Running head: FAMILY ASSESSMENT

Family Assessment Katie D. VanderVelde Ferris State University

FAMILY ASSESSMENT Family Assessment A thorough assessment of a family includes family composition, stages of family development, home and community environment, cultural and religious traditions, family functions, role strains, communication, discipline, and strengths and potential problems. Each family is different and some aspects of the assessment may reveal more problems than others.

During the family assessment I will define what the problems are and create interventions to help solve these problems. Family Composition The family assessment I will be performing is on my aunt and uncles family. The family is going through a divorce, however, are still living together. One grandparent, who is 75, has always been heavily involved with the family, but she just moved in after being in the hospital for several weeks. The mother is 47 and the father is 42. They have a son, who is 8 years old, and a daughter, who is 11 years old. Currently, the family has both parents involved, but after the divorce the family will be classified as a single parent family. Stages of Family Development According to Duvalls developmental stages of the family, the family is in stage five. The tasks to be accomplished for the family are for the 11-year-old to develop increasing autonomy, for parents to refocus on midlife marital/career issues, and to begin to shift toward concern for the older generation (Wong, 2001). T.M., the 11-year-old daughter, has been becoming more independent and caring about her self-image. The parents are also going through a divorce and the father is trying to find a job due to being laid off. The grandmother just moved in, and the mother, B.M., has been very concerned about her mothers health. The grandmother fell a couple

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weeks ago and was in the hospital for a while. Developmental tasks to be accomplished by T.M., according to Piaget and Erickson, would be to be capable of mature, abstract thought and to search for self-identity leading to independence from parents and reliance on peers (Ball, Bindler, & Cowen, 2012, p. 78). T.M. would rather go to her friends house on the weekend and after school. Usually when she arrives home she goes to her room and comes out during dinner time and to help with chores. As for P.G, the grandmother, developmental tasks, according to Ericksons ego integrity vs. despair, include reminiscence about life events and feeling like she accomplished what she could in her life (Taylor, Lillis, LeMone, & Lynn, 2011, p. 366). As stated by my aunt, Grandma talks a lot about what she went through as a child, and worked hard on the farm. However, she stills has only been to Florida on vacation and wanted to go to Nashville, Tennessee to see Elvis Presleys grave. Home and Community Environment The family lives out in the county, outside of Cadillac. They are about fifteen minutes from downtown, and there are not very many neighbors for the children to play with. The road they live on gets hard to drive down in the winter, but sometimes the plow man comes to help. The father has been laid off for about 2 years now, which is one reason they are filing for divorce. The mother makes between $30,000-$40,000 a year, as a dietary manager, and is finding it hard to pay bills. The parents fight frequently about money and living pay check to paycheck. The grandmother just moved in and her husband died 15 years ago. She has never worked, and lacks the physical ability to get a job. She gets social security, but is just now starting to help with the familys income.

FAMILY ASSESSMENT Cultural and Religious Traditions

The family goes to church once in a while, and they are Christian. They are not a certain denomination, but the grandmother is Lutheran. She tries to get the family to go to church as much as possible, but sometimes does not follow through. The mother believes healthcare is very important for her children, considering she works at a long term care facility. As stated by B.M., Both children are updated on all immunizations, and I do not have any practices that influence the care they would receive in a healthcare setting. Family Functions B.M. has most of the control over the family responsibilities and the childrens chores. She supports most of the family, and if the son or daughter does not listen to the mother the father takes over. B.M. takes care of the grandmother if she needs help with transferring and reminding to take her medication. The mother is the busiest one in the family, and does most of the work around the house. She has little time to herself; however, the father frequently has time to spend with his friends. Now that the grandmother is living there, even though her physical health is not up to par, she will pick up around the house and help a little financially. The father does help with his sons football team and goes to his daughters volleyball games, but is not there for the mothers emotional support. The children are having problems with their emotional support and self-esteem because of the familys problems with the divorce. The son has been acting out in anger more frequently, and the daughter tries to be away from the family whenever possible. However, the grandmother tries to help as much as possible in regards to comforting the kids during this difficult time. When the father is home he does not try to communicate with the mother unless they are fighting.

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Role Strain There are many role strains in the family especially with the impending divorce. The mother feels as if she has to be a mother and father, because she is not only supporting the family but also making the rules and doing most of the work at home. The father feels helpless at times, because the lack of a job and not being able to support the family. The grandmother is having a hard time with helping the mother, because she is not in the greatest shape and is fatigued from being in the hospital. The oldest child does not seem to have any role strains, and is trying to be positive with everything that is happening. Communication The mother and father are not talking with each other, unless they are fighting. They have very little communication and seem to be distant from one another. The older child is polite with her family, but the younger brother is argumentative and yells at the mother. When he is asked to do something he disregards her commands. The grandmother speaks with kindness to the whole family, but has a stricter voice with the younger boy, because of the way he communicates with his mother. Discipline The mother is in control of most of the discipline within the family. B.M. has a hard time with disciplining the children, because she is worn out and stressed. She has chores set out for the son and daughter, but the son hardly ever listens. She usually takes his privileges, for example, his $10 allowance. Even after taking his privileges away, he does not listen. The

FAMILY ASSESSMENT grandmother often steps in and talks to the 8-year-old, but he does not listen to her well. When

he is present, the father usually yells at the son when he is misbehaving. In this circumstance, the father is really the only one that the son listens to. Strengths and Potential Problems Some strengths the family has is that since the grandmother has moved in she has begun to provide some financial and emotional support for the family. The daughter is also very helpful when helping with picking up and listening to the mother. The father is also willing to help out with his childs sports and education. The mother does not have a high income, but it is enough to support the family for now, and the grandmother starting to support, financially, will help. B.M. does what she can to support the family. The children are well groomed and doing well with school and sports. On the other hand, there are several problems that could be worked on as a family. Ideally, the father should participate more with the family and help out with things around the house. The mother is stressed out, because she has significant responsibilities. The father also has no income, which greatly affects the family as a whole. The mother and father are not on good terms, and hardly communicate with one another. This not only affects them but also the children. The younger son does not listen to the grandmother or the mother, which is overwhelming for the mother. The grandmother is recovering from a fall, so physically she cannot help with many tasks around the home. Her move into the home helps financially; however, it can increase the stress on the mother. Emotionally the family, as a unit, has problems that need to be addressed and taken care of. Assessment of these areas helps improve understanding of the family as a whole. In order for problems to be resolved or improved a detailed assessment must be performed. To further the

FAMILY ASSESSMENT nursing process, diagnoses, necessary interventions, and rationales should be made (See Appendix).

FAMILY ASSESSMENT References Ball, J., Bindler, R., & Cowen, K. (2012). Principles of pediatric nursing: Caring for children (5th Ed.). Upper Saddle River, NJ: Pearson Education. Finch, B. K., & Vega, W. A. (2003). Acculturation stress, social support, and self-rated health among Latinos in California. Journal of Immigrant Health, 5(3), 109-117. Ladwig, G.B., & Ackley, B.J. (2011). Mosbys guide to nursing diagnosis (3rd Ed.). Maryland Heights, MO: Mosby Elsevier. Pennell, J., & Burford, G. (2000). Family group decision making: Protecting children and women. Child Welfare-New York, 79(2), 131-158.

Saltzman, W. R., Pynoos, R. S., Lester, P., Layne, C. M., & Beardslee, W. R. (2013). Enhancing family resilience through family narrative co-construction. Clinical Child and Family Psychology Review, 16(3). Retrieved October 9, 2013, from General Reference Center GOLD database Taylor, C.R., Lillis, C., Lemone, P., & Pamela, L. (2011). Fundamentals of nursing: The art and science of nursing care (7th Ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Wong, D.L. Wongs essentials of pediatric nursing. (2001). St. Louis, MO: Mosby.

FAMILY ASSESSMENT Appendix Necessary assessments/interventions 1) Interrupted family 1) - Counsel family members processes r/t parents that it is normal to be angry getting divorced and and afraid. post fall grandmother. - Allow and encourage family 2) Ineffective family members to assist in the therapeutic regimen r/t clients treatment. economic difficulties. - Encourage family members 3) Disabled family coping to list their strengths. r/t parents getting - Motivate family members to divorced. speak openly about illnesses and feelings (Ladwig & Ackley, 2011). 2) - Base family interventions on knowledge of the family and family functions. - Collaborate with expert nurses or other consultants regarding strategies for working with families. - Promote and support public health programs to support families. - Use a family approach when helping an individual with a health problem that requires therapeutic management (Ladwig & Ackley, 2011). 3) - Identify correct roles of family members. - Assist family members to find professional assistance for primary stressors, like financial issues. - Evaluate the familys perceived strength of its social support system. Encourage family to use social support to moderate stress. - Assist families to identify physical/mental health effects of caregiving (Ladwig & Ackley, 2011). Nursing Diagnosis Rationale

1) Families in crisis can develop collaborative skills including the ability to anticipate difficulties, problem solving as a family, or use interpersonal cues to monitor and regulate emotion (Saltzman, Pynoos, Lester, Layne, & Beardslee). The grandmother just fell and is now living with the family. Being a part of the treatment of recovery may develop collaborative skills and help keep the family strong. Going through a crisis, such as this, along with getting a divorce can be very difficult. Focusing on strengths rather than weaknesses may be the only way to get through the difficult times. The ability to anticipate difficulties and speak about illnesses and problems is a good way to let out feelings to help solve family problems. Communication may help bring out feelings and emotions toward one another. The parents right now do not even communicate, and letting each other know how they feel may develop collaboration and working things out. The younger brother may not be listening to the mother because she does not explain chores should be done or how disrespecting her makes her feel. 2) Even though the family is

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10 facing financial difficulties due to the father not working, talking about these problems can help dramatically. The dad may feel like he is not helping and may not know where to start. Referring the family to a counselor or family group may help with communication in the family. A qualitative analysis on how conferences helped family unity found that promoted family unity helped strengthen positive ties among the family members, removed some negative ties, and enhanced their sense of being family (Pennell & Burford). I am sure the dad is stressed because pressure is on him, but may be giving up on marriage. Money is playing a huge part in the divorce and should be taken care. Public health services may help financially with the family along with counseling the family as a whole. 3) Disabled family coping may be part of family members being under stress. For instance, the mother is under a lot of stress considering she is the main provider for the family. The mother should have some type of social support to release some stress and anger she may have. Greater numbers of peers and family members in the United States, and a higher reliance support systems decrease the likelihood of poor health (Finch & Vega). The mother feels as if she has too many roles in the family, and

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11 identifying these may relieve some stress. Even though the mother is under the greatest amount of stress, the whole family is being affected. Talking to others about financial problems and family issues can relieve the mothers feelings that she is not talking about with her husband.