Family Health Assessment Proforma Case Study

Description of the Family

The family under consideration is a single-parent family composed of the mother, Kate, and her three children (two boys and a girl). Kate’s husband passed on six years ago, leaving her as the sole breadwinner and the head of the family. The children are young in age – 12, 10, and 8 years old respectively – and have not yet attained grade 10 level of education. The mother is in her early 40’s and works an 8-hour job as a real estate agent.

The family also lives with the mother’s parents, who are in their late 70’s. The mother’s father suffers from dementia which was diagnosed eight years ago. At the time of diagnosis, the dementia was mild but it has been deteriorating over the years. The condition is now at an advanced stage. The mother’s parents moved in with the family two years ago when it became too difficult a task for Kate’s mother to take care of her husband single-handedly. Presently, Kate is not only the sole breadwinner of the family but also the primary caregiver of her demented father.

Note taking

• Family profile:
  • The father is absent through death
  • The mother, Kate, is in her late 40’s and works as a real estate agent
  • The daughter is 10 years old
  • The sons are 12 and 8 years old respectively
  • The family lives with Kate’s parents
• Health issue:
  • Kate’s father suffers from dementia which was diagnosed eight years ago
• Family’s relationships:
  • The mother, Kate, is the sole breadwinner and primary caregiver of her family
  • Kate’s mother assists with the household chores and taking care of her husband
  • The children are also helpful in taking care of their ill grandfather
  • The family interacts harmoniously and engages daily in dining and family prayers

Major Health Needs/Stressors Experienced by the Family

The family has a family member, Kate’s father, suffering from severe dementia. The condition was discovered eight years ago at a moderately mild condition. However, like many dementia-related conditions, the illness has been worsening over the years. The first person to recognize the illness was the patient’s wife who noticed strange behaviors in him. Kate’s father would lose his memory or get lost in the middle of conversations. He also found it difficult to perform some tasks that he initially performed with ease. These symptoms raised concerns in the patient’s wife who convinced him to seek medical attention.

It was then that the family physician diagnosed him with dementia. As the condition worsened, Kate’s father began to lose items, miss appointments, and get lost in familiar places. In addition, he began to forget people’s names, including his closest friends and family members. It was then that a family meeting was held and a decision made that the patient and his wife would move in with Kate’s family. Kate is now primarily responsible for her father’s health condition but is usually assisted by her mother and three children when she is not around. When at work during the day, Kate’s father attends an Adult Day Care which assists him to regain his functioning ability.

The need to enroll him in an Adult Day Care arose from the advanced age of Kate’s mother which does not allow her to take good care of her husband given his serious condition. In the evening, after school, the children take their grandfather for a walk and other activities that keep him actively engaged and distract him from his condition. Despite the assistance from the Day Care and her children, Kate remains the primary caregiver. She not only administers medication to her father but also assists him in his daily activities such as feeding, bathing, and grooming. All these she does in the evening after work and early in the morning before she leaves for work.

Family Structure and Function

Kate’s family will be assessed using the Calgary Family Assessment Model (CFAM) proposed by Wright and Leahey (2005). The model assesses families according to three categories namely: structural, developmental, and functional assessments. The structural assessment dimension comprises of three sub-sections which include: internal, external, and context (Wright and Leahey (2005).

Internal structure

The internal structure is comprised of six subcategories which include: family composition, gender, sexual orientation, rank order, subsystems, and boundaries.

• Family composition. Kate’s family is primarily a single-parent family consisting of the mother and her three children (two boys and a girl) all aged between 12 and 8. The family also lives with Kate’s parents.
• Gender. Because of the absent father, the mother is not only the home-keeper and child-rearer but also the breadwinner of the home. In short, she plays the roles of both a father and a mother to her children. In addition, she is forced to take care of her ill father. She is however assisted by her mother and children in taking care of the demented patient.
• Sexual orientation. Since her husband’s death, Kate has not engaged in any sexual activities. She has also not noticed any sexual orientation problems among her children. Kate’s parents are no longer able to engage in any sexual activities due to Kate’s health condition.
• Rank order. The primary family is ranked according to age: mother and her three children. The boys are aged 12 and 8 respectively while the girl is 10 years old. The relationship between the mother and her children is normal in that she is the head of her family, takes care of her children’s needs, and is also solely responsible for their guidance and discipline. The relationship between Kate and her parents is however one of reversed roles. Rather than the parents taking care of their child, Kate, it is Kate who takes care of her parents.
• Subsystems. There are four subsystems in Kate’s family. Kate belongs to the female, wife-husband, parent-child, and child-parent subsystems. Kate’s two sons belong to the male, sibling, child-parent and child-grandparent subsystems. Kate’s daughter belongs to the female, sibling, child-parent, and child-grandparent subsystems. Kate’s mother belongs to the female, wife-husband, parent-child, and grandparent-grandchild subsystems. Kate’s father belongs to the male, husband-wife, parent-child and grandparent-grandchild subsystems. All the family members, except Kate’s father, function well within their subsystems and have strong relationships with each other. Kate’s father is unable to play his parent, husband and grandfather’s duties due to his illness.
• Boundaries. The family’s boundaries can be described as semi-flexible. The family members, that is, Kate, her children and her mother, cooperate well in taking care of Kate’s father. Each member has her/his own roles to play in the care of the demented patient. Kate is involved in the primary care of her father. Kate’s mother assists her when she can and the children assist in keeping their grandfather engaged in active and helpful activities. In addition, the family also seeks assistance from outside sources, for instance, the Adult Day Care which takes care of Kate’s father when Kate and her children are away at work and school respectively.

External structure

• Extended family. Although Kate’s parents live with Kate and her children, they also have three other adult children living in different states. The decision to live with Kate’s family was reached because Kate resides in a large metropolitan city where there is easy access to healthcare facilities and personnel. In addition, Kate’s children are still young and have plenty of time to look after their grandfather. The other grandchildren are either working or away in colleges hence they lack adequate time to care for their grandfather. However, Kate’s siblings communicate regularly with Kate and their parents by phone to monitor their father’s progress. Occasionally, they visit their parents when time allows.
• Larger systems. The larger systems of Kate’s family include: Kate’s work systems, the Adult Day Care, mental health organizations, and outpatient clinics. Kate’s father’s physician keeps regular contact with the family to monitor his progress and provide much-needed advice when changes occur. A nurse from a nearby mental health organization is also in charge of the patient’s care and regularly visits the family to provide assistance to the patient and the entire family. The nurse’s presence and contact are indeed useful to the family’s coping abilities. The Adult Day Care is also involved with the family because it takes care of Kate’s father when the family needs to attend to their daily activities. Kate’s place of work has been supportive to her. Her boss and colleagues not only allow her to take time off work for her father’s medical appointments but they also step in for her and offer emotional support.

Context

• Ethnicity. The family is a Caucasian family and therefore engage in similar practices and hold similar beliefs concerning, illnesses, treatment options and general wellness. Ethnicity plays an important role in the general wellness of patients. This is especially the case in which the patient and his family’s ethnic orientation differ from the ethnicity of the healthcare providers. Issues such as miscommunication, language barriers and ethnocentrism are highly likely to affect the quality of care provided to patients. In this case, however, all the healthcare providers involved with Kate’s family are Caucasian.
• Race. The family belongs to the same race with similar beliefs, traditions and attitudes. The care and management of Kate’s father is therefore harmonized within the family.
• Social class. Before the death of Kate’s husband, the family was a well-to-do upper-middle class family because of two income sources. The death of Kate’s husband reduced the family’s income level by more than half thereby pushing them to a lower-middle class family. In addition, the illness of Kate’s father is putting more pressure on the family’s resources.
• Religion and spirituality. Kate’s family is a Christian family which attends Sunday services at a local Baptist church. In addition to the Sunday services, the family holds payers and reads the Bible together before the evening meal. The family’s religion and spirituality provide them with additional support and inner strength needed to cope with their situation. This is because they believe in a Supernatural power that controls their lives.
• Environment. The family lives in an urban city where there is easy access to health facilities and other social amenities such as schools, entertainment parks, and public transport. Indeed, Kate’s children’s school is only a 15-minute walking distance from their home. Kate’s place of work is a 20-minute drive away. There are several parks in the neighborhood as well as health facilities including a mental health organization. The major environmental problem is high insecurity level due to the home’s location in the urban center.

Family Relationships and Communication Patterns

The family relationships and communication patterns can be examined through functional assessment. Functional assessment of families entails an examination of how members of families interact and communicate with each other. Functional assessment consists of two sub-dimensions: instrumental and expressive (Wright & Leahey, 2005).

Instrumental: Daily life activities

The daily activities of the family are routine in nature. In the morning, the children prepare themselves for school. Kate prepares herself for work and also bathes, grooms, and feeds her father. On her way to work, Kate drops her father at the Adult Day Care where he spends his days. Kate’s mother is left at home taking care of simple household chores such as cleaning utensils and preparing dinner for the family.

In the evening after school, the children engage their grandfather for about two hours or until Kate arrives home. The children then proceed to study for about one or two hours before dinner is served and the family prayer is said. Kate feeds her father again and prepares him for bed after which she spends time interacting with her children and preparing for the next day.

Expressive

• Emotional communication. The family members communicate emotionally with each by sharing their feelings and concerns about any issue ranging from school work, job, caring for their ill member, and their general health. Quality family time, especially in the evenings, is a crucial asset fro the family in which they can unwind and address each other’s problems. Emotional communication is also enhanced through dining together, praying, reading the Bible and attending church services together.
• Verbal communication. All the members of the family are outspoken about their feelings and experiences which helps them to relieve their stresses. Only Kate’s father is unable to effectively communicate with the rest. However, the family has learned to engage him in all their activities regardless of his speech disabilities.
• Nonverbal communication. It plays an important role in the family’s communication pattern due to Kate’s father’s speech disabilities. As a result, the family pays close attention to his body language and facial expressions which tell them a lot about what he needs at a particular moment.
• Circular communication. This refers to the mutual communication between a husband and a wife (Wright & Leahey, 2005). Unfortunately, in this family, circular communication does not exist for Kate due to her husband’s death.

Health Needs of the Family

In this family, Kate’s father is the ill member suffering from dementia. His health needs are therefore enormous. He requires therapies and medications for his condition as well as someone to assist him with his daily living activities. In addition, Kate is in dire need of de-stressors. As the sole breadwinner of her family and the primary caregiver of her father, Kate is often stressed and exhausted both physically and emotionally. Kate’s mother and children are in good health.

Challenges and Strengths of the Family

Challenges

The family’s major challenges include: taking care of a demented patient and limited resources. Taking care of a demented patient is challenging for the family. The family has to assist the patient in carrying out simple activities such as bathing, feeding and grooming. The health condition of the patient makes it difficult for the family to engage in effective interaction, communication and relationships with him. The family has limited resources in terms of finance and time (Sexton, Weeks & Robbins, 2003). The family’s sole income is spent on taking care of the patient, the family’s daily needs and the children’s education. Kate and her children are also busy with work and school and are forced to create time for their ill member. This robs the family of quality time that should be spent on recreational activities.

Strengths

Kate’s family is a close-knit family in which the members cooperate in the caring for their ill member. The children are well adjusted to their grandfather’s condition and needs and they do all they can to make him comfortable. The family has several support systems which provide much-needed additional support and advice. The family’s religion is Christianity from which they obtain inner strength and moral support from fellow Christians.

Problem Solving Techniques

The family uses a number of strategies to deal with their challenges. The challenge of taking care of a demented family member is solved by sharing the responsibilities and obtaining external assistance from healthcare providers, the mental health nurse and the Adult Day Care. The financial challenge is solved through Kate’s dead husband’s pension scheme, the parents’ health insurance scheme as well as financial support from Kate’s siblings.

Support Systems

The healthcare system (family physician, mental health nurse and Adult Day Care) is the major support provider for the family. They assist the family to address the health needs of their demented family member as well as their own. Other support systems include work systems, religious system and extended family support systems. All these systems provide moral, psychological, physical and material support (MCubbin, Thompson, Thompson and Futrell, 1999).

Application of the Knowledge Developed

Nursing interventions are an important part of families dealing with an ill patient. A nurse is not only interested in the general wellbeing of the patient but also of the entire family. This is because a stressor in the form of illness affects the entire family to a great extent. Such family members are more likely to develop health complications as a result of taking care of an ill member. A family nurse therefore provides families with the appropriate strategies for managing the health condition of the patient as well as strategies for coping with stressors in the family (Walsh, 2006).

In Kate’s family, for instance, it is the nurse who recommended that Kate’s father should be enrolled in an Adult Day Care during the day where he would receive professional care while his caregivers attend to their job and school work. It is also the nurse who convinced the patient’s wife to accept external assistance due to the limited time resources of the family.

Personal Reflection

Working with this family has provided me with a deep insight into family nursing. I have learned the importance of family members’ cooperation when caring for an ill member. Cooperation among family members helps to reduce the burden of the primary caregiver through the sharing of the care giving responsibilities.

I have also learned how useful support systems are in not only caring for a sick family member but also in maintaining the emotional and psychological stabilities of the caregivers (Hanson, 2001). Through this family assessment activity, I have been able to put the theory of family nursing practice and I have realized just how interesting the field is.

Conclusion

Nurses play an important role in the recovery of an ill patient. However, the input provided by family members goes a long way in the treatment and recovery of patients. Family members should be cooperative and assist each other in taking care of an ill member. In addition to the family, other support systems are also important in the recovery of patients. Support systems may come from different sources such as friends, workmates and church members. Through the different support systems, the burden of taking care of a patient is made lighter.

Reference List

Hanson, S. (2001.). Family health care nursing: Theory, practice and research (2nd ed.). Philadelphia: FA Davis.

McCubbin, H., Thompson, E.A., Thompson, A.I., & Futrell, J.A. (Eds.). (1999). The dynamics of resilient families. Thousand Oaks: Sage.

Sexton, T., Weeks, G.R., & Robbins, M.S. (2003). Handbook of Family Therapy: The Science and Practice of Working with Families and Couples. New York: Brunner-Routledge.

Walsh, F. (2006). Strengthening family resilience. New York: Guilford Press.

Wright, L. M., & Leahey, M. (2005). Nurses and families: A guide of family assessment and intervention (4th ed.). Philadelphia: F.A. Davis Company.