Running head: FAMILY ASSESSMENT

Family Assessment Jessica M Hart Goldfarb School of Nursing at Barnes Jewish College NURS 4440 21 February 22, 2013

FAMILY ASSESSMENT Family Assessment Family nursing can be one of the most important assets to a family. Not only is a family nursing worried about her patient but also how that patient interacts in the family setting. I assessed a Caucasian family from Christopher, IL. This household consists of two married

adults (Rex and Amy) and two of their children (Jenna and Dillan). They have an older daughter (Alicia) that has already moved out on her own (see Figure 1 on p. 3). Both parents smoke in the home so my assessment will focus on this issue. Tobacco-related diseases are the most preventable cause of death and illness in the United States. It is estimated that 1 in 5 deaths occur because of smoking. Thats about 440,000 people in this country alone every year and about 5 million people worldwide (Nelson, Li, Sorensen, & Berkman, 2012, p. 1767). Additionally, secondhand smoke can cause serious health problems to children, including respiratory symptoms, middle ear infections, allergies, asthma, decreased lung function and cognitive function, and increased emotional arousal and behavioral problems (Chen, Hsiao, Miao, & Chen, 2013, p. 193) The parents grew up in same neighborhood and attended school together. They started dating when Amy was seventeen years old. At this point Rex already had six month old Alicia from a previous relationship. Amy adopted her and took on sole mother role from the very beginning. Neither adult is sure of family lineage past great grandparents who were all in this area their whole lives as far as they know. The whole family is Christian but do not attend church at this time. They are a middle class family with Amy as the sole wage earner. Rex collects disability because of a health condition. She handles stress of being single earner very well. So

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FAMILY ASSESSMENT does the family according to a family Apgar score of 10/10. Both adults grew up in lower middle class families so they feel that they have improved.

This family is in stage VI: families launching young adults according to Duvall. They are fulfilling each task successfully. They have recently assisted their oldest daughter Alicia in finding an apartment. Alicia is currently attending a local community college full time. They continue to be involved with their younger children. Both parents are active and supportive with school sports and functions. They are readjusting well to the added alone time. They both stated that their sexual relationship has always been good and continues to improve with age. Both parents wanted children; however, the youngest was unexpected but welcomed. Amy states that they still have that spark and enjoy embarrassing the kids and showing them what love is supposed to look like so hopefully one day they wont settle for mediocre. Rex agreed. So far they do not have to worry about assisting aging and ill parents, because Amys parents are both healthy and Rexs mother has had health problems for decades but they are not close (Friedman, Bowden, & Jones, 2003, p. 125). Their extended family history is limited. Amys family: Father was a coal miner and dog trainer and mother was a house wife and took care of the children. Both grew up in the same area. Rexs family: Parents were married but divorced when he was 10 years old. Amy states that Rexs mother is uncertain if his dad is actually his father. Both he and his father are unaware of this. They own and live in a four bedroom, two story, older wooden house with a basement. The outside of the house is in good condition. Guttering needs fixed and no railing is present on the stairs leading up to the front door. The living room has a flat screen television with both a WII and an Xbox. The kitchen has a new gas stove and refrigerator. They do have a kitchen

FAMILY ASSESSMENT table, but the family eats in the living room together. Rex and Amy have their own bedroom upstairs which contains a master bath. Both children have their own rooms downstairs and a

bathroom that they share. There is an extra bedroom that Alicia used to inhabit when she lived at home. Decorations consist of family photos and things that Amy and Jenna have Bedazzled. Both parents state that they are happy with the size of their home. It has adequate heating, cooling and lighting. They have one pet, a French bulldog named Meat. There are no signs of infestation. The home is kept clean. Only safety hazard is that the outside steps do not have a railing. Christopher is a very small, rural town of a little under 2400 people. It is composed mostly of lower-middle class and working class families. There is no form of public transportation and no supermarket, but both adults have safe, personal transportation. Amy does most of the familys shopping on the way home from work which she commutes to 28 miles one way. The family has lived in the same community and neighborhood for all their lives. The whole family communicates openly. Rex is very quiet but will answer questions when asked. He talks more with his son than his daughter. The children ask questions of both parents equally although it is usually Amy that makes the final decision. Communication between spouses is effective, and both state that they are happy with their marriage. The only area of closed communication that was noted was with extended family which seems minimal. They make large decisions together but Rex seems to hold more weight in the really big decisions. Household work and work outside, such as fixing things and the lawn, is done by him. Amy as a lot of resource power because she is the sole earner and works 40-50 hours / week. She is in charge of bills and distribution or funds. She delegates household chores evenly

FAMILY ASSESSMENT between the Jenna and Dillan. The children have a large amount of influence on what is done in the evenings based on school work and school activities.

Both parents have legitimate and reward power over the children. Amy has resource and expert power over both of the children and Rex because of her job as a nurse. Both Rex and Amy seem to attempt to equalize power and decision-making. Overall, however, it seems that the Amy is the dominant one in the family. Each family member has distinct roles that keep the family moving forward. Rex is father and husband. He is currently disabled but used to work as a truck driver and welder. Because he is home every day he really takes on a parental role, especially with Dillan. Both he and Amy have companion, therapeutic, sexual roles in their marriage, which they state is above average. Amys main roles consist of mother and wife. She shares a fairly symmetrical relationship with Rex. She acts as sole wage earner, working full-time. She acts as cook and shopper but delegates cleaning to the children. She enacts a childcare role assisting with homework and driving to functions. She also takes on the recreational role although this is somewhat easier because of them living in a small, safe neighborhood, because the children are able to run freely with little to no supervision. She does experience some role strain but handles it well by communicating and gathering help from her family and friends. Jennas role is that of the younger daughter and sister to siblings, cheerleader, student and dishwasher. Dillan is the only son and brother to siblings, student and towel washer. I asked each individual separately what they thought about the roles that the others played and found that Rex is the distant one. He plays a role in his childrens and wifes lives but often stays home because of being tired (r/t his illness). Amy plays multiple roles, such as: the encourager and family caretaker. She is always positive and attempts to lift up others in the

FAMILY ASSESSMENT family. She is always initiating new ideas and contributing when needed. She is the one person people call when they have a problem, because she thinks outside of the box. She is also the family coordinator working to make sure that everyone gets where they are supposed to be. Jenna is the cooperative, peppy one according to Amy. Rex describes Dillan as the hyperactive, sweet child. Values are very important to them, especially Amy. Their values are fairly congruent with the normal American family. A lot of emphasis is put on honesty. Work ethic is very

important to them, especially the Amy. Education seems just as important, as well as health care because of Rexs health conditions. With Amy being a nurse she holds the function of health care in high regard. Rex has been sick for a long time, and no doctors would listen so she took it upon herself to find him a specialist that would listen. She finally did and it saved his life. The only value this family differs in is the often misplaced value on worry. Amys favorite saying is, Did anyone die? No? Then its ok cause the only thing you cant fix is dead. No one has any allergies to food or medications. However, Rex is on numerous medications. He is a very picky eater so the family does not eat many vegetables, but they do get sufficient daily calorie intake. Both parents drink numerous cups of coffee on a daily basis and beer socially. They both smoke about one pack of cigarettes per day. I chose smoking as their family issue because 40% of children come in contact with second hand smoke in their homes (Chen et al., 2013, p. 193). While actually smoking the cigarette yourself is harmful, the smoke that comes off the end of the cigarette and straight into the air is more toxic (Jones & McEwen, 2012, p. 389). The risk is not only a problem now but also in the future. Children that have parents the smoke are more likely to become smokers themselves. Around 17,000 adolescents begin smoking by fifteen years of age every year. This

FAMILY ASSESSMENT statistic is directly related to having someone smoke at home on a regular basis (Jones & McEwen, 2012, p. 389). Even if they did not want to quit themselves, by making their home smoke-free it could help prevent the childrens exposure to second hand smoke (Chen et al., 2013, p. 206). However, in the home is not the only place that second hand smoke is a danger. Exposure to second hand smoke in cars has also been linked to with adverse health effects including an increased risk of allergic and respiratory symptoms, in particular, wheeze and hay

fever symptoms and an increased risk of never-smoking children reporting at least one symptom of nicotine dependence by the time they become adolescents (Jones & McEwen, 2012, p. 389). One issue related to smoking that most people are not aware of is that it can cause dental problems (beyond merely staining the teeth) The risk of periodontitis increases with every cigarettes smoked and is also an issue with non-smokers that come into frequent contact with second hand smoke (Sutton, Ranney, Wilder, & Sanders, 2012, p. 186). The family nursing diagnosis that I chose for my care plan is: Ineffective Family Health Maintenance R/T deficient knowledge AEB smoking in the home . Suggested outcomes: Parents and children will explain harmful effects of second hand smoke immediately following education session Parents will cease smoking in home/vehicles within one week Parents will decrease number of cigarettes smoked per day to half a pack within one month Nursing interventions Establish a partnership with the clients to collaborate on finding goals that fit their lives.

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Develop a contract with the family to maintain motivation for change in behaviors. Creating a contract can assist in keeping track of progression. It may also make them feel more obligated to change. By involving the children the parents are more likely to want to make a change.

Listen to their stories about any previous attempts at quitting or cutting back. This can give you insight on what might work for them or for what they have already tried and failed. Their previous failures may assist you in coming up with potential barriers.

Assess for barriers that may interfere with treatment recommendations. For example, these barriers may be cost (if pharmacotherapy is provided) or inclement weather.

Involve family members in education and shared decision making. If the client has support they are more likely to succeed. The National Centre for Smoking Cessation and Training (NCSCT) has free training available in the form of modules. These modules provide information for the nurse on: the harms caused by secondhand smoke, why it is important to raise the issue, how to ask, advise and act, and encouraging and supporting behavior change (Jones & McEwen, 2012, p. 391).

Identify what the family already knows and adjust teaching accordingly. Learning what the client already knows will speed up the process as well as identify areas that need to be addressed. They should be aware that if a smoking bans is enacted, it is very important that it is a complete ban and not just a partial (like smoking only in one room). By having a smoke free home you increase the chances of smoking less or quitting entirely (Jones & McEwen, 2012, p. 390). Attempt to make the education fit the family. They may know that smoking increases chances of lung cancer but the numbers are staggering and may help persuade the family to quit smoking entirely. Smoking causes

FAMILY ASSESSMENT about 80% of lung cancers in men and about 50% in women (Woodgate & Kreklewetz, 2012, p. 2). -

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Provide health information that is consistent with the health literacy of clients. With the client being a nurse information should be at a higher competency level.

The government has attempted to control smoking in numerous ways. One of the ways they attempted this was to require cigarette companies to put nine graphic warnings on the top half of each cigarette pack including a phone number to a smoking cessation hotline. This should have gone into effect January 2013; however, it was ruled unconstitutional (Goodfellow, 2012, p. 1528). The government is limited in many ways so the role of the nurse is very important for getting education out into the communities. Education is the most important intervention that we can perform. This family seemed extremely positive about making this change and was excited about the future.

FAMILY ASSESSMENT References

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Ackley, B. J., & Ladwig, G. B. (2011). Nursing diagnosis handbook an evidence-based guide to planning care. (9th ed.). St. Louis, Missouri: Mosby Elsevier. Chen, Y., Hsiao, F., Miao, N., & Chen, P. (2013). Factors associated with parents perceptions of parental smoking in the presence of children and its consequences on children. International Journal of Environmental Research and Public Health, 10(1), 192-209. doi:10.3390/ijerph10010192 Friedman, M. M., Bowden, V. R., & Jones, E. G. (2003). Family nursing: Research, theory & practice (5th ed.). Upper Saddle River, N.J: Prentice Hall. Goodfellow, L. (2012). Asthma and tobacco: not to be shared with family and friends!. Respiratory Care, 57(9), 1528-1529. doi:10.4187/respcare.02056 Jones, L., & McEwen, A. (2012). Reducing secondhand smoke exposure at home. British Journal Of School Nursing, 7(8), 389-393. Nelson, C., Li, Y., Sorensen, G., & Berkman, L. (2012). Assessing the relationship between work-family conflict and smoking. American Journal Of Public Health, 102(9), 17671772. doi:10.2105/AJPH.2011.300413 Sutton, J. D., Ranney, L. M., Wilder, R. S., & Sanders, A. E. (2012). Environmental tobacco smoke and periodontitis in U.S. non-smokers. Journal Of Dental Hygiene, 86(3), 185194. Woodgate, R., & Kreklewetz, C. (2012). Youth's narratives about family members smoking: parenting the parent- it's not fair!. BMC Public Health, 12(965). doi:10.1186/1471-245812-965