determination of death has occurred, the deceased ceases to be a “patient” and should not be
transported by ambulance unless certain criteria are present
• these include, but are not limited to:
• death has occurred in a public place where it is not possible to ensure privacy and the dignity of the
deceased
• a request is made by police to transport the deceased to the nearest hospital morgue for medical
pronouncement of death
• routine transport of deceased to a funeral agency or morgue is an unacceptable use of an ambulance
• unless unusual circumstances exist, once a death has been determined in the field the crew should be
considered available to accept additional assignments, and should notify their dispatch agency

Clinical death is the medical term for cessation of blood circulation and breathing, the two
necessary criteria to sustain life.[1] It occurs when the heart stops beating in a regular rhythm, a
condition called cardiac arrest. The term is also sometimes used in resuscitation research. Clinical
death is determined by either the cessation of heart beat and breathing or the criteria for
establishing brain death.

Biological death Definition:

The permanent end of all life functions in an organism or part of an organism.

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Professional ethics
Professional ethics concerns the moral issues that arise because of the specialist knowledge

that professionals attain, and how the use of this knowledge should be governed when
providing a service to the public. The concept of Professional Ethics is partly comprised of
what a professional should or should not do in the work place. It also encompasses a much
greater part of the professional¶s life. If a professional is to have ethics then that person needs
to adopt that conduct in all of his dealings. Things that are included are concepts like:
professional respect, avoidance of dishonest or fraudulent activity such as plagiarism and the
professional development of the individual. Another aspect of this is the enhancement of the
profession and the industry within which the professional works.