How adequately have individual family members accomplished age-appropriate developmental tasks? 6. Do individual family member’s developmental states create stress in the family? 7. What developmental stage is the family in? How well has the family achieve the task of this and previous developmental stages?  8. Any family history of genetic predisposition to disease? 9. Immunization status of the family?

COMMUNITY HEALTH NURSING

FAMILY HEALTH ASSESSMENT

After you have read chapter 20 of the class textbook and review the PowerPoint presentation, choose a family in your community and conduct a family health assessment addressing the questions below.

1. Family composition.

Type of family, age, gender and racial/ethnic composition of the family.

2. Roles of each family member. Who is the leader in the family? Who is the primary provider? Is there any other provider?

3. Do family members have any existing physical or psychological conditions that are affecting family function?

4. Home (physical condition) and external environment; living situation (this must include financial information). How the family support itself.

For example, working parents, children or any other member

5. How adequately have individual family members accomplished age-appropriate developmental tasks?

6. Do individual family member’s developmental states create stress in the family?

7. What developmental stage is the family in? How well has the family achieve the task of this and previous developmental stages?

8. Any family history of genetic predisposition to disease?

9. Immunization status of the family?

10. Any child or adolescent experiencing problems

11. Hospital admission of any family member and how it is handled by the other members?

12. What are the typical modes of family communication? It is affective? Why?

13. How are decisions make in the family?

14. Is there evidence of violence within the family? What forms of discipline are use?

15. How well the family deals with crisis?

16. What cultural and religious factors influence the family health and social status?

17. What are the family goals?

18. Identify any external or internal sources of support that are available?

19. Is there evidence of role conflict? Role overload?

20. Does the family have an emergency plan to deal with family crisis, disasters?

Identify 3 nursing diagnosis and develop a short plan of care using the nursing process.

Please present your assessment in an APA required font, word document attached to the forum in the discussion tab of the blackboard and in the SafeAssign exercise title “family assessment”.  4 evidence-based practice references besides the class textbook are require and must be quoted in the assignment. A minimum of 1000 words are required, excluding the first and reference page (Websites can be used but will not count toward grading). 2 replies to any of your peer’s assessment/posting are required sustained with the proper reference. You must identify two family problems and present a nursing care plan using the nursing process addressing the problems.

The assignment must be posted in the discussion tab of the blackboard for your peers to review and reply and in the SafeAssign Exercise in the assignment tab of the blackboard to verify originality. Assignments must be posted in both forums if not the assignment will grade it as 0.

Due date: Sunday, July 19, 2020 at 11:59 PM to be posted in both forum and for replies on Wednesday, July 22, 2020 at 11:59 for replies only. I will not accept assignments posted in the reply’s forum.

If you have any questions, please contact me via e-mail as soon as possible.

· Name

DQ Rubric 2019

· Description

· Rubric Detail

  Levels of Achievement
Criteria Proficient Competent Novice
Introduction and quality of discussion’s Argument

Weight 60.00%

100.00 %

It is consistent with application in research related to its context. Clarity of ideas. Comprehensive, in-depth and wide ranging.

70.00 %

The topic has a partially weak association to clarity of ideas and related topic. Relevant but not comprehensive.

15.00 %

Unable to address any part of the question and/or topic. Little relevance/some accuracy.

Objectivity of Tone, overall quality & Review of Literature in APA 6th format within past 7 years

Weight 10.00%

100.00 %

Tone is consistent, addressed professionally and objectively. Evidence in literature supports arguments.

70.00 %

The tone is not consistently objective. Some observations, some supportive evidence used.

15.00 %

No objectivity in tone. No evidence of literature review provided. Lacks evidence of critical analysis, poor to no use of supportive evidence.

Grammar / Writing Skills

Weight 7.50%

100.00 %

Excellent mechanics, sentence structure and organization with no grammatical mistakes.

70.00 %

Some grammatical lapses , uses emotional responses in lieu of relevant points.

0.00 %

Poor grammar, weak communication, lack of clarity.

Peer Reply #1

Weight 7.50%

100.00 %

Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions.

70.00 %

Some ability to meaningfully comment on other students work and ask meaningful questions.

0.00 %

No peer response

Peer Reply #2

Weight 7.50%

100.00 %

Demonstrates an exceptional ability to analyze and synthesize student work, asks meaningful extending questions.

70.00 %

Some ability to meaningfully comment on other students work and ask meaningful questions.

0.00 %

No Peer response

Overall APA Use

Weight 7.50%

100.00 %

Demonstrates an exceptional ability to apply 6th edition APA standards.

70.00 %

Some ability to to apply 6th edition APA standards. i.e. use of in-text citation, reference structure, quoting,etc.

0.00 %

No adherence to 6th edition APA standards.

Chapter 20

Family Health

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Working with Families

Working with families has never been more complex or rewarding than now.

Nurses understand the actual and potential impact that families have in changing the health status of individual family members, communities, and society as a whole.

Families have challenging health care needs that are not usually addressed by the health care system.

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How Do You Define a Family?

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Definitions of a Family

Historical definitions:

The environment affecting individual clients

Small to large groups of interacting people

A single unit of care with definable boundaries

A unit of care within a specific environment of a community or society

Current theorists:

Two or more individuals who depend on one another for emotional, physical, and economic support. Members of family are self-defined.

– Hanson & Kaakimen (2005)

The family is who they say they are.

– Wright & Leahey (2000)

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Inclusive Definitions of Family

“Family” means any person(s) playing a significant role in an individual’s life. This may include person(s) not legally related to the individual. Members of “family” include spouses, domestic partners, and both different-sex and same-sex significant others. “Family” includes a minor patient’s parents, regardless of gender of either parent … without limitation as encompassing legal parents, foster parents, same-sex parent, step-parents, those serving in loco parentis, and others operating in caretaker roles.

– Human Rights Campaign ( 2009)

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The Changing Family

Purposes of the family

To meet the needs of society

To meet the needs of individual family members

Examples of different family types

Traditional, nuclear family

Multigenerational family household

Cohabitating families

Single-parent families

Grandparent-headed families

Gay or lesbian families

Unmarried teen mothers

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The “Sandwich” Generation

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Figure 20-1 From Pew Research Center: Social and Demographic Trends: The Sandwich Generation. http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/. Accessed March 15, 2013.

Why Is It Important for the CHN to Work with Families?

The family is a critical resource.

Any dysfunction in a family unit will affect the members and the unit as a whole.

Case finding can identify a health problem that leads to risks for the entire family.

Nursing care can be improved by providing holistic care to the family and its members.

– Friedman, Bowden, & Jones (2003)

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Approaches to Meeting the Health Needs of Families

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Moving from the Family to the Community

Moving from the Individual to the Family

Moving from the Individual to the Family

Family interviewing

Manners

Therapeutic conversations

Genogram and Ecomap

Therapeutic questions

Commending family or individual strengths

Issues in family interviewing

Many locations, family informant, family health portrait, involvement of children

Intervention in cases of chronic illness

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Moving from the Family to the Community

The health of communities is measured by the well-being of its people and families.

Families are components of communities.

Cross-comparison of communities must include health needs as well as resources.

Cross-compare the needs of the families within the community and set priorities.

Delegation of scarce resources is essential.

A double standard in public health is tolerated.

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Family Theory Approach

Any “dysfunction” that affects one member will probably affect others and the family as a whole.

The family’s wellness is highly dependent on the role of the family in every aspect of health care.

The level of wellness of the whole family can be raised by reducing lifestyle and environmental risks by emphasizing health promotion, self-care, health education, and family counseling.

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Family Theory Approach (Cont.)

Commonalities in risk factors and diseases shared by family members can lead to case finding within family.

Individual is assessed within larger context of family.

Family is vital support system to individual member.

– Friedman (1994)

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Systems Theory Approach

The family as a unit interacts with larger units outside the family (suprasystem) and with smaller units inside the family (subsystem).

– Friedman (1998)

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Healthy Families

Members interact with each other; listen and communicate repeatedly in many contexts.

Healthy families establish priorities. Members understand that family needs are the priority.

Healthy families affirm, support, and respect each other.

Members engage in flexible role relationships, share power, respond to change, support the growth/autonomy of others, and engage in decision making that affects them.

– DeFrain (1999) and Montalvo (2004)

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Healthy Families (Cont.)

The family teaches family and societal values and beliefs and shares a religious core.

Healthy families foster responsibility and value service to others.

Healthy families have a sense of play and humor and share leisure time.

Healthy families have the ability to cope with stress and crisis and grow from problems. They know when to seek help from professionals.

– DeFrain (1999) and Montalvo (2004)

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Structural-Functional Conceptual Framework

Internal structure

Family composition, gender, rank order, functional subsystem, and boundaries

External structure

Extended family and larger systems (work, health, welfare)

Context: ethnicity, race, social class, religion, environment

Instrumental functioning (routine ADLs)

Expressive functioning

Emotional, verbal, nonverbal, circular communication; problem solving; roles; influence; beliefs; alliances and coalitions

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Developmental Theory

Family life cycle (Duvall & Miller, 1985)

Leaving home

Beginning family through marriage or commitment as a couple relationship

Parenting the first child

Living with adolescent

Launching family (youngest child leaves home)

Middle-age family (remaining marital dyad to retirement)

Aging family (from retirement to death of both spouses)

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Family Health Assessment Tools

Genogram

A tool that helps the nurse outline the family’s structure

Family health tree

Family’s medical and health histories

Ecomap

Depicts a family’s linkages to their suprasystems

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Family Health Assessment Tools

Family Health Assessment

Addresses family characteristics, including structure and process and family environment

Information obtained through interviews with one or more family members, subsystems within the family, or group interviews of more than two members of the family

Additional information obtained through observation of family and their environment

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Genogram

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Figure 20-2 Redrawn from Genopro Software: Symbols used in genograms, 2009: www.genopro.com.

Ecomap

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Figure 20-4 Redrawn from Hartman A: Diagrammatic assessment of family relationships, Soc Casework 59:496, 1978.

Social and Structural Constraints

Identify what prevents families from receiving needed health care or achieving a state of health

Usually based on social and economic causes

Literacy, education, employment

If disadvantaged, often unable to buy health care from private sector

Hours of service, distance and transportation, availability of interpreters, and criteria for receiving services (age, sex, income barriers)

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Family Health Interventions

Institutional context of family therapists

Ecological framework: A blend of systems and developmental theory that focus on the interaction and interdependence of families within the context of their environment

Social Network Framework: Involves all connections and ties within a group; social support

Transactional model: A system that focuses on process as opposed to a linear approach

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Applying the Nursing Process

Knowledge of self, previous life experiences, and values is crucial in planning home visits

Gather referral information, review assessment forms, and gather intervention tools (e.g., screening materials, supplies) before going to the home

Flexibility is important in working with families

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