Running head: FAMILY ASSESSMENT

Nursing 341 Family Assessment Sara J Staffen Ferris State University

FAMILY ASSESSMENT Family Assessment I performed a nursing family assessment on the W family that is a non-relative acquaintance of mine. They are a nuclear family that consists of three members currently, with

another child expected in January 2014. The mother is twenty five years old, the father is twenty six, and their oldest child is a two year old girl. The family relationship with paternal grandparents, both aged 53, was also assessed via personal communication with the mother M.W. Stage of Family Development According to Duvalls family developmental theory, the family I assessed is in stage II: families with infants. (Wong, 2001). Duvall states that at this point in development there are three developmental tasks that should be met by the family. The infant should be integrated into the family unit, the family should accommodate to new parenting and grand parenting roles, and both should maintain the marital bond. (Wong, 2001). It is evident by interaction with the family that the infant, S.W., is fully integrated into the familys life. She is their main focus and they are very proud to tell stories about her. The family has a daily routine in place that includes family time and work while the grandparents regularly participate in child care during the week. They appear to have adjusted well to parenting, however the dynamics are about to change and everyone will have to accommodate parenting two children soon. Maintaining the marital bond has been a difficult task for the parents, M.W. and J.W. They have been together for a significant amount of time, but unfortunately there has been some emotional infidelity committed by J.W., the father. The couple has attended marriage counseling and M.W. indicates that it has helped but they have trouble communicating and still have some trust issues to work through. According to Eriksons developmental theory S.W., the oldest child, is in the stage of Autonomy vs. Shame. (Eriksons Stages of Development, 2007-2013). The parents encourage

FAMILY ASSESSMENT autonomy by allowing S.W. to express herself; one of her favorite things to do is pick out her

own outfits. She does not always match from head to toe, but she is very proud of what she picks out. S.W. is also experiencing her terrible twos. She is defiant at times pressing the limits of what she can get away with and she is very stubborn. S.W. likes to run around the house and play with toys even after she has been told to put something away. She will screech loudly if something isnt going her way. The grandparents are in Eriksons stage of the middle-aged adult: Generativity vs. Stagnation. (Eriksons Stages of Development, 2013). This is affirmed by the fact that their careers and family really are the most important things in the grandparents life. This is evidenced by talking to the grandparents and the clients of the grandmothers hair salon that her clients clearly love her and value her services. Major life shifts have taken place recently in the grandparents life, as the grandfather has stayed in the same field of work but he has changed jobs and the company he works for. Home Environment As I was performing the family assessment, I also evaluated their home and living environment. The family home appears to be well kept, there are a lot of belonging but they are picked up off the floor and in appropriate places. Upon entering the home, the mother states excuse my house, its a little messy, I like to call it lived in. As I was driving to the familys home I noted that the neighborhood seemed very charming, it is set back in the woods about ten minutes from Big Rapids, the houses are single-family style homes with one to two floors that have relatively large side and back yards. The mother expressed some anxiety with the river being just across the street. We have not told our daughter S.W. that the river is right there, she is smart and it scares me that there is such close access to water. I have never been to the

FAMILY ASSESSMENT grandparents house, so I asked the mother to describe it for me. They have a nice house; it is a manufactured type home that they have added on to several times. Their house is quite cluttered but it is kept clean. They live in the country and dont have any close neighbors for at least a mile.

I would describe the socioeconomic status of the family as lower-middle class. They are a working family just starting out as first time homeowners. They live paycheck to paycheck and at times barely have enough to pay all of the bills. The mother is a graduate of radiography technology but due to a lack of jobs in the area, she works as a bank teller. The father is a mechanic and works a lot of hours. The socioeconomic status of the grandparents is middle class. The grandmother is a hair salon owner and the grandfather is a truck driver whom drives freight across the country. Culture and Traditions The family is Caucasian, I asked the mother about the familys heritage on either side and she was unsure of their roots. She described her family as American. When I asked the mother, M.W., about her familys religious views she said we dont go to church regularly, but we believe in God and everything. I guess were just Christians because we dont really identify with a specific denomination. J.W.s parents do not go to church regularly either, but we all believe in God. M.W. indicated that the family does not have any cultural practices that she thinks are note worthy. We celebrate Holidays and what not, but I cant think of any specific traditions that we partake in. M.W. also stated As far as health care, I dont think we have any beliefs that stop us from attaining health care for any of us. I believe in immunizing my children against communicable diseases and I take S.W. to the Doctor regularly for well check-ups and when shes sick.

FAMILY ASSESSMENT Family Functions The family shares the responsibility of child care duties. The mother, M.W., takes

responsibility for caring for S.W. most of the time at home but she also has support. Two days of the week S.W. goes to a day care center and four days a week, both maternal and paternal grandparents share child care duties while the parents are at work. The mother and father provide safety and security for the family by providing shelter, a home for the family to live in, basic needs such as food, and financial stability. The grandparents contribute to familys security by caring for the child while the parents work to afford their basic needs. J.W. also has guns, locked in a safe, to protect his family from home invasion. Both J.W. and M.W. encourage their child S.W. to meet milestones in learning new things and compliment her regularly when she does something well. The parents encourage S.W.s independence and take pride in watching her learn and understand new concepts. M.W. indicates that she turns to family members and close friends/co-workers for support when she is feeling down. M.W. does the majority of the household chores and feels she has to nag J.W. to get his help. The family does try to include two year old S.W. in the household chores, to instill a good work ethic, when it is something age appropriate that she is capable of doing. Possible Role Strain There are several potential sources of role strain for the W family. M.W. often feels overwhelmed by her roles as a mother, wife, and housekeeper. There will be a newborn in the family very soon and that could potentially cause role strain for the oldest child. In the future, as the family continues to grow, the older children may feel left out or as though their household duties have grown exponentially as the parents are busy caring for the new baby.

FAMILY ASSESSMENT Communication

M.W. indicated several times throughout the assessment that their family is not very good at communicating with each other and that is in fact probably their biggest fault. M.W. said the tone that we talk to each other in really depends on the day. Were not good at communicating with each other and everything ends up being a fight. If there is a problem usually we just let it build up until something has to give. We try not to yell or fight in front of S.W. though. From what M.W. has told me, I get the impression that problems really arent solved in their family. Things are just swept under the rug until finally one person or another has had enough and all the little problems turn into one big fight. When the grandparents get involved, they tend to take the side of their only son, J.W. M.W. did reveal that she and J.W. attended marriage counseling three months ago and they were actually making progress in their relationship. They went on a planned vacation and missed their counseling session and have not been back since. Discipline The parents do not believe in spanking their children. They choose to discipline S.W. through verbal reprimanding and occasional time-out sessions. The time outs are not regular and only last for a couple of minutes as per her age. Both parents share the duty of disciplining S.W., whose most common offense is not listening or getting into things she knows she is not supposed to. I noticed S.W. is a rambunctious two year old, running around the house and giggling. Family Weaknesses The areas several areas of concern for this family, the largest issue specifically includes their lack of communication which is a major deficit and leads to other problems in their relationship. According to M.W. her husband J.W. is self-absorbed at times and suffers from only child syndrome. He was raised as an only child, therefore is used to be catered to and

FAMILY ASSESSMENT having things go his way without compromise. M.W. often resents her husband because of his unwillingness to compromise and the multitude of daily tasks expected to be completed by her without much help. J.W. makes a point that his wife tends to nag and pick fights over minuscule

issues. Daughter S.W. is a good child but she is stubborn and has a problem listening to direction at times. The only problem M.W. expressed about the grandparents is that sometimes they go over the parents head and allow S.W. to do or have something that parents have already said no to. Family Strengths The family unit as a whole is a close knit supportive group. They are there for each other when it matters and help each other out in times of need. The grandparents are actively involved in S.W.s life and often care for their grandchildren.

Running head: FAMILY ASSESSMENT 8 Educational Needs/Interventions

Nursing Diagnosis

Necessary Assessments/Interventions
Assess for precipitating events, family members perceptions of the problems, family strengths & weaknesses, developmental levels of family members, and coping ability. Provide opportunity for family to express concerns, fears, and expectations. Promote communication and support Assist family in breaking down problems into manageable parts. Assist with problem-solving Assist family is setting realistic goals and expectations Refer to social services or counseling

Rationale
Scholars Morr-Serewicz, Dickson, Huynh Thi Anh Morrison, and Poole (2007) state that increasing autonomy and the decline of reliance on parents are expected components of development during young adulthood. However, continuing family relationships is just as important for developing a healthy sense of self and maintaining future relationships. When the parents in the W family are fighting, the grandparents tend to take sides. This is not beneficial for any party involved because both M.W. and J.W. need the support of the grandparents they look to as role models. These same researchers have identified a variety of communication behaviors that contribute to relationship maintenance. Including positivity, openness, talking about the relationship and disclosing needs, reassurance, emphasizing commitment and continuation of the relationship, and sharing household tasks. (Morr-Serewicz et al., 2007). The nurse should facilitate continuity of familial relationships and refer family counseling services when appropriate to avoid a breakdown in the family structure and daily process. The family will soon be caring for a newborn baby and another child under the age of two years old. Sleep deprivation is viewed as a regular part of parenting a newborn but it can have real physiological consequences. One study by Balkin, Rupp, Picchioni, and Wesensten, (2008) suggests that sleep loss has been proven to debilitate many mental capabilities, ranging from simple psychomotor skills and mood

Risk for: Interrupted Family Processes

1.

2. 3. 4.

Risk For: Disturbed Sleep Pattern. AEB: Newborn to care for soon, parents voice concern about raising two young children.

Assess familys past sleep patterns, current anxiety levels related to sleep deprivation and raising a newborn 1. Instruct family to follow a consistent sleep pattern and establish a schedule with the children as best possible 2. Instruct family members to avoid strenuous activity

FAMILY ASSESSMENT before bed time, over exhaustion can lead to worse insomnia 3. Recommend an environment conducive to good rest. Such as the parents bed, not a chair in the babys room. 4. Explain the need to avoid concentrating on the next days activities or ones problems at bedtime

9 changes to decision making and a lapse in major mental functions. Due to changes in circulating hormones, sleep loss may also impact metabolism and energy expenditure leading to obesity in previously healthy weight individuals as well. (Balkin et al., 2008). Therefore, it is important to help the family adjust to being new parents and establish a routine that will allow them the most amount of sleep possible for proper daily functioning. Dalemans, De Witte, and Beurskens, (2013) defines communication vulnerable people as those who struggle to communicate in a particular environment. In the case of the W family, the parents struggle to communicate with each other in their home living environment. This barrier in communication impacts activities of daily life for the W family. Problems are not dealt with and emotional needs are not met, which adds stress to their relationships. Research shows that communication between professionals and family members is the best received. This is possibly because family members found it important to feel welcome, involved and informed, which is often easier for a third-party to do without bias. Nurses should be aware of the needs of family members and facilitate other types of communication when verbal conversation is lacking. (Dalemans et al., 2013). The W family has acknowledged that their lack of communication is a major frustration in their lives. They have attended marriage counseling and M.W. sticking by her husbands side even during his infidelity, proves that she loves him and is willing to work through their marital issues.

Assess how family is managing communication and potential difficulties, assess circumstances that result in familys desire for better communication

Communication, 1. Determine clients developmental level of speech Readiness for and language comprehension. Provides baseline for Enhanced. AEB: developing plan for improvement Attendance of Marriage 2. Evaluate level of anxiety, frustration, or fear, Counseling presence of angry, hostile behavior preventing proper communication 3. Observe body language, eye movements, and behavioral clues. May reveal unspoken concerns 4. Encourage family to use new successful techniques for communication

FAMILY ASSESSMENT References

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Balkin, T., Rupp, T., Picchioni, D., & Wesensten, N. (2008). Sleep loss and sleepiness: current issues. Chest, 134(3), 653-660. Dalemans, A., De Witte, R., & Beurskens, A. (2013). Challenges in the communication between 'communication vulnerable' people and their social environment: An exploratory qualitative study. Patient Education & Counseling, 92(3), 302-312. Eriksons Stages of Development. (2007-2013). Retrieved from http://www.learningtheories.com/eriksons-stages-of-development.html Morr-Serewicz, M., Dickson, F., Huynh Thi Anh Morrison, J., & Poole, L. (2007). Family Privacy Orientation, Relational Maintenance, and Family Satisfaction in Young Adults' Family Relationships. Journal of Family Communication, 7(2), 123-142. Wong, D.L. (2001). Wongs Essentials of Pediatric Nursing. St. Louis: Mosby.