Family Nursing Care Analysis Paper

3569 words (14 pages) Essay in Nursing

23/09/19 Nursing Reference this

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Family Nursing Care Analysis Paper

Family Assessment and Analysis

 The participating family client for this assignment is L.M. from the M family, which consists of Mrs. L.M., Mr. L.D.M., and their son M. M. The M family currently reside in a modest home in a small town outside of Pittsburgh. L. M. and L.D.M. just celebrated their 24th wedding anniversary. This is the first marriage for L.D.M. and the second marriage for L.M. L.M. has two children from her previous marriage and L.M. and L.D.M. have two children together. The oldest daughter is married and had two sons who were both diagnosed with a severe genetic disorder. The youngest son passed away in 2016, and the oldest son is severely disabled. The middle son is married with a son and a daughter. The youngest daughter lives on her own. Their youngest child M. M. recently graduated high school this past June and still lives at home. L.M. grew up in the suburbs of Pittsburgh. Her mother and father were married for 55 years. Her mother passed in 2007 and her father passed in 2017. Her older sister passed away in early 2018 due to cancer. She is a middle child with an older sister and a younger brother and sister. Since her father and sister’s passing, her relationship with her younger brother and sister has been strained. She has a high school diploma and obtained her cosmetology license after graduation. She currently manages a Senior Activities Center full-time and works part-time as a caregiver. L.M. is very dedicated to her work and it often consumes most of her time. She has many ties in the community and is very involved in it. As a manager of the Senior Activities Center, she volunteers after work with community activities. She also coordinates many of the community activities for the small town that they live in. L.D.M. and M.M. will also volunteer at these activities if their schedule allows. L.D.M. grew up in the suburbs of Pittsburgh also. His parents are still currently living in the home he grew up in with his older brother. He is very close with his parents, but his older brother is estranged. He completed high school and some college. He recently received his real estate license. L.D.M. used to work for the steel mill until he had a stroke in late 2013. He was unable to return to the steel mill following the stroke, so he has worked odd jobs over the past few years. He currently works side jobs fixing homes, drives for Lyft and Uber, and is starting his career in the real estate market. M. M. recently graduated high school. He is currently attending a trade school through the school district, where he is learning contractor skills. He attends classes in the morning at the high school to complete courses towards college, trade school in the afternoons, and works part time at UPS. He was recently promoted to shift manager at work. All three family members are in seemingly good health. L.M. is a smoker but does not have any comorbidities. She eats a healthy diet and researches healthy medicinal alternatives to maintain her health. L.D.M. has hypertension that is currently controlled with medications. He is compliant with his medications and doctor’s appointments. He eats a healthy diet, including protein shakes, to keep his weight under control. Even though he has had a stroke, he does fairly well, but does have residual weakness on the right side of his body. This impairment has put some strain on the family financially. L.D.M. was unable to work for most of 2014. L.M. and L.D.M. are still trying to recover financially because L.D.M. has been unable to find a stable job that will accommodate his disability. Now that M.M. has been promoted at work, he is able to contribute and help his parents financially, which has eased some of the family strain. M.M. is a healthy 18-year-old and is physically fit. He was a swimmer in high school and still works as a life guard at the community pool in the summer.

All members of the M family have busy schedules. They may not see each other every day but they are all off of work on Sundays. Having only one day of the week that isn’t full of responsibilities is hard on the family. This causes extreme stress to L.M. as she feels that no one helps her around the house and “no one seems to care that she has to do it all”. L.D.M. is very tired after working and feels that on his day off he should be able to relax and should not have to worry about the house. M.M. feels that he isn’t home enough to make a mess and that when he has free time, he should be able to spend it with his friends and other family members. Work, extended family, bills, and money are all stressors to the M family. The family recently went through a hard time as L.M.’s father passed away in November. He lived with the M. family for 10 years. L.M.’s oldest sister passed away five months later due to cancer. The passing of L.M.’s family members has caused fractured relationships with her younger brother and sister. This is a cause of stress to L.M. She wishes things “weren’t so broken”. L.M. hopes that if everyone puts forth effort in household duties that this will alleviate some stress and frustration that the M family experiences every day. The M family have all agreed that they need to share responsibility for the upkeep of the house and make an effort to spend quality family time together with each other. This will help them to talk about and resolve their frustrations.

Listed below in Figure 1 is the genogram for the M family. Figure 2 is the ecomap illustrating the family’s various relationships with the outside environment.

 

Figure 1: Genogram

Figure 2: Ecomap

Ext. Family

Family

 

Friends

L.M.

L.D.M

 

 

 

Work

M.M.

Community

 

 

School

Money

Chores

 In the Figure 2, the black lines represent a good relationship and red lines represent a strained relationship or stressor. As you can see L.M. has a good relationship with work, the community, friends, and family. L.M. has a strained relationship with extended family and money is a stressor. L.D.M. has a good relationship with friends, family, the community, and extended family. L.D.M.’s stressors are work, money, and chores. M.M. has a good relationship with family, extended family, friends, and the community. M.M.’s stressors are chores, money and school. Because the family has very busy work schedules, and M.M. also has a school schedule, it is hard for them to find time to spend quality time as a family and take care of the household duties. The M family all look to family and friends for support when they are stressed. They state that this is very helpful to them to be able to share their stressors with their friends and have a good time. L.D.M. often has “guy weekends” where he and a group of friends get together for a weekend. L.M. mostly talks to her friends on the phone, which she has done for years. M.M. works with his best friend and they go out after work often. The M family members all agree that they need to support each other to reduce the stressors in their life and they need to make an effort to spend quality time together.

 After assessing the M family, the family developmental stage that they are in is the families with adolescents (Kaakinen, Coehlo, Steele, Robinson, 2018). In this theory some family developmental tasks are increasing the adolescent’s role in the family by cooking, doing repairs around the home, and allowing them to establish their own identity (Kaakinen, Coehlo, Steele, Robinson, 2018). L.M. and L.D.M. are maintaining their household by working multiple jobs and long shifts. M.M. helps out as well when he can.

 The family assessment tool used with the M family was the Family Systems Stressor-Strength Inventory (FS3I) this assessment tool is used to help identify the stressors in families (Hanson, 2001). It also shows how much the family is affected by the stressors and how they are coping with them by maintaining healthy family functioning. This tool is broken down into three different sections; family systems stressors (general), family systems stressors (specific), and family systems strengths. Each section has multiple questions for the family to complete, with scores in each section from 0-5 or 1-5. To score the results the total score in each section is divided by the number of questions. The results from the assessment tool were, section one: L.M. 3.1, L.D.M. 3.0, M.M. 2.1, evaluator 3.0; section two: L.M. 3.2, L.D.M 3.2, M.M. 3.0, and evaluator 3.1; section three: L.M. 3.5, L.D.M. 3.6, M.M. 3.5, evaluator 3.5. The results of the assessment varied between family members. M.M. does not have the same feelings of responsibility as do L.M and L.D.M. This may be because M.M. has not had a chance to really find his independence yet. L.M. and L.D.M. had more similar results. They both share the same stressors of feeling unappreciated, insufficient couples time, and finances. All three agreed that they have a strong sense of family, encourage and support one another, and have a deep development of trust. L.M.’s high stressors were housekeeping standards, lack of shared responsibility, and holidays. L.D.M.’s high stressors were guilt for not accomplishing more, lack of shared responsibility, and unhappiness with his work situation. M.M.’s high stressors were self-image/self-esteem, lack of shared responsibility, and insufficient family time. The general results show that the M family deals with stressors daily, but they have many strengths and coping skills to overcome these stressors. The M family states that their major strengths as a family are commitment, resiliency, and communication.

 In addition to the FS3I, the Family Assessment and Intervention Model was used to guide the family care plan and interventions based on the results. This model shows families who are subjected to tension when they experience stress and it shows the reactions to the stressors and how far it penetrates the family unit (Kaakinen, Coehlo, Steele, Robinson, 2018). The Family Assessment and Intervention model addresses three areas: “1) health promotion, wellness activities, problem identification, and family factors at lines of defense and resistance; 2) family reaction and instability at lines of defense and resistance; and 3) restoration of family stability and family functioning at levels of prevention and intervention” (Kaakinen, Coehlo, Steele, Robinson, 2018 pg. 121).

 By using this assessment tools for the M family, the main stressors were finances, feeling unappreciated, and lack of shared responsibility.  Their strengths are commitment, communication, and resiliency. The M family help each other out in stressful times. They have had to deal with a lot regarding deaths in the family and the stress of broken relationships. They have also had to deal with a loss of income because of L.D.M.’s stroke in 2013. Before the stroke occurred, they had recently bought a new house. They have worked very hard to keep it and maintain their lifestyle. In the past few months no new stressors have arisen in the M family. They believe they can “handle anything that is thrown their way”. They have developed unique coping skills which involves a lot of communication including laughter to get through their hard times, and they rely on their strengths to keep the family unit stabile. They are also aware that there are other ways to cope with the stressors that they are experiencing. Instead of L.M. getting angry and yelling at the others she believes there is a better way to handle it. Also, L.D.M. and M.M. realize that they could help out more and decrease the stress that L.M. is experiencing.

Nursing Care

Family nursing diagnosis #1: Readiness for enhanced family coping

Goal of care: Reduction in arguments related to household responsibilities and increased communication between family members.

Objectives

Implementation

Scientific Rationale

Evaluation

1.Evaluate strengths, coping skills, and current support systems.

-Have each family member list their strengths.

– Have each family member communicate how they currently deal with stressful situations

-Have each family member list their current support system.

Providing these openings may help promote communication among family members and promote more effective coping skills (Gulanick & Myers, 2014).

After each family member completed a list of their strengths and their support systems, we were all able to discuss the results. L.M. listed her strengths: great work ethic, compassionate, and family oriented. L.D.M. listed his strengths as; hard working, goal oriented, and persistent. M.M. listed his goals as: a good listener, good work ethic, and loving. After completing this task, the family communicated together about how they deal with stressful situations. Each family member also explained how they see each other dealing with stressful situations. This was very eye opening for them because they were unaware of what others observed. Surprisingly when each family member wrote down their list of supports, they included each other and some friends. This helped them to realize how much they depend on one another.

2. Discuss various sources of stress in the household

– Have each family member discuss their stressors related to the household.

– Have the family create a plan of action to reduce stress among each other in the household

– Identify specific stressors

By providing these opportunities for open communication, this will help each family member to acknowledge each other’s stressors. This will also help to promote a sense of connectedness among the family members (Gulanick & Myers, 2014).

L.M. stressed how frustrated she is that L.D.M. and M.M. do not clean up after themselves. This is a major stressor for her and she wants to resolve it. She also stated that M.M. needs to start doing his own laundry. She shared her frustrations regarding L.D.M. and the fact that he does not hang the clothes when the dryer is finished. She states that both men could help more with the yard work by using the ride on mower and miscellaneous gardening tools to help her keep up, so it does not get out of control. L.M. and M.M. agreed that these were reasonable requests to help reduce stressors. They also stated that L.M. leaves coffee cups in random parts of the house. L.M. agreed to change that. The family then made an agreement to reduce stressors for each other as much as possible.

Family nursing diagnosis #2: Readiness for managing stress.

Goal of care: Evaluate daily, on a monthly calendar, tasks completed regarding household, and rate level of stress on a scale of 1-5 each session.

Objectives

Implementation

Scientific Rationale

Evaluation

1. Assist the family in setting realistic goals for managing stressors.

– Review the list of realistic goals for managing household stressors

– Determine that all family members agree with listed stressors.

It is important for the family to understand that life will be full of stressors. By creating realistic goals this will help to develop the skills to deal with their reactions to these events, and not let the stress control their lives (Gulanick & Myers, 2014).

Each family member created a list of realistic goals to manage the household. These goals included a list of each person’s household stressors. They shared their lists with each other and created a master list. This was then transcribed to a monthly calendar. Each family member was in agreeance to this task list and each agreed to signify that the tasks were completed, so that there was full communication. After creating the task list, the family seemed much more relaxed and knew they all had a direction to follow.

2. Teach the family about the body’s common responses to stress; physical, mental, emotional, and behavioral symptoms.

– Provide family education regarding stress and stress reduction techniques.

– Have family rate level of stress on a s scale of 1-5 each session.

The family needs to understand the consequences of maintaining a stressful lifestyle and how it can compromise physical and emotional well-being (Gulanick & Myers, 2014).

Common stress responses and their consequences were discussed at length with the family. L.M. was surprised by how much stress can affect health and the emotional state. L.D.M. was not surprised by the impact stress has on the physical aspects of the body. He experiences stress headaches every now and then. M.M. wasn’t very receptive to the stress response teaching. His lack of maturity may hinder his knowledge of the effects of stress. We also discussed stress reduction techniques such as breathing exercises and listening to music. L.M. stated that she likes to take a hot bath whenever she is stressed, and this really helps to clear her head. L.D.M. and M.M. are very into music, so they agreed that music helps them manage their stress. The family was asked at the end of all sessions to rate their stress level on a scale of 1-5. 1 being least amount of stress and 5 being most amount of stress. At the first session L.M. and L.D.M. rated their stress levels at a 5. M.M. Rated his stress level at a 3. By the last session L.M. rated her stress level at a 3, L.D.M. rated his stress level at a 4, and M.M. rated his stress level at a 2. The family plans to continue working on their stress management and coping.

References

  • Gulanick, M., & Myers, J. (2014). Nursing Care Plans: Diagnosis, Interventions, and Outcomes.Philadelphia: Elsevier Mosby.
  • Hanson, S. M. H. (2001). Family health care nursing: Theory, practice, and research (2nd Ed.),  pp. 425-437. Philadelphia: F.A. Davis    
  • Kaakinen, J.R,. Coehlo, D.P., Steele, R., Robinson, M. (2018). Family health care nursing: Theory, practice, and research (6th Ed.). Philadelphia, PA: F.A. Davis Company

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