Introduction
Generally, many people consider the family to be an important social unit. This is fundamentally true because societies are made up of family units. Similarly, families dictate the type of social structure a society would have. Furthermore, the actions of family members and their lifestyles often affect societal wellbeing. Nurses have a duty to improve this wellbeing by improving family health (Weber & Kelley, 2013). This duty highlights the importance of having a family health assessment report. The report’s main purpose is to understand current and future health implications of family structures on societies. Researchers have used different conceptual models to understand family health (Brown & Edwards, 2013). In this paper, we identify three nursing diagnoses and develop a short plan of care for a family living in Miami, Florida.
Family Background
The Dominga family is an autonomous nuclear family comprised of a father, mother, and three children. The family is headed by second generation Cubans who live in a neighborhood called Little Havana, which is located in Miami, Florida. The middle-class neighborhood has a population of more than 49,000 people and is home to many Cuban immigrants (Archer, 2013). Dominga is the head of the household and is aged 56 years, while his wife is aged 42 years. Both parents work, but the wife makes more money than the husband. She is a principal in one of the local high schools. The husband works as a clerical officer in one of the local security companies. Their average household income is $37,000.
According to Duvall and Hill (cited in White, Klein, & Martin, 2014), families undergo eight developmental stages. The Domingo family is in the fifth stage of development because their children are 18, 16, and 12 years respectively. Two of the eldest children are girls, while the last one is a boy. The Domingas believe that they have successfully passed the previous stages of family development because they have raised their children to be responsible and confident. The family also believes that each member has accomplished age-appropriate tasks, including doing well in school and at work. The fact that the children are in their teenage years creates some stress for the family, especially because the parents are working and are not always at home to discipline them (we will discuss further information about this type of conflict in the role relationship section). Nonetheless, each member of the family has a well defined role. Although the mother is the breadwinner in the family, the Dominga family structure resembles most traditional families because the father is the head of the household. In line with the traditional theme that defines roles in the family, the mother mostly takes care of the children. However, there are instances when the father plays this role, especially when the mother has pressing issues at work. Generally, all members of the household have shared responsibilities.
Role Relationship
As mentioned above, the father is the ultimate decision-maker in the Dominga family. This is mostly true when both parents are at home. However, when the father is away, most of the family decisions are made by the mother. Conflict among family members often occurs between the mother and the daughters. However, the family has a good communication structure that resolves such conflicts in Sunday gatherings where members of the extended family interact and talk about domestic issues. Conflicts are often discussed and resolved in such meetings.
The external family is the external support of the family. Internally, the father is the main support pillar. There is no evidence of role conflict in the Dominga family because the roles of each family member are clearly defined. However, when the father is absent, there are usually cases of role overload on the mother because she has to assume the role of both parents. The family’s emergency plan to manage crisis is calling the father, regardless of where he may be to arbitrate a matter. The mother and children always believe that he knows best and if he is not home, a phone call would do. The two daughters in the family are the most problematic children because they are adolescents. Therefore, they get in trouble a lot with their mother. When such conflicts arise, the parents always use time-outs as a disciplinary technique.
The Domingo family often uses a pluralistic communication style. Here, communication is often steered towards conversations and not towards conformity (Cooper & Dryden, 2015). In line with this communication structure the parents often believe in the importance of life lessons. This is why they prefer to let their children interact with extended family members. Cooper and Dryden (2015) support this communication structure by saying it empowers children to make decisions in the family and allows them to be confident while doing so.
Value-Belief Pattern
The Dominga family members are Catholics who like to go to church every Sunday. Their beliefs and values in life are not only influenced by their religious predisposition, but by their Cuban culture as well. For example, both parents believe that their children should grow up learning Cuban traditional values about family, social bonds, and relationships. They have raised their children this way. Thus, once a year, they organize for the entire family to visit their grandmother who lives in Havana, Cuba. They have also taught their children to know that they would be punished for doing wrong. They believe that this is the only way they would learn to be obedient to authority. However, they do not have sacred, or unique, religious practices. Nonetheless, they always try to attend mass, at least twice a week, and often confide in prayer during difficult times.
Activity and Exercise
If we look at the family health goals of the Domingo family, we find that they are mostly concerned about maintaining a healthy lifestyle through proper nutrition, exercising and dieting. In line with these goals, Ward and Hisley (2015) say many families fail to achieve their goals because they set too many of them, thereby making it difficult to follow up on each one. Consequently, the authors suggest that families need to set realistic goals, which they could easily measure over a specific period (Ward & Hisley, 2015). The Domingas have a specific goal, which is to buy and eat less processed food. Thus, they choose to eat more fruit by serving fresh fruits as one course of their meals for dinner, two times a week, for the next six months. To improve their exercise regimen, the family also plans to take a 45-minute hike every Sunday after church. This idea was mostly borne by the father because he believes that it would not only be a bonding experience for the family, but also a healthy choice to make to reduce some of the inherent risks of diabetes that they are predisposed to. The father’s initiative in this regard shows part of the internal support system in the family that steers them towards making healthy lifestyle choices. Therefore, the traditional role of the father as the head of the house is one cultural aspect of the Domingo family dynamic that influences the family’s health because he makes sure that everyone follows the family health plan. In other words, his role is like that of a watchdog for everyone.
Health Perception and Management
The Dominga family has a history of diabetes that killed two close relatives in 2009 and 2011. The head of the household suffers from this condition, but the rest of the family members do not suffer from any known condition. Nonetheless, the family members are very efficient in managing the father’s illness, especially after learning the hard way through the death of two relatives. The Domingo family has a good immunization record in the sense that all family members have taken all the necessary immunization jabs. For example, the three children have all taken vaccinations for tetanus (lock jaw), Pertussis (whooping cough), Haemophilus influenza type-b (Hib disease) and Varicella (chicken pox). There is no history of hospital admissions in the Domingo family except for the youngest son who was admitted in hospital for two weeks after undergoing a circumcision procedure. Generally, all family members are supportive when one of them is admitted. The same support is mirrored in their father who enjoys immense support from his family in his struggle with diabetes.
Wellness Diagnosis
Based on the above evaluation of the Dominga family, three diagnoses are eminent:
- Readiness for enhanced activity and exercise pattern
- Readiness for improved role-relationship pattern
- Readiness for improved health perception and management
Nursing Care Plan
References
Archer, K. (2013). Cultures of globalization: Coherence, hybridity, contestation. New York, NY: Routledge.
Brown, D., & Edwards, H. (2013). Lewis’s medical surgical nursing: Assessment and management of clinical problems. Sydney, AU: Elsevier Health Sciences.
Cooper, M., & Dryden, W. (2015). The handbook of pluralistic counseling and psychotherapy. London, UK: SAGE.
Ward, S., & Hisley, S. (2015). Maternal-child nursing care optimizing outcomes for mothers, children, & families. New York, NY: F.A. Davis.
Weber, J., & Kelley, J. (2013). Health assessment in nursing. London, UK: Lippincott Williams & Wilkins.
White, J., Klein, D., & Martin, T. (2014). Family theories: an introduction. London, UK: SAGE Publications.