Nursing Assessment of Family - Assignment Example

Family Assessment Name Institution Introduction An important skill for nurses who work with nurses is to develop their assessment skills. Family assessment is a complicated experience due to the complex nature of families (Duhamel, 2010). This assessment occurs in the family’s environment and requires that the members of the family feel comfortable to open up to the nurse (Silva, Moules, Silva & Bousso, 2013). Family nurses assess families to determine the health of the unit and its members. This assessment is important because it shifts the nurse’s focus from an individual to the family. This helps nurses to think of the family as a collective unit, discover the collective concerns and health needs of the family and to tailor their nursing interventions or treatments accordingly (McMurray & Clendon, 2011). Family nurses achieve this by using a systematic approach for working with patients and families (Léveillé & Chamberland, 2010). This paper performs a systematic evaluation on a case scenario involving the Courtney family. It will use the Calgary Family Assessment Model to describe the family’s history, health concerns, and needs for developing a healthy family. Family Assessment Family assessment is concerned with addressing the needs of the family in response to the health problems of a member. This concept does relinquish individual patient care but allows the family nurse to work with families collectively to meet their health needs (Duhamel, 2010). Family nurses use assessment models to help determine the health issues affecting their patients such as grief, anxiety or domestic violence (Léveillé & Chamberland, 2010). The assessments help the nurses to understand the needs of the families at each development stage, the communication between members, and how the family functions (Kendall, Rodger & Palmer, 2010). A family assessment would obtain this information for developing foundational knowledge Family assessments are important because they direct nursing practice to families. The assessments motivate family nurses to apply their expertise, knowledge and practice on families seeking medical support (Kendall, Rodger & Palmer, 2010). This focus by family nurses has positive benefits for patients and their families. Family assessment is also important because it reveals the social influences on an individual’s health. For example, an assessment would show how communication between family members affects a patient’s development (such as independence) or sensitivity to health needs. This would reveal the health level and needs of the patient. The assessment would reveal whether the patient has sufficient coping skills to deal with health or emotional issues, can communicate effectively using verbal and non-verbal communication, can adapt to life cycle changes, has stable family support, and lives in a hygienic and safe conditions. Another importance is that enables nurses to identify the health of a family (Kendall, Rodger & Palmer, 2010). Health assessments can show whether a family possesses the characteristics of a healthy unit such as positive interaction between members, effective role structures, support for individual development, healthy lifestyle, active problem-solving and communication with the society (Duhamel, 2010). The outcome of the assessments would help nurses to empower the family system and help members of each family to identify his or her needs and develop solutions for those needs (Hempill & Dearmun, 2010). Family Assessment Tool Various tools can be used to evaluate systems. These include the Resiliency Model, Family Management Measure, the Calgary Family Assessment Model and the McGill Model (Riper, 2010). The McGill model helps family nurse to assess the strength of a family system and empower the family to use its strengths and resources to achieve collective goals and cope with life changes. The Calgary Family Assessment Model (CFAM) is most appropriate for carrying out family assessments (Bell, 2011). The model combines concepts of nursing and family therapy to help nurses to evaluate a family unit. The CFAM model comprises of three key areas: family structure, family development phase, and functional status (McMurray & Clendon, 2011). The development aspect refers to the attachments, tasks, and stages of the family’s development. The functional aspect comprises of instrumental and expressive functioning of the family members. The instrumental component focuses on the daily family activities while the expressive component looks at the communication, beliefs, influences, and alliances among family members. The family structure examines internal, context and external structures (Bell, 2011; Silva, Moules, Silva & Bousso, 2013). CFAM has benefits and limitations. The benefits include a simple framework for evaluating the family system and developing tailored interventions (Lee, Leung, LingChan & Chung, 2010). The model is simple to use because it breaks down the assessment areas for family nurses. The model also provides a systematic method for analyzing the family by considering its structure, development and functioning. Secondly, CFAM provides summarized information on a family. This information can help nurses to determine at glance whether the family depicts the characteristics of healthy or unhealthy family units. For instance, the communication aspect of the functioning assessment can reveal whether family members collaborate or support facilitative interactions during problem-solving (McMurray & Clendon, 2011). Similarly, the internal and external structure shows the role relationships among members. Thirdly, the model has useful assessment categories, which aid in data collection and assessment of the family’s functioning (Lee et al., 2010). These categories are defined by the frameworks for community health nursing (structural-functional, development and interactional). The drawback with CFAM is that it does not show how nurses can apply their expertise and interventions to solve family problems or health needs. It only describes the family unit with the aim of revealing any issues or concerns about members of the family (Bell, 2011). Secondly, the model does not provide a mechanism for summarizing interactions between the family and the external environment. A Courtney family assessment using CFAM provides insight into the family structure, development phase and the functional status (McMurray & Clendon, 2011). The family structure assessment involves an internal evaluation of the family composition, rank order and gender. Angela and Duncan have three children. There are three grandparents, one deceased grandparent, two uncles, two aunts and four cousins. On rank order, Angela is the only child whereas Duncan is the oldest followed by Jeff then Stella. On gender, Angela is the only female child while Isabella’s family includes 2 male sons, 1 female, 3 grandsons and 1 granddaughter. The total ratio of males to females is 9:7. The context component refers to the extended family. This includes Midred, Bill, Isabella and Robert (deceased). The external evaluation of the family structure refers to the religion, environment and social class of the Courtney family (Hempill & Dearmun, 2010). Religion is not mentioned in the case. The Courtney family is working class because Angela and Courtney have white-collar occupations. There is no description on the hygiene of the family environment but Angela appears to create a balance between her family responsibilities and work by working part-time. The emotional environment reveals psychosocial problems with Sally and Jake’s delayed development. The development aspect of the CFAM tool examines the attachments, tasks and stages of the family’s life cycle (McMurray & Clendon, 2011). The Courtney family is in the marriage stage. Both their parents were conventionally married. Duncan’s siblings are in the separation/divorce stage. The challenge with this family status is that it destabilizes relationships between family members (Kendall, Rodger & Palmer, 2010). Divorce and separation stages require family nurse interventions to restabilize the interactions and inter-relationships between the divorced/separated spouses, their children, and the extended family. Angela and Duncan have also formed attachments with the sibling’s spouses (Stan and Gina) and children (Sam, Ben, Britney and Geoff). The functional aspect assesses the family’s instrumental and expressive functioning (Hemphill & Dearmun, 2010). Instrumental functioning examines the daily family activities performed. Duncan works full time while Angela works part-time. Michael attends school and participates in after-school activities while Sally attends the local kindergarten twice a week. Sally has problems communicating due to her temper tantrums but has a good relationship with Jake. Jake is fully dependent on his mother and shows signs of delayed development in psychosocial growth, language and motor skills. Expressive functioning looks at communication, beliefs, influences and alliances among members (Ganong, 2011). Angela and Duncan appear to have good communication skills since there is no mention of arguments. Angela moved closer to her parents as an emotional reaction to their age while Isabella’s forgetfulness hinders her from communicating her feelings about the assisted living unit. Angela and Stella do not have a strong alliance while Duncan has a stronger alliance with Stan compared to Jeff. Key Issues A genogram was produced to provide more information about the family’s internal structure. The genogram is a useful tool for family assessment because it helps the family nurse to create a summary of the family in a simple manner, gives insight into the functioning of the family, and incorporates the family system in the assessment (Hemphill & Dearmun, 2010; McMurray & Clendon, 2011). It also provides new insights into the family’s stage of development and adaptability to change (Hemphill & Dearmun, 2010; McMurray & Clendon, 2011). The genogram reveals two key issues: Sally’s psychosocial health and Jake’s delayed development. Sally’s psychosocial development is a key challenge for the family. An assessment of psychosocial development is important because it provides insight into the challenges and stresses faced by family members (Hemphill & Dearmun, 2010). This assessment applies Erikson’s theory to understand the emotions and behaviors of children and other family members. At three years, Sally’s psychosocial development should be at the intuitive stage. According to Erickson’s theory, three-year old children discover their relationships, differences and sex roles during intuitive stage (Avan & Kirkwood, 2010). Girls transfer their love and feelings toothier fathers while the boys vie for their mother’s affection (Hemphill & Dearmun, 2010). Both genders are attracted to adult roles and develop their egos at this phase which creates a sense of guilt or over-obedience. Sally does not depict this behavior. Her psychosocial development depicts an inability to practice self-control or autonomy. Erikson’s theory posits that appropriate psychosocial behavior for children aged between one and three years is autonomy and a sense of shame or doubt (Hemphill & Dearmun, 2010; Megel, Wilson, Bravo, McMahon & Towne, 2011). Sally does not appear capable of understanding how her tantrums evoke negative responses. Angela knows that her daughter has temper tantrums which hinders the grandparent’s ability to socialize with the girl. Sally uses her tantrums to exert her will regardless of the social rules that dictate behavior for children her age such as being content instead of using temper tantrums for selfish purposes. The challenge for Courtney family is to focus on Sally’s parenting. They need to teach her how to be content and understand how social rules influence individual behavior. Parents also need to avoid being over-controlling to give their children the autonomy to do things independently (Hemphill & Dearmun, 2010). Sally needs to learn social behaviors from her parents without affecting her free will or autonomy. Giving the child responsibilities such as clearing her plate would build Sally’s confidence in her feeding abilities (. In addition, Sally needs to learn emotional problem solving and to develop communication skills so that she can express herself clearly and verbally. Sally also needs to be taught to listen to her siblings, parents or authority and to respond to what she is told in a direct and clear manner. Jake’s delayed development is another issue for the Courtney family. Parents are required to take their children for regular well-child consultations. These consultations provide an opportunity for health care practitioners to assess the physical health, cognitive growth and the development of children periodically (Belsky & Haan, 2011; Mitchell & Ellis, 2011). The intervals for consultations often coincide with the milestones for child development. A family assessment of the child’s development would also require an evaluation of the home environment (Mitchell & Ellis, 2011). The home environment needs to be evaluated to ensure that the Jake has adequate and age-appropriate toys and play activities. In addition, Angela needs to be encouraged to follow up with regular child surveillance activities or check-ups. These check-ups ensure early detection and treatment for the child’s health issues before joining school. A parenting program would also be beneficial for Angela. Parenting programs provide support services to parents such as day care and group sessions where parents share the challenges associated with parenthood (Glascoe & Lee, 2010). The sessions would teach Angela how to cope with family challenges, communicate her needs, have a positive outlook to her family’s wellbeing and survive difficult times (McMurray & Clendon, 2011). These group sessions would help Angela to enhance her interactions with the children, improve her parental confidence, enhance her emotional well-being and provide an opportunity for forming strong support networks (Nelms & Eggenberger, 2010). Conclusion This paper performed an assessment of the Courtney family using CFAM. The assessment reveals that the family has two key issues: the developmental delay of the lastborn and the psychosocial development of Sally. These two issues reveal the need to strengthen the Courtney’s family through resilience and adaptation. Angela needs emotional support to help her improve her parental confidence, build resilience to family challenges. and tolerate the physical needs of her children which would require behavioral adjustment. References Avan, B. I., & Kirkwood, B. R. (2010). Review of the theoretical frameworks for the study of child development within public health and epidemiology. Journal of epidemiology and community health, 64(5), 388-393. Bell, J. M. (2011). Relationships: The heart of the matter in family nursing.Journal of family nursing, 17(1), 3-10. Belsky, J., & de Haan, M. (2011). Annual Research Review: Parenting and children’s brain development: the end of the beginning. Journal of Child Psychology and Psychiatry, 52(4), 409-428. Duhamel, F. (2010). Implementing family nursing: How do we translate knowledge into clinical practice? Part II: The evolution of 20 years of teaching, research, and practice to a Center of Excellence in Family Nursing. Journal of Family Nursing, 16(1), 8-25. Ganong, L. (2011). Return of the “Intimate Outsider” Current Trends and Issues in Family Nursing Research Revisited. Journal of family nursing, 17(4), 416-440. Glascoe, F. P., & Leew, S. (2010). Parenting behaviors, perceptions, and psychosocial risk: impacts on young children's development. Pediatrics, 125(2), 313-319. Hemphill, A., & Dearmun, A. K. (2010). Working with children and families. In Edward A. Glasper and Jim Richardson (Eds.) A textbook of children’s and young people’s nursing (2nd ed.) (pp.17-29). Edinburg: Churchill/Livingstone Elsevier. Lee, A. C. K., Leung, S. O., LingChan, P. S., & Chung, J. O. K. (2010). Perceived level of knowledge and difficulty in applying family assessment among senior undergraduate nursing students. Journal of family nursing, 16(2), 177-195. Léveillé, S., & Chamberland, C. (2010). Toward a general model for child welfare and protection services: A meta-evaluation of international experiences regarding the adoption of the Framework for the Assessment of Children in Need and Their Families (FACNF). Children and Youth Services Review, 32(7), 929-944. McMurray, A., & Clendon, J. (2011). Community health and wellness: Primary health care practice (4th ed). Chastwood, NSW: Elsevier Australia. Megel, M. E., Wilson, M. E., Bravo, K., McMahon, N., & Towne, A. (2011). Baby lost and found: Mothers’ experiences of infants who cry persistently. Journal of Pediatric Health Care, 25(3), 144-152. Mitchell, C., & Ellis, I. (2011). Promoting family and health. In D. Kralik and A. Loon (Eds). Community nursing in Australia (2nd ed.) (pp.313-351). Milton, Queensland: John Wiley. Nelms, T. P., & Eggenberger, S. K. (2010). The essence of the family critical illness experience and nurse-family meetings. Journal of Family Nursing, 16(4), 462-486. Riper, M. (2010). Genomics and the family: integrative frameworks. In Handbook of Genomics and the Family (pp. 109-139). New York: Springer. Silva, M., Moules, N., Silva, L., & Bousso, R. (2013). The 15-minute family interview: A family health strategy tool. Rev Esc Enferm, 47(3), 634-639. Appendix 1. Genogram Family Name: Courtney________ Family Nurse: ­­­­­­­­­­­­­­­­­­­______________________ Date: _______________________ Physical Address: ___________________ Generation 1 Generation 2 Generation 3 Key life events Male M Marriage (M) Female S Separated (S) Divorce Marriage line II. The Calgary Family Assessment Model Figure 1. Calgary Family Assessment Model Read More