Running head: FAMILY

Family Assessment Sasha Gapczynski Ferris State University

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Family Assessment The family being assessed is a family of four. It would be considered a nuclear family, which according to the Merriam-Webster dictionary is a family group that consists only of father, mother, and children. The fathers parents will also be a part of the assessment. The family unit being assessed is an acquaintance of mine and the assessment is taking place in their home. The mother and father are married with two children, boys ages 6 years and 2 months and the fathers parents are actively involved in the family but do not live with them. Stage of Family Development There are eight stages in Duvalls Developmental Stages of the Family beginning with the joining of the family and going to the stage of aging families. The stage this family is in is Stage IV: Families With Schoolchildren according to Duvalls Stages (Wong, 2001). With this stage comes several developmental tasks that the family is supposed to accomplish. One of those tasks is that the Children develop peer relations (Wong, 2001). This family is accomplishing that task by sending the oldest boy to kindergarten and encouraging him to make friends. They are participating in play dates and afternoon playtimes with other children in the neighborhood as well as things such as birthday parties. Another task that the parents should accomplish during this stage is adjusting to the peer and school influences that the child has. These parents have adjusted well and continue to do so in this transitioning period. They are conscious of who their son is around and they are doing what they can to ensure they are good influences. A third developmental task the family is to accomplish is to encourage and support growth and development and educational achievements. They accomplish that by helping the older boy with school tasks and praising him for his accomplishments. Another thing they do to accomplish that

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task is promote their son to do things such as group sports and by joining the Cub Scouts which supports growth according to the Boy Scouts of America Website (2012). The oldest chid needs to accomplish several developmental tasks as well according to Erikson and Piagets Developmental theories. Eriksons theory for the school-aged child is focused on the end result of what they are doing and they feel the need to be accepted by their peers and meet their parents expectations as well (Taylor, 2011). When looking at where the oldest child fits in according to Piagets Theory of Cognitive Development, he is in the Preoperational Stage. A developmental task he needs to accomplish according to that theory is to develop an understanding of life events and his relationships to others (Taylor, 2011). With the grandparents who are also very involved in the family they have some developmental tasks to be accomplished as well. According to Erikson, the stage the grandparents are in is Ego Integrity versus Despair and the developmental task they are faced is thinking about if their lives had some sort of fulfillment and purpose (Taylor, 2011). Through this assessment it appears that the grandparents feel that their life events give them fulfillment, the grandchildren are their world. Home and Community Environment The neighborhood this family lives in is a suburb of a large metropolitan city. There is an elementary school a few blocks from their home, a grocery store within a mile and several parks. The area is very safe and there are many other families with children living in the neighborhood. Traffic on the street is minimal as well as slow with the speed limit being 25mph and lower closer to the school. The home is a three bedroom, two bath ranch style house. There is a large, fenced-in back yard and the front yard is also quite large but not fenced-in. The inside of the

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home is clean and picked-up, there is not trash laying around just a few baby blankets and few toys scattered about the family room. The only tv is in the den and according to the Mother the children do not watch television with the exception of the older boy who is allowed one hour on Fridays and Saturdays. There is a radio on in the kitchen playing a country music station. The grandparents live in the same neighborhood, three blocks down the road in a similar ranch style house. Their house is also very clean and well kept-up. They have a tv in the living room and kitchen, neither were on during the assessment. The socioeconomic status of both the family and grandparents are middle class. The grandparents as well as the mother and father being assessed all of have college degrees as well as jobs. The grandfather is a product designer at Ford and the grandmother is an elementary school teacher. The father is a software developer and can work from home a few days a week. The mother is a high school biology teacher. Upon asking, all adults stated that they like their jobs and feel like they will continue working for a while longer. Religious Traditions and Culture This family is Christian and celebrates Christian holidays such as Christmas. They attend a Catholic church but not on a regular basis and both of the children are baptized in it. The mother stated that in the future they will have their children attend religious classes. They do not practice any cultural traditions. Their ethnicity is a mixture of German and English, but do not practice any cultural traditions related to their ethnicities. Family Functions The major responsibility for childcare rests on the mother in this family though both parents contribute a share of the responsibilities. The family provides security and survival needs

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to the children by having two working parents that can afford a house and food and other necessities of survival. The father is the major contributor financially and the grandparents are in control of their own finances. Emotional support is given by all members of the family towards the children and the other adults. The older son also shows emotional affection to his parents, grandparents and brother. They are a hugging family and also verbalize affection to each other. Social development occurs with the oldest son going to school and with the parents at work socializing with coworkers and friends. The household chores are divided up evenly among the mother and father. She cooks dinner and cleans the house, though the father and oldest son are responsible for picking up their things and taking their plates to the dishwasher and such. The father is responsible for the maintenance on the house and yard and the care of their cars. The oldest son has chores that include making his bed in the morning and setting the table for dinner. The oldest child also has the responsibility of helping out with the baby when his parents ask him to do something such as grab a diaper from the bag or a wipe. Role Strain There is a potential for role strain for the members of this family in a few different ways. The first potential role strain is that the mother may feel overwhelmed with a school aged child and a baby. She might feel like she is doing everything because of the busy schedule they have and that could lead to role strain. The father may also feel role strain in a situation that finances are involved in, he isnt the sole provider but he is the major contributor of income. The oldest son may feel role strain in the area of letting down his parents if he feels that he doesnt meet their expectations according to Eriksons Developmental Theory (Taylor, 2011). A potential

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source of role strain that could effect the grandparents is that they may feel that they are overstaying their welcome when they come over to see the children which is often. Communication While performing the assessment, the family members all spoke to each other openly in a positive tone. They dont shout or yell or use obscenities when speaking to each other, especially around the baby. I asked the parents how they state their needs and feeling to each other and the mother said they just ask if they need something or tell each other how they are feeling. They both say that they have very open and effective communication with each other and with the grandparents as well. It was stated in the assessment that problems are worked through civilly. When communicating to the older son, the parents and the grandparents both stated that they speak to him on his level and that they have no problems communicating to him. Discipline Both parents implement the discipline that is used on the oldest child. The type of discipline they use is positive discipline. The main focus on positive discipline is to have structure so that desirable behaviors are more likely to happen (Ball, 2012). They only have a few essential rules for the child and they praise him for his good behaviors as well as give him incentives for being good. When he does need to be disciplined for a bad action or behavior they warn him and tell him what will happen if he does it again. If he does it again they remove him from the situation and put him in a timeout type place. During the assessment the older child was playing by himself and did not exhibit any negative behaviors. Strengths

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This family has several strengths that enhance their relationship with each other. One strength is their communication habits. They have a very healthy communication system and very seldom have arguments. Another strength is that they are financially stable. They can afford to provide their family everything that they need and have an excess. The community they live in is also a strength because it provides socialization for all of the family members and a way to be a part of their neighborhood. Potential Problems Individually, the mother might feel like she is overworked. She has a full time job and two children to help raise and all of her household duties when she gets home from work. That may cause her to have some stress and anxiety. With the father, he might feel a struggle to find a balance between work and family. He may feel pressure to work more in order to earn more money but it would come at a cost of less time at home with his family, which would also burden his wife. He may also feel overwhelmed with the two children who are so far apart in age they cant all bond the same because they are in stages in their young lives. The potential problem that the son may feel is a lack of attention from his parents because of the baby. He can be somewhat independent with certain tasks so he may feel alone in doing them while the parents are tending to the baby who is helpless. The grandparents may face the potential problem of aging and not being able to do everything that they once were able to do. As a family unit a potential problem is being overwhelmed with all of their duties and with having two children who are at different very busy stages. Between working full-time jobs and having two children, one being a baby, there is a potential for added stress in all of their lives.

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References Alsn, P., Brink, E., & Persson, L. (2008). Living with incomprehensible fatigue after recent myocardial infarction. Journal Of Advanced Nursing, 64(5), 459-468. doi:10.1111/ j. 1365-2648.2008.04776.x

American Academy of Pediatrics. (2013). Evidence based child and adolescent psychosocial interventions. Retrieved from http://www.aap.org/en-us/advocacy-and-policy/aaphealth- initiatives/Mental-Health/Documents/CRPsychosocialinterventions.pdf Ball, J., Bindler, R. M., & Cowen, K. J. (2012). Principles of pediatric nursing: caring for children (5th ed.). Boston: Pearson. Boy Scouts of America. (2012). The benefits of cub scouting. Retrieved from http:// www.scouting.org/scoutsource/cubscouts/parents/about/benefits.aspx Cox, H. C., Newfield, S. A., Hinz, M. D., Scott-Tilley, D., Sridaromont, K. L., & Maramba, P. J. (2007). Cox's clinical applications of nursing diagnosis: adult, child, women's, mental health, gerontic, and home health considerations (5th ed.). Philadelphia: F.A. Davis Co.. Davis, N., & Carter, A. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: associations with child characteristics. Journal Of Autism & Developmental Disorders, 38(7), 1278-1291. Duff, E., Firth, M., Barr, K., & Fox, A. (2009). A follow-up study of oncology nurses after communications skills training. Cancer Nursing Practice, 8(1), 27-31. Levac, A., McCay, E., Merka, P., & Reddon-D'Arcy, M. (2008). Exploring parent participation in a parent training program for children's aggression: understanding and illuminating mechanisms of change. Journal Of Child & Adolescent Psychiatric Nursing, 21(2), 78-88.

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Lusk, P., & Sawyer, M. (2013, April). The anxious school age child: early and active interventions. Annual conference on pediatric health care, Orlando, FL. Retrieved from http://www.napnap.org/Files/2013 Conference Files/413_Lusk.pdf Nuclear family. (n.d.). Merriam-Webster.com. Retrieved October 9, 2013, from http:// www.merriam-webster.com/dictionary/nuclear family Smith, A., Hefley, G., & Anand, K. (2007). Parent bed spaces in the PICU: effect on parental stress.Pediatric Nursing, 33(3), 215-221. Taylor, C. (2011). Fundamentals of nursing: the art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Wong, D. L. (2001). Wong's essentials of pediatric nursing. St. Louis: Mosby.

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Appendix Child: Nursing Diagnosis Risk for anxiety due to change in environment related to new sibling

Necessary assessments/ interventions Assessment will be on familys developmental stage, the roles, the childs emotional level and understanding and the family dynamics. Interventions would include Cognitive Behavior Therapy with a school therapist or family therapist, play therapy as a part of the CBT and relaxation techniques such as stretching and breathing exercises.

Rationale The rationale for those interventions was from a table put together by the American Academy of Pediatrics (May, 2013) that was compiled using an evidence-based services database. In a presentation by Lusk & Sawyer (2013) she mentioned that CBT lowered anxiety rates, increased coping skills, leads to a positive outlook.

Grandparent: Nursing Necessary assessments/ Rationale Diagnosis interventions Risk for The assessments would include According to Duff et al (2009) ineffective the grandparents roles, their communication increases wellcoping due to abilities to help, the familys being of clients and minimizes their children want of their help and their the psychosocial problems. not needing relationship with the When clients identify and their help. grandchildren. Interventions reduce stressors it increases would include therapeutic their ability to cope (Alsen, communication with clinicians. Brink, & Persson, 2008). Another intervention is to have the client set goals and identify personal skills and knowledge such as what they are good at and can help the new family with. Family:

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evac Nursing Necessary assessments/ Diagnosis interventions Risk for The necessary assessments parental role would be the function of the conflict due to caregivers, the environment, stress of their goals, strengths and needs, expanding addressing their concerns would family also be assessed. The interventions that could be implemented would be to locate the parent sources of stress and their coping mechanisms. Another intervention would be to support the family and discuss concerns with them. A final intervention is to encourage the parents to meet their own needs; nutrition, rest and hygiene Rationale Assessment of parental stress and the difference in the parental experience between mother and father is needed according to Davis and Carter (2008). Supporting the family and discussing concerns helps the parents to reflect on their own thoughts and feelings and see positive behavior outcomes (Levac et al, 2008). Encouraging the parents to meet their own needs helps to reduce parental fatigue and lowers stress levels (Smith, Hefley, & Anand, 2007).