The 'T' family has been chosen for the completion of this assignment. Mr. T is the 95-year-old patriarch. His wife and mother of their two children is Mrs. T, 92 years of age. Their children are Wilma and Leon; ages 60 and 62 respectively. Theirs is a nuclear family. Both husband and wife are quick to affirm their lives are full of joy and fulfillment at having a family and raising two healthy kids.
Diagnosis of the Family
Developmental Stages and Tasks
I made the acquaintance of Mrs. T approximately four years ago when we worked side-by-side as customer service representatives; and remained work colleagues for the ensuing three years. Today we are fast friends although I have returned to school to pursue a degree in nursing. I enlisted her aid in a nursing theory project recently; her response was enthusiastic. The assignment was to be done as partial credit for a class in community health. Students were required to interview a family in their homes to better understand the unique and dynamic parameters of this environment - referred to as a 'community setting'.
In the spirit of full disclosure I prepared Mrs. T in advance about the types of questions that would be asked including queries about individual family members' health definitions; current health-related issues and coping strategies to address them. Her response was heartening; ensuring me the family was available to assist any evening that was best for my schedule. Before parting I thanked her profusely in advance for her cooperation; and advised her that the family could be guaranteed their exchanges would remain private - the point of the exercise was to allow me an opportunity to develop therapeutic communication expertise. To further ensure confidentiality - only the participants' initials would appear in any report and not their entire names. Any information that was forthcoming from the interviews would only be seen by the professor; and only for the purpose of assessing my abilities to interact effectively in a home setting. Before departing I advised her to prepare her family for the upcoming interview. When next we spoke it was to set up a date and time to meet.
With final arrangements in place I showed up at their doorstep promptly on time; dressed casually but professionally and conspicuously sporting my student I.D. Introductions were made all around with warm handshakes and excited smiles. We sat and I explained I was attending school at GBC in the field of practical nursing and then shared assignment expectations; reiterating in particular the extreme measures of confidentiality to be taken on their behalf. Before proceeding, I confirmed the consent of each family member of their voluntarily participation; the adults were additionally required to sign an agreement to that end - a class prerequisite to submitting any part of the assignment. Thus began my first experience in community nursing.
As would be instinctually expected of the community nurse; I was highly respectful of the household and its members upon each visit. I focused on my non-verbal communication techniques that called for non-judgmental expressions and gestures. All facial expressions, body posture, eye contact and voice modulation were designed to put the interviewee at ease; and more likely to be honest and forthcoming. I did not have to feign interest and I smiled and listened attentively to each family member. I leaned forward during verbal exchanges to develop a sense of intimacy and kept eye contact to reassure the speaker that I was 'mentally present' and highly interested in their responses; thereby setting an engaging tone that superimposed itself over the length of the assignment. I found that this authentic interest prompted family members to be more open and willing to share private thoughts and concerns.
One instance that challenged my communication skills occurred almost immediately at the opening of our first session when the daughter seemed unable to grasp the need of 'interviewing' at this length. To drive home the idea I returned to the text that explained to nursing students effective communication relies on message delivery, interpretation and feedback that allows for proper interpretation. The daughter peppered me with questions; and tried to draw a correlation to her own life experiences. I reiterated that an interview is a verbal exchange that opens up the doors of communication - but in this context it was a tad different and more intricate. I explained to her that one of the most important aspects of an interview is honesty and used some simple questions as examples such as querying her about her favorite activities. To cement the concept I used television viewing as a second example and pretended again to be the interviewee and interviewer - showing that one answer could be that she enjoyed a show about tree houses. At this point Wilma revealed that she comprehended the need of the interview at this time and was clear on what was expected of her.
Correlation with HP2020 Objectives and LHIs
Universal health care requisites
The requisites of universal self-care are common to everyone along the continuum of phases despite an individual's age, health and/or developmental status. These health care prerequisites universal to all people include Food, Elimination, Activity and rest, Solitude and social interactions, Hazards to human life, functioning and overall well-being. These factors are used to assess all families as part of the overall community health process. Let us consider each briefly and separately.
Food: The community nurse must determine the extent to which each member of the family is nourished and hydrated. Who is responsible for food preparation? Does the family eat together? In the case of the T. family there are no obvious signs of alcohol and/or substance abuse of any kind by any member. However, meal time atmospheres are somewhat chaotic so a thorough assessment of each family member's meal intake was difficult. In general, when siblings are enlisted to oversee the eating habits of their younger counterparts; the latter are often fed such unhealthy foods as soda, snacks and candy.
Elimination: This is a fact of life that many are reticent to discuss openly; therein lies the need for trust. In the case of the T. family there are inadequate resources for proper hygiene despite all bathrooms being functional in the home. The real problem is a shortage of bathrooms that cramps everyone's morning routine as they prepare for the day. The T. family does employ a nanny; and one of her responsibilities is to attend to the physical hygiene needs of the S. children. The home appears clean and neat however.
Surprisingly, the family has quite a menagerie that includes a rat and pig. The T. family tends to the elimination needs of their pets and attempts to ensure there is no risk of contamination of their food supply. But the truth is that the possibility exists the pets occasionally have access to human foodstuffs. Disposal and cleanup of pet wastes is proper.
Activity and rest: In this example the father is employed full time in the Navy and the mother is a stay-at-home fashion designer. Their inability to receive the proper amount of rest is not uncommon in families with children. One problem is that the children enter the parents' bedroom at night; preventing them from receiving restorative sleep. However, the parents do not use sleep aids - which tend to become a crutch to the sleeping process long-term.
Solitude and social interaction: The example for use in this section is a step-family. The step children do not get along and incompatibility reigns. Additionally, the children are rude to their step-parent and inclined to disregard instructions. The parental units have tried to repair the rift by creating multiple opportunities for family activities including such things as sailing, shopping and home repair. A nanny is responsible for mean preparation and the family takes meals together. The children attend public schools and take part in a wide variety of activities in the arts, sports, leadership and more. The parents exude mutual respect, affection, sexual attraction and love for each other. Finally, each has personal transportation that ensures they are able to meet their own obligations.
Hazards to human life, human functioning and human well-being: There are relatively few safety hazards evident in this household. However, they reside in an older home that requires a challenging amount of cleaning and repair. As the parents and nanny are busy; the children are not always supervised appropriately the chance exists for accidents. They have also been the cause of a number of unsafe impish acts such as setting off fire alarms, using a forklift in a shopping center, climbing on unsafe objects and more. The parents are not always able to ward off these behaviors successfully.
Defining the Health of a Family
Next, I requested that family members work as a team to develop a definition of 'health' and then explain its personal meaning. After a few moments of…