Family Health Assessment: The Hernandez family
The Hernandez family is made up of 3 children: Jose (age 13), Oswaldo (age 8), and Marilyn (age 4), of Fausto (age 33) and Milagros Hernandez (age 30). As families are not democracies, each member of the Hernandez family has their assigned roles, privileges, rights, and obligations. The power lies with Fausto Hernandez and Milagros Hernandez, who are the leaders of the family. Children are expected to follow the leadership of their parents. Mr. Hernandez is the primary provider, working as a junior supervisor in the nearby production factory. His wife does part time jobs to raise more money. The father is the ultimate decision maker and provider; while the daily household chores, domestic affairs, and children are handled by the mother.
Marilyn, the youngest daughter, at only two years, was diagnosed with cancer of the brainstem via MRI, later confirmed by the 15 hospitals that reviewed her biopsy. It was a Ganglinoma of the cerebellum, the Pons, and Medulla. Doctors gave her a 100% morbidity rate if excision was ever attempted. Radiation was eliminated from her treatment plan as she was too young, with her only hope now being chemotherapy. After eight months of intense chemotherapy, the tumor is slowly regressing. The daughter still has the tumor, together with the accompanying effects, but nevertheless, the family is happy that they have an extra year with their daughter. During the visit, Oswaldo hugged his older brother Jose suffering from flu and unnoticeably fed the other younger siblings with her bare hands before washing them. The fingernails of the children were notably long and dirty. After running outside, the children ran into the house with their feet smudged in mud. Marilyn wet her shorts and had the elder brother clean them; the place was not cleaned, and the wetted pillow was sundried.
Fausto and Milagros had their children immunized at the appropriate ages. They are well aware that immunization protects children against severe illnesses, leading to positive outcomes of physical health, reduced family stress, and increased school learning (Carpenito, 2013). From the immunization charts of their children obtained, all children were immunized against tuberculosis, diphtheria, pertussis, and tetanus. They were also given doses of MMR and DTP vaccines. The children are also vaccinated against varicella, chicken pox, and polio. Jose has been immunized against hepatitis B and Haemophilus Influenza.
Jose is almost an adolescent. Of late he has been having conflicts with members of high class during after school hours that always end in a fight. He has a healing bite mark on the left forearm, a tiny scar on his face and a few other injuries as a result of interpersonal violence. All the other children show proper cognitive abilities for their ages.
Holzemer (2012) in the book Community health nursing: An alliance for health, notes that communication within families is more than just the exchange of words but also encompasses the facial expressions we make, the tone of speech and body language. From time to time, Hernandez’s family experiences problems in communicating. Mr. Hernandez is a protective man who does not value open conversations and is strongly oriented toward conformity. He expects his wife and children to obey his word, and never shares the reasoning for his decisions. On the upside, he rarely argues with his wife, neither does he have conflicts with children as most of the time they adhere and behave per his wishes. The protective communication model that Mr. Hernandez employs is not efficient as at times during conflicts his family is ill-equipped to handle even the trivial of matters. Jose, the first born, has grown in this environment, never trusting any decisions that he makes.
Each member of the Hernandez’s family plays a role in decision making. Jose is an information gatherer, collecting information of relevance on products as he has a decent knowledge of technology. Oswaldo and Marilyn are influencers; they have no ultimate say in the making of decisions but make their wishes known by creating embarrassing situations or ask for specific products. The parents, Mr. and Mrs. Hernandez, are the ultimate decision makers, deciding on what product to buy, and which school should their children attend, when purchasing a product and what brand to buy.
Mrs. Hernandez strives to teach her children responsible behavior and self-control. She appropriately and consistently disciplines her children- teaching them self-control, taking responsibility for their actions, and manage their behaviors and feelings. She believes that using fair and positive means of discipline will reward her children with appropriate behavior. Contrary, Mr. Hernandez believes that physically punishing his children is the solution to misbehaviors. When drunk, he threatens his children, hits them, smacks them and verbally abuses them. Jose has learned that problems are solved by violence, and any misbehaving will bring upon him unfathomable pain and suffering. His sense of fairness and justice is destroyed, has a broken father-son relationship, lost his sense of positive identity, self-respect, and dignity, has become a bully, is fearful and tells lies to avoid physical punishment.
The family is ill-equipped to deal with a crisis. Mr. Hernandez-as the head of the family- has even admitted to feeling overwhelmed by the sickness of his daughter and the financial distress it has caused. His usual coping mechanisms so far have failed; he has even tried new strategies that too have failed, leaving him with a poor morale and more anxious than ever. To cope, he has resorted to maladaptive coping strategies- chronically abusing alcohol and tobacco, involvement in violent behavior and has decompensated from the regular psychological cycles. Notably, the family also lacked a proper emergency plan to deal with a family crisis.
The family is Protestant, believing in the existence of a single God. Religion gives them a thing to commit beyond themselves and empowers them to have respect for human life and protection during conflicts. The family has had a long history of positive health seeking behavior by taking a sequence of remedial actions.
Mr. Hernandez is a progressive man, encouraging is family to set goals at the beginning of each year- both individual and family goals. They include at least a character trait change such as being more careful with words, consistency or develop some fruit or virtue of the spirit. His family goals have a common and hopeful outcome- to bring his family closer and grow it with religious teachings. The family aims at taking a vacation every after eight months, sit at a table for dinner every night, do a community project together and have a daily family devotion time.
The family does not strike a balance between the psychological well-being of a person and the multiple role demands. Domestic and work paid expenditures (role overload), and perception of work interfering with families (role conflict) have significantly affected the satisfaction of Mr. Hernandez in domains such as his marriage and job which in turn have led to increased stress levels- affecting his well-being. Mrs. Hernandez is a part time worker who has to balance between household responsibilities and work interaction- as traditionally the husband and family place demands on her- developing the role overload notion. Her plight is that managers understand that women and men have different working patterns, and only the quality of her work should be evaluated, not the number of hours she spends seated behind a monitor.
Family Nursing Diagnosis and Care Plan of the Hernandez family
Family nursing diagnosis. Unhygienic practices, psychological disturbance caused by the ill daughter and lack of proper plan to deal with crisis and emergencies
Goal of care. The family will be able to recognize the need for psychological and emotional support, point out the current hygienic practices and home environment. The family will learn proper hand washing, houses cleaning, waste disposal, and other health practices and consistently practice them. The family will learn the importance of preparedness for different emergencies, such as death, identify the responsibilities of each family member and how they would work together in case of a crisis. The family would then practice various elements of a model plan.
Objectives. During the 5 hours of the visit, the family should be able to: highlight the various factors that contribute to unhygienic practices and gain knowledge on proper hygiene. Note the need for proper hand washing after the toilet, before and after meals and accept together with exhibiting the desire to change the current unhygienic practices. Psychologically counsel them and give them hope. Identify various ways that the members would communicate and the different steps to take during emergency situations.
Interventions and Rationale. After checking, the family is aware of their health practices and the severity of the health problem assessed. Proper hand washing technique is to be demonstrated by the nurse so that the family can see the proper technique, with an assessment of a return method. The importance of hygiene is to be emphasized so that the family members are aware of the consequences of harmful health practices. The concerns of individual family members will be listened to as regarding hindrance to the practices. Through this, concrete ways as to achieving proper hygienic goals will be met. Psychological counseling would require a more professional to handle the situation, who will be appropriately contacted. Making a family communication plan, illustrating that making a call to a person in the same town may be difficult as compared to making a call to an individual in a different city. Making a sample and complete contact card for each family member. A family disaster plan would include finding safe spots within the house, determining the best escape routes and choosing multiple meeting places.
Tools and Evaluation: Gulanick and Myers (2011) indicate that some of the necessary tools for such would include a simple but comprehensive diagram of steps for correct hand washing and infection paths. A sample emergency plan, home visiting, and appropriate demonstrations. Supplies as well as effort and time from the Hernandez family and the nurse. Evaluations of the interventions will be assessed after five hours with the family. The parents and the siblings should be able to demonstrate proper hand washing techniques. A little change in attitude and acceptance of the situation would be welcome. Evaluation of the preparedness of the family and noting any changes to be made.
References
Carpenito, L. J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
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Gulanick, M., & Myers, J. L. (2011). Nursing care plans: Diagnoses, interventions, and outcomes. St. Louis, Mo: Elsevier Mosby
Holzemer, S. (2012). Community health nursing: An alliance for health. Sudbury: Jones & Bartlett Learning.Bottom of Form
