Family Health Assesment Essay

The Family discussed in this paper has two children and both parents have been married for seventeen years. The paternal and maternal grandmothers are alive, while both paternal and maternal grandfathers have died of heart disease. The maternal grandmother lives with the family. The family assessed was interviewed two times and both times, the interview took place in family’s home and lasted for thirty minutes. The author of this paper has used Calgary Family Assessment model in assessing the family, which is an integrated, multidimensional framework based on the foundation of systems, cybernetics, communication and change theory and influenced by post-modernization and biology of cognition (Wright & Leahey, ). For complete assessment to take place as described by this model, a sense of importance and open communication was established between nurse and family. The family was encouraged to attend interview together . Names of family members have been changed to protect their privacy & confidentiality. Structural Assessment It is meant to identify the composition which consists of internal and external structure of family and its connectivity. Internal Family Composition Immediate family consist of father [Tim] and mother [Maria] who are a married couple and together they have two sons; older son (Jim) aged 14,younger son [Jacob] aged 10, grandmother [Gia] and pet dog [Sheenu] aged 2 years. Gender Both genders seem equal in this family. Differences in genders were not evident. Tim and Maria both consider themselves as breadwinners of family. Tim goes on business trip for weeks and Maria work long hours to make family financially secure. This was evident when Maria stated, â€Å"I want to make sure that we have everything for decent living and best education for Jim and Jacob† (Maria, October 16, 2010). Gia stays at home and does all the cooking and look after Jacob and Sheenu. Love, respect and appreciation for one another’s contribution to the family unit were evident in this family. Sexual Orientation The sexual orientation among the couple is heterosexual. Both Jim and Jacob stated their interests for girls, and are heterosexual. Any other sexual orientation will not be accepted by the family due to family’s culture. Rank Order Gia is sixty five years old. Tim is forty seven years old and Maria is forty five years old. Jim is fourteen years and Jacob is ten years old. There is a gap of 4 years between Jim and Jacob’s birth. The family takes pride in mentioning that everybody was born in October. Jim and Jacob, both are tall and handsome. Physically they have similar features but Jacob is healthier than Jim. During family interview Jim opened up easily and talked while Jacob was quite and answered only when specifically asked. Jacob was having more non verbal communication than anybody else in the family. Based on observation of interviewee there was sense of equality between Tim and Maria but Jim seems to have some kind of control over Jacob. Before saying anything Jacob would look towards Jim. The couple state that Tim finish outdoor family tasks while Maria deals with family issues. Tim referred Maria as â€Å"Finance Minister of family† (Tim, personal communication October 16, 2010) Subsystems Dyad subsystems were evident in the family. Gia is playing role of mother, grandmother and holding the whole family together. Tim and Maria seem very close but Jim and Jacob were not so close. Jacob was trying to avoid Jim all the time. He was comfortable sitting closer to Gia and changed to another sofa when Jim sat beside him. There was strong bond between mother and sons as well as grandmother and grandchildren. The bond between sons and father was not so strong. Father’s tone of talking to sons’ was authoritative. The mother was patting her sons’ back and was quite cheerful while talking about her sons; father would only smile and admitted that his wife knows more about kids because he spend more time away from home. The whole family agreed that if there is any problem or issue within the family, everybody would sit and discuss to sort out the problem. The family could be described as close knit. Boundaries The family has set some clear boundaries. Jim is not allowed to hang out with friends without his parents’ permission. The elders in the family and outside family are to be treated with respect and love. Both Jim and Jacob have been taught to knock at door before entering and seek permission to use or borrow anything whichever does not belong to them; to give a kind of respect to each other. Both the boys have to complete their education. Jim and Jacob have been given choice to study whatever they want and their education will be paid by parents. Maria stated â€Å"all the basic necessities like food, clothing housing will be met by us as long as the boys are studying; if they keep changing their mind every year about their future studies; then this is wastage of time and money. As long as they have definite plans for a career we are ok with that; if the boys don’t want to study they have to move out and find their own living† (Maria, personal communication, October 16, 2010). External Extended Family Maternal grandmother lives with the family. Maria has three sisters. All are married and live in Michigan. Tim’s mother, brother and sisters live in New York. All of them stay in touch with each other via phone. Tim has a cab and trailer business in New York and visits his family twice a month and stays with them for couple of weeks. Maria’s family lives in the same city and visits each other quite often. Maria’s sisters’ come to help her when needed, if Tim is away on business trip. The sisters’ children and Maria’s boys sleepover at each others’ places and get along well. Gia admitted that the sisters stand by each other in thick and thin. Be it a family sickness or children’s school problem or any other appointment they are always there to help each other. Larger Subsystems Family visits their temple once in a week to say their prayers and socializes in their community. Other than this the family does not have any connections with any other religious organization or community agency. Context Ethnicity/Race /Religion/Spirituality This family is South Asian, originally from India, and immigrated to United States in 1992. Both Tim and Maria are Hindus; they have respect for all religions. They have not forced their religion on children and are free to follow any religion. Environment This family lives in safe, high middle class neighborhood in a two story four bedroom house with finished basement and a big front and back yard. They live closer to shopping malls, grocery stores, schools and library. Home is ten miles away from Maria’s place of work but she don’t mind driving as home is in safe and secured area. Developmental This family is upper-middle class family and according to Calgary health assessment model the family is in stage four of family life cycle. In this stage families often increase flexibility of boundaries to include children’s independence (Wright and Leahy, p. 91). While observing family interactions, there was typical parent-child relationship. The parents would keep quite when teenager wanted to talk. Functional Assessment Instrumental Activities of daily living Tim works less; since he has business in New York; almost two weeks in a month he spend over there. Whenever he is in Michigan he just stays home. Maria works full time. During her day off she takes care of house and children. Jim and Jacob go to school and they are underage to work outside. Jim does not help family with household chores like cutting grass and removing snow. Expressive Emotional and Verbal communication Family was respectful to each other’s opinion and gave everyone chance to speak a. Nonverbal communication was also present. They were nodding in approval or disapproval. There was time when Jim was interrupting parents to enforce his statement rather than listening. Roles/Influences and Power When asked about roles and power sharing between family members, all of them smiled at each other. Maria stated boys do help but its Jacob who helps more in doing chores than Jim. Jim usually put garbage outside for pick up. Jacob help his mom by vacuuming the house and putting dishes in the dishwasher and taking Sheenu out for walk. Maria does all the grocery shopping and Gia cooks food for the family. Maria has role of wife, mother and daughter which she is carrying with responsibility. Tim has role of father and husband. Gia has role of mother and grandmother. Jim and Jacob have roles of sons, grandsons and brothers. Family Strengths and Challenges The family’s strength lies in adherence to their cultural norms, beliefs and values and desire to form strong relationships with other cultures. The family uses the resources available for their health care needs; visits physicians for annual physicals and dental exams. The family wants to pass the positive things about their culture to next generation like respect, trust and loyalty. Being educated and believing in healthier relationship is also strength of family. The challenge for this family is the behavioral problems of teenager son within the family and outside the family; which is a source of stress for family. During the second interview Tim was not present due to business trip and children were away to school. Gia admitted that Jim is having some behavioral problems, to which Maria also agreed. Maria stated â€Å"Since he is a teenager it is really hard to keep him under control like other kids but he do have some problems† (Maria, personal communication, October 20, 2010). The problem started with Jim arguing with teachers at school. He would laugh in class for no reason; making other students to laugh and disturbing class. He used to argue a lot with teachers always stressing that he is right which was disrespectful. At home he gives hard time to Jacob and Sheenu. Gia stated that he comes home earlier than Jacob and as soon as Jacob comes home; Jim would not let Jacob in or would tell him that he is a loser or saying that nobody loves him. When Jim says something like that, Jacob would start crying. Gia stated that she does not like to intervene as Jim is in habit of pushing others and she is scared that if he pushes her; she will fall and can get a fracture. Jim also yells at Sheenu. When Jim is home Sheenu would like to stay with an adult to have a sense of protection. Jim’s behavior at school and home had brought a lot of stress for the family. Maria admitted that she was made to sit in his class to watch Jim’s behavior while he was not aware of Maria’s presence and was acting as a clown in the class. Asked about Tim’s reaction to his son’s behavior, Maria stated that Tim consider it normal for growth and development. Maria seems to be quite concerned about his son’s behavior. Maria agreed that his behavior problems started in middle school. He would come home and tell stories about boys selling â€Å"candies† in the school and he had put up those candies in his locker. The candy story made Maria worry about his son’s company and getting drugs. Without further questioning Jim; next day Maria had a meeting with school principal and Jim’s locker was searched in presence of Jim, Maria, principal and two other teachers. Nothing was found and Jim could not give any description of the person selling â€Å"candies† and what they look like. He admitted that he was just playing a joke on his mom. After this he stopped telling lies and shifted his focus on being a clown in the class. When he comes home after school; he usually takes a nap and then stays up whole night to watch television or play games. The next day he would sleep in the class. Jim does have some behavioral problems but he is a homely guy. After coming home from school, he likes to stay home and spend some time with Maria telling about school activities. Jim’s behaves well in Maria’s presence. The family’s main concern is to change Jim’s behavior. Summary of Assessment The family operates within close knit system; having internal and external harmony among friends and extended family. In terms of completing the family cycle, the mother is putting extra efforts for adjusting to the fact that she is mother of a teenager while the father has laid back attitude towards his son’s behavior. The father needs to take responsibility to find reasons for his son’s behavioral problems. Given the fact that the teenager spend most of his time in school and at home, interventions should be directed at peer influences. According to Erickson’s stages of development the teenager is going through establishment of identity versus role confusion (Kozier et al. , p. 325). The need for independency and family support creates conflict between teenager and family. The family’s ability to cope with stress affects the health of individual family members, and the health of this individual family member influences the family’s ability to cope (Kaakinen et al. , p. 65). Guidance need to be presented in a way that the teen feel loved. The above summary will be basis of health promotion for this family. Health Promotion Plan The goals of health promotion plan will be to incorporate all individuals of the family within interventions. The health concern of the family should not be for individual member but for family as unit. The health plan will be aimed at improving dimensions of family life, promoting health of this family. Family is considered a most important part in a child’s growth and development. Open communication, child-parent interaction can have a positive effect on child’s development. To stop an inappropriate child behavior, first we need to know the triggering event to that behavior. It’s important to just focus on offending behavior rather than criticizing the child. The teenager in this family has attention seeking behavior in school. He should be encouraged to participate in school games; to divert his mind and energy from unacceptable behaviors. More time need to be spent with him. Since both his parents are busy in their jobs and other responsibilities; they are spending less time with the children. The teenager is at risk of developing other health problems like smoking, drinking and dropping out of school. For prevention of those risk behaviors among teenagers; time devoted to shared activities is important for the child’s healthy development. Parent’s education, their motivation in favor of healthy lifestyle, positive thinking, guidance as well as encouragement to acceptable behaviors can reduce the manifestations of risk behavior among the adolescents. Monitoring what teenager is watching on television and internet will help in reducing problems. Both the parents are educated; they should make the teenager aware of their expectations from him. A sense of trust should be developed between teenager and parents to help his transition into adulthood and to become independent, responsible, communicative young adult. The child should be encouraged to be a role model for his younger brother and should be rewarded for taking responsibility. Making him aware of inappropriate behavior will help him in deciding right and wrong. Inappropriate behavior should be ignored and appropriate behavior, must be reinforced. Positive reinforcement used immediately after appropriate behavior like offering praise immediately after the behavior will help. Setting limits for watching television and access to internet and making rules for going to bed at specific time will help in dealing with problems at school. The parents have already recognized the need for seeking counseling for their son. The mother has taken the responsibility to go with him or he can talk in private to counselor about his problem. After going for 2-3 sessions the family has observed positive changes in teen’s behavior. Conclusion Of all the interventions discussed above, the most applicable in implementing health promotion plan for the family assessed in this paper will be the parent-child interaction. Interaction between them will help in preventing other health problems in adolescent like drinking, smoking. The parents should present their own behavior in a positive way, so that children can learn from them. It is time that family should pay close attention to teenager’s behavior problems to protect and prevent him from developing other health problems.