Purpose:
Students will read a family case and apply components and tools of family assessment as a creative nurse thinker.
Tasks:
- Read the provided family case carefully.
- In assigned group, discuss and decide who will answer which question among the 5 questions total listed at the end of the family case (from page 4).
Part A (6 points):
- After every group member makes a choice of the question to answer, work on the question you choose.
- Write your answer following APA 7th style in Microsoft Word (Title page is not required).
- Post the word file back to the discussion board by the Part A deadline.
Part B (4 points):
- After the Part A deadline, choose and review one (1) (or more) other team members’ original answers.
- Directly post your comments (no file attachment) with 200 words max. each onto the discussion board by the Part B deadline (Double space is not required).
- Your comments should include 1 literature citation (either the textbook or any relevant journal article).
- APA 7th style is required only for the reference(s) which will need to be listed at the end of your comments.
[A Family Case]
Raquel is a single mother of a 20-month-old son, Miguel. Raquel works the day shift at a factory that produces air conditioners. Raquel currently lives in a two bedroom duplex that she shares with her boyfriend, mother, her sister and her sister’s three- and six-year-old daughters. When Raquel dropped off her son at the factory’s day care this morning, she noticed that Miguel still had a runny nose and a harsh cough, a problem he had for the last two days. When Raquel returned home with Miguel, her mother took a look at him and said: “His cheeks are flushed. Why didn’t you stay home with him or take him to the doctor?”
No one in the home had a thermometer, so Raquel decided that it would be best if she took Miguel to the urgent care center. Raquel’s boyfriend, Alfonso, accompanied her. Once at the urgent care center, Miguel’s temperature was found to be 103°F. The nurse practitioner listened to his lungs and said, “I’m hearing some wheezing and he’s breathing rapidly. I think you should take him to the hospital emergency department. They will be able to x-ray his chest. Is that possible for you to take him to the emergency room? What do you need to help make that possible?”
Raquel became visibly more frightened and asked the nurse practitioner, “What do you think is wrong with him? Do you think this is more than a cold? Do you think he picked up something at day care?” The nurse practitioner responded by sitting next to Raquel, looking directly at Raquel and saying: “I know that it can be frightening to see your baby so sick, but I want you to know that most children at this age will have several respiratory illnesses every year. Most of the time, these are illnesses that you can take care of at home, but I know that you want to be certain that it is not something more severe. So, I think the best thing is to go to the hospital and have an x-ray to help us determine the correct actions to take. Is this plan agreeable with you? Do you have other questions that I might answer before you leave? What other things come to mind while we’re together?”
Raquel starts crying and pulls Miguel closer toward her chest, she says, “I feel bad that I took him to daycare today. I probably should have taken a vacation day and stayed home with him; I feel like his being sick is my fault. My mother is blaming me.” The nurse responded, “I can appreciate your feelings; however, I want to commend you on the fact that you’ve taken the first and most important step to get Miguel the care he needs.” The nurse practitioner documented her plan for visiting the family in the hospital and exploring family concerns about daycare, family communication, and caregiving at follow-up visits.
Raquel and Alfonso take Miguel to the community hospital emergency department, where they were greeted by the triage nurse who, after determining that Raquel is the mother of Miguel, turns to Alfonso and asks, “What is your relationship to Raquel and to Miguel?” This nurse asks questions similar to those asked by the nurse practitioner, such as how long as Miguel been sick, and continues with an assessment of presenting symptoms. The family was quickly guided to a room in the emergency department, where the curtains were drawn so that privacy and calm could be maintained for Miguel. The nurse asks if she can provide anything, such as a plastic toy car, while the family is waiting. Raquel says, “That’s a great idea!”
The nurse takes Miguel’s vital signs and applies a pulse oximetry. Because the nurse knows that the family wants information, she tells them that Miguel’s temperature is now 103.6°F and his respirations are rapid. The nurse explains the oxygen saturation measurement of 92% and explains the meanings of the readings. Knowing that families often don’t know how to express their concern, the nurse says, “I know that being in the emergency room with your child can be very stressful. We are here to do everything we can to figure out what is wrong with Miguel, and to do what is necessary to help him get better and back to his normal playful self.” The nurse goes on, “Can we talk about Miguel and your family before the doctor comes in to see him? His temperature is high, but we are monitoring it closely and going to bring it down. His oxygen levels are also being watched. Can you tell me more about how Miguel’s health has been? Can you tell me what your main concern is right now?”
Raquel, Alfonso, and Miguel waited until the physician entered the room to meet with the family. The physician observed Miguel’s breathing and after the physical assessment stated, “I think it is best for us to take a sample of Miguel’s blood and a sample from his nose so that we can see if he has an infection. It is important to take an x-ray of his chest and get a clear picture of how his lungs look right now. Parents often want to stay with their child when they’re having these tests. Do you want to stay with Miguel and help comfort him during the procedure, or do you want to wait outside of the room and come in to comfort him later?” Raquel decided to stay in the room to comfort Miguel during the procedure. The nurse explained what would happen and to best comfort Miguel.
After the procedures were completed, the physician returned to the room and said, “I think that we might have two things going on. I think Miguel might just have a common respiratory illness called RSV, but, in addition, his chest x-ray looks as though he might have pneumonia.” The physician draws a picture of the chest for Alfonso and Raquel so both understand what “normal” lungs look like and what Miguel’s look like. The physician continues, “It looks like his white blood cells, the ones that fight infection, are elevated. We don’t know yet what bacteria is causing the infection and must wait for the laboratory test to come back, but I think it is important that he is admitted to the hospital. You said his breathing rate during the day has become more rapid and he is not drinking fluids like usual. Are you agreeable with this plan?” Raquel and Alfonso both respond positively.
A pediatric staff nurse greets the family when they arrive on the pediatric unit, “I am Jonathan Homer, the registered nurse who will be caring for Miguel and your family.” They entered a brightly colored room with floor-to-ceiling windows with a view of the garden. The nurse oriented them to the new room Miguel will occupy. He explained how to operate the crib rails. Miguel started to cry and his respirations increased when laid down in the crib. The nurse encouraged Alfonso to continue to hold Miguel. A comfortable rocker in the room allowed Alfonso to rock Miguel. A nearby pull-out bed with pillows and blanket provided Raquel a chance to relax while calling her mother to update her. Another phone call was made to the factory where she worked to notify them that she would not be at work in the morning. Raquel started to feel a bit of control.
After the nurse obtained admission information from the family, the nurse Jonathan said, “I need to start IV therapy on Miguel in order to get his body fluids back to the level they should be.” He asked Alfonso and Raquel if either of them wanted to accompany him and explained that it is important not to have procedures that hurt a child be associated with the child’s room. He said, “The child’s room should be a safe space, one where Miguel can trust that no one will hurt him.” They decided that neither wanted to accompany Miguel to the treatment room. The nurse acknowledged this decision and said, “Sometimes the parents’ anxiety and concerns are transferred to the child, so the child has a harder time coping with procedures during the hospitalization. So, if you are afraid of that happening, I praise your choice. Do you have questions I can answer?” He explained that the procedure would take about 15 minutes and encouraged them to rest in the parent lounge at the end of the hallway. He explained that visiting hours are unlimited and that one or both could stay overnight to provide the important emotional support he might need.
During the procedure, a nurse came to reassure the family that Miguel was doing well and would soon return to the room. After Miguel returns following the procedure, Jonathan, Miguel’s nurse, explained the equipment in the room. The nurse said, “We are responsible for your child’s safe care while he is in the hospital. However, you know your child best and we want you to report anything that concerns you.” The nurse continued to build a trusting partnership with the family. “We will be checking on Miguel very frequently night and day, but if you see anything unusual, don’t hesitate to come and get me or another nurse. We consider you an important part of our team while Miguel is here at the hospital.”
Miguel continues to whimper, but notices the actions taken by the nurse. Knowing that a child’s temperament is highly related to response to hospitalization the nurse asks Raquel, “Is this how Miguel usually responds to upsetting situations?” Alfonso responds, “I think that he is used to being held and rocked a little more slowly than Raquel is doing right now; she seems to be rocking at 50 miles per hour.” The nurse smiles, “You’ve made a good point, Alfonso. Children are very aware of the level of their caregiver’s anxiety.” At this point Raquel breaks into tears and says, “It is so hard to see my baby so sick, he’s always been so healthy.” The nurse said, “I know it must be difficult to see your child sick. It’s normal for you to be somewhat frightened. We share the same goals. We want Miguel to be comfortable during his hospitalization. You both play important roles in helping Miguel get well again.”
Miguel finally fell asleep and Alfonso did also. Raquel took some time to look around the hospital. She was amazed at the efforts taken to create a child-friendly environment. The wallpaper in the hallway represented a never ending series of roads, traffic signs, and buildings that resemble a city. A book bunker at the end of the hallway was filled with books for all ages. Another room was filled with space for teens and another area designed for younger children. Raquel thought, “When Miguel is feeling better, he will love to come to this playroom and enjoy the toys and building sets available.” The comfortable setting helped Raquel feel calmer and experience a sense of well-being in the environment. This well-being was beginning to translate to a sense of hope and optimism.
Raquel returned to Miguel’s room and spent time on Facebook updating friends on her status and soliciting their prayers and support. When Jonathan, Miguel’s nurse, stepped back into the room to complete hourly rounds, he smiled at Raquel. She said, “I’m letting my friends know about Miguel being in the hospital and telling them to say prayers for him; would you mind saying a prayer for him as well?” Knowing the value of religious and spiritual support for families, he answered, “I will add him to my prayers.”
In two days, Miguel was healthy again and ready to go home. Jonathan was on duty as they prepared for discharge. He gave them some printed information and explained what they need to do at home. He listened to their questions and answered each one. He knows it is important for them to know the best ways to care for Miguel at home. He provided them with contact information and instructions if they became alarmed that Miguel was not getting better as expected. Jonathan took time to be sure that the family fully understood the information and had all questions answered before he makes the final discharge arrangements.
[Family Nursing Discussion #1 Questions]
(1) There are several episodes of communication between health care providers and Raquel’s family members in this case. Which of the following 4 episodes of communication you think is the most effective? Please refer to the 4 colored sections of communication. Provide the rationale for your answer by citing the textbook or other literature. Include the most effective statement that was made during the encounter. (300 words maximum)
- communication with the nurse practitioner at the urgent care center (in yellow)
- communication with the triage nurse at the community hospital emergency (in green)
- communication with the physician at the community hospital emergency (in sky blue)
- communication with the pediatric staff nurse at the community hospital pediatric unit (in gray)
(2) Genogram and ecomap are useful in family assessment, planning and interventions. Please draw a genogram and an ecomap for Raquel’s family using information from the case. Please refer to Robinson et al. Chapter 5, including figures 5-2, 5-3, and 5-4, and make sure to follow APA 7th style (refer to your APA style manual and/or online resources, such as this link, https://apastyle.apa.org/style-grammar-guidelines/tables-figures/figures).
(3) Curran (1985) studied family stressors as well as traits of healthy families to understand family functioning (Chapter 1 of the Robinson et al textbook). Please list 3 major stressors and 3 healthy family traits that you’ve found from this family. (300 words maximum)
(4) Using the Family Reasoning Web Template (Fig. 5-5 of the Robison et al. textbook), identify 3 most meaningful family categories and assign a family nursing diagnosis to each of the 3 categories. (300 words maximum)
(5) Identify the two most important things that the nurse, Jonathan, needs to discuss with Raquel on discharge for her family’s management of health. Base you answer on the assessment of this family type and family function by citing the textbook or other literature. (300 words maximum)
