Gender-Appropriate Care for Men Assignment

Gender-Appropriate Care for Men Assignment

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Gender-Appropriate Care for Men Assignment

Community health nurses are in an ideal position to address the health needs of men at individual, family, and community levels.

The community health nurse may promote self-care in male members of the family, facilitate men’s health by addressing needed changes at the family level, buttress women’s roles as caregivers of the family’s health, and bring about change that influences policies that affect men at the community level.

Planning gender-appropriate care for males is outlined in the following case study, which is an application of the nursing process at the individual, family, and aggregate levels initiated in a home visit, and applies the previous discussions about the levels of prevention, roles of the community health nurse, research, and men’s health.

Application of the nursing process to aggregates is facilitated by the use of systems theory, in which the nurse identifies the system and subsystems involved.

The nurse may use a deductive or an inductive approach. A deductive approach would involve carrying out a community assessment and identifying an area or areas, such as a program needed by the community. Planning, implementation, and evaluation of the program would be carried out at the family or group level.

An inductive approach would involve entering the community system through a person or client via a referral about a problem or concern. Assessment of the individual would be followed by identification of those groups to which the client belongs, such as family and community, and assessment of those groups.

Beth Lockwood, a community health nursing student at a health department, received a referral from the high school nurse to visit the Connors family to assess Richard Connors’ mental health status. Richard was a 16-year-old sophomore whose academic work in school had declined rapidly after the premature death of his 46-year-old father.

The father had died of a myocardial infarction, which he had while cleaning the garage with Richard one evening after school. Richard and the neighbors failed to revive Mr. Connors, and Richard carries feelings of guilt. Household members include Mrs. Connors, age 44 years, and Richard’s sister Yvonne, age 12 years.

Assessment

The referral to assess the Connors family called for an inductive approach to assessment. Beth used a deductive approach later, when her experience with the Connors family piqued her concern about the status of men’s health in her community. Beth assessed Richard, his mother, and his sister as household members of the family.

However, she could not stop with the immediate family; she had to continue to identify the other groups within the community to which each individual family member belonged.

Viewing the community as a system and focusing on systems and subsystems helped Beth organize the data she collected during assessment.

Knowing that “the whole is greater than the sum of its parts,” Beth prepared for her visit by reviewing adolescent theories of development and family theory. Beyond individual assessment, she noted factors related to the development of sex role–related behavior that may influence health.

Examples of assessment areas include the following:

Family Configuration, Traditional or Nontraditional

Sex role–related behavior of parents, including work patterns in and out of the home, division of household labor, and decision-making patterns

Patterns of parenting: mothering, fathering, and substitute father figure(s)

Ability of male children to disclose feelings to family members and others

Degree of assertiveness in female children

Ability of family members to give emotional and physical support during crises and noncrises

Ability of family members to trade off role-related behavior during crises and noncrises

Risk-taking health behaviors

Processing of stress and grief

Communal lifestyle patterns that place the individual or family at risk (e.g., lack of exercise, poor diet, smoking, and drinking)

Family history of death and illness

Health care–taking patterns of family members

Preventive health behaviors

Leisure activities

Assessment of other groups includes neighborhood and other peer groups, school environments, sports, and church and civic activities.

Diagnosis

Through induction, the nurse makes a diagnosis for each individual and each system component, including family and the community. The following are examples of diagnoses.

Individual

Loss of interest or involvement in an activity related to conflicting stages of grief process secondary to premature death of father (Richard)

Expressed dissatisfaction with parenting role related to feelings of helplessness and sadness secondary to premature death of husband (Mrs. Connors)

Risk of interpersonal conflict resulting from prolonged, unrelieved family stress secondary to premature death of father (Yvonne)

Family

Decreased ability to communicate related to family stress secondary to premature death of father

Risk of family crisis related to disequilibrium

Community

Inadequate systematic programs for linking families in crisis to community resources

Inadequate systematic programs for populations at risk of premature death related to inadequate planning among community systems

Planning

Planning involves contracting and mutual goal setting and is an outcome of mutually derived assessment and diagnosis. A contract with the family alone is shortsighted and may provide little community benefit over time. The following are examples of other aggregates with which a contract may be established:

The school subsystem that does not provide ongoing counseling but will meet periodically with family members to evaluate pupil progression

The school subsystem that provides physical education in football, basketball, and baseball (i.e., nonaerobic, nonlifetime sports) but offers extramural aerobic, lifetime sports such as swimming, tennis, golf, and track after school hours

The American Red Cross, which does not offer cardiovascular pulmonary resuscitation (CPR) courses on evenings or weekends but offers to consider doing so for a defined minimum-size community

Mutual goal setting requires collaboration regarding long- and short-term goals. Again, mutually defined needs and diagnoses are important to this process.

Regardless of the diagnosis, each individual in the family and the subsystem must participate in development of a care plan. The following are examples of goals.

Individual

Long-Term Goal

Individual family members will be able to trade off role-related behavior.

Short-Term Goal

Individual family members will express feelings related to abandonment and loss.

Family

Long-Term Goal

The family will exhibit an increased ability to handle crisis, as evidenced by ability to discuss roles and interdependencies.

Short-Term Goal

The family will identify specific ways to recognize and use support services.

Community

Long-Term Goal

Systematic programs, with ongoing program evaluation, will be established for populations at risk of premature death from coronary heart disease, as evidenced by local planning bodies.

Short-Term Goals

Information is disseminated to individuals, families, groups, and planning bodies in the community about the incidence of coronary heart disease.

Existing programs are identified that address coronary heart disease.

Existing programs are coordinated to bridge gaps and avoid duplication of effort.

Intervention

The nurse, family, and other aggregates carry out interventions contracted during the planning phase to meet the mutually derived goals.

Most important, the nurse empowers the family and community to develop the networks and linkages necessary to care for themselves.

Individual

Individual counseling regarding loss and grief may be beneficial to each family member, but options may need to be explored and referrals may need to be reevaluated for members of the rural family.

Education regarding preventive measures that combat risk factors for heart disease include those aimed at individual family members and those that address areas such as diet, exercise, smoking, alcohol use, and stress management.

Family

Examples of interventions with the family include counseling, education, and referral aimed at family self-care promotion. For example, Beth’s interventions with the Connors family depended on the family’s ability to solve problems, investigate community resources, and create linkages between the family and resources.

Periodic family conferences at school and more inclusive family therapy may enable the family to work through the death of Mr. Connors; this process results in the development of new roles and the communication necessary to maintain family equilibrium.

Education regarding preventive measures to combat risk factors for heart disease may need discussion at the family and individual levels (e.g., diet, exercise, smoking, alcohol use, and stress management).

Community

The nurse must also carry out interventions with other aggregates. These may involve activities such as educating, facilitating program expansion, and tailoring programs to meet community needs.

Intervention at the aggregate level calls for group and community work. The nurse carries out interventions at this level in several ways (e.g., by communicating community statistics from a community analysis, relating anecdotes from families served, or linking family experience to program needs by acting as an advocate and bringing family members to board meetings or hearings on community health issues).

Education regarding preventive measures to combat risk factors for heart disease also includes those interventions aimed at the community.

A rationale for the development of lifetime aerobic sports is needed not only by Richard but also by school districts. Exploration of options with the school nurse and review of the school district health education curriculum would be beneficial.

A community assessment of heart disease awareness, including determination of the availability of resources such as emergency response and CPR courses, is an aggregate intervention.

Taking the outcome of the assessment in the form of statistics and the anonymous anecdotal story of the Connors family to planning bodies in the community is also intervention at the aggregate level.

Creative programs other communities used (e.g., teaching CPR within the school system) should be investigated and proposed.

Evaluation

Evaluation is multidimensional and ongoing. Using a systems approach to evaluation, the nurse evaluates each component of the system, from individual family member to family and community, in terms of goal achievement.

Evaluation consists of noting degrees of equilibrium established, extent of change, how the system handles change, whether the system is open or closed, and patterns of networking. Ongoing evaluation includes noting referrals and follow-up of the individual, the family, and other aggregates in resource use.

Individual

Use of resources such as support groups by the individual family member may be noted. These resources may include a teen support group, a women’s support group, support groups for those experiencing the loss of a spouse or other family member, reentry programs for women at a local junior college or university, and Parents Without Partners.

Family

Evaluation of the Connors family would include follow-up of their use of support services specifically for the family, such as counseling options for the family as a unit. Evaluation would also focus on the family’s ability to handle crises in the future.

Community

Aggregate evaluation would focus on the community. For example, to what extent do school programs encourage sports options that promote lifetime aerobic activities and prevent premature death from heart disease? Are programs systematically planned in the community for populations that are at risk of premature death from heart disease?

Levels of Prevention

Society’s expectations of men and women are in transition. Application of levels of prevention by the community health nurse must take into account men’s health status, men’s socialization, men’s use of health care services, men’s primary needs for prevention and health promotion, and the role of women as caregivers in family health.

Primary

Men are more likely to engage in risk-taking behavior than women and are less likely to engage in preventive behaviors; therefore primary prevention must be marketed specifically to men. Examples of primary prevention for the Connors family are applied at the following individual, family, and community levels.

Individual

Assessment, teaching, and referral related to diet and exercise behaviors

Family

Assessment and teaching related to food selection and preparation at home and food selection at fast-food restaurants

Teaching and role-modeling gender roles that allow male members of the family to use alternative expressions of emotion

Community

Provision of CPR courses for members of the community; consultation with schools regarding need for aerobic activities in physical education and sports programs

The nurse must pull men from the family, workplace, or other aggregates into involvement with family planning, education, antepartum and postpartum care, parenting, dental prophylaxis, and accident prevention.

In addition, assessment of need for immunizations and classes (e.g., retirement preparation) is considered action aimed at primary prevention.

Secondary

Men have higher mortality, morbidity, and health care use rates for many of the leading causes of death, but they are second to women in overall use of health care services, including preventive physical examinations and screening; therefore early diagnosis and prompt intervention must also meet men’s needs. Examples of secondary prevention regarding the Connors family include the following:

Individual

Screen for risk factors related to CVD in the individual, such as how the individual handles stress.

Family

Screen for risk factors related to CVD in the family, such as how the family processes stress.

Community

Organize screening programs for the community, such as health fairs.

The nurse must screen individuals and aggregates of men according to lifestyle risk factors, mortality rates at different age levels, morbidity rates, and occupational health risks.

Tertiary

Activities that rehabilitate individuals and aggregates and restore them to their highest level of functioning are aimed at tertiary prevention. The nurse in the community is ideally situated to locate people in need of rehabilitation services. The nurse may provide evaluation and physical, mental, and social restoration services.

Men in need of rehabilitation may have special needs because their disabilities influence them, their families, and ultimately their communities. Financial assistance and vocational counseling, training, and placement may be priorities for the well-being of the family. Socialization causes men to have difficulty admitting they need help.

Community health nurses who teach men with chronic disease to rest at specified periods during the day or to continue with medical regimens or speech or occupational therapy are providing tertiary prevention. Working with couples as a unit is also important because caregiving patterns may shift as a result of chronic disease and disability.

Encouraging men to express their concerns about their health, families, and jobs and their frustration with themselves is important. The following are examples of tertiary prevention with the Connors family.

Individual

Assist individual family members in dealing with grief from the loss of the father and husband.

Family

Assist family in dealing with grief and assuming alternative roles.

Community

Assist the community in dealing with loss of a fully functioning family by providing grief support services that include males or target males and females.

Select a family that has a man in the household who is accessible. Select two “door openers” appropriate to initiate discussion of health concerns with this man.

Devise a gender-appropriate nursing care plan that includes primary, secondary, and tertiary prevention for this man as an individual, for his family, and for his community.

2. Select a family that has a man in the household who is not readily accessible. Interview the female caregiver in the household and obtain information by proxy about the man’s health.

If possible, arrange to meet the man for lunch, at work, or after work and obtain information about his health. Compare the information obtained by proxy with that obtained from the client.

RUBRIC
Excellent Quality 95-100%	Introduction 45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.		Literature Support 91-84  points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned.			Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met.
Average Score 50-85%	40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided.		83-76  points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration.			52-49  points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met.
Poor Quality 0-45%	37-1 points The background and/or significance are missing. No search history information is provided.		75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration.			48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met
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