Family Assessment

Running head: HEALTH ASSESSMENT Family Focused Health Assessment Nancy E Gundersen Grand Canyon University NRS429v December 4, 2011 Family Focused Health Assessment This paper will assess a family interviewed using Gordon’s 11 functional health patterns. It will summarize the findings for each health pattern from a designated number of interview questions. The author identifies two wellness nursing diagnoses based on the author’s assessment of the family health patterns and the answers provided to the interview questions. The family interviewed was a husband and wife who live active lives. They have recently moved from Colorado to Texas and both have new jobs. They have 3 children and 2 grandchildren who reside in Oregon and Colorado. The wife recently went through radiation therapy for MALT lymphoma and the husband recently learned he has been living with only 1 kidney and a herniated disk. The husband has had gout since he was twenty five and the wife was diagnosed with irritable bowel syndrome at age eighteen. These conditions have been controlled by diet and medication. Otherwise this family is fairly healthy. They are from different backgrounds and different cultures but have adapted their own traditions and health habits. Both are mastered prepared and share similar hobbies and interests. Summary of functional health patterns; 1. Values, health perceptions a. Both family members value health and do not have cultural influences as it relates to how they obtain a healthy lifestyle. They understand that eating right and exercising will increase their chances of regaining their health. 2. Nutrition b. Both family members work fulltime and have a very full schedule. They arise early and are out the door with a minimal breakfast. The husband has a slim fast nutrition drink while the wife may have a bowl of cereal or slice of toast. Their lunch habits vary. The wife usually brings lunch with her that includes a sandwich or protein bar. The husband usually goes home for lunch and will make himself a cup of soup or a leftover salad. The wife usually does not arrive home until 6:30 or 7pm while the husband is home by 5pm. He is able to make healthy dinners as he enjoys cooking. They both try to stay away from t he foods that will bring on symptoms of gout or irritable bowel syndrome. 3. Sleep/Rest c. The husband does not usually have problems falling asleep but will get up during the night to use the bathroom. He only uses sleep aids when he travels as his sleep patterns are interrupted. The wife has a hard time falling asleep because of the stresses of the day and will occasionally use an over the counter sleep aid if she is unable to get a good night sleep for several days. 4. Elimination d. The husband has no issue with proper elimination. He attributes this to eating a lot of salads. The wife however, because of her irritable bowel syndrome will sometimes alternate between having constipation and diarrhea. She takes a probiotic routinely, benefiber and drinks plenty of water in addition to trying to watch what she eats to stay regular. . Activity/Exercise e. Both family members consider exercise as an important part of their daily life. Recent illnesses have prevented their ability to do strenuous exercise. The husband most recently hurt his back and the wife has not yet fully recovered from her radiation treatment. Both do other forms of activities however including taking stairs inst ead of elevators, walking nine holes of golf and routine household chores such as yard work. 6. Cognitive f. Both family members do much better when they are in control of a meeting or situation. They feel clear headed and better prepared. They both have periods when they may forget to do something they were asked and have learned to write things down to help prevent this from happening. 7. Sensory-perception g. Both family members are dealing with conditions that have not allowed them to be as active as they have been in the past. They frequently complain of joint pain or muscle aches. They try to stretch and work up to more strenuous activity. Gout causes joint pain and a recent diagnosis of a herniated disk has increased back pain for the husband who is going to physical therapy once a week. 8. Self-perception h. The wife was diagnosed with cancer. This was a very stressful situation and the husband felt helpless as he could not alleviate her symptoms. The wife was afraid and felt helpless and fearful. The husband has also come to the realization that he is not able to play golf like he use to as he has restrictive movement due to his back problems. They both feel discouraged at times and have feelings of despair. 9. Role Responsibility i. Both family members feel they communicate well with each other and have developed routines that fit their lifestyle. The wife does not like to cook but the husband does so that works out very well. The husband’s recent role of caregiver while the wife was going through radiation therapy was a situation they both had to deal with but in different ways. The wife stated she always thought she would be the one caring for her husband not the other way around. 10. Sexuality j. The recent stresses that both have gone through has affected their sexual patterns. Moving, a critical medical diagnosis, a new job, making new friends and leaving their children was very difficult for both. Each stated they just worked through it. 11. Coping k. They both have been through a lot this past year and ? and it is maintaining a level head, knowing that they can count on each other and using logic not emotion to deal with issues has gotten them through some difficult times. Wellness nursing diagnosis The wellness nursing diagnosis within this family that might be candidates for intervention would be in the areas of activity and exercise and sleep rest patterns. The recent diagnosis for both family members has affected their normal exercise routine. Their wellness nursing diagnosis would be the readiness for an enhanced exercise program. They need more exercise to increase their aerobic cardiac health and need to resurrect the exercise routine that they enjoyed prior to their illness. Their risk diagnosis is disuse syndrome and the husband is at risk for peripheral neurovascular dysfunction and impaired physical mobility. If this family does not follow a proper exercise program that best fits their health condition and lifestyle they can easily become sedentary and increase their chances for other health risks. The actual wellness nursing diagnosis for both family members is they currently have activity intolerance. The nursing wellness diagnosis for sleep-rest pattern is necessary for this family is they need to have a program established to enhance their sleep habits. They both have interrupted sleep patterns and use medication to help them rest. They both have disturbed sleep patterns and are at risk for sleep deprivation. The actual nursing wellness diagnosis would be sleep pattern disturbance and sleep deprivation. This family has done exceptionally well coping with the recent health issues they have had to face. They are a team and stated they need to regain their health. Continuing their healthy lifestyle, with all the obstacles, has only brought them closer together. They are working hard to get healthy again and building up their stamina when it comes to exercising is top of their list. They continue to do research on what may be beneficial for them and will do whatever it takes to accomplish their goals. References Edelman, M. Health promotion throughout lifespan 7th edition. Mosby Elsevier. Gundersen, N. E. (2011, December 4). Family health assessment. (Interview with Mr. and Mrs. John Howard) (Mr. and Mrs. John Howard, Trans. ) (Interviewed using Gordon's 11 functional health patterns as a guide). Austin Texas (Original work published 22 Questions developed using Gordon's 11 functional health patterns). Weber, J. R. (2005). Nursing diagnoses (Wellness, risk and actual) grouped according to functional health patterns. In Nurses handbook of health assessment 5th edition Philadelphia, Lippincott, Williams &Wilkens. Retrieved from http://jxzy. smu. edu. cn/jkpg/Uploadfiles/file/TF_06928152357_nursing%20grouped%20by%20functional%20health%20patterns. pdf Family Assessment Family Assessment a) Family form A definition of family: â€Å"A family is two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of a family. † Friedman (1997) The Jordan’s are a nuclear family. The family members include husband, wife and three children. Dad is forty four years old, Mom is forty one years old and the three boys are seven, nine and eleven. The children are all in school, the parents help the seven year old who is in second grade with his homework. While I was visiting, the youngest child was working on a book report.He was asking several questions of his Mom during the interview. The boy was very well-mannered and said â€Å"excuse me† before asking for help. The nine and eleven year old boys are quite independent with all their school work. When they have a bible reading schedule related to their worship, they read together as a family. b) Patterns of Interaction/Communi cation The wife does all the domestic duties with the help of the oldest child. This family are Jehovah’s Witnessess and culturally, the husband is the bread winner of the house and should work hard to provide for the entire family. The wife should take care of all the house work.Jehovah’s Witnessess believe the wife should not work. The Mothers job is to make sure the entire family’s needs are met. This includes caring for her children emotionally, physically and psychologically. Like the Bowen’s Family Systems Theory, the family is seen as an emotional unit. I did observe Mrs. Jordan as a very compassionate, concerned and emotional mother. She was very serious when talking about her children; she felt strongly that the boys should be able to come to her with any issues, good or bad. Mrs. Jordan is also responsible for the family budget and finances. When asked â€Å"Who has the power and authority in our family? Mrs. Jordan replied, â€Å"The Bible, J ehovah’s Word has the power in our family. It is the essence and the foundation of our family. † If there is a decision to be made that affects the whole family, the husband and wife make the decisions, but the husband is the head of the household. The family believes in what the bible says, â€Å"The Golden Rule†, â€Å"Treat others the way you want to be treated. † The developmental theory considers overtime the family unit foes through various phases that can be predicted based on norms. The family development approach examines role expectations within the family unit.I asked the family, â€Å"Are there any role assessments, such as â€Å"the good child† or â€Å"neat freak† the boys laughed and look at each other. Then the mom quickly responded, â€Å"No. Not at all. Our children know the law contained in the Bible and are governed by its principles. † They all seemed to be comfortable when answering the questions in the interview , although their answers were somewhat vague, the dad did not participate much in the interview. Instead, he was answering calls and working from home. The family was asked if they engage in any activities together. The family volunteers in Life Saving Preaching Work.They are all involved in this ministry that saves lives. In other words, they share the gospel with others, believing that they with come to know the Lord. The husband is also a volunteer in the medical field. He was not specific when answering this question. The Jordan’s also have what they call â€Å"round table discussions† which they partake in every Friday night. c) Boundaries I wanted to know if their family had any subjects that were difficult to discuss together. The family brought up the subject of racism. Mrs. Jordan shared a story about other children in school making racial comments to her child.This was devastating to Mrs. Jordan and she found it very hard and complicated to discuss. She felt anger toward the children that bullied her son. We discussed other boundaries as well. For example, I asked if the family members interact with groups outside of their family, Mrs. Jordan said â€Å"We’re Jehovah’s Witnesses and as such, we are a part of an international brotherhood and we do not need invitation before visiting any of our brothers and sisters what we do not do is associate closely with non-witnesses, because bad association spoils useful habits. Everyone in the family seemed to agree with mom on this subject. In fact, the middle boy shared that they were only allowed to have a sleepover with other children born into Jehovah’s witnesses with manners based on the bible. He also mentioned that it is a rule in their house; they can only play their videos or watch TV on Friday, Saturday and Sunday until noon. d) Family Values & Norms The Structure Function Theory suggests the family is viewed as an organization; roles, values, and communication are integral components. The Jordan’s differ from many families I know because of their strong religious beliefs.The Jordan’s values are based on the bible and all of them are equally important, according to Mrs. Jordan. She also stated â€Å"Honesty, it’s a way of life. † It is also very important to the family that they are sharing the gift of everlasting life with others who decide to listen to their preaching work. The family likes to spend time with each other every day. During breakfast they read their daily devotionals, and the father says a prayer on behalf of the whole family before they depart for the day. e) Religion Religion is very important to the family, and they have strong religious beliefs that may affect their healthcare decisions.They are to put their spiritual well-being before any other things. As a Jehovah’s Witness, they do not accept blood transfusions under any circumstance, even in the face of death according to scriptures Le viticus 17:10, 11, Leviticus 17:13,14, Acts 15:22-29. When asked if the family attended church, Mrs. Jordan informed me that they do not attend church, but they do attend regular meeting at their Kingdom Hall. Mrs. Jordan said, â€Å"We are fifth generation Jehovah’s Witnesses therefore we are born and raised to do everything according to the bible.When asked if the family attended church, Mrs. Jordan informed me that they do not attend church, but they do attend regular meeting at their Kingdom Hall. Mrs. Jordan said, â€Å"We are fifth generation Jehovah’s Witnesses therefore we are born and raised to do everything according to the bible. f) Culture g) Family Stressors Lastly, I wanted to know if the family is currently dealing with any stressors. Currently Mrs. Jordan says that she is bored at home and would like to go back to work. h) Family’s Strength and Resources The children were very well behaved during this interview.The oldest son, took my coat, and asked if I would like anything to drink. I thought the three boys were all extremely well mannered, gentlemen. The Father did not participate much in the interview; he was also very polite and welcoming. The Jordan family has much strength such as, communication, honesty, love and discipline. Like Mrs. Jordan I feel that discipline is a form of love. The family I connected, they sound time with one another and they help each other out. In addition, the family has many resources in their community of Jehovah’s Witnesses.From what I understand this is a very connected community. They are likely to find the help of others in their community if they needed. Summary I think the family and I both learned a few things from this interview. I particularly found it intriguing that the family reads the bible together every day. If and when I have children of my own, I will have this tradition with my family as well. I found out more interesting information when I asked questions regard ing the family’s health care. The family uses primary prevention measures such as; a healthy diet and exercise.The entire family has a membership at a fitness gym. The family is however against immunizations because they believe it can cause other health issues. The husband is a doctor and says he â€Å"has knowledge† of the serious side effects. I can understand the concern as parents, but as their nurse it is my job to explain both the risks and benefits. The American Academy of Pediatrics (AAP) strongly recommends that the risks and benefits are discussed by a nurse or doctor before any refusal documents are signed. That means that we are to teach on each vaccine and the disease it prevents.I would also refer them to the AAP website that has information on immunizations, providing parents an opportunity to ask questions about their concerns and attempting to understand parents’ reason for refusing one or more vaccines. It is important to maintain a supportive relationship with the family. The AAP encourages documentation the health care provider’s discussion with the parents of the serious risks. Have the parent sign the refusal for and keep it the patient’s medical record. The secondary prevention measures were regular checkups which are performed by the mom and dad.The dad is a neurosurgeon, and the mom has a nursing degree. The husband is the wife’s primary physician also. She also admitted that she has never had a dental checkup, but the children have. She never had a mammogram and doesn’t intend to until she is sixty five years old. And lastly, when asked about medication taken, Mrs. Jordan explained, no one is on any medications. The goals I develop must be realistic, asking myself, â€Å"to what extent can the goals be achieved? † I personally feel like the parents are adamant regarding the children’s immunizations.I would however provide them with the information from the AAP website to increase the knowledge or provide them with information that they may have previously misinterpreted or misunderstood. I would set a goal with Mrs. Jordan that she gets her annual mammogram and dental check-ups every six months as recommended by the American Dental Association (ADA). The National Cancer Society (NCI) recommends that women age forty or older have screening mammograms every one to two years, and the standard recommendation is to visit a dentist twice a year for check-ups and cleanings. Family Assessment Family Assessment a) Family form A definition of family: â€Å"A family is two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of a family. † Friedman (1997) The Jordan’s are a nuclear family. The family members include husband, wife and three children. Dad is forty four years old, Mom is forty one years old and the three boys are seven, nine and eleven. The children are all in school, the parents help the seven year old who is in second grade with his homework. While I was visiting, the youngest child was working on a book report.He was asking several questions of his Mom during the interview. The boy was very well-mannered and said â€Å"excuse me† before asking for help. The nine and eleven year old boys are quite independent with all their school work. When they have a bible reading schedule related to their worship, they read together as a family. b) Patterns of Interaction/Communi cation The wife does all the domestic duties with the help of the oldest child. This family are Jehovah’s Witnessess and culturally, the husband is the bread winner of the house and should work hard to provide for the entire family. The wife should take care of all the house work.Jehovah’s Witnessess believe the wife should not work. The Mothers job is to make sure the entire family’s needs are met. This includes caring for her children emotionally, physically and psychologically. Like the Bowen’s Family Systems Theory, the family is seen as an emotional unit. I did observe Mrs. Jordan as a very compassionate, concerned and emotional mother. She was very serious when talking about her children; she felt strongly that the boys should be able to come to her with any issues, good or bad. Mrs. Jordan is also responsible for the family budget and finances. When asked â€Å"Who has the power and authority in our family? Mrs. Jordan replied, â€Å"The Bible, J ehovah’s Word has the power in our family. It is the essence and the foundation of our family. † If there is a decision to be made that affects the whole family, the husband and wife make the decisions, but the husband is the head of the household. The family believes in what the bible says, â€Å"The Golden Rule†, â€Å"Treat others the way you want to be treated. † The developmental theory considers overtime the family unit foes through various phases that can be predicted based on norms. The family development approach examines role expectations within the family unit.I asked the family, â€Å"Are there any role assessments, such as â€Å"the good child† or â€Å"neat freak† the boys laughed and look at each other. Then the mom quickly responded, â€Å"No. Not at all. Our children know the law contained in the Bible and are governed by its principles. † They all seemed to be comfortable when answering the questions in the interview , although their answers were somewhat vague, the dad did not participate much in the interview. Instead, he was answering calls and working from home. The family was asked if they engage in any activities together. The family volunteers in Life Saving Preaching Work.They are all involved in this ministry that saves lives. In other words, they share the gospel with others, believing that they with come to know the Lord. The husband is also a volunteer in the medical field. He was not specific when answering this question. The Jordan’s also have what they call â€Å"round table discussions† which they partake in every Friday night. c) Boundaries I wanted to know if their family had any subjects that were difficult to discuss together. The family brought up the subject of racism. Mrs. Jordan shared a story about other children in school making racial comments to her child.This was devastating to Mrs. Jordan and she found it very hard and complicated to discuss. She felt anger toward the children that bullied her son. We discussed other boundaries as well. For example, I asked if the family members interact with groups outside of their family, Mrs. Jordan said â€Å"We’re Jehovah’s Witnesses and as such, we are a part of an international brotherhood and we do not need invitation before visiting any of our brothers and sisters what we do not do is associate closely with non-witnesses, because bad association spoils useful habits. Everyone in the family seemed to agree with mom on this subject. In fact, the middle boy shared that they were only allowed to have a sleepover with other children born into Jehovah’s witnesses with manners based on the bible. He also mentioned that it is a rule in their house; they can only play their videos or watch TV on Friday, Saturday and Sunday until noon. d) Family Values & Norms The Structure Function Theory suggests the family is viewed as an organization; roles, values, and communication are integral components. The Jordan’s differ from many families I know because of their strong religious beliefs.The Jordan’s values are based on the bible and all of them are equally important, according to Mrs. Jordan. She also stated â€Å"Honesty, it’s a way of life. † It is also very important to the family that they are sharing the gift of everlasting life with others who decide to listen to their preaching work. The family likes to spend time with each other every day. During breakfast they read their daily devotionals, and the father says a prayer on behalf of the whole family before they depart for the day. e) Religion Religion is very important to the family, and they have strong religious beliefs that may affect their healthcare decisions.They are to put their spiritual well-being before any other things. As a Jehovah’s Witness, they do not accept blood transfusions under any circumstance, even in the face of death according to scriptures Le viticus 17:10, 11, Leviticus 17:13,14, Acts 15:22-29. When asked if the family attended church, Mrs. Jordan informed me that they do not attend church, but they do attend regular meeting at their Kingdom Hall. Mrs. Jordan said, â€Å"We are fifth generation Jehovah’s Witnesses therefore we are born and raised to do everything according to the bible.When asked if the family attended church, Mrs. Jordan informed me that they do not attend church, but they do attend regular meeting at their Kingdom Hall. Mrs. Jordan said, â€Å"We are fifth generation Jehovah’s Witnesses therefore we are born and raised to do everything according to the bible. f) Culture g) Family Stressors Lastly, I wanted to know if the family is currently dealing with any stressors. Currently Mrs. Jordan says that she is bored at home and would like to go back to work. h) Family’s Strength and Resources The children were very well behaved during this interview.The oldest son, took my coat, and asked if I would like anything to drink. I thought the three boys were all extremely well mannered, gentlemen. The Father did not participate much in the interview; he was also very polite and welcoming. The Jordan family has much strength such as, communication, honesty, love and discipline. Like Mrs. Jordan I feel that discipline is a form of love. The family I connected, they sound time with one another and they help each other out. In addition, the family has many resources in their community of Jehovah’s Witnesses.From what I understand this is a very connected community. They are likely to find the help of others in their community if they needed. Summary I think the family and I both learned a few things from this interview. I particularly found it intriguing that the family reads the bible together every day. If and when I have children of my own, I will have this tradition with my family as well. I found out more interesting information when I asked questions regard ing the family’s health care. The family uses primary prevention measures such as; a healthy diet and exercise.The entire family has a membership at a fitness gym. The family is however against immunizations because they believe it can cause other health issues. The husband is a doctor and says he â€Å"has knowledge† of the serious side effects. I can understand the concern as parents, but as their nurse it is my job to explain both the risks and benefits. The American Academy of Pediatrics (AAP) strongly recommends that the risks and benefits are discussed by a nurse or doctor before any refusal documents are signed. That means that we are to teach on each vaccine and the disease it prevents.I would also refer them to the AAP website that has information on immunizations, providing parents an opportunity to ask questions about their concerns and attempting to understand parents’ reason for refusing one or more vaccines. It is important to maintain a supportive relationship with the family. The AAP encourages documentation the health care provider’s discussion with the parents of the serious risks. Have the parent sign the refusal for and keep it the patient’s medical record. The secondary prevention measures were regular checkups which are performed by the mom and dad.The dad is a neurosurgeon, and the mom has a nursing degree. The husband is the wife’s primary physician also. She also admitted that she has never had a dental checkup, but the children have. She never had a mammogram and doesn’t intend to until she is sixty five years old. And lastly, when asked about medication taken, Mrs. Jordan explained, no one is on any medications. The goals I develop must be realistic, asking myself, â€Å"to what extent can the goals be achieved? † I personally feel like the parents are adamant regarding the children’s immunizations.I would however provide them with the information from the AAP website to increase the knowledge or provide them with information that they may have previously misinterpreted or misunderstood. I would set a goal with Mrs. Jordan that she gets her annual mammogram and dental check-ups every six months as recommended by the American Dental Association (ADA). The National Cancer Society (NCI) recommends that women age forty or older have screening mammograms every one to two years, and the standard recommendation is to visit a dentist twice a year for check-ups and cleanings.