3 CHN-SPECIAL FIELD IN COMMUNITY HEALTH NURSING SCHOOL HEALTH NURSE (SHN) It is a public health nursing that focuses on the

promotion of health and wellness of the pupils/students, teaching and non-teaching personnel of the school. OBJECTIVE OF SHN GENERAL To promote the health and maintain the health of the school populace by providing comprehensive and quality nursing care SPECIFIC 1.To provide quality nursing service to the school population 2.Create awareness to school children, personnel, and administrators on the importance of the promotive and preventive aspects of health through health education 3.Encourage the provision of standard functional facilities 4. Provide nursing personnel with opportunities for continuing education and training 5. Conduct and participate in researches related to nursing care; and 6. establish/strengthen linkages with government and nongovernment organization/agencies for school community health work Duties & Responsibility of the SN 1.Health advocacy 2.Health and nutrition assessment including other screening procedures such as vision and hearing 3. Supervision of health and safety of the school plant 4. Treatment of common ailments and attending to emergency cases 5. Referrals and follow-up of pupils and personnel 6. Home visit 7. Community outreach like attending community assemblies and organizing school community health councils 8. Recording and reporting of accomplishments 9. Monitoring and evaluation of programs and projects Skills and Competencies 1.Assessment and screening skills 2.Health counselling skills 3.Social mobilization skills 4.Good oral and written communication skills 5.Basic management skillls 6.Life skills Function of School Nurse 1.School health and nutrition survey 2.Putting up a Functional School Clinic 3.Health assessment 4.Standard vision testing for school children 5.Ear examination 6.Height and weight measurement and nutritional status determination 7. Medical referrals 8. Attending to emergency cases 9. Student health counselling 10. Health and nutrition education activities 11. Organization of school-community health and nutrition council 12. Community disease control 13. Establishment of data bank on school health and nutrition activities 14. School plant inspection for healthy environment 15. Rapid classroom inspection

16. Home Visitation OCCUPATIONAL HEALTH NURSE ( OHN) Is an autonomous practice requiring independent decisions and creative solutions to complex occupational and environmental health and safety problems. A Public Health Nurse can be OHN who is in a prime position to assess the health needs of the working population and design healthful working intervention MISSION Continuously provide opportunities to all nurses into a complete community health nurse FUNCTION OF OHN 1.Work with the OH team to lead the sanitary and industrial hygiene of all industrial establishment 2.Recommends to Local Health Authority the issuance of license/business permit\ 3.Coordinates with other government agencies 4.Attends complaints of all establishments in the area of assignment 5. Participates to provide, install and maintains good condition all control facilities and protective barriers for potential and actual hazards. 6. Informs all affected workers regarding the nature of hazards and reasons for the control measures and protective equipments. 7. Make periodic assessment of physical examination of workers 8. Provide control measures to reduce noise, dust, health and other hazards 9. Ensure strict compliance on the regular use of PPE ( personal protective equipment) 10. Provides occupational health services and facilities 11. Refers to elevates to higher authority all unsolved issue relation to occupational and environmental health problems 12. Prepares and submits yearly reports to the Local and National Government Application of Public Health Principles to OHN 1.Community assessment 2.Worker assessment 3.Application of epidemiology principles 4.Team appraoch 5.Program planning and implementation 6.Primary prevention 7.Secondary prevention 8. Tertiary prevention 9. Referral to community resources 10. Program evaluation ISSUES IN OHN 1.Physical hazards 2.Chemical hazards 3.Biological hazards 4.Mechanical hazards 5.Psychosocial hazards MENTAL HEALTH NURSE (MHN) Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community. In this positive sense, mental health is the foundation for individual well-being and the effective functioning of a community.

MHN provides the full range of primary mental health care services to individuals, families, groups and communities FUNCTIONS OF MHN At the basic level, registered nurses work with individuals, families, groups, and communities to assess mental health needs, develop diagnoses, and plan, implement, and evaluate nursing care. Basic level nursing practice characterized by interventions that promote and foster health, assess dysfunction, assist clients to regain or improve their coping abilities, and prevent further disability

Nursing Care in the HOME PRINCIPLES 1.Nursing care utilizes a medical and plan of care and treatment 2.The performance of nursing care utilizes that would give maximum comfort and security to the individial 3.Nursing care given at home should be used as a teaching opportunity to the patient or to any responsible member of the family 4.The performance of nursing care should recognize dangers in the patient s over-prolonged acceptance of support and comfort 5. Nursing care is a good opportunity for detecting abnormal signs and symptoms, observing patient s attitude towards care given and the progress exhibited by the patient. ISOLATION TECHNIQUE IN THE HOME 1.All articles used by the patient should not be mixed with the articles used by the rest of the members of the household 2.Frequent washing and airing of beddings and other articles and disinfection of the room are imperative. Abundant use of soap, water, sunlight and same chemical disinfectants is necessary. 3. The one caring for the sick member should be provided with a protected gown that should be used only within the room of the sick 4. All discharges, especially from the nose and throat of a communicable disease patient, should be carefully discarded 5. Articles soiled with discharges should first be boiled in water 30 minutes before laundering. CLINIC VISIT The patient visit the health center/clinic to avail of the services thereto offered by the facility primarily for consultation on matters that ailed them physically. Standard Procedure of Clinic Visit 1.Registration/Admission 2.Waiting time 3.Triaging 4.Clinical evaluation 5.Laboratory and other diagnostic examination 6.Referral system 7.Prescription/dispensing 8.Health education Bag Technique It is a tool during home visit which enable her/him to perform a nursing procedures with ease and deftness, to save time and effort A public health bag is an essential and indispensable equipment of a public health nurse which she has to carry along during her home visits Principles of Bag Technique 1.Performing bag technique can minimize if not prevent the spread of infection 2.Saves time and effort in performing nursing procedures 3.Shows the effectiveness of total care given to an individual or family 4.Can performs a variety of ways to avoid the transfer of infection Important points to consider 1.The bag should contain all necessary article, supplies and equipment used to answer ER needs 2.Always clean and supplies used was replaced 3.The bag and content should be protected form contacts with any article in the patient s home

2 CHN-ACTIVITY OF COMMUNITY HEALTH NURSING Home Visit The home visit is a family-nurse contact which allows the health worker to assess the home and family situations in order to provide the necessary nursing care and health related activities. In performing this activity, it is essential to prepare a plan of visit to meet the needs of the client and achieve the best results of desired outcomes. Purpose of Home Visit 1.Nursing care to the sick, post-partum mother and her newborn 2.Assess living condition of the patient and his family 3.Advocate health teaching in the prevention and control of disease 4.Establish close relationship between health agencies and the public in health promotion 5.Make use of inter-referral system and to promote the utilization of community services Principle of Home Visit 1.Home visit must have a purpose or objective 2.In planning for home visit, make use of all available information about the patient and his family through family record 3.We should consider and give priority to the essential needs of the individual and his family 4.Planning and delivery of care should involve the individual and family 5.Plan should be flexible Guidelines to consider regarding the frequency of Home Visit 1.The physical needs, psychological needs and educational needs of the individual and family 2.The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate 3.The policy of a specific agency and the emphasis given towards their health programs 4. Take into account other health agencies and the number of health personnel already involved in the care of a specific family 5. Careful evaluation of past services given to a family and how the family avail of the nursing services 6. The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits. Steps in Conducting Home Visit 1.Greet the patient and introduce yourself 2.State the purpose of the visit 3.Observe the patient and determine the health needs 4.Put the bag in a convenient place than proceed to perform the bag technique 5.Perform the nursing care needed and give health teaching 6.Record all important data, observation and care rendered 7.Make appointment for the return visit

4.The bag should be convenient to the user to facilitate efficiency and avoid confusion

1 CHN: COMMUNITY AND PUBLIC HEALTH NURSING Community is a group of people with common characteristics or interest living together within a territory or geographical boundary. It is a place were people under usual condition was found. According to WHO Public Health Nursing is a special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability . According to DOH Public Health Nursing is a unique blend of nursing and public health practice waves into a human service that properly developed and applied has tremendous impact on human well being. It s responsibilities extend to the care and supervision of individuals and families in their homes in place of work, in school and clinics. Concept of PHN 1.The primary focus is health promotion 2.It provides care necessary to rest the requirements of the individual all throughout the life cycle 3.Knowledge on different field ( biological, social science, clinical nursing and community health organization) is used. 4.Nursing process changes based on the needs of the community Principles of PHN 1.Based on recognized needs of individual, families, group and community 2.The PHN must understand fully the objective and policies of the agency she represents 3.In PHN, the family is the unit of care 4.PHN must be available to all regardless of race, creed and socio economic status 5. CHN/ PHN make use of available health resources 6. CHN/PHN utilize the already existing active organized group in the community 7.There must be provision for education, supervision in CHN/PHN 8.There should be accurate recording and reporting in CHN/PHN Goal of CHN/PHN To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high level of wellness The philosophy of CHN is based on the belief that care directed to the individual, family and the group contributes to the health care of the population as a whole. Levels of Clientele in CHN INDIVIDUALS FAMILY COMMUNITY SPECIAL POPULATION GROUPS Individual as a Client Open system viewed on holistic and atomistic approach General adaptation system BIOLOGICAL Beyond the person s control (age, gender, heredity, and race)

NON-BIOLOGICAL Learnt and acquired factors. Influences from family, school teachers, friends and role models, traditions, food habits, social norms, customs, folkways, and mores. Family A number of persons joined together by bonds of marriage, blood and adoption. - Burgess 1963 Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family. - Friedman 1992 Family Stages and Tasks Beginning Family Establishing a mutually satisfying marriage Planning to have or not to have children Child Bearing Family Having and adjusting to infants Supporting the needs of all members of the family Family with Pre-School Children Adjusting to cost of family life Adapting to needs of pre-school children Family with School age Children adjusting to the activity of growing children Promoting joint decisions between children and parents Traditional Family Values 1.Galang or Respect > Primary Filipino Values 2.Amor Propio > Having Personal Pride 3.Acceptance of pain and sufferings > This two values are considered honorable, considering pain provides opportunity for spiritual growth Function of the Family 1.Physical Function 2.Economical Function 3.Reproductive Function 4.Socialization Function Health Tasks of the Family Recognizing interruptions of health and development Seeking health care Managing health and non-health crises Providing nursing care to the sick, disabled and dependent member Health Tasks of the Family Maintaining a home environment conducive to good health and personal development Maintaining a reciprocal relationship with the community and health institutions. These health tasks are the bases in identifying family nursing problems. COMMUNITY as a Client Is a group of individuals who are bound in time and space. They are dependent on each other. They act together for the achievement of common goals.

The unit of the community is the family. -It is composed of different sub groups. -Rural or urban -organism Characteristics Defined by its geographic boundaries within certain identifiable characteristics It is made up of institutions organized into a social system with the institutions and organizations linked in a complex network having a formal and informal power structure and a communication system -A common or shared interest that binds the members together exists -It has an area with fluid boundaries within which a problem can be identified and solved -It has a population aggregate concept Healthy Community Awareness that we are community Conservation of natural resources Recognition of, and respect for, the existence of sub groups Participation of subgroups in community affairs Preparation to meet crisis Ability to solve problem Communication through open channels Resources available to all Setting of disputes trough legitimate mechanisms Participation by citizens in decision making Wellness of high degree among its members POPULATION GROUP as Client POPULATION GROUPS - Aggregate of people who share common characteristics, developmental stage or common exposure to particular environmental factors thus resulting in common health problems ( Clark, 1995:5) e.g. children . elderly, women, workers etc. Infant and young children- most vulnerable School age- accident prone Adolescent- identity crisis, teenage pregnancy Mothers- problems related to pregnancy Males- risk of not being treated Old people- degenerative diseases Roles and Function of Public Health Nurse Health Care Provider provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities. Teacher aims towards health promotion and illness prevention through dissemination of correct information; educating people Counselor analyzes nursing procedure and technique, she advices health care organization organization and public health group. Facilitator who establishes multi-sectoral linkages by referral system Supervisor who monitors and supervises the performance of midwives

In the event that the Municipal Health Officer (MHO) is unable to perform his duties/functions or is not available, the Public Health Nurse will take charge of the MHO s responsibilities Monitor uses symptomatic and objective observation and other form of data gathering Manager provides supervision, management and clinical support Changing Agent motivates changes in health behaviour of individual, family and community including lifestyle in order to promote and monitor health Researcher participates/assist in the conduct of surveys and studies on nursing and health related subjects Competencies and Skills of PHN Integrated knowledge, skills, judgment and attributes required of a public health nurse to practice safely and ethically. Attributes include, but are not limited to attitudes, values and beliefs. These competencies describe the activity that a public health nurse engages in to meet a standard or a set of standards. 0 intro. chn DEFINITION OF HEALTH WORLD HEALTH ORGANIZATION -health is a state of complete physical , mental and social well being and not merely the absence of disease or infirmity WHO meaning has 3 Dimension

Physical. Mental, Social Physical Dimension

    

All his parts, organs, tissues, systems and senses are intact and functioning normally. He possesses enough bodily reserves to meet any emergency. His appetite is good, bowel, sexuality are normal and sleep is sound. Normal vital signs Exercise tolerance are normal

Mental Dimension

    

His perception of the surroundings is realistic. His intelligence, memory, learning capacity and reasoning faculty is normal. Emotional reactions are proportional to the intensity of the stimulus concerned. Confidence in himself is high and his realization of his innate potentialities is maximal. Intact ego integrity. Social Dimension

  

Able to communicate effectively with his family, friends and colleague If he discharges his obligations toward family and state If he contributes constructively to the progress

The three dimensions of health are interrelated and interdependent. A sound body is necessary for a sound mind and vice versa. Persistent and unresolved emotional tensions predispose to somatic diseases Community Health Nursing CHN is a specialiazed field of nursing practice. Its basic knowledge and skills are anchored on nursing theories and important concepts from the science of public health such as; 1. 2. Emphasis on the importance of the greatest good for the greatest number Assessment of health needs, planning, implementing and evaluating the impact of health services on population group 3. Priority of health promotive and disease strategies over curative interventions. 1. 2. preventive

2. 3. 4.

Create Supportive Environments Strengthen Community Action Develop Personal Skills Reorient Health Services

MCN 3RD LECTURE HOMOLOGOUS STRUCTURES FEMALE Glans Clitoris Labia majora Vagina Ovaries Fallopian tubes Skene s glands Bartholin s glands Ovum PUBERTY MALE Glans Penis Scrotum Penis Testes Vas Deferens Prostate glands Cowper's glands Spermatozoa

Tools for measuring and analyzing community health problems and Application of principles of management and organization in the delivery of health services to the community. - Araceli Maglaya Nursing Practice in the Community,3rd Edition

 

the stage when the reproductive organs become functional the stage of life at which the secondary sex changes Girls- age 9 to12 years; Boys- age 12 to 14 years SEQUENTIAL ORDER OF PUBERTAL CHANGES IN GIRLS

Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability -WHO Expert Committee of Nursing The first use of Health Promotion occured in 1945 when Henry E. Sigerist, the great medical historian defined the four major task of medicine as; 1. The promotion of health 2. The prevention of illeness 3. The restoration of the sick, and 4. Rehabilitation According to Sigerist health is promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation . This concept is found in Ottawa Charter for Health Promotion which occured 40 years later. Ottawa Charter for Health Promotion Ottawa Charter defines health promotion broadly as the process of enabling people to increase control over and to improve their health

1. 2. 3. 4. 5. 6. 7.

Growth spurt Widening of the pelvis Breast development Growth of pubic hair Onset of menstruation Growth of axillary hair Vaginal secretions

MENSTRUAL CYCLE

 

is the scientific term for the physiological changes that can occur in fertile female humans and apes A menstrual cycle is episodic uterine bleeding in response to cyclic hormonal changes. -Adele Pillitteri

        
1.

Prerequisite for Health Peace Shelter Education Food Income A stable eco-system Sustainable resources Social justice and; Equity Concept of Health Promotion Charter recommends the following action areas; Build Healthy Public Policy

Menarche Average age onset 11-13 years Average range is 9-17 years Interval Average of 28 days cycle, 23-35 is not unusual Duration average flow is 2-7 days ranges 1-9 is not unusual Amount Difficult to estimate, average of 30-80ml per menstrual period Saturating a pad or tampon in less than an hour is heavy bleeding Color Dark red; combination of blood, mucus and endometrial cells Odor Similar to that of marigolds

ESTROGEN

FAMILY HEALTH NURSING 2ND LECTURE FAMILY HEALTH NURSING PROCESS The health status of the family as a unit including the impact of the health of one member of the family on the family as a unit and on individual family members; also, the impact of family organization or disorganization on the health status of its members. The definition of family health nursing as set out by WHO is broad in its aspirations to meet the needs of individuals, families and communities. The provision of care involving the nursing process, to families and family members in health and illness situations. -( from Lippincott Manual of Nursing Practice. 6th ed.) FAMILY ASSESSMENT

      

There are 3 kinds of estrogen Estradiol, estrone and estriol Inhibit Follicle stimulating hormone Hormone of the women Cause mucus to be thin, transparent, and highly stretchable Stimulates the ductile structures of the breasts Menarche and Menstruation PROGESTERONE

      

Thermogenic effect- increase basal body temp Relaxes uterine muscles Promotes growth of the acini cells of the breasts Causes wt gain by promoting fluid retention Is thought to be the cause of PMS Causes of tingling sensation and fullness of the breast before menstruation Stimulate endometrial glands to secrete mucin and glycogen in preparation for implantation FOLLICULAR PHASE 1. 2. 3.

It is the first major phase of nursing process. It involves a set of actions by which the nurse measures

    

This is the time before ovulation Main event of this phase is the formation of graafian follicles During these phase , FSH stimulates the devt of around 30 follicles in each ovary. Only one will be selected to reach maturity and release an ovum. Around 24- 46 hours before ovulation- serum estrogen level peaks There are also a surge in the prod of LH which can cause the release of the ovum. SPINNBARKEIT TEST

the status of the family as a client, Ability to maintain wellness, prevent, control or resolve problems prevent, control or resolve problems in order to achieve health and well being of its members.

1. 1. 2. 3. 4.

. Initial data base

Family structures, characteristics, and dynamics Members of the household and relationship to the head of the family Demographic data age, civil status, position in the family Place of residence whether living with the family or elsewhere Type of family structure

  

Happens at the height of the estrogen secretion Cervical mucus becomes thin and watery but also stretched into long strands. Indicates that ovulation is about to occur LUTEAL PHASE

5. Dominant family members in terms of decision making especially in matters of health care 6. General family relationship/dynamics B. Socio-economic and cultural characteristics Income, occupation, place of work (of each member) Educational attainment of each member Ethnic background and religious affiliation Significant others and other roles they play in the family s life Relationship of the family to the larger community(membership in organizations)

    

The period following ovulation This period lasts 14 days, variation of 13-15 days After ovulation, corpus luteum produces large amounts of progesterone. The glands of the uterine endometrium become corscrew or twisted in appearance The corpus luteum has a life span of about 7 days only. 8 days after ovulation it begins to regress. TEACHINGS ABOUT MENSTRUAL HEALTH

     

Exercise- Moderate exercise during menses promotes a general sense of well being. Sexual relations- Not contraindicated during menses. ADL- Nothing is contraindicated Pain relief- Ibuprofen are most effective for menstrual pain. Local heat may also be helpful. Rest- More rest may be helpful for dysmenorrhea Nutrition- Incorporate iron supplement

C. Home and Environment Information on housing and sanitation facilities which includes: Housing agency, sleeping arrangements, food storage, cooking facilities, water supply, source, ownership, potability, presence of accident hazards, toilet, garbage disposal Availability of social health, communication and transportation facilities in the community D. health status of each member

past/current significant illness Beliefs/ practices about health Nutritional and development status Decision making on which or whom to seek advice regarding health E. Values and Practices on Health Promotion and Maintenance Preventive aspects immunization status Adequate rest and sleep, exercise, relaxation activities Street management activities, utilization of health care facilities a.)Observation method of data collection through the use of sensory capacities . sight, hearing, smell and touch. Data gathered through this method have the advantage of being subjected to validation and reliability testing by other observers. b.) Physical Examination done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing the body systems. c.) Interview completing the health history of each family member. The health history determines current health status based on significant past health history. d.) Record Review reviewing existing records and reports pertinent to the client.( individual clinical records of the family members; laboratory & diagnostic reports;immunization records; reports about the home & environmental conditions. e.) Laboratory/Diagnostic Tests -performing laboratory tests,diagnostic procedures or other tests of integrity and functions carried out by the nurse herself and/or other health workers. Genogram is a pictorial display of a person's family relationships and medical history. It goes beyond a traditional family tree by allowing the user to visualize hereditary patterns and psychological factors that punctuate relationships. An Eco-map is a graphical representation that shows all of the systems at play in an individual's life. TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE First level assessment- is a process whereby existing and potential health conditions or problems of the family are determined. 1. 2. 3. 4. Wellness state/s Health threats Health deficits Stress point or foreseeable crisis situations

Wellness potentials a nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state Is a nursing judgment on wellness or state condition based on client competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance 1. 2. 3. 4. Healthy lifestyle Health maintenance/health management Parenting Breastfeeding Readiness for enhanced wellness state Is a nursing judgment on wellness or state condition based on client competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance 1. 2. 3. 4. Healthy lifestyle Health maintenance/health management Parenting Breastfeeding Conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. 1. 2. 3. Presence of risk factors of specific diseases- e.g. Lifestyle diseases, metabolic syndrome Threat of cross infection from a communicable disease case Family size beyond what family resources can provide

D. Accident hazards Broken stairs Pointed sharp objects Fire hazards Fall hazards Others specify E. Faulty/unhealthful nutritional/ eating habits or feeding techniques practices. Inadequate food intake both in quality and quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding techniques F. Stress provoking factors Strained marital relationship Strained parent- sibling relationship Interpersonal conflict between family members Care giving burden G. Poor home/environmental condition/sanitation Inadequate living space Lack of food storage Polluted water supply Presence of breeding or resting sites of vectors of diseases Improper garbage disposal Unsanitary waste disposal Improper drainage system

Stated as potential or readiness- a clinical nursing judgment about a client in transition from a specific level of wellness or capability to a higher level.

Poor lightning and ventilation Noise pollution Air pollution H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/practices Alcohol drinking Cigarette / tobacco smoking Walking barefooted or in adequate footwear Eating raw meat or fish Poor personal hygiene Self medication/ substance abuse Sexual promiscuity Engaging in dangerous sports Inadequate rest or sleep Lack of/inadequate exercise/physical activity Lack of/inadequate relaxation activities Non-use of self protection measure (bednets)

A. Recognizes signs of health and development B. Manages health and non-health crisis C. Provides health care to its members D. Provides home environment conducive to good health and personal development E. Utilizes community resources for health care.

THE FAMILY HEALTH PROBLEM AND PRIORITIZATION Family health condition- a statement of family s capabilities to maintain health and prevent illness A. Ability to recognize the signs of health and development B. Ability to manage health and non-health crisis C. Ability to provide health care to its members

J. Inherent personal characteristics-e.g. Poor impulse control K. Health history which may participate/ induce the occurrence of a health deficit e.g. Previous history of difficult labor L. Inappropriate role assumption-e.g Child mother s role, father not assumin his role M. Lack of immunization/ inadequate immunization status especially of children

D. Ability to provide a home environment conducive to good health and personal development E. Ability to utilize community resources for health care.

N. Family disunity Self oriented behavior of members Unresolved conflicts of members Intolerable disagreement Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner Failure to thrive/develop according to normal rate Disability- whether congenital or arising from illness transient/ temporary (e.g. aphasia or temporary paralysis after CVA) It is anticipated periods of unusual demand on the individual or family in terms of adjustment/ family resources

     

  

Marriage Pregnancy, labor Parenthood Additional member Abortion The nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem, and the etiology or barriers to the family s assumption of these tasks. I. Inability to recognize the presence of the condition or problem. II. Inability to make decisions with respect totaking appropriate health action. III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk member of the family.

IV. Inability to provide a home environment conducive to health maintenance and personal development. V. Failure to utilize community resources for health care

There are a lot of different free exercises to increase penis size and make your penis larger and wider. This article will be talking about a few of the better free exercises to increase penis length and width with free penis enhancement exercises. Before we get going it is very important to keep in mind that you should not do these exercises each day because your penis requires a little rest period from these exercises every so often. You will discover that if you use these exercises day-after-day that you will be doing much more harm than good and would finally harm your chances of enhancing your penis. So as sharp as you might be to begin these exercises I would really recommend that you relax at the start and set up a plan for when you will perform these physical penis exercises and follow through with them. The first exercise to enhance your penis is known as the PC Flex. This is considered a very good exercises because exercising this muscle will give you a real hard erections. Just like with women who are experiencing pregnancy, the PC muscle is the muscle that controls when you urinate and when you are able to stop urinating. The important thing here is preparing your PC muscle to be stronger and you are able to do this exercise anywhere. At the start simply do these exercises for a few minutes and when you first start, slowly increase it up to a half-hour at one step at a time and leave it at that limit. While you are squeezing your PC muscle you will feel the muscle around your anus working as well. What this does is increase the blood flow to the penis, which finally will add to your penis width. This is the perfect exercise to begin with, but to increase the quantity of blood moving to the numerous sections of your penis you must do more. This next exercise calls for taking a hold of your penis head with the grasp of the okay symbol by creating the figure of the letter O with your forefinger and your thumb. Stretch out your penis in front and hold it in this position for no more than 10-15 seconds. After you have finished that lightly rub down your penis. Now continue to stretch and hold the penis for about 10-15 seconds in a upwards, left, right, straight and downward directions. Make sure you rub down between each repetition. If you have difficulty holding on to your penis we recommend using tissue paper or toilet tissue. Make sure you do not to extend your penis too far, this exercise should not be harmful in any way that might harm your penis. The jelqing exercises calls for some type of lubrication. Baby oil will work just fine and it is affordable for any man. It is very important to do your penis stretching exercises prior to you doing any exercises to broaden your penis, because it will be that much easier to grab a hold of your penis. For this exercise get a semi erection, roughly about eighty percent. Then once more apply the okay grasp, beginning at the base of your penis and going up toward the head. While you are performing this exercise concentrate on forcing the blood up towards your penis head. Once you have made it to the head, change hands and keep doing around twenty-five of these jelqing exercises for the first seven days, and then add at least twenty five more every seven days. Within two months you will be doing two hundred jelqing exercises and just leave it at that. Just like every other penis enhancement exercise, always make sure you lightly rub down your penis after every repetition. It is very important that you do warm ups and also do a warm down before and after you exercise by taking a lukewarm bath towel and for three minutes or so wrap up your penis.