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Abstract

Discuss about the Family Assessment for Family Centered Care.

Abstract

A family assessment is a process of gathering and organizing information in relation to a family’s problems, strengths, values and goals. It is normally conducted by a nurse or a social health worker. It is carried out mainly to identify challenges that a family is facing and how to solve these problems. It also enables the health workers spend time with their patients and understand the weaknesses and strengths in their family set ups. The case study carried out is about a family of Scott Jenson and Sheila Jenson who have been married for two years now. The nurse conducting the family assessment uses the verbal questioning as an assessment tool. Sheila opens up about her situation to the nurse. The major challenges she is facing are with her children. Her daughter Jessie, has not received toilet training and is therefore still using nappies. Her son Grant is a two week old boy who is suffering from a condition called colic. The nurse gives Sheila the appropriate ways to deal with the challenges she is facing. The nursing goal used by the nurse is that of educating parents and their patients which fits perfectly with Sheila’s situations. Some of the contributors towards the development of this article include; Bell, Nabors, Deacon, Foxx, Grotevant, Lillis, Polit, Rubin, Stifter and Wright.

A family assessment refers to the continuous process of gathering and organizing information with regard to a family’s problems, strengths, values and goals. It refers to a process where nurses and social health workers visit homes and interact with the family members in order to obtain information about their strengths, weaknesses, values and goals.The family assessment is usually carried out for the purpose of identifying challenges that a family is facing, come up with a plan and give the services that can assist in solving the issues that this particular family is facing (Wright &Leahey, 2012). A family assessment is an important process in the health sector and some of the benefits of conducting it include; first, a family assessment enables the health workers to spend time with their patients so as to understand the strengths and weaknesses that are present in their lives and how they affect their response to the illness they are suffering from. Second, a family assessment encourages the process of relationship building, because the health workers and the family members engage in a comprehensive discussion where they explore existing strengths and weaknesses in a family. This in return, helps to build trust between the family members, hence helping them build their relationship. Third, through a family assessment, the whole family is involved in the conversation, making both the family members and the health workers aware of the needs and support requirements of each individual. Fourth, a family assessment enables the health workers have a strong relationship, enriched with trust and respect, with the members of a family. Lastly, a family assessment enables both the family members and the health workers identify the existing gaps towards supporting a member of the family who has a certain illness and measures being taken towards the well-being of the sick member of the family (Grotevant& Carlson, 2009).

Part One

In this part, the selected family scenario is the Jenson family where Sheila Jenson is married to Scott Jenson for two years. The family assessment tool applicable here is the use of verbal questions (Deacon, 2007). Through the verbal questioning, Sheila Jenson opens up and tells the nurse that is conducting the family assessment about her current marital situation. Sheila feels overwhelmed about what is happening to her. First of all, she feels the pressure each moment she feeds Grant and he keeps crying. As a result, Sheila is not able to have adequate sleep since Grant was born. Jessie, her first child, still needs her care and attention because she is still too young to be left on her own. She has not undergone toilet training and still uses napkins. Besides, the girl is not eating properly and barely gets sleep.

Another problem that Sheila is facing is isolation because she has little interaction with the world outside. This is because their family house is one kilometer from the nearest bus stop and it is difficult going out considering she has two children who need constant attention. Besides, the family car is normally used by Scott to drive to work. Scott comes home late from work and carries work with him. As a result, Sheila does not have ample time to interact with her husband. In a nutshell, the life of Sheila revolves around her house and around the life of her children.

Sheila faces yet another challenge whereby Scott expects the house to be spotlessly clean and dinner already served when he arrives from work. This is pressurizing to Sheila. Sheila also reveals, through the questions asked by the nurse, that she has plans to take Jessie to a day care in the nearby town. However, she is facing a challenge because the day care is far from their residential home using public transport. Her husband Scott is not getting along well with Jessie because of her tantrums. Jessie still sucks her thumb and needs someone to watch her so as to keep her away from the poor habit.

Strengths of the verbal questioning include; there is motivation of the family members to open up to the nurses because the members of the family feel that the nurses have taken their time and focused on their problem with an aim of assisting them. The family members are also able to ease their anxiety by sharing the various problems they are facing with the social health workers and the nurses. Some of the limitations of verbal questioning include; the process can be time consuming because the health care providers are forced to visit a particular household more than once. This can be time consuming to the health care providers or to members of the particular household who are expected to be at work. Another limitation is that the family members might not trust the health workers because they may feel that the nurses are invading their privacy (Nabors et al., 2013).

Part Two

The family of Scott and Sheila is facing a lot of challenges that are health and developmental in nature. The health challenge is seen in the fact that Grant keeps crying, a sign that he may be suffering from colic. The developmental challenge is seen by the developmental process of Jessie because she has not undergone toilet training. The issues are discussed as follows:

The health challenge of Grant is stressing to Sheila. It can be described as a condition in which a baby cries excessively when they are not facing any serious health problem. The babies with colic tend to cry more than three hours a day. The condition of colic is usually depressing for parents and can lead to relationship stress, postpartum depression, child abuse where the mother shakes the baby vigorously, termination of breastfeeding, prescription for medication for acid in the stomach and excess visits to a doctor, especially mothers, just like in the case of Sheila. The condition is normally realized when the baby is a few weeks old which could be the case with Grant. A nursing goal which can be used to address this issue of Grant suffering from colic is by educating patients and families (Stifter &Braungart, 2009). The nurse conducting the family assessment can advise Sheila with regard to her baby’s condition. She can advise Sheila that the bay’s colic is not her fault at all. The baby is not sick and it does not mean that the baby is rejecting her. Besides, the baby will get well with time because the condition subsides when the baby is between four and six months old. The nurse can also advise Sheila to look after her own well-being by asking her parents and sister to support her to enable her take breaks in between and rest as well to ease her pressure and anxiety.


Some of the causes of colic can be due to indigestion, sensitivity to proteins and sugars or trapped wind (Rubin & Prendergast, 2013). Sheila can also help her baby in several ways such as; holding Grant when he has a crying episode so as to soothe him, burping the baby after feeding him, gently rocking him over her shoulder, bathing the baby in warm water to enable him sleep faster, gently massaging her baby’s tummy just in case he has a stomach ache and preventing the baby from swallowing air by holding him in an upright position so as to ensure that the colic does not lead to a fatality. Some of the symptoms of colic include; predictable crying episodes where a baby cries almost the same time every day, intense crying where the baby sounds distressed and high pitched, crying that occurs for no clear reason where by the baby is not hungry or is not in need of a clean diaper, and posture changes such as tensed abdominal muscles. Sheila should also take some time and visit a doctor to seek some advice concerning her baby’s condition. The nurse will further advise her that she should watch out for signs such as if he is not feeding, has a high fever or has a bulging fontanel. The nursing goal is relevant to the issue of Grant because Sheila could be unaware of what is happening to her baby and she might not know how to handle the situation. Besides, she could be blinded by her feeling of depression, making her not think straight towards helping herself and her baby. The advice of her nurse would therefore be appropriate in dealing with her situation (Polit & Beck, 2010).

Part Three

The developmental challenge Jessie is facing is also contributing to the stress of Sheila. The nurse conducting the family assessment should assist Sheila by giving her tips to toilet train Jessie. She should advise her that it is important for Sheila to be patient with Jessie and go at the child’s pace. Through the mother’s patience, the child will be able to master the steps clearly. It is also advisable that she does not compare her child with other children because children see the need of controlling their bladder when they are physically ready and when they want to be dry and clean (Lillis et al, 2010).It is possible for a child to start by controlling their bowels then they learn controlling their bladder. Sheila should know that she cannot force her child to begin potty training unless she is ready. She should ensure that she initiates the toilet training when there are no magnificent changes in the family routine. The situation should be as calm as possible so that the child does not face emotions like fear and anxiety. She should also be consistent enough so that Jessie does not feel confused about the skills she has already acquired. If she happens to go out with Jessie she should carry the potty along with her so that Jessie understands that she needs her to start using the potty.


She should also adopt the following techniques later when Jessie is ready so as to monitor if she has started developing bladder control; when Jessie starts realizing when she is wet or dry, when she becomes aware that she is passing urine, if the time gap between wetting is an hour, when she shows the need to pass urine by moving to a hidden place or when she knows she needs to pee and is able to say it. Jessie should be able to sit on the potty and get up when she is done (Foxx &Azrin, 2013). If Sheila is able to, she should change Jessie in the bathroom so that she knows that when somebody feels the need to urinate or empty their bowels, they go to the bathroom. If it is possible again, Sheila can allow Jessie to help her flush the toilet or alternatively, she can help the baby to wash her hands. The potty should be placed in a strategic place where Jessie can easily see it and also tell her the purpose of the potty. It is also important allowing Jessie see Sheila using the toilet and explains what she is doing. Sheila should encourage Jessie to sit on the potty after meals and give her books and toys to play with because this will enable her play as she sits on the potty. If Sheila has realized that Jessie empties her bowel at the same time each day, at that time, she should leave her nappy off and ask her to use the potty. It is also not right for Sheila to scold Jessie when she messes and pees on the floor. Instead she should just mop the mess and allow Jessie another chance to try using her toilet skills. If she does not scold her, she will not feel anxious before using the potty and there are chances that she is going to be successful. She should put on clothes that are easy to remove so that she does not urinate on herself. The nursing goal that can be used to address the issue is educating patients and families. It is relevant because the nurse conducting the family assessment is forced to guide Sheila on the toilet training steps because she is overwhelmed by the situation she is in (Bell, 2013).

References

Bell, J. M. (2013). Family nursing is more than family centered care. Journal of family nursing, 19(4), 411-417.

Deacon, S.A. (2007). Family Assessment Tool. The Therapist’s Notebook: Homework, Handouts and Activities for use in Psychotherapy.

Foxx, R. M., &Azrin, N.H. (2014). Dry pants: A rapid method of toilet training children.Behavioral research and therapy.

Grotevant, H. D., & Carlson, C. I. (2009). Family assessment: A guide to methods and measures. Guilford Press.

Lillis, C., LeMone, P., LeBOn, M., & Lynn, P. (2010). Study guide for fundamentals of nursing: the art and science of nursing care. Lippincott Williams & Wilkins.

 Nabors, L. A., Kichler, J. C., Brassell, A., Thakkar, S., Bartz, J., Pangallo, J., ... & Lundy, H. (2013). Factors related to caregiver state anxiety and coping with a child’s chronic illness. Families, Systems, & Health, 31(2), 171.

Polit, D. F., & Beck, C. T. (2010). Nursing research: Principles and methods. Lippincott Williams & Wilkins.

Rubin, S. P., & Prendergast, M. (2013). Infantile colic: Incidence and management in a Norfolk Community. Childcare, health and development.

Stifter, C. A., &Braungart, J. (2009). Infant Colic: A transient condition with no apparent effects. Journal of Applied Developmental Psychology.

Wright, L. M., &Leahey, M. (2012). Nurses and families: a guide to family assessment and intervention. F.A Davis.

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