A nursing assessment of a family is the basis of nursing interventions.

Stanhope and
Lancaster (2008) state, “By using a systematic process, family problem areas are
identified and family strengths are emphasized as the building blocks for interventions
and to facilitate family resiliency (p. 567). The following paragraphs will describe a typical
family. The family consists of a mother, a father, a 10 year old daughter, and a six year
old son. The family chosen was interviewed individually and as a family.
This family consists of SM, CM, daughter EM, and son DM. The family lives in a three
bedroom brick house, with three entrances, nine steps to enter the front of their home, 8
steps to enter from the garage and four steps to enter the back door. The back yard is
fences with a four foot wood privacy fence. Their home is in a quiet neighborhood with
an elementary school across the street where DM attends. Mom can watch DM play on
the play ground at school from their back deck. Their daughter, EM, attends middle
school. The family’s neighbors are all young couples with ten children ranging from age
four to thirteen. Their mortgage is $998.00/month. They have city water and sewage.
They gas heat, gas logs and a heat pump. Their house is kept clean and well maintained
since CM only works part-time at a local physician’s office. CM’s, part-time position
allows her to stay home when the children are ill or school is out. When you walk in the
front entrance it is a split level home. You can either go up six steps up to the bedrooms
or walk straight in to the main level or go down eight steps to the garage and down eight
steps to the basement. On the main level you enter the great room which is carpeted
floors and consists of a couch, love seat, and an oversized chair, television and fire
place. Connected to the great room is their dining room and kitchen which have tiled
floors. The dining room has a table that seats six, and a tall cabinet containing dried and
canned foods. The kitchen has a refrigerator, a dishwasher, microwave, and lots of
counter, and cabinet space. Out of the kitchen is the main hallway which is tiled. Leading
up the stairs to a full size bathroom and two bedrooms on the right on the left is the
master bedroom and bath. The hallway bathroom is decorated in soft beige and red
colors with simple wall hangings. The bedroom on the left is the bedroom of CED, the 5
year old daughter, and the bedroom on the right is the bedroom of LRD, the 3 year old
son. Back down the stairs is the lower level. When you first go downstairs you see and
big open family room that has a couch and two lazy boy recliners. The downstairs is all
carpeted. To the immediate right is a second full bathroom and next to that is the master
bedroom. Opposite the master bedroom is the fourth bedroom which was converted to
a toy room for the children. The downstairs is where the family spends most of their time.
There is a big screen television and there is a game station connected to the television.
BAD has taken the time to child proof their home using child safety locks on all cabinets,
and electrical outlet covers. The children have a lot of toys, and it seems they do not
have a lot of storage, yet their home is kept very tidy.
The family does not interact much with their neighbors or community. BAD’s family lives
in another state, and MLD’s family lives in another town about an hour away. MLD has
a car that he drives to and from work, and BAD uses a van to take CED to school, and
to run errands. MLD smokes cigarettes, but he steps outside when doing so to protect
the children especially CED since she has asthma. He also does not smoke when in the
car.
The family is not limited in food choices; they just do not seem to choose balanced meals
when eating. The only income that they have is what MLD earns from his job and so the
family chooses foods that are cheap and accessible, such as canned foods, frozen
foods, and snack food such as chips and cookies. The only vegetables they had were
canned vegetables. BAD does try to make a balanced dinner, but still uses frozen meals
that are easier to prepare.

BAD is a 29 year old Caucasian female. She is 64 inches and 225 pounds. Her hair is
uncombed and unwashed. She stated that since losing her job, and being diagnosed
with thyroid cancer, she does not feel the need to look presentable every day. She said
when she does leave the house that she does do her hair and makeup. She needs
surgery to remove her thyroid, but the family has already used up their allotted insurance
money for the year, so they are waiting until January to have the surgery.

MLD is 33 year old Caucasian male. He is 68 inches and 195 pounds. He is well kept in
appearance and has on slacks and a button down long sleeve shirt. He has just gotten
off work. He said he usually works overtime, 12 hour days, to make extra income for the
family. MLD also takes night classes two nights a week and is working on getting a
bachelor in business to advance at his company.

The two children are CED, and LRD. CED is 5 years old and is in kindergarten. LRD is
3 and will start kindergarden when he is 6. CED has childhood asthma, and has to have
a breathing treatment every night before bed. She also has 2 rescue inhalers and has to
take a pill every day. LRD is a healthy 3 year old boy with no diseases at this time. He
has however had several issues with ear infections, and BAD said he might have to have
tubes in his ears next year.

BAD enjoys taking care and playing with her daughter and son, CED, and LRD. She also
enjoys listening to music, drawing, and watching movies. She is not very active, thus
leading to her obesity. The family has recently gotten a video game, which is a dancing
game and she says she has since lost 10 pounds. BAD does not like cleaning, and
therefore MLD does so when he get’s home from work. BAD does the cooking and
laundry. BAD does not have a good sleep pattern and has admitted she has bouts of
insomnia. She does not exercise regularly and does not take the children out often, and
so the children are at risk for childhood obesity. When interviewed individually, BAD
stated that she is unhappy with her current sexual activity and feels that it is because of
her weight. Before their daughter was conceived and born, BAD said the couple was
sexually active several times a week. Since having both her children, she has gained
over 80 pounds and cannot seem to get motivated to lose the weight. She stated that
MLD does not make comments about her weight but does make comments that they are
not as sexually active as before. She has had several illness since having children and
believes that now she has been diagnosed with thyroid cancer, that her husband, MRD,
is upset with her. She said she is willing to try a new diet and exercise routine in order
to feel happier about herself, and states that this might make their sex life as it was
before.

When MLD was interviewed he stated that he is overwhelmed at work, and feels under
a lot of pressure to be the sole provider for the family. He also admitted that he wishes
he could come home and the house be tidy, but he usually is the one to clean when he
gets home from work. He is taking classes two nights a week, and mentioned that he
might take some time off school to work even more at work. MLD stated that his wife’s
weight does not bother him, he just wants her to be healthier, and wishes she would take
the children out more often to get some fresh air and exercise. He hasn’t noticed any
other problems with their relationship, but states he is scared of losing his wife with her
new diagnosis.

Family Structure/Functions

This family is the typical family that consists of a married couple and their children. They
have a five year old daughter and three year old son, and a 7 year old large dog. BAD
and MLD have the same expectations for their children in terms of importance of
education. They both expect them to complete high school and attend college. They
want them to do more with her life than they were able to do with theirs at this time. The
family does not attend church and when the topic of religion was brought up they both
wanted to change the subject matter.

Communication seems to be an issue within this family with BAD feeling secluded due
to her weight and MLD working long hours and overtime. BAD feels that MLD gets on
her a lot, and therefore has just about stopped communicating with MLD. BAD feels that
she is always trying to talk to MLD about their relationship but he doesn’t want to talk
about it. MLD feels there is nothing wrong with their relationship and therefore does not
want to talk about it. He has stated that he does use sarcasm when talking with BAD
because he is uncomfortable talking about their relationship when he doesn't feel
anything is wrong. In times where decisions need to be made about the children or their
household, BAD and MLD make the decisions together after first talking about the
possible outcomes of each possible path.

Family Functions

According to Stanhope and Lancaster (2008) “The two primary functions of families in
the twenty first century are relationship and health care functions” (p. 555). This family
is having problems in their relationship between mother and father and also with their
health because BAD has been diagnosed with cancer, and CED has childhood asthma.

Developmental Stages

According to Stanhope and Lancaster (2008) Duvall’s Developmental Stages of the

Family “are based on the age of the eldest child” (p. 560). This family would fit into Stage
III, which is the family with a preschooler stage. BAD and MLD’s main focus in this stage
is providing adequate housing, nutrition, activity, and safety for each person in the family,
along with socialization of CED and LRD. BAD and MLD need to focus on maintaining a
healthy relationship between the two of them to promote a well balanced life for CED
and LRD. They also need to accomplish forming a relationship with their community.
Communities offer a lot of activities, companionship, and educational opportunities that
would be very healthy for CED and LRD, and her parents.

Nursing Diagnoses

Three nursing diagnoses were identified using the family assessment data that was
obtained from this family, and Duvall’s Developmental Stages of the Family. The nursing
diagnoses are listed below, in order of importance, the first being the most important to
the third being the least.

Imbalanced nutrition: more than body requirements, related to metabolic needs, as

evidenced by poor dietary habits and sedentary lifestyle.

Family process, interrupted, related to loss of income and poor communication, as

evidenced by tension among parents.

Activity intolerance, related to excess weight, as evidenced by verbal reports of not

exercising regularly.

Nursing Interventions

After reviewing the families level of education, and their knowledge on nutrition I was
able to come up with nursing interventions that correlate with the diagnosis.

Problem: Imbalanced nutrition: more than body requirements, related to metabolic

needs, as evidenced by poor dietary habits and sedentary lifestyle:

Nursing Interventions:

The nurse must identify what the family knows about possible results of unhealthy eating
and sedentary lifestyles.

The nurse must educate the family about possible diseases, illnesses, and injuries
related to unhealthy nutritional intake and sedentary lifestyles.

The nurse must educate the family on healthy food choices.

The nurse will provide example of a well balanced, healthy meal plan for one week along
with recommended activities to begin an exercise routine.

Family interventions:

The family will use the Food Pyramid and education provided by the nurse to create a
grocery list before each shopping day, with only healthy food choices and food to create
well balanced meals.

The family must strictly adhere to the shopping list.

The family will begin to increase their activity levels, including CED and LRD in all
activities, making the activities fun for them.

The parents will only give CED and LRD sugary snacks, juice, soda, and chips sparingly.

Evaluation:

After three weeks, I met with the family to assess for the needed changes to meet their
goal of a healthier lifestyle. BED and MLD were very open to the changes when it came
to their diet. The children however were not as open. They did not like several of the
healthy meals prepared, but after realizing what the children liked and disliked the couple
were able to come up with other healthy solutions. Upon looking through their cabinets
and refrigerator, very little canned foods and frozen meals were found. The children are
now drinking low fat milk and sugar free fruit juice. BAD and MLD have cut back on
drinking soda’s and when they do they have switched to diet soda’s instead. BAD and
MLD have bought several healthy cookbooks and have highlighted the meals they would
like to try. One of these books is a children’s cook book to help get the children involved
in the healthy meal planning. BAD and MLD have increased their activity levels. BAD
walks CED to school in the mornings, and walks with LRD in the afternoon to pick of
CED. The family has also worked out together with a game that they play in the living
room. MLD continues to work long hours and overtime frequently to make ends meet
financially, not allowing him to exercise as often with the family. He stated that once BAD
finds a job he will be able to cut back on his hours and maybe join the local YMCA with
the family.

Problem: Family process, interrupted, related to loss of income and poor communication,
as evidenced by tension among parents.

Nursing Interventions:

The nurse must assess the cause of the poor communication and educate them on the
importance of good communication.

The nurse must assess each person’s coping strategies and support systems.
The nurse will educate the family on resources available to them for counseling to help
save their relationships.

The nurse will encourage the family member’s to show empathy for each other to help
foster healing.

Family interventions:

BAD and MLD will make time at least twice a week for family time. This time will allow
them to catch up with what has been going on in each others lives and to also talk about
their feelings and talk about anything else.

BAD and MLD will include the children during one or two of these times to let them feel
included and to help establish good communication with them.

The family will set aside time for a family activity each week, whether it be a game night,
movie night, a walk, or some other activity.

Evaluation:

BAD and MLD both talked openly together about their relationship whereas on the first
meeting they talked separately. The family as a whole have had several game nights the
past few weeks where they exercise by dancing. BAD and MLD have both agreed that
their communication has increased and improved and both agree that they still have a
lot to work on. BAD is currently looking for a job, and states that she thinks that will take
a lot of stress off of her and MLD’s relationship.

Conclusion

This paper was developed to provide a family assessment and prioritized nursing
diagnoses. Along with the diagnoses, nursing and family interventions were placed and
also an evaluation of the family and how they reacted to the interventions. After
evaluating the family after the interventions were started, the problems have been greatly
reduced and some have been completely solved.

References:

Stanhope, M., & Lancaster, J. (2008). Public health nursing: Population-centered

health care in the community (7th ed.). St. Louis, MO: Mosby Elsevier