Unit II: The Home Visit as a Program for Addressing the Family

UNIT II

THE HOME VISIT AS A PROGRAM

FOR THE APPROACH OF THE FAMILY

Introduction General Objective:

Unit II aims to Describe the Home Visit as

offer the participant information about the program and as an activity for the
Home Visit, as a program, attention to the family and to groups of
advantages and disadvantages, criteria of risk at home by
assignment and selection, as well as the nursing and the health team.
development of the activity, both in the
consultation at the home of the Specific Objectives:
family. Similarly, a develops a
specific theme related to the 1. Describe the aspects more
care of the elderly in the highlights of the home visit
home visit program, how as an instrument of attention to
at-risk population y as an axis family group at home.
fundamental for care according to the 2. Describe the organizational aspects
WHO. Home care is the from the home visit.
service that is performed at home 3. Describe the adult's attention
of the person, with the purpose of major in the visit program
detect, assess, provide support y home
monitoring health issues
of the patient and their family, empowering
its autonomy, reducing the crises due to
imbalances y in general,
improving the quality of life of the
people.

Community Nursing - Nursing - University of Los Andes, Mérida. Velasco, A. 2014

General considerations of the One technique: because apply
Home Visit knowledge scientific-technological
to produce changes related to the
What is a Home Visit? self-responsibility y
self-determination of care of the
According to Roca and Úbeda cited health of individuals, families and
in Sánchez (op cit) the home visit communities.
c) A program: because it constitutes
a tool to be executed with
The set of activities of based on objectives, activities and
social and health character that is specific resources, considering
provided at home at the administrative aspects for your
people. This attention allows implementation. In this regard,
detect to value support y the organization coordination
control health problems supervision y evaluation son
of the individual they family fundamental elements a to be
empowering autonomy y taken into account.
improving the quality of life of d) A service: because it is about the
the people. (p. 195) assistance offered to the family group
to contribute to the
This definition encompasses multiple satisfaction of their needs and
aspects that go beyond the health problems.
care of sick people, position
which encompasses both health and the It is important to clarify some
disease throughout the life cycle terms: it's not the same to talk about
of the individual, hence the visit comprehensive visit, home visit of
home detention constitutes the instrument rescue, epidemiological, with care
ideal for getting to know the environment in which home care or home assistance
long live the family, and its influence on health they are different concepts.
of those who inhabit the dwelling, already Home attention is the
what is at the address, the place where he care provided by professionals
man feeds, rests, occupies from the health team to a member of
leisure time and is related to its the family in their own home, with the aim
primary nucleus. of to provide support diagnosis
According to Salazar (op cit p. 116) treatment recovery y
depending on the perspective of rehabilitation; it is focused on the
study and the objective that is proposed, disease process and includes the
the home visit can be defined palliative care for pain relief,
how: activity that is currently taking place
in primary care, as well as the
a) An activity: which would be the set attention to the bedridden. These actions
of activities that are carried out in they are carried out according to an evaluation
the family group's address to previous and a care plan that
through of tasks specific, it should be negotiated and agreed upon
turning it into a means of with the family and not imposed from the
link between the family and the system health team.
of health.
 The epidemiological visit is a that it is carried out in its
scheduled activity that is own means.
mainly aimed at making a  An interpersonal relationship is achieved
epidemiological investigation of the case sincere, real, and active among the team
index of a disease that is and the family group.
under surveillance, of an emerging event  It facilitates the development of actions
or some risk event for the proposals and the compliance of the
population. It can be done in the proposed objectives.
address, but it is not essential;  The family accesses with less
they are totally different things and the resistance and greater flexibility
people who work with the public the compliance with the
They know they have different records. commitments made with the
The comprehensive home visit health team.
define as the activity carried out by  It allows to ascertain and verify the
one or more members of the team of information obtained from others
health in the home of a family, with means about the conditions
the objective of to establish a family health.
integration with one or more members and  Allows to identify the problems and
his environment to know his surroundings
express and hidden needs and the
environment and provide them support to face real availability of resources and its
bio-psycho-sanitary problems, in the management.
framework of a care relationship  Facilitates monitoring and tracking
continuous and integral, which must be the from the evolution of achievements
characteristic of the work in the achieved.
primary care. It could be added  A global view is obtained of the
that has a centered component in family and its real behavior
the actions of promotion, protection, facing general problems and
recovery and/or rehabilitation of the specifically health.
health  Allows the development of the
education activities for the
Advantages and disadvantages of the visit
targeted health a the taking of
home
awareness and to seek a change
in behavior.
Salazar (op cit) considers some
 Enables the development of the
advantages
operational research.
home, among which there
 Allows to expand the coverage of
they mention:
health program practice
a) Advantages: familiar.

b) Disadvantages:
 Their practice allows for greater
trust y security in the
 It does not present disadvantages as such.
individual and their family group facing
the service offer. home visit, but issues may arise
 Allows for one more participation o to derive from a lack of
organization and scheduling by
broad, sincere y real in the
part of the health service and of
family health program, given
 team of visit being able based on the criteria of affiliation
convert into inconvenient, causing from family to health program
rejection in the family group. familiar.
This makes it necessary for the visit
home confinement must be justified and with a) Criteria for assignment
the very precise objectives, to avoid
setbacks and loss of credibility  Socioeconomic criterion: it is given to him
of the assistance service, as well as of the gives priority to the groups
health team. relatives classified within the
strata of greatest poverty y
There are some benefits, such as extreme poverty, derivatives of the
as: application of the Graffar Method
Modified.
 Improve health care  Epidemiological criterion: it is classified
 Increase the participation y to the family based on the risks of
responsibility of the family in the health, considering aspects of
care process. family life cycle, factors
 Improve the quality of life of the endemic and epidemic of the
users. diseases infectious diseases,
 Grants a sense of intimacy and factors of disability and invalidity,
well-being, as people feel that diseases occupational,
this type of personalized assistance needs of attention of
it is more human. terminally ill and follow-up in the
 Improve education delivery. home for patients who do not require
 Prevents social exclusion, hospitalization.
benefit that can only be  Demographic criterion: it is considered to
to achieve in primary care, no the different population groups.
at the secondary or tertiary level. Children under 5 years old are the most
vulnerable, and among this group, the
Criteria for the assignment of the under 1 year old, being even more
family to the family health program susceptible to illness in minors
and criteria for the selection of the of 1 month.
family for the home visit.  Criterion administrative is
related with the resources
According to Salazar (op cit), the following available (technical, human,
these are the criteria for assigning to a financial y materials, what
family to the family health program, redundant in any case, in the
just as those that prevail for the increase in coverage according to the
home visit. In this sense, it is worth mentioning real demand for health care services,
Emphasize that they are practically the based on the needs and
the same, but it must be considered that family group risks.
fact of organization and principles
that are generated in each of the b) Selection criteria. In this
activities. In this sense, the epidemiological criterion is
The selection criteria for the the one who prevails above the
home visit, must be established
 remaining for the selection of the sick) and to his family. Among these
family for the home visit. criteria are found:

 Epidemiological criterion: for the visit a) Families with adults over 80

domiciliary is considered the magnitude years.
of the damage in terms of morbidity, b) People who live alone or without
mortality and disability or invalidity; families.
the risk of individual exposure; c) People what no they can
vulnerability and the degree of move to the health center.
dependency o capacity to d) Families with seriously ill patients or
face or solve the needs invalid.
of health. e) People with hospital discharge
 Criterion socioeconomic himself recent.
also consider the strata f) People with vital medication.
socioeconomic a through del
Modified Graffar Method, how Likewise the OMS (1981)
tool that measures quality of establish some key objectives with
life and well-being of the population. based on these criteria, that everything
 Criterion demographic: is home care program must
related to the stability of to fulfill, among them are:
family households, that is,
those that have remained a) The proportion of attention to the
between three and five years in the same population that cannot move
sector. The distribution is considered at the health center.
from the family in a specific area, b) The proportion of the information,
education and support for the patient and their
geographic accessibility, the
displacement and the distance that family.
media between housing and service c) Facilitate primary prevention,
of health, in addition to the structure secondary and tertiary.
gender and the reason for masculinity d) Avoid unnecessary income.
among others. e) Unify the quality of care
 Administrative criterion: take in all the professionals involved:
account for resource availability action protocols, sessions
what do the visits have clinics, pain management, prevention
domiciliary: personal, transportation of ulcers, etc.
community resources and the f) Promote coordination between the
own of the home, in addition to the offer of health services and
support services for the visit. social

According to the WHO (1981), there are Likewise, to ensure the

some minimum criteria regarding the program development is required
situations that require form de:
priority home care, with the
object of providing information, a) The participation of everyone
education and support for the individual (healthy or) health team members.
b) The comprehensive assessment of the patient and
his family.
c) Coordination with others necessary, it must be consulted the
health and social resources. family medical history. On the other hand,
d) Community participation, from the work team is fundamental
the family itself up to the various (home visit briefcase), with
associations that exist. all the work tools.
b) Presentation at the home: the
Similarly, the WHO considers that presentation a the family is
the activities that take place fundamental, as well as saying what
they will depend on the capacity the institution comes, above all
functional of the patient, of the pathology when the visit is for the first time.
that present, of the characteristics of In this sense, the initial perception
the family that takes care of him and the resources that has the family of said
with what this account has. a professional can condition the
This is why the staff of opinions and the relationships that
nursing should to strengthen the establish in the future.
intervention with the family and the visit c) Assessment: it is very difficult to carry out
home care as a strategy. Even with a complete assessment a the
difficulties in integration with the members and the family group in the
work team, nursing has the first visit, but this will be able to
opportunity to provide care complement in the visits
appropriate and to apply the tools successive, giving the opportunity,
necessary for prevention y in addition, to strengthen the relationships
group health promotion with the family. The health personnel
familiar. must respect the negatives of the
family members, if they
Organizational aspects of the Visit they produce,o a respondent a
Home care certain questions or doubts, yes
they arise. It is necessary to have
Once the criteria have been established presents that home care
affiliation and selection of the family a specific day begins, but
for the home visit, it is important can continue for a long time
consider that for the development of the time.
activity, it must be established a
relationship of equality and cooperation with d) Care planning: in
the family, as their participation is this stage must be taken into account
fundamental. three fundamental aspects:
According to Antón (1998) cited in
Sánchez (op cit), the home visit  Set the objectives that need to be.
requires different stages: reach short, medium and long
deadlines, which must be realistic,
a) Preparation for the visit: before relevant, measurable y
to visit the home, it must be arranged observables.
with the family the day and the time when Establish agreements or pacts with the
it will be done to make a better family.
use of time, both of the  Identify and mobilize resources
professionals like family, and available: the family and the caregiver of
avoid inappropriate situations. If being
 the family, the health team, the Based on the above, the visit
material and technical assistance and home care represents for
community resources. nursing, a great opportunity of
intervention and strengthening in the
e) Execution of care: these identification of needs y
They can be the care problems of the familyy group,
direct professionals, aimed at having a direct impact on the
people who need it and the increase in coverage of the
indirect professional care, programs of the Ministry of Health and
what are those that affect Social Development, as well as in the
the improvement of the quality of life of the improvement of the quality of life of
attended individuals. the population.
f) Evaluation of the visit: it serves to
continue or modify the planning Importance of the home visit
from care, detect them in Family Medicine
difficulties, review the objectives and
plan new ones. Family medicine is narrative:
g) Visit registration: once it is a story or tale composed of
after the visit, the proceeding will be the countless visits that the doctor
registration of the same: symptomatology,carry out a through the years,
changes observed, care, establishing a principle of
prescribed and administered medication,continuity, since the team of
date of the next visit, among others header and the doctor accompany that
elements. family in the history of your life and
they participate in the milestones related to
The home visit is an activity the processes of health, disease and
complex, as it must address various crisis. The dialogue that the doctor
aspects such as the observation of the holds with the families is marked
individual needs within the for the historical milestones of health
family framework, the establishment these milestones that constitute a part
of cooperation and equality relationships important to your narrative.
between the health team and the group The main tool of the
familiar, and the strengthening of the role of Family medicine is semiology;
the family in the care of its own semiosignifies sign and for co-
health. For this, it is necessary the build this narrative with the families,
planning the visit taking into account semiology should be taken into account
account: like the art of gathering symptoms or
signs not only in the biological field,
a) Interdisciplinary work. but in any aspect that allows
b) The coordination betweenlevels to the doctor to establish a model
assistance. explanatory or hypothesis, from a role
c) The mobilization of resources institutional. The symptoms or signs of
available. happening in everyday life
d) The helping relationship and education they constitute the clues about the
for health. problem what it faces the
semiology is the art of knowing how to read in
them and to expand understanding,
establishing links between variables of invade the homes of families without
the biological, psychological fields, meet certain requirements, of which
social and family, of which the doctor the most important thing is that it has been
also forms part. Therefore, the a previously established link.
a clinic is nothing more than a set An epidemiological or rescue visit
of relationships that extends from the it can be carried out by anyone
molecular to the social and the medical person, but in the case of the visit
has the obligation to know how to read and home, which has a character
search according to the problem that has Integral and aims to evaluate the
decided to address. human being in its context, is
Family medicine works with it is essential that there is a bond
this expanded semiology and the visit prior at least with one of the
integral home care is one of the team members, so that the
richer scenarios to apply it, activity can be framed in the
but it is not the only one. Within the narrative of the family and grant
Canasta, the visits are still missing. continuity of care. Therefore,
schoolchildren, as an instance of this activity must be planned and
meeting of parents, teachers, authorized, in a negotiation that
schoolchildreno teenagers y others must do beforehand.
important elements of life The objectives of the family visit,
these students and the health team, from the point of view of the system and
to solve many problems that based on the needs of the
they are presented daily to the users, they are: getting to know the home, the
primary care. environment and family situation; detect
The expanded semiology allows us to see needs, resources, and networks; evaluate
to the individual and beyond, because to the family as a unit of care;
include all its context: where he/she lives, improve the definition of the problems
who lives with, the people, their of health and differentiate the diagnoses
relationships and the circumstances in which of the people. This allows for visualization
that develops their mental occurrence; to people, not as a pathology,
in this context, it should always be but as human beings who have
remember that it is one of the activities a health problem; the diagnoses,
more invasive that they can carry out they are necessary to evaluate the
health professionals, therefore result of the actions aimed at
it is a risky activity and I don't know reduce morbidity figures and
can be done without preparation mortality but en terms
previous. For all human beings, relational, and considering that the
the home is a private space that the main medical labor is to achieve that the
they must protect; those who carry out the humans change their behavior and
visitors should imagine what adopt healthier habits, the
what would happen if a person arrived at their habit of seeing the patient only as
house a to point out to what
them they have a diagnosis it is not so useful. When
determined health problem; thus health problems are touched upon in the
they would understand that the relationship of home visit, the relationship must be
asymmetry that occurs in this field, mutually obligatory between the user or
especially in the most sectors case index and the family and the team of
dispossessed, does not give them the right to health; it should even include neighbors and
friends. For achieve this aspects: problems of health
essential to improve communication physical disability, cognitive decline
among the team members of social risk factors, conditions
health and families. from housing, service registry or
health or social resources
Valuation instruments that the person uses (day hospital,
home visit program home assistance), a
situation of the
caregiver.
The valuation integral y
multidimensional constitutes a stage  Functional Assessment: activities of
fundamental within the process daily life (basic,
assistance of people included in a instrumental and advanced). For
home care program. A evaluate the basic activities of the
good selection of instruments for daily life can use the Index of
estimate physical needs y Barthel or the Katz Index.
social is essential for the  Cognitive assessment: there are several
objective planning of care instruments among which are
what we offer to the users of this the Mini-Mental State Examination
type of programs. Mini-Mental State Examination
To ensure quality in the MEC, Short Portable Mental State
compliance with the home visit, Questionnaire (SPMSQ), Mental
it is important what there is a Status Questionnaire (MSQ), Set-
clinical documentation, for use of Test the mental scale of the Red Cross.
team and family, where it is verified  Assessment of the Socio-
all those data that are of interest to The evaluation of a
both, and allow to be constituted in patient at home does not remain
technical-scientific instruments for complete without the analysis of the
facilitate and enable measurement and the socio-family situation, which will allow
comparability of the activities that determine the family support and
they are met at the operational level. social networks available to you in order to
(Bahsas, 1996) prevent future crises as much as possible
According to Agullo and Col (200), the selection relatives, as well as valuing the
of instruments o scales of need to seek other resources.
integral assessment in programs of It is important that we do not limit ourselves.
home care can be addressed to arrive at the home 'to spend a
considering a basic option new survey", but rather try
addressed to all patients, and a detect all those factors that
complementary evaluation for the they can influence health, evaluating
that present certain risks. beliefs, habits relationships
relatives y social, factors
a) Basic option socioeconomic among others.
It is therefore advisable to assess the
A package has been selected. person and their environment, the experience of
basic instruments that allow the disease y the services
make an assessment based on the sanitary. For do this
intervention plan afterwards and that we can use various instruments
includes the valuation of the following
 basics in family care. In degree of overload what
first place we must know its the caregivers experience.
structure and demographics, and for that  Psychological disorder and/or discomfort.
data must be recorded from the Anxiety-depression: The importance
family history and problem sheets quantitative of the disease
by means of a interview depressive and psychological discomfort in the
semi-structured and the realization of the community is clearly proven
family tree. Secondly, y documented. The factors
we can assess and understand the support related to this pathology,
social and social networks, through such as age, marital status, level
a series of instruments such as socioeconomic and social support, are
the social valuation scale aspects that are developed and
familiar; as instruments of magnified in people who
the measure of the social network is they require home care, for the
APGAR II, the Perception Test of that it is justified to value the
Family Functioning y a psychological discomfort both in the
simplified method to know the patients like in the caregiver. For
size of the network. Thirdly, the Goldberg Scale is used,
can evaluate the family function Geriatric anxiety scale and the
through the family APGAR. Geriatric Depression Scale
 Assessment of needs Yessavage
Basic care: The needs of  Risk of ulceration: There are several
Maslow. risk valuation methods,
among them the first y more
b) Complementary option the Rating Scale is well-known.
from Norton, in which through a
It allows to complement the evaluation score for each of the
basic integral with instruments that reflected criteria obtain a
study patients in depth number that indicates if it is a patient
of higher risk. Includes scales of of risk (below 15 points),
depression and anxiety, self-perception or if it is a patient who with all
of health level, scales of security will develop an ulcer
pain assessment (especially in under pressure (below 12)
palliative care) and scales of points).
risk assessment for the establishment of  Assessment of symptoms of
decubitus ulcers. patient with terminal cancer: The
It would be carried out later in selection of an instrument of
target population groups identified assessment of the situation of a
previously as risky due to the person with terminal cancer
basic assessment. during their stay at the
address raises difficulties
 Valuation del caretaker: The related to the characteristics
caregivers endure a very high degree of the patients, of the instruments
intense stress, due to the of valuation and of the valuation in
intensity and continuity of the attention primary. The scarce
care. The exposed scale (Test experience of the professionals in
from Zarit), is aimed at detecting the
 the use of instruments of identify the situation of each one
valuation in the field of the them. In this sense, the figures and
palliative care complicates its lines represent people and their
implementation as a supportive measure relationships.
to daily clinical practice. The family tree helps to organize the
 Nutritional assessment: It is proposed that the information of the family the
questionnaire 'Know Your Health' characteristics of its members,
nutritional” proposed by the NSI understand the patterns
Nutritional Screening Initiative. multigenerational family systems,
to know the existing relationships between
The Family Tree or Genogram each of the members and collect
data that guides the members of the
The Family Diagram (Annex 1) is a health team, about the behavior of
graphical representation of the structure continue regarding each of the
familiar. The structure of the family is not members that make up the system,
a static phenomenon, but a process influence the modification of the dynamics
dynamic that changes continuously and in the solution of the problem.
regarding the stages of the cycle of With a look fast to the
family life and events family tree, it can be estimated the
vital events that occur within the family. composition of the family and determine if
(Bahsas, op cit) it is a nuclear, extended, or
The familiogram or genogram was extensive compound; the number and age
developed in 1978 by Murray of each of the members, both of
Bowen. It is used to represent the members as those who have
graphically on a page a deceased sus interrelationships
amount of information regarding the (separations, emotional ties, of
main characteristics e conflictivity, rejections, among others), thus
interrelationships of a family group. It is such as situations of illness.
widely documented its usefulness The basis of the family tree is founded
as an instrument for exploration of in the study of genealogy, which
the family, help a elaborate a using the family tree register
diagnosis of the family. They are also conventional symbols that are
known as family pedigree or tree they interpret as equivalents of
familiar. ancestors, descendants, line of
The family tree is of great importance consanguineous and lines between spouses.
because allows to study the For the preparation of the family tree
background relatives, clinical several interviews are required,
pathological, biological, and social that obtaining the initial information from
could cause problems in some first member of the family that is
family member, as well as allows attended, either in the consultation of
obtain information about its members to assistance center or at home during
over several generations. the home visit.
The family tree as representation It is recommended to integrate into the
graph, requires a symbology that family tree of at least 3 generations
sketch it out in general form in order to investigate its functions,
structure y dynamic of sus alterations psychological,
members, in a way that allows behaviors y diseases
hereditary. It constitutes a framework of a) Front face of the instrument: it is
reference for conducting the analysis related to identification
critic of family functionality; institutional (name of the
furthermore the formation of this establishment, sector, office,
system by clearly defining the date
subsystems, units and elements, medical record number, code,
as well as the type of relationship and connections last names and name of the family and
presents. Also it works for responsible), and with the diagram. The
identify weaknesses and strengths of the diagram it the information
group moments of mayor represented in symbols, includes
susceptibility y aerial of three or more generations and the
opportunity. Its preparation must be names of the members
simple and brief. By means of the scheme o date of birth of the
of 3 or more generations are represented family members
to all members of amabas family problems the y
families of origin of the couple, which demarcation of the members that
must be considered as the axis that they live under the same roof. The
integrate the household members into symbols unite according to the
study. Each generation is marital status and type of union that
identified with Roman numerals. they present. (Fig. 1)
The family tree consists of two sides:

Marriage

Cohabitation

Common-law marriage

Divorce -- -- -- -- -- -- --

Separation //

Fig. 1: Types of bond

The generations each of them occupies a single line

represented in three sections (Fig. horizontal.
The first corresponds The arrangement
a by age and gender is
generation of the grandparents, the second begins with the first generation. The
the one of the parents and the third one to the symbol of man is square and goes
children. The data of the first always to the left, and that of the woman
generation corresponds to the grandparents is a circle and goes to the right. Of the
Paternal and maternal relatives of the family in the union line must show a line.
study. perpendicular, which begins the
Generations must be marked by the generation of the children, and it is represented
using Roman numerals and from largest to smallest and from left to
right. (Fig. 3)
b) The back side of the instrument: The narration is the information
is related to the detailed narration of relationships and positions
interpretation of the family diagram of the family members, that is,
the team makes important data about the system difficult to explain
familiar in study. with the symbols. It must include:
 Catastrophic events
 Communication between sus (separations, repeated unions)
members (horizontal, diagonal or and death)
vertical).  Conflictive issues, children of
 Movements of a family of a other marriages, contribution of
people to another. (emigrations, money.
migrations or immigrations  Religious, cultural, social affiliation
y ethnic of the family.

Generations

Fig. 2: Location for the family generations.

The descending lines are the format and the maternal line is registered
family lines. The paternal line is on the right side. (Fig. 4)
register on the left side of the
 Disposition by Age Disposition by Gender
Male

From the oldest to the youngest of the children

Fig. 3: Distribution by age gender

Descending lines

Paternal Line Maternal Line

Fig. 4: Paternal and maternal descending lines.

The interpretation relates to reaching the relational patterns.

information contained in the But we must not forget that this
The genogram contains data of separation by categories.
different nature and different to facilitate interpretation, already
value in each clinical situation. Their reality overlaps.
utility to generate and contrast one with the other, and it is the vision of
diagnostic hypotheses depend on the set that allows for proposal
systematic reading, interpreting and hypothesizing about what is happening in
classifying sequentially the family system.
different types of information. It is evident that the interpretation
The reading of the genogram must the genogram is limited by the
be organized methodical
y quality of its construction. Also
starting, for example, with the it depends on the experience that
study of the structure, the typology he has the doctor who analyzes him.
and the fraternal subsystem, passing It is understood that as
through the family life cycle until this instrument is used with
more frequency will be in paying special attention to the
better conditions for patterns of the disease and its causes
interpret it correctly. of death. The genogram can be
The following will be evaluated enriched with additional information
different informative aspects that obtained during each contact with the
family. As it is added the
transmit the genogram:
information, the family is capable of
join a the nurse for the
 Rules and patterns of interaction with identification of your strengths, risks
the family. and problems, and the health nurse
 Patterns of transmission community must be aware of the
multigenerational. gaps in the information regarding
 Principles of oppression in moments the individual members that differ
of stress. way could have gone unnoticed.
 Conflictual issues. The nurse will be attentive to
 Relevance of the extended family. observe what each person knows and what
 Influence of a member of the information has not been mentioned by
family about another or others. the members.
 Family group members that The genogram also offers to the
they live with others families o family a help to reflect
independent of them and that still regarding the dynamics itself, matters
they influence decision-making. and intergenerational problems. The
 Life events. community health nurse can
 Overprotection of parents towards build the genogram with the family
the children or towards some member of theas a way to stimulate the
family. family reflection y the members
they can help her fill the gaps
The analysis of the genogram also existing in the information. The
it is used to identifya those genogram can become a
family members about whom family tree, a source of
little is known to warn the family information that may be
nurse that the health assessment transmitted to future generations.
familiar may not be complete.
The importance of the genogram Test of Perception del
it consists of notifying the nurse about Family Functioning (FF–SIL)
community health on the impact of
the multigenerational patterns of the The Test of Perception del
disease and the elevated risks of Family Functioning (FF-SIL) is a
emotional and health problems. The instrument that allows evaluating the
genogram serves as a reference structure and estimate quickly the
quick history of family health, family functionality (Annex 2).
its risks and patterns, and provides a Dolores de la Cuesta cited by
large amount of information through Solórzano, Brandt and Flores (2001),
at a glance. consider the family functioning
The community health nurse as the interactive relational dynamic and
you can quickly assess the patterns systematic that occurs between the
that are repeated in a family, members of a family. The Test,
allows measuring qualitatively-quantitatively the  6 and 10
family functionality, through the
following variables: Scale of answers which-
quantitative
a) Cohesion: physical family union and
emotional when facing different  Almost Never: 1 point
situations y in the capture of  Few Times: 2 points
decisions of daily tasks.  Sometimes: 3 points
b) Harmony: correspondence between the  Many times: 4 points
interests y the needs  Almost Always: 5 points
individuals with the members of the
family in emotional balance Each situation is responded to by the
positive. user by means of an X (X) in the
c) Communication: ability of the scale of qualitative values, according to their
family members of transmitting perception as a family member.
your experiences and knowledge in Then the summation of the
clear and direct way. points which will correspond with a
d) Permeability: ability of family scale of categories to describe the
to change the structure of power, family functioning. Remaining of the
relationship of roles and norms, in the face of a
next form:
situation that requires it.
e) Affectivity: capacity of the  From 70 to 57 points: Functional Family
family members of experiencing and  From 56 a 43 points: Family
demonstrating feelings and emotions
Moderately Functional
positive to one another.
 Of 42 a 28 points: Family
f) Roles: each family member
Dysfunctional
fulfills the responsibilities y
 From 27 a 14 points: Family
functions negotiated by the core
familiar. Severely Dysfunctional
g) Adaptability: ability of the
family of to provide y receive Evaluation scale of
experiences of other families and adaptability and family cohesion III
institutions. (FACES III)
So that it can be understood the
It is the third version of the Family.
application of the instrument is done
it is necessary to divide into two aspects the adaptability and cohesion evaluation
scales (Annex 3). It is an instrument
methodology:
developed by David H. Olson and Col.
Variable situations: in 1985, conceptually based on
the circumflex model of systems
 Cohesion: 1 and 8 marital and family, conceived by
the same authors. It was developed
 Harmony: 2 and 13
in order to facilitate the link
 Communication: 5 and 11
between clinical practice, theory and the
 7 and 12 family research. Integrates
 Affection: 4 and 14 three dimensions of functionality
 Roles: 3 and 9 familiar
 Adaptability: the ability to investigate four dimensions of
family system to change its support: emotional/informational,
power structures, their roles and their instrumental, affective and interactional
relationship rules in response to social
situational or developmental stress
 Cohesion: degree of linkage Family care: strategy of
emotional that the members have change.
of the family systems among themselves,
degree of individual autonomy that Since the chronic illness,
Can a person experience? disability and death are
within the family universal experiences that put
 Communication. Cohesion and the families facing one of the greatest
adaptability is the dimensions challenges of life, a
mainly, as the new approach that allows and facilitates the
communication favor the relationship of chronic processes of
optimal maintenance among the others older people with their environment
two. social and family.
In order to work with families, one must
The questionnaire should be applied to needs a plan that allows understanding
people over 10 years old who the phenomena produced in the
be members of families with children and families and their social environment and what
wayto the
that they know how to read and write. The request is made they affect each one of their
surveyed what respond the members and the entire system.
questions rating from 1 to 5 There are different aspects that
according to your particular situation. they relate the family to the illness
chronicle, among which stand out the
The MOS Support Questionnaire following:
Social
a) Chronic illness is capable of
Social support is a construct produce negative effects on the
multidimensional with different family, effects that act on the
structural and functional aspects. function and family organization.
In literature, a great b) The family can influence the course
variety of instruments that attempt of the disease chronicle
evaluate this construct. All of them understanding that the interaction between
they have been designed for certain the family and the typology of the
populations with certain characteristics disease can have a
very specific because us positive or negative influence on
we found a wide range of the course of the chronic process.
very heterogeneous questionnaires amongc) The family is the main source of
yes. resources and social support with which
The perception of social support is the chronic patient accounts for
measures through the MOS questionnaire successfully tackle the problems at
(study group to analyze) that gives rise to the disease,
different styles of medical practice highlighting the role of the caregiver
primary care in the U.S. primary that is what contributes the
(Appendix 4). This questionnaire allows
 maximum instrumental, emotional support e) Analyze the workload that
and emotional. The main caregiver and the suffers.
repercussions on their health, and
Family attention, considered about their work activities,
as a model oriented towards a economic and social.
holistic approach can contribute to the f) Evaluate informal supports and the
conceptual support y technological need to use resources
necessary to address in a way formalities of the community.
different y new a the patients g) Make the diagnosis, decide the
chronic, immobilized, and terminal intervention y to plan the
empowering them to solve both the monitoring of the clinical process
patient's physical problems such as family and home visits
the psychosocial problems to which scheduled.
the family is subjected when one of
its elderly members suffer a Special mention deserves the
chronic illness. detection, study and approach to the
From this new perspective of the at-risk families, as they will require
home care focused on the global coordination strategies
family attention, the approach to the interprofessional and interinstitutional level
chronic illness in the elderly and to work with a risk-based approach for
immobilized or disabled must establish an appropriate intervention
fulfill the general objective of carrying out socio-sanitary like thishow, for
assistance activities, prevention, develop transformation policies
promotion and rehabilitation of health social, that prevents and stops these
in older people, from the deterioration processes.
triple perspective, individual, family and It is important to note that the
social, at the patient's home. families at socio-health risk are
It is considered that professionals, those that have a person
doctor, nurse and worker older with a chronic illness, in
social, involved in a program of the one due to the type of health problem,
home care and family care, the situation chronological of the
they must prepare to carry out the disease, the importance of the
next activities: disability, and especially by
the presence of problems in the function
a) Diagnose the clinical problem. and organization of the family or by the
b) Plan therapeutic activities, existence of problems
the care and rehabilitation. socioeconomic requires a
c) Transfer the clinical to the psychosocial. health intervention, socio-health or
d) Study the clinical problem y emergency social.
psychosocial in the family context, discovery of a high-risk family
analyzing the repercussions of the socio-health, will require a meeting
chronic illness of the elderly urgent health team, expanded
about the family y vice versa, with the social worker, to evaluate the
evaluating in a special way the case and decide the pertinent intervention
repercussions on the organization It is for this reason that the home visit,
and family function. it is an activity inherent to attention
primary, which adopts an approach
new when the concepts are used end of continuing care
and techniques of family care, of the patient.
allowing to improve the quality of the  Preserve the quality of care
attendance a the elderly provided at the patient's home
immobilized or disabled. Here the assuming the responsibility
nursing resource, it corresponds to joint continuous care and
play a decisive role in the integral of the person as a whole
compliance with the activities of with the caregiver, as well as the
attention to the elderly, and of this community participation in the
it depends on the efficiency and effectiveness of the same.
program.  Explicit and clear service portfolio
for the person, caregiver, their family,
Population prioritized for the and the community. There must be a
Home Care: previous definition of the activities and
procedures what will be
 Families with member(s) with delivered to the home and its
chronic debilitating disease that periodicity.
it makes it impossible to attend the Center of Study of the needs of each
Health. person, to design a plan
 Families with at-risk individuals individualized care. This
high socio-health, for example: it must be carried out by the team of
family members mistreated, health, caregiver and the family.
patients with mental disorders,  Prior cost-benefit analysis in
fragile or vulnerable elderly. each of the cases, to decide
 Families with affected individuals by better and more home care
a process morbidity whose efficient compared to others
socio-sanitary characteristics possibilities of provision of
disqualified from attending the Center of services.
Health.
 Families with affected individuals by Attention to the elderly in the
terminal illnesses: home visit program
Cancer, AIDS.
 Families dysfunctional y/o Among the criteria for assignment of
overwhelmed by critical events the family to the family health program,
normative or non-normative. the epidemiological criterion is found,
 Families with people for which it is considered of great
disabled. importance of addressing the aspect of the
incapacity e invalidity how
When it comes to people with fundamental elements for the
disability exist some priority at the time of inclusion.
principles This is why, simply
describe the care of the elderly
 Coordination of the different as a risk member of the group
levels of care in the network familiar, and the care provided by it
assistance and community with the the rest of the family.
 The population in many countries has shoring a those cases that
suffered in the last decade a they need sanitary services.
marked demographic transition from This approach is far from
young populations to aging, the reality, since a very small percentage
these changes are due, among others high of the elderly, has
reasons for the decline in birth rate and multiple chronic health problems,
to the increase of hopes for that affect, to a greater or lesser extent
life through the reduction of mortality. measure, their daily activities, by
A large part of these people what is before a problem
older women have health problems that complex, what it is, at the same time, sanitary and
they require medical attention y a social one and requires a new model of
a significant percentage of them have attention, able to combine the aspects
difficulties in carrying out activities of that have to do with health and the
daily life o they undergo processes social context.
motors, cognitive or sensory that
they limit their relationship life and in many The family as a source of care
sometimes they are confined in their home. of the elderly
The situation of this population
elderly disabled o with The term 'third age' is a
difficulties in leaving home, anthropic-social term that makes
requires an organizational response reference aolder people or
able to provide satisfaction to the elderly women, as it is a group
complex demands of this group of of the population that is 65 or older
age. years old. At this stage the body
Society is increasingly it is deteriorating and consequently
sensitized to this problem, by it is synonymous with old age and senility.
It is not surprising that they rise. Nowadays, the term is starting to leave
voices demanding from public authorities used by professionals and is
social and health solutions for more commonly used the term people
the problems of the elderly and that they adults (in Spain and Argentina) and
media of communication elderly social (in Latin America).
(press, radio, television) sensitive After the prenatal stages,
in response to these demands they worry about childhood, youth, adolescence y
the situation of the elderly, youth, it is considered that it is the
especially for those who have any seventh and final stage of life
motor and cognitive deficits, which imply (adulthood y old oage senility)
an unsustainable workload for happening after this, the
the families. death.
One can have a false impression In Venezuela, this age group
that the solution to the problem of the has been growing in the pyramid of
adults, is limited to the aspects population or age distribution
social and consequently require mainly due to the drop in the
solutions of institutions mortality rate (5.2% in 2013)
governmental o not for the improvement of quality and for
governmental bodies in the field of increase in life expectancy to
social services and that from this to be born. The reduction of the base of the
fields are transferred, in pyramid cases since 1990, and projection
2025, indicating a decrease of significant prevalence of disability
percentage of the minor population functional, so some authors
age, and at the same time a growth of they approximate that age the cutoff point
percentage of the adult population. The of old age and consider the elderly as the
increase in the average age will accumulate people aged 75 or older
the majority of the population in the years (Perlado, 1995).
groups that are in the stage Among the sources of care in the
most productive of her life. old age is found in the family, as the
According to the Population Census and the most important support network for him
Housing from 2011 in Venezuela elderly (Marrugat, 2005), and in their role
there are 243,425 people aged 80 and of elderly caregiver, has been
more, and in 2015 there will be 323,575 marked for having as its objective,
older adults with that and more is greater emotional security and greater
age. (National Institute of Statistics intimacy, while avoiding the
INE, 2013). psychopathological problems of the
According to the World Health Organization institutionalization
Health (WHO, 1986), is considered depersonalization abandonment
older adults "to those over 60 negligence mental confusion
years for those who live in the countries exaggerated medicalization and lack of
in developing countries and 65 years old to the affection, among others. (Diéguez and De los
who live in developed countries Reyes, 1999)
(agreement in Kiev, 1979, WHO)". In Family caregivers are
In 1994, the OPS adjusted the age to 65 and non-professional people who help to
more to consider it older adult. main title, partially or totally, to
The living conditions for the a person from their environment who
elderly people are presents a situation of dependence
especially difficult, as they lose regarding the activities of
quickly job opportunities, daily life. (Confederation of
social activity y capacity of European Union Organizations.
socialization, and in many cases it COFACE, 2006). This regular aid
they feel postponed and excluded. In it can be provided in a way
developed countries, mostly permanent or not, and can adopt
they enjoy a better standard of living, they are various forms particularly
subsidized by the State and have basic care, help in the
access to pensions, health guarantees education and social life, management
and other benefits. administrative, coordination, surveillance
In the world, the social image of permanent, psychological support
aging is associated with this communication, domestic activities,
age, as it is attributed to them among others. The first family caregiver
over 65 years old the characteristics is usually the spouse and in front of the
to be elderly, how to present overflow, the children, are usually the ones who
greater number of diseases that they take on the task.
young people, and suffering disabilities Today the job of caregiver,
physical and memory deterioration in addition to continuing to be exercised
(Casanova, Casanova and Casanova) by family members, has
(2003). Nevertheless, they are the elders practically acquired levels of
80 years old those who present a professionalization, being every day
greater demand for caregivers education received and the messages that
qualified, so the time the society is transmitted, the favor is given to the
dedicated to health care and the conception that the woman is better
characteristics of the homes of the prepared that the man for the
caregivers and patients are key to be careful, as it has more capacity
determine the perception regarding the of self-denial, of suffering and furthermore
implementation of care, seen as the voluntary
action of taking care (preserve, guard) On the other hand, the experience of
to conserve, to attend care is very influenced by the
When it comes to the care of the type of relationship that maintains the
people in the home, the caregiver and the person being cared for, before
responsibility mainly falls that the latter will need help
in the family, especially in the to continue answering the
household women (Velasco, 2010) demands of everyday life. The
whether by sociocultural assignment, existing relationship between the caregiver
patient's choice or self-assignment. and the cared for person is important
However, there are other members factor that greatly influences the
from home, neighbors, and friends, who care experience.
they carry out care activities Taking care of an elderly person in the
awarded based on their relationship with home, offers a large amount of
the elderly, or by the acceptance of the opportunities experiences
y for
same, and this is carried out according to the learn to care for the elderly, always and
level of responsibility assigned and to when the conditions are met
available time of the caregiver. socio-healthcare, economic, of
The Spanish Society of Geriatrics and relationships and educational of the caregiver,
Gerontology (SEGG) considers that otherwise it would represent a burden
one of the main reasons why for the family and for society in
most caregivers are general.
women is that, through the