Running head: FAMILY ASSESSMENT 1

Family Assessment

Jessica M Hart

Goldfarb School of Nursing at Barnes Jewish College

NURS 4440 – 21

February 22, 2013

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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. That’s 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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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 won’t settle for mediocre.” Rex agreed. So far

they do not have to worry about assisting aging and ill parents, because Amy’s parents are both

healthy and Rex’s mother has had health problems for decades but they are not close (Friedman,

Bowden, & Jones, 2003, p. 125).

Their extended family history is limited. Amy’s 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. Rex’s family: Parents were married but divorced when he was 10 years old. Amy states

that Rex’s 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
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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 family’s

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
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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”. Amy’s 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. Jenna’s 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 children’s and wife’s 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
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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

hyper-active, 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 Rex’s 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. Amy’s favorite saying is,

“Did anyone die? No? Then it’s ok ‘cause the only thing you can’t 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
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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 children’s 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
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about 80% of lung cancers in men and about 50% in women (Woodgate & Kreklewetz,

2012, p. 2).

- 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.

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),

1767-1772. 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),

185-194.

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:10.1186/1471-2458-12-965