The family discussed in this paper consists of five children belonging to two parents. Included are the father (PF), age 60, the mother (EF), age 54, and five children (CF, JF, AF, KF, KF), whose ages are 18, 16, 14, 12, and 9. All of the children are biological to the two parents who have been married almost 30 years.
The father is a small business owner of a furniture store in downtown. He is the sole financial support of the family. The mother is a stay at home mom and home-schools the three younger daughters.
The children are all almost two years apart except for the youngest. The oldest son, CF, lives at home and has just graduated high school after being home-schooled by his mom for most of his grade school life. He will be attending college in the summer and fall. The second son, JF, lives at home and is going to be a junior at a private high school in Raleigh this coming school year. The three younger daughters all live at home and are home schooled by their mom.
In general, the family stays very busy with their individual lives. They make time almost every night before bed to get together and have family worship. The kids would like it if they had more time with their dad but say that he works a lot and that it is okay because they understand why. The mom would like to have more time to plan meals for dinner but is so busy that she has to buy their meals from a company that pre makes them and freezes them. The mom says that she used to be able to cook before she had kids and even had time to exercise but now she just barely has time in the day to get everything done on her list. The husband spends six days a week at work, 12 to 14 hours every day.
It is all he has known for the past 30 years. He would like more time to spend with his kids but somebody has to run the business and ensure that the family is provided for. The whole family agrees that they wish they did more together as a family outside of their home and going to church. Their biggest concerns are a lack of time and a conflict in everyone’s schedules as well as a desire to work on their diet and nutrition. After asking them, they would love to go to the park together and go on vacation as a family more often than once a year, which is stressful enough to plan that. The wife hopes to be able to start cooking meals again for the family and planning healthier snacks for the kids. The husband says that he pretty much eats pepperoni pizza every day.
The family is very close to their extended family, which is huge. For the most part, the family spends as much time as possible with the mom’s parents. The kids all have strong bonds with their grandparents. These relationships are very important to the family.
Using the Friedman Family Assessment Model helped me to gather and organize my verbal conversations I had with the family. It was helpful in pinpointing appropriate nursing diagnoses and health issues for this family.
The family structural assessment was broken down into communication, roles, power, and family values. Communication between the family members was easily assessed from conversation. The three younger girls tell me that they get along most of the time and do everything together. That being said however, the oldest daughter, 14, expresses that she sometimes feels held back from doing teenage things because her two younger sisters cannot be included. The boys share a room together and get along quite well. It is important to note that they both have very different schedules and do not spend a whole lot of time together like they used to be able to do. They both tell me however, that they are still best friends. The oldest brother jokingly says that his younger brother, JF, can be really annoying and loud sometimes and then the whole family chimed in saying, “Oh yes that’s our JF!” JF agreed smiling.
Between the mom and dad there was little emotional conversation noted and it got very awkward when I started to ask about their communication. The dad said shortly that it was “just fine.” The mom obviously disagrees because she rolled her eyes at me. Seems to be a lot of tension between the parents when it comes to communication. The mom later told me that they are working on it and some days are better than others. The dad was very good about keeping the kids under control when it came to family meetings with me. At times, everyone would be talking and it could get loud but PF would get the kids to be quiet and remind them to be respectful of whomever is speaking. I can see that the kids all respect and love their father. He is constantly joking around with them and can be very sarcastic. The kids love this but the wife, not so much sometimes.
The family’s roles were very clearly defined. The mom makes the rules at home. She actually does a lot for the home as far as maintenance and improvements go. She also pays all of the bills and manages all of the money. The mom also home-schools the three youngest girls and spends her days taking them to different classes and activities. The mom is also the disciplinarian of the kids when it comes to grounding them or even taking the door off of their bedroom. On top of everything, the mom also makes sure there is food on the table every night.
Over the last few years this has been a struggle for her because she does not have the time to plan healthy meals like she used to. She is not even able to cook them anymore and has to buy their meals from a company that pre-makes them and freezes them. The dad stays busy running the small furniture business downtown. He gets home from work around 6 o’clock every night and is exhausted. He does all of the yard work, with the help of they boys, and he says that he enjoys it because he gets to get up on his big tractor. The dad also manages the rental house they have next door. There is a lot of stress on the dad being the sole financial provider of the household.
Community and public health nursing assesses the relationship of variables in the community with the patients and overall health. Personal upbringings, culture, religion, and ethnicity are all variables that are considered in order to have a basic understanding of the community’s framework. After doing the family assessment, using my windshield survey, and current research, nursing diagnoses related to this family and interventions with potential outcomes will be discussed. Nurses are advocates for patient whether it is within a hospital or in community health nursing. Advocacy in community health is the nurse advocating the family or community’s needs to organizations and businesses that can or are supposed to help the community.
Incorporating Jean Watson’s theory of caring is important when providing education for a family within a community. Watson’s theory uses a contemporary holistic framework viewing the persons into dimension of body, soul, and mind. Nursing is always changing yet the foundation and values will forever stay the same; evident by Watson’s theory of caring. This caring theory is a moral/ethical foundation for professional nursing. Caring science is a sacred science that acknowledges the connection of nurses with the human-environment field (Watson, 2012). The nursing profession must be careful in sustaining meaningful, ethical, philosophical foundation to its’ science and theories (Watson, 2012).
There are three nursing diagnoses that apply to this family based off of the assessment: knowledge deficit related to emotional state affecting learning, imbalanced nutrition more than bodily requirements related to lack of knowledge of nutritional needs, food intake, and/or appropriate food preparation, and lastly, activity intolerance related to insufficient sleep or rest periods. Healthy People 2020 leading health indicator of nutrition, physical activity, and obesity applies to this family’s vulnerability. Most Americans do not eat a healthy balance diet in combination with no getting enough exercise therefore leading to obesity (Healthy People 2020, 2015). Generally speaking, the family is not obese, however, a few are a bit overweight and the boys and dad have no muscle tone due to either stress (on the dad’s part) or lack of physical activity (on the boy’s part). Three interventions related to the nursing diagnoses and the Healthy People 2020 LHI include; educating the family on time management and prioritization, having a family dietician consult meeting with the family on better eating habits and balanced convenient meals, and establish guidelines and goals with the family for physical activity.
A recent study done on time management shows the effectiveness of time prioritization coaching (Boniwell, Osin, & Sircova, 2014). This article may be an effective tool in addressing the family’s imbalance of time management and perspective therefore resulting in improved stress over a lack of time. Conflicting values may be a closed mindedness towards approaching time management through coaching and the family will therefore not make improvement on time management. Due to the nature of coaching, there may be some ethical issues such as upholding a professional relationship, maintaining expertise, respect, and competence in coaching. That being said, the family could benefit a lot in time prioritization coaching. In order to address the imbalance of nutrition diagnosis, a recent clinical study shows that online dietician services can help families with what they eat on a specialized personal level. With the Internet ever evolving, why not be able to meet with a dietician online that can evaluate the family’s nutritional status and provide healthy interventions (Brandt, Pedersen, Glintborg, Toubro, Nielsen, Eysenbach, Sendergaard, 2014).
This may be just what the family needs; internet-based interactive and personalized weight management. Family values may differ in that they do not feel they need to spend money on a dietician program of any kind and know what is healthy and what is not. Basically, the family may be somewhat in denial therefore preventing the family from receiving education and personalized information to improve their diet. Ethical issues include the risk for developing an eating disorder, maintaining a professional relationship, and the management of patient data must be secure. Addressing the nursing diagnosis of a need for physical activity will require improvement on time management. The family needs to be provided with a list of activities that can be done together as a family and on their own.
The mom would love to join a gym but in the past when she does join she never finds the time to go. In order to solve this problem, the mom needs to sign up for classes that are at a scheduled time so that she can put these times in her schedule and make the time for her to go. A conflicting value of the mom may be that she feels she should be spending that time with the family instead of on herself, which would prevent her from getting the physical activity she needs to improve her health. Ethical considerations for improving the family’s physical activity include respecting the individual’s wishes, offering a non-judgmental environment, and protecting the individual’s information.
Boniwell, I., Osin, E., & Sircova, A. (2014). Introducing time perspective coaching: A new approach to improve time management and enhancing well-being. International Journal of Evidence Based Coaching & Mentoring, 12(2), 24-40. Brandt, C. J., Brandt, V., Pedersen, M., Glintborg, D., Toubro, S., Nielsen, J. B., Eysenbach, G., Brandt, K., & Sendergaard, J. (2014). Long-term effect of interactive online dietician weight loss advice in general practice (LIVA) protocol for a randomized controlled trial. International Journal of Family Medicine, 1-6. Healthy People 2020. (2015). Leading health indicators. Retrieved from http://www.healthypeople.gov/2020/Leading-Health-Indicators
Stanhope, M., & Lancaster, J. (2012). Public health nursing: Population-centered health care in the community (8th ed.). St. Louis, Mo: Mosby Elsevier.
Watson, J. (2012). Human caring science (2nd ed.). Sudbury, MA: Jones & Bartlett Learning, LLC.