Kelly CascarioMichael Mata

Crystelle Santos Beverley Bailey-Hudson Tiffany Karschamroon

Evan Dean Appollinaire Funwie

Jonah San Diego

GESTATIONAL DIABETES

RN-BSN ProgramCalifornia State University, San Marcos

Picture taken from:http://whatisgestationaldiabetes.org/

Introduction Family Dynamic

• Hispanic Family• Family of Four

• Mother- 37 years old• Father-38 years old• Son-16 years old• Daughter-10 years old

Family Member with Condition: Mother • Gestational Diabetes: “Pregnant women who have never had

diabetes before but who have high blood glucose (sugar) levels during pregnancy are said to have gestational diabetes” (American Diabetes Association, 2014).

Picture from: https://www.123rf.com/

Calgary Family Intervention Model (CFIM)

• Strength and resiliency based• Goal is to support optimal family functioning• Domains affected: Cognitive, Affective, Functional• Nursing actions guided by CFIM

• Commend their strengths• Offer information/opinions• Validate responses• Encourage illness narratives• Draw forth family support• Encourage family to be caregivers• Encourage respite care• Develop rituals

(Denham et al., 2016)

Impact of Gestational Diabetes on the Family

Nursing Action Following CFIM Recommendation

● Shock of diagnosis/Coming to term with illness

● Concern about health of mom and baby

● Learning to manage gestational diabetes

(Keygan, 2013)

● Acknowledge the family’s difficulty, ask how they are doing, ask them to share what they are thinking, ask if there is anyone they would like to be called

● Provide literature, identify specific questions and concerns, commend the family’s strengths

● Find out how the mom wants her family to help her, facilitate communication among family members

(Denham et al., 2016)

According to Carolan (2012), “husbands and partners offered the most support by eating the same food as the woman, encouraging them to

avoid overeating and by accompanying them during exercise” (as cited in Keygan, 2013, p. 16).

Condition Description Gestational DiabetesAmerican Diabetes Association defines gestational

diabetes as: “Pregnant women who have never had diabetes before but who have high blood glucose sugar) levels during pregnancy” (2014).

· The prevalence of gestational diabetes is as high as 9.2%.· Causes of gestational diabetes are unknown· Hormones of the placenta cause the body to block the action of the mother’s insulin in her body, causing hyperglycemia· If untreated, the fetus’ pancreas produces extra insulin & absorbs extra glucose, which can lead to “macrosomia”, which causes fetus to gain “extra weight” and other complications such as hypoglycemia at birth, risk for childhood obesity or type 2 diabetes

Reference: http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html#sthash.pbxkkPqQ.dpuf

Roles • In the Hispanic Culture, the dynamic of household roles is

historically very family-oriented.• The needs of the family are more important than the concerns of

the individuals, and the individual's self-esteem and identity is strongly affected by his or her relationship with family members (Clark, 2013).

Parental RolesFather: The role of a man in the Hispanic culture would emphasis in “machismo”

• Machismo means that the man is the head of the household & main provider of the family. As a provider, the man will work hard in order to protect and provide for his family. The man is considered strong, fearless, brave, & honorable (Vick & King, 2016).

• Machismo places men over women and gives males rights and privileges denied to women, such as independence and authority (Clark, 2013).

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Roles (cont’d.)Mother: The role of a woman in the Hispanic culture would emphasis in “marianismo”

• Marianismo means that the woman is religious, self-sacrificing, and responsible for running the household.

• Motherhood is highly valued; They define themselves through their children. • In the Hispanic culture the woman are supposed to be submissive and dedicate themselves to

their family.• Their role is to nurture while the father is the main disciplinarian (Clark, 2013)

Children Roles• Parents expect them to be responsible and cooperative and teach them not to talk too much to

authority figures and to exhibit emotional restraint (Clark, 2013).• Respect is one of the most important values in the Hispanic culture that parents instill in their

children.• Hispanic families instill in their children the importance of honor, good manners, and respect for

authority and the elderly. Son: sons are not required to do household chores

• obligated to help their fathers protect the family

Daughter: The roles of daughters for their family are highly essential in the Hispanic culture

• are required to do housework and care for their siblings Picture from: www.pinterest.com

Developmental Stages

Stage III: Family with young childrenTasks of stage:

1. Accepting new members born or adopted into family system.

2. Adjusting martial system to make space for child/children.3. Joining in childrearing, financial, and household tasks.4. Realignment of relationships with extended family to

include parenting and grandparenting roles. (Kaakinen et, al, 2015, pg 177)

Culture/Religion

• Under Structural Category from Calgary Family Assessment Model• Practicing Hispanic culture is important for this family.

• Family, education,language,food, music and art, religion, and socioeconomic status are some aspects that Hispanic families value and practice.

• “Familismo is the value of family over individual or community needs and the expression of strong loyalty, reciprocity, and solidarity among family members” (Smith, 2000).

• This family have a close relationship with each other.• Religion

• 68% Hispanics are practicing Catholics and believe that God is an active force in everyday life. (Pew Hispanic Center, 2007).

• This family attends Spanish mass every Sunday in a Catholic church near where they live.

Function • Functional Category is the third assessment category from CFAM

• Aspects of family functioning consists of:• ADLs, Communication, problem solving, roles, influence and

power, beliefs, alliances and coalitions. • Each individual has their role in the family.

• Father is the main provider, works 40 hours a week, his children has respect for him and listens to him.

• Mother is a stay-home mother who takes care of the children, prepares meals, does the laundry, takes care of the daughter’s homeworks and many more

• Son is in high school, active with sports and the usual teenager who likes to stay in his room

• Daughter is in 4th grade, likes to be with her mother most of the time, excited for the baby to be born.

Verbal and Nonverbal Communication

• Under the Functional (Expressive) Assessment• Concepts derived from communication theory used in

CFAM:• All nonverbal communication is meaningful• All communication has two major channels for

transmission: digital (verbal) and analogical (nonverbal) (Kaakinen et, al, 2015, pg 114)

• Verbal communication is courteous and respectful using the Spanish usted form (i.e., the formal,polite “you”) to address others (Guarnero, 2005)

• This family has an open communication, listen to each other and communicates with respect.

Picture from: http://www.livestrong.com

Family Health Intervention

Knowledge Deficit• Family-focused and individualized education

• Verbalize need for blood glucose monitoring• Understand detrimental effects of poor management

• Maternal• Fetal

• Familial changes to ensure health of mother and fetus• Change in diet and/or types of meals prepared• Exercise regimen

• Return demonstration of proper blood glucose testing• Return demonstration of proper insulin administration

technique (Nettina, 2014)

Family Health Intervention Diet and Exercise • Family-focused and individualized diet plan

• Strict Kcal/kg/day diet control method (not always optimal)• Suggest as a family, eat similar foods for convenience and

support• Determine the foods at risk for high blood sugars and re-

evaluate • Provide lists of food groups to meet diet plan goals

• Family-focused and individualized exercise plan• Gestational diabetes mellitus (GDM) can easily be controlled

with exercise• Suggest exercise activities with the family for support and

convenience• Provide evidence-based practices that support exercise with

GDM. (Hicks, 2016)

Picture from: http://www.aljamila.com/node/38786/

Family Health Intervention

Anxiety changes in health status• Individual anxiety intervention ▸provide information ▸reduce source of anxiety when possible ▸physical reaction related to anxiety•Family focused anxiety intervention ▸disturbance in normal family function ▸anxiety and cultural diversity ▸anxiety of sudden separation or loss•Teaching ▸evaluate education level and additional teaching ▸teach symptoms of anxiety and techniques to reduce

anxiety Picture from: licensedmentalhealthcounselor.org

ReferencesAmerican Diabetes Association. (2014). What is gestational diabetes?. Retrieved from http://www.

diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.htmlDenham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2016). Family-focused nursing care.

Philadelphia, PA: F.A. Davis Company.Guarnero, P. (2005). Mexicans. In J. Lipson & S. Dibble (Eds.), Cultural and Clinical Care (pp.330-

342). San Francisco: UCSF Nursing Press.Hicks, P. (2016). Gestational Diabetes in Primary Care. In Medscape . Retrieved April 14, 2016,

from http://www.medscape.com/viewarticle/408910_4Keygan, J. (2013). The impact of gestational diabetes mellitus on the pregnant woman, her infant(s)

and family, midwifery practice and the health care system. Nuritinga, (12), 12-23 12p.Nettina, S. M. (2014). Lippincott Manual of Nursing Practice (10th Edition). Philadelphia,

PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.Pew Hispanic Center. (2007). Changing faiths: Latinos and the transformation of American Religion

. Washington, DC: Pew Research CenterSmith, A. (2000). Ethnomed: Mexican Culture Profile. Retrieved from https://ethnomed.

org/culture/hispanic-latino/mexican-cultural-profile#section-6