Family Assessment Assignment The purpose of this paper is to present a family assessment. Community health nurses work with individual families and with families as an aggregate within the population (Clark, 2003). Several areas will be presented such as biophysical, psychological, physical environmental, sociocultural, behavioral and health system considerations. The data obtained during family health assessment enable the nurse to make informed decisions about the health care needs of families (Clark).
On the maternal side, this family has one living eighty five year old male and one living seventy seven year old female. Two of the paternal members are deceased at the age of forty and eighty-eight. There is one living fifty-three year old male and one living forty-eight year old female. This couple has three children, two males, age twenty and fifteen, and a female age eighteen. All of the above family members have accomplished age-appropriate developmental tasks. The younger male has a learning disability which does cause some excess stress in the family.
This is an example of an extended family and also the dual-earner family. This family consists of two working parents with children and also includes a kin network which provides mutual support for the family (Clark, 2003). The younger family members are currently healthy and are not being treated for any health conditions. The eighty-five year old male is currently undergoing treatment for colon-rectal cancer. This treatment consists of weekly visits to a doctor’s office for chemotherapy. There is a family history of genetic pre-disposition to cancer as his mother had this illness also.
The typical mode of communication in the family is verbal. The family uses the switchboard pattern, in which all members have reciprocal communication. A successful pattern of communication is the “switchboard” in which there is reciprocal communication among all family members (Clark, 2003). The family lives in the same city and is able to have frequent face-to face verbal conversations. The family also uses the telephone frequently to have verbal conversations. The subject of death and dying is taboo for the family. The family members are reluctant to talk about the eighty-five year old male’s illness.
Many things are withheld from the children in the family. There is an attempt at denial for the outcome of this illness. The family is very cohesive. The elderly couple has been married fifty-two years and is very supportive to each other. The forty-eight year old mother and twenty year old son are a sub-group and at times exclude the father from decision-making. The two brothers are slightly alienated from each other. The sister has a good relationship with both brothers. The daughter seems to have a closer relationship with the father than the mother. Decisions are made by the whole family.
A problem is first defined and evaluated by the parents with all alternatives being presented to the rest of the family. The family members give their ideas and usually a compromise can be found if there is a disagreement. The women in the family usually are the ones to carry out the decision. The elder male had a “telling” relationship in regards to his family but with his current illness, he has let his spouse become the “telling” leader. This is appropriate at this time due to role adjustment and lack of motivation for him. The forty-eight year old female is the leader in her immediate family.
She has a “participating” leadership style with the husband and twenty year old son. She uses a “selling” leadership style when dealing with her learning support son. A “delegating” style of leadership is used with her daughter which is appropriate due to her daughter attendance at a college in Philadelphia. At times she uses a “telling and selling” leadership style with her parents which is appropriate to their age and abilities. These are the four basic styles that differ in terms of follower maturity and their emphasis on task accomplishments and relationships (Clark, 2003).
The family members express respect for each other. The parents and children in this family are viewed as individuals who work, attend school and have separate lives. There is no evidence of violence in this family. Physical punishment is not used as a form of discipline. A time-out period is usually given to allow a bad behavior to end and to contemplate the behavior (Clark, 2003). Removal of privileges such as not going outside with a friend, or not watching a certain television show is sometimes used to discipline. This type of discipline is appropriate for the school aged child who values his friends and his free time.
A positive self image is conveyed to all family members. Even minor accomplishments such as good report card grades are praised and sometimes awarded. The family is currently dealing with change as far as the grandfather’s illness. Selective inattention and intellectualization are two of the defense mechanisms being used for avoiding this problem (Clark, 2003). Slowly, the use of talking with family members and expressing both positive and negative emotions are being used as coping strategies. The entire extended family comes together in a crisis which helps every member of the family to deal with the situation.
The family has the goal of providing a long, comfortable, and safe life for their children. This includes providing health care to live a long life, a college education so the children can be independent and comfortable, and a loving family to always be there for them. Family goals are a function of family values and reflect a family’s cultural background (Clark, 2003). Physical Environmental Considerations The family owns a two-story home in Annandale, Virginia. The home was built in 1989 and is large enough for the children and parents to have their own rooms. There are three bathrooms with adequate plumbing.
There are smoke detectors on every level and the family has a plan in case of a fire. There are currently no safety hazards in the home. There is a built in pool with a 6 foot fence surrounding it in the backyard. The quiet neighborhood has homes that are pleasing to the eye. All neighbors have at least two vehicles for use and are able to access food stores. The families range from elderly retired couples to young couples with school aged children. Most of the members are not at home during the day due to jobs and school. In the summer, children can be seen throughout the neighborhood.
The area is very safe as there is a very low crime rate. There are no environmental hazards in the neighborhood. Sociocultural Considerations Each person in a family occupies several roles by virtue of his or her position (Clark, 2003). The formal roles of the adult male are breadwinner, house repairman, chauffeur, and sometimes cook. His informal roles are the harmonizer, the follower, and at times the blocker, and scapegoat. The formal roles of the adult female are homemaker, child caretaker, financial manager and cook. Her informal roles are the encourager, martyr, and go-between.
The children have various roles of blocker, follower, and pioneer. Since both parents work, the formal roles between the adult male and female are very interchangeable. Usually role conflict can be avoided by this change of roles. There is evidence of role overload at times as the female does attend school part-time, works full time, attempts to cook and keep house while helping her learning disabled son. The male also experiences role overload as he works harder to pay the regular bills plus his two children’s college education, while trying to balance childcare and cooking at times. Role models were adequate for the family.
In the maternal set of grandparents, there was a male breadwinner, chauffeur, and financial manager. The female stayed at home to raise the children, cook and clean the house. In the paternal set of grandparents, the female became the breadwinner, chauffeur, cook, child raiser, and financial manager after the early death of her husband. Family roles often change when a family member is absent, ill, or incapacitated and cannot fulfill his or her usual roles (Clark, 2003). With this family there could be an expected change in family roles if a grandparent comes to live in the home. All members of the family ill need to adjust their roles at different times to accommodate this change. Both the husband and wife attended parochial grade schools and were married in a Catholic church. All three children were Baptized and received Holy Communion and Confirmation. At the present time, only the wife attends weekly mass. This affiliation provides her emotional support to deal with her father’s illness. The family’s income is currently sufficient to meet their needs. The wife is employed as a full time sales proposal manager in a government office in Maryland. The husband is employed full-time by the government in Washington D. C.
The twenty year old son works part-time as a mental health technician in a local hospital. His income is not used towards family bills. The younger son and daughter attend school full time and are not employed. There is enough money to support the mortgage on the home, all accompanying bills, college tuitions, and even a yearly vacation. Occupational roles do not tend to conflict with family roles as roles can be adjusted according to need. A family’s nutritional status can be assessed through physical assessment of each member and by observing the way in which the family selects, purchases, and prepares food (Clark, 2003).
Food preferences are usually cooked meals prepared by the female or male in the family. Some of the preferred foods are baked chicken, baked or mashed potatoes, pasta dishes and cooked or raw vegetables. At times fast foods are brought home due to time constraints. The husband does not drink alcoholic beverages but he does smoke cigars on a regular basis. The wife will usually have a small amount of alcohol on a holiday or celebration and she does not smoke. The twenty year old does not drink alcohol and the 18 year old drinks a moderate amount on weekends while away at college. Both of these young adolescents do smoke cigarettes.
The eighty five year old male drinks a beer or a glass of wine every night. At one time he smoked cigars regularly. His wife occasionally has a glass of beer and does not smoke. There is no evidence of substance abuse in this family. The elderly couple is on maintenance medications for hypothyroidism, hypertension, heart disease, and osteoporosis. Newly added to these is the chemotherapy drug and occasional use of over the counter anti-emetic and anti-diarrheal medications. The younger couple takes vitamins and the wife uses a calcium supplement. The children are on a daily vitamin.
All medications are kept in a high cupboard in the kitchen. The eighty-five year old male naps several times a day. There is not an adequate amount of exercise for this family member. The elderly female is often out shopping and does get an adequate amount of exercise in the form of walking. The younger male and female both work and do enjoy a lot of exercise during their everyday life style. The wife is often up late at night doing house chores and does not get a proper amount of rest. The children have very active lives with plenty of exercise in the form of leisure activity and instructional sports.
They do prefer to stay up late at night with only a few hours of sleep for the next day. The twenty year old male enjoys skiing and 4-wheel driving. He is often alone when he is 4-wheel driving, which can pose a health hazard if he becomes injured or incapacitated. He does use a seat belt and carries his cell phone with him in case of an emergency. The fifteen year old enjoys snowboarding, ice hockey, and dirt bike riding. These can be considered health hazards due to injuries than can occur. He always wears the appropriate gear which includes a helmet. The husband enjoys fishing and hunting with his dog.
The hunting can be a health hazard since a weapon is used. He has undergone safety courses to prevent injuries from happening. The young couple does engage in sexual activity without the use of contraceptives as the wife has gone through menopause. The eighteen year old does have a boyfriend and has been instructed on the use of contraception. It is not known at this time if they are engaged in sexual activity. The twenty year old is not currently in a relationship and the sexual history is not known. The family keeps their sexual activity private and does not discuss sex openly. The wife makes the health related decisions in this family.
If a child is ill the wife would be the one to take him/her to the doctor’s office or give medications. The wife would inform the husband of the illness but he would not be involved in the care. Some home remedies or cultural health practices are used before consulting a health care provider (Clark, 2003). All members of the family frequently use an anti-inflammatory pain reliever drug called Motrin. They also use zinc lozenges or eat chicken soup at the first sign of a cold or sore throat. The daughter who is away at college uses the health clinic frequently for problems with urinary tract infections, colds, or headaches.
Prescribed antibiotics are often used but are not taken for the full length of duration. The family’s usual source of health care is their physician’s office or local hospital. The elderly couple is covered by private health insurance with Medicare benefits. A dental and eye care plan is not included with this insurance although they do visit the dentist and optometrist yearly. The younger family is covered by the husband’s health insurance. All members are covered for hospital and doctor visits with an eye and dental plan also offered with this particular insurance.
They do chose preventive healthcare by having routine dental, physician, and optometrist visits. The data obtained during family health assessment enable the nurse to make informed decisions about the health care needs of families (Clark, 2003). The data obtained from this extended nuclear family shows a nursing diagnosis of caregiver role strain due to extra measures taken to work with the learning support son and the illness of the eighty-five year old male. New living arrangements may also come into play due to aging parents living alone which can cause further strain on family roles.
In conclusion, a complete family assessment plan is necessary so that nurses can play a significant part in reducing the strain caregivers feel or even help to prevent its occurrence (Burns, Archbald, Stewart, Shelton, 1993). A nursing diagnosis for this family would be caregiver role strain due to extra measures taken to work with the learning support son and the illness of the eighty-five year old male. New living arrangements to incorporate extended family members into the nuclear family can also occur when aging parents can no longer live alone (Clark, 2003).