The Biopsychosocial Model of Assessment - Case Study Example

Running head: FAMILY ASSESSMENT Family Assessment [Writer’s name] [Institution’s name] Family Assessment Introduction This essay will provide the assessments undertaken with Lowanna Pike to obtain data that has then been used to develop the included nursing care plan. Aim of this study was to describe the strengths and stressors of the family using the Australian Family Strengths Nursing Assessment Guide and how to manage major stressors in the family. The case study is based on Josh and Lowanna Pike who have recently moved from a small mining town 500 kilometres away, leaving behind their family and friends. Josh, 34, has secured a relatively good paying job in the city and Lowanna, 32 has a place a University to undertake a teaching degree. They have two children, 5 year old Shawn and Chloe, 3 months. Her son has started to wet his bed, she is also afraid that she may be pregnant and that she will have to drop her plan of joining university. This may mean that she will not be able to return to the small mining town. Analysis The Biopsychosocial Model The biopsychosocial model of assessment maybe able to provide a comprehensive evaluation of Lowanna. It allows information regarding the biological, psychological, sociological, developmental, spiritual and cultural aspects of the patient to be collected (Barling, 2009). This assessment will be able to establish a baseline by providing a snapshot of where Lowanna. It creates a written record and helps to determine any changes during treatment. Assessments should be performed regularly to monitor any changes in behaviour following the initial assessment. Open ended questions will receive more constructive responses from the patient (Barling, 2009). Biological aspects will include questions regarding the Lowanna current and past health status and a pharmacologic assessment will help to determine what treatment had been given previously, and what medications where prescribed. A physical examination with review of body systems and physical functions should also be undertaken to ascertain if there are any medical issues or problems and also to give a baseline for future reference (Dale, 2005). This will help her find out if she is pregnant or not. Psychological assessments including mental status examination (MSE) which incorporates general observations of appearance, behaviour, attitude, mood, affect, orientation and emotions are also carried out (Melnyk , Fineout-Overholt, Stone & Ackerman 2008). The behaviour shown by Lowanna will help to identify any patterns to significant events, like the shifting to a new town and having to leave her family behind. The information derived from this examination will help to determine Lowanna’s functional status and evaluate her present ability to cope with the problems and pregnancy. Social assessment of Lowanna will help to provide information regarding her functional status, social systems, occupational, economic, legal status and quality of life (Barling, 2009). Important information about Lowanna’s recent fear of having to leave university, her leaving her family, both her children’s problems, after gaining her degree the family had hoped to return to the small mining town they came from. Socially the stressors will effect her as she will not know too many people around. Apart from this, if she is pregnant then she will not be able to make new friends by joining university. Stressors and Strengths Family stress can be defined as "a real or imagined imbalance between the demands on the family and the family's ability to meet those demands" (Clemson, 2000 p1). Bed wetting of Shawn, shifting to a new town and Lowanna‘s pregnancy are the main stressors for Lowanna and her son. Another minor stressor is the fact that she will have to stop giving her baby breast milk. The main stress for this family is shifting to a new town. Shifting to a new town causes confusion and insecurity as the family has to start from scratch. (Lindsey & Mize, 2001). Lowanna is concerned about how she might have to stop thinking about joining university if she is pregnant and Shawn’s bedwetting since they shifted. She is also worried about the fact that her youngest child is demanding a lot of milk and that she may have to stop breast feeding her and give her solids. This to may serve as a stressor as she will have to stop giving her baby breast milk at an early age. Her milk cannot fulfil the requirements necessary for her baby, as she is becoming more and more demanding. This could effect the development of her baby. Shawn also has not shared his anxieties and, thus he wets his bed daily. This is worrying because it can generate a variety of negative impacts not only on Lowanna but, on whole family. However, the fact that Lowanna misses her family and finds that she often complaining to Josh about moving to the city makes matters worse (Darbyshire & Jackson, 2005). This in the long run could also affect their marital relationship. However, this family also has it’s strengths, the fact being that they are trying to adjust to the new environment without letting Josh feel that he has made a mistake by shifting or by telling him how many problems have risen after their shifting. They are a family who supports each other this truly is strength of the family. Nursing Assessments In a case like the above mentioned one the nurse must be aware of and respect the values and beliefs of the family. A nurse should know, that family interaction is an important factor for the development of depression and for the family's adaptation to change. Therefore, the nurse who Lowanna has turned to for help should be family-cantered not only child-cantered, as this issue may impact the whole family. Nursing care should be based on thoughtful, evidence-based scientific planning that includes the preferences and needs of this family (Crisp & Taylor, 2009). When deciding on the best possible clinical intervention for an identified practice problem it seams logical to convert the issue into a single answerable question (Coyer & Klamath, 1999). Several authors have identified that the use of frameworks to inform the development of the clinical question provide the practitioner with a systematic process of formulating an answerable question (Sackets , Richardson, Rosenberg & Hayes 1997; Ridsdale, 1998). One such framework as described by Sackets, Richardson, and Rosenberg & Hayes 1997 (1997) is a four- stage process, known by the acronym PICO: patient or population, intervention or indicator, comparison or control and outcome. The construction of an answerable question is the basis of evidence-based practice and should guide the practitioner to how to find an answer (Ridsdale, 1998). It is important that each variable under the PICO framework is clearly defined, by the nurse being as detailed and explicit as possible in order to extend clarification to the question. Working through PICO methodically, the nurse would instigate Lowanna‘s process by defining the 'Patient or Population'. Characteristics such age, gender and diagnosis would need to be deliberated and, whilst the aforementioned were easily recognised in the practice area as adult , identifying appropriate terminology for diagnosis can prove problematic. A well-formulated search strategy is an essential component in gathering appropriate evidence (Hewitt-Taylor, 2002). Ridsdale (1998) discusses a four-stage search strategy that helps to translate the question into a meaningful search - a) Identify the subject elements of the question b) Define the relationship between the subject elements c) Convert the subject elements into search themes d) Decide on the scope of the search Thus the nurse should follow this in Lowanna’s case. Assistance to define the subject elements can be found within the PICO framework - In accepting this hierarchy of evidence, the nurse should concede that the systematic review of multiple well-designed RCTs constitutes best available evidence , in the case in question (Coyer & Klamath, 1999). Sullivan (1998) adds weight to this argument when he states that, RCTs constitute the strongest source of evidence and that the scientific community prefer the quantitative research technique that makes use of empirical data following a systematic process. Whilst, a number of RCTs were found (Dadds & Spence 1997, Scholing & Emmelkamp,1999). During undertaking the search strategy, none belonged within the patient who had anxiety due to a variety of problems regarding the environment. The only evidence found specific to the original questions were literature reviews aimed at CBT and anxiety with mild depression. The literature reviews (Hatton, 2002) revealed that a number of case studies and a case series had demonstrated the potential feasibility of CBT reducing anxiety amongst the patients. This type of evidence appears in the lower reaches of the hierarchy of evidence, and as such its subjectivity, reliability and validity can be disputed (Sullivan, 1998). Whilst acknowledging the hierarchy of evidence and the proposal that comparative / prospective studies and, ideally RCTs were the best forms of evidence to answer this type of question (Sackets, Richardson, Rosenberg & Hayes 1997). It appears that in their absence the evidence revealed is the best available. RCT with CBT is widely acknowledged as the gold standard of evidence-based practice (Rowland & Goss, 2000). However, it is suggested that they bear little resemblance to day-to-day reality (McInnes etal, 2001). RCTs can be pragmatic or explanatory, the former is concerned with the overall effectiveness of an intervention whilst the latter examines the impact of specific treatment elements on outcome (Parry, 2000). However, neither considers the perspectives and uniqueness of the respondents. The evidence recovered for the question (Hatton, 2002), as for Lowanna ,lower reaches of the hierarchy acknowledges her feelings due to its qualitative nature (patient centred, holistic and humanistic). Therefore, making it extremely suitable for the case study of nursing phenomena along with its relevance as regards answering a therapy question (Parry, 2000). Nursing Interventions The formulated nursing diagnoses provide direction for the planning process and the selection of nursing interventions to achieve the desired outcomes (Crisp & Taylor, 2003). Expected outcomes are what are expected to be achieved by implementation of nursing interventions. With most of the research evidence displaying integrated treatment as the most successful type of treatment for Lowanna . Martel etal (2001), believe the integrated combined together with a cognitive based therapy (CBT) approach is successful with patients suffering anxiety due to a lot of problems. The fact that Lowanna and her family’s strength is adjustment, this would be the best one for CBT. CBT is based on the basis that individuals lack the appropriate and adequate affective, emotional, and behavioural skills to deal with negative and distressing situations. Due to this their anxiety levels go high. However, this family has good adjustment skills and if the CBT can help them use this strength to try to deal with the problems. (Martel etal 2001). Additionally, Lam & Cheng (2001) have recently reviewed the evidence for cognitive based integrated therapy programs. They noted that, anxiety improved among a proportion of patients following only minimal intervention for the problems. They suggested that, depending on the patient’s amount of anxiety and intensity of problems use would depend on how much treatment was needed and whether it was inpatient or outpatient setting. (Lam & Cheng 2001). A sound therapeutic relationship provides a passageway to communication, understanding, warmth, respect and acceptance (Dale, 2005). Thus, the nurse should have a good sound relationship with Lowanna. Evidence based practice is additionally as important, it is about applying the best available evidence to a specific clinical question. Practise based on evidence can reassure the patients and clinicians that quality clinical care is being received (Melnyk and Fineout-Overholt, 2005) .They also encourage nurses to think critically about the perspectives that they bring to their practice (Melnyk & Fineout-Overholt, 2005). All this suggests that, it is imperative to work collaboratively with Lowanna and create a safe therapeutic environment incorporated with evidence based practice in order to achieve results. Conclusion The above case study is based on a family who has recently shifted to a new city from a small mining town. The problems, which Lowanna Pike and her children are facing, may be tackled with the intervention mentioned in the analysis of the paper. Lowanna Pike seems to a normal functioning house wife, however the shifting along with the problems of her children have caused her to feel distressed. Her hope of gaining her degree was the only thing which could help them in to returning to the small mining town they came from. Her being pregnant worries her that this may result in her being unable to undertake her degree, and prevent them from returning home. These problems and fears have become anxieties for Lowanna. This may result in depression if the interventions given in the analysis are not followed. The nurse, she has asked for advice has even given an intervention regarding her son who may also be going into depression. His bedwetting habits and not talking to nay one but his parents are all symptoms of this. The fact that CBT and RCT is recommendation for Lowanna, thus her only way of living a happy life is by taking up this recommendation. References Barling, J 2009, Assessment and Diagnosis in R Elder, K Evans, D Nizette (ed), Psychiatric and Mental Health Nursing, 2nd ed, Elsevier Mosby, Sydney. Clemson (2000); From Family Stress to Family Strengths p1 retrieved from http://nasdonline.org/document/1455/d001249/from-family-stress-to-family-strengths.html Colyer, H. Kamath, P. (1999). Evidence-based practice A philosophical and political analysis: some matters for consideration by professional practitioners, Journal of Advanced Nursing, 29(1), 188-193. Crisp, J & Taylor, C (2003). Potter & Perry's Fundamentals of Nursing, Elsevier Mosby, Marrickville. Dadds, M.R. Spence, S.H. (1997). Prevention and Early Intervention for Anxiety Disorders: A Controlled Trial, Journal of Consulting and Clinical Psychology 65(4), 627-635. Dale AE (2005). Evidence-based practice: compatibility with nursing. Nurs Stand 19 (40), 48–53. Darbyshire P., Jackson D. (2005). Using a strengths approach to understand resilience and build health capacity in families. Contemporary Nursing, 18(1-2), 211-12. Hatton, C. (2002). Psychosocial interventions for adults with intellectual disabilities and mental health problems: A review, Journal of Mental Health, 11 (4), 357-373. Hewitt-Taylor, J. (2002). Evidence-based practice, Nursing Standard, 17 (14-15), 47-52. Lam Danny and Cheng Linda (2001). Cognitive behaviour therapy approach to assessing dysfunctional thoughts. Counselling Psychology Quarterly, #3 14. Lindsey, E. W., & Mize, J. (2001). lnterparental agreement, parent-child responsiveness, and children's peer competence. Family Relations, 50(4), 348-354. Martell, Christopher R.; Michael E. Addis, Neil S. Jacobson (2001). Depression in Context: Strategies for Guided Action. New York: W. W. Norton McInnes, E. Harvey, G. Fennessy, G. Clark, E. (2001). Implementing evidence-based practice in clinical situations, Nursing Standard, 15 (41), 40-44. Melnyk, B. M., & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia, PA: Lippincott Williams & Wilkins. Melnyk, B.M., Fineout-Overholt, E., Stone, P., & Ackerman, M. (2008). Evidence-based practice: The past, the present, and recommendations for the millennium. Pediatric Nursing, 26(1), 77-80. Parry, G. (2000). Evidence-based psychotherapy In: Rowland N. Goss S. (Eds) Evidence-Based Counselling and Psychological Therapies Research and Applications, London, Routledge. Ridsdale, L (1998). Evidence-based Practice in Primary Care, London, Churchill Livingston. Rowland, N. Goss, S. (2000). Evidence-Based Counselling and Psychological Therapies Research and Applications, London, Routledge. Sackett, D.L. Richardson, W.S. Rosenberg, W. Hayes, R.B. (1997). Evidence-based medicine: how to practice and teach EBM, London, Churchill Livingston. Scholing, A. Emmelkamp, P.M.G. (1999). Prediction of treatment outcomes in social phobia: a cross-validation, Behaviour Research and Therapy, 37, 659-670. Sullivan, P. (1998). Developing evidence-based care in mental health nursing, Nursing Standard, 12 (31) 35-38. Read More

This will help her find out if she is pregnant or not. Psychological assessments including mental status examination (MSE) which incorporates general observations of appearance, behaviour, attitude, mood, affect, orientation and emotions are also carried out (Melnyk , Fineout-Overholt, Stone & Ackerman 2008). The behaviour shown by Lowanna will help to identify any patterns to significant events, like the shifting to a new town and having to leave her family behind. The information derived from this examination will help to determine Lowanna’s functional status and evaluate her present ability to cope with the problems and pregnancy.

Social assessment of Lowanna will help to provide information regarding her functional status, social systems, occupational, economic, legal status and quality of life (Barling, 2009). Important information about Lowanna’s recent fear of having to leave university, her leaving her family, both her children’s problems, after gaining her degree the family had hoped to return to the small mining town they came from. Socially the stressors will effect her as she will not know too many people around.

Apart from this, if she is pregnant then she will not be able to make new friends by joining university. Stressors and Strengths Family stress can be defined as "a real or imagined imbalance between the demands on the family and the family's ability to meet those demands" (Clemson, 2000 p1). Bed wetting of Shawn, shifting to a new town and Lowanna‘s pregnancy are the main stressors for Lowanna and her son. Another minor stressor is the fact that she will have to stop giving her baby breast milk.

The main stress for this family is shifting to a new town. Shifting to a new town causes confusion and insecurity as the family has to start from scratch. (Lindsey & Mize, 2001). Lowanna is concerned about how she might have to stop thinking about joining university if she is pregnant and Shawn’s bedwetting since they shifted. She is also worried about the fact that her youngest child is demanding a lot of milk and that she may have to stop breast feeding her and give her solids. This to may serve as a stressor as she will have to stop giving her baby breast milk at an early age.

Her milk cannot fulfil the requirements necessary for her baby, as she is becoming more and more demanding. This could effect the development of her baby. Shawn also has not shared his anxieties and, thus he wets his bed daily. This is worrying because it can generate a variety of negative impacts not only on Lowanna but, on whole family. However, the fact that Lowanna misses her family and finds that she often complaining to Josh about moving to the city makes matters worse (Darbyshire & Jackson, 2005).

This in the long run could also affect their marital relationship. However, this family also has it’s strengths, the fact being that they are trying to adjust to the new environment without letting Josh feel that he has made a mistake by shifting or by telling him how many problems have risen after their shifting. They are a family who supports each other this truly is strength of the family. Nursing Assessments In a case like the above mentioned one the nurse must be aware of and respect the values and beliefs of the family.

A nurse should know, that family interaction is an important factor for the development of depression and for the family's adaptation to change. Therefore, the nurse who Lowanna has turned to for help should be family-cantered not only child-cantered, as this issue may impact the whole family. Nursing care should be based on thoughtful, evidence-based scientific planning that includes the preferences and needs of this family (Crisp & Taylor, 2009). When deciding on the best possible clinical intervention for an identified practice problem it seams logical to convert the issue into a single answerable question (Coyer & Klamath, 1999).

Several authors have identified that the use of frameworks to inform the development of the clinical question provide the practitioner with a systematic process of formulating an answerable question (Sackets , Richardson, Rosenberg & Hayes 1997; Ridsdale, 1998).

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