Family Focused Health Assessment

Family Focused

Health Assessment

A family health assessment is an essential instrument in developing a health care plan for a family unit. This paper will examine the intricate role the nurse has in family assessment and health promotion. I will be covering eleven functional health patterns which is a method created by Marjory Gordon in 1987.

Family Structure

Understanding family structure is essential for the nurse in patient and family care. The family I interviewed is the Johansen family. They are comprised of a nuclear setting, involving a husband, 42, a wife, 41, and two female children, ages 13 and 10 (Green, S. 2018) They are a middle-classed Caucasian family where both parents work, and the children are in the public-school system. The husband is a Physical Therapist and works Monday through Friday and the wife is an RN in a local hospital, working 3 days per week. The 13-year-old is involved in cheerleading and the 10-year-old is involved in volleyball.

Health Assessment

Values/Health Perception

This family values family ties and family time. They support one another in life issues and extracurricular activities. Husband or wife, or both when possible, will always attend their children’s activities. but the parents make sure they touch bases with the children each day via text/phone call or at the end of the day to ask them how their day is going. The 13-year-old thinks this is not necessary, but the parents believe this is essential to the family tie and believe the children will appreciate this when they grow into parenthood themselves. They do not attend church, as they are not religious, but the parents are a spiritual entity. No one smokes in the family, but the parents do have drink periodically. The family as a unit do not think there is a problem with this, as it is rare. The parents think they are relatively healthy, and the children have no health issues.

Nutrition

The husband primarily eats a Ketogenic diet and encourages his family to do so also. He believes this is one of the healthiest things they can do for themselves. Wife knows she should lead a healthier life. She is overweight and does not like to exercise. She eats what she wants but has considerably lessened her portion sizes. She too was doing the Keto diet and did feel better but states it’s hard to stay on it. She states that while she was on this diet, she was able to lose weight and did not feel as hungry as she does now. She and her husband do however, practice intermittent fasting, which they feel has made a difference in how they feel. Due to all their demanding schedules, they rarely get to eat a meal together, but the parents make sure there are always healthy meals and snacks for their children on hand, such as salad ingredients and precooked chicken, but when the children are out doing their activities, they eat whatever is available. The parents believe it is extremely important to eat meals together and use that time for talking as a family, but they find it is almost impossible at this stage of the children’s lives.

Sleep/Rest

Husband and wife both have sleep issues, as they both have problems with anxiety. Husband has a very difficult time going to sleep and most nights it takes him several hours to do so. On these nights, he reads or meditates to try to relax. Wife falls asleep easily and sleeps mostly throughout the night, but due to depression issues, she oversleeps most days off and can easily take long naps during the day. Being that the children are so active, they have no problems with sleep. The parents usually go to bed between 9:30 and 10. The 16-year-old goes to bed around 9 and the 10-year-old goes to bed at 8.

Elimination

Husband has a long history of gastrointestinal problems. Most of what he ate on a traditional diet sent him to the restroom immediately. Upon starting the Keto diet, he noticed a change in his elimination pattern. Sometimes he will feel slightly constipated. Wife and children have normal bowel movements, although wife used to have severe constipation issues. She states she does not know what has changed. Wife also has stress incontinence with heavy coughing or sneezing. Wife also has a problem with urination at night after laying down. Sometimes she will need to get up several times a night. Husband’s bowel movements come after each meal. Wife’s bowel movements are pretty regular, maybe once a day to once every other day. The children have maybe one bowel movement a day.

Activity/Exercise

Husband does something active each day, whether it be lifting weights, doing core exercises, swimming, or taking a walk around the neighborhood. He states if he does not do at least something, he will not feel very well. Wife, as stated before, does not do much exercise, but when she does, it will be lifting light weights or swimming. She says she feels accomplished when she participates in these activities but does not have much motivation to get them started. She states she would rather be sitting and reading or watching tv. The children will sometimes go to the gym with their parents or walk around the neighborhood with them, but mostly they get plenty of exercise in their own activities.

Cognitive

Husband and wife both have some problems with remembering things. Mostly the wife, as she says most times when walking into a room to do something, she will forget why she walked in there in the first place. Husband tends to forget where he places his keys. They both, however, are very intelligent and tend to do a lot of reading and podcast listening for personal research on their down time. The husband has his master’s in physical therapy and the wife has her associates in nursing. The 16-year-old, when she was in elementary school, had some issues with math and reading and needed a tutor for a short time. Wife has a problem with depression and anxiety and husband has a problem with anxiety, and both are taking medications for these conditions. Wife sees a Psychiatrist every few months and sees a therapist monthly.

Sensory/Perception

Husband and wife both feel their sensory and perception are intact. He wears glasses daily and she wears reading glasses sometimes. They both love to taste new foods and try to figure out the ingredients. The 10-year-old may need to start wearing glasses after her next exam. They are not very keen on trying new things like their parents, but their sensory and perception are also intact, they say. Each family member sees an optometrist once a year.

Self-Perception

Husband states he feels good about himself and his place in life, although he says it was not always this way. He says he had to deal with balding at an early age and states he had someone in his life who made him feel insecure about himself but says he has worked through those issues and loves himself for what he is. Wife has self-perception issues. She began gaining weight about 7 years ago when she placed on steroids for Rheumatoid Arthritis and she stress eats, so she had put on a lot of weight. She says her hair has also started thinning in the last few years which she says makes her uncomfortable with herself. She says she also is more introverted than she would like to be. She says this makes it hard to make friends. Conversation is hard for her and this makes her feel uncomfortable around people and possibly unlikable. The 16-year-old is having some problems with a couple of her peers at school. They make fun of her because she is taller than the others. Her parents try to reassure her that she won’t have these problems later in life. That everything balances out once everyone is out of school and worrying about their own lives. She is also having problems with cyber-bullying from the same girls at school. The 10-year-old says she likes her hair and can sing well, and these things make her happy. Husband views himself as an optimist, the wife as a pessimist, and they see their 16-year-old as a pessimist and the 10-year-old as optimistic.

Role Relationships

Husband tends to be the disciplinarian in the household, as he is calm and very patient. Husband and wife both consider themselves bread winners. They cook together when they can and pay the bills together. The children’s roles are to go to school, get good grades, and to help maintain the house.

Sexuality

Husband and wife feel sex is a very important part of their relationship. They feel it keeps them close and connected. Due to the antidepressants the wife is on, she has lost her libido but makes an effort anyway, and says they have sex maybe once per week (Nall, R. 2017). The 16-year-old says she has not “done that”, but that if she had, she would not be saying it in front of her parents. Her parents say they want to keep the lines of communication open on this subject, but their daughter just shakes her head no. The 10-year-old does not seem to know what to make of this conversation.

Coping

Husband says he sometimes has a hard time coping with the demands of his time between work and family but says exercise and meditation with his wife seem to help. Wife has very limited coping skills. She agrees that exercise would probably help, and that meditation can be difficult due to her mind racing. The 13-year-old says she is learning coping skills through a counselor her parents have her going to. As a family, they try to cope with stressors together, but say this is not always easy with a teenager. One serious problem the family had to face together was the tragic death of the wife’s mother, the children’s grandmother. There was a lot of discussions as a family and wife needed counseling and medication to get through it.

• Wellness Nursing Diagnosis
• Readiness for enhanced activity-exercise pattern
• Readiness for improved self-image and life satisfaction
• Family Systems Theory

Family systems theory was created by Dr. Murray Bowen that states a nuclear family is an emotional unit and one cannot be understood in isolation from the other family members. There are eight concepts to this theory and are as follows:

• Differentiation of self- the variance in individuals in their susceptibility to depend on others for acceptance and approval.
• Triangles- Triangles usually have one side in conflict and two sides in harmony, contributing to the development of clinical problems.
• Nuclear family emotional process- The four relationship patterns that define where problems may develop in a family.
• Marital conflict.
• Dysfunction in one spouse.
• Impairment of one or more children.
• Emotional distance.
• Family projection process- The transmission of emotional problems from a parent to a child.
• Emotional cutoff.
• The act of reducing or cutting off emotional contact with family as a way managing unresolved emotional issues.
• Multigenerational transmission process- The transmission of small differences in the levels of differentiation between parents and their children.
• Sibling position- The impact of sibling position on development and behavior.
• Societal emotional process- The emotional system governs behavior on a societal level, promoting both progressive and regressive periods in a society.

(Kerr, M., 2000)

Wife lives at a lower level of self-differentiation, but with help from her family and a counselor, they believe she is making progress in accepting herself as she is. The 13-year-old could not handle the stressors at school and was taking it out on her family. Once she told her parents what was happening, they went to the school to attempt to sort things out and sent their daughter to a counselor to help her deal with it. She states she is learning valuable coping skills and her stress level is diminishing. The sibling’s relationship suffered some due to the problems the 13-year-old is having, but this has since regulated. This is due tos the family trying to work as a unit to help her through her problem.

Conclusion

All families are different, and they handle problems in varying ways. Doing a family health assessment is the most accurate way to get to the heart of whatever problems they may be facing. All eleven topics that are touched on is of great importance to getting to know the family as a  people.