Family studyFamily study

Family studyFamily study

•Greg BabwahGreg Babwah

•Shivan GoolcharanShivan Goolcharan

•Chawangwa Chawangwa LetsholathebeLetsholathebe

•Celeste ManchoonCeleste Manchoon

•Deepavali RambalackDeepavali Rambalack

•Candice RamdinCandice Ramdin

OutlineOutline

• Social Determinants of HealthSocial Determinants of Health• Cultural Influences on HealthCultural Influences on Health

• AttitudesAttitudes• BeliefsBeliefs• BehaviorsBehaviors

• Impact of Illness on the familyImpact of Illness on the family• Medically, Socially, Economically, Medically, Socially, Economically,

PsychologicallyPsychologically• Lifestyle as a Risk FactorLifestyle as a Risk Factor

What is a family?What is a family?

The family is a group of individuals related by The family is a group of individuals related by blood ties, marriage, adoption or by a feeling blood ties, marriage, adoption or by a feeling of closeness, who form a social and economic of closeness, who form a social and economic

unitunit• Group of relativesGroup of relatives• People living togetherPeople living together• LineageLineage• OffspringOffspring• Group with something in commonGroup with something in commonEssential readings pg 19

Family life cycleFamily life cycle

• The emotional and intellectual stages you pass The emotional and intellectual stages you pass through from childhood to your retirement years as through from childhood to your retirement years as a member of a family.a member of a family.

• In each stage, you face challenges in your family life In each stage, you face challenges in your family life that cause you to develop or gain new skills. that cause you to develop or gain new skills.

• Developing these skills helps you work through the Developing these skills helps you work through the changes the family goes through.changes the family goes through.

Family life cycleFamily life cycle

• Not everyone passes through these stages Not everyone passes through these stages smoothly.smoothly.

• Situations such as severe illness, financial Situations such as severe illness, financial problems, or the death of a loved one can problems, or the death of a loved one can have an effect.have an effect.

• Fortunately, if you miss skills in one stage, Fortunately, if you miss skills in one stage, you can learn them in later stages.you can learn them in later stages.

Life tasks of a family life cycle

• Independence (unattached young adult)

• Coupling or marriage

• Childbearing

• Family with adolescents

• Launching adult children

• Later life, senior years retirement

1. Social determinants of health1. Social determinants of health

Social determinants of healthSocial determinants of health

• Occupation• Socioeconomic status• Culture• NetworksFamily structureStage of family evolutionVariations of family structure• Social networkPublic health and human ecology pg 233

Roles of various health fieldsRoles of various health fields

• HospitalHospital– DoctorsDoctors– NursesNurses– Social workerSocial worker– PhysiotherapistPhysiotherapist

• Health centerHealth center– DoctorsDoctors– NursesNurses

• PharmacyPharmacy– PharmacistPharmacist– CDAPCDAP

• Rotary club associationRotary club association– wheelchairwheelchair

• GAPPGAPP– assistanceassistance

Case Study

Mr. JGMr. JG• Mr JG, 30 yr male. african descent, known autistic for 28 Mr JG, 30 yr male. african descent, known autistic for 28

yrsyrs• HistoryHistory

o Diagnosed with autism at age 2Diagnosed with autism at age 2o Clinically muteClinically muteo No other known medical conditionsNo other known medical conditionso Incomplete schooling (sign language)Incomplete schooling (sign language)o Tendency to wander of from homeTendency to wander of from homeo Last incident Jan 3Last incident Jan 3rdrd 2011 ( found at Mt. Hope hospital by family 2011 ( found at Mt. Hope hospital by family

registered as a John Doeregistered as a John Doe

• DiagnosisDiagnosiso Autism Autism

Mr. JGMr. JG

• Duration of stay 3 weeksDuration of stay 3 weeks• Discharged withDischarged with

– MedicationMedicationo StelazineStelazineo Artane Artane – Referrals to Referrals to

• Tacarigua extented care health centreTacarigua extented care health centre• Social workerSocial worker• psychiatrypsychiatry

• Resides at home with mother and siblingsResides at home with mother and siblings

Mr. JGMr. JG

• SingleSingle• 33rdrd child of 5 siblings child of 5 siblings• Lives in St. Joseph with mother (65yrs), but taken Lives in St. Joseph with mother (65yrs), but taken

care of by sisterscare of by sisters• Never been formally employed, but disability fundNever been formally employed, but disability fund• °alcohol, °smoking°alcohol, °smoking• Healthy appetite Healthy appetite • BMI > 23BMI > 23

Mr. JG Mr. JG

• ?? aware of his situation?? aware of his situation• unable to communicate efficientlyunable to communicate efficiently• On inspection health young adult maleOn inspection health young adult male• No verbal communicationNo verbal communication• Constant monitoringConstant monitoring

Mr. JGMr. JG

• Physically capable of grooming himselfPhysically capable of grooming himself• Assist with household chores and dutiesAssist with household chores and duties• Religious personReligious person

– Goes to church with familyGoes to church with family

GenogramGenogram

Mr. JGMr. JG

RameshRamesh

RamnarineRamnarine

Sintra Sintra

ChandraChandra

Geeta Geeta

Gaitree Gaitree

KavitaKavita

GenogramGenogram

EcomapEcomap

EcomapEcomap

Structure of homeStructure of home

Impact of geographic and socio-economic Impact of geographic and socio-economic milieumilieu

• Lives approximately 500 ft from a main road for Lives approximately 500 ft from a main road for absolute transportation accessabsolute transportation access

• Concrete house in need of minor repairsConcrete house in need of minor repairs

• Walkway from house to street is not flat and not Walkway from house to street is not flat and not accessible via wheelchairaccessible via wheelchair

• Community is very congested with narrow roads, and thus visiting the Health Centre is tedious

Occupation of family membersOccupation of family members

• Mrs. BJ – pensionerMrs. BJ – pensioner• Sintra – unemployedSintra – unemployed• Ramnarine – part time bank tellerRamnarine – part time bank teller

– Sits in front a computer all daySits in front a computer all day– ?Carpal tunnel?Carpal tunnel– ?Neck injury?Neck injury– ?back Injury?back Injury

What’s money gotta do with it?

FINANCES:• Mrs. BJ – pension - $1600• Ramnarine - $3000• Total household income - $4600

• Maintains:– Household and bills– Medication and medical bills for Mrs. BJ– Some of pension goes to Sintra to help look after

herself and her household

What’s money gotta do with it?

• Sintra :Sintra :– UnemployedUnemployed– Deceased spouse (pharmacist) was sole breadwinner – she Deceased spouse (pharmacist) was sole breadwinner – she

has understanding of most medical matters relating to her has understanding of most medical matters relating to her mothermother

– Will - assetsWill - assets– ??supports herself and her household??supports herself and her household– ??lives solely off her mother and daughter??lives solely off her mother and daughter

NO other contribution from other family members except, NO other contribution from other family members except, Kavita who helps pay the Geriatric nurseKavita who helps pay the Geriatric nurse

Levels of supportLevels of support

Mrs. BJ – financialMrs. BJ – financial

Sintra – 1Sintra – 1° care giver° care giver– TimeTime– LoveLove– Emotional supportEmotional support– physicalphysical

Ramnarine – financialRamnarine – financial– GroceriesGroceries– MedicationMedication– BillsBills– Unable to help with Unable to help with

mother as he ‘can’t be mother as he ‘can’t be around sick people’around sick people’

2. Cultural Influences on Health2. Cultural Influences on Health

Cultural InfluenceCultural Influence

• AttitudesAttitudes• BeliefsBeliefs• BehaviorsBehaviors

– As related to health and illnessAs related to health and illness

Family perception of illnessFamily perception of illness

• Both Sintra and Ramnarine talk about their Both Sintra and Ramnarine talk about their mother’s illness, and aware of the long term mother’s illness, and aware of the long term impact it may have on both their and their impact it may have on both their and their mother’s lifemother’s life

• Sintra, however is more open about Sintra, however is more open about everythingeverything

• For both its hard to see their mother in this For both its hard to see their mother in this state, even harder for Sintra who gets VERY state, even harder for Sintra who gets VERY emotional when talking about her and the emotional when talking about her and the event of her untimely death, should it occurevent of her untimely death, should it occur

Family perception of illnessFamily perception of illness

• Both are willing to do anything for their Both are willing to do anything for their mother, including getting better health caremother, including getting better health care

• Expect full recoveryExpect full recovery

• Believed putting nutmeg in BJ’s mouth would Believed putting nutmeg in BJ’s mouth would have helped with the CVAhave helped with the CVA

Expectation of the Health systemExpectation of the Health system

• Education - about what to do to help re-habilitate Education - about what to do to help re-habilitate their mother and how to lower her risk of a 2their mother and how to lower her risk of a 2ndnd CVA CVA was givenwas given

• Need some form of help for transportation for Need some form of help for transportation for Health Center visitsHealth Center visits

• GAPP – more efficiency in allocation of assistance to GAPP – more efficiency in allocation of assistance to themthem

• Financial assistanceFinancial assistance

Expectation of the Health systemExpectation of the Health system

• Communication – between them and the Communication – between them and the Hospital staff was goodHospital staff was good

• wheelchair donated to them via the Rotary wheelchair donated to them via the Rotary Club Club – ?Mrs. BJ ability to use it?Mrs. BJ ability to use it

Influence of culture and religionInfluence of culture and religion

• Nutmeg in mouth and nutmeg oilNutmeg in mouth and nutmeg oil

• It was their mother’s fate to suffer a CVA. It was their mother’s fate to suffer a CVA. They don’t understand why, but have They don’t understand why, but have accepted itaccepted it

• Positive outlook and attitude toward illnessPositive outlook and attitude toward illness

• Blessing to look after their motherBlessing to look after their mother

Patient and health care service Patient and health care service utilizationutilization

• ONLY Mrs. BJ attended the Chaguanas HC for ONLY Mrs. BJ attended the Chaguanas HC for Mx of her HTN and OsteoporosisMx of her HTN and Osteoporosis– Now unable to, due to her immobility and lack of Now unable to, due to her immobility and lack of

proper transportproper transport

• Neither Sintra nor Ramnarine utilizes the health Neither Sintra nor Ramnarine utilizes the health systemsystem

3. Impact of Illness on the Family3. Impact of Illness on the Family

Impact of Illness on the FamilyImpact of Illness on the Family

• Medical Medical • SocialSocial• EconomicEconomic• PsychologicalPsychological

Illness impacts on the quality of life and social Illness impacts on the quality of life and social relations in any family, not solely the patient relations in any family, not solely the patient

Impact on Mrs. BJImpact on Mrs. BJ

• Physical – cant walk, sit, leave house, go Physical – cant walk, sit, leave house, go templetemple

• Social interactions with other elders limitedSocial interactions with other elders limited• Pension – most used on her medical expensesPension – most used on her medical expenses• Totally dependent on childrenTotally dependent on children

– Can’t feedCan’t feed– Help with householdHelp with household

Impact on Sintra• 1° care taker, moved into mom’s house, ° care taker, moved into mom’s house,

sleeps in same bedsleeps in same bed

• Previously unemployed and now can’t even Previously unemployed and now can’t even look for a joblook for a job

• Rarely leaves houseRarely leaves house– Social activities – not much friendsSocial activities – not much friends– leisureleisure

Impact on SintraImpact on Sintra

• Wishes someone could help herWishes someone could help her

• Health - Worsening scoliosis – moving momHealth - Worsening scoliosis – moving mom

• Very religiousVery religious– +ve attitude+ve attitude– Tries to smile ALL the time, happy dispositionTries to smile ALL the time, happy disposition– Gives her mom all the love she could ever wantGives her mom all the love she could ever want

Impact on RamnarineImpact on Ramnarine

• Medical condition Medical condition • Rarely goes out – now can’t, comes home Rarely goes out – now can’t, comes home

after work to help Sintraafter work to help Sintra• Emotionally hard on him…..’can’t be around Emotionally hard on him…..’can’t be around

sick people’sick people’• Depressed and feels helpless at timesDepressed and feels helpless at times• Severe financial burden….recently >$1000 on Severe financial burden….recently >$1000 on

ripple mattressripple mattress

Barriers to Implementation of Care Barriers to Implementation of Care PlanPlan

• Lack of information about servicesLack of information about services• Appointment at health centre for appropriate Appointment at health centre for appropriate

follow up carefollow up care• FinancesFinances• Geographics – location, transportGeographics – location, transport• Support – physical, emotionalSupport – physical, emotional

Characteristics of family on Characteristics of family on Improvement of HealthImprovement of Health

• Both willing to make any changes necessary to Both willing to make any changes necessary to assist their motherassist their mother

• The love for their mother keeps them goingThe love for their mother keeps them going

• Ramesh has not been told about mother’s Ramesh has not been told about mother’s condition, has not visited nor does he condition, has not visited nor does he contributecontribute

4. Lifestyle as a Risk Factor4. Lifestyle as a Risk Factor

Lifestyle as a Risk FactorLifestyle as a Risk Factor• Infants:Infants:

– 1. Unhygienic environment1. Unhygienic environment– 2. Poor sleep habits due to parental constraints2. Poor sleep habits due to parental constraints– 3. Insufficient Parental care3. Insufficient Parental care

• Children:Children:– 1. Poor Diet: Fast Foods, Junk food1. Poor Diet: Fast Foods, Junk food– 2. Insufficient Physical Activity: Indoor activities only2. Insufficient Physical Activity: Indoor activities only– 3. Poor supervision3. Poor supervision

• Adolescents:Adolescents:– 1. Substance Abuse: illicit drugs1. Substance Abuse: illicit drugs– 2. Criminal Conduct2. Criminal Conduct– 3. Promiscuity3. Promiscuity

• Adults: Adults: – 1. Stressful Job positions1. Stressful Job positions– 2. Alcohol Consumption and Smoking2. Alcohol Consumption and Smoking– 3. Sedentary3. Sedentary

• Elderly:Elderly:– 1. Poor Diet: Insufficient nutrition1. Poor Diet: Insufficient nutrition– 2. Lack of Physical Activity2. Lack of Physical Activity– 3. Social isolation3. Social isolation

Lifestyle patterns that may affect Lifestyle patterns that may affect healthhealth

• Mrs. BJMrs. BJ

patternpattern conditioncondition interventionintervention

immobileimmobile DVT, PE, MIDVT, PE, MI Elevate legs, Elevate legs, TED stockings, TED stockings,

constipationconstipation Fiber in diet, Fiber in diet, waterwater

spasticityspasticity Positioning Positioning

depressiondepression Move around Move around househouse

Bed pressure Bed pressure soressores

Turn regularly, Turn regularly, ripple mattressripple mattress

Lifestyle patterns that may affect Lifestyle patterns that may affect healthhealth

patternpattern conditioncondition interventionintervention

Poor dietPoor diet dehydrationdehydration Adequate waterAdequate water

Electrolyte Electrolyte imbalanceimbalance

MalnutritionMalnutrition

Food Food supplementssupplements

Aspiration Aspiration pneumoniapneumonia

Watch pt Watch pt swallow food swallow food and waterand water

Lifestyle patterns that may affect Lifestyle patterns that may affect healthhealth

• Sintra and RamnarineSintra and Ramnarine– Both have poor dietary intake and no exercise and Both have poor dietary intake and no exercise and

live in a stressful environmentlive in a stressful environment– At risk of developing HTN, DM, MI, CVA At risk of developing HTN, DM, MI, CVA – Advised about proper diet (food groups, fruits, Advised about proper diet (food groups, fruits,

meal size and frequency)meal size and frequency)– Some form of exercise into work routineSome form of exercise into work routine– Relax and some form of meditation, whenever Relax and some form of meditation, whenever

possiblepossible

Essential Conditions for Successful Essential Conditions for Successful AgeingAgeing

• DietDiet• ExerciseExercise• Challenge the brainChallenge the brain• NewnessNewness• Human loveHuman love

ConclusionConclusion • A wider array of diseasesA wider array of diseases• Goals for elderly and doctor - often to maintain ability to Goals for elderly and doctor - often to maintain ability to

function as comfortably as possiblefunction as comfortably as possible - - notnot seek a cure seek a cure

• Need for individualized health care - one size does not fit all!Need for individualized health care - one size does not fit all!• Exposed to many medicationsExposed to many medications• Older people do not always report change in condition.Older people do not always report change in condition.• Fear factor:-Fear factor:-

1.1. That condition might not be treatableThat condition might not be treatable2.2. Economic consequencesEconomic consequences

Learning ObjectivesLearning Objectives

• Importance of good communication skillsImportance of good communication skills

• Patient-centered carePatient-centered care

• Role of spirituality in medicineRole of spirituality in medicine

Communication skillsCommunication skills

• It was realized from our close interactions It was realized from our close interactions with this family, the importance of good with this family, the importance of good communication skills as a doorway to:communication skills as a doorway to:

• Successful interaction between patient & the health Successful interaction between patient & the health care systemcare system

• Patient’s & Doctor’s satisfactionPatient’s & Doctor’s satisfaction• Patient concordance and compliancePatient concordance and compliance• Continuity of careContinuity of care• Improved clinical outcomesImproved clinical outcomes

Patient-centered MedicinePatient-centered Medicine

• This study highlighted the importance of:This study highlighted the importance of:

• Respect for patient’s values, preferences & expressed Respect for patient’s values, preferences & expressed needsneeds

• Co-ordination and integration of careCo-ordination and integration of care• Information, communication & educationInformation, communication & education• Physical comfortPhysical comfort• Emotional support & alleviations of fear & anxietyEmotional support & alleviations of fear & anxiety• Involvement of familyInvolvement of family• Transition and continuity from hospital to homeTransition and continuity from hospital to home

Role of Spirituality in Medical HealingRole of Spirituality in Medical Healing

• Grasping the importance of prayer to Mrs. BJ Grasping the importance of prayer to Mrs. BJ and her family & its influence in their life was and her family & its influence in their life was critical to understanding their dynamicscritical to understanding their dynamics

• Spirituality was a way of life for this family and Spirituality was a way of life for this family and

it was observed to be an extremely effective it was observed to be an extremely effective coping techniquecoping technique

ReferencesReferences

• Oxford Handbook Of Clinical MedicineOxford Handbook Of Clinical Medicine• PAHOPAHO• Family Problems by Peter Williams, (Oxford Family Problems by Peter Williams, (Oxford

General Practice Series No.17)General Practice Series No.17)• WHOWHO• Handouts – Family Life CycleHandouts – Family Life Cycle

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