The family involved has two children and both parents who have been married for close to fifteen years. The grandparents to the children are alive with the exception of the paternal grandmother who died of a heart condition. The family visits hospital to seek medical attentions for their adolescent son who presents conditions close to what is seen in asthma cases. The child is accompanied by both parents and a closer look shows his fondness for both parents. The interview starts with the nurse inquiring when the symptoms were first experienced by the sick child.
The mother seems ready with the answers though as the interview progresses, the father chips in a statement or two, of course the sick child too has his own bit of the story which he does not shy from revealing. After a duration of half an hour, the nurse wraps up the interviews while observing that the family has special concern for their seek child and the problem is shared by both parents. Though they have taken long to disassociate the symptoms with any other condition for example a chronic cough, they readily agree that their family has previously suffered cases of asthma.
Interestingly the cases are common in both extended families. The nurse also recognises the willingness of the family as represented in the couple to support their child in the process of medication and healing. The family is also willing to invest time and other resources to ensure that similar health problems do not face the family in future. Family Assessment During subsequent visits, the nurse engages the family in a more vigorous assessment advised and based on the Calgary Family assessment model.
For the assessment to take palace as espoused by this model the nurse created a sense of importance to the family attending the session. He built communication link and opened rapport between him and the clients. He encouraged the client to consider themselves as a single unit rather than individuals in the system of family. This was done in education and information sessions which the clients were encouraged to attend either uniquely or a group of clients. The nurse took the earliest moment to explain to the said family about the assessment model he intended to use.
When information is given to the client prior to their inquiry on the same, confidence about the system is built and rapid and free information exchange follows. The nurse therefore saw this as opportune. Highlight of the model were given subject to the expressions in Wright, and Leahey, (2002) as categories of family life owing from its structural, developmental and functionality dimensions. Each of these dimensions in respect to this family is discussed below: The structural assessment is meant to identify the composition and connectivity of the family within and without.
In other words it explains the internal structure of the family, the external structure and the context which the family finds itself. The family was composed of two married adults in their late thirties and two children all from this marriage. One aged 14 years and the other 8 years, the latter is male and the former female. The father was observed as the head and the bread winner while the mother played a major role of taking care of the children. She also did part time work amounting to twenty hours a week, which means that she was available for the kids most of the time.
The sexual orientation among the couple is heterosexual. Any other orientation would be frowned at since the family is catholic. When the father is not at work, he spends his time with the children though the boy has complained to the mother that the dad seems fond of the sister. Except for this, the family can be described as close knit. Externally, the family is related to the grandparents mentioned above. A thanks giving dinner is served at the paternal grandparents home which must be attended by all their children and grandchildren. This home has three siblings.
One of them has since moved to Asia for a job with a development agency. He rarely comes to the US and after suffering divorce with his wife, he seems to have cut communications with the family. The old folks are very fond of their grand children. The grand mum even made a point of visiting the sick boy. The family also has family friends most of whom comprise of women who attend the same church. The father does not talk much about friends. He says his nature of work does not allow him much socialisation though he is glad enough to welcome those who appear courtesy of the wife.
The children are fond of their classmates. The boy confided to the mother the other night that she was eyeing some girl at school. One of the family’s friends has a daughter with a similar condition which was diagnosed two years ago. The mother has been very helpful in encouraging and sharing her experiences with this family. The context of this family can be summarised as follows: their race is Caucasian, their great grand parents are said to have migrated from England in the early sixteenth century. The father is employed in white collar employment working as an accountant in a securities firm.
This leaves his family enjoying a middle class income level. The family lives in a relatively safe neighbourhood free from cases of drug abuse, gangs and other types of lawlessness and children attend public school. As mentioned earlier the family is catholic. At least the mother accompanied by her children go to church every Sunday. Both parents have expressed deep feelings in prayer and hope that God will heal their sick child. During her spare time the mother is occupied in tending a flower garden in the backyard.
An inquiry on whether any of the flowers and bushes would be precipitating her child condition leaves her distraught. She does not believe that she would do anything to hurt her children. In so far the developmental dimension is concerned, this family has gone through the typical stages. Sally remembers fondly the first meeting with her in-laws and the kind words she received from Joe’s father. Their wedding was a small church wedding at Sally’s home well attended by their families and friends. During the second year of their marriage, Ralph was born to them. The second child so them wait longer.
The gynaecologist they were seeing talked of secondary infertility attributed to Sally but after investigations, Joe sperm count was found low. After treatment and support from Sally, the second child was finally conceived and born through caesarean section. The family is comfortable with these two children. Their aim is to give them the best care and education. There is something else worrying Sally about Ralph other than his ailment. He seems so robust and athletic. In fact he is involved in most athletic competitions in his class and even plays football for the school team.
Sally believes that these activities will only worsen his condition. Joe has tried to convince Sally otherwise without success. During our last meeting, which Joe did not attend because of work commitments, Sally explained her dilemma. On my part, I showed her the positive part of her son’s behavior and the fact that exercises would help the healing process. I also explained to her that as an adolescent mother, she ought to provide more space to her children so that they may seek their own identity. Marie is keen to learn music and is taking ballet classes. The children do not come home early any more from school as they used to.
May be its time Sally considered a more occupying job as part of her mid life career adjustment. On the other hand, Joe has just been promoted to the position of the chief finance officer. The only time that he seems to have time for the family is only on Sunday. In terms of functional assessment, the family has been rated as highly functional in achieving the routine duties. Children go to school, meals are shared, economics needs are well taken care of, parents report to work on time and they turn up for routine or arranged meeting with friends and medical personnel.
Emotional communication is fairly good. The couple look up to each other for emotional support. Joe gave up his drinking so that he could come home early and be with the wife. Sally confided to me that their sex life is fairly active. The children look up to their parents for comfort and support. Sometimes the same comfort can also be sought from grand parent. Verbal communication is quite good. The couple however said it is something they had to work on. They remember during early in their marriage Joe was fond of complaining that Sally was doing all the talking.
Frequent phone calls are made to each other during the day. Their children are quite articulate in expressing themselves, a quality they may have taken up from their parents, though uniquely, Marie has been noted to throw tantrums very often until it was discovered that she was having problems with her fourth grade mathematics teacher. Sally is the primary house keeper and it follows that problems of the home appear to her first hand. She has learnt to solve them and consult Joe latter. Sometimes there are differences on how each supposes the problems would be solved.
Joe has sometimes complained though tongue in the cheek that Sally may be usurping his powers. Sally is not worried by these remarks. She believes that if every thing else is to run smoothly, then she must try and be in charge which she has fairly succeeded in doing. During one of the visit, Sally remarked that her husbands smoking behavior might have spurred their sons’ illness. I was surprised because their was nothing I had seen in Joe to point to the habit to which she clarified that he had quit smoking after an uncle of his was diagnosed with lung cancer secondary to smoking cigarette.
This was when Ralph was three years old. Apparently, no respiratory conditions presented to the boy at that point in time. I also mentioned that Joe should attend a regular check up just to ensure that his health is good. Summary of assessment The assessment discussed above may be summarised as follows: The family operates as close knit system which finds harmony internally and externally even among its extended relatives and friends. This kind of set up is very ideal for promoting its health concerns. The family has adequate resources required to be invested in health management.
The only constrained resource might be time since it is spent in acquiring the other resources. In terms of completing its family cycle, progression is seen though the mother of the family need to put more effort to adjusting to the sense that she now is a mother of teenagers and not toddlers. Given that the sick member is a teenager, who spends much time in school, interventions may be directed to the school setting and peers. Expressive functioning is fairly good though there are notable power struggle among the couple and overt attention seeking by the girl.
The key weaknesses is that this family has enjoyed fairly good health spell and may not respond as adequately to the required intervention out of taking things for granted. There is also some element of shifting blame for the cause of the diseases afflicting them, therefore, rather than acceptance and problem solving, quality time may be spent in denial and bargaining which do not in anyway ease the disease condition. Facts are also ignored in part in favour of believes and prejudices. Exercises in most cases will aid the healing process rather than deter it.
It may seem like common sense until you come face to face with prejudices. Finally, belief in God may help in appositive mind set. All the same the effect of this would have been much better in cases where the adult is suffering because there is greater resolve as opposed to a child or teenager. This summary will form the basis of health promotion strategies adopted in dealing with these case as suggested by Thomlison (2007) and Wright, and Leahey, (2002). Health Promotion Plan The health promotion plan will have the following goals: To incorporate every member of the family within the intervention,
To consolidate the health effort into one unit, To meet the health concerns for the family as a unit and not for individual members, and to ensure that the family’s long-term health needs are addressed. According to Thomlison (2007), the health plan should be aimed at promoting, sustaining and improving the dimensions of family life identified above. These goals will be actualised through the following strategies: Organisational commitment This requires that the health institution that fosters the health promotion plan for families provide adequate accompanying resources to aid and facilitate the process.
Documentation should be provided, scheduled meeting, locations, and general support from management required. Support should be seen to be given to nurses as well as clients attending the programs. Policies Time should be taken so that sound clear cut policies can be prepared. The promotion plan involves assessment which in itself is passing on information which is highly confidential. Policies should guide the users of this information and protect the giver from misuse and confidentiality breaches. Advocacy
Advocacy means going a step further to ensure that the needs of the client and his family are met under the plan. Sometimes clients may need more than medical care, thus food, shelter and so on. Its therefore up to the nurse applying this strategy to ensure that he lobbies for these needs for his respective client. The nurse should also attempt to harness resource available in the family set up where they are currently unavailable in application. Educational resources Information and lack of it about diseases and adjustment to the fact of the disease is one of the greatest impediment.
Information should therefore be sourced and disseminated to the families participating in the plan in timely interval. This information will guide decision making and action causing the health plan to succeed. These four strategies are adopted from Nursing Now (1997). Conclusion Of the four strategies highlighted above, the most applicable in building and implementing a health promotion plan for the family discussed above is educational resources since the family needs factual information to reinforce its believes and to spur action.
Information will also assure them on how to prevent other health conditions from recurring. Advocacy will also play a part in ensuring that the resources available within the family setting are made available to the health care plan. May be its time Joe committed more resources in making his wife more fruitful career wise other wise the family may end up grappling with more serious and undefined health problems arising from depression.
It is expected that the system and establishment will support the plan in terms of policy and infrastructure.
Reference Nursing Now (1997). “Issues and Trend in Canadian Nursing: The Family Connection”. No. 003 September 1997, Canadian Nurses Association. Thomlison, Barbara (2007). Family assessment handbook: An introductory guide to family assessment and intervention (2nd ed. ). Thomson: Belmont, CA. Wright, L. M. , Leahey, M. (2002) Nurses and families: A guide to family assessment and intervention (4th edition). Philadelphia: F. A. Davis.
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