Assessment is the first tool in the nursing process in formulating health care plans for the individual as well as the family. A through assessment lays groundwork to promote family health (Edelman & Mandle, 2010, p. 175). The purpose of this paper is to examine one familys view of their health.
The author will use several family focused questions addressing the 11 health patterns outlined by Gordon’s functional health patterns ("Functional Health", 2010). With completion of the family assessment, s summarization of findings and wellness nursing diagnoses will be formed.
The questions addressing all 11 functional health patterns (Appendix) and how it related to the family. The older couple chosen for this assignment are from English, Irish decent living most of there life in Nebraska now reside in Arizona. Husband 73, wife 68 married 43 years with three grown children a oldest son 43, daughter 41 and youngest son 39. Two of the children are out of the house, have spouses and children of there own. The oldest son is not married and lives out of state solely supported by his parents and has developmental and psychological issues from a childhood traumatic brain injury.
The couple maintains close relationships with the two youngest children and families. When assessing there perception of health there was no habits that would be detrimental to their health. Neither smokes, drinks or does any drugs. The husband is extremely obese, suffers from peripheral vascular disease, non-insulin dependent diabetes and has to work a fulltime job to maintain the household and support his oldest son. The wife has lost her job and has been trying to gain employment for over a year.
She has a medical history of hypertension, and is pre-diabetic. She had been active all her life as a dancer, but rarely participates in physical activity now. They both acknowledge the need for more physical activity, but lack motivation or initiative to do so. With respect to nutrition and metabolism, the diabetes and hypertension medical complications affect the husband’s metabolic function, both are supposed to be on a low sodium low glycemic diet.
The husband does most of the meal preparation, grocery shopping and cooking. His wife expresses the need for more healthy meal choices and frequently reminds her husband he should not be having sugar rich deserts. A typical nightly meal consist of beef a vegetable, starch and some type of desert like pie or ice cream. Portion sizes are addressed and healthy alternatives to deserts were suggested.
Both drink diet sodas, iced tea with little water. Both identify the need for nutritional education and are now starting to juice on the suggestion of their youngest son. There is no physical complications obstruction caloric or fluid intake. There have been no changes with elimination patterns, but the husband has intermittent diarrhea that he is unable to control and required him to wear an adult brief during the day and has concerns with frequency of urination at night. He states having to get up out of bed 3 to 4 times nightly to urinate.
The wife reports no difficulties with urination, but does have problems with constipation approximately one to two times per month. They may have complications due to medications, diet or disease process. A necessary element to promote health and prevent illness is engaging in regular physical activity. Neither one participates in any physical activity, but. The husband is sedentary at work primarily working at a desk behind a computer for 8 to 9 hours per day.
He has difficulty walking or preforming any activity due to his weight, peripheral vascular disease and complaints of being to tired after work to do anything. When asked about sleep and rest patterns both states almost immediately after a evening meal they head to bed. On average both get greater than 8 hours of sleep. He states sleep in interrupted due to elimination patterns witch wakes his wife. Both feel tired and not rested in the morning. Family relaxation time consists of watching television on the weekends and before dinner during the week.
The cognitive-perception pattern focuses of sensory perceptions, how the family retains information and how they best understand the information provided (Staff, 2006). The family states getting health and medical information from their physicians during their regular routine visits, but admit to adjusting medication and health planning based of public information from television and friends and neighbors. Each member takes responsibility for making his or her own medical and dental appointments. Both admit that they do not regularly discuss each other’s medical or health issues with each other.
They both read the daily newspaper and receive and implement material learned from these resources. The family perceives itself as a hard working honest member of their community. They have acquaintances within the neighborhood, but do not regularly socialize with people outside of their son and daughter and their families.
They are not socially active out side of their home. They regularly turn to the youngest son when needing assistance around the home or when having difficulty dealing with the older sons financial and emotional problems. In terms of roles and relationship patterns, the husband takes on the role of the breadwinner and is in charge of all finances. He states having financial difficulty being sole financial income and wishes he could be retired. His wife spends here days at home taking care of the home and has given up trying to find work after being laid off over a year ago. Relating to sexuality and reproductive patterns, the couple expressed dissatisfaction and lack of sexual intimacy.
This may be due to physical factors of the husband’s obesity and medical issues that could decrease sex drive. They both view marriage and relationship as a religious union that will not be broken. Some counseling would be beneficial to the couple to help facilitate open communication and a close bond to increase personal intimacy. The couple has a reactive plan in coping with stressful situations. Conflict arises with regards to their oldest son inability to function independently.
The wife continues to give her son money and creates stress and conflict between the couple. Neither have a plan or pattern in place when dealing with financial or health problems or other issues. They both often depend on the youngest son for advice and help with issues that come up. The son is tired of hearing about the oldest and has tried to assist his parents with a plan, but unable to have both parents in agreement.
Stress management and grief counseling will be necessary to deal with sons past injury and how to assist him to a functioning level. Their main belief system is the Catholic religion. The wife attends church on Sundays and participates in church functions, which she enjoys doing.
The husband states being religious and spiritual, but states is tired and exhausted from his work week to attend services with his wife. The both believe in the principals of the religion and use prayer to keep in good spirits and give a sense of hope. Wellness nursing diagnosis can be defined as a clinical judgment about an individual, family, group or community from a specific wellness level to achieve a high level of wellness (Carpenito-Moyet, 2007, p. 17). After the assessment of this couples functional health patterns a number of risk diagnoses and actual diagnoses are present.
Promoting the wellness nursing diagnosis of readiness for enhanced nutritional metabolic pattern as shown by the family’s willingness to adopt healthy habits and obtain education on nutrition and caloric intake. The family’s readiness for enhanced spiritual well-being as evidenced by the desire to attend services and strong belief in their chosen religion will help the family acknowledge and implement plans to tackle other health deficits. Providing education for nutritional choices low on the glycemic index, encourage the juicing, physical activity and regular primary care visits to evaluate and reassess progress.
Addressing the actual and risk diagnosis, planning and impanation of interventions will be addressed simultaneously. Reviewing all 11 functional health patterns provides an accurate assessment for the nurse to plan and implement appropriate interventions.
Questions for addressing family functional health patterns:
Health Perception/Health Management:
1. How would you describe your family’s current state of health, and what are you doing to promote health? 2. Are there any habits that can be detrimental to your of your families health, for example anyone in the household smoke, use alcohol, or any drugs (street or prescription). 3. Are there any safety issues or physical, emotional barriers to maintaining/promoting the family’s health?
Nutrition and Metabolism:
1. Is there any diseases or medical complications that affect nutritional or metabolic function? 2. What is a typical family meal, and typical daily fluid intake? Are supplements a part of your diet regiment? 3. Are there any physical complications preventing or making obtaining the proper nutrition or daily caloric or fluid intake?
1. Explain your normal bowel, bladder patterns. Have there been any changes in these patterns? Any problems with constipation, diarrhea, dysuria or polyuria? 2. Any physical or safety barriers that limit your movement or ability to eliminate?
Activity and Exercise:
1. What are your and your families feeling towards physical activity and exercise? 2. Describe a typical daily schedule, work, school, weekday and weekend days. Does physical activity play a role in your daily or weekly routine? 3. How many days/hours of physical activity a week and what types do you or your family participates?
1. What are your preferred ways of learning, retaining and obtaining information pertaining to your health. Do you have any problems with medical terms or information received from providers? 2. How does your family acquire information and who makes decisions about health care in the household?
Sleep and Rest:
1. How would you describe your rest, relaxation time as a family? 2. How many hours of sleep on average per night do you and family members get? 3. Are there any difficulties with falling or staying asleep? Do you feel rested in the morning?
Self -Perception- Self-Concept:
1. How does your family perceive itself, similar or different from other families? 2. How does your family feel they assimilate into the community and neighborhood? 3. How does the family describe the events that led to a change?
Roles and Relationships:
1. How does the family manage daily living and how are household tasks divided? 2. Who is employed outside of the house and what are long term plans for the future as a family?
1. How does the family commit love and care for each other are needs and responsibilities toward one another being met? 2. Individually are you comfortable with your partner in discussing sexuality. 3. How do as a married couple view marriage, parenthood and relationship as lovers?
1. How does your family cope with stressful life events? 2. Have any family members had a chemical dependence issue and how did the family deal with the problem? 3. What resources do you have access to or use already?
1. Do you as a family identify with any cultural, ethnic, religious, or other organizations? 2. What principals as a child are still important to you? 3. What are your family’s values and beliefs and how do they influence your daily life?
References Carpenito-Moyet, L. J. (2007). Nursing diagnosis application to clinical practice (12 ed.). Philadelphia PA: Lippincoltt, Williams & Wilkins. Edelman, C. L., & Mandle, C. L. (2010). Health promotion throughout the life span (7 ed.). Missouri: Mosby, Inc.. Staff (2006, July 16). Nursing Forms. . Retrieved from http://www.scribd.com/doc/6418349/Gordons-11-Functional-Health-Patterns Weber, J. (2005). Nursing Diagnosis. Retrieved September 7, 2012, from http://jxzy.smu.edu.cn/jkpg/UploadFiles/file/TF_06928152357_nursing%20diagnoses%20grouped%20by%20functional%20health%20patterns.pdf