Family Assessment

Family Assessment

Grand Canyon University: NRS-429VN

A family is an organization that can be detrimental or can be a positive influence that encourages healthy life choices (Allen, Ryan, & Framer). A family is defined as a set of individuals related by blood, marriage, cohabitation or adoption who perform functions by performing expected roles within the family system (Edelman & Mandle). Examples of these roles include values, beliefs, and behaviors. Health practices are actions performed by individuals or families that promote and prevent disease.

A comprehensive family assessment provides the foundation to promote family health. It allows the nurse to assess and then implement a plan of care based on problems that are found during the assessment process (Allen, Ryan & Framer). The family the nurse completed a comprehensive health assessment on consisted on a husband, Don and his wife Tina, both in their late forties. They have three children ages 20, 17, and 15. The eldest son recently moved away to college. The parents have been married for twenty five years and are both educators in the Florida School System. They currently own their own home for the past 16 years in a family friendly neighborhood outside of Tampa.

Using Marjory Gordon’s eleven functional health patterns, the nurse first organizes open ended questions for each of the health functions and once the interview is complete will then develop an evaluation of the patterns assessed during the interview (Black). The purpose of this paper is to identify, through a nursing family assessment, strengths, weaknesses and possible dysfunction of a family.

The nurse began the family assessment by sitting with the husband, wife and two of the children as the eldest was not at home at the time the interview was conducted. The assessment began with questions pertaining to family health perceptions, health management and preventative practices. The family places health and wellness high on their priority list and comply with yearly health screenings and wellness visits. The definition of health for their family was described as the “absence of being sick and feeling well enough to enjoy doing daily activities.” The family reported that during this past year, Don (the father), had open-heart surgery due to endocarditis.

For nutrition, the family usually prepares their own food at home and is following a low-sodium diet due to Don’s cardiac issue during the year. They mostly buy organic produce and meats and have limited their intake of sugar. The family mostly drinks water with an occasional soda on the weekends. Dinner is thought of as a time when the family comes together to talk and spend time together.

Relaxation and sleep was described as satisfactory with no issues being reported. No sleep problems such as snoring or frequent waking during the night were reported and the family noted that they spend time every day on activities that are relaxing such as reading, quiet meditation or just sitting outside. Elimination patterns were described as normal with no abnormalities such as incontinence were reported. Activity and exercise was described as an important area of focus for the family. All members participate in a daily physical fitness program such as yoga, running, bike riding and weight lifting. Don, who had an aortic valve replacement is currently participating in a cardiac rehab program that incorporates daily physical fitness activities.

Cognitive functions such as decision making, problem solving and learning were described as a family asset. The family reported that when issues or concerns arise within the home they will sit down as a family and discuss what is happening and possible solutions for whatever the issue is. No barriers to learning were reported or observed. Sensory perception, which explores issues pertaining to the senses, such as sight, hearing and vision were not reported. There appeared to be no abnormalities within this health function to note.

Self-perception function is how members of the family view themselves (Edelman & Mandle). Don reported that since his heart surgery he has been feeling self-conscious. Prior to getting sick, he was extremely muscular. During the whole process leading up to his cardiac issue and his recovery, he has lost over forty pounds and reported feeling “weak and scrawny.” He looks forward to being able to lift weights again and get back to his usual physical fitness routine. Role relationships were defined within the family however Don reported that he role has changed since his illness and surgery. Prior to becoming sick, Don was “the man of the home.” He handled finances, mowed the lawn, did handyman work in the home and for his neighbors, and maintained their cars and boat. Now his wife has somewhat taken over those roles. He described being grateful to her for being supportive and taking on his role while he is recovering, however he is looking forward to being able to resume his daily roles within the home. Since becoming sick, Don reports that their children have become more distant and quiet. His wife and he agree that they believe the children were afraid that Don would pass away and in turn withdrew. They report that the family is currently in counseling to help the family deal with the adjustments, emotions and communication during this process. The family describes that they have extended family nearby that they are close to as well as friends and neighbors. They describe their support system as excellent.

Sexuality was described as normal with no issues reported. Lastly, coping was described as a big issue in their home due to Don’s illness and surgery and also their eldest son moving out of the home. The family has been adjusting to the changes by video chatting with their son on a weekly basis and visiting him when they can. Their son has also made trips home frequently while Don was sick. Dons health problems over the course of the last year has also been an area relating to coping that the family has had to address. Don’s father had a heart condition similar to his so when he was diagnosed there was a lot of fear and confusion in the home. Roles within the home were changed with Dons’ wife taking over his roles within the home and the children becoming frightened and withdrawn. Due to the cost of the surgery, hospitalization and insurance premiums, Tina has taken a second job to help cover some of the costs that the family has inquired. They do get support from family and friends but still are in the process of coping with the change that has occurring in their home over the past year.

The areas that the nurse would find to be problematic at the conclusion of this family health assessment would be in the areas of role relationships, coping and health perceptions. Don is a fifty two year old man who taught physical education and coached football. He worked out every day and was what most would describe as extremely active. He was an avid fisherman and enjoyed boating on the weekends with his family. Earlier this year he was diagnosed with endocarditis. He lost 40 pounds and could hardly breathe. He could no longer perform his activities of daily living without assistance. Shortly after he was diagnosed, he was told he needed open heart surgery to replace his aortic valve. His father had the same surgery twenty years ago and sadly did not survive it. He was told that after the surgery he would need home health care and 10 weeks of IV antibiotics. His role of “man of the house” was gone and his wife was left to take on those roles, to care for her husband, and to care for her three teenage boys who were experiencing grief, sadness and fear. The family had to adjust to an acute illness and one such as this is problematic and further intervention by the nurse would be appropriate.

The strengths noted for this family is that they have had a good communication system in place prior to Dons illness. They also report that they have supports systems such as family and friends in place and they are currently in family counseling to address the issues such as fear and anxiety that they are experiencing. Having these factors in place during an acute crisis situation such as Dons is important to have because an acute illness in the family disrupts usual family activities, family function and family roles. In addition, stress and anxiety related to it can become compounded (Berman & Synder).

Interventions that could be helpful in assisting the family with interrupted family processes could be determining how well members of the family understand the illness. Having a discussion about Dons illness, recovery and any other questions the family may have about it would be helpful and would also lead to open communication by members of the family which would be a positive nursing intervention relating to this family process (Berman & Synder). A second intervention could be to refer the family to social services in order to inquire about financial interventions that could be of assistance to the family. The cost of medical care, especially when combined with a long term leave of absence from work, could lead to financial disasters such as bankruptcy. Insuring that the family has resources available to help them during this time would be of great value (Black).

The purpose of family assessments is to determine the level of family functioning, family interaction patterns and evaluate strengths and weaknesses (Edelman & Mandle). A family assessment helps the nurse identify areas within the family that require interventions that not only focus on problems but also utilize the families strengths and outside resources such as was the case for the family that was interviewed for this health assessment.

References

Allen, J., Ryan M., & Framer, E. (2013). Family wellness: the power is in being healthy together. American journal of health promotion. Retrieved from: https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=84769299&site=ehost-live&scope=site

Berman, A., & Snyder, S. (2012). Fundamentals of nursing: concepts, process and practice. (9th ed).

Black, B. (2017). Professional nursing: concepts and challenges. (8th ed).

St. Louis, Missouri: Elsevier

Edelman, C., & Mandle, C. (2010). Health promotion throughout the lifespan. (7th ed.)

St. Louis, Missouri: Elsevier