FAMILY NURSING PROCESSASSESSMENT

CALGARY FAMILY ASSESSMENT MODELA theoretical foundation for assessing and intervening with familiesWright and Leah in 2000 Drawn from systems, cybernetics, communication, change theory, postmodernism.

ASSUMPTION:Individuals are the best understood within their larger context, which is usually the family.A circular/systemic perspective guides the practitioner to understand the reciprocity between family relationships and health status. Unlike linear perspective, which focuses on individual, the circular/systematic perspective emphasizes relationships and the reciprocal effects that individuals have on each other.A change in one family member affects all others. For instance, a childs diagnosis of chronic renal failure affects the family members. All form of communication is relevant. There is no such thing as not communicating-silence is communication.

Reality is subjective, not fixed or true, and cannot be imposed. Therefore each family members perspective is valid and legitimate and deserves to be heard. Negative labels such as dysfunctional family, noncompliant are observers perspective and is disrespectful of families and do not stimulate thought of how to help family to change.Practitioners are not change agents rather facilitators of change. By creating a context of collaboration and mutual trust with families , the knowledge, expertise, and strengths of both the practitioner and family are honoured and exemplified.

INTRODUCTION Every patient is a member of a familyA physician must always keep in mind that the way a patient reacts to an illness will depend a lot on his family It will depend on the family physician as to up to what level he will involve a patients family to evaluate his problem.

FAMILY SYSTEMS MEDICINEThe primary goal of Family Systems Medicine is to view the patients problem in multiple context

FAMILY SYSTEMS IN CLINICAL PRACTICEThe family physician must be able to understand first the basic concepts of family structure and function.

GUIDE LINES FOR FAMILY HEALTH ASSESSMENT :Focus on the family as total unit.Ask goal-directed questions.Collect data over time.Combine quantitative and qualitative. Exercise professional judgment.

FAMILY GENOGRAMFamily TreeMust consist of 3 or more generations with each generation identified by Roman numerals The first born of each generation is farthest to the left with the following siblings going to the right according to order of birthFamily name is placed above each major family unit

Names and ages written below the symbolIndex patient is identified with an arrowDate must be indicated when it was made to be able to adjust the ages over time

2. Functional Chart It gives a more dynamic image of the family especially the relationship of each member to other members. This allows one to judge the familys totality as a unit, its strengths and weaknesses, and its adaptability in future stressful situations

3. Family Illness/HistoryThis indicates the presence of heredofamilial diseases in which potential problems in the family can arise.

STEP 2Understand the normal family function

5 BASIC FAMILY FUNCTIONSProvide support to each otherEstablish autonomy and independence for each person in the systemCreate rules that govern the conduct of the family and its membersAdapt to change in the environmentCommunicate with each other

FUNCTIONAL FAMILYDefined as a family wherein a balance between these functions is achieved. Imbalances may result from over or under emphasis of these functions.

DYSFUNCTIONAL FAMILYDefined as a family with chronic inability to respond to the needs or to cope with changes and stresses in the environment

STEP 3Learn to assess Family Structure and Function in Clinical PracticeFamily assessment tools have been made to aid the family physician in assessing the family structure and function in clinical practice.

FAMILY ASSESSMENT MODELI. Family Identification by its:Composition- family members currently living in the household, if they are kin or non-kin, and their agesSocial History- social background of each member regarding education, income, occupation, marital status, ethnicity, and cultureCommunity and Neighborhood- the general tone of the neighborhood, its resources and their availability, the affluence or meagerness of the area, and the character of its residents

II. Individual and Family DataHealth historyFamily dynamics- dysfunction is often reflected in the health status of the family

FAMILY ASSESSMENT TOOLSFamily GenogramFamily CircleFamily APGARFACES (Family Adaptability and Cohesion Evaluation Scale)FES (Family Environmental Scale)Clinical Biography and Life EventsSCREEMDRAFT (Draw A Family Test)Family Mapping

FAMILY GENOGRAMA graphic representation of a family tree that displays detailed data about the relationships among individuals in a familyAllows the user to analyze hereditary patterns and psychological factors that punctuate these relationships

FAMILY GENOGRAMQuickly identify and understand various patterns in the patient's family history which may have had an influence on the patient's current state of mind Maps out relationships and traits that may otherwise be missed on a pedigree chart

FAMILY GENOGRAMAn excellent tool to learn about the family structure but has limited role in assessing the family functions. It contains the following informations:Names, gender, date of birth, date of death, and roles of each family memberDivisions of an extended family into several householdsMedical problems and chronic illnesses of each family memberSignificant dates in the family historyNature of the family relationships

VERIDIANO FAMILYAS OF APRIL 11, 2010PROJECT 4, QUEZON CITY 1943 1947Constantino, 64 2006 Mila Fatima 47 1994

Ruptured aneurysm Heart failure Hypertension Bronchial Asthma

Thess 42 Nel 45 May 39 Jojo 44 1973 1971 Peng 27 1967 1964 1968 1970 1965 1982 Chok 36 2005 Tere 38Ja 4 2007

FAMILY CIRCLEFamily circles are often used on individuals and in some small groups. Instructions are given to the patient to look at the circle as if it is his family and then draw small circles to represent the patient and those people who are important to him. Difficulty of interpretation and standardization poses as a disadvantage.

FAMILY CIRCLE

FAMILY APGARThis is a 5-question assessment tool used for rapid assessment of family function and dysfunction. It measures an individuals level of satisfaction about family relationships.

FAMILY APGARAdaptation- the ability of a family to use and share inherent resources which can be either intra- or extra-familialPartnership- the sharing of decision making which measures the satisfaction of solving problems through communicatingGrowth- pertains to both physical and emotional aspects and measures the satisfaction of the freedom to changeAffection- emotions that are shared with and between family members which measures the satisfaction with the intimacy and emotional interaction that exist in the familyResolve- refers to how time, money, and space are shared; this measures the satisfaction with the commitment made by members of the family

FAMILY APGARThere are 4 basic situations wherein the Family APGAR is needed:When the family is directly involved in caring for the patient.When treating a new patient in order to get information to serve as general view of family functionWhen treating a patient whose family is in crisis.When a patients behavior makes you suspect a psychosocial problem possibly due to family dysfunction.

FAMILY APGAR QUESTIONNAIRE PART IHelps define the degree of the patients satisfaction or dissatisfaction with family function

PART I

Almost always (2)Some of the time(1)Hardly ever(0)AI am satisfied that I can turn to my family for help when something is troubling me.PI am satisfied with the way my family talks about things with me and shares problems with me. GI am satisfied that my family accepts and supports my wishes to take on new activities or directions. AI am satisfied with the way my family expresses affection and responds to my emotions such as anger, sorrow, and love. RI am satisfied with the way my family and I share time together.

FILIPINO FAMILY APGAR PART I

Palagi(2)Paminsan-minsan (1)Halos hindi(0)AAkoy nasisiyahan dahil nakakaasa ako ng tulong sa aking pamilya sa oras ng problema.PAkoy nasisiyahan sa paraang nakikipagtalakayan sa akin ang aking pamilya tungkol sa aking problema.GAkoy nasisiyahan at ang aking pamilya ay tinatanggap at sinusuportahan ang aking mga nais na gawin patungo sa mga bagong landas para sa aking ikauunlad.AAkoy nasisiyahan sa paraang ipinadadama ng aking pamilya ang kanilang pagmamahal at nauunawaan ang aking damdamin katulad ng galit, lungkot, at pag-ibig. RAkoy nasisiyahan na ang aking pamilya at ako ay nagkakaroon ng panahon sa isat-isa.

FAMILY APGAR PART IIDelineates relationships with other members, identifies persons who can give assistance to the patient, and indicates conflicts not revealed in part I

PART IIWho lives in your home?

How do you get along?

Name Relationship Age Sex

Well Fairly Poor

PART IIIf you dont live with your family, list down the persons you turn to for help

How do you get along?

Name Relationship Age Sex

Well Fairly Poor

FAMILY APGAR Scoring: 8-10 points = highly functional family4-7 points = moderately dysfunctional family0-3 points = severely dysfunctional family

CLINICAL BIOGRAPHIES AND LIFE CHART Clinical biographies and life charts make valuable tools because it has the capacity to put side by side significant life and clinical events with their dates of occurrences and make a connection between these facts.

SCREEMAn important tool to assess a familys capacity to participate in the provision of health care or to cope with crisis. It makes use of 6 factors which can be considered as resource or as pathology.

SCREEM

Resource Pathology Socialsocial interaction is evident among family membersFamily members have well-balanced lines of communication with extra-familial social groups Isolated from extra-familialProblem of over commitmentCultural-cultural pride and satisfaction can be identified- Ethnic and cultural inferiorityReligious - Offers satisfying spiritual experiences as well as contacts with an extra-familial support group- Rigid dogma/rituals

SCREEM

Economic- Economic stability is sufficient to provide both reasonable satisfaction with financial status and an ability to meet economic demands of normative life eventsEconomic deficiencyInappropriate economic planEducational - Education of members is adequate to allow members to solve or comprehend most problems that arise within the format of the lifestyle established by the family-handicapped to comprehendMedical - Medical health care is available through channels that are easily established and have previously been experienced in a satisfactory manner - Not utilizing health care facilities/resources

FAMILY MAPPINGThis assessment tool was developed by a psychiatrist-family therapist Salvador Minuchin to facilitate the communication of information about a family system to colleagues through the use of symbols.

FAMILY MAPPINGA double line between two people indicates a functional relationship

A single line with a break in the middle indicates dysfunction

Three parallel lines between two people denotes an over-involved relationship where there is plenty of intrusion.

A solid line perpendicular to the relationship line symbolizes a rigid boundary where the rules are but non-negotiable

A broken line perpendicular to the relationship lines symbolizes a boundary that is clear but negotiable

A dotted line perpendicular to the relationship line signifies a boundary that is diffuse or unclear.

A bracket encompassing several people signifies the presence of a coalition or alliance between these people

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An arrow pointing away from the system signifies escape from the system

An open ended arrow with its open end embracing two individuals and the pointed end pointing to a third signifies that the third person is being triangulated by the conflict between the other two

ASSESSMENT OF FAMILY CAPABILITY TO PERFORM HEALTH TASKS:

Primary AssessmentSecondary Assessment

PRIMARY ASSESSMENT OR 1ST LEVEL Goal: To identify the problems of the family.Tools: Family genogram, Ecomap, Family APGARMethods for Data Collection:Direct observationInterviewExaminationRecords Review

SECONDARY ASSESSMENTGoal: To determine the extent to which family is able to perform the different health tasks.Tools: Family Coping Index, Typology of Nursing ProblemsProblem IdentificationHealth ProblemNursing ProblemsHealth threatsHealth Deficit Stress point/Foreseeable Crisis

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