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Family health assessment aims at using a holistic approach to ensure the health of individuals, communities and families to ensure that care remains client centered. It focuses on ensuring that families acknowledge their health needs and address them by planning proper intervention strategies. Often, those individuals who are vulnerable may required an intervention that is supportive and on going so as to ensure health gains remain sustainable. The Gordon assessment has 11 components which are used to assess a family’s health (Edel and Mandelman, 2005).
Using Gordon’s assessment, the family profile is as follows. The family has a mother (39years), father (46years), four children, two girls (5 and 4 years old) and two boys (16 and 10 years. All the individuals are in good health. The ten year old boy was diagnosed with ADHD when he was 3 and OCD at the age of 6.
On the Health Perception/Health Management Pattern, the family scores themselves 7 on a scale of 1 to 10. 5 years ago the family rated themselves at 7 as well. The family does not use alcohol, smoke or use any drugs. The father has thalassemia minor, a genetic disorder inherited from his father. The 4year old daughter also inherited the blood disorder. The father mostly feels fatigue. The daughter was diagnosed with the blood disorder at one year when her hemoglobin was low. The mother is in good health though she has minor gastroesophageal reflux disease (GERD). She takes protonix daily. The 5 year old boy and the 16 year old boy have no health conditions. The family engages in exercise activities such as hiking, biking, camping though not on a daily basis. The parents also have an elliptical which the parents use about three times a week for a minimum of 30 minutes a time.
Nutritional/metabolic pattern
The family attempts to eat a healthy diet on a daily basis consisting of low fat/sodium, high fiber and consumption of whole wheat bread and white bread. The father tries to ensure that the children eat healthy meals. He mostly broils or bakes the fish/meat. The family ingest juices in moderation and they try to take as much water as possible. His role as the main person in food preparation has helped to ensure that the children eat healthy. Gordon’s framework refers to influences that affect food intake; these include knowledge of food preparation, family values and others. The person who prepares, secures and serves also influences the food intake (Janice, 2004). The father is so far a positive influence as far as healthy food intake.
The children enjoy eating vegetables. When making French fries at home, the family uses yams which are a healthier approach. Generally, the family’s appetite is good and none of the family members have shown changes in skin, hair, body weight or nail texture. However the father’s weight has been fluctuating since he lost his job and he has been spending a lot of time for caring for the children. He aims to lose 25lbs. The mother has lost 20lbs and has attained a favorable body weight. Her BMI is 22.6. The children are within the appropriate weight for their height or age according to the pediatrician.
Elimination pattern
The pattern of elimination varies with every individual in the family. The father has regular bowel movements (every morning after breakfast). The mother and the five year old daughter often suffer from constipation; the other three children have at least one bowel movement every day. There have not been any difficulties in voiding noticed recently. The appearance of the urine is yellow and clear without sediments. There is no pain on urination for any of the family members. The family uses laxatives only occasionally, particularly after a plane trip or a long car trip.
Activity/ Exercise pattern
The family does not exercise daily but they have an active lifestyle. The family enjoys activities such as hiking, swimming, hiking, camping and biking. The parents exercise on an elliptical. The children play sports like soccer, basketball and baseball during the school year. They are also involved in other activities such as karate, dance, piano and guitar lessons. Other family activities include watching television, playing video games though these are regulated and viewed as a reward. These activities help the family to build trust and unity.
Sleep/rest pattern
The quality and quantity of sleep seem to be adequate for this family because the children have a routine for sleep. The children sleep 9-10 hours every night while the parents sleep for about 6-7 hours. The quality of the mother’s sleep however may not be so good as she has to work alternate shifts due to her nursing job. This creates a potential problem as it is possible the mother may not get adequate rest especially when she has to work during the night and still keep up with the housework later in the day.
Cognitive perceptual pattern
None of the family members has any cerebrovascular disorders, neurologic infections, autoimmune disorders, neuropathies, oncologic and degenerative neurologic disorders. The mother, daughters and ten year old son all have one sensory input disorder which is an eye disorders. The boy is long-sighted, has astigmatism and a left lazy eye while their mother is short-sighted. The daughters are also long-sighted. The father underwent laser eye surgery 5years ago which resolved the need for him to wear glasses though he seems to encounter vision problems once in a while. There no other sensory disorders within the family. The father reports suffering from joint/muscle pain frequently which is relieved by use of cold or heat applications.
Self-perception/self-concept pattern
The ten year old boy has trouble expressing himself as a person due to his disability. There were vital cues that showed identity confusion, disturbances in self-esteem, feelings of powerlessness and altered body image. The boy has been receiving treatment for his depression though there still remains work to be done. The family reports themselves as being able to adjust to changes such as loss of employment and income. They are also aware of the risks to health posed by a failure to cope with change.
Roles and relationships
With regard to their current major relationships and roles in the family, the individual family members described the role of the mother as the main bread winner and the father as the care giver. Several issues such as the threat of change, actual change and loss are issues that may cause stress especially for the mother who has to combine both work and family roles.
Coping and Stress management
When asked how the family copes with stresses, they reported that it took them a couple of years to learn how to manage stress effectively. The coping strategies that the family uses include spending time with a friend or close family member, taking time away from one another and working. The family understands that stress is a necessary part of life. The mother pointed out that stress becomes problematic when the tolerance to stress is weak affecting a person’s daily activities.
Sexuality and Reproduction
The mother reported that she has had eight pregnancies and 4 births. The parents reported that they did not have difficulty in sexual functioning and had a satisfactory sexual relationship. They mentioned that the two older boys get sex education within the school system however they also reinforce the issues at home. The older boy has been taught the importance of proper testicular self-examination. The mother conducts regular breast self-examination.
Values and Beliefs
The family reports not having specific religious practices but they report that they believe in doing the right thing and being a good person generally. The family indicated that they value the family most. They are a close knit family and do a lot of activities together.
Summary
Holism and the totality of the individual’s interaction with the environment form the foundation for the family health assessment (Heardman, 2008; Janice, 2004). Gordon’s framework provides a solid position from which nurses can participate together with clients in decision making for their own healthcare. This family currently has a good health status. They do not have any obvious illnesses, rather they have regular health maintenance habits and regular health check ups. The family is generally health conscious. The family has a high level of physical activity and does not use drugs, alcohol or tobacco. They have a healthy diet consisting of high fiber foods and low fat foods with sufficient intake of fluids. They also have good elimination patterns with the exception of two family members who were having constipation. Leisure and recreation is mainly through outdoor activities and activities with the family.
The perception parameters are normal in all the family members, sleep is normal, rest is adequate for the children but the parents’ quality of rest and sleep seems inadequate. The family members are satisfied with the family relationships and roles. The mother has had 8 pregnancies and 4 childbirths, two girls and two boys. Both parents have a satisfactory sexual relationship and the two boys received some sexual education both at home and school. The family does not have any special religious practices but believe in doing the right thing and treating others the way one would want to be treated.
Nursing Diagnosis
- Anxiety related to being out of work manifested by difficulty in sleeping and verbalization of stress by father (Heardman, 2008)
- Disturbed sleeping pattern related to altered activity patterns manifested by difficulties in sleeping and changes in activity level
- Potential for interrupted family processes related to father’s recent job loss and mother’s combination of work role and family roles manifested by mother’s report of inadequate sleep and father’s statements of feeling useless.
Family Health Promotion Strategies
Several family health promotion strategies can be applied as interventions to the diagnoses above. One of the major stressors in the family is the fact that the father has no job. To deal with this the father has been occupying himself with caring for the family. The anxiety can be reduced by the father looking into employment agencies where he can find employment in line with his qualifications and experience. Additionally, he could also identify a hobby that he has that could provide an avenue for earning money. It will keep him occupied while at the same time bringing in some money for the family. This intervention needs to be done as a combined effort between the nurse, the father and the family so that the nurse provides assistance in identifying the father’s strengths and does not control the situation.
The mother also needs to rest more due to her alternate shifts. She could schedule a specific time for sleeping after doing a night shift and make sure she adheres to this. The older children can also assist in the household chores so as to leave their parents with more time for rest and sleep. This is bound to reduce their exhaustion levels and also contribute to strengthening the family unity. This should be done in cooperation with all the family members.
Systems Theory
The systems theory holds that objects relate to each other by interdependence or regular interaction (Skytnner, 2005). According to the systems theory, the whole is greater than the sum of all parts (Skytnner, 2005). Changes in these parts (subsystems) lead to changes in the whole system, that is what affects the subsystem will eventually affect the system. The system usually works to restore homeostasis in response to changes. This system theory guides the assessment of family in the sense that most families are systems with subsystems. Most families also fall on a continuum that falls between dysfunctional and healthy. The actions of family members affect all the members of the system. When individual members change, the family (system) seeks to restore itself. In this way a family is greater than the sum of its parts.
Conclusion
Gordon’s framework is a helpful tool in making family diagnosis. It is useful in determining the psychosocial functioning of the family and provides a framework for intervention by providing the necessary information about family members and their interactions and roles.
