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Family Assessment

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Submitted By bjames715
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Family Health Risk Assessment
Beverly James submitted to Laura Lisicki MS, FNP-BC in partial fulfillment of
NR 478 Community Health Nursing Practicum
Regis University
October 17, 2012

Family Health Risk Assessment
Health risk assessment is an important component in health promotion and disease prevention in the individual, the family and the community. Choices can be healthy or unhealthy and each individual’s exposure may not have the same implementation. “The factors that determine or influence whether disease or other unhealthy results occur are called health risk” (Stanhope & Lancaster, 2010, p. 334).
This paper discusses the family and the assessment process. The use of the genogram and ecomap will be used to present family data. By reviewing the genogram, biological and age-related risks facing the family will be determined. The ecomap will present the social and environmental risks facing the family. As a final point, an analysis of the genogram and ecomap will be utilized to summarize the family strengths and problems or potential problems.
Introduction of the Family and the Assessment Process
The J family has the following family members: * Mr. D. J., a 58 year old financial analysis who just recently lost his job, has obesity, hypercholesterol, sleep apnea and borderline hypertension * Mrs. B. S., a 58 year old mother, a full-time Registered Nurse, and going to college part-time, has hypercholesterol and suffers with gastroparesis * R. S., a 32 year old medical assistant, works full-time, is a single mother who lives with her parents D. J. and B. S. for support, presently going to college part-time to become an Registered Nurse, smokes 1 pack per day-cigarettes and has attention deficit disorder (ADD) * P.S., a 10 year son of R. S., who is a full-time student, has asthma and ADD
D. J. and B. S. have been married for 25 years and have four children between them. D. J. has a 34 year old daughter from a previous marriage. B. S. was a single mother with her first daughter R. S. They have two children between them, a twenty-two year old son and a twenty-four year old daughter.
D. J.’s father had passed away three years ago from brain cancer, dementia, hypercholesterol, and a stroke. D. J. has been under a lot of stress from losing his job. He has borderline hypertension, hypercholesterol, sleep apnea and obesity which he does not go to a physician for follow-up.
The assessment process utilized was the Friedman Family Assessment Model. Only the short form of this assessment model was used. It consist of the following six board categories of interview questions: 1. Identifying data 2. Developmental family stage and history 3. Environmental data 4. Family structure, including communication, power structures, role structures, and family values 5. Family functions, including affective, socialization, and health care 6. Family coping (Stanhope & Lancaster, 2010, p. 325).
Not all data was obtained while interviewing the family secondary to it not being relevant to the assessment. While collecting data, it allows the family system to be seen through the nurse’s eyes as a whole. “The model takes a broad approach to family assessment, which views families as a subsystem of society. The family is viewed as an open social system. The family’s structure (organization) and functions (activities and purposes) and the family’s relationship to other social systems are the focus of this approach” (Stanhope & Lancaster, 2010, p. 325).

GENOGRAM of the J FAMILY m 2/1947 m 2/1947
BH 11-20-27
BH 11-20-27

Brain Cancer Dementia Hypercholesterol Stroke Smoker d. 2009

Brain Cancer Dementia Hypercholesterol Stroke Smoker d. 2009

DJ 11-17-53 CO
DJ 11-17-53 CO
Hypercholesterol Hypertension Sleep Apnea Obesity
Hypercholesterol Hypertension Sleep Apnea Obesity
ADD Obesity Smoker
ADD Obesity Smoker
Sleep Apnea Obesity Smoker
Sleep Apnea Obesity Smoker Obesity Obesity
JJ 9-18-1981 MD
JJ 9-18-1981 MD
Obesity Smoker
Obesity Smoker
Obesity
Obesity
DM Alzheimer Hypertension Smoker d. 2010

DM Alzheimer Hypertension Smoker d. 2010

Septic Shock Rare Neurologic Disorder Smoker d. 1992
Septic Shock Rare Neurologic Disorder Smoker d. 1992
DM COPD Smoker
DM COPD Smoker
DM Alzheimer Hypertension Smoker
DM Alzheimer Hypertension Smoker
Developmentally Impaired
Developmentally Impaired
Gastroparesis Hypercholesterol
Gastroparesis Hypercholesterol
NS 4-18-88 PA
NS 4-18-88 PA
JJ 4-24-2001 MD
JJ 4-24-2001 MD
JJ 4-24-2001 MD
JJ 4-24-2001 MD
OS 1978 MD NC
OS 1978 MD NC never married never married
AM 12-7-1978 NC
AM 12-7-1978 NC m 3/2007 m 3/2007
Sleep Apnea Obesity
Sleep Apnea Obesity
DJ 6-2-1977 NC
DJ 6-2-1977 NC
Sleep Apnea Lymphoma Obesity
Sleep Apnea Lymphoma Obesity m 5/1976 m 5/1976
DS 3-19-1956 MD
DS 3-19-1956 MD
DJ 6-17-1957 MD
DJ 6-17-1957 MD m 10/1952 m 10/1952 m 8/1980 m 8/1980
RJ 2-4-1931 MD
RJ 2-4-1931 MD
SJ 6-6-1932 MD
SJ 6-6-1932 MD
JH 2-18-1925
JH 2-18-1925 m 10/2010 m 10/2010
CF 2006 MD
CF 2006 MD
CF 2004 MD
CF 2004 MD m 5/2011 m 5/2011 m 6/2004 m 6/2004
MF 1982 MD
MF 1982 MD
CS 11-7-1984 MD
CS 11-7-1984 MD
JS 1987 MD
JS 1987 MD
BK 11-17-55 PA
BK 11-17-55 PA
JS 11-28-61 WA
JS 11-28-61 WA
DS 4-28-84 PA
DS 4-28-84 PA
DS 1963 MD
DS 1963 MD div div
CS 2-19-27 DE
CS 2-19-27 DE
6/1980
6/1980
AS 1946 DE
AS 1946 DE m 11/1973 m 11/1973
Hypercholesterol Hypertension Asbestosis Obesity

Hypercholesterol Hypertension Asbestosis Obesity

m 1/1982 m 1/1982
SS 8-02-83 PA
SS 8-02-83 PA
JS 2-04-85 PA
JS 2-04-85 PA
CS 7-29-55 PA
CS 7-29-55 PA
Asthma ADD
Asthma ADD
PS 2002 CO
PS 2002 CO
DJ 10-21-53 MD
DJ 10-21-53 MD never married never married never married never married
LL 1980 HI
LL 1980 HI
RS 2-29-80 CO
RS 2-29-80 CO
RJ 1-29-90 CO
RJ 1-29-90 CO
HJ 5-17-88 MD
HJ 5-17-88 MD
BS 11-99-55 TN
BS 11-99-55 TN m 10/2005 m 10/2005
AK 2010 MD
AK 2010 MD
JK 9-4-74 MD
JK 9-4-74 MD
BS 1-2-54 CO
BS 1-2-54 CO
CK 7-5-78 MD
CK 7-5-78 MD m 6/1987 m 6/1987 m 7/1975 m 7/1975 divorced divorced 6/1981 6/1981

Use of Genogram
A genogram can demonstrate issues with health or illness within the family. It not only looks at the core family being assessed but several generations back. A genogram is demonstrated by different drawing structures: * A square indicates a male. * A circle indicates a female. * An X through either a square or a circle indicates a death. * Marriage is indicated by a solid horizontal line. * Offspring/children are noted by a solid vertical line. * A broken horizontal line indicates a divorce or separation. * Dates of birth, marriage, death, and other important events can be indicated where appropriate. * Major illness or conditions can be listed for each individual family member (Stanhope & Lancaster, 2010, p. 337).
According to the genogram, issues with smoking, hypertension, obesity and diabetes can be seen throughout the generations.
Use of Ecomap
The ecomap takes a look at what interactions there are within the family and other social organizations such as college, work and friends. * The family is represented by the large blue circle within the center of the page. * Other colored circles on the outside of the core circle represent the organizations, family and friends the family interacts with. * Lines are drawn between the family sphere and the colored spheres demonstrating the path of energy. * Arrows point to the route the energy is flowing. * Energy strength is indicated by the different weights of the lines.
The map demonstrates for the J family, that most of their energy goes into their extended family and work. Work and lack of work becomes stressors in their lives. Sources for support within the ecomap are their family and friends.

ECOMAP of the J FAMILY

Extended family
Elderly father with Alzheimer’s
Stepmother stressed out
Brother with asbestosis

Extended family
Elderly father with Alzheimer’s
Stepmother stressed out
Brother with asbestosis

Extended family
Elderly mother very frail
Brother with lymphoma
Extended family
Elderly mother very frail
Brother with lymphoma

Biker friends Close group of peers
C
Biker friends Close group of peers
C

Primary health care regular
Primary health care regular a Primary health care regular
Primary health care regular

Lost job Lost job
Works full-time
Works full-time

Motorcycling Walking
Motorcycling Walking
Attending college
Attending college

DJ 58
DJ 58
Biking Motorcycling Walking
Biking Motorcycling Walking
BJ 58
BJ 58
DJ 58
DJ 58

Works full-time
Works full-time
RS 32
RS 32

Works fulltime
Works fulltime
HJ 24
HJ 24
RJ 22
RJ 22
JK 38
JK 38
CK 34
CK 34

AK 2
AK 2
Friends Community involvement
Friends Community involvement

Single mother
Single mother
PS 10
PS 10

Works part-time
Works part-time

Attending college
Attending college
Exercises at the gym
Exercises at the gym

Friends
Good social network
Friends
Good social network

Exercises at the gym
Exercises at the gym
Friends
Friends

Strong Tenuous Female

Flow of Energy

Stressful Male

__/_/__ Divorce

Strong Tenuous Female

Flow of Energy

Stressful Male

__/_/__ Divorce

Attending college
Attending college

Attending college
Attending college

Biological and Age-Related Risks
“The family plays an important role in both the development and the management of a disease or condition. Some illness can be related to either genetics or lifestyle patterns. These factors contribute to the biological risk for certain conditions” (Stanhope & Lancaster, 2010, p. 336). When looking at the genogram for the J family, you can see several patterns of diseases. One being diabetes and the other being hypertension. Risk factors point to smoking and obesity.
“Transition (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another” (Stanhope & Lancaster, 2010, p. 336). Death within the J family structure can be a life-event risk within the family, placing a negative outcome on their health. It can produce a domino effect by increasing smoking and increasing eating which increases obesity which places into a risk for hypertension.
Social and Environmental Health Risk
The importance of social risks to family health is gaining increased recognition. A family’s health risk increases if they are living in the following: * High-crime neighborhoods * Communities without adequate recreation or health resources * Communities that have major noise pollution or chemical pollution * Other high-stress environments (Stanhope & Lancaster, 2010, p. 339)
The J family according to the ecomap has a high stress environment secondary to a major wage earner recently losing a job and feeling inadequate to provide for the family. There is a feeling of discrimination secondary to looking for a job, being 58 and without adequate education to meet the market demands. Another stressor is illness in the extended family that lives in other states.
Family Strengths and Problems
A summary of the problems the family faces according to the ecomap and the genogram are: * Decreased physical activity-in some members * Hypercholesterol * Obesity-in some members * Smoking-in some members * Hypertension-in some members * Lack of work-in one member * Lack of health care follow-up-in one member * Extended family illness * Extended family deaths
Despite these stressors and risks, when the J. family was interviewed they still were able to demonstrate the following strengths: 1. Commitment (focusing on promoting family welfare and happiness, balancing relationships, sharing responsibilities, not overcommitting to activities outside the home, and setting common goals) 2. Appreciation and affection (positive recognition in a positive environment to enhance personal self-worth) 3. Positive communication (respectfully using listening and conversation skills to discuss family issues without attacking each other) 4. Enjoyable time together (to enhance relationships and establish family identities) 5. A sense of spiritual well-being ( a unifying force that brings meaning and purpose to guide lives) 6. The ability to cope with stress and crisis (uniting the family through good communication skills, adding humor to the situation, keeping things in perspective) (Sittner, Hudson & Defrain, 2007, p 354-355)
Family commitment is strong and they are able to support each other through the crisis and stressors of life.
Conclusion
In conclusion, the family was introduced and the assessment process discussed. Family data was presented utilizing the genogram and the ecomap. Biological and age-related risks that the family faced were determined by reviewing the genogram. The ecomap was reviewed for the family and social and environmental health risks and findings were discussed. Finally a summary of the family strengths and problems based on the genogram and ecomap analysis were identified.

References
Sittner, B., Hudson, D., & Defrain, J. (2007). Using the concept of family strengths to enhance nursing care. American Journal of Maternal Child Nursing, 32(6), 353-357.
Stanhope, M., & Lancaster, J. (2010). Foundation of nursing in the community. (Third Edition) St. Louis, Missouri. Mosby Elsevier.

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LMA Family Assessment

...Family Assessment and Teaching: LMA Family The purpose of the family assessment is to identify the family problem areas, and the family strengths. These are used as building blocks for the provider to use for interventions, and to strengthen the family. The use of family-identified problems and the provider’s interventions allows for commitment on solutions, and ensures more successful interventions (Stanhope & Lancaster, 2014, p.319). The Family Development and Life Cycle Theory is a framework that predicts stressors on families as they change and transition overtime. This theory describes the family at the different stages, based off of the oldest child of the family. The theory also talks about how the family has to accomplish the different task for each stage (Stanhope & Lancaster, 2014, p.312-313). The LMA family includes...

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