Family Health Assessment Part I: The Verbitzki Family

Family Health Assessment Part I: The Verbitzki Family

Grand Canyon University: NRS-429VN-O502

Family Health Assessment Part I: The Verbitzki Family

“Health behaviours comprise any behaviours (habits, attitudes, customs, values) that concern health. Pro-health activities are all deliberate actions aimed at maintaining or improving health” (Magdalena et al., 2019). The various strategies for assessing health within a family system include assessments of the structure, function, development, risk factors, primary caregiver, location/support, ecomaps and genograms of the family. The goal of family health assessment is to identify the structure of families and their specific family health needs. The assessment phase aids the nurse in looking beyond the individual patient and consider the bonds, roles, and processes of the contemporary family. Viewing the family as a system, consisting of subsystems together within larger systems, offers perspective on influences within and outside of the family. Expanding the concept of health from an individualistic approach to a family approach, fosters the duality of emotional and behavioral support for healthy changes. Assessing and promoting health of families supports the individuals and communities involved and fosters the social determinants of health.

Family Structure

The Verbitzki family structure includes a father, mother and their young adult son. Igor is the father who is 59-years-old and works as a district chief in the Boston Fire Department. Kathy is a 63-year-old mother of one son who works as a bus aide for children with special needs. Andrew is the 29-year-old son who lives on his own with his girlfriend and works as a firefighter in a suburban fire department. They are a Caucasian family with Igor being of Ukrainian descent and Kathy being of Irish descent, both being born in the United States. Igor is first generation American and Kathy is second generation American. The son Andrew is half Ukrainian and half Irish. Kathy and Igor are a middle-class working family and live in a retirement community within a middle-class suburban neighborhood in Massachusetts. Andrew lives with his girlfriend on the outskirts of the city of Boston. All members of the family own and operate their own vehicles. Igor is Ukrainian Orthodox, Kathy is Catholic, and Andrew was raised Catholic. All are somewhat involved in the church but do not regularly practice. Igor still attends his Ukrainian Orthodox church for any religious practices.

Health Behaviors

Igor is a healthy 59-year-old adult male with no major diseases and has been diagnosed with sleep apnea and wears a CPAP mask overnight to regulate his breathing. He is slightly overweight but tends to watch what he eats and keeps a good nutritional balance. Kathy is a 63-year-old adult female who has Type 2 Diabetes and struggles with weight issues. Her weight issues have led to knee weakness and pain that elicit an unsteady gait when walking. Andrew is a mainly healthy 29-year-old young adult male who is within a healthy weight range and has struggled with high blood pressure during doctor’s appointments, referred to as White Coat Syndrome. This is attributed to him being anxious and worried that the doctor will find something wrong. His physicals are very important for his job as a civilian firefighter as well as an Air Force firefighter and carry a lot of weight in regard to his work ability within his professions. When he monitors his blood pressure at home, it is well within the normal range. Igor and Kathy go to regular doctor’s appointments and screenings and consider health to be an important part of their overall well-being. Andrew schedules regular checkups with doctors and tries to remain physically active every day by either running or going to the gym. Igor tends to be more physically active than his wife Kathy and enjoys long bike rides within his community. Kathy has stability issues because of her knee problems from being overweight and doesn’t get a lot of physical activity or exercise aside from working on the bus as an aide to children with special needs. She is very active within the home and loves to cook dinner daily and prioritizes completing her household chores. Andrew is a very busy young man with three jobs and likes to keep busy and feels more accomplished when he remains busy. With having such a demanding schedule, Andrew enjoys relaxing at home during his free time with his girlfriend and dog.

Functional Health Patterns

Health patterns are “habits, conduct, and behaviors that have an effect on health; depend on both individuals and the contexts in which they develop their life; and are susceptible to modification” (Lozano, M., Manyes, Peiró, & Montes, 2019). Functional health patterns can be identified as either strengths or barriers to health.

Strengths

Some health pattern strengths within this family are the importance they place on health and scheduling regular doctor’s appointments for physicals and screenings. They take any recommendations from doctors seriously and always are an active participant in their health care and compliant in following any treatment plans. They are also proactive in their health by trying to maintain balanced nutrition by preparing meals according to the My Plate recommendations. Due to her Type 2 Diabetes, Kathy eats regular snacks and limits her carbohydrates during meals to keep her blood glucose level stable and within a normal range. She takes her medications regularly and organizes her medications weekly to stay on task.

Barriers

A barrier to health patterns is the strictness of the families work schedule. Igor and Andrew both have multiple jobs which makes it very difficult to incorporate time for exercising or to shop for and cook healthy meals. Kathy works full-time also and remains very busy with household chores and taking care of her family. She admittingly focuses too much on other people and not enough on herself. The amount of sleep the family gets is not sufficient and varying work schedule make it difficult for Igor and Andrew to get a balanced amount of sleep each night. Being tired also affects their ability to remain physically active and affects their level of motivation. Kathy is well versed in her dietary restrictions due to her Type 2 Diabetes, but she is not knowledgeable about all nutritional values of foods and how to eat a nutritionally balanced meal. She is ill-informed on nutrition other than her specific disease restrictions. She gauges meals on the amount of carbohydrates they have and forgets to consider the other nutritional values of the meals she prepares such as the level of fat or protein.

FST Application

Pratt and Skelton (2018) view the Family Systems Theory as a multifaceted, interrelating system, and delivers an outline for understanding family functioning as an “open, ongoing, goal seeking, self-regulating social system,” with 4 essential suppositions: “elements of a system are interconnected, systems are best viewed as a whole, environment interacts with the system in a feedback loop and system is a heuristic model used for understanding, and is not reality”. The Family Systems Theory can be applied to solicit changes in family members, that, in turn, initiate positive changes to the overall family functions over time by the FST operating as an interconnected system. If positive change is made to one facet of the family system, it will equally affect the entire family system as a whole. By the system interacting as a feedback loop, once a positive change is applied to an individual within the group, positives changes will be produced for the entire group. Individuals within a family system are viewed as subsystems and once change is applied to a subsystem, consequently, change is applied to the entire family system.

It is imperative to understand the entirety of a family system to comprehend the family’s needs and requirements in order to deliver complete and optimal care. The assessment phase consists of a complex evaluation method that takes a deeper look into the many facets of a family. Expanding the assessment beyond an individualistic approach to a family approach, delivers a complete method to the overall health and lifestyle modifications within a family system.

Appendix

Family-Focused Functional Assessment

Values/Health Perception

How do you interpret the term health?

Igor: “Health is how you feel overall”.

Kathy: “Health is how well you are”.

Andrew: “Health is something that describes how healthy you are”.

How important is health in your overall well-being?

Igor: “Health is very important to your overall well-being”.

Kathy: “Health is an important part of a person’s life”.

Andrew: “Health means that you don’t have any illnesses and is very important”.

Which aspects of health are the most valuable to you?

Igor: “I’d day not being sick is the biggest thing”.

Kathy: “Being free of illness and happy”.

Andrew: “The most valuable part would be not being sick”.

Nutrition

Describe your interpretation of the “My Plate” recommendations.

Igor: “Eating a balanced meal at most meals”.

Kathy: “Making your plate half protein and lots of veggies with little carbs”.

Andrew: “It looks like a well-rounded meal plan”.

How would you rate the nutritional value of your daily food intake?

Igor: “I’d say they are pretty good”.

Kathy: “I try to focus on not eating too may carbs because I am a diabetic”.

Andrew: “I think my meals are moderately healthy”.

Do you have any nutritional restrictions or limitations within your diet?

Igor: “I personally don’t, but my wife does”.

Kathy: “I have to watch my carbs because I’m a diabetic and know too many carbs are not good for me”.

Andrew: “I don’t have any limitations”.

Sleep/Rest

Describe the amount of sleep you get on an average night.

Igor: “Probably 6 hours”.

Kathy: “For me, I’d say on average 5 hours”.

Andrew: “It depends on my work schedule for that week”.

How would you describe your quality of sleep?

Igor: “My quality of sleep is moderate”.

Kathy: “My sleep is good once I can fall asleep, which can take me a while”.

Andrew: “I fall asleep easily but some nights I toss and turn”.

What modifications would you like to make to your sleep cycle?

Igor: “I would like to not have to wear my sleep apnea mask”.

Kathy: “I’d like to get to bed earlier”.

Andrew: “I’d really like to have a balanced amount of sleep and not feel like I’m always trying to catch up on sleep”.

Elimination

Describe your elimination pattern throughout the day.

Igor: “I usually go once or twice”.

Kathy: “Maybe the same, about once or twice”.

Andrew: “I try to go every morning as part of my routine”.

What is the quality of your stools?

Igor: “I’d say normal”.

Kathy: “I guess normal”.

Andrew: “Normal but sometimes I don’t go in the morning and it affects my energy level for the day”.

What discomfort experienced affects your elimination patterns (urgency or retention)?

Igor: “I notice I urinate more when I drink too much coffee”.

Kathy: “I don’t think I have any issues”.

Andrew: “If I don’t go number 2 in the morning I feel it affects how I feel the rest of the day. Sometimes I get headaches”.

Activity/Exercise

Describe your level of daily physical activity or exercise.

Igor: “Probably moderate, depending on the day or if I’m working at the firehouse”.

Kathy: “Only at work on the bus with the kids and some housework at home”.

Andrew: “I try to run or do my Insanity workout DVD every day”.

Describe your activity level: sedentary in terms of slightly active, very active?

Igor: “I’d say active”.

Kathy: “Probably closer to sedentary”.

Andrew: “Could be slightly active or very active depending on the day and if I’m working or not”.

How important to you is physical activity as part of a healthy lifestyle?

Igor: “Physical activity is somewhat important to me”.

Kathy: “I don’t really focus on how much physical activity I’m getting because I’m so busy”.

Andrew: “It is very important to me to be physically active to feel better and lead a healthy lifestyle”.

Cognitive

What precedes any mood fluctuations throughout the day?

Igor: “If something annoys me or I get aggravated”.

Kathy: “I think I’m pretty good at keeping my mood stable, but I do get overwhelmed when I have a lot to do”.

Andrew: “If something doesn’t go my way”.

Describe any mood disorders that you have been diagnosed with?

Igor: “I have never been diagnosed with a mood disorder”.

Kathy: “No mood disorder for me”.

Andrew: “I haven’t been diagnosed with one, but I feel like I tend to get depressed sometimes”.

How important is mental health to you?

Igor: “I don’t really think about it often”.

Kathy: “I think mental health is very important”.

Andrew: “I know that when I don’t feel my best, it affects other things in my life”.

Sensory-Perception

Describe any sensory perception issues such as visual, hearing, or tactile issues.

Igor: “I have some slight hearing loss from the firehouse and I wear glasses for distance”.

Kathy: “I wear glasses every day. I also have to be careful of my skin and injuries because I’m a diabetic”.

Andrew: “I have slight hearing loss and am declared as a Disabled Veteran”.

How do your sensory perception issues affect your ability to live a healthy lifestyle?

Igor: “Sometimes I don’t hear what people say”.

Kathy: “I have to be careful about any skin issues or injuries”.

Andrew: “I find myself looking at people’s mouths when they talk to me”.

What changes, if any, would you like to make to increase your functionality?

Igor: “I’d like to be able to hear better”.

Kathy: “I think I’d like to not be as nervous about injuring myself”.

Andrew: “I’d like to not have to read people’s mouths sometimes”.

Self-Perception

How would you rate your self-esteem?

Igor: “I think I have overall good self-esteem”.

Kathy: “I’d say I have good self-esteem”.

Andrew: “I struggle with positive self-esteem sometimes. I tend to get down on myself easily”.

How important is your individual role within the familial system?

Igor: “I think everyone has an important part in the family”.

Kathy: “Everyone in the family plays an important part”.

Andrew: “I feel like everyone has their own separate role but contributes evenly”.

Describe your perceived level of control over your health decisions?

Igor: “I feel that I have a good amount of control over my health decisions”.

Kathy: “Sometimes I get overwhelmed at the doctor and the terminology they use”.

Andrew: “I think I have a good amount of control over my health decisions. I am very vocal at my doctor’s appointments”.

Role Relationship

How would you define your role within the family?

Igor: “I am the dad in the family”.

Kathy: “I’m the mother and caretaker”.

Andrew: “I’m the son”.

Describe your level of satisfaction with your designated role within the family?

Igor: “I think I do a good job of being the dad”.

Kathy: “I like to take care of everyone else”.

Andrew: “I feel good about my role, I could maybe participate more”.

What changes would you like to apply to your role?

Igor: “Helping out more around the house”.

Kathy: “Taking more time for myself”.

Andrew: “I could contribute more to the family”.

Sexuality

Describe sexual health.

Igor: “Having a good sex life”.

Kathy: “Being healthy and going to the doctor regularly”.

Andrew: “I think it means being satisfied with your relationship and sex life”.

What sexual issues affect your health or well-being?

Igor: “I don’t think I have any”.

Kathy: “I recently had a biopsy on my left breast. It was negative”.

Andrew: “I think I am pretty healthy and don’t really see any issues”.

How satisfied are you with your ability to practice your sexuality?

Igor: “I feel good about my relationship with my wife”.

Kathy: “I have no issues expressing myself to my husband”.

Andrew: “I am happy with my relationship with my girlfriend and don’t have any major issues in feeling I can be myself”.

Coping

How would you define coping mechanisms?

Igor: “Ways you get through things”.

Kathy: “Things you do to help you deal with things”.

Andrew: “Coping mechanisms are things someone does to feel better when something bad happens”.

Describe your coping mechanisms?

Igor: “I like to go on long bike rides to clear my head”.

Kathy: “I tend to focus more on others to distract myself”.

Andrew: “I don’t think I have good coping mechanisms, I tend to get overwhelmed easily”.

How effective are your coping mechanisms?

Igor: “I think it works well for me”.

Kathy: “I think I could focus more on myself and work through the issues instead of ignoring them”.

Andrew: “I think I need to figure out what coping mechanisms work for me and use them”.

References

Lozano, M., Manyes, L., Peiró, J., & Montes, F. (2019). Applied nutritional investigation: Geographic conditioning in dietary, social, and health patterns in elderly population with disabilities. Nutrition, 57, 17–23. Retrieved from https://doi-org.lopes.idm.oclc.org/10.1016/j.nut.2018.05.015

Magdalena Zych, Wiesław Marian Fidecki, Mariusz Wysokiński, Dorota Kulina, Zofia Sienkiewicz, Katarzyna Zuń, … Agnieszka Kijowska. (2019). Assessment of health behaviours in family nurses. Journal of Education, Health and Sport, (1), 251. Retrieved from https://doi-org.lopes.idm.oclc.org/10.5281/zenodo.2550989

Pratt, K. J., & Skelton, J. A. (2018). Family Functioning and Childhood Obesity Treatment: A Family Systems Theory-Informed Approach. Academic Pediatrics, 18(6), 620–627. Retrieved form https://doi-org.lopes.idm.oclc.org/10.1016/j.acap.2018.04.001