Family health concepts and applications

Family Health

The X Family

Family X consists of a father, mother, and two children (ages seven and nine). Both parents work as lawyers but the mother is able to work partially at home, which gives her more time to care for her children when they come home from school. Sometimes she works late and her husband takes over the 'second shift' of overseeing the children's homework in the evening.

Mealtimes are described as rushed by the mother. Both children participated in afterschool activities year 'round, including gymnastics, soccer, and cheerleading (the girl) and karate and baseball (the boy). Lunch and snacks tended to consist of prepackaged foods although the mother said that she did make an effort to get healthier snack bars and fruits, versus fast food. She said that she tried to put a healthy meal on the table for her family every night but was only able to cook from scratch 2-3 times per week.

As well as being busy with her career, the mother was training for a half marathon. Her husband would sometimes run with her on the weekends, but he was generally less enthusiastic about physical activity. His physician had advised him to lose at least ten pounds and to eat a diet with more fresh vegetables, fewer processed foods, and fewer carbohydrates. Sometimes the mother would go to yoga with her husband or take her daughter. Eating well was described as a priority, but as something difficult to balance out with other obligations. Also, both children were described as highly selective, poor eaters and would eat chicken nuggets and pizza at every meal if given a choice.

The daughter of the family was not overweight but the boy was and the mother expressed concern over this, given that her husband was overweight and she was overweight as a child. Even though her son was active, she was afraid he would be teased because of his weight and not be able to find a girlfriend when he grew older. As well as participating in physical activities, she also encouraged him to go on short runs with her and to try out local kids' fitness classes. Overall, however, the family would be diagnosed for "readiness for enhanced diversional activities" given that they were still much more active than the average family and ready to add further activities.

If any advice could be given regarding exercise, it would be to include more fun and functional activities into the family's behavioral patterns. The family's schedule was so compressed there was little time for fun and unstructured play. Most of the children's activities were concentrated into relatively short, closely watched periods. The mother said that when they were unsupervised, they would generally chose to play with some electronic device or watch television. The mother said that she enjoyed gardening in addition to her own running and yoga but that she seldom had time for outdoor physical activities other than what she had carefully planned.

The mother described her own diet as basically healthy even though this sometimes meant selecting the 'healthiest' option at a fast food restaurant the rest of her family wanted to eat at. She expressed frustration that her children ate so much junk food but she also admitted that "she wasn't necessarily helping things" because she did not cook. Her husband, she said, arrived late too often to cook and because her work was primarily based out of the home (although still very much a full-time job) she was primarily expected to perform the domestic duties, including cooking. When she did cook, she said that while she did try to serve a wide variety of vegetables and healthier dishes, sometimes she fell into the pattern of offering lots of pasta, tacos, and pizza, because she knew that her children would eat them and that this would prove to be less of a struggle. The family would overall be diagnosed as "at risk for imbalanced nutrition -- more than body requirements" because of its reliance upon fast food and convenience foods. These foods tend to be highly caloric and lacking in nutrient density as well as extremely high in sugar, saturated fat, and salt, which encourages over-consumption.

In terms of healthy eating strategies for the children, she would try to encourage them to eat healthier foods by stressing that this would give them more energy for the things they liked to do. Sometimes they expressed more enthusiasm about the subject than other days but "when push came to shove" they preferred the unhealthier foods. The husband admitted that he was also part of the poor role modeling, in terms of eating healthy foods, but said he was often too stressed about work to give this much thought.

In terms of alcohol consumption, both parents were moderate drinkers, mainly consuming one or two glasses of wine with meals on weekends. They said that their schedules did not permit a great deal of entertaining outside of the home. While on one hand, this had certain positive benefits in terms of limiting alcohol consumption, on the other hand this was limiting for their social life.

Both parents reported forgoing sleep to cram in all of their activities for the day. The mother reported rising very early to run in the morning or running very late at night. Both parents said that by the time they had come home from work, had dinner, made sure their children's homework was done, and unwound from their day, it was very late at night. Getting six hours of sleep was their average.

The children also reported getting less sleep than recommended for young children. They often spent a great deal of time on the computer late at night and said that they did not feel tired staring at the lit-up screen until it was extremely late in the evening. Although their parents said that they tried to make sure their children got to bed at a reasonable hour, this often resulted in a fight with the children. While sometimes they were willing to 'do battle' with this issue, other times they were not.

The family would thus warrant the nursing diagnosis of "risk for disturbed sleep pattern." However, unlike their eating and exercise habits, the family did not express a great deal of angst or discomfort about their lack of sleep. However, poor sleeping habits have been linked to a greater tendency to overeat -- particularly late at night -- to sustain energy and also because of elevated stress hormones.