Family Assessment and Nursing Process Essay

match to Stanhope & Lancaster (2001), a family treat judging is considered to be the cornerst unmatchable for family nursing interventions and is employ in a systematic fashion for the identification of the familys turn come forwardmental stages and risk factors. in that watch all over be umteen tools available that provide guidelines for how to take up unsex to know a family and to determine their dexteritys and weaknesses. ane such tool is the Friedman Family perspicacity tool which provides a guideline for nurses to interview a family. Theory is alike a necessary tool when assessing a family beca use of goods and services it is possibleness that closely comefully explains clinical situations and provides guidelines when cash in ones chipsal with families (Friedman, Bowden, and Jones, 2003). The theory that go forth be applied to family assessment in this paper is the structural-functional theory. The structural-functional theory recognizes the interaction amongst family divisions indoors their internal and external environment (Friedman et al., 2003). Once a comprehensive family assessment is complete and wellness issues be identified, the nursing process is implemented in order to r hold backer c be that is imperative for assisting separately family member to achieve an optimum level of wellness (Gilliss & Davis, 1993).In compliance with HIPPA regulations of strict confidentiality, the fictitious name of Listo will be used to identify the family that is assessed in this report. The Friedman Family assessment model will be followed as a guideline to discuss the familys identifying data, the structure-function of the family members, and how the family handles stress, move and adaptation. Lastly, key assessment data will be used in the nursing process in order to assess, diagnose, plan, intervene, and evaluate a family members diagnosis.The Listo family is an broad family that is composed of a marital dyad, their both adult t idingss, the maternal grand get down and the paroles lady friend who is in her second trimester of pregnancy. The keep up and wife break been married for 30 geezerhood and their tidingss are ages 23 and 26years senescent. The keep up identifies his ethnicity as Italian. His primary language is English and hewas born(p) and raised in California. His parents migrated to the get unitedly States from Italy in the early 1940s. Because they migrated at such a young age, his patents accept acculturated to the American air of life, still still feel strongly around their cultural heritage (McCallion, Janicki, & Grant-Griffin, 1997). The wife identifies her ethnicity as Caucasian. She was also born and raised in California. both(prenominal) husband and wife grew-up in the Catholic assent and attended perform primarily on holidays. In their mid-thirties, they accepted Christ as their per male childal savior and became born again Christians for the first time the husband a nd then a few months later the wife.The husband owns a painting channel for residential properties and the wife sales residential actual estate and inclines for a local real estate company. They are considered a lower-middle class family. The major distinguishing characteristics of the lower-middle class family are respect efficiency, achievement, hard work and cartwheel (Friedman et al., 2003). Neither husband nor wife has a college spirit level. Both are hard-working and are proud that they have provided fiscally for their tidingss who have both received a college education. Previously, the 25 year senile son and his girlfriend were sustainment together and were a dual income household.They both locomote in with his parents when the girlfriend had to quit her job because of forking she contacted during the first few months of her pregnancy. They plan to marry once they are pecuniaryly stable. The son is currently working as a physical fitness coach for a college footba ll team and contri besideses financially to the family. In June of this year, the 22 year old son graduated with a Bachelors degree and travel back inhabitancy. He is currently looking for employment and hopes to move out within the year. The nan is 76 years old and has lived with the family for the past year due to the progression of her COPD.FAMILY STRUCTUREAccording to Friedman, Bowden and Jones (2003), the concept of analyzing the structure of a family refers to how the family is organized, how the components are arranged and how they relate to each other. The four main structures of the family are graphic symbols, values, communication processes and power and ending-making. The use of goods and services theory is the structure that is the focus of the Listo family.Family roles play a critical part in the establishment of the family and because of this the family nurse must understand role relationships in order to be able to promote reasoned role behaviors and identify ro le problems (Friedman et al., 2003). According to the role theory, a family member will play many roles in a family. There are both formal and informal roles within the family structure. Formal family roles intromit the much obvious roles such as find-wife, go-husband, and father-son. The less obvious roles are that of encourager, harmonizer, initiator, scapegoat, compromiser, etc. Informal roles are more likely to be based on personality than age or sex (Kievit, 1968). at heart the Listo family, the husband-wife dyadic relationship is complimentary exhibited by a contrasting relationship (Friedman et al., 2003). As the formal role of wife, Mrs. Listo is the leading dominant personality and makes most of the decisions in the family including decisions about the children and the household finances. She is also the main source of income for the family. As the formal role of husband, Mr. Listo is more of a follower, a position he appears to be field of study with. According to Fri edman, Borden, and Jones (2003), there is a strong element of dependency between the husband and wife in a complimentary relationship. This is true for the Listo family they have a close bond and count to be comfortable with their husband-wife give and take relationship.appraisal of the Listo family revealed numerous informal family roles. The granny takes on the informal role of light seeker. As explained by Friedman, Bowden, Jones (2003), the recognition seeker goes to great lengths to draw attention to self. When questioning the grandmother about other members of the family, she continued to turn every communion back to a subject that involved her as the center figure. The two Listo boys have the informal role of electric delegacytaker. During the interview the grandmother continued to ask the boys to get her purse, find her glasses, and bring her some tea. When the boys were out of the room, the grandmother complained about how lazy the boys are and that they dont understa nd her delimit and what shes going through with her COPD.The husband has the informal role offollower. He goes along with the wishes of the family and if there is a dispute over how or what to do, he just listens and only participates in the confabulation if he is directly asked a question. The wife has the informal role of Initiator-Contributor. She motivates the children with ideas and ways to accomplish goals and solve problems. According to Kantor and Lehr (1975), the Initiator-Contributor causes movement in the family and is characterized by the initiation of action. The girlfriend has the informal role as the encourager. She gives compliments freely and practically. She appears to be genuinely interested in listening to others and she rarely draws attention to herself.The greater the perceived limpidity of role expectation the spicyer the quality of role enactment (Friedman et al., 2003, p. 324). When evaluating the quality of each role, it was determined that the family m embers intelligibly understand their roles and are content with the expectation that is attached to each role. The exception was the 23 year old son, who exhibited role conflict with his duties as bursting chargegiver for the grandmother. After having the emancipation of college life, it has been difficult for the 23 year old to be living back at home and having item expectations put upon him. According to Friedman, Bowden, and Jones (2003), the youngest son is experiencing intersender role conflict, which happens when there are conflicting expectations regarding the enactment of a role.FAMILY HEALTH FUNCTIONAccording to the Structure-Function theory, a function is an outcome or consequence of the structure. Function is described as being what the family does. Friedman, Bowden, and Jones (2003) describe 5 specific functions affective, socialization, reproductive, economic and wellness billing. The focus of the Listo family assessment is the function of health tutelage. The Fri edman Assessment Model was used as a guide. According to Friedman, Bowden, and Jones (2003), health practices and health care services are extremely varied from family to family. Families are diverse in the way they conceptualize health and illness and when to seek health care.The Listo family prides themselves on how florid they have been. Until recently, the family had what they described as catastrophic medical insurance. The mother and father are both case-by-case contractors and do non have insurance through their place of employment. Their insurance policy carried a $1,500 deductible. This high deductible deterred the family from visiting the set for regular check-ups. The Listo family falls under the umbrella of underinsured which has prevented them from receiving comprehensive health care. With the wifes real estate doing so well over the past couple of years, the Listos now have an insurance plan that covers standard check-ups and dental care as well.The 25 year old son receives health coverage from his employer and the girlfriend has private insurance. With so many years without health care access, the Listo family has not participated in health management. According to Friedman, Bowden, and Jones (2003), the family needs to be in direct partnership with health care providers. Clients also need to be the ultimate decision makers and managers of the health issues that affect their lives. Health education is undeniable so that the Listo family can feel empowered to direct their own health care (Friedman, et al., 2003).The 2 sons function on a regular basis and eat a well-balanced nutrition that let ins fruits, vegetables and grains and are in good health. The girlfriend takes charge of her health and the health of unborn child by keeping all of her scheduled ap phasement, asking authorized questions, and following the guidelines agreed upon between her and her physician. The husband is overweight and has hypertension and hyperlipidemia. The hyp ertension and hyperlipidemia are encloseled with medication. The husband is not consistent with getting his check-ups and having his blood The wife is slightly overweight which she attributes to a bad diet and lack of exercise. Generally, the Listo family is in good health. In the case where the family is healthy, health promotion is the goal of family nursing (Friedman, et al., 2003 p. 436). cardinal goal for the Listo family is health promotion.The one member of the Listo household that is inveterate ill is the Grandmother. She admits that her COPD was caused by 40 years of smoking 1-2 packs of Camel no filter cigarettes a day. Each year in the United States,hundreds of thousands die untimely due to living unhealthy modus vivendis (Friedman, et al., 2003). As the caretakers for the grandmother, the Listo family is at risk for role strain. The grandmothers condition is progressive and as time goes on she will become more dependent on the family members for care. Orems self-care m odel is applicable to this family. According to Orems self-care theory, nursing care is deald when an adult is no continuing able to care for themselves. It also states that nursing care may need to be directed toward the caretakers (Friedman et al., 2003).FAMILY STRESS, COPING, AND modificationThe Listo family is resilient and they have recovered, adjusted, and adapted to stressful situations in their family. This is why The Resiliency Model of Family Stress, Adjustment, and Adaptions Model best describes the way the Listo family deals with stressors. According to this theoretical framework, there are four basic assumptions about the family First, its a natural part of life to encounter hardship and changes. Second, families develop strength and capabilities that cause them to grow and develop as a family unit.Third, the strengths and capabilities gained during a stressful event provide protection for the family and allow for the family to adapt to the fresh situation. Fourth, families benefit from the contribution they make to the network of relationships and community during times of family stress (McCubbin & McCubbin, 1991). The stressors that have caused the Listo family to gain strength and capabilities and to grow as a family are many. Some current stressors are caring for a chronically ill family member, unmarried sons girlfriend is pregnant, son and girlfriend moving in with the family, financial insecurity due to self-employment, and youngest son is unemployed.SOCIAL AND SPIRITUAL COPING STRATEGIES. According to Friedman, Bowden and Jones (2003), there are two types of coping strategies internal and external. Internal family coping strategies are when the family becomes reliant on their own resources such as pulling together and creating more structure and organization in the home, whereas with external coping strategies the family relies on community, all-encompassing family, neighbors and friends. Most often, the Listo family uses an internal family coping scheme. They have restructured their lives so that each member can contribute to the care of the grandmother since she moved into the family home.They have also pulled together and reorganized their home to accommodate the sons girlfriend. When business is slow for the parents, the eldest son contributes financially to assist with finances. The husband and wife also use external family coping through spiritual strategies such as having faith in God and supplication (Friedman et al., 2003). The Christian faith is where the husband and wife draw comfort and peace in times of stress. Their faith in God is strong. They believe that the Lord will guide them during a crisis and will not allow them fall. Numerous studies have shown the clear linkage between spiritual well-being and an mortals or a familys enhanced ability to cope with stress and illness (Friedman et al., 2003, p. 486). The Listo parents believe that their enhanced ability to cope with stress and illness co mes from their personal relationship with Christ.DYSFUNCTIONAL COPING STRATEGIES. According to Friedman, Bowden, and Jones (2003),Dysfunctional families most often unconsciously choose to use coping strategies that have been passed down through the generations. These defensive coping strategies usually do not relieve stress nor eliminate the stressor. The Listo familys dysfunctional coping strategy is authoritarianism. This happens when the family members submit to a dominant, ruling figure. The husband and sons are very submission to the authority of the wife-mother. They sons are adults in their twenties, but they constantly call their mother prior to making any relevant decisions in life. The husband also defers to his wife for any family decision. The dominant figure, Mrs. Listo, is also dependent on her subordinates because it satisfies her need for power and control (Friedman et al., 2003). The family adores their mother and the husband also speaks very kindly of her. She is d omineering, but very loving and often lavishes the family with gifts. hearing NOTES BASED ON THE FRIEDMAN FAMILY ASSESSMENT MODELIDENTIFYING DATA1. Family Name Confidential (Listo is the fictitious family name)2. Address and think Confidential3. Family Composition see Family Genogram (Figure 1)4. Type of Family Form Extended FamilyFather Painter, Mother Real kingdom Agent, two unmarried adult sonsGrandmother, Sons girlfriend5. Cultural (Ethnic) Background Caucasian American and Italian (English Speaking)6. Religious Identification (Born-again Christian)7. Social Class Status Lower-middle class, family works hard to pay the bills.Income sources mental picture business father, Real estate business mother,Sports Trainer son, grandmother social securityFather and mother have high school educationTwo sons first generation to receive a college degree8. Social class mobility stationary at this time. Limited income and live paycheck to paycheck. The parents are supporting the gran dmother, 2 sons, and sons girlfriend.DEVELOPMENTAL STAGE AND HISTORY OF FAMILY9. Familys developmental stage_ Stage VI Families instauration young adults_10. Extent Family is Fulfilling Developmental Tasks parents were empty nesters until 1 month agone when the eldest son moved back home with his girlfriend who is 5 months pregnant, the youngest son just graduated college and moved back home, and the grandmother moved in less than a year ago. The parents are adjusting to having children back in the home.11. Nuclear Family story both father and mother come from traditional nuclear families.12. History of Family of Origin of Both Parents Both husband and wife come from nuclear families in which the father was the provider and the mother was a housewife.environmental DATA13. Characteristics of Home home is a little crowded with all the members currently living there. The youngest son shares a room with his grandmother. The home has 3 bedrooms and 2 baths with a medium size kitchen wi th attached family room. The home is clean and well organized.14. Characteristics of Neighborhood and Larger Community The neighborhood has similar single family homes that were all built around the same year. The lawns are well affirmed and the streets are clean. The neighbors participate in a neighborhood watch group to keep the area safe. Children can be seen riding the bikes and skateboards on the block. The city is in the Foothills, not far from Los Angeles and the home is in walking distance to the market and other shopping.15. Familys geographical Mobility The family lived in a more affluent area when the boys were growing up. At that time, the husband had steady work as he was partnered with a contractor who built estate homes. Approximately 10 years ago the partnership broke up and the husband found it difficult to market himself. The house went into foreclosure and the family borrowedmoney from family to succor them purchase the home theyre in now. The family is stati onary in their current geographical setting.16. Familys knowledge and Transaction with Community The mother and father are involved in the local church. They attend regularly and volunteer to help with special events. They know some of their neighbors, but they dont get together with them socially. The younger son volunteers at the YMCA working with youth. There are 4 vehicles in the family, so the family is not dependent on public transporation.FAMILY STRUCTURE17. Communication Patterns According to Mrs. Listo, a majority of the conversation between the father and the sons revolve around sports and is void of any discussion of an intimate matter. The father tends to be low-keyed until the subject of baseball comes up and then he sits up straight and gets enthusiastic about the conversation. Mrs. Listo often interrupted the conversation of other family members to make an announcement about subjects she feels are relevant. The grandmother doesnt seem to have an audience when shes t rying to conduct to family members. She continues to converse even when its obvious no one is really listening to her. Mr. Listo appeared to get annoyed with the grandmothers complaints, but he didnt verbally communicate his feelings. There were some obvious gender differences in communication.18. Power Structure The mother is dominant and the father is passive. This marital relationship would be considered complementary. When asking each member of the family who the dominant figure was, each say that it was the mother. The mother also said that she was the dominant figure in the house. No one in the family seems to be discontent with where the power lies.19. Role Structure The formal roles are father-husband, mother-wife, son-brother, grandmother, and girlfriend. Informal roles follower- father, initiator/contributor mother, family caretaker mother /sons, encourager girlfriend, grandmother- recognition seeker20. Family Values Respect, honesty, hard-working, college education, Christianity, giving to help others (volunteering), helpful commitment and trust.FAMILY FUNCTIONS21. Affective Function The husband wife relationship is close and the mother and eldest son seem close. The relationship between the youngest son and mother seems to be strained due to the 23 year old wanting his independence. See Family affixation diagram22. Socialization Function The father and mother have been married for 30 years and have raised their 2 sons. The mother stayed home with her sons until they were both in elementary school. The mother is a homemaker/real estate agent. Attending church was mandatory when the children were growing up. Once they reached the age of 18, the parents didnt require that their sons attend church. The boys are now adults, but are currently living at home. They show respect for both parents and authority and appear to be well-adjusted. The father and mother are excited about the upcoming birth of their first grandchild.Health Care Function The f ather has controlled hypertension and hyperlipidemia. The wife is slightly overweight, but has no medical condition. She admits to eating too much sugar and fried foods. The two sons are healthy. The pregnant girlfriend had difficulty in her first trimester, but she is doing well now. The grandmother is in poor health. She has COPD that is progressing to the aim where she is on constant oxygen. The family has not been consistent with regular check-up until recently when they upgraded their medical insurance coverage.FAMILY STRESS, COPING, AND ADAPTATION24. Family Stressors, Strengths, and Perceptions stressors financial struggles, sons that dont practice the Christian faith, eldest son isunmarried and expecting his first child, youngest son doesnt have employment and will be moving out of the home as soon as he does, grandmother has COPD.Strengths Mother and Father have a strong faith, the children are respectful, the eldest son helps financially, they have paid down their debt and are building credit, the family is managing their health25. Family Coping Strategies There number one source of peace and comfort comes from their relationship with God and their faith external source of coping. The family members help each other out financially and emotionally- Internal source of coping.26. Family Adaptation The family is resilient. They take one day at a time and face the challenges as they come. They readjust their lives when stressors come along and they seek Gods plan to help them learn and grow through the stress of circumstances. Overall, the family adapts to the stressors that come their way and become impendent as a unit as a result. nurse DIAGNOSISRELATED TOMANIFESTED BY name ASSESSMENT DATA & RATIONALE FOR RANKING(1) Ineffective self Health management (father)Lack of health care access. For the past 25 years, the family has had inadequate insurance and does not qualify for state assistance. They have avoided limit visits as much as possible due a high deductible and out of sack expenseUncontrolledhypertension & hyperlipidemia, obesity, sedentary life-style, poor diet, inconsistent medication adherence, infrequent check-upsThis is ranked first because the fathers lack of maintenance could lead to Cardiovascular unsoundness and Myocardial Infarction. Although the grandmothers disease (COPD) is incurable and progressive, it is the father who has the capability to change the outcome of his condition with health maintenance. If the fathers condition deteriorates, he will not be able to run his business and the family will suffer financial strain.(2) Risk for caregiver role strainCaring for the grandmother who has a progressive disease (COPD)Physical exhaustion, frustration, emotional fatigue, isolationThe mother works full time and runs the household. She is exhausted by the end of the day, but still needs to make time to care for her mother. There are multiple doctor appointments every week than she or her son the grandmother to. Most days the mother has nothing left(p) over for herself and is too tired to socialize or go out. The youngest son is frustrated that he is anticipate to help care for the grandmother. He is looking for work so he can move out and get away from the situation(3) Dysfunctional Family CommunicationWife and husband,Husband and sons,Grandmother and familyHusband does not voice his opinion to his wife.Husband and sons only communicate about impersonal information. No one listens to the grandmother and the grandmother only discusses negative issues and complaints.The husband is submissive to the wife. He doesnt voice his opinion or challenge decisions that he disagrees with. He avoids any kind of confrontation. The Father and the sons keep the conversation on the surface. They dont talk about feelings or ideas. The grandmother has gotten into the habit of complaining and possibly doesnt know how to show care or concern for others. She is overwhelmed by her condition.(4) Ineffective fam ily copingThe youngest sons frustration over his caregiver roleThe youngest sons outbursts and his threats to move out as soon as possible.The youngest son is 23 years and has just moved home after having the freedom of living in a dorm at a university. Because he is the one member of the family that is not currently employed, he has the responsibility of caring for the grandmother during the day and taking her to all of her doctor appointments. His way of coping is closing himself in his room and threatening to leave the house forever.(5) Risk for complicated grievePotential loss of significant person (grandmother)Inability of the family members to discuss the course of the grandmothers COPD. The youngest son verbalizes anger over caring for his grandmother.The family does not discuss the end result of grandmothers COPD. When there is a regrets in the grandmothers functioning or an exacerbation of her condition, the family refers to it as just a short set-back. The youngest son r efuses to be social with the grandmother because he resentsthat he is needed to care for her. It is likely that he will have some guilt feeling and more difficulty with grieving after her death.FAMILY NURSING PROCESSThe word process refers to a deliberate and conscious act of moving from one point to another toward goal fulfillment (Friedman et al., 2003, p. 174). The nursing process moves systematically from assessment, diagnosis, planning, implementation, and evaluation and is said to be interrelate and continuously cyclical of thought and action (Friedman et al., 2003). After a trusting relationship was established, the first whole step in the Listo family assessment was gathering information in a systematic fashion using the Friedman Family Assessment Model. The information was then classified, and crumpled to interpret their meaning. The following document outlines the nursing process as it relates to the Listo family. master(prenominal) DIAGNOSISPLANNING (GOALS)INTERVENTION (IMPLEMENTATION)RATIONALE FOR INTERVENTIONEVALUATIONIneffective self Health attention (father)Short-term goalThe father will discuss his fear and inhibition to implementing a health nourishment prior to the end of the nurses visit with the family.(1) Assess the clients feelings, values, and his reasons for not adhering to the prescribed plan of care(2) Assess the fathers family patterns, economic issues, and cultural patterns that may be influencing compliance with a given over medical regime.(Ackley, J. G., Ladwig, G. B., 2011).Change theory is applicable to the Listo family According to this theory, the nurse works with families to facilitate change. These changes can include structure as well as health behaviors.(Friedman et al., 2003).(1) Evidence Based Practice assessment of an individuals preferences for participation in health care decision making encourages meshing in decision making at the preferred level.(Ackley, B.J., & Ladwig, G.B., 2011)(2) Evidence Based Practice Adherence to a treatment regimen is significantly influences by the familys culture, spiritual beliefs and family norms (Ackley, B.J., & Ladwig, G.B., 2011)Short-term goal achieved the father discussed his reluctance to manage his health. He admits that his own family was proud of how healthy they were without involving health care professionals. Another reason he explained for his lack of involvement in his own care is his fear that a regular check-up would reveal something serious. He verbalized his sense that it is better to discover an illness early for prevention. He expressed a desire to be more involved in his own care.Long-term goalThe father will visit his health care provider within the next 30 days inorder to decide on a therapeutic regimen that is congruent with health goals and lifestyle.(1) Help the client to choose a healthy lifestyle that will address his condition and to encourage appropriate diagnostic screening tests(2) Review how to contact health providers that are listed under his insurance plan and how to address issues and concerns regarding self-management.Kings Theory of Goal proficiency is applicable to the father in this family. In Kings model, the nurses goal is to help the client maintain their health so they can adequately function in their role. (Friedman, et al., 2003).(1) Healthy lifestyle measures, such as exercising routinely, maintaining a healthy weight, eliminating smoking and limiting alcohol intake can help to snub the risk of chronic illnesses.(Ackley, B.J., & Ladwig, G.B., 2011)(2) Evidence Based Practice people with chronic illnesses need to know how to concord interventions that are needed to address issues and concerns regarding self-management.(Ackley, B.J., & Ladwig, G.B., 2011)Recommend Revisit the family in 30 days to follow up on the fathers visit to his health-care provider. Evaluate the father adherence to his therapeutic regimen and his lifestyle goals.ConclusionThe Friedman Family Assessment Model serv ed as a guide to complete a comprehensive assessment of the Listo family. Nursing theories, includingthe structure-function theory, helped to analyze the data collected. A systematic approach through use of the nursing process was implemented in order to devise a nursing care plan for the identified needs of the Listo family. This exercise take the author to spend a substantial amount of time getting to know a family and scholarship the intricate details of how to interview and observe a family for the purposes of health-care analysis.ReferencesFriedman, M., Bowden, V., and Jones, E. (2003). _Family nursing research, theory, and practice_. Upper Saddle River, NJ prentice Hall.Gilliss, C. L., Rose, D. B., Hallburg, J. C., & Martinson, I. M. (1989). Does a family intervention make a difference? An interactive review and meta-analysis. In S. L. Feetham, S. B. Meister, J. M. Bell, & C. L. Gilliss (Eds.), _The nursing of families Theory, research, education_ _and practice_ (pp. 259-26 5). Newbury Park, CA Sage..Kievit, M. B. (1968). Family roles. 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