Family and Community Health Nursing

Nursing care Plan
Focus on Family and Community Health Needs
University
Name
Date

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Family Care Plan
Family assessment
Family assessment is vital in the care delivery process. Assessment of family issues is
critical in community nursing process towards fulfillment of health needs. Undertaking a
needs assessment is critical in this avenue as systemic method of reviewing health needs of
the family leading to agreed priorities of care and rescue allocation vital for improving their
health state. As a community nurse engaging with the community and families is vital in the
process of promoting, protecting and preserving health states. In this review family
assessment of care and planning is undertaken based on family caring for chronic illness
patient as home care service .For the purpose of the confidentiality, our family will be
referred to family X.
Family X are resides of Ontario community, one of the Canadian province territory.
The family s comprise of the 5 people in the household. An elderly grandmother aged 85
years currently receiving palliative care at home for lung cancer diagnosed 3 years ago. Her
son aged 50 years together with her wife aged 45 years, both working in local industries
around the community. Together in the house hold is the grand daughter and grandson both
whom finished their graduate studies recently and awaiting placement of job.
The grandmother is receiving palliative care for management of lung cancer, whereby
she receives community nurse on weekly basis to assess her metastatic lungs; further social
worker often comes biweekly to assess progress of care being received. Currently the family
has employed a caretaker to manage care affairs of the ailing grandmother, as they are feeling
the pinch and pain of palliative care. The health state of the grandmother is average with mild
symptoms of pain occasionally managed through pain medication. Key priority care for the
family through initial health care assessment demonstrates caring for their grandmother who
Is ailing and they are not ready to put her in care home due to culture and attachment values.
Family oriented nursing diagnosis
The family nursing diagnosis in this case is fundamental for developing appropriate
nurse care for the patient. In the initial state of the diagnosis is outlining first level of
assessment for this family. The nursing diagnosis for the patient entail;

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Subjective data
- The family is experiencing challenges with managing palliate care patient;
their grandmother. They have experiencing difficulties regarding her
management and feeding occasioned by her frailty and lung cancer
management care process.
- Due to ageing needs the ability of the caregiver to cope up with the daily
activities is hampered by the frailty on the patient.
- The elderly health state is deteriorating and declining daily leading to poor
health state and declined level of health. She has been expe3icign challenges
in eating and undertaking normal daily activities
- Nursing assessment show case that the patient is experiencing challenges in
daily activities due to her state
- The patient often send most of her time either in bed or in the chair, he
reveals that she often feels week and unable to walk around.
- Nursing care manager in charge reports reveals that she is has poor eating
habits which are compromising her health state.
Objective data
- Patient nutritional state poor signaling the side effects of cancer medication
process.
- Increased levels of body ability to perform daily activities
- The patient current weight indicates that she has lost significant weight due
to her condition.
Diagnosis
The assessment of patient diagnosis reveals that she has imbalance nutrition intake
consuming less food requirements in relation to her body state. In terms of the caregiver there

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is an increased in risks of caregiver strain in managing her needs and limited help from other
family members as they are not readily available for her care. The patient is experiencing
impaired physical mobility linked to fatigue pain and impairment of neuromuscular observed.
Further there are risks of impaired skin integrity linked to her immobility and malnourished
state. These are fundamental care diagnosis for the patient and the family requiring urgent
attention of care.
The increased dependency is having an elevated burden on the care level of the family.
Developing avenues and coping mechanisms in the care process is key to enable the family
care for their kin with limited challenges and facilitated successful ageing process and
palliative care process which reduced more harm, pain and suffering to the patient and the
entire family unit.
Goal/outcome statement
General goal: Improving the overall wellbeing of the patient and increasing the level of
care among the family members towards positive health outcome.
The outlining goals of care and outcome for the patient and the family are to increase
the level of food intake for the patient so as to manage deteriorating health state. In
cooperating dietary practices which enhances diet intake and improves the overall nutrition
state of the patient is vital. Further focusing on care giving and supportive initiatives are
fundamental for the patient, caregiver and the family at large. Enhancing coping mechanism
and diversity of care giving strategies is essential to prevent family burn out which have an
impact on the general health state of the patient. Lowering levels of pain is a key nursing
avenue essential for the patient. Cancer management is often occasioned by increase pain
levels which need management through medication and therapy processes. Improving the
level of the activity levels for the patient is vital at this stage. There is need for improving
patient activity levels which will be essential in improving the immobility state of the patient.
There is an urgent need to maintain contact skin through avenues of increasing physical
mobility and enabling the patient to walk around while at home during resting period.
Intervention
Altered nutrition

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Patient altered nutrition state is linked to medication management and state of cancer
causing increased occurrence of anorexia, nausea and loss of appetite. Further, increased state
of distress and pain levels on the patient could have a significant impact. This is observed by
the patient inability to adequate consume food and decline in the weight state of the patient.
The desired patient outcomes entail stable weight state reversing the lost weight and stopping
further deterioration, assessment and verbalizing of the patient interference to adequate food
intake and enabling the patient to self manage through self care avenues on aspects of dietary
stimulation.
Key nursing intervention entail daily monitoring of food intake for the patient and
keeping food diary as observed. This is crucial in identifying the nutritional strengths and
deficiencies for the patient.
Encouraging the patient to increase intake of high calories diet and fluid intake and
encouraging frequent small spaced meals. The metabolic tissues requires urgent need for
fluids and supplements play a fundamental role in improving adequate protein and caloric
levels. Dietary adjustments for the patient will be crucial after medication due to drug
nutrient interaction which can affect the overall food acceptance levels for the patient.
There is need for nursing management on administration of antiemetic medication
regular administration schedule in the care process. Often vomiting and nausea are prevalent
and disabling states which affect the psychological state of the patients due to chemotherapy
effects.
Pain management
Patient pain state is linked to increased state of cancer condition which is increasing the
overall inflammation common with cancer therapy management. Managing pain is geared
towards improved relief of pain and employing relaxing skills which are crucial for the
patient state. Underlying nursing intervention is to determine pain history of the pain in terms
of location and intensity based on rating scale levels.
As part of therapeutic plan for the patient there is need for incorporating caregivers non
pharmacotherapy approaches such as the use of body massage, back rub, repositioning and

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offering diversion aspects such as watching of television and listening to music.This will be
essential in promoting and helping relaxation at home and soothes away the pain.
Altered family processes
Due to her burden of care, focus on the family relationship is vital for the patient. This
is occasioned by her long term of illness which has significant impact and change on her
family process leading to increasing burden of care. Key underlying nursing intervention is to
teach the caregivers on strategies of care management while offering respite and support
(Kulakami et al., 2014). There is need to engage on the family members and their roles in
managing the grandmother, identification and sharing of expectations is crucial in this
process as it promotes understanding among the participants. Further, as nurse planning and
assessing on energy direction is key in enabling problem solving abilities. This offers clues
on the appropriate intervention for the patient and her family and directing these energies
towards that care aspect.
Care giving coping strategies and mechanism
According to Antony, George and Jose (2018), palliative care on the caregiver can be
stressful and have tremendous impact on the overall psychological, emotional, social and
emotional state. There is need for developing an understanding for meeting the needs of care
giving. Elaborating and assessing these experiences is crucial for improving support guidance
and education of health care givers at home. Developing a plan for the caregiver in this
context will be aligned towards successful strategies of improving care for the patient.
Evaluation
Evaluation management for the patient will entail an observation of the plan of care.
Management of altered nutrition for the patient will be evaluated through the amount of foods
consumed and dietary practices entrenched. Observations will assess the level of fluid and
dietary modification progress for the patient so as to improve the weight loss and improve the
appétit to foods. Assessment of fruit based and high calories diets will be made based on
calculated daily calorie intake fulfillment. This will form as a guide to ensure that the patient
is able to meet the recommended calorie intake and levels of the food. Continuous monitoring

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of weight progress will be vital for the family, caregiver and he patient. An increased in
weight signifies improved management state of the patient.
Management of the patient pain in regards to her palliative care process is key.
Administration of both pharmacological and therapeutically avenues are crucial for the
patient. Planning and implementing non pharmacological therapies for the patient are
essential in this care process. Pain management evaluation is initiated through pain score,
with score of 10 signifying severe pain while signifies no pain. Regular monitoring and
assessment will be essential in determining the patient pain management is being managed
effectively or not.
Formulation and planning of family care process s essential. Incorporating all the
family members in the care process of their grandmother is vital in this process. Evaluation of
this aspect will be undertaken through family views on the patient progress and feeling of
burden they are experiencing and whether they are negative or positive impact on their lives.
Cares giving coping strategies are essential aspects in the care process. Ensuring that
the caregiver is well equipped with various strategies of managing burn out and burden of
care is vital for the patient. Regular biweekly assessment of the caregiver will be initiated to
review progress and challenges they are experiencing while offering the care services to the
patient.
Conclusion
Family care plan is an essential tool for managing care in the family set up. In this
process assessment and analyzing of this family demonstrates the need for care plan in
managing and offering respite and support for their ailing grandmother. From this assessment
it is evident that outcome of care are geared towards managing altered nutrition, managing
pain, strategies for care giving mechanisms and improving giving the family processes in
improving the overall well being of the family. Implementing these avenues is essential in
achieving the goals of care for the patient and the family at large.

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Substance and Drug abuse In Ontario Community
Community project
Assessment of the community -250-obesity
Drug abuse has been a widely developing health issue across the world Canada
included. Many countries continue to experience this problem. Canada is increasing with
cases of opioid pediatric which has seen an increased rates of hospitalization and mortality
rates scoring higher occasioned form heroin, fentanyl and other related opoids (). The key
underlying statistics obtained shows that about 24% of the Canadians have felt opioid issue
being a crisis in Canada while 46% of the respondents’ interview stated that it is a serious
problem. About half of the respondents responded to have been used an illicit drug in their
lifetime with cannabis usage being the most widely abused and consumed drug substance.
This consumption trend was followed by hallucinogens, cocaine and ecstasy.
From this assessment, it was found out that 10 of the 20 respondents have accessed
drug abuse and substance abuse treatment process, while about 5 have used mutual support
groups while the rest used residential addiction programs. Among this community over 50%
of the youths stated they have used any one of the substance abuse, majority of these
population are of male gender accounting to 70% against 30% of the female users. The age
ranges of the community youth interview ranged between 18 and 35 years.
Due to the inherent problem posed by drug and substance abuse, focusing on
community care plan in addressing this avenue is vital. The nursing focus entails community
oriented approach and identification of an effective goal, planning and implementation of a
strategy to manage this need. Evaluation process will be undertaken to assess the level of
impact and success of the community care plan in management of drug and substance abuse.
Community oriented nursing diagnosis
Substance abuse is linked to usage of drugs in a manner that is inconsistent with
medical and social norms despite the negative consequences. Substance abuse disorders are
common chronic illness which are encountered after relapse linked to drug seeking and
taking behaviors despite consisting of negative consequences.

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Current community diagnostic entail poor coping mechanism which affect the
community continue to undergo continuous relapses. This has been extended by the
community vulnerability to prevalent drug abuse avenues and drugs which are obtained over
the country and peddled in the stresses easily. Further, increased rates of crimes and harm
have been exacerbated by increase usage and abuse of substance and drugs affecting many
young livelihoods in the community.
Further from the assessment the community is experiencing effective states of denial
which are linked to maladaptive behaviors occasioned by this substances abuses. Increased
usage and long term effects have led to poor recognition of bad behaviors viewed as
maladaptive with respect to community values and standard.
Moreover, nutrition assessment among the community members respondents signify
and imbalance state. Majority of the population interview are experiencing decline weight
loss and underweight status which is a great risk for malnutrition states. Poor nutrition habits
coupled with drug substance abuse is increasing health related risks and negative outcome
levels for the community at large.
The drug abuse issue at the community portrays increased effects on the youth
population as they are the most affected category. The reported and observed objective and
subjective information from the community show case an increased state of health in the
community. There is need for critical care plan on how to mitigate the effects of the drug
abuse among the youth and reduce the over dependence of drugs which contribute
significantly to increased crime rates, poor coping mechanisms and poor nutritional states.
Goal/outcome statement
Overall goal of care: Improving adherence rates and coping mechanisms among drug
users in the community
It is expected that the likely outcome of this care plan will revolve around the
community expressing true feelings on during abuse as a form of coping stressful conditions
and peer pressure roles in influencing health outcomes in the community. The fundamental
aspect is to ensure that the communities are able to identify adaptive and coping mechanism
on the drug issue and outlining underlying effects on their health state. Further it is expected

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that the community members will be able to verbalize the negative effects of drug abuse and
engage in therapeutic organization and behavioral changes mechanism is currently being
offered in the health care system.
The end outcome of the care plan in the community is reduction of crime and behavior
reliant drug states. Reduction in drug usage and dependency is fundamental towards recovery
phase. The community members especially the youth are likely to abstain from alcohol and
drug abuse, while engaging on open verbalization and acceptance of their own behaviors.
Further engaging on avenues of participating and enrolling in therapeutic program in the
health care settings and at the community level is fundamental in this phase.
Intervention
In the intervention care plan for the community the need for addressing underlying
aspects are critical. There is need for conveyance of acceptance attitude among the
community members is vital this is essential as a first step towards promoting feeling of
dignity and self worth processes. Understanding the patterns of drug dependencies and
categories of symptoms and patterns of use in the community is essential, this is key towards
making the community to make decisions pertaining their choice and acceptances of drug
abuse as a problem, thus necessitating a treatment plan.
Denial
Denial is linked to personal vulnerability linked to difficult y in handling difficult
situations. In the nursing care process, confronting and assessing critically aspect of denial
and peer group rationalization is key. The need for positive confrontation to the community is
fundamental in the care process. Often denial has been viewed as a major defense obstacle in
addictive illness. Peer level confrontation is an essential aspect of accepting the reality of
adverse behavioral consequences which the drug possesses as a major challenge. Aspects of
caring attitude to the community are key towards preservation of self concept and discourage
defensive positions.
Ineffective community and individual coping mechanisms

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Ineffective coping mechanism is described as a valid appraisal mechanism for stressors
and inadequate coping practice responses and inability to adapt to care. This is aspect is
linked to community vulnerability especially the younger generation and inadequate support
systems. This is often observed through impaired adaptive behavior occurrences, lower stress
handling and verbalization aspect. As an end term intervention the need for encouraging and
supporting the community in taking responsibility of the recovery phase and abstinence of
drug abuse is key. There is need for offering the community members with the assistance in
learning responsibilities and recovery process.
Further health promotion arenas on understanding the current substance abuse situation
and other aspects of coping is essential in providing the community with information
concerning denial degree levels, accepting personal responsibilities and identifying coping
skills in the present state. Further, fundamental nursing intervention for the community
entails encouraging aspect of verbalization which is key in expressing anxiety, feelings and
fears. This is essential for the community so as to express long term unresolved issues in their
lives which might be a causative factor leading to indulgence of substance abuse. The need of
utilization is essential in examining avenues of coping mechanism. Self support groups are
key in the community to enhance learning and promoting abstinence through understanding
and supporting each other.
In supporting coping mechanism, community therapy model in this aspect can entrench
application of medication such as Disulfiram which is essential in maintaining abstinence
from substance and drug usage. This is used in line with other therapy process which is key
for the patient. This mechanism acts by release of acetaldehyde which has unpleasant feelings
when other drugs such as alcohol and hard substance are consumed ().
Low self Esteem
Low self esteem is linked to development of negative perception and low levels of self
worth in responding to a current situation. This is linked to social stigma and behavior control
among the users. This was evidenced among the community members through verbal
statements of being unable to deal with their current veents and lacked self purpose and
direction in their life’s.

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Providing opportunity and time for open talk while encouraging verbalization is
essential in addressing the underlying conditions of the community. More often drug abuse
patients demonstrates difficulty of self expression thus sees no relevance of stopping drug
and substance abuse. Further as way of improving self worth, there is need for providing
avenues for positive reinforcement and encouraging the patients to accept positive actions.
Engaging with the community on aspects of family life and dynamics is crucial.
Substance abuse is a family disease which entails a mix of the family input and victims view
their behavioral the course of drug usage. Negating the family units is crucial in making them
realize there is a problem worth tackling and engage the victims on positive avenues of
improving self worth and abstinence of drug usage.
During the planning phase there is a need for establishing trusting relationship with the
community members and sending ample time while discussion their feelings, anxieties and
fears in the care process .Undertaking medication management and behavioral therapy
strategies for the community is key working in collaboration with the health care service. The
need for explaining to the community the needs for altering drug abuse and its effects on the
body is paramount. Further there is need for enhancing relaxation techniques in the
community especially for the drug and substance users. This is essential in aspects of
tolerating the withdrawal effects and coping mechanism key for
Evaluation
During the evaluation process, setting community targets and individual targets is key.
Engaging on behavior change will be on self acceptances and engaging in the health care and
support system for assistance. Encouraging feedback processes and linking them to support is
key. Feedback review from these systems is essential in evaluation the progress of the
community in behavior change and abstinence d of substance and drug abuse. Bi monthly
reviews from the community through feedback reviews and care requisition from the support
systems will be essential.
Community openness is a crucial aspect which will signify the acceptance of the
problems they are facing and working towards reducing its effects. Engaging in coping
mechanisms is essential for the community members feedback responses and behavior
change will be long term evaluation plans for the community members. Increased aspects of

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openness, acceptance of the problem and engaging on behavior change is key for the
community members. This will be key in ensuring the community is working towards
behavior change and lowering of drug and substance abuse in the long term.
Conclusion
Nursing care process is vital step towards engaging change on health care issues.
Designing plan of care for the Ontario community is vital in tackling drug and substance
abuse issues. The nursing approach is geared towards addressing three underlying
interventions; denial, low self esteem and ineffective coping mechanisms in behavior change
of drug and substance abuse. Working in collaboration with the community is a vital game
changer towards acceptance of the problem as an issue facing them, hence increases the level
of behavior change towards it. This is fundamental in reaching and attaining the goal of
enhancing adherence and improving coping mechanism of drug behavior change process
across the community continuum.

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References
Antony, L., George, L. S., & Jose, T. T. (2018). Stress, Coping, and Lived Experiences
among Caregivers of Cancer Patients on Palliative Care: A Mixed Method Research.
Indian journal of palliative care, 24(3), 313–319.
https://doi.org/10.4103/IJPC.IJPC_178_17
Kulkarni, P., Kulkarni, P., Ghooi, R., Bhatwadekar, M., Thatte, N., & Anavkar, V. (2014).
Stress among care givers: the impact of nursing a relative with cancer. Indian journal
of palliative care, 20(1), 31.