Running head: FAMILY ASSESSMENT

Family Assessment Paper Jessica L. Schultz Ferris State University

FAMILY ASSESSMENT Family Assessment Paper Family Composition In order to conceal the actual identity of the family involved I will be using initials

followed by a number indicating placement of birth into the family. The three female children all shared the same initials until the second child married. The Mother and Father, KA and BA, are 48 and 52. They are also grandparents in the home. The eldest child living in the home is CA1, a 27 year old female with two children living in the home as well. The children KG1 and RG2 are ages 8 and 6. KG1 is the eldest of the two and female, RG2 is male. Both are attending school 25 miles from the mother and 5 miles from the father. CA1 moved into the home a few months ago due to an eviction from her apartment. She is separated from the childrens father, whom, has since married another woman. The parents have joint custody of the children and rotate them weekly. The second child to mom and dad (KA and BA), CT2, no longer lives in the home. She married in July and lives in a home with her new husband. She is 23 years old and has no children. CA3 is the youngest child belonging to KA and BA. She is a 16 year old high school junior. She has no children. The seventh member of the family is aunt JM. She is the sister to KA and moved into the home sometime last year after the death of their mother, whom she lived with previously. She has some slight mental disability, which they did not want to disclose with me, and prefers not to work. She is able to work but not willing. So, she lives with the family and does not contribute monetarily nor does she cook or clean, watch the children, or contribute in any way to the family other than her presence. Her mother was a grandmother and great grandmother to the kids and the loss of her has been stressful on the entire family.

FAMILY ASSESSMENT I would consider this family type an extended family as a whole and also a binuclear

family for the young children in the home. They are all an extended family as an extended family shares expenses, household and child bearing responsibilities with grandparents, the siblings of a parent, or other relatives. Families may reside together to share housing expenses and childcare (Jane, Ruth, & Kay, 2009, p. 23). CA1 contributes by purchasing a portion of the food but pays none of the bills. The parents KA and BA pay all of the bills and maintain the household. BA has money saved from when he used to work, collects social security and sued a previous business for work injuries. He is disabled and unemployed. KA and CA1 are the only people in the family who work and bring home a biweekly paycheck. KA, BA, and CA3 contribute to the childcare and are helping CA1 raise and care for the children. The young children, KG1 and RG2, are part of a binuclear family. In a binuclear family the children alternate between the two homes, spending varying amounts of time with both parents, in a situation called co-parenting, usually involving joint custody (Jane, Ruth, & Kay, 2009, p. 24). This describes the childrens situation perfectly. Both parents are equally involved in the childrens lives and put the children in extracurricular activities in which they both attend. I have known the family since 2003. I met CA1 in high school and mentored CA3 when she was in 2nd grade. I have been close to the family for years and have witnessed many good as well as many stressful events within the family. I was present with CA1 for the birth of both children, the break-up of the nuclear family, the death of her grandmother, and her eviction. I was also present for the marriage of CT2 and spent many days with the entire family at sporting events for KA and BAs three children and two grandchildren and spent time in their home. They actively participated in volleyball, basketball, and softball in high school years. CA3 is still

FAMILY ASSESSMENT participating. The two grandchildren KG1 and RG2 play softball, soccer, have dance class, and karate. Stage of Family Development This family has multiple members contributing to multiple stages. I believe the family is in stages 4-7 as a whole. Stage 4 is families with school children or The Family with Adolescents. CA1 is the eldest child and has 2 children in school and the entire family is involved. The family stage according to Duvalls theory is based on the eldest childs age (Wong, 2001). Therefore, we will focus on stage 4 for this current family circumstance. Three developmental tasks to be completed by the family in this stage are taking on parental role, realignment of relationships with extended family to include parenting and grand parenting roles, and joining in child-rearing, financial, and household tasks (Basavanthappa, 2007, p. 323). CA1 has taken on the parental role with the help of her parent. CA3 is also very helpful in assisting with the care of the young children. The realignment of relationships with extended family to include parenting and grand parenting roles Developmental tasks which must be met by the eldest child, CA1, according to Erikson

are Intimacy versus Isolation. Intimacy refers to establishing intense, lasting relationships, such as marriage. Such relationships contribute to a sense of belonging and further contribute to a persons self-esteem (Basavanthappa, 2007, p. 264). CA1 is currently struggling in this area as her previous relationship failed. She is very promiscuous and admits to it openly. She is looking for love in all the wrong places as some would say. The grandparents are in the stage of Generativity versus Stagnation: Middle Adulthood or Age 30 to 65. Generativity involves making contributions to family, society, and succeeding generations through activities such as parenting and pursuing career. The generative adult

FAMILY ASSESSMENT demonstrates consideration, productivity, charity and perseverance (Basavanthappa, 2007, p. 264). The grandparents are the main supporters of the entire familys well-being. The grandparents contribute with money, time, energy, and support. They help contribute towards many of CA1s bills and items needed for the children. Home and Community Environment The family lives in an area 15 miles from the city limits. The home is surrounded by woods and the neighbors are very spread out. They live in a rural area with many small farms surrounding them.BA is a collector of many things. His back yard is full of junk cars, scrap metal, and miscellaneous items he calls treasures. He says his yard is full of investments. They

have a large pole barn filled with miscellaneous objects and an old shed with the roof caved in in the back yard. They also sold their properties mineral rights and collect from a company who pumps the oil. The home has been under construction the entire time Ive known the family. The bedrooms at one time were just 2x4s without drywall so you could see everyone and everything at all times. The bedrooms have been finished but the flooring is still just a base wood board and the walls need to be finished in one of the bathrooms and the walls to the downstairs area. The house layout is very open with a large kitchen, dining, and living room combination. The couch is almost always covered in clean laundry that needs to be folded and put away. The family spends most of their time in this room. The basement is split in two and has two separate entry ways. One of the basements is packed full of JMs belongings, her late mothers belongings, BAs treasures and other miscellaneous stored family items. The other basement is where CA1 stays with her 2 children and all of their items from their previous home.

FAMILY ASSESSMENT I would consider the families socioeconomic status as middle class (Basavanthappa, 2007). They are wealthy enough to take care of the household and are not struggling financially as a whole. CA1and JM as individuals would be considered part of a low socioeconomic class. Socioeconomic status (SES) is often measured as a combination of education, income, and occupation. It is commonly conceptualized as the social standing or class of an individual or group (American Psychological Association, 2013, para. 1). JM and CA1 have no education or skills beyond high school and are dependent on KA and BA. BA has enough money saved to support the family financially and KA has a college education and works in the public school system to help support the family and get out of the house. CA1 depends on the government to provide her and her children with healthcare and has no savings account and lives paycheck to paycheck. She often needs her parents to help her pay

for gas to get her children back and forth to school. Unlike JM, CA1 contributes to groceries and household necessities when she gets paid. She is between jobs as she was fired from her last job. She just picked up a waitressing job 25 miles from her home. CA3 works at the local subway as a sandwich artist and keeps what little money she makes to spend as she wishes. Culture/Religious Traditions The family does not attend church regularly or on holidays. They all claim to be part of the Christian religion except CT2 and CA3. They dont practice their religion or teach the children how to practice. I asked if RG was circumcised for religions purposes or hygienic purposes and CA1 answered hygienically. The childrens care and education has nothing to do with the families religious beliefs. CA3, KG, and RG used to attend church with me. They have since become busy and dont make it a priority to attend.

FAMILY ASSESSMENT The grandparents and immediate children are Caucasian and of proud Irish decent. KG and RG are half Porte Rican and half Irish American. Their dad is a full blooded Porte Rican whose grandparents came to the United States and started a family here. Their father does not speak Spanish or practice anything related to the culture. CA1 teaches the children some Spanish. They know more than their father. Family Functions

CA1 takes the most responsibility for the childrens healthcare. The parents communicate the care with each other and both agree to take their children to the same physician when necessary though, CA1 takes the most responsibility for this. The childrens fathers new wife has two children with two different fathers and one with him. Therefore, he has three other children to worry about and would prefer CA1 take responsibility for the two that they share. The children are well provided for and always cuddle their family members. They still love to sit on laps and cuddle and play. RM especially likes to cuddle his mother and tells her he loves her frequently. From the outside looking in the children feel safe, secure, and well looked after. They have wants, as all children do, but need for nothing. CA1, the grandparents, the aunts, and the father all provide for the children. The children are not afraid to speak their minds and have absolutely zero responsibility around the home pertaining to chores. CA3 does not have designated chores either. CA1 and KA keep up on the housework. CA3 cleans her own room occasionally. Higher levels of emotional and behavioral difficulties, including anxiety, depression, attention-deficit/ hyperactivity disorder, and conduct disorders and high levels of aggression (American Psychological Association, 2013, para. 5) are associated with children from low socioeconomic families. RG does have some behavioral difficulties that are visually apparent

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and he has had many notes sent home from the school. As sweet as he acts towards his mother and grandparents he is occasionally quite aggressive, hyper, and disobeys his family. I have witnessed him go through an elbow anyone in the stomach phase. His mother does not like to discipline the children because she wants to be their favorite parent and she admits it frequently. They get disciplined at their dads and he spanks them frequently. CA1 has used this in court against him on multiple occasions. Role Strain As described above there is some role strain. Role strain: the stress or strain experienced by an individual when incompatible behavior, expectations, or obligations are associated with a single social role (Dictionary, 2013). The mother does not discipline the children at home. The father is responsible for that and he only has the children every other week. The siblings of CA1 as well as her parents yell at the children but never spank them or discipline them in a way displeasing to their mother. The role strain is on the mother because her children behave wildly in her presence and on the father because he is viewed as the bad guy. The children do not enjoy spending time with their dad as much as their mom because they are made to behave. Communication Someone is always yelling in the home. Whether they are mad, annoyed, or indifferent. The family is always communicating in loud voices and screaming from one end of the house to another. Even the children yell to communicate. They hold nothing back when communicating. The entire family uses foul language except for the young children. They fight often but seem to recover quickly. One minute they express their dislike in one another and the next they act as if the fight never took place. To my knowledge there has not been abuse in the home in years. When CA1 was an adolescent in high school her mother used to beat her. CT2 and CA3 never

FAMILY ASSESSMENT received the same treatment. CA1 came to school with a black eye her senior year, her mother and her got into a yelling match and KA punched CA1 in the face. Discipline

As mentioned above the young children are mainly disciplined by their father. CA1 will often call him when the children are misbehaving to have him speak to them on the phone. CA1 does not even put her children in a timeout chair. She yells at them on occasion but they just yell back. The parents/grandparents KA and BA discipline CA3 by grounding her on occasion by not allowing her to use the car. The family does not practice a particular style of discipline or behavior expectations. They all act as they feel necessary and learn from their own mistakes.

Strengths They family, as much as they fight, still love each other very much, and express it often. They spend a lot of time together and support each other well. The grandparents and siblings have always attended sporting events and special functions for one another and CA1s children. The family makes time to spend holidays together and support one another financially. JM is well taken care of due to the care and generosity of her family. CA1 saves money and is able to work when she has a job because her father, BA, is always willing to watch the children when CA3 and KA are not available to.

Potential Problems Potential problems for KA are role strain as she is the main provider and coordinator for the family. She does the majority of the shopping and housework while working a full time job and caring for her children and grandchildren. She is at risk for stress and feeling overwhelmed. According to Mosbys Guide to Nursing Diagnosis, (2011, pg.704) stress overload is excessive

FAMILY ASSESSMENT amounts and types of demands that require action. She has many obligations pulling on her daily between the entire families wants and needs and her job. I cannot think of any problems or concerns for BA or JM other than nursing diagnosis pertaining to their weight and sedentary life styles. Future health risks may come into play for them especially for BA as he suffers from them currently as he is disabled. JM does have psychological issues that I am not aware of nor have witnessed putting her at risk for a domino effect of related mental health concerns. CA1 is at risk for pain as she suffers from fibromyalgia and is in pain frequently. As she cannot afford insurance she receives it through the state but it does not cover care or cost of

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medications pertaining to this diagnosis. She also is so concerned with being the favorite parent that is may come back to bite her when her children continue to act out. She and her children are also at risk for many conditions associated with being part of a low socioeconomic class such as;

Higher rates of attempted suicide, cigarette smoking, and engaging in episodic heavy drinking

Higher levels of emotional and behavioral difficulties, including anxiety, depression, attention-deficit/ hyperactivity disorder, and conduct disorders

Higher levels of aggression, hostility, perceived threat, and perceived discrimination for Higher incidence of Alzheimers disease later in life Higher likelihood of being sedentary and higher body mass index for adolescents, possibly because of a lack of neighborhood resources such as playgrounds and accessible healthy food options

Higher physiological markers of chronic stressful experiences for adolescents

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Higher rates of cardiovascular disease for adults (American psychological association, 2013, para. 6).

She currently smokes and is a heavy drinker. CA1 is overweight and expresses her perceived high levels of stress and anxiety. CA3 is comfortable and expresses no problems. She yells and is yelled at as much as the rest of the family and says she is unaffected by CA1 and the grandchildren moving into the home. She loves spending time with the kids and gets plenty of support and attention from the entire family. CT2 lives in her own environment away from the family that I am unaware of. According to her life that I see on Facebook she is happy and in love. The entire family including the children experience role strain as they are all responsible for the children and each other but dont want to take responsibility for the discipline of the children. They are all at risk for stress and illness is more easily spread as there are 7 people living in the same space. I have carefully researched and reviewed the lifestyles and interactions of this family and have come up with some nursing diagnoses and interventions which you will find in the Appendix. I believe the family could benefit from the diagnoses and improve their overall health if they implement them in their daily lives.

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References Ackley, B. A., Ladwig, G. B., (2011). Mosby's guide to nursing diagnosis. (3rd ed.). Maryland Heights, MO:Mosby Elsevier American Psychological Association. (2013). Children, Youth and Families & Socioeconomic Status. American Psychological Association. Retrieved from http://www.apa.org/pi/ses/resources/publications/factsheet-cyf.aspx Ball, J. W., Binder, R. C., & Cowen, K. J. (2009). Principles of pediatric nursing, caring for children. (5th ed.). Boston. Pearson Education Inc. Basavanthappa, B. T. (2007). Psychiatric mental health nursing . New Delhi. Jaypee Brothers Publishers. Dictionary.com. (2013). role strain. Retrieved from http://dictionary.reference.com/browse/role+strain. Ralph, S. S., Taylor, C. M. (2005). Spark' s and taylor's nursing diagnosis reference manual. (6th ed.). Philadelphia. Lippicott Williams & Wilkins. Wong, D. L. (2001). Wong's essentials of pediatric nursing. St. Louis: Mosby.

FAMILY ASSESSMENT Appendix

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(All diagnosis, assessments, interventions, and rationale were retrieved with assistance from Mosbys Guide to Nursing Diagnosis, (2011) and Nursing Diagnosis Reference Manual, (2005). Both referenced above.) Family Member BA(grandfather) Nursing Diagnosis Ineffective selfhealth management (Ackley, 2011, pg.407) Necessary Assessments/ Interventions Assessments: he has failure to include treatment regimens in daily living, failure to take action to reduce risk factors, and verbalizes desire to manage illness. Interventions: he should describe his daily food and fluid intake that would meet his therapeutic goals, involve family members in knowledge and development, and practice strategies to exercise regularly and change his sedentary overeating lifestyle (Ackley, 2011, pg.407). Assessments: KA has excessive amounts and types of demands requiring action. She demonstrates increased feeling of anger (frequent yelling), increased feelings of impatience, expresses feeling of tension, and reports negative impacts of stress. Interventions: Listen actively to help KA identify her stressors, Rationale BA is very sedentary and obese. Knowledge of an effective lifestyle change could improve his overall wellbeing (Ralph & Taylor, 2005, pg. 192). He sits in his chair and rarely exercises. He also eats food with little or no nutritional value.

KA(grandmother)

Stress overload (Ackley, 2011, pg. 704)

I will inform KA that stress can lead to multiple illnesses to provide a baseline for stress management tools and education (Ralph & Taylor, 2005, pg. 136). Talking about ways stress is affecting her life and body will encourage patient to manage stress as a way to improve

FAMILY ASSESSMENT categorize stressors as modifiable or nonmodifiable, and assisting KA to mobilize social supports for dealing with recent stressors (Ackley, 2011, pg.407). Assessments: Caregivers psychosocial status, interaction between caregiver and child, caregivers educational level and family role, financial stressors, and absence of spouse or significant other. Interventions: Assess amount of developmental stimulation provided by the caregiver Praise the caregiver for display of appropriate parenting (Ralph & Taylor, 2005, pg. 438) Teach the caregiver about normal growth and development. quality of life (Ralph & Taylor, 2005, pg. 136).

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RG (youngest child)

Risk for impaired parenting related to lack of knowledge of ineffective role model (Ralph & Taylor, 2005, pg. 437)

Family as a whole

Risk for other directed violence

Assessment: The age differences in the family

Is the home developmentally stimulating? (Ralph & Taylor, 2005, pg. 438) Is the child being stimulated in a positive way? Yelling can impact the childs behavior and belief of right and wrong behaviors. If the mother is praised for positive behavior she may then praise the child for positive behaviors and provide positive reinforcement to herself and the child (Ralph & Taylor, 2005, pg. 438). Knowledge of normal growth and development is important and will help the parent monitor the child and practice appropriate safety precautions and further enhance the parents understanding of developmental norms (Ralph & Taylor, 2005, pg. 438). Low levels of stimulation aids to

FAMILY ASSESSMENT (Ralph & Taylor, 2005, pg. 630) members, recent stressors and coping strategies, past history, reactions to family members episodes of violence (yelling creates more yelling), Mental status exams (Ralph & Taylor, 2005, pg. 630). Interventions: Maintain low level of stimulation when possible. Set limits on the individual family members behaviors, Express understanding of feelings, and request administration of medications when necessary (Ralph & Taylor, 2005, pg. 630). avoid increasing agitation and provoking violent behavior (Ralph & Taylor, 2005, pg. 630). Setting limits on behaviors will reinforce the expectation that the patient will act in a responsible, controlled manner (Ralph & Taylor, 2005, pg. 630). Providing support to the family members with encouragement can help promote positive behaviors and encourage them to open up to one another in a more productive manner (Ralph & Taylor, 2005, pg. 630). Medications are not always necessary but may be necessary to provide calmness and aid in the prevention of aggression. Medications may promote complianceand help keep the patients calm (Ralph & Taylor, 2005, pg. 630).

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