Child and Family Nursing

Justification of Family Assessment

Over the last few years, the importance of family has been recognized in nursing. Family assessment is an ongoing practice, which is used to make informed decision making by finding and evaluating the important factors that impact the health of children, youth and their families. The family assessment is done as soon as the family and children comes in contact with the welfare or healthcare organization. There are many factors found within the family history that may affect the future child’s future growth, safety, risk of maltreatment, parent’s protective ability and child’s well-being (Caldwell et al, 2001).

Nursing practice is critical care setting, which is focused on addressing and recognizing the needs of the patients suffering with chronic illness or serious health issues and family members of the individuals. The main aim of the family assessment is to identify the family functioning. Many studies have shown that the youth showing chronic pains and chronic illness are associated with improper physical and psychological working in childhood. The data evaluated and collected from the family assessment are used in different clinical ways and researches (Carlson, & Carlson, 2014). Family assessment is a strength based approach that includes the culture and community of the family. The assessment can provide vital information that can lead to effective interventions and healthcare goals (Neabel, Fothergill-Bourbonnais, & Dunning, 2000).

The biggest thing is the family assessment is voluntary, family members can share the information if they want or may not share. Building trust and faith with family is the important part of implementing any kind of family assessment in a proper manner. Thus, it is correct to say that family assessment guide provides the basis for the evidence based practice and choose this practice in providing quality care to the family. The information, which is collected from the family must include family culture, strengths, goals and daily routines. This information helps in understanding the family from the depth.  The benefit of Family assessment is that it is used for evaluation in nursing practice, but it can be used any time to determine the changes in the family. As evidence based practice, family assessment tool focuses on the daily routines of the family that helps to evaluate the child’s ability, requirements and support system. The focus of family assessment is also on identifying the resources that family use to support the child.

Some of the other benefits of family assessment are that it facilitates the participation of the complete family, which allows that care providers to understand the family arrangement, strength and goals in detail. Providers can also understand the family resources and family system (McDaniel et al, 2005). The family assessment tool helps in reflecting the choices and voices of the family members. The family needs can be understood through this assessment, which helps the care provider to tailor the interventions according to the needs of the family. The care providers may have to face some challenges; however, building trust with the family members can help in accessing important information. Conducting a successful family assessment requires a provider to have effective observational and listening skills (Coffin, 2006).

To do the justification to the family assessment, the correct approach is required. First approach the family and understand their structure. The position and role of the patient in the family must be understood. It is also important to indentify the health status of the family. It must also be identified that are there any physical limitations that can affect the care needs of the patient. The care provider must evaluate that are the family members able fulfill the patient’s physical needs. Doing the complete justification to the family assessment, it is important to determine educational background, cultural and religious beliefs, and lifestyle of the family members (Crain, 2011).   

Family Assessment: The Calgary Family Assessment Model (CFAM)

Family assessment is very important providing essential support and care to the family. For this nurse nee to indentify the family unit, what kind of illness is present in family members, what is the meaning of illness to family members, what will be the affect illness on family, and what kind of support is required by the family? The Calgary Family Assessment Model (CFAM) is a very efficient and a recognized model for nurses (Gomes, 2014). This model is very useful in conceptualizing and organizing data gathered by working with different families. This model is effective in compiling the data, but it is considered as very essential and useful, when a family requires addressing a specific health issue (Wright, & Leahey, 2012). This model is also considered as one of the four leading family assessment of the world. The model can be prepared by being divided in three main categories: structural, developmental, and functional levels (Wright and Leahey 2009, Chapter 3).

Structural Assessment

Structural assessment can be divided into internal, external and contextual structures. Internal Structure: Internal structure is meant to describe the close relationships between the family members. According to the case of the Henderson Family, the internal structure displays the nuclear family. Tracey and Tom are married for 3 years. Tracey had a son Billie, who is five years old, from her first marriage with Barry (36). Tracey and Tom are both working and both participate equally in decision making.

Tracey has clothes boutique business and Tom is fly in fly out electrician. Tracey had a bitter divorce with Berry and now spending a good life with Tom. To stays out for four weeks on his job and comes home for two weeks. Billie attends the local preschool. Tracey is pregnant again with 35 weeks pregnancy. Tracey plans to stop working by 38 weeks of gestation and will resume back to work only after her second baby will be six months old. Tom and Tracey have mortgaged a new three bedroom home in the coastal suburb on the southern Gold Coast. Berry lives with her girlfriend in the nearby suburb. Her girlfriend has two children from her first marriage. However, Billie loves to send time with his father Berry.

External Structure: Tracey has a 52 years old mother, who had been a patient of postnatal depression, but her health is improved and she is very excited about her new grandchild. Tracey’s parent got divorced when she was 14. Her father now lives in Philippines and had a Filipino wife; they come to Australia twice a year. Tracey’s brother Dan is an architect and lives in Melbourne. Tom’s father died last year and his mother lives in Sydney. She is trying to cope up with her husband’s death. Tom has a brother, who works as an engineer in India.

Development a Structure: The importance of this structure is that family also goes through developmental stages (Crain, 2011 and Wright & Leahey, 2009). Mcgoldrick & Carter’s model of the six stages of the family life cycle is used by CFAM model (Mcgoldrick & Carter, 1999). Tracey had a bitter divorce with Berry and now happily married to Tom. She had a son from her first marriage and had to face many problems in conceiving with Tom. But, she is got pregnant and had a premature baby girl by caesarean section.

1. She is now entering to a new phase of motherhood after a long time.
2. Tracey is finding difficulty in adjusting to new role, as she is not sure that how she will take care of two small children alone, when Tom will out for four weeks for his job.

Functional Assessment: The critical interaction between the family members defines the functional structure of the family. This also includes the basic and routine activities of the family. The interaction defines the relationship among the family members (Hughes, 2008). This interaction also helps to understand the family functioning at the time of illness or needs. Tracey is close to her mother, and her mother is very helpful, she is also ready to take care of her child. However, Tom is much worried about the finances that may become a problem for next six months as Tracey would go for her business; however, Tom is hopeful that things will change over time and will come back to normal. He is not much concerned about the children as he believes that Tracey can handle everything, as she has handled Billie earlier, though he might help her in evening dinner and would like to have family time. The communication pattern of Tom is not very supportive, as he is more concern about money and his relationship with Tracey. 

The families benefitted with CFAM model are those, which are mainly facing physical, emotional or spiritual problems. The family might also face the problem regarding a child, who is having any kind of difficulties (Martinez, D’Artois, & Rennick, 2007). The issue of the child might also affect the relationships in the family. This model is also helpful for those families, who have a child been hospitalized for some kind of treatment. Tracey is facing same issue, as her baby girl is admitted in the hospital, as she was born immature. Tracey visits her baby everyday and the baby is being fed with expressed breast milk.

The strength of this model is that it provides varied information to access the family through comprehensive list of different areas (Schene, 2005). The limitation of the model is that it does not access emotional needs of the family.

According to this family assessment model the family is facing two main issues:

Fly out Fly In family: Tom is a fly out and fly in electrician, who remain out for four weeks and come for two weeks at home. After the birth of immature baby girl, Tracey may require more emotional and mental support from her husband. But due to this issue, she would not be able to receive love and support from her husband and would have to look after her baby alone in hospital.

Nursing Goal: The nursing goal in this case is to provide emotional and mental support to Tracey.

1. Nurse must ask Tracey to come out of emotional distress and take the support of the family members. Fly out fly in job of her husband may affect their relationship (Meredith, Rush, & Robinson, 2014)
2. Nurse should focus on interacting with the family members of Tracey, as her mother is very supportive, she can help Tracey in taking care of new born.
3. Tom must be counseled to provide more moral and emotional support to Tracey. He can also be encouraged to help her in daily activities, as well as taking care of Billie. So, that Tracey may not be worried about taking care of both children (Meredith, Rush, & Robinson, 2014).
4. First caregivers are often considered as secondary patients, they also require guidance and protection (Friedman, Bowden, & Jones, 2003). Nurses should also focus on the health and safety of Tracey. Tracey can also feel postnatal depression and will require more support from family members.

Breast Feeding: Tracey has been a mother of one son, before giving birth to baby girl. But, now she needs more support as this is a transitional phase for her. She had to face the issue of being distant from her husband and then her baby girl is admitted in hospital even weeks after her birth. She is not able to breast feed child, as she is in hospital and being tube fed with expressed breast milk.

Nursing Goal; The goal of this intervention is to help Tracey in understanding the importance of breast feeding.

1. Nurse must help Tracey in understanding the importance of maternity care. Her family members should be involved to understand the important maternity care, as this will affect the breast feeding practice (Berens, 2001).
2. Ineffective breast feeding can have adverse effects on the physical health and development of child. Unsatisfactory breast feeding could also be due to unsupportive partner (Orshan, 2008). Nurse should encourage Tom to support her wife, when he is at home.
3. Due to premature birth baby might not be able to do effective breast feeding. Thus, nurse must help the mother to hold the child in correct position and to record the pattern of suckling and swallowing (Berens, 2001).

References

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