Section I: Documentation of Family Assessment Data Collection Process
Overview of The Family
The family that I interviewed is a nuclear family. The family is an Ethiopian/American immigrant family comprising of two parents with two teenage children. The head of the family is a 45-year-old civil engineer who graduated from the University of Addis Ababa. His wife is aged 44 years. She was a college student, but now a stay at home mom to help care for the family and her ailing mother in law who lives nearby. The family’s two children are a daughter and a son aged 15 and 13 years respectively. The family moved to America in 2006 when the children were aged four and two years respectively. The family currently lives in Milton West Virginia after migrating from Baltimore, Maryland. The wife frequently visits to care for husband’s frail mother.
The husband was diagnosed with primary hypertension two years ago and currently is on anti-hypertensives. He is also 30 pounds’ overweight and has recently also been diagnosed with sleep apnea. He acknowledges that his lack of regular exercise, hypertension, and excess weight are threatening his long-term health, consequently becoming approaching the diet and exercise routine of his youth in a more disciplined manner. He is tentatively following his prescribed medicinal, has enrolled with a weight loss group, making healthier food choices, monitoring his conditions and maintaining his supply of medicine. His daily routine now includes recording his pressure at home and at work, generating a trend report with each reading taken and emailing it to his doctor.
Family Diagnoses Developed
- Impaired verbal communication
- Enhanced relationship readiness.
- Readiness for enhanced decision-making
- Readiness for enhanced health management.
- Ineffective health management
- Readiness for enhanced family coping.
Family Strengths Identified
- An adequate home environment that is clean and reduces the spread of disease-causing organisms
- Good health insurance.
- Proximity to health care for the chronically ill extended members.
- Maintenance of dynamic ties with the broader community.
- positive appraisal of a situation.
- Open communication between parent and children
Areas for Improvement Within the Family Identified
- Practicing resilience: exhibiting more tolerance toward difficult situations and adapting to changing situations in positive ways.
- Proper eating habits.
- Recognition of the need for external assistance, accepting help and pursuing opportunities to eliminate or decrease the stressors affecting the family
- Encouraging children to communicate with their parents
- frequently. Continued adherence to exercise routines
Family Teaching Opportunities Identified
- The family can be taught on the importance of arriving at decisions as a family based on census and family values
- Teaching the family the importance of encouraging teenagers to appropriately balance between freedoms and responsibilities as they mature and become increasingly autonomous.
Family Health Promotion Opportunities
- The family can be encouraged to continue maintaining safe and hygienic living conditions
Overview of Student Experience and Lessons Learned
The assessment of families in nursing is a challenging experience because families are complex and the assessment of families occurs in the environment of the particular family, where the family feels at home, and the nurse feels like a stranger. The importance of family-level problem-solving techniques is paramount as it is needed in dealing with numerous health issues, including promotion of health and management of chronic illnesses.
Section II: Family Assessment Process
Table 1: Identification Data:
| Initials | Gender | Age | Relationship | Educational level | Individual developmental task (Families with adolescents) |
| JS | Male | 45 | Husband | Graduate | The adolescents can be allowed to establish their identities and still be part of the family; breadwinner |
| AS | Female | 44 | Wife | College | Increasing the role of adolescents in the family; taking care of the family |
| MS | Female | 15 | Daughter | High school | Thinking about the future, educational milestones, jobs and working |
| ESh | Male | 13 | Son | Grade 9 | Independence within the confines of a family |
Developmental Stage and History of the Family
Family developmental stage: The Family Systems Theory allow for nurses to assess and understand families as an organizational whole. Similarly, the developmental theory outlines a framework that nurses can use in understanding family experiences and changes of the member’s lifetime. The family is classified as a family with adolescents under the developmental theory.
Composition: the family is made of two mid-aged parents with their two teenage children. The husband is an employed as a civil engineer in a local construction company whereas the wife took a break from school almost one year to care both for the family and her mother in law. The wife reports that caring for her family and ailing mother in law is exhaustive. Additionally, her husband’s sleep apnea is negatively affecting her sleep patterns. She has requested for sleeping pills and is considering moving to the visitor’s bedroom.
Her daughter goes to high school, 10 miles away. She does well in her coursework but travels to her maternal grandmother home during weekends to help with the feeding. She openly states her desires to make her mark in the world. Her parents are proud of her. Son is a grade 9 student, a typically good student; but his progress report showed that his grades are dropping in most subjects. He is an outgoing boy who likes hanging out with friends from the neighborhood. His mother is worried that her son might have joined bad peer groups. She is considering enrolling him in a boy scout club but has not spoken to her husband.
History of the Family: the husband and wife conducted a traditional Ethiopian wedding ceremony on the 20th February 2001. They were blessed with their children in Ethiopia, siring they are first born a year later. Two years later, wife gave birth to their son. In May 2006, political turmoil in the mother country forced them out. Their daughter was then four years and their son two years old.
Cultural/Ethnic Group: They are Ethiopian/Americans.
Religious Identification/Spiritual Beliefs: the family is a follower of the Abrahamic religion, they are Christians.
Family Celebrations/Traditions: as religion plays an important role in the family, the family celebrate unique ceremonies including the Enkutatash (New Year), Meskel (Finding the True Cross), Ledet (Christmas), Timket (epiphany) and Fasika (Easter). Other traditions observed include the celebration of Kulubi (Feast of Saint Gabriel), and Debra Damo (Feast of Saint Aregawi).
Family Motto/Mantra: Put your best in whatever you do, and you will never be disappointed.
Hobbies/Activities: traditional pottery, gardening, hiking, and quilting.
Financial Resources: only the husband is employed. He is also the sole breadwinner, providing both the family’s basic and secondary needs. Health insurances accrued to the husband and wife at work cover for the family. Hospitalizations are covered 80/20 and thus have to pay 20% of their bills out of their pockets.
The incidence of Chronic Illness (Family Residing in Home): the husband suffers from hypertension; all the other family members are healthy.
The incidence of Chronic Illness (family outside the home): the paternal grandmother who lives in their neighbor with the other extended family. She is diabetic and also have renal failure. She is taking insulin and doing dialysis at home. The family who she lives with just had a twin babies and the family is thinking about getting in-home services form of PACE (Program for All-inclusive Care for the Elderly) for the grandmother. The wife does stop by on regular occasions to oversee her feeding and mediation routines.
Table 2: Environmental data
| Environmental data | Findings | Strengths/ areas of improvement | Family nursing diagnosis(es) | Teaching/ health promotion opportunities |
| Family home. | Healthy home environment and lifestyle. Safe and hygienic living conditions. | Adequate: a clean home environment that reduces the spread of disease-causing organisms | None | The family can be encouraged to continue maintaining safe and hygienic living conditions |
| Neighborhood | Neighborhood organizations promoting safety and beautification | Marginal: reported drug abuse cases among youths in the area | None | Substance abuse should be reported to authorities for appropriate action |
| Community | Regular links with the broader community are established. The family is aware of what is happening around them. The family uses external resources suited to their needs | Adequate: the family maintains dynamic ties with the broader community. Regular participation in external groups and activities often in a leadership capacity | None | The family can benefit from involvement in scouting programs, regularly attending church or other various civic activities such as parent-teacher associations. |
| Family social support network | Enrollment in clubs and organizations and communication with other family members and neighbors. | Adequate. | None | None. |
Table 3: Family Structure
| Family structure | Findings | Strengths/ areas of improvement | Family nursing diagnosis(es) | Teaching/ Health promotion opportunities |
| Communication patterns | The parents are conversation oriented whereas the adolescent children communicate in a more conformity oriented manner, shying away from topics deemed private such as sexual relationships. | Marginal; failure to adequately communicate. Less humor is used, minimal respect for opinion differences voiced by the younger members, less use of negotiation and failure to seek clarity on another person’s meaning. | Impaired verbal communication. | Encouraging children to communicate with their parents frequently may lead to a more rewarding family life and helps educate and socialize children, consequently preparing them for the outside world interactions (open.lib.umn.edu) |
| Role relationships | Positive family role relationships structured to meet the changing needs. Each family member makes an effort to trust each other, sharing the responsibility for caring roles where possible. | Adequate: changing life cycle stages require alterations on the structure of relationships. Each family understands, appreciates and respects the unique qualities of each family member. | Enhanced relationship readiness. | Practicing resilience: exhibiting more tolerance toward difficult situations and adapting to changing circumstances in positive ways. Putting the well-being of a family member as the priority and acting accordingly with loyalty and commitment. |
| Decision making | The husband makes critical decisions. | Marginal: Familial traditions, in conjunction with established rules and defined structures on how decisions are made. | Readiness for enhanced decision making | Teaching the family on the importance of consensus in arriving at decisions as based on census and family values. Democracy in decisions makes the other feel that their opinions matter. |
| Patterned values | Values and beliefs on how money is made and spent, work, religion, community involvement, and health are defined. | Adequate | None. | Exposure of the family to the community can build connections lost due to previous cultural practices and familial expectations. |
Table 4: Family Function
| Family function | Findings | Strengths/ areas of improvement | Family nursing diagnosis(es) | Teaching/health promotion opportunities |
| Affective function | The family members respond with emotions appropriate for given situations – the family was pleased to learn that Shale received a promotion. | Adequate: developmental tasks are carried out, and the needs of each member are met. | None. | The husband can put more effort into knowing the academic progress of his children(Family nursing: Family structure, function, and process, 2015). |
| Socialization function | The family functions as a unit. The children are getting taught on how to assume adult roles gradually. | Adequate | None. | Whereas the children are completely dependent on the family for survival, autonomous activities can be encouraged. |
| Healthcare function | The provision of physical necessities that keep the family healthy, including food, clothing, and shelter as well as health care is majorly dependent on the breadwinner. | Inadequate: the family has a single breadwinner. | Readiness for enhanced health management. | Encouraging the family members to fully participate in their healthcare, follow through and compliance with professional advice. |
| Use of Alternative/ Complementary Therapies | The family does not use complementary therapies. | |||
| Use of Home Remedies/Herbal Supplements | Use of herbal remedies with conventional medicine less frequently. The frequently visiting grandparent brings with the herbal medicine. | Marginal: The family reports failing to inform their health care providers on the use of traditional medication | Ineffective health management.
| Educating the family on the potential of traditional medication in adversely interacting with conventional medicine.
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Table 5: Family Coping
| Family Coping | Findings | Strengths/ areas of improvement | Family nursing diagnosis(es) | Teaching/health promotion opportunities |
| Family stressors | Cultural transitions led to the disintegration of the family code and the role of family members. This is also exacerbated by economic stressors as the family has a single breadwinner. | Marginal: The family’s positive appraisal of a situation greatly enhances the adaptability of the family to a stressor. Ability to cope with day to day changes | Readiness for enhanced family coping. | Recognition of the need of external assistance, accepting help and pursuing opportunities to eliminate or decrease the stressors affecting it. . |
| Perceived threats to the family | Substance abuse among the local youths | Marginal | Readiness for enhanced family coping. | Dealing with threats are they pop up. |
| Coping task/strategies | Shifting of parent-child relationships to permit adolescents to move in and out of the family system. Maintaining clear boundaries. Attributing positive meanings to a situation. | Adequate: Balancing freedoms with responsibilities as teenagers mature and become increasingly autonomous. | None | Developing cooperative relationships with professionals. Balancing the chronic illness with other family members. Developing proper communication competence. |
| Ability to plan for change | Maintaining commitment to the family as a unit. | Adequate | None | None |
References
(2015). Family nursing: Family structure, function, and process. Retrieved from https://intranet.tdmu.edu.ua/data/kafedra/internal/magistr/classes_stud
Friedman, M. (2003). Family nursing: theory and practice (5th ed.). Norwalk, CT: Appleton & Lang.
