High-Risk Family Assessment and Health Promotion

High-Risk Family Assessment and Health Promotion
NUR/542
August 11, 2014
Professor James Bon

High-Risk Families A high-risk family is a family unit that is at an increased risk for emotional, intellectual, or developmental problem because of the type of environment or circumstances that is occurring within the family unit. Adults and children that are involved in these high-risk family units are at a higher risk to develop problems, both physically and emotionally. There are many indicators for early detection of risk factors: neighborhood environment, poverty, poor kept homes, characteristics of adults present in the home, marital problems, and child neglect. There are many programs and interventions that can be implemented to try to change the negative effects and ensure a positive outcome within the family unit.
History of Teen Pregnancy According to Furstenberg, Brooks-Gunn & Chase-Lansdale (1989), in an article titled Teenaged Pregnancy and Childbearing, teen pregnancy did not become prevalent until the 1960s. Two changes occurred contributing to the increase in teenage pregnancies: 1.) an increase in sexual activity of young girls and 2.) a decrease in the number of teenage marriages. By the 1980s over half of white females and three-fourths of black females were sexually active by the age of 18 (Furstenberg, Brooks-Gunn & Chase-Lansdale, 1989). Contraception was not regularly used when having sexual relations, and many of these females became pregnant during their teen years. Furstenberg, Brooks-Gunn & Chase-Lansdale (1989), also continue to say that compared to the number of unmarried teenage females in 1950 the females of 1980s were two-thirds white and almost 97% black single females. Also, 40% of these teenage pregnancies would end with abortion, and that the younger teenagers would have more abortions. A pregnant teenager has many decisions to make regarding her future: 1.) future schooling 2.) relationship with the baby’s father 3.) family’s support 4.) peer’s support.
Summary of the Health Profile of a Pregnant Teen The risk of some teenagers getting pregnant is high in some circumstances. There are many life situations that place teenage girls at a risk of becoming pregnant. These may include poor school performance, sexual abuse, poverty, being raised by a single parent household, having a mother who was an teenager mother, or having a sister who has become pregnant at a young age.
According to Saewyc, Magee & Pettingell, (2004) the risk of a teenager getting pregnant is increased if that teenager has been sexually abused. The pregnancy is because they have been sexually abused they have a feeling of powerlessness which can lead to impairment when it comes to using a contraceptive (Saewyc, Magee & Pettingell, 2004). Also, if the teenager has been sexually abused then they may have a higher chance of substance abuse and running away from home (Saewyc, Magee & Pettingell, 2004). Substance abuse can lead the risk for multiple partners, unprotected sex, and turning to sex work in order to support their habit. Many teenagers feel that they are under pressure to have sexual relations. Peer pressure, bullying, and teasing by friends can lead to sexual intercourse at a much earlier age. Also, being allowed to date at an early age can lead to pregnancy, especially if the individual they are sleeping with refuses to use contraception. There are many social and cultural changes that have occurred regarding dating. Getting to know a person over a long period, or courting, is no longer part of dating. Couples now move onto physical relationships much quicker, and sex is part of the relationship. Poor education and low achievement levels in school can lead to unwanted pregnancies. Teenagers who drop out of school are more likely to become pregnant and not complete their education. Teens that get pregnant tend to come from more disadvantaged families than those who do not become pregnant. Being of lower income contributes to a low hope of possible financial success which usually leads to choices of short-term contentment, having a baby while they are young and unmarried.
Orem’s Self-Care Model
Dorothea Orem published the Concepts of Nursing in 1971 and the sixth publication in 2001. According to Sitzman & Eichelberger, (2011), “Orem’s Self-Care Model describes a structure where the nurse assists the client, as needed, to maintain an adequate level of self-care. The degree of nursing care and interventions depend on the degree to which the client is able (or unable) to meet self-care needs” (p. 96). Orem’s general theory is in three parts: 1.) theory of self-care 2.) theory of self-care deficit 3.) theory of nursing system (Chitty, 2005, p. 283). The theory of self-care focuses on patient’s self-care capacities. The theory of self-care deficits specifies when nursing care is needed. Orem identifies five methods of helping: 1.) acting for and doing for others 2.) guiding others 3.) supporting others 4.) providing an environment promoting personal development in relations to meeting future demands
5.) teaching another (Orem, 2001 as cited in Masters, 2011, p. 183). The theory of nursing system describes the responsibilities and roles of the nurse and patient, the reason for the nurse-patient relationship, and the types of interventions needed to be provided to meet the patient’s needs.
The theoretical framework of Orem’s theory as it relates to the metaparadigm for nursing is based on the person, a nurse, environment, and health. Nursing is the ability to assist patients to provide and manage self-care to improve and maintain human function at some level. Health is not only taking care of the body but is also how a person performs with daily activities of living and progressing toward higher levels of functioning. Environment includes four features: 1.) physical 2.) chemical 3.) biological 4.) social (Orem, 2001 as cited in Masters, 2011, p. 183). The environment has an impact on the individual’s health and well-being. Finally, persons are human beings who are different from other living beings. Human beings can reflect, symbolize, and use symbols. The person is a patient whom the nurse cares for.
Orem’s theory can be applied to all three levels of prevention: primary, secondary, and tertiary. Every person needing nursing care has requirements at the primary level of prevention. Secondary prevention is required after the onset of illness and is directed toward reducing complications and disability. Tertiary care is appropriate when functioning is limited.
Dorothea Orem’s theory provides a widespread foundation to the nursing practice and is specific to when nursing care is needed.
Orem’s theory can be applied can be applied to various age groups including teenage mothers of newborns. The self-care deficit theory of nursing is useful with teenage mothers of newborns. The theory will focus on the strengths and/or weaknesses of the individual. Methods of help and interventions include teaching, guiding, and providing for and/or maintaining direction in an environment that supports personal development.
Healthy People 2020 Objectives According to Healthy People 2020 goals are to improve pregnancy planning and spacing, and prevent unintended pregnancy. Reducing pregnancies among adolescent females aged 15 to 17 years, reducing the number of pregnancies conceived within 18 months of a previous birth, increasing the number of both males and females who have never had sexual intercourse, increasing the number of sexually active persons who use condoms to both effectively prevent pregnancy and provide barrier protection against disease, and increase the number of adolescents who received formal instruction on reproductive health topics before they are 18 years old are all applicable objectives related to teenage pregnancy ("Family planning,"). There are many nursing interventions that are applicable for prevention of teen pregnancies. Nursing education that includes teaching about contraception, abstinence, and having schools administer condoms through the health office. Interventions can also include designing and presenting programs that includes parent-teen communication with their parent(s), while promoting abstinence and the proper use of contraception. According to Furstenberg, Brooks-Gunn & Chase-Lansdale (1989) there have been efforts made to prevent teen pregnancies. According to the Panel on Adolescent Pregnancy and Childbearing primary prevention, delaying sexual activity, and using contraception is where all efforts should be focused on for prevention (Furstenberg, Brooks-Gunn & Chase-Lansdale, 1989). Primary prevention programs include: 1.) educating teens about sexuality and contraception 2.) changing attitudes about early sexual involvement and 3) providing contraceptives and family planning (Furstenberg, Brooks-Gunn & Chase-Lansdale, 1989).

Role of the Advanced Practice Nurse as a Case Manager
Advanced Practice Nurses have the education, training, and skills to perform many of the primary-care duties performed by physicians. Advanced Practice Nurse Case Manager carries out advanced practice functions and develops functions that help to achieve the best results for the client through valuable interactions with clients. The Advanced Practice Nurse will manage and coordinate care for the pregnant teenagers and their families, provide health education, teach self-care behaviors, and offer psychosocial counseling and support, assess the efficacy of the health care system, and assist and monitor improvement ideas of the health care system.
Conclusion
Teenage pregnancy has been a major problem facing our children since the 1950s. Teen parents are less likely to finish school, more likely to live in poverty, more likely to have babies with low-birth weights and more likely to have children who become teenage mothers themselves. The goals of the health educator should include changing the behavior, providing counseling services, primary and preventative health care, and family educations. For the future, all teens should be aware of the risks involved of sexual intercourse and be educated on the ways to prevent pregnancies.

Reference
Chitty, K. K. (2005). Professional nursing, concepts & challenges. W B Saunders Co.
Family planning. (n.d.). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=13
Furstenberg, F. F., Jr., Brooks-Gunn, J., & Chase-Lansdale, L. (1989). Teenaged pregnancy and childbearing. American Psychologist, 44(2), 313-320. doi:http://dx.doi.org/10.1037/0003-066X.44.2.313
Masters, K. (2011). Nursing theories, a framework for professional practice. Sudbury, MA: Jones & Bartlett Publishers.
Saewyc, E. M., Magee, L. L., & Pettingell, S. E. (2004). Teenage pregnancy and associated risk behaviors among sexually abused adolescents. Perspectives on Sexual and Reproductive Health, 36(3), Retrieved from https://www.guttmacher.org/pubs/journals/3609804.html
Sitzman, K., & Eichelberger, L. W. (2011). Understanding the work of nurse theorists, a creative beginning (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.