Family Assessment Visual Report

MED SURG PNEUMONIANURS 480

Family Nursing: Theory and PracticeProfessor Phinney

Created by:Concepcion de Guzman, Kristina Fong,

Nancy Lavoie, Analisa Mendoza, Pauline Soares, Nancy SpenceApril 24, 2016

IntroductionFamily DescriptionClient: C. F.Son: Charles Chief Medical ComplaintChronic Obstructive Pulmonary Disease (COPD)

Family AssessmentCalgary Family Assessment Model

Psychosocial ImplicationsMother-Son relationship

Financial StatusHealth coverageIncome

Family Health Theory

Family Systems TheoryThe Family Systems theory is an approach for nurse so that they may assess the family as a whole unit and the family members individually. Through this specific theory, nurses can assess how the family is functioning when a family member is ill, how caregivers are coping, and the changing dynamics within the family due to illness. The Family Systems Theory is composed of four concepts that create a framework to analyze the family unit, this includes family members within three generations (Kaakinen, Coehlo, Steele, & Tabacco, 2015, p.76).

We will apply the Family Systems Theory to patient C.F. and her son Charles.

Family Systems Theory

Concept 1: All Parts of the Systems Are InterconnectedConcept one states that all family members carry influence on each other, this includes illness as well. Through these concepts, it is understood that when one family member experiences a health event, all members in the family are impacted because they are a unit. Because C.F. has made a decline in her health, it affects her son’s ability to provide complete care for her, he may even experience caregiver strain. Concept 2: The Whole is More Than the Sum of its PartsConcepts two describes the family as one whole relationship rather than several separate relationships. When a family member has a change in health status it affects all relationships. C.F. and her son Charles relationship will change due to decline in C.F.’s health.

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Family Systems Theory Concept 3: All Systems Have Some Form of Boundaries or Borders between the System and its EnvironmentConcept three describes family units as protective mechanism; they protect the family by controlling the “in-flow” on members who join the family and the stressors that may affect them. Some families have boundaries that are supportive, meaning in a time of crises they assist one another. Charles recognizes his mother’s need for assistance and protection, he has her move in with his so she would not be alone as a widow and he can help with her health needs. Concept 4: Systems Can Be Further Organized Into SubsystemsConcept four describes the subsystems that within the family such as husband to wife and father to son. It’s important that these subsystems expand over generations such as grandmother to grandchild and mother-in-law to daughter in-law. Within these subsystems nurses analyze three dimensions: functions, dimensions, and processes. Charles and his mother are within the parent-child subsystem. Their functions have changes during the course of C.F’s health decline, Charles is now the caregiver.

Calgary Family Assessment Model

The Calgary Family Assessment Model (CFAM) blends nursing and family therapy concepts that are grounded in systems theory, cybernetics, communication theory, change theory, and a biology of recognition (Kaakinen, Coehlo, Steele, & Tabacco, 2015).

Theoretical Framework:

● Family system is part of a larger suprasystem and composed of many subsystems.● Family as a whole is greater than the sum of its parts.● Change in one family member affects all family members.● Family is able to create a balance between change and stability.● Family members behaviors are best understood from a perspective of circular rather than

linear causality.

3 Major Categories for Assessment:

Structure, Development, and Function

Patient & Family Condition

The patient C. F. is a 68 year old caucasian female. Her spouse was deceased in 2005, and she has been living with her only son for two years. The patient and her son, Charles, live in a one story house, with no steps. The patient had been independent with her activities of daily living (ADL’s) and instrumental activities of daily living (IADL’s), until recently (last 5 months), she has been having a harder time with some household chores and providing some of her own self care. The patient has stopped driving five months ago. The patient is having a hard time getting around due to shortness of breath (SOB) which is making her weak and unable to walk far distances. The patient receives 500$ a month from social security, and has both Medicare part A & B.

The patient was admitted to Med-Surg with Acute Pneumonia, Community Acquired, with complaints of shortness of breath (SOB), dyspnea, weakness for one week, and fever for the past two days. She has a history of COPD, smoked for 20yrs, and quit 15 years ago.

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StructureInternal:

● Nuclear Family: C. F (mother/patient), Charles (son)* Subsystems: Relationships between family members

External: ● Extended Family: Not close with any distant relatives. C. F. and Charles have a poor

relationship with Charles ex-wife Susan● Charles job● Medical staff, home health agency, church, health insurance

Context: ● Caucasian, middle class, Protestant no longer attends church, live in single story home in

suburban area. Family background stems from an American culture.

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Development-Stages & Tasks

C. F. is in her late-adulthood developmental stage. She is experiencing the shift and adaptation of generational roles, which is occurring at a faster rate due to her physical deterioration. She is still cognitively sound, alert and oriented, cooperative, with limited barriers to understanding, such as hardness of hearing, and motivation due to her weakness.

Charles is in his middle-adulthood, divorced with no children, and had shared duties with his mother who can no longer sustain the shared role. His cognitive abilities are still intact without barriers. He is still physically capable of maintaining his job, and has minimal health concerns, which include high cholesterol and high blood pressure which he manages fairly with diet control and medication.

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Function Instrumental:

● C. F. Was independent with ADL’s five months ago. Now having a harder time with some household chores and providing some of her own self care.

● C. F. Stopped driving five months ago. ● C. F. is having difficulty ambulating long distances due to shortness of breath (SOB) and weakness. ● Charles works full-time as a construction worker and travels.● Charles had shared household duties. Needs caregiver for mother or housekeeper.● Independent with all his ADL’s and IADL’s.

Espressive:● The patient family consist of a close relationship, and supportive. ● Charles does not believe in placing his mother in a home, but does need assistance to care for his mother. ● The patient and family are open and acceptable to outside assistance.● Both patient and son have faith in God. Patient no longer attends regularly since spouse deceased. ● Charles does not attend church due to the demands of his work schedule, but will attempt on special

occasions such as Christmas or Easter.

Expressive Function:Communication

Communication is defined as the transmission of messages from person to person through processes such as writing, speaking, texting, teaching, e-mail, and body language (Kaakinen, 2015).

Communication is the way individuals, families, and nurses come to understand each other in the context of the family health experience (Kaakinen, 2015).

According to the family systems theory, communication both Verbal and nonverbal occurs within the family and between them and the outside world (Denham, 2015).

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Expressive Function:Communication (cont.)

● Verbal: When it comes to verbal communication, both CF and Charles speak honestly and always express their concerns. Cf puts emotion into her words, therefore you can tell when she speaks if she is happy, sad, concerned or upset. Charles tends to not speak much or keep it to shorter sentences when he is in disagreement with a subject.

● Nonverbal: CF tends to use her hands when communicating and always holds great eye contact. Charles avoids eye contact when he feels uncomfortable but for the most part maintains eye contact out of respect.

● Effective Communication: Communication has been proven effective, since both CF and Charles do not consider miscommunication a problem and CF has been happy with her plan of care.

● Strengths: Communication is fairly productive between CF and Charles. Charles is good at closing the communication loop.

● Challenges: CF being older, cannot use emails and texts for communicating. Hard of hearing also proves a challenge where Charles makes sure to double check and close that feedback/communication loop.

Genomap

Genomap (fig. 1) shows C. F. was born to Rose and Walter (both now deceased), where she also had a brother Joe who died at 16 from the flu. C.F. and Henry (also deceased) only had one son, Charles who married, then divorced Susan.

A family ecomap provides information about systems outside of the immediate nuclear family that are sources of social support or that are stressors to the family (Kaakinen, Coehlo, Steele, & Tabacco, 2015). See next slide

Fig. 1

Ecomap

Family Health Intervention

· Establish a therapeutic relationship between nurse and family· Distinguish family and individual strengths· Emphasize family’s influence on illness· Explore concerns and address them· Provide empowerment· Create solutions in collaboration with the family

Family Health Intervention

Help C.F. apply for Medical inorder to hire a caregiver who will help her with IADLs and ADLs

Suggest to learn about advanced directive

Establish a power of attorney

Teach family/patient about disease process

Teach family/patient what to expect in the hospital ex. Applying oxygen, antibiotics.

Teach patient and family plan of care.

Teach hand hygiene.

Answer questions that the son and patient may have.

References

Denham, S., Eggenberger, S., Young, P. & Krumwiede, N. (2016). Family-focused nursing care.

Philadelphia, PA: F.A. Davis Company.

Kaakinen, J.R., Coehlo, D.P., Steele, R. & Tabacco, A. (2015). Family health care nursing: Theory, practice and research. Philadelphia, PA: F.A. Davis Company.