Family Assessment Paper

Daiane Arruda Saraiva

Dr. Rhonda Powell
Academic Research Paper NU-2320
Milwaukee School of Engineering
May 15, 2015

Outline
Introduction

I.

Family Health Care Nursing

a. Bioecological Systems Theory
b. Presentation of the Family

II.

Family Assessment
a. Gordons Functional Health Pattern
b. Genogram
c. Ecomap

III.

Comparison of assessed family to a family nursing theory

IV.

Reflection

V.
VI.

Family Assessment Conclusion

References

Nurses in family care can promote health education, prevention and improvement.
According to Kaakinen, et al. (2010), families refer to two or more individuals who depend on
one another for emotional, physical, and economic support. The members of the family are selfdefined. In addition, family health care nursing is considered an art with science that provides a
way to deal with family health problems. The interaction between nurses and clients affects the
quality of collecting information, intervention, strategies of care, advocacy, and spiritual
approach with the family members. The concept of nursing care includes relevant assumptions
such as health affects all members of a family, health and illness are important familiar events,
and the members of the family influence the process and outcome of health care service. Nurses

need to apply theoretical knowledge during the assessment of the family. Family nursing theory
is a fusion of nursing conceptual structure and social science focus on the family. In addition,
family nursing theory provides nurses a holistic perspective of the family, comprehension of their
structure system, influence of society on the family, communication style among individuals,
understanding of rules, values, and finally its function in society. Moreover, nursing theory helps
professionals to get important perspectives to incorporate the theoretical knowledge into their
practice. As a consequence, care interventions and understanding of the family needs can be
more effective (pg 4).
It is important to consider all relationship dynamics that are connected with the family.
The bioecological system theory is the ecological approach to understand the multidimensional
aspect of health promotion. According to this theory, proposed by Bronfenbrenner (1977), family
health promotion is one product of family interactions with both factors and systems outside the
home and also the internal family process. The social interactions related to the family occurs
among different system levels: microsystem, mesosystem, exosystem and macrosystem. The
microsystem is related to individual factors such as biology, personal experience, and general
demographics (age, gender, and education). The mesosystem pertains to interaction between the
individuals and their relationships with partners, friends, and families. The exosystem refers to
the community contexts for the family such as schools, work, and neighborhoods. In addition,
macrosystems are defined as a broad context of cultural attitudes, ideologies, and belief systems
that have influence on the family health choices (Kaakinen, et al., 2010). The understanding of
the theory into the nursing practice is a relevant purpose of this assessment. The assessment of
family M. was made in their home. The couple, D. and J., and their dog were present for the
interview. The analyzed family is a nuclear model composed of father, mother, and siblings.

They live in a house situated in Milwaukee which has a good physical structure. The couple were
very communicative, and attentive during the entire interview.
Name
D.
J.
D.
D.
D.

Gender
M
F
M
M
M

Relationship
Husband
Wife
Son
Son
Son

Date and
Place of Birth
04/07/1962
08/19/1966
12/19/1991
03/11/1994
06/17/1996

Occupation
Accountant
Teacher
Student
Student
Student

Education
BA
BA
+ 4 years
3 years
1 year

HEALTH-PERCEPTIONHEALTH-MANAGEMENT PATTERN
1. History
a. How has the family's general health been (in last few years)?
J. said that they have good health. However, almost two years ago her husband D. had
kidney cancer, but in general they have good health.
b. Colds in past year? Absence from work or school?
No, every year they get some small infections but this never was a reason to stay away
from work and school. Only D. had to have six weeks off to be submitted for surgery a
couple years ago. J. said that during most of the year they have good health, and the
family feels blessed because of it.

c. Most important activities to keep healthy? Think these make a difference to health?
(Include family folk remedies, when appropriate.)
The family has the routine to play basketball together every Saturday, especially the boys
and the father. Generally, the family enjoys exercising and playing basketball. J. said that
she prefers practicing exercise at home and watch videos. Moreover, in the spring J. do
exercises at school. All the boys are very active, especially the youngest. They used to
bike, skateboarding and go to the college gym.
d. Members' use of cigarettes, alcohol, or drugs?
No smoking, no drugs, and no alcohol.
e. Immunizations? Health care provider? Frequency of check-ups? Accidents (home,
work, school, or driving)? (When appropriate: storage of drugs, cleaning products,
or scatter rugs?)
The immunization of all family members are updated. They have a pretty good
relationship with their health care provider; all the family are covered by health
insurance. The family has at least one check-up per year, but the boys only go because J.
The family doesnt have any accident history.
f. In past, has it been easy to find ways to follow suggestions of physicians, nurses, or
social workers (when appropriate)?
The family has a good relationship with health professionals because they always ask
questions and participant in their care. Even when there are misunderstandings about
something, they ask for clarification. When their children got sick because they werent
able to eat any products with lactose, sucrose, and maltodextrose, the family learned how
to deal with the health care system. During this experience, they learned that it is

important to listen, but it is also important to ask questions. When the family has a
concern or does not agree with something, it is important to talk and ask questions.
g. Things important in family's health with which I could help?
They believe that exercising is important to health because it helps you have quality of
life in the aging process. It is important to exercise now to have better health in the
future.

2. Examination
a. General appearance of family members and home.
I had the opportunity to talk with the couple J. and D. during the interview their children
were at college. The family M. was very polite and patient with the interviewers.
The family M. house has living room, kitchen, rooms, bathroom, garage and garden. The
house has a good appearance and it was clean and organized.
NUTRITIONAL-METABOLIC PATTERN
1. History
a. Typical family meal pattern or food intake? (Describe.) Supplements (vitamins,
types of snacks)?
The family always makes sure that they have vegetables in every meal. J. said that they
have started to eat more vegetables and to eat out less. Now, the family tends to make
more food instead of going to McDonalds. Sometimes the family goes out to dinner, but
they try to do it rarely. The family believe that it is important to eat breakfast. Moreover,
they have eaten less snacks and potato chips, especially after D., was diagnosed with
cancer. This event changed how they eat, and nowadays they have vegetables and fruits

in every meal. J. said that the family meal routine includes drinking a lot of water, and
eating breakfast, lunch, and a lighter dinner every day. According to J., something has
happened over time because they are baking more, and eating more vegetables instead of
fried chicken. The couple agreed that things definitely have changed as they become
older.
b. Typical family fluid intake? (Describe.) Supplements: type available (fruit juices,
soft drinks, or coffee)?
J. said that all members of the family are coffee drinkers; but she has to drink decaf
coffee, but the boys drink regular coffee. They drink soda just for special occasions or for
an upset stomach, and D. drinks a lot of lemon juice. She is conscious that it is important
to not abuse sugar. The family likes to drink a lot of water and juice. D. had kidney stones
10 years ago and the doctor told him to drink very good lemonade. In summary, the
family drinks a lot of water.
c. Appetites?
According to J., everybody has a good appetite because they are very active, so they are
big eaters.
d. Dental problems? Dental care (frequency)?
The family does not have dental problems because they go to the dentist every six
months. Some years ago companies could pay for workers to have dental care, but now
there is a co-payment for every bill. This change makes the family pay more for dental
care. They believe that all dental service is very expensive.
e. Skin problems? Healing problems?
No, they just take care of their skin, and keep it clean, especially when it is hot.

ELIMINATION PATTERN
1. History
a. Family use of laxatives or other aids?
No, the family does not have stomach problems. They drink a lot of water and J. thinks
that this helps a lot and is associated with the vegetable ingestion.
b. Problems in waste and garbage disposal?
The family does not have any problems.
c. Pets' or animals' waste disposal (indoor and outdoor)?
No, there is a man responsible for taking care of the garden. J. said that his service is
pretty good and he does a very good job in the yard.

d. When indicated: problems with flies, roaches, or rodents?

No problems.
ACTIVITY-EXERCISE PATTERN
1. History
a. In general, does family get a lot of or little exercise? Type? Regularity?
The couple agree that they drink a lot because everybody in the family is very active. For
example, D. walks two blocks every day and plays basketball with hsi friends. He thinks
that everybody in this family is very active.
b. Family leisure activities? Active or passive?
The family likes to go to movies and watch sports events together. They enjoy playing
board games, such as Uno, and Monopoly, but as their children get older, they are playing
other things like video games. J. said that they do many things together but they dont do

much of this now because their children are in college. They also like family vacations,
too.
c. Problems in shopping (transportation), cooking, keeping up the house, budgeting
for food, clothes, housekeeping, house costs?
No, because they recently bought a second car. There are five people and three cars in the
family. So, transportation is very easy for them and their expenses are pretty good.
2. Examination
a. Pattern of general home maintenance and personal maintenance.
The couple has a good income to maintain their home. Family Ms house is clean and
organized. In addition, the couple has adequate personal maintenance because they
maintain proper hygiene.
SLEEP-REST PATTERN
1. History
a. Generally, family members seem to be well rested and ready for schoolwork?
The members of the family get up very well. They have a very good sleeping pattern.
b. Sufficient sleeping space and quiet?
Yes, they have good sleeping space.
c. Family finds time to relax?
Each one has his private space to sleep and relax. They have television in each room. So,
each one can relax or do homework in his own room. However, right now just one son
lives with them and the other two live on campus. One boy only comes on weekends and
the other two only on holidays.

COGNITIVE-PERCEPTUAL PATTERN
1. History
a. Visual or hearing problems? How managed?
All family members wear glasses. No hearing problems.
b. Any big decisions family has had to make? How made?
J. said that when her husband had kidney cancer it was very stressful. She thinks that
dealing with the diagnosis was very difficult. J. defined her husband as a very logical man
and this helps a lot because he finds answers for any problem. They are Christians and
prayers to God helps them in everything. J. argues that their faith in God helps them not
to worry much about anything. They also have good doctors and this helps a lot. They
feel blessed because their doctors are very good and they explain to them everything that
they need to know about the problem. So, they can make decisions easily because the
family understands the process.
2. Examination
a. When indicated: language spoken at home.
English is the language that is spoken by the family.
b. Grasp of ideas and questions (abstract or concrete).
All the answers were concrete.
c. Vocabulary level.
They had a medium vocabulary level.

SELF-PERCEPTIONSELF-CONCEPT PATTERN
1. History

a. Most of time, family feels good (not good) about themselves as a family?
Yes, but they always have something to work on. The couple likes to sit down with the
boys and talk with them to see if everything is going okay. J. said that their conversation
should not be intentional, but natural. They always talk with the kids about college and if
everything is going well.

b. General mood of family? Happy? Anxious? Depressed? What helps family mood?
They described themselves as a blessed family. They believe that happiness is how things
go are, actually, they are very happy. They feel blessed for all that they have. Moreover,
they feel blessed because they have and love each other. J. said that it is not perfect, but
they are learning how to work together. They are very thankful and they think this is the
best word.
2. Examination
a. Mood state generally nervous = 5 or relaxed = 1; rate from 1 to 5.
1
b. Members generally assertive = 5 or passive = 1; rate from 1 to 5.
5
ROLES-RELATIONSHIP PATTERN
a. Family Members
D., the father, was born on 04/07/1962 in Chicago, Illinois, and he is 53 years old. He has a
bachelor's degree in art and works as an accountant. J., the mother, was born on 8/19/1966 in
Beloit, Wisconsin, and is now 47 years old. She has a bachelor's degree in art, and works as a
teacher. D1. is the oldest son, and was born in 12/19/1991 in Milwaukee, Wisconsin. He is

currently studying civil engineering. D2. is the second oldest son, and was born on 03/11/1994 in
Milwaukee, Wisconsin. He is studying international affairs at college. D3. is the youngest son,
and was born on 06/17/1996 in Milwaukee, Wisconsin. He is studying journalism.
b. Any family problems that are difficult to handle (nuclear or extended)?
J., made a joke and said that her children are not teenager anymore. According to J. there
is not a difficult that they cannot handle. She said that only normal things, they might
have misunderstandings, but nothing serious because they always are working in improve
their communication.

2. Family Assessment
a. Relationships good (not good) among family members? Siblings? Support each
other?
The couple agree that the family has a good relationship. J. said that it is nice to see how
their children are connected and take care of each other. They agree that with the passing
of years they can see the importance of having siblings and the relationship between their
children has continuously improved.
b. When appropriate: income sufficient for needs?
J. affirmed that their income is sufficient for their needs.
c. Feel part of (or isolated from) community? Neighbors?
D. said that the family has a relationship with the neighbors to one side of their home. In
addition, J. explained that over the years they have a good relationship with several
people. She defined the neighborhood as interesting because it was populated by people
who are in their 70s and 80s, caucasians, and most of them have passed away. Now, the

neighborhood has a mix of families and the majority are composed of young people.
Because of this, they do not know some neighbors very well because their children are
not living with them. She said that when the children used to play, they usually knew the
children who were living in the area. Due to this, they feel a distant between them and
their neighbors. The relationship with the new neighbors are considered good, but
different from the other ones who used to live in the area.
3. Examination
a. Interaction among family members (when present).
During the interview, the couple always looked at each other, and they seemed to be very
connected.
b. Family leadership roles.
The leadership is shared. The couple said that they usually decide important things together.
1. History
a. When appropriate (sexual partner within household or situation): sexual relations
satisfying? Changes? Problems?
The couple agreed that their sexual relationship is satisfactory and there are not any
changes or problems related to it.
b. Use of family planning? Contraceptives? Problems?
J. had a hysterectomy procedure a few years ago. She affirmed that it was something sad
for her even when they decided to not have anymore children. J. said that this procedure
was difficult for her because the idea of not having the opportunity of being a mother was
hard. Moreover, she said that for her husband it was alright, but not for her. On the other
hand, she agrees that it was the best for her health.

c. When appropriate (to age of children): feel comfortable in explaining or discussing

sexual subjects?
Yes, J. and D. always talk about changes in their body and how they can prevent
pregnancy. She said that they talk a lot about it because they want the boys to know about
sexuality before they learn it in school. They want to give the idea to their children that
the body is an important and unique thing which is according to their faith. J. believes
that school can teach about it, but it only focuses on the physical. She said that it is
important to have an education based on Gods conception of life. J. explained that now
all of them are adults to make their own decisions, but they know that God cares about
their lives. They were educated to treat their body with care and to respect a women
rather than treating them as sexual object.

COPINGSTRESS TOLERANCE PATTERN

1. History
a. Any major changes within family in last few years?
Kidney cancer diagnosis of D. in 2013.
b. Family tense or relaxed most of time? When tense, what helps? Use of medicines,
drugs, or alcohol to decrease tension?
The family does not use any type of drugs.
c. When (if) family problems, how handled?
The first step for the family to handle problems is to analyze the reactions because they
have feelings, but they always try to see the things from a biblical point of view. After,
the members listen to each other to understand their feelings. J. said that they always

have a conversation to comprehend the situation and find a solution for their problems.
The family uses the bible as a basis to educate their children to practice forgiveness.
VALUES-BELIEFS PATTERN
1. History:
a. Generally, family gets what it wants out of life?
Yes, because of their belief in God and hard work to achieve goals. They are always
learning how to be better people and love each other through serving other people.

b. Important goals for the future?

According to the couple, they have a dream that their children will get married because
they believe that this is a good thing for them. They want their children find a good
person and have a family. For the family, another goal is to continue staying connected
and overcoming challenges.
c. Any "rules" in the family that everyone believes are important?
The first rule is love and respect is the second. They believe that these are essential
principles for their children. Moreover, they value honesty, loyalty, and hard work in the
family.
d. Religion important in family? Does this help when difficulties arise?
Religion is the most important thing for the family. It gives them a reason to believe and
overcome difficulties. For J., a relationship with God is more than religion and rules.
The relationship with God is what really matters for the family.

Ecomap- Family M.
Church
Church

Work fulltime

Work fulltime
Jackie

Deivi
d

48

52

Church

College

Danie
l

Donnov
an

Darrie
n

23

21

21

Church

College

Church

College

Genogram Family M.
Samu
el
Samio

Anna

John

67

58

Edith
M. 06/1950

67

68 68
Retired

Cataracts

Car Accident- 2009

Osteoporos
is

Residual Problems
Hyperkalemia

Train
worker

Homemaker

Lung
cancer

d.1987

Fire

Jane

Samu
el

DianeDeric
k
59

40

46

61
Selle Unemploye
d
r
Thyroid

Jackie
Teacher
48
Stude
nt

Danie
l

Allergy
Stude
nt
Hysterecto

Deivi
d
Donnov Accountant
52
an
Kidney Cancer-

Retired
Nurse
Diabetes
Arthriti
sNephropat
hy
Stude
nt
Darrie
n
workin
g

Comparison of assessed family to a family nursing theory

The bioecological system theory was chosen to comprehend the M. family because it is a theory
that provides understanding of the stressors and supports related to the family. During the assessment
of the family, it was possible to realize that the external factors affect the adaptation of family M.
through difficult moments of their lives. The interaction between the individuals is as important as the
interaction with other systems such as church. The couple J. and D. said that they find support to
overcome their health difficulties with health care providers and church. The support from the health
care professionals during kidney cancer was very important to the family, and it gave them emotional
support to deal with a stressful moment which was the cancer diagnosis and treatment.
According to microsystem understanding, a social group is submitted to physical, social and,
symbolic influences, such as family, school, and the workplace. During the assessment of family M. I
came to realize that they really appreciate education and internal values that are important to their
relationship. All the members of the family had access to attend college, which reflects how this area is
important to them. The family likes to talk together, share their feelings, and stay together for holidays,
such as Easter, when they have an opportunity to celebrate their union.
The mesosystem approach comprehends two or more physical settings that are connected with
the development of a person; for instance, relations between home and school. It is possible to say that
the family wants to stay connected with their siblings even though the distance between them may be
great. According to D., they are always in contact with their siblings by phone and all the family knows
what is happening with each other. J. said during the interview that the school has influence in the
education of her children. She believes that schools give good educational support for the boys in many
fields, especially sexuality. However, J. and D. agree that only having a school education is not enough
for their children to learn about this theme. Due to this, church and Christian values have a strong

influence in their education and moral learning. The work routine was considered a stressful activity for
the couple; however, the family believes that working hard is an important way to achieve their goals.
Working is an honest activity that provides a family with +income to give the best they can to their
children. I think the idea of labor for family M. is related with honor, pride, and dignity.
The exosystem level teaches that the enviroment is not directly related with a person but it
influences their lives, such as the relationship between the house and the parents work. According to
the ecomap assessment, it is possible to understand that work causes a stressful relationship; however,
this interaction does not harm family M. In addition, the stress caused by work is a reason for the
family be more connected because after the parents daily activities, they like to exercise together to
relax.
The macrosystem definition is related with customs, lifestyles, and belief systems related to the
family. The family M. defined Christian ideology as something very important for them. J. said that
religion is the most important area in their lives. Moreover, it has a relevant influence in their behavior,
and faith is fundamental for them to overcome all fears related to Ds cancer treatment. The family is
influenced by the Christian belief that God helps them in every moment of their entire life. Faith has
been an important support for them to deal with all the difficulties, and it helps them to believe in
finding D.s cure.
The chronosystem involves changes that affect a persons characteristics and the environment
where he lives, such as place of residence and changes during life. The relationship of the family in the
neighborhood has changed with the passing of years. In the 90s, the neighborhood had influence the
boys childhood, and in the friendship that the couple D. and J. had with their neighbors. After the death
of many neighbors and others who moved, the family now has a good relationship with some people,
but it is different than before. The family has changed their routines, such as playing in the park with

their neighbors, as a result of this alteration in the social structure of that area. However, even when
many things have changed, their values and beliefs are the same.
Reflection
The opportunity to have contact with an American family was an amazing experience. As an
international student, I was very excited to know what the similarities and differences between the
Brazilian and the American culture are. During the conversation with family M., I realized that even
when families are from different countries, values such as love and respect are universal in human
relationships. In the beginning of the interview, I felt insecure because it was the first time that I was
acting as a nursing student in the United States. However, the family was wonderful to us, and in a few
seconds my insecurity disappeared. I believe that the familys behavior made this experience enjoyable
and unique. After the interview, I could reflect on some definitions that I have learned during this
course.
First, I could think about how the family is important for society. I agree with Friedmans family
assessment model, which points out that individuals act according to the conception of relationship,
education, and values learned within the family. Every family has a way to deal with the transformation
that occurs over the years, but it is interesting to see how faith has a strong influence in family M. I
really appreciate seeing how the members of the family find support in each other. One interesting fact
is that they always are trying to improve their communication, and I believe that this explains why their
relationship is very positive. Second, I think that family M. is an example of resilience because they
stayed together, and kept moving the best way they could. The cancer diagnosis was a reason to
improve their relationship and keep them more closely connected.

Finally, I believe that the family relationship with the neighbors can be an area for
improvement. The neighbors can provide socialization outside the nucleus of the family. I really
appreciate this process of learning which includes both theory and practice. I am very grateful for
family M. to have accepted sharing important moments and feelings with me during this interview.
Family Assessment Conclusion
The bioecological system theory was applied to analyze the stressors and strengths that
family M. has. This theory provides comprehension about the five following levels:
microsystem, mesosystem, exosystem, macrosystem, and chronosystem. During the assessment
of the family, it was possible to comprehend the events that have affected their lives. The
assessed family has many social supports to overcome difficulties. The most important strengths
of this family are religion, communication between the family members, work, health nutrition,
and an active way of life. The couple J. and D. said that religion and faith are important source of
strength to them. Their Christian beliefs have influenced their lives and the education of their
siblings. Moreover, it was essential to deal with Ds cancer diagnosis.
According to Rolland & Baker (2005), cancer is a disease that affects not only the
individual, but all the family members, coworkers, and friends. In addition, it is important to
understand how cancer affects the survivors family to provide an effective approach of care. In
addition, Taylor (2003) points out that patients with cancer expect that nurses provide kindness,
prayerfulness, and forms of religious support. Family M. has an important support-base to
overcome their difficulties: faith. As a nurse, it is relevant to provide respect for family beliefs.
Moreover, it is important to comprehend what the strengths and stressors related to family M.
are. As a consequence, it is possible to promote orientations and interventions based on their
needs.

The cancer diagnosis can cause negative effects on the functioning and emotional
relationship within family. Even with the difficulty and fear of Ds treatment, the family
improved their communication and stayed together. Another interesting fact is that the family
uses external support to keep in close contact, such as when they are away at work. The couple
D. and J. have found ways to live moments together after work. The stressful routine the
members have doesnt affect their relationship. In addition, the family has a good way to deal
with stress which is exercising during the week. This action is a great option for health
promotion associated with a good nutrition and ingestion of water. The assessed family has
changed their nutrition habits since Ds diagnosis. This change in their nutritional routine gave
support to D. while he was in treatment. It may have influenced Ds the successful oncological
treatment. Family Ms routine change is an important factor of protection because their health
habits can prevent the occurrence of diseases, such as diabetes, obesity and hypertension. In
addition, the family effectively copes, which provides them with the capacity to stay connected
and help each other. They have their own effective way to deal with difficulties, and the most
important key to improve their relationship is communication.
However, the family has some stressors that may affect its stability. There were some
changes in the routine of the family, such as their siblings moving to college, alterations in the
neighborhood structure, lack of communication between the neighbors, Ds history of cancer,
and stress related labor activity which might cause negative consequences to the familys
interaction. Moreover, family M. has one possible health risk which is Ds recurrence of cancer.
In conclusion, family M. has important mechanisms to cope with the difficulties that
influence their lives. It is important to reiterate that the familys values, beliefs, and faith are
components which strengthens their resilience to overcome problems.

References
Bronfenbrenner, U. (1994). Ecological Models of Human Development. In International
Encyclopedia of Education (2nd ed., pp. 1643-1647). Oxford: Ed. Oxford: Elsevier.
Kaakinen, J. R., Gedaly-Duff, V., Coehlo, D. P., & Hanson, S. M. (2010). Family Health Care
Nursing: Theory, Practice and Research (4th ed.). Philadelphia: F. A. Davis Company.
Rowland, J. H., & Baker, F. (2005). Introduction: Resilience of Cancer Survivors across the
Lifespan. Cancer Supplement, 104(11), 2543-2548.
Taylor, E. J. (2003). Nurses Caring for the Spirit: Patients With Cancer and Family Caregiver
Expectations. Oncology Nursing Forum, 30(4), 585-590.