Family Health Assessment of the Allen Williams Family Nurses are frequently called upon to conduct family health assessments in order to develop wellness and family nursing diagnoses that can be used to improve family relationships and coping skills of family members (Smith, 2001). This paper presents the results of a telephonic family health assessment of the Allen Williams family (not their real name), comprised of Mr. Williams, aged 65 years (retired military), his wife, Robin (a part-time bookkeeper), and their two adult children, Barry, aged 42 years (a certified management accountant) and Jerry, aged 40 years (an animal control officer). At present, Mr. and Mrs. Williams live in a modest three-bedroom ranch house in a Midwestern suburb and their two adult sons share a home in a nearby suburban community. The family health assessment of the Williams family was divided into eleven functional health patterns as follows: Values, Health Perception; Nutrition; Sleep/Rest; Elimination; Activity/Exercise; Cognitive; Sensory-Perception; Self-Perception; Role Relationship; Sexuality and Coping. Mr. Williams was asked three questions in each of these domains (see question list at Appendix A) and the results are summarized below, followed by two corresponding family and wellness nursing diagnoses based on this assessment.

Values, Health Perception

When asked to rate how important maintaining a healthy lifestyle was to him on a scale of one to ten, Mr. Williams stated it was very important and responded with an "8" rating. However, Mr. Williams also conceded that he does not receive regular check-ups from either his primary care physician or his dentist but reports visiting a local Department of Veterans Affairs (VA) outpatient clinic on occasion when his lower back hurts. Mr. Williams denies any specific injury to his lower back but notes the pain is exacerbated after sitting long hours (i.e., in front of a slot machine or at the computer).

Nutrition

Although Mr. Williams claimed mainly he ate a balanced diet, he also reported being about 30 pounds overweight, a condition that is not uncommon among elderly Americans (Ade-Oshifogun, 2012). In addition, Mr. Williams reported eating an average of two meals a day (no breakfast), but he also noted that he engaged in heavy snacking late at night on many occasions, including potato chips, grapes, peanut M&Ms (his favorite), sunflower seeds and Doritos.

Sleep/Rest

With respect to sleep and rest, Mr. Williams stated that he felt like he was usually getting enough sleep but reported drinking several cups of coffee throughout the day, including some during the evening hours which may cause sleep disruptions. In addition, Mr. Williams reports having to get up several times at night to urinate, and in some cases he is unable to get back to sleep. The Williams family has not taken a vacation since 1999 (Las Vegas) but they entire family unit attended a 3-day family reunion in 2011 in another city.

Elimination

While Mr. Williams reported usually being regular, he also noted that he generally avoids dark green and cruciferous vegetables because they made him feel "uncomfortable." None of the Williams family members, including Mr. Williams, have experienced any elimination problems that required medical care.

Activity/Exercise

According to Mr. Williams, the most exercise that he gets is "walking through the casino to my favorite slot machine." Mr. Williams also reports enjoying other indoor activities such as playing computer games such as Age of Empires and Call of Duty. Although he states he and his wife enjoy walks in the woods, Mr. Williams reports that his physical limitations have restricted their outdoor activities in recent years. In addition, Mr. Williams is an avid wood carver and he reports that the family home is decorated with several of his sculptures and wall hangings.

Cognitive

When asked if he has noticed any discernible impairment to his thinking after reaching 60 years, Mr. Williams stated that he sometimes forgets why he went into a room or what he was going to ask his wife, but attributes this to "just getting old." Notwithstanding his failing eyesight, Mr. Williams reports that he still reads for pleasure (science fiction is his favorite but he also enjoy American history).

Sensory-Perception

With respect to his sensory perception, Mr. Williams hesitated before answering but admitted that he had been experiencing trouble driving at night, especially when it is raining or the roads are very dark. He reported this process has been very gradual, and he does not usually notice until the driving conditions make it difficult for him to see the road clearly. In addition, Mr. Williams reported falling on an ice-covered parking lot while carrying out groceries and striking the back of his head but he has not fallen recently otherwise. When asked if his hearing had become less acute over the past 5 years, Mr. Williams said, "What?" and laughed but admitted that his wife has been telling him the television is too loud lately.

Self-Perception

Williams reported that his current life situation is largely what he visualized 10 and 20 years ago as he made plans for his retirement from the U.S. Army after 23 years of active service with a full pension. In addition, Mr. Williams began drawing Social Security when he turned 63 years old, and this income, together with the part-time salary earned by his wife, allows them to live comfortably with few real money worries. Based on his current relatively comfortable situation, Mr. Williams reported being mostly satisfied with his life choices and believes he had a rewarding military career that contributed materially to the welfare and security of his country.
Role Relationship

Mr. and Mrs. Williams will be married 35 years as of September 28, 2016 and they have been separated once (1999) for a 3-month period following a major fight over a relatively trivial issue. The couple reconciled, though, and has become closer today as a result of this shared experience. In fact, Mr. Williams stated that divorce was never regarded as a viable option during this separation, but both individuals felt they were in the right are were reluctant to forgive and forget. Although their actual fights have now become extremely rare (Mr. Williams reports not having raised his voice in over 8 years), they still have verbal disagreements over longstanding points of contention such as the manner in which the daily newspaper is left by Mrs. Williams ("in complete disarray") and the most especially the frequency of conjugal relations as discussed below.

Sexuality

The one major issue that Mr. Williams reported as detracting from the couple's quality of life was a loss of interest in sexual relations on the part of Mrs. Williams following her hysterectomy in 2005. Although Mr. Williams emphasized that sexual relations remained important to him, he also stated that he understood his wife's changed views and does not usually press the issue.

Coping

When he experienced stressful events, Mr. Williams reports turning to his hobbies, especially wood carving, that provides him with relaxation and sorely needed "Zen moments." In addition, during a 1-year combat tour in Vietnam, Mr. Williams reports having used marijuana and alcohol and he continues to drink beer moderately (five to ten cans a week). Mr. Williams denies using alcohol as a coping tool, but admits to drinking more alcohol (usually beer only but wine occasionally) during the holidays and "special events" such as the Superbowl, birthdays, Christmas and even Halloween, behaviors that are commonplace with many Americans of all ages (Planken & Boer, 2010). Mr. Williams also admits that he is reluctant to talk about his feelings, even with his wife of 35 years or anyone else, and he reports that he usually keeps his feelings bottled up.

Wellness nursing diagnoses

Based on the foregoing assessment, the two main wellness and family nursing diagnoses described by Weber (2010) that are applicable to Mr. Williams are as follows:

Readiness for enhanced self-control due to the interruption of his sleep patterns most likely attributable to excessive caffeine consumption and risky drinking patterns (p. 38); and,

Readiness for enhanced martial relationship due to the cessation of sexual relations between the couple (p. 36).

References

Ade-Oshifogun, J. B. (2012, September). Model of functional performance in obese elderly people with chronic obstructive pulmonary disease. Journal of Nursing Scholarship, 44(3), 232-235.

Planken, M. J. & Boer, H. (2010, August). Effects of a 10-minute peer education protocol to reduce binge drinking among adolescents during holidays. Journal of Alcohol & Drug Education, 54(2), 35-38.

Smith, L. (2001, Summer). Evaluation of an educational intervention to increase cultural competence among registered nurses. Journal of Cultural Diversity, 8(2), 50-54.

Weber, J. R. (2014). Nurses handbook of health assessment (5th ed.). Philadelphia: Wolters Kluwer Health.

Appendix A

List of Health Assessment Questions

Values, Health Perception

1. On a scale of one to ten, how important is maintaining a healthy lifestyle to you?

2. Do you receive regular check-ups from your primary care physician?

3. Do you receive regular check-ups from your dentist?

Nutrition

1. Do you eat a balanced diet?

2. Are you overweight or obese?

3. How many meals do you usually eat every day?

Sleep/Rest

1. Do you feel like you get enough sleep?

2. Have you taken a vacation during the last year?

3. Do you drink a lot of coffee?

Elimination

1. Are you usually regular?

2. Do you have to avoid certain foods?

3. Have…