Family Composition
The assessment of a family is important in identifying family health care needs for appropriate nursing interventions. This family health assessment will focus on a nuclear family that comprises Jim Smith, his wife of 15 years, Kelly, and their three children. The couple’s children include Jake, aged thirteen, Stan, aged nine, and Sharon, aged six.
Roles of Each Family Member
The father is the head of the household and the caregiver. The primary provider is the mother who is a Registered Nurse at a local health care facility. Kelly is the sole breadwinner, as the father is currently unemployed. Jim and Kelly share daily household chores and the responsibility of caring for the children.
Existing Physical or Psychological Conditions
The mother suffers from thalassemia, a hereditary blood condition she acquired from her father. The condition is manifested in fatigue and physical exhaustion. The nine-year-old son also has this condition, which was diagnosed when he was aged one. The father is generally healthy, except for occasional episodes of GERD for which he takes protonix. Stan and Jake have no existing physical condition. With regard to psychological conditions, the father suffers from an anxiety disorder indicated by chronic insomnia and verbalized stress. The mother’s work demands and role as the breadwinner may be a source of stress.
Home and External Environment
The Smith family lives in a rented house in Greenville Manor, Miami County. They do not own the house, but it provides safe and clean living conditions for the family. They emphasize on healthier lifestyles and physical activity. Kelly is a nurse and her husband is unemployed, but he occasionally does odd jobs. Their combined monthly income is about $7500. This income is barely enough for them due to school fees obligations for their children.
Age-appropriate Developmental Tasks
The parent’s ability to “accept and perform their responsibilities” determines the extent to which family members accomplish age-appropriate developmental (Persson & Benzein, 2014, p. 79). In the Smith family, physical maintenance is affected by financial constraints due to low household income. Further, the family is at risk of elevated stress due to the chronic condition affecting Kelly and Sharon and Jim’s occupational status. Jake and Stan do home management tasks. However, the two display ineffective coping behavior manifested in conflicts between them due to the changing roles.
Developmental States
The developmental states of individual family members create stress in the family. Sharon’s blood disorder means that the family has to make adjustments in terms of diet and household chores. Further, the mother (41 years old) complains of chronic back pain after her shifts. This has led to adjustments in family member roles. She also reports that she experienced excessive bleeding after each birth. Further, Jake’s deviant behavior causes filial crises and stress in the family.
Developmental Stage of the Family
The family is in the developmental stage 4. The couple’s children are of the school-going age, i.e., 6-13 years (Umberson, Crosnoe, & Reczek, 2012). The children help with home management tasks according to gender role expectations. Jake and Stan help with landscaping the yard while Sharon mostly does household chores. All the family members have achieved the developmental level expected at this family stage with no signs of delayed growth.
Genetic Predisposition to Disease
There is a maternal family history of thalassemia minor. The mother inherited the blood disorder, which is characterized by a low hemoglobin count, from her father. Her daughter has also been diagnosed with this condition. The paternal grandfather died from heart disease. Therefore, there is a genetic predisposition to thalassemia minor and heart disease in the Smith family.
Immunization Status
The couple and their children are up-to-date in their immunizations. Thus, the family is protected against preventable diseases, including whooping cough and polio. The couple maintains an up-to-date immunization record for each member to keep track of the vaccines received.
Child or Adolescent Experiencing Problems
Jake displays a difficult temperament that includes episodes of rage and yelling. On the other hand, Stan and Sharon exhibit tantrums and extended crying when provoked. Sharon is a finicky eater and does not show a defined eating schedule. In contrast, Jake tends to feast on junk food. As a result, he is overweight.
Hospital Admission
The family would be devastated by a hospital admission of a family member. The financial stress of caring for a sick family member would weigh down on Kelly given that her husband has no stable job. The other family members would also be affected emotionally.
Family Communication
The family members communicate openly with each other at home. The open communication policy is highly effective, as it allows family members to express their views freely and share their feelings with each other for emotional support. However, sometimes Kelly feels out of touch with Jim’s experiences given the demanding nature of her work. Moreover, the parents often scream at their children when they display overt deviance. Stan often throws temper tantrums when he feels angry or ignored. Sharon usually cries when she wants her parents’ attention or affection.
Decision-making
Decision-making in the family follows a hierarchical pattern. In a family, each member has a certain level of power and influence on collective decisions (Arestedt, Benzein, & Persson, 2015). Sharon and Stan have limited power or influence on family decisions. Jake assigns household tasks when the parents are away. Jim holds the greatest influence on decisions, as he is the head of the family. However, decision-making power tends to be fairly distributed between him and his wife.
Violence and Discipline
Kelly reports that there is no violence in the family. The main discipline mode the parents employ is punishment in the form of timeouts and scolding. Unacceptable behavior or conduct from any child leads to punishment. The punishment may involve denying the offender gaming or entertainment privileges. However, the disciplining is often left to Jim.
Dealing with Crisis
The family members employ diverse strategies when dealing with family crises or problems. In times of a crisis, Kelly normally dives into religion and prayer while Jim often turns to heavy drinking. While religious orientation can enable Kelly cope with the crisis, alcohol use is ineffective because it denies Jim the benefits of social support. Kelly confides her fears in her mother who she considers a neutral and supportive party. For the children, playing video games or watching TV helps them deal with family crises.
Cultural and Religious Factors
The family believes in leading healthier lifestyles through balanced diet and physical activity. However, due to Kelly’s work demands, the family rarely takes home-prepared meals. The family believes in the conventional treatments for common illnesses such as fever and chronic conditions. Jim takes protonix for his GERD, while Kelly and Sharon take medication for thalassemia minor. Kelly obtains comfort from her strong religious orientation, meditation, and prayer.
Family Goals
Families shape the members’ perspectives by imparting certain goals and values (Eggenberger & Nelms, 2012). For the Smith family, the primary goal is the academic excellence of the children. The family also focuses on socializing the children along traditional gender roles and behavior. The other goal is to bring up the children in a godly way that is grounded in Roman Catholic teachings.
External or Internal Sources of Support
The nuclear family obtains external social support from close friends and relatives living nearby. Kelly’s mother lives three miles away and occasionally visits the family. She is her closest confidante and supports her financially. Jim’s brother also comes to visit during the holidays. The children have friends in the neighborhood and in their school. The family enjoys strong associational bonds. Jim and Kelly give each other emotional support during times of crises.
Role Conflict or Overload
Kelly has experienced role conflict/overload related to her breadwinner status since the time Jim became unemployed. Further, caring for the children coupled with work-related demands is a source of strain for her. On the other hand, Jim’s occupational status means that he no longer plays the provider role. This change in family structure has resulted in inter-role strain and conflict in the family.
Emergency Plan
The family’s emergency plan for dealing with family crisis involves an open communication policy. The family members freely share their fears and feelings at the dinner table to resolve crises or problems. Disaster planning involves fire and first aid drills and equipment.
Nursing Diagnoses
A nursing diagnosis reflects the need for interventions to promote family health (Ghanbaripanah, Mustaffa, & Ahmad, 2013). The key indicators of the nursing diagnoses include unstable employment, alcohol abuse by the father, work overload, and unhealthy eating practices. The three diagnoses that can be made based on the health assessment of the Smith family include:
- Increased potential for poor physical health due to the consumption of unhealthier foods and the lack of physical activity
- Anxiety related to the father’s occupation status manifested through insomnia and verbalized stress
- Possible strain in family processes due to work-family role overload manifested through the mother’s back pains and stress
Nursing Plan of Care
According to Proulx and Snyder (2011), nursing interventions aim at promoting family health through “primary, secondary, and tertiary preventions” (p. 501). Various interventions can be used to manage the three diagnoses. The father’s unemployed status is the main cause of stress in the family. As a result, the father has assumed the caregiver role, leaving the breadwinner role to his wife. His anxiety can be alleviated by connecting him to recruitment agencies that would link him to a potential employer. Moreover, the nurse could work with Jim to identify a business opportunity that would keep him occupied and productive.
The problem of unhealthy eating could be addressed through health education. Education regarding healthier alternatives to processed food could alleviate unhealthy food from the diet. Further, encouraging the family to stock the fridge with affordable, nutritious food can help address the problem. Emphasis on physical activity and workout routines would also help the family lead healthier lives.
Kelly needs sufficient rest to recover from the fatigue related to her work demands and family roles. Jake and Stan could help with household tasks to reduce her household workload. With regard to her work, Kelly could request for weekend offs to rest and sleep. In this way, her exhaustion levels would decline. She would also find sufficient time to spend with her family and give emotional support to her husband. In addition, she would find time to visit friends and relatives for social support and bonding.
References
Arestedt, L., Benzein, E., & Persson, C. (2015). Families living with chronic illness: Beliefs about illness, family, and health care. Journal of Family Nursing, 21(2), 206–231.
Eggenberger, K., & Nelms, T. (2012). Being family: The family experience when an adult member is hospitalized with a critical illness. Journal of Clinical Nursing, 16(9), 1618–1628.
Ghanbaripanah, A., Mustaffa, M., & Ahmad, R. (2013). Structural analysis of family dynamics across family life cycle in Iran. Procedia – Social and Behavioral Sciences, 84(9), 486-490.
Persson, C., & Benzein, E. (2014). Family health conversations: How do they support health?, Nursing Research and Practice, 6(2), 75-83.
Proulx, M., & Snyder, A. (2011). Families and health: An empirical resource guide for researchers and practitioners. Family Relations, 58(4), 489-504.
Umberson, D., Crosnoe, R., & Reczek, C. (2012). Social relationships and health behavior across life course. Annual review of sociology, 36, 139-145.