Nursing Assessment of a Family
Aim: The aim of this written assessment item is to apply evidence based care to the nursing assessment of a family. When an infant, young child or adolescent experiences a health or social issue, the issue can impact upon all family members. Nurses working in acute care and community settings need to understand the functioning of the family unit so they can care for and assist the whole family. There are several family assessment tools that may be used by nurses to perform a family assessment, and it is important to understand the strengths and the limitations of any tool you use in clinical practice to provide a family-centred and partnership approach to your nursing care.
Instructions: This written assignment has three distinct parts that you should address separately (as three distinct pieces of writing). You do not need to provide an introduction, or a conclusion for any of these parts.
(Part one) The Principles of Family Assessment: (approx. 400 words) ? Describe the principles of family assessment, and explain why it is important for a nurse to undertake a family assessment. ? Use at least three scholarly references from separate sources to support this part.
(Part Two) The Nursing Assessment of a Family: (approx. 600 words) ? There are two family scenarios on the following pages for you to choose from; select one. ? Select one of the family assessment tools we have explored in lectures and tutorials. Demonstrate an understanding of the selected family assessment tool by appropriately using it to assess your selected family. You may include a diagram as an Appendix. ? Identify the strengths of the assessment tool (tasks or actions that it does well) and the limitations of the assessment tool (its weaknesses, what it does not ‘capture’ or assess well) to justify your choice of the tool you are going to use. Note that these strengths and weakness are in general terms, and not in relation to your chosen scenario. ? Use at least two scholarly references from separate sources to support this part.
(Part Three) Identification and Discussion of Family Issues: (approx. 1000 words) ? Identify two issues for the family, and using appropriate research, discuss what is known about each of these issues. Note that most of part three should be allocated to this dot point, as per your marking guide (30% of your overall marks). ? Provide a nursing goal1 to address each of the two issues you have identified. Note that this dot point has 10% allocation of marks, so ensure you use your word count wisely in part three. ? Use at least five scholarly references from separate sources to support this part.
Other elements: ? Refer to the School of Nursing & Midwifery Writing and Referencing Guide for guidance on writing, and referencing according to APA 6th style and presentation. ? Ensure that you use scholarly literature2 (digitised readings, research articles, relevant Government reports and text books) that has been published within the last 10 years. If you use literature older than 10 years, you will need to justify why you are not using recent literature, i.e. seminal3 research. ? Use headings to identify each part of the written assessment. (It is recommended that you use the headings suggested in the instructions for parts 1, 2 and 3). ? Use academic language4 throughout and write in the third person. ? Refer to the marking guidelines when writing your assignment. This will assist you in calculating the weightings of the sections for your assignment. ? State your word count (excluding your reference list) on the Assignment Cover sheet. ? Maintain academic integrity
1 Goal setting in nursing provides direction for planning nursing interventions and evaluating patient progress. We suggest writing nursing goals that are SMART. SMART goals are Specific, Measurable, Action-Oriented, Realistic and Timely. For example, a vague nursing goal is: Increase patient hydration. A SMART nursing goal would be: The patient will drink 100 ml of water per hour over a 12 hour shift.
2 Scholarly or peer-reviewed journal articles are written by scholars or professionals who are experts in their fields, as opposed to literature such as magazine articles, which reflect the tastes of the general public and are often meant as entertainment.
3 Some papers are of central importance to a research topic, often because they report a major breakthrough, insight, or a new and generative synthesis of ideas. This kind of paper may describe a study that changes our understanding of a topic, or describes and illustrates a new and highly useful research method. These kinds of articles are often referred to as seminal or classic papers.
4 Everyday language is predominantly subjective. It is mainly used to express opinions based on personal preference or belief rather than evidence. Written academic English is formal. It avoids colloquialisms and slang, which may be subject to local and social variations. Formal language is more precise and stable, and therefore more suitable for the expression of complex ideas and the development of reasoned argumentation.
The Benson Family
Parents: ? Tina Benson, 26, operates a successful coffee shop business. ? Matt Benson, 29, mechanic for a V8 racing team and, up until this pregnancy, travelled away a lot with the team. About eight months ago Matt negotiated to work locally, travelling away only once each year to support the team at Bathurst.
Background: ? Married five years, difficulty conceiving due to Tina’s pelvic inflammatory disease. Received treatment and couple were on a fertility program for two years prior to conceiving. ? Two confirmed pregnancies, spontaneously aborted before 12 weeks, so undertook genetic testing when became pregnant a third time. ? Results negative, fraternal twins confirmed. ? Uneventful pregnancy; Tina continued to work full-time until 36 weeks gestation. ? Couple relocated to a larger three bedroom home in a coastal suburb on the southern Gold Coast at three months gestation, increasing their mortgage to do so. ? Tina planned to return to work five months following the birth and her sister Suzi, 24, agreed to care for the twins at her home until they turn 12 months old. After this, the twins will attend a local child care centre.
Extended family: ? Suzi and partner Tyler, 27, live in Logan and have two children; Sam, 1 and Daniel, 3. ? Tina’s mother, Marion, 52, had postnatal depression (PND) after the birth of Suzi. This remained undiagnosed and untreated until Suzi went to school. ? Marion’s neighbour at the time, a registered nurse, recognised her depression and encouraged her to visit her local doctor and attend a PND support group in the local area. ? Marion gradually gained confidence and entered part time work in retail. She and her husband divorced when Tina was 14. ? Two years ago Marion retired to the northern Gold Coast. She is very supportive of Tina and is looking forward to helping with more grandchildren. ? Tina’s father, Bruce, who is 58 years old, lives and works in Indonesia. He has a new Indonesian wife, Ade, 39, and they visit Australia twice a year. ? Matt’s parents, Henry (64) and Marcia (59) are also divorced. Both live in Perth and both have remarried in the last five years. ? Matt’s older brother Max, who is two years older than Matt, has remained single and works as an engineer in India. ? Henry was a harsh disciplinarian to his sons. He showed little warmth to them and travelled away a lot with work. Up until Matt turned 12, when Henry returned from his work trips, Matt’s
mother would report on the behaviour of both boys. Sometimes, he would give the boys a ‘good walloping to teach them how to behave’. Max would try and protect Matt from his father’s punishments. When they became teenagers Henry would take the boys to the beach to surf. ? Matt has not seen his parents or brother for over a year but has told them about the twins. His parents seemed pleased to hear of the impending birth and suggested that Matt and Tina plan a holiday in Perth when the twins are about three months old.
Current situation: ? Tina gave birth to the twins a week ago and will be discharged from hospital tomorrow. She started breastfeeding in hospital and is planning to breastfeed the twins for the first six months before she returns to work. She also plans to paint and make new curtains for their bedroom, the lounge and dining areas to save some money. She likes to keep fit and hopes to join a new parents walking group to meet other new mums. ? Due to work commitments over recent years and with the new move, Tina and Matt have not met many people on the Gold Coast. Since moving to the Gold Coast Matt has taken up surfing again in his spare time. He greets other surfers on his early morning excursions but he does not socialise with any of them. He has joined the local Surf Club and plans to take the family there for lunch soon, declaring that this might be a good place to meet some ‘likeminded people’. ? Due to her sore back and legs and her size before the birth, Tina has declined to resume a sexual relationship with Matt, which he says he understands. He is anticipating that they will be able to resume sex within a week or so, stating that ‘things will be back to normal again soon’. He adds that because Tina is taking time off work he thinks she will be rested, more relaxed and willing to resume their sexual relationship. ? Matt is a little concerned about how they will manage financially during the first few months, so is keen for Tina to return to work full time. When asked about how he will manage being woken up by the twins early in the mornings he says that, ‘Tina can sort that as I will go for surf before catching the train up to work’. He adds that he still plans to help with the cooking in the evenings. In the weekends he is looking forward to family time as long as the twins ‘don’t cry too much’.
As the Child and Family Health nurse, the Midwife has notified you about Tina and the twins’ impending discharge. You meet the family at the home visit when they are discharged from hospital.
The Tenney Family
Parents: ? Annie Tenney, 43, is an accountant, and Grant Tenney, 46, is an architect. They have been married for 10 years.
Background: ? They delayed starting a family whilst they completed further studies and travelled and lived overseas. Grant had considered not having a family due to his age, though relented in view of how much this meant to his wife. ? The couple have three children, Michael , Sally  and Jack [6 months]. ? Annie is working part-time from home at present to ensure she spends quality time with her third child, as she has endeavoured to do with all of her children. Annie deliberately left a longer period between having Sally and Jack than she did when having Michael and Sally. Annie found that the age difference between Michael and Sally resulted in a great deal of sibling rivalry between these two children. She is pleased that Sally is very accepting of her younger brother.
Extended family: ? They recently moved to a four bedroom low-set home in the northern suburbs to be closer to Annie’s aging parents Grandma Florey, 71 and Grandpa Bill, 70. Annie has no other siblings and felt that it was the ‘right thing to do’ for her parents. ? The house is smaller than their previous home and they have plans to extend as it does not have a separate office for Annie. ? Grant’s mother Brydey, 79, lives alone in an assisted living unit two hours away, but does not feel settled there and is becoming increasingly forgetful and agitated. She moved there after her husband Robert passed away suddenly two years ago from bowel cancer at 84. ? Grant’s sister, Scarlet, 48, lives nearby to where Annie and Grant have moved, but she and Annie have never been close. ? Scarlet runs a business from home, and is separated from IT executive Stan, 52. ? They have two children Geoff, 18, and Britney, 16, who live with Scarlet, but often spend weekends with their father who lives in an inner-city apartment. ? Stan works in the same firm as Grant and they have remained good friends and often socialise at work functions. ? Grant’s brother Jeff (47) lives alone close to their parents in the old family home. He is divorced from his wife Gina (42) and rarely sees his adult children, twins Sam and Ben (23) who both live and work in Canada with their mother.
? Annie is finding there are increasing demands on her time now with Michael attending school and being involved in music and after school activities. A month ago, Sally started at a local community kindergarten two days per week, and the other days stays at home with Annie. Jack is also cared for at home, with occasional help from Annie’s mother, Florey now that they live close by. ? Florey has recently been diagnosed with Type 2 Diabetes and Annie is very conscious not to enlist her help with child minding too often. Florey dotes on her only grand-daughter but finds her temper tantrums increasingly difficult to manage and no longer feels she can cope with Sally’s behaviour on her own. ? Grant regularly comes home late from work and often brings work home with him.
Current situation: ? Annie is feeling very tired and discusses this with you, the Child and Family Health nurse when she attends the clinic for Jack’s six-month developmental assessment. He is still breast fed and Annie has recently introduced solids but this has not been successful as he only wants the breast. He has been a very irritable baby with a history of feeding problems. ? Annie has noticed that he is not developing at the same rate as her other children, recalling that by six months of age Michael and Sally were sitting quite well without support, whereas Jack cannot yet manage this. ? Annie raises some concerns she has about Jack’s progress when she comes to see you. Sally is at Kindy on the day of the clinic visit, but Annie also discusses her concern about Sally’s increasing temper tantrums, food refusal and frequent night waking. Annie agrees to bring Sally to the clinic next week for further follow up. ? You refer to notes you had taken previously regarding Jack’s pre-term birth and notice that there had been some complications and Annie had an emergency lower segment caesarean section [LSCS] for foetal distress during her labour at 34 weeks. ? His APGAR scores at birth were 3 at one minute, and 6 at five minutes. ? He was in Neonatal Intensive Care Unit (NICU) on a ventilator for 24 hours and spent 2 weeks in Special Care Nursery (SCN) prior to discharge.
As the Child and Family Health nurse, you assess Jack’s developmental progress and discover he is significantly delayed in a number of key motor, language and psychosocial behaviours, and that he seems to favour one arm over the other.
You wonder whether Jack may have cerebral palsy and suggest to Annie that he be referred back to his paediatrician for further assessment, as they have not seen him since his three-month follow up.
Part One: The Principles of Family Assessment ? Clearly describes the principles of family assessment ? Explains why it is important for a nurse to undertake a family assessment
Part Two: The Nursing Assessment of a Family ? Demonstrates an understanding of the selected family assessment tool by appropriately using it to assess the selected family
? Clearly identifies the strengths and limitations of the chosen family assessment tool to justify its use
Part Three: Identification and Discussion of Family Issues ?
Uses appropriate research to discuss two issues identified for the family selected
? Provides an appropriate nursing goal to address each of the two issues that have been identified
All Parts – PRESENTATION and STRUCTURE ? Conforms to the Assignment Presentation Formatting Guidelines o Word count is stated and within acceptable limits (2,000 words +/- 10%) o Uses academic language throughout o Essay is well presented, with correct spelling, grammar, and well-constructed sentence and paragraph structure
All Parts – REFERENCING and USE OF EVIDENCE ? The written assessment task is appropriately supported by no fewer than ten different sources from the scholarly literature ? Referencing (in-text citations and reference list entries) as per APA Style 6th Edition ? Reference list starts on a separate page