The Friedman Family Assessment assists the nurse in assessing a family and establishing family nursing interventions. This tool allows the community nurse to assess the family system as a whole, as part of the whole society, and as an interaction system (Stanhope & Lancaster, 2008). This paper will review a family that consists of a mother, stepfather, and adopted son.
Identifying Data and Composition
The family name, address, and phone number is not disclosed in this paper in-order to protect the family’s identity. The mother CD, who is 44, stepfather PD, who is 55 and her adopted son KD, who is 10 live in the home. The family form is a low middle-class income family of three and the son’s adopted father is still in the picture and has joint custody. CD and PD have been married only three years. They are Caucasian and speak the English language. CD is not aware of her ethnic background because she was adopted. PD has a French descent. KD has an Asian descent. CD was previously married for 22 years. CD and her x-husband adopted KD at birth. This is PD first marriage. The family religious affiliation is Baptists; they are members at a church two miles away from the home. CD is very involved in their church attending services every Sunday and on Holy Days of Obligation. They live in a singlewide two bedrooms mobile approximately 25 years-of-age and station in a small community trailer park on the outskirts of town.
The mobile home is completely paid for and solely owned by CD. CD makes a living as a unit clerk at a local nursing home and is the breadwinner of the household. She also sells jewelry on the side. PD makes a living at a manufacturer plant that makes engines for lawn mowers, approximately 20 miles from home. Their eating, dressing, and health views are typically of a low middle-class household. CD lives week-by-week on her paycheck, and she pays for everything accepts the park rent. PD is only responsible to pay the park rent with his paycheck. The household income is not a combined income to help share the responsibility. CD states, she does not know what PD does with his money. The family eats together usually at breakfast and dinner only but in front of the television. They try to eat healthy but sometimes with their busy schedule, they eat out more than they eat in. Both CD and PD states, they do not drink or smoke and believe that they are in good health, but believes they have a weight problem.
CD currently weighs 250 lbs. and is 66 inches; she has a body mass index (BMI) of 30, which is obese according to the United States Department of Health and Human Services (2010). PD currently weighs 230 lbs. and is 72 inches; he has a body mass index (BMI) of 32, which is obese according to the United States Department of Health and Human Services (2010). KD currently weighs 95 lbs. and 65.0 inches; he has a body mass index (BMI) of 18.6, which is a healthy weight according to the United States Department of Health and Human Services (2010). The family states, they have a good appetite and have been trying to lose weight but find it difficult because of the day-to-day stressors they encounter.
They believe they need more exercise in the lifestyle but cannot find the time to fit it into the daily lives. They do get annual check-ups and follow-up with their physician as needed. CD and PD both have a high school degree and KD is in the fifth grade at the local elementary school. CD likes to hang out with her son and is involved with her community church. PD likes to watch television and hangout with his guy friends. KD likes to play video games and occasional play basketball with the neighborhood children and play with is pet dog, a miniature long hair Dotson name Jack.
Developmental Stage and History of Family
The CD is in her forties, and PD is in his fifties and according to the Erikson’s developmental stage, they are both in generativist versus stagnation. Harder (2009) “so when we’re in this stage we often fear inactivity and meaninglessness” (7). The son is 10 years-of-age and according to Erikson’s development stage, he is in industry versus inferiority. During this stage, the son is capable of learning, creating, and developing new skills. In addition, he should be very social but if feelings of inadequacy among his peers he may have problems with competence and self-esteem (Harder, 2009). CD was born in America on August 11, 1965, was adopted by the age of eight. She recently has contacted with her biological father and keeps in-touch with him. Her biological fathers’ background is unknown because he was also adopted at birth. CD does not know anything about her biological mother and prefers to keep it that way.
CD states, she was abandoned along with her two younger brothers at a young age. CD’s father was could not handle the children, both financial and emotional so he gave them up for adoption. CD and her younger brother were adopted together to an English-speaking American family in Colorado. A younger couple looking to adopt a baby adopted CD baby brother at the age of one. CD states, her adopted parents were both very loving parents to them, and they had good religious upbringing. CD first marriage failed after 22 years and through this marriage, they adopted CD’s niece infant son. KD who is 10, and he was born on March 5, 2001.
CD’s husband PD, was born in the East Coast of New Hampshire in 1956, and he has lived here his entire life. CD and PD lives in a trailer park and just barely makes ends meet. They both work but their income is not pulled together and shared to pay the bills. CD states, she pays for everything, whereas, PD is only responsible for park rent, but there has been time that he neglected to pay and CD had to pay the rent. CD is concerned where he spends his money, and although she loves him, he is not a partner in this relationship.
The family’s home was factory built-in 1986. As I drive up to their home, they have a paved driveway and storage shed adjacent to the trailer. There is no garage for their two vehicles they own. As you walk up to the home, they have a small deck at the front entrances. Once inside the front door you walk into an open concept kitchen, dining room, and living area. The bedrooms are at the end of the narrow hallway and with one full size bathroom and a laundry-room adjacent to the bathroom. The home is heated by propane force-hot-air. There are smokes and carbon monoxide detectors located at both end of the home are functioning properly. Their home is very well maintained and presents a welcome home like feeling.
The neighborhood is somewhat a loner community not actively with socializing. Everyone keeps to himself or herself unless they have kids. There are 25 other well-maintained trailers and good landscaping in the park. There are five families in the park that have children at the same age as KD, and the neighborhood children frequently get together to bike or play sports. There is a play park with basketball hoop, swings, and jungle bars for the neighborhood kids, so they can play and interact. Major grocery store is just one mile from the park, and the park is approximately five miles from downtown. CD states, she does not socialize with her neighbors but thinks that they are pleasant. The family believes that the neighborhood is safe and has a low crime rate. The family spends most of their time with community service through their church.
Family Structure and Functions
I found during my interview with the family that communication patterns were not shared but was dominated by CD who was more out spoken than PD and KD. CD answered most of the interview questions but PD charmed in from time-to-time if he wanted to add more in-site to the questions or if the question were more pertaining to his background. KD was somewhat shy and clinks to his mother most of the time especially, when he was not feeling well. KD is well behaved and communicates with his parent with respected. KD gets along well with his stepfather; there is no evidence of any behavioral issues in the relationship. KD sees his adopted father every other weekend, and he enjoys his visit with him. Both CD and PD do not believe in spanking as a form of punishment when KD needs discipline but believes in time-out and or grounding him when its’ needed. CD states, she is the sole decision maker in the family. They do not have a joint bank account, PD’s money is his, and CD’s money is hers. CD manages and pays the bills, whereas PD is only responsible for the park rent.
CD states, her employer has cut her hours from 40 to 32 hours, she is finding it difficult to keep up with the bills and being the main support of the family. She states, PD has not always paid the park rent so that leaves the burden on to her. When I asked PD why CD is managing the household financials by herself, he did not want to discuss the matter. PD and CD share the responsibility in cooking the meals, cleaning the house, and taking care of the laundry. KD helps with keeping his room cleaned and takes out the trash. PD is also responsible for mowing the grass and taking care of the yard. The family demonstrates reserved affective and socialization functions. Their affection is demonstrated by helping each other with the household responsibility and taking care of KD. CD and PD shows affection with verbalization of I love you and a kiss. KD is close with his mother and hangs out with his step dad occasion.
The family as hole respects each other and can express their concerns or issues to one another. The family takes their health care functions seriously. They receive routine health care check-up and believe in healthy eating but do not always practice it routinely. The family at present seems to be healthy and well developed they like to take frequent walks around the neighborhood as a form of exercise. CD is currently being treated for depression and for neck pain. She has a past medical history of asthma, arthritis, and hysterectomy at the age of 34 years-or-age, and she wears prescription glasses to drive.
PD is currently being treated for GERD and hypertension. He is not always good about taking multivitamins and the last doctor visit was a year ago. Both CD and PD do not drink or smoke. CD and PD make sure that KD has regular health check-ups, along with keeping up his immunization shuts. Recently KD has developed constipation and stomach pain, he has been through testing, and his physician is not able to find anything medically wrong. KD’s physician believes it could be related to the new stressors in his life regarding his adopted father and his new girlfriend.
Family Stress and Coping
As talking to both CD and PD, they both demonstrate dealing with stressors in the household and at work. CD and PD are worried about KD and what is causing his feeling sick both emotional and physical at times. The family has seek both medical and psychological advice and getting KD the help, he needs dealing with his adopted father and his new girlfriend. CD is also dealing with several stressors at the present both at home and work. Her work-related stressor is that her hours have been cut back, and she does not know how she going to get all her work done in a short period.
She believes her home-related stressor is she will not be able to financial support her family because of her decrease income and her x-husband has been laid-off so most likely will not get child support for a while. PD stressor at home is not providing more of the financial support that he should. They believe most of the time they handle stressors well, by talking things through, but they admit there is some things they do not feel comfortable bring things up in-order to deal with them.
Family Nursing Diagnosis
As I looked at the information that I had gathered through Friedman Family Assessment, I found several opportunities that I could focus on for a priority nursing diagnosis. However, I felt that the one that I could contribute more energy to is improving the family nutritional intake and improve in the family activities to promote good health. The priority nursing diagnosis is imbalanced nutrition: more than body requirements related to food intake that exceeds body needs, psychosocial factors, and socioeconomic status. The evidence is noted by the lack of exercise, family activities, excessive intake in relation to metabolic need and BMI indicates obesity for both parents and eating out more often than cooking meals at home.
The second nursing diagnosis is interrupted family processes: changes in mutual support related to modification in family finances. The evidence is noted by CD work hours decrease so she will be bring home less pay, PD not contributing to the household income, and x-husband lose job and no longer will be able to provide child support. The third diagnosis is impaired parenting: frequent illness related to KD coping with the stressor the potential of him feeling he is losing his adopted father who is in another relationship. The evidence is noted by KD complaining of stomach pain, nausea, and constipation.
Community Health Nursing Interventions
The interventions that the nurse will start with for this priority nursing diagnosis is ascertain previous dieting history. This will help the nurse and family determine, which diets and strategies used, results, and individuals frustrations, and factors interfering with his and her success. Another intervention is to implement and review a daily food diary. Both CD and PD are to keep a daily diet dairy for the next two weeks to help determine what time they eat, what they eat, how much the eat, where they eat and why they are eating or reflect on their feelings at the time. This will help the nurse understand CD and PD eating patterns with the when, what, how, and the why approach.
The last nursing intervention is for the nurse to determine the CD and PD motivation for weight loss, by assessing why both want to lose weight. Weight loss is depended on what type of motivates CD and PD. Is the motivation related to health concerns, own satisfaction, and gain approval from others or from each other. The community nurse will be able to help families like this one by using assessment tools such as Friedman Family Assessment model. The tool is important to assess the family in-order to provide valuable information about the family to help complete the nursing process. The information collect will help the community nurse to focus on the family needs. In addition, to help the family develops objectives, goals, and intervention on how to achieve and maintain the goals along with making sure that the family has a positive outcome.
Harder, A.F. (2009). Erik erikson stages of development. Retrieved from http://www.learningplaceonline.com/stages/organize/Erikson.htm Stanhope, M., & Lancaster, J. (2008). Public health nursing: Population-centered health care in the community, (7th ed.). Retrieved from the University of Phoenix eBook collection database.
U.S. Department of Health and Human Services (2010). Calculate your body mass index. Retrived from http://www.nhlbisupport.com/bmi/bmicalc.htm
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