Conducting a family assessment is a challenging and important step in the care of the client. It is essential to identify problems and situations inhibiting a family from practicing healthy behaviors and developing healthy habits to thrive in the home and community. Identifying problems then deciding the family nursing diagnosis and planning interventions beneficial to the family is the next step in the client’s care.
Three Family Nursing Diagnoses
The three family nursing diagnoses identified to assist SS and her family are anxiety related to several short- and long-term stressors, delayed growth and development related to CS’s handicaps, and chronic pain related to SS’s rheumatoid arthritis. These nursing diagnoses were most appropriate for this family.
Healthy People 2020 Indicator
The indicator chosen that links to the nursing diagnoses mentioned above is social determinants (“Healthy People 2020”, 2012). This indicator is relevant to the identified family nursing diagnoses because of numerous reasons. CS has a disorder that has caused him to have developmental delays and numerous health issues. He reports getting bullied at school periodically, is in special needs classes, and will not be able to live independently. The indicator is also relevant because of the number of stressors SS has identified through the family assessment that affects the family’s lives daily. Researching information on Healthy People 2020 and specifically the social determinants indicator reveals that assisting the client and her family with healthy behaviors, physical activity, assistance with dealing with stress-related issues leads the family to being successful members of the community and being successful in tasks necessary for improved health and longer life expectancy. Linking the indicator to the family nursing diagnoses will also provide the family with strategies to deal with school, community, and workplace issues that are barriers to accomplishments within the family.
Opportunities for Community Health Nursing Interventions
One opportunity where I can make a positive impact with community health nursing interventions would be providing a lecture at CS’s high school about bullying. This would be beneficial for students in many high school communities. The lecture should include information about why children bully each other, strategies for how to deal with bullies, and why bullying is wrong. Another way to influence in a positive way is provide SS and her family ways to deal with the issues that cause the most stress in the family, whether it is financial concerns, time management issues, or health concerns. Conducting family meetings to share responsibilities for chores around the house, making the children aware of what can be afforded monetarily month to month, and ensuring the family is keeping regular health check ups are a few techniques that may be beneficial. Making sure SS is aware and takes advantage of workplace assistance for a variety of reasons is another opportunity to make a positive impact on her family and on the social determinant indicator.
Health Education Topics
There are a number of topics related to health education that would be beneficial to SS and her family as well as any community. One topic SS may find helpful deals with emotional wellness, which is a subject I have spent time discussing with SS and her family. Finding a balance between everything going on in one’s life, such as school, work, sports, or other activities is necessary in protecting emotional health. Another topic relates to stress, which is another area of concern for SS.
There are different levels of stress and they can be short-term and long-term stressors as SS has identified within the family assessment. Stress does not have to be bad, but how to deal with it is what makes the difference. Developing and learning coping strategies are helpful in managing stress. Here is where the emphasis in education should be. Nutrition and physical activity is another health education topic beneficial for everyone. SS’s oldest son who is in college could be a target of this topic, as college students are not known to have healthy eating or sleeping habits. Diet teaching and assistance with developing a physical activity plan would be a focus of the education (“Health Education Center”, n.d.).
A family assessment is a vital step in diagnosing what potential problems and areas for improvement a client may have. Evaluating aspects of the family unit including family history, support system, stressors, and social structure will aid in determining and prioritizing the family diagnoses. Family involvement in decision-making of what diagnoses to conquer and intervention planning will help the success of the plan. What is learned through the family can help develop topics the general public could be educated on and benefit from.
Health Education Center. (n.d.). Retrieved from http://www.healtheducation.uci.edu Healthy People 2020. (2012). Retrieved from http://www.healthypeople.gov Nursing Diagnosis List. (2012). Retrieved from http://www.nandanursingdiagnosislist.org Stanhope, M. (2012). Public Health Nursing: Population-Centered Health Care in the Community (8th ed.). Retrieved from The University of Phoenix eBook Collection.
I. Family Demographics
a) Family Name-Sindle
b) Family Composition-mother, 3 sons
c) Type of family form (single parent)
d) Cultural Background-English, German, and Cherokee….great., great, great grandmother was Cherokee Indian e) Religious Affiliation-Baptist and Presbyterian
f) Social Class Status-low income class
g) Family’s recreational or leisure-time activities-soccer, 2 of 3 boys very involved with soccer teams. Watching movies, riding bikes.
II. Developmental Stages and family history
a) Family’s present developmental stage-one child in college, one in high school and one in middle school. Mom taking classes part-time to earn nursing degree. b) Nuclear Family History-SS’s parents are originally from Franklin, NC. Mother is of English and German descent and dad is English and Cherokee Indian. I
II. Environmental Data
a) Characteristics of home-reside in a 2 story home in a single-family dwelling subdivision. Approximately 300 homes in the neighborhood. b) Characteristics of neighborhood and larger community- There is a community park with a small playground used for gatherings. They have neighborhood watch in their subdivision. Gloucester is considered a rural community. It has a large shopping center that has a Walmart, Home Depot, Lowes, Applebees, Chick-fil-a, Pizza Hut, McDonalds, Hardees and Wendy’s. Several churches of various denominations, one free medical clinic, a wellness center, one small hospital, a boys and girls club, several parks with baseball fields, soccer fields, and playground equipment. Family-owned shops on main street with restaurants and banks, a bookstore and antique stores.
Volunteer fire stations and rescue squads throughout the county. c) Family’s Geographic mobility- SS was born and raised in Williamsburg, VA. Lived in Tappahannock, VA for a year and then moved to Gloucester, VA where she have resided for 25 years. Her sons have lived in Gloucester since they were born. d) Family’s associations and transactions with community- Her boys participate in parks and rec activities. They go bowling as a family and to the movies occasionally. Attend annual Daffodil festival that is held in the community every spring. e) Family’s social support network-SS has aunts, uncles and a few friends that help out sporadically. Her two youngest boys go to Florida every summer to spend time with their grandparents. SS sees her work environment and peers as a support system as well. Her oldest child has a support system through his soccer teammates and friends at college.
IV. Family Stress and Coping
a) Short and long-term familial stressors and strengths: Short term- SS is trying to finish classes so she can start nursing school. Also trying to balance work and school and getting children where they need to go for activities. Long term- son (CS) with special needs-what will he do after he graduates high school in 2 years. Has Williams Syndrome and has cognitive and developmental delays. Finances. Getting oldest son through college. Single parent (children’s father passed away in 2009, he and SS were divorced prior to that). SS has recently been diagnosed with rheumatoid arthritis. CS’s health-worry about his cardiac issues as he gets older, hypertension, and GI issues. b) Extent of family’s ability to respond, based on objective appraisal of stress-producing situations- This family has been able to respond to the stressors that have been placed on them relatively well. They have had their ups and downs, but are a very close family and they rely heavily on each other and help each other out. SS’s sons are very protective of their mother. c) Coping Strategies Utilized by all members of family-They work together as a family to get things accomplished. The boys have had to grow up quick. Working through one issue at a time. Make time for fun and for the 2 boys to participate in soccer.
V. Family Functions
a) Family’s need-response Patterns (affective function)- Very close knit family. They watch out for each other always. They go to soccer games together as a family to watch the 2 boys play. Take at least 2 family vacations each year with SS’s parents. Watch a lot of family movies together. Watch professional sports on TV. b) Socialization Function (child rearing practices, who is socializing agent for children, cultural beliefs that influence family’s child-rearing patterns)- SS is primary socializing agent. Discipline for bad behavior depends on what the infraction is, ranges from no TV to no friends over for bad grades or if school work not completed.
c) Adequacy of home environment for children’s needs to play- have a large fenced-in backyard with an above-ground swimming pool. Pool table, ping-pong table. Bikes, soccer net and balls, tennis rackets, TV room with xbox 360, DVD player, Computers. d) Health care function-SS has health insurance through her employer. Middle child now 18 and qualifies for Medicaid. The family sees a physician yearly for physicals. CS sees many different specialists. JS has frequent bouts of strep throat which makes him miss several school days each year. SS sees a rheumatologist for her RA.