Family study

Family study
•Greg Babwah
•Shivan Goolcharan
•Chawangwa
Letsholathebe
•Celeste Manchoon
•Deepavali Rambalack
•Candice Ramdin
 Outline
• Social Determinants of Health
• Cultural Influences on Health
• Attitudes
• Beliefs
• Behaviors
• Impact of Illness on the family
• Medically, Socially, Economically,
Psychologically
• Lifestyle as a Risk Factor
 What is a family?
The family is a group of individuals related by
blood ties, marriage, adoption or by a feeling
of closeness, who form a social and economic
unit
• Group of relatives
• People living together
• Lineage
• Offspring
• Group with something in common
Essential readings pg 19
 Family life cycle
• The emotional and intellectual stages you pass
through from childhood to your retirement years as
a member of a family.

• In each stage, you face challenges in your family life

that cause you to develop or gain new skills.

• Developing these skills helps you work through the

changes the family goes through.
 Family life cycle
• Not everyone passes through these stages
smoothly.

• Situations such as severe illness, financial

problems, or the death of a loved one can
have an effect.

• Fortunately, if you miss skills in one stage,

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 health
 Social determinants of health
• Occupation
• Socioeconomic status
• Culture
• Networks
 Family structure
 Stage of family evolution
 Variations of family structure
• Social network
Public health and human ecology pg 233
 Roles of various health fields
• Hospital • Pharmacy
– Doctors – Pharmacist
– Nurses – CDAP
– Social worker
– Physiotherapist
• Rotary club association
– wheelchair
• Health center
– Doctors
– Nurses • GAPP
– assistance
Case Study
 Mr. JG
• Mr JG, 30 yr male. african descent, known autistic for 28
yrs
• History
o Diagnosed with autism at age 2
o Clinically mute
o No other known medical conditions
o Incomplete schooling (sign language)
o Tendency to wander of from home
o Last incident Jan 3rd 2011 ( found at Mt. Hope hospital by family
registered as a John Doe

• Diagnosis
o Autism
 Mr. JG
• Duration of stay 3 weeks
• Discharged with
– Medication
o Stelazine
o Artane
– Referrals to
• Tacarigua extented care health centre
• Social worker
• psychiatry

• Resides at home with mother and siblings

 Mr. JG
• Single
• 3rd child of 5 siblings
• Lives in St. Joseph with mother (65yrs), but taken
care of by sisters
• Never been formally employed, but disability fund
• °alcohol, °smoking
• Healthy appetite
• BMI > 23
 Mr. JG
• ?? aware of his situation
• unable to communicate efficiently
• On inspection health young adult male
• No verbal communication
• Constant monitoring
 Mr. JG
• Physically capable of grooming himself
• Assist with household chores and duties
• Religious person
– Goes to church with family
 Genogram
Mr. JG

Ramnarine Chandra Gaitree

Ramesh Sintra Geeta

Kavita
Genogram

Ecomap
Ecomap
Structure of home
 Impact of geographic and socio-economic
milieu
• Lives approximately 500 ft from a main road for
absolute transportation access

• Concrete house in need of minor repairs

• Walkway from house to street is not flat and not

accessible via wheelchair

• Community is very congested with narrow roads, and

thus visiting the Health Centre is tedious
 Occupation of family members
• Mrs. BJ – pensioner
• Sintra – unemployed
• Ramnarine – part time bank teller
– Sits in front a computer all day
– ?Carpal tunnel
– ?Neck 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 :
– Unemployed
– Deceased spouse (pharmacist) was sole breadwinner – she
has understanding of most medical matters relating to her
mother
– Will - assets
– ??supports herself and her household
– ??lives solely off her mother and daughter

NO other contribution from other family members except,

Kavita who helps pay the Geriatric nurse
 Levels of support
Mrs. BJ – financial Ramnarine – financial
– Groceries
Sintra – 1° care giver – Medication
– – Bills
Time
– – Unable to help with
Love
mother as he ‘can’t be
– Emotional support around sick people’
– physical
2. Cultural Influences on Health
 Cultural Influence
• Attitudes
• Beliefs
• Behaviors
– As related to health and illness
 Family perception of illness
• Both Sintra and Ramnarine talk about their
mother’s illness, and aware of the long term
impact it may have on both their and their
mother’s life
• Sintra, however is more open about
everything
• For both its hard to see their mother in this
state, even harder for Sintra who gets VERY
emotional when talking about her and the
event of her untimely death, should it occur
 Family perception of illness
• Both are willing to do anything for their
mother, including getting better health care

• Expect full recovery

• Believed putting nutmeg in BJ’s mouth would

have helped with the CVA
 Expectation of the Health system
• Education - about what to do to help re-habilitate
their mother and how to lower her risk of a 2 nd CVA
was given

• Need some form of help for transportation for Health

Center visits

• GAPP – more efficiency in allocation of assistance to

them

• Financial assistance
 Expectation of the Health system
• Communication – between them and the
Hospital staff was good

• wheelchair donated to them via the Rotary

Club
– ?Mrs. BJ ability to use it
 Influence of culture and religion
• Nutmeg in mouth and nutmeg oil

• It was their mother’s fate to suffer a CVA.

They don’t understand why, but have
accepted it

• Positive outlook and attitude toward illness

• Blessing to look after their mother

 Patient and health care service
utilization
• ONLY Mrs. BJ attended the Chaguanas HC for
Mx of her HTN and Osteoporosis
– Now unable to, due to her immobility and lack of
proper transport

• Neither Sintra nor Ramnarine utilizes the health

system
3. Impact of Illness on the Family
 Impact of Illness on the Family
• Medical
• Social
• Economic
• Psychological

Illness impacts on the quality of life and social

relations in any family, not solely the patient
 Impact on Mrs. BJ
• Physical – cant walk, sit, leave house, go
temple
• Social interactions with other elders limited
• Pension – most used on her medical expenses
• Totally dependent on children
– Can’t feed
– Help with household
 Impact on Sintra
• 1° care taker, moved into mom’s house,
sleeps in same bed

• Previously unemployed and now can’t even

look for a job

• Rarely leaves house

– Social activities – not much friends
– leisure
 Impact on Sintra
• Wishes someone could help her

• Health - Worsening scoliosis – moving mom

• Very religious
– +ve attitude
– Tries to smile ALL the time, happy disposition
– Gives her mom all the love she could ever want
 Impact on Ramnarine
• Medical condition
• Rarely goes out – now can’t, comes home
after work to help Sintra
• Emotionally hard on him…..’can’t be around
sick people’
• Depressed and feels helpless at times
• Severe financial burden….recently >$1000 on
ripple mattress
 Barriers to Implementation of Care
Plan
• Lack of information about services
• Appointment at health centre for appropriate
follow up care
• Finances
• Geographics – location, transport
• Support – physical, emotional
 Characteristics of family on
Improvement of Health
• Both willing to make any changes necessary to
assist their mother

• The love for their mother keeps them going

• Ramesh has not been told about mother’s

condition, has not visited nor does he
contribute
4. Lifestyle as a Risk Factor
 Lifestyle as a Risk Factor
• Infants:
– 1. Unhygienic environment
– 2. Poor sleep habits due to parental constraints
– 3. Insufficient Parental care
• Children:
– 1. Poor Diet: Fast Foods, Junk food
– 2. Insufficient Physical Activity: Indoor activities only
– 3. Poor supervision
• Adolescents:
– 1. Substance Abuse: illicit drugs
– 2. Criminal Conduct
– 3. Promiscuity
• Adults:
– 1. Stressful Job positions
– 2. Alcohol Consumption and Smoking
– 3. Sedentary
• Elderly:
– 1. Poor Diet: Insufficient nutrition
– 2. Lack of Physical Activity
– 3. Social isolation
 Lifestyle patterns that may affect
health
• Mrs. BJ
pattern condition intervention
immobile DVT, PE, MI Elevate legs,
TED stockings,
constipation Fiber in diet,
water
spasticity Positioning
depression Move around
house
Bed pressure Turn regularly,
sores ripple mattress
 Lifestyle patterns that may affect
health
pattern condition intervention
Poor diet dehydration Adequate water
Electrolyte Food
imbalance supplements
Malnutrition
Aspiration Watch pt
pneumonia swallow food
and water
 Lifestyle patterns that may affect
health
• Sintra and Ramnarine
– Both have poor dietary intake and no exercise and
live in a stressful environment
– At risk of developing HTN, DM, MI, CVA
– Advised about proper diet (food groups, fruits,
meal size and frequency)
– Some form of exercise into work routine
– Relax and some form of meditation, whenever
possible
 Essential Conditions for Successful
Ageing
• Diet
• Exercise
• Challenge the brain
• Newness
• Human love
 Conclusion
• A wider array of diseases
• Goals for elderly and doctor - often to maintain ability to
function as comfortably as possible
- not seek a cure
• Need for individualized health care - one size does not fit all!
• Exposed to many medications
• Older people do not always report change in condition.
• Fear factor:-
1. That condition might not be treatable
2. Economic consequences
 Learning Objectives
• Importance of good communication skills

• Patient-centered care

• Role of spirituality in medicine

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

• Successful interaction between patient & the health

care system
• Patient’s & Doctor’s satisfaction
• Patient concordance and compliance
• Continuity of care
• Improved clinical outcomes
 Patient-centered Medicine

• This study highlighted the importance of:

• Respect for patient’s values, preferences & expressed

needs
• Co-ordination and integration of care
• Information, communication & education
• Physical comfort
• Emotional support & alleviations of fear & anxiety
• Involvement of family
• Transition and continuity from hospital to home
 Role of Spirituality in Medical Healing

• Grasping the importance of prayer to Mrs. BJ

and her family & its influence in their life was
critical to understanding their dynamics

• Spirituality was a way of life for this family and

it was observed to be an extremely effective
coping technique
 References
• Oxford Handbook Of Clinical Medicine
• PAHO
• Family Problems by Peter Williams, (Oxford
General Practice Series No.17)
• WHO
• Handouts – Family Life Cycle
Thank You