COUNSELING
INDIVIDUAL AND FAMILY HEALTH COUNSELING
Health Counseling
In Nursing, counseling may be considered as the application of the
professional nursing relationship and of professional knowledge and skill for the
purpose of increasing the competence of individuals or families in defining and acting
upon their own health problems.
Counseling in nursing may include activities varying all the way from telling
individuals or families what they should do or know to giving encouragement or
support that provides decision to solve the problems.
Purpose of Counseling
1. The fundamental purpose of counseling is to help the individual and family to
recognize what is needed.
2. Help the individual and family to take appropriate action to meet the need.
3. It enhances the ability towards solving their own problems with a high degree
of competence.
4. Provide adequate information and support to make wise decision in order to
maintain high level of wellness/
Definition
1. In Nursing Counseling may be considered as the application of the
professional nursing relationship and of professional knowledge and skill for the
purpose of increasing the competence of individuals or families in defining acting
upon their own health problems.
Major elements/steps in counseling
1. Establishing and maintaining a professional relationship.
2. Strengthening Motivation towards health.
3. Telling, explaining or directing action.
4. Releasing and guiding family or individual potentials for self help.
5. Anticipating to care (health).
6. Evaluating results.
1. Establishing and Maintaining a Professional relationship
Good professional relationship are the foundation, upon which
good professional service must be built and also one of the most powerful
elements of nursing practice. The degree which the nurse is able to
establish and maintain associations that contributes positively to the
accomplishment of her services.
It also promoting the maximum level of self direction in the
individual and family which much influence in the effectiveness of nursing
care. Skills in interpersonal relationships and must be developed as other
skill are developed by the nurse.
The relationship promote social contacts to gain attention. A
professional contact is expected to produce changes in behaviour and the
nurse is an agent of change. The individual or family relationship with
health care provider is influenced by their values, interest, health
problems/needs and participation.
2. Strengthening motivation towards health.
Sometimes families have problems which they recognize fully or
partially, but about which they are not stimulated to take any action. This
inaction or lack of desire to learn or to do something may be due to
several reasons. They are :-
Families may not realize fully the implications or importance of the
problems.
They may feel the actions threatens their sense of security or
prestige.
They may give less priority.
They may be discouraged by many reasons.
It is an essential part of public health nursing to build in families a
desire to do something about their health problems and health needs.
The desire to do something is dependent not only on knowledge of the
need, but it is also frequently affected by emotional factors. Motivation
towards a particular course of action rests on what an individual believes.
The nurse can do much to get families steamed up about the health
problems.
She can evoke dissatisfaction with the present situation.
She can relate health action to existing goals.
She can make specific goals on relation to the problems.
She can recognize, respect and help to relieve emotional blocks.
She can appeal to the individuals best concept of herself.
Effective and positive motivation supporting the family
getting ready to do something to attain the objectives.
3. Telling, Explaining and Directing
An important aspect of counseling by the public Health Nurse is that of
providing information or direction in matters in which the family does not have
skill to proceed. In telling and explaining to families, the nurse needs to
organize and present materials in accordance with the present knowledge of
the family and in such a way that the facts are understood and acceptable.
The instruction and explanation should be based on present knowledge
and desires of the family. Sometimes related information also important and
should be understandable and should be presented with sufficient details to
avoid misunderstanding.
The nurse should use specific applications to produce some result.
Emphasize important points by repetition. It may be secured by using visual
aids (eg) picture, demonstration etc. The nurse should pace the instruction to
suit the family to secure some response. If possible the result of explanation
and telling should be checked after an interval or by revisit.
4. Releasing and guiding family potentials for self help
Encouraging the family to talk, listening with interest will help family
members to evaluate the problem. An essential a most significant
component of counseling is releasing and guiding families to help
themselves. The following ways, the family nurse relationship and
contact is strengthened to help the family to cope with its health
problems.
(a) Setting. This is an emotional climate that allows the
relationship to function sense of “We” feeling.
(b) Clarifying the doubts. Because of the emotional stress threat
and misconception family may develop tendency to deny the problems
or needs. In such occasions the nurse should help them to realize the
actual problems in order to find solutions.
(c) Buildup family self confidences. The family must have
confidence in its own ability to cope with problems. They need to have
the assurance that comes when the help is given.
(d) Coping with interfering emotional status. Fear and guilt are
frequent causes of failure to carryout plans for health action.
Encouragement, support help to strengthen competences to achieve a
higher degree of maturity.
(e) Coping with social and cultural variations to care. Some of
the superstitions beliefs, social customs are the negative influence
because they prevent or delay the acceptance of sound health care.
Adequate encouragement and independence allow sufficient freedom
to develop initiative and judgment.
(f) Anticipating and securing forward movement in thinking
and action.
Sometimes a family nurse contact is very pleasant and active,
but does not move forward. The family may move forward solution
rather than discussing the problems. In order to implement action
the nurse need to consider the following :-
Guide conversation to the objective of the visit or conference.
Re-direct conversation when it becomes non-productive.
Take decision and plans for action.
5. Evaluation.
It takes fine distinction and judgment to know, when to encourage
when to shut off conversation. It should contribute to the clarification
between the nurse and the family that will enable them to work with one
another in the solution or the problems.
When the family has reached a decision or decided upon a particular
course of action, this needs to be directed so that the way can be cleared
for moving on to new things.
This can be done be helping the individual or family to state
exactly what has been decided by asking question of asking whether
the families or individual understood correctly what has been decided.
COMMON HEALTH TOPIC CONSIDERED FOR COUNSELING/AREAS OF
COUNSELING IN SPECIFIC HEALTH SITUATION
The important responsibility of community health nurse is helping the families
to overcome the health problems with adequate measures without delay. The main
strategy of developing the effective health seeking behaviour is counseling.
Counseling can be imparted on each and every topic related to health and
diseases. The common priority topics are as follows :-
1. Health and diseases. Counseling may be required on concept of health
and diseases. Manifestations and its management to maintain the well-
being or positive health.
2. Maternal and Child Health. Health of Women, care during and after
pregnancy care during delivery, care of newborn and infant care of under
fives, care of school age kids.
3. Family Welfare. Regulation or births, spacing, contraception practices,
population and sex education.
4. Environmental Sanitation. Portability of water, safe disposal of excreta
and soil wastages. Control of insects and pests and relationship to health
and disease.
5. Nutrition. Nutritional needs according to age, sex and physiological
condition, balanced diet, diet planning, seasonal changes diet in disease,
relationship to disease.
6. Mental Health. Counseling may be required with reference to individual,
personality, physiological and pathological conditions, economic
variations, stress and strain.
7. Registration of vital events. Family should realize the importance and
legal provisions in relation to the registration of vital events.
8. Health Facilities. Adequate information is needed about the health
facilities available as different level. Community participation and
relationship to community development can be enhanced through
counseling.
9. Health service utilizations. Families to be motivated to utilize
appropriate health care services available in the society. The character,
availability, variety may also be informed for high level of utilization for
maintaining positive health.
10. Communicable Disease and its preventive measures. Adequate
information and the proper measures prevent many infections disease.
Diarrhea and respiratory infections are the common illness affects the
children.
Opportunities
1. Opportunities in Health Centre
(a) Outpatient department.
(b) Inpatient department.
(c) Specialty clinics/services
(eg) antenatal, immunization diabetes etc
2. Opportunities in Community setting
(a) Home visit - Family.
(b) School - Student, Teachers and Other staff.
(c) Camps - F.P Camp etc.
(d) Surveys - Morbidity and mortality survey.
(e) Industries.
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