Case Study: Family Assessment
Review The Nursing Process in Practice: Formulating a Family Care Plan, chapter 13, page 364.
Utilize the Box 13-7 Family Assessment Guide, pages 364-368.
Make sure to use all of the VI steps of the assessment.
Chapter 364 to 368
· 1. Family nursing takes place within the framework of the nursing process.
· 2. Family needs, style, strengths, and functioning are assessed with the Family Needs Model of family nursing. Families are assessed on several levels: individual, subsystem, family unit, and family–environment interaction.
· 3. The goal of family assessment is mutual identification of needs and care planning that includes both the nurse and the family. The success of family health care depends on setting realistic goals related to the level of family functioning.
· 4. Several diagrams help assess families. A family map diagrams the structure and organization of the family and its subsystems. A genogram identifies family facts and process, including illnesses and multigenerational patterns of relationships. An eco-map describes the energy exchanges between the family and the environment.
· 5. Analysis of family data helps the nurse determine family needs, family style, family strengths, and family functioning. Analysis of family data includes determination of the targets of care, nursing contribution, and the priorities of family needs.
. NANDA International
· 6. NANDA International has specified several nursing diagnoses related to families, focusing on family processes and family coping. The Omaha System identifies family problems related to the use of social resources and the environment.
· 7. Different nursing intervention strategies are used for each family need: developmental and health-promotion needs, coping with illness or loss, inadequate resources and support, disturbances in internal dynamics, and coping with the environment. Nursing interactions are adjusted to the family style. Family strengths are as important as family problems.
· 8. Families are resistant to change, but a time of crisis is often the best opportunity for change. As the importance of the family member increases, the impact of a change in that member on the family increases. Helping a family change its internal dynamics is not a goal for every community/public health nurse or every family.
· 9. Evaluation should include examination of goals and the effect of intervention on a family member who is ill, other individuals, family subsystems, the entire family, and the environment. Evaluation should also include evaluation of the quality of nursing performance. The outcome of evaluation may be modification of the plan, continuation of the plan, or resolution of the problem.
The Nursing Process in Practice
Formulating a Family Care Plan
Mr. R., an 80-year-old retired pipe fitter, lives with his wife; he has had diabetes for 15 years. Although his diabetes has been moderately controlled with diet and daily insulin, some complications have occurred. He experiences arteriosclerotic cardiovascular disease and peripheral neuropathy, and he recently spent 2 months in the hospital due to circulatory problems in his left leg. The progressive deterioration of circulation resulted in an amputation below the knee. Although fitting him with a prosthesis would be possible, he has refused this and is wheelchair bound. Mr. R. currently depends on someone else to help with transfers. He is cranky, irritable, and demanding to almost everyone. He recently has stopped following his diabetes regimen because he claims, “It just doesn’t matter anymore.”
Mr. R.’s wife, Doris, is a 74-year-old woman who has been a homemaker most of her life. She has always been the “watchdog” for Mr. R.’s health. Mostly through her changes in food preparation and her lifestyle adjustments, Mr. R.’s diabetes has been managed. She schedules his physician appointments, buys his medical supplies, and administers his insulin. He is now refusing to accept her help, and she is anxious and angry about his behavior. They frequently have arguments, after which Mrs. R. retreats to her room.
Mr. and Mrs. R. have three children and four grandchildren who live in the same city. The eldest daughter, Patricia, calls or stops by about once a week. The other children, Tom and Ellen, are busy with their families and see their parents mostly on holidays; they have very little communication with Patricia or their parents. When the children do come to visit, Doris tries to put on a happy expression and pretend that everything is going well to avoid worrying them. She is also embarrassed about Mr. R.’s behavior and does not want anyone from outside the family to see what is happening.
On her initial home visit to this family, the community health nurse notes that Mr. R. appears somewhat drowsy and unkempt. Mrs. R. looks anxious and tired, her skin color is slightly ashen, and she has circles under her eyes. When the nurse asks them what they hope to get out of the nursing visits, Mrs. R. says, “Actually, you don’t need to keep visiting. In a few weeks we’ll be back to normal and doing fine.”
Based on a thorough assessment of the family, the community health nurse may begin to develop a mutually acceptable plan of care with the family.
In the initial interview, the community health nurse completes a genogram and an eco-map with the family (see Figures 13-3 and 13-4 ). After the second family interview, the nurse also completes a family map that describes the members’ interactions with each other (see Figure 13-2 ). A family guide to help structure a family assessment is presented in Box 13-7 .
Completing the genogram helps break the ice to get the family to talk about their situation. The genogram provides a safe and thought-provoking way for Mrs. R. to supply appropriate information about the situation. During this process, the nurse obtains information about other family members, their general levels of functioning, and the possibility of acting as resources. She identifies family members’ patterns of closeness and distance.
Box 13-7 Family Assessment Guide