A patient is considered to be individual and unique in his or her own way, a family is one and distinctive within a community (Christianson, Powell, Huhn, & Blanton, 2012). According to Stanhope and Lancaster (2012), a family nursing assessment identifies family problem areas and family strengths that help build for interventions to maintain health. In providing a family with nursing diagnoses, utilization of appropriate family assessment tool would be of benefit (Christianson, Powell, Huhn, & Blanton, 2012). A.T. is a 36 year old Caucasian female who is 5 feet 3 inches and weighs 180 pounds.
A. T. has two chronic illnesses: Hypertension and Diabetes, with prescribed medication that she is supposed to takes twice a day. A.T. is a full time cashier at Marshalls and lives in the Old Salem, the minority area of Winston-Salem, North Carolina. A.T. lives with her three children and husband of five years.
A.T. was married previous and had two sons N.W. and H. W. She is currently in the process of getting full custody of her two oldest sons.
Her husband T.T. is a 39 year old Caucasian male who is 5 feet 5 inches and weighs 230 pounds. He is self-employed as an electrician. T.T. was in a four wheeler accident two years ago which lacerated his spleen. T.T. had surgery to remove his spleen. He takes daily medications to prevent serious infection. T.T. smokes one pack of cigarettes a day sometime in the home and outside. N.W. is 12 year old male who does not like school, but enjoys baseball and hunting.
He has a comprehension learning disability and has an IEP with the school system to assist with learning needs. N.W. is in middle school. His school starts at 6:45 am which mean N.W. has to be on the bus at 5:50 am because the middle school is a 20 minutes from the family’s home.
H.W. is a 9 year old male. He enjoys school and spending time with his family and friends. E. T. is the family’s five year old daughter who is in kindergarten at a title one school. E.T. has asthma which is controlled by Singular and Albuterol inhaler. E.T. also has a speech delay and receives speech therapist twice a week at school. The T family currently lives in a 1950 one story 1000 square foot house with a basement. The family remodeled the basement to make two bedrooms, therefore, the home has four small bedroom and two bathrooms. A.T. dislikes the way the home was placed on the property. She feels she has no privacy because both homes to her right and left are extremely close. A. T. also would like a larger driveway due to having to park on the street and a larger backyard.
The family feels safe in their community due to community watch by neighbors and the police patrol the area often. A. T. and T. T. has no family that lives near but has numerous friends. A.T. enjoys reading, shopping, and spending time with family. A.T. and T.T. drink socially. A.T. and T.T. does not exercise often. A.T. said that she has not been to a primary care provider in over three years and admitted that the whole family does not go to their primary care provider unless they are sick or needs medication refills. A.T. said that she uses meditation and relaxation techniques to handle stressful situations. The family eats fast food three times a week.
Watson’s theory of caring is the foundation for professional nursing (Simourd, 2013). Watson’s theory of human caring focus on the human aspects of nursing as it relates to scientific knowledge and nursing practice (Simourd, 2013). Her theory focused on promoting health, preventing illnesses, caring for the sick and restoring health (Simourd, 2013). Watson’s theory promotes nurse and patient interaction but focuses on developing a caring relationship. Caring for patients promotes growth and caring environment which promotes healing. Watson believed that holistic health care is central to the practice of caring in nursing (Nursing Theory, 2013). Many of the Watson’s carative factors are helpful for community health nurses.
Several carative factors focus on the nurse’s part of the caring relationship in clarifying values to the clients (Nursing Theory, 2013). Understanding one’s self and being sensitive to others is as important in caring for the community as individuals. Community caring occurs within a helping-trusting relationship and is directed toward protecting and enhancing the self-esteem of other (Nursing Theory, 2013). Watson’s theory is connected to community health through it focus of promoting health, preventing illnesses, and restoring health.
One nursing diagnoses for the T family is Nutrition, Altered: Imbalance more than body requirement related to increasing BMI for both parents and the children. Healthy People 2020 Leading Health Indicator related to this nursing diagnosis is Nutrition, Physical Activity, and Obesity (Healthy People 2020, 2013). One nursing intervention related to the nursing diagnosis includes providing education to the family about appropriate calorie intake, the need to increase the intake of fruits and vegetables, the importance to reduce sugar intake among the children, and to reduce fast food.
Another nursing intervention is connecting the family with the Forsyth County Department of Public Health for nutrition classes and cooking class that is offered through Cooperative Extension Service. A third nursing intervention is to discuss and implement an exercise plan with the family that includes at least one hour of vigorous exercise each day as tolerated. Good nutrition, physical activity, and healthy weight are essential parts of a person’s overall health and well-being (Healthy People 2020, 2013). The second nursing diagnoses for the T family is Ineffective Health Maintenance related to insufficient knowledge about the detrimental effects of active and passive smoking. Healthy People 2020 Leading Health Indicator related to this nursing diagnosis is tobacco (Healthy People 2020, 2013). One nursing intervention is to provide education to T.T. about the effects of secondhand smoke and provide education to T.T. about smoking outside and not around the family (Wang, Hu, & Lam, 2011). Second nursing intervention is to provide education on cessations and identify triggers that increase tobacco usage (Wang, Hu, & Lam, 2011).
A third nursing intervention is to provide T.T. information to QuitlineNC which provides free cessation service to any North Carolina resident who needs assistance quitting tobacco use (OuitlineNC.com, 2014). The QuitlineNC information is provided through the Forsyth County Department of Public Health. Tobacco use is one of the most single preventable cause of disease, disability, and death in the United States (Healthy People 2020, 2013). Tobacco usage is one of the United States deadliest and most costly public health challenges (Healthy People 2020, 2013). The third nursing diagnosis for the T family is Ineffective Health Maintenance related to limited use of primary care provider.
One nursing intervention is to provide education about the value and need for regular preventive visits with a primary care provider for the family. Second nursing intervention is to assist the entire family in obtaining a primary care provider appointment for each member of the family and remind the family of the appointments that are scheduled. A third nursing intervention is assessing the barriers related to reason the family is inconsistent with primary care visits. Healthy People 2020 Leading Health Indicator related to this nursing diagnosis is Access to Health Services (Healthy People 2020, 2013). Increasing access and providing information about routine medical care is one essential step in improving the health of all Americans (Healthy People 2020, 2013).
There are a few legal and ethical considerations in the community of Winston-Salem. The homes within the city are built close to each other. Homes close together may have been completed so that contractors could maximum the number of homes within the city. In doing so, this has violated the resident’s privacy and sense of space. A solution for this concern is that the city of Winston-Salem provides each resident with a privacy fence around the property. Another legal and ethical consideration in the community is that the City of Winston-Salem fire department is limiting the number of emergency medical calls due to an increase in fuel amounts and usage. The residents’ concerns continue to rise due to the limited number of ambulances and personal.
Solutions to this concern is to have the Winston-Salem Fire Department start back running medical calls with Emergency Services or to increase the number of paramedics and ambulance within the community. A third legal and ethical consideration for the community of Winston-Salem is banning cigarette smoke on and around County property, the local hospitals, and the property of the school system. Secondhand smoke is as dangerous as first hand smoke. Secondhand smoke can cause cancer and heart-disease for non-smokers. A solution for this concern is for the Forsyth County Department of Public Health to advocate to the county commissioners to ban cigarette smoke on and around county property, local hospitals, and school systems.
I will advocate and provide case management services for the T family. I will explain options for access to care and explain the importance of playing an active role in their healthcare. T.T. has no spleen, therefore, it is vital for him to use services within the community to prevent disease and maintain compliance with medications. E.T. has asthma; it is a chronic condition that requires frequent monitoring and education. Medications can be expensive and it is important that E.T. stays compliant with her healthcare. A.T. works full time receiving minimum wage and T.T. attempts to work as much as possible but is not guaranteed hours or money which can be stressful for the family. I am committed to assisting the family with community resources. A.T. and T.T. can use services at the Forsyth County Department of Public Health, Southside United Health Center, or Community Care Clinic for primary care related to medical and dental due to having no insurance.
The T family health will be affected by secondhand smoke at home and in the community. E.T. suffers from asthma; therefore, the secondhand smoke can trigger asthma exacerbation. E.T. must carry her Albuterol inhaler at all times. T.T. has no spleen; therefore, he has an increased risk for infection. A.T. has hypertension that can lead to heart problems such as CHF and MI. Stress can elevate the blood pressure and cause serious health issues. Stressors for A.T. are the well-being of her children, an attempt to get full custody of her two sons, her children learning concerns, and financial concerns. It is important that A.T. monitor her blood pressure at least daily and to check her blood sugar three times a day before each meal. A.T. needs to keep a log of the values. Due to A.T.’s chronic condition her role as mother and primary caregiver could change at any time.
A.T. and T.T. are reluctant in allowing the whole family to receive flu vaccination. A.T. is against the vaccination because of the negative feedback she has heard about the Flu vaccination. She explained that the reason she was reluctant to the vaccination, stating that she heard the vaccination was a live virus, therefore, she feels the family would get the flu. My belief was different from A.T. because I am aware that the flu vaccination is an inactive form of the virus that is injected into individuals, to allow the body to build up immunity. I explained the reason the flu vaccination is needed each year and A.T. stated that she would get the family their flu vaccination this fall (Oppel, 2012).
I explained to A.T. that the Forsyth County Department of Public Health can provide more education on the need of the vaccination and can administer the vaccination free to the family. Education for this family will include healthy eating habits, daily exercise regimen, smoking cessation, the effects of second hand smoke, health management, and health access. Resources available to this family are Forsyth County Department of Public, Community Care Clinic, Southside United Health Care center, and QuitlineNC. These resources were chosen because the family displayed and verbalized needs for education.
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