Family & Societal Nursing

16

Theory Interview project: Family Follow Through

Name

Institution

NURS 362: Family & Societal Nursing for RNs

Prof

June 29, 2022

Family Follow-Through Experience

Interview is one of the effective methods of assessing a patient’s physical and psychological wellbeing. There is a strong correlation between nursing care and a healthy family. Nursing care entails evaluation of family member regarding the physical and psychological wellbeing and their capacity to provide care among the family members. It is prudent to note that a family is descendants of a common ancestor, and in case a disease affects a person, and heredity may be part of the primary cause. For example, living in a family where the parents had sickle cell anemia increases the chances of the children having sickle cell anemia.

Family and its obligation in healthcare domain

A family is defined by its numerous features, such as common habitation, which means they stay in the same environment. Whenever one has an infectious disease, the entire family needs to take note of it and care for their health scenarios. An emotional bias guides a family and an economic provision structure where a traditional patriarchal family has the father as the head of the family and the breadwinner. The latter provides for the family's financial needs (Haase et al., 2021). The woman is the person who takes care of the house and prepares the children for school and takes care of their general needs.

Primary care nurses aim to ensure that they take care of the needs of the patients and consequently improve their quality of life. As the nursing practice evolve to be more patient-centered, the concept of the family is becoming more critical as a part of ensuring that the family understands the basics of healthcare and helps each other stay safe at all times. The composition of a family stipulates that there are people who are in a position to take care of one another, which means that they are in a place to do so. What sets family aside in the healthcare domain is that family loves and cares for each other, and nurses can therefore take note of the love and what they have for one another to improve the patient-centered care, to improve the quality of life among the patients, and make them lead better lives through comprehensive care.

Various models seek to explain the family structure and how the families relate. The Calgary Family Assessment Model (CFAM) subdivides the family into three major categories that work together to ensure that the family succeeds in its endeavors. The categories are developmental, structural, and functional, which share all the family members' roles and responsibilities. If the correct family assessment tool is used, it can help nurses develop better relationships with families and facilitate speedy healing for patients suffering from various diseases. Denham's Family Health Model (DFM) is another model that helps the nurse understand the roles of family members and therefore prepare to support the family based on the parts each member plays.

This paper revolves around interview findings of the case of Dan Brown and how his family interaction can help him live with his challenge of obesity, and two of his children are obese as well. Based on the family model, it can be made clear that a family follow-through can help the nurses understand the family structure and the best advice to give the people in the family for a speedy recovery and better health outcomes in due course. Nursing support theories require that the nurse create a positive relationship with the family to have positive feedback and a better product.

Family illness story

Mr. Dan Brown is a 51 years Caucasian man who lives with his family in Minnesota. He has a wife and two children, and one grandchild who lives with them. Mr. Brown works as a casual employee in local government authority and spends most of his time in meetings and offices. In 2012, he suffered a heart attack after the sudden demise of his father. He was diagnosed with severe depression and cardiovascular disease in the same year. Since his diagnosis, he has visited the nearby nursing center for a regular checkup. Mr. Brown is on drugs to stabilize his blood pressure and ensure that he works in harmony with his heart disease, and most nurses have recommended lifestyle changes. His health condition had been deteriorating since then because of the financial constraints as the father was one of his support system and upon his demise, Brown was shocked as the burden of facing life alone was inevitable.

Past medical history

Previously, Mr. Brown has been making beer in the evenings with his friends, and after dinner, he usually takes a glass of wine. His late father has a history of cardiovascular problems and died of a heart attack. Brown also loves taking snacks most of his time in the office and is overweight. It is further necessary to note that Mr. Brown has a car that he uses to move around, and whenever he has a mechanical problem, he usually takes a taxi to work and back home (Shajan & Snell, 2019). He has physical inactivity and is likely to suffer obesity if he does not take up physical exercise to improve his body shape. However, Mr. Dan Brown has not been diagnosed with any other illness and has been progressing well with his life normally.

Mr. Dan Brown however stated that his family was his greatest support system because they understand him and are ready to support him in all his endeavors. As Mr. Brown takes the drugs prescribed for the blood pressure challenges, he lives in fear that the disease that killed his father may attack. The nurse took adequate time to explain about the risk factors for the cardiovascular illness and although heredity is the cause, it does not guarantee infection as long as the person follows the instructions of avoiding cardiovascular disease risk factor. The nurses therefore have a role to educate the patient on the lifestyle modifications that are key to improve their quality of life. Since the family is all supportive, it should be educated and motivated to help Mr. Brown avoid all the risk factors.

Family Assessment using Denham’s Family Health Model

A continuous visit to a family is the sole responsibility of a nurse to understand the family's challenges and devise ways through which the family members can help the patient experience speedy healing and higher quality of life. During the first visit, Mr. Brown was present with his wife and his grandchild, taking tea in their living room as they watched television. Before the home visit was scheduled, the patient was advised to avoid stressful situations on the homestead. The risk factors determine heart health, and his cardiovascular problem will likely worsen when they are not well taken care of. The way they behaved during the interview shows that the family is happy and the husband and wife live in peace and harmony.

It was, however, important to use a scientific model to determine the family's status and how the family structure can be used to improve the patient's health status. Denham's Family Health Model is an essential tool that is used to determine whether the family structure can be helpful to the patient or not (Asen et al. 2018). The model divides the analysis into three major approaches to the family setting, and that is contextual, functional, and structural. The model subdivides the family members on three different dimensions so that people are not only judged from one aspect but on all the overall actions such as mental stability, and ability to communicate better before being allocated the task to lead a better life.

Contextual perspective for family health

According to the contextual perspective, the environment a person lives in directly impacts the health of the people living in the family. The philosophy focuses on how people’s interaction affect their state of health. The first case of heart attack was witnessed when Mr. Brown heard about the death of his firstborn son. The implication means that the father and son share a strong bond affecting their daily quality of life (Sarma et al., 2021). On arrival for the interview, Mr. Brown was sharing a light moment with his wife and grandchild, meaning that the family offered a mechanism through which stress could be avoided and therefore increases the quality of life a person experiences. A person living in a stressful environment where people keep fighting is not likely to enjoy peace of mind and is therefore at risk of developing illnesses.

The microsystem defines a family as a constituent of people and how they relate with one another. Mr. Brown is the head of a family of seven. His wife, his two sons, their wives, and the grandchild. The family relates well with one another, and the peace and atmosphere help the family members experience peace and tranquility as they live with one another. Although the family does not always spend their time together as the two sons work in a distant city, they come over during weekends and public holidays (Shajan & Snell, 2019). However, the family has a communication channel where they share news and experiences and are always aware of what the other person is facing in their lives.

It is further essential to consider the family's ecosystem. According to the interview, the way they relate based on their hobbies and financial position also impact their health status. Though Mr. Brown did not identify any person outside their nuclear family other than his late father, he shared the hobbies that the family enjoys having wine together after dinner. Further, whenever she is out of work, he loves hanging out with his friends taking beer (Asen et al. 2018).

However, when his two sons are not at work, they prohibit their father from taking beer, complaining that it is not suitable for his health. The family enjoys getting together, and whenever one of the family members is in trouble, the entire family is worried. The day he was diagnosed with heart attack and depression, the whole family was concerned, and they all had to change their diet in favor of their father. The outcome of the changes in ideology can be used to favor the treatment procedure because the family shares love, care and concern, and they are willing to change their lifestyles in favor of their father, who is their sole breadwinner.

Chronosystem is the ability of a family to change their style over time and the unique way they react to the changes as they come. During the interview, Mr. Brown confirmed that his wife is always charming and has something to speak about. He confirmed that in the previous conversation, they were discussing his weight and heart condition, and she had warned him that if his weight was not controlled, he may be at risk for obesity alongside the heart condition as his father was also a victim of the same.

The functional perspective on health

According to the model, the functional nature of a family shows how the family members share responsibility and care for one another. The model offers seven Cs in determining how families function with the family members and how they can use the relationships to improve their lives (Haase et al., 2021). The seven Cs of the perspective are caregiving, cathexis, celebration, change, communication, connectors, and coordination, which are essential parameters affecting a person's health (Crandall et al., 2020). According to the interview, Mr. Brown noted that his family was not only concerned when he was diagnosed with a heart attack but also communicated in the best ways of handling the family's situation. Mrs. Brown is a perfect caregiver because she is watchful and has attention to detail; therefore, whenever something is about to go wrong with the patient, she is likely to be very instrumental in promoting health.

The bond Mr. Brown shares with his family is so strong that they celebrate whenever possible and coordinate their actions whenever they are in a happy mood. Mr. Brown recounts that when he was diagnosed with a heart attack and enrolled on the blood pressure medication, the family convened a meeting to advise their parent on the lifestyle changes they needed to take in the discourse. The functional perspective of the family offers nurses an excellent opportunity to educate them on their father’s health condition and the best way to manage it. Managing and changing a lifestyle for better healthcare makes it possible to offer a better quality of care not only to the patient but also to the entire family, as it can play a significant role in managing the family's healthcare situation.

Mr. Brown was happy to disclose that his family was always connected, communicated in case of a change, and worked together to find an amicable solution (Ramos et al. 2018). Such a united family can offer an enabling environment for a patient to get well soon and quicker in the discourse. The way family members communicate and care for each other provides an enabling environment for the patient and his challenges to be addressed amicably in the lesson.

A structural perspective of the family

The structural perspective of the Denham Family Health Model views the people's behaviors, attitudes, reactions, and routines and how they can be used to improve a person's quality of life. The interaction with Mr. Brown showed that the family has structures that are likely to improve the quality of life for the patient and the family at large and make them stay safe from the hereditary factors that are evident in the family (Sarma et al. 2021). Mr. Brown is aware of the routine, such as eating a healthy diet and getting enough rest, and he is willing to start physical exercise to ensure that he gets better and starts working on the weight.

Mr. Brown clearly understood the dangers in life, and he was ready to take care of his situation to ensure that it did not deteriorate his health further. The patient confirmed that there were reminders in his room that warned him against taking alcohol because alcohol is one of the risk factors that could deteriorate his heart condition. When Mrs. Brown was asked what he did when her husband fell ill, she replied that all her children researched to understand the heart diseases and the lifestyle changes that were supposed to be taken to ensure that Mr. Brown is well taken care of for a better health outcome. The family members are willing to care for each other regardless of their busy schedules at work. The patients have a cooperative family that can collaborate well with the healthcare facility to offer better health advice and care to ensure they are always informed on the health status of their father. Therefore, a primary care nurse can form a positive relationship with the family, which can help provide effective home care (Crandall et al. 2020). The care and coordination at home cascaded with love and care is likely to improve the healing rate.

The family is of the catholic faith, and according to their faith, they are allowed to take small quantities of alcohol for their happiness. They are also good readers of the bible, and during the hard times the family faces, they use the occasion to come together, pray for blessings, and work towards forgiveness. Religion plays a critical role in the health condition of families. During the process of treating the patient, the nurses must put into consideration the religious beliefs and put them into consideration.

Family Nursing Interventions and Actions

Depending on how the nurses institute and improve the drug, Mr. Brown's heart condition will likely improve or deteriorate. As a cardiovascular patient with a history of heredity of the heart condition, an improvement in the lifestyle will likely improve his quality of life in the discourse. The nursing intervention in the family is to improve the physical exercise, diet, and ability to keep off alcohol and drugs. The patient's healing process can be made more accessible if a family approach is incorporated to have the family do things together (Ramos et al., 2018). Mr. Brown's family, with the aid of a professional nurse, will make up a procedure that will enable them to learn more about the challenges they face and how they can overcome them using SMART goals and objectives in their day-to-day activity. A summary of the objectives is as the state in the table below:

NUMBER	OBJECTIVE
SMART goal 1	An exercise program involving the family members must be in place in three months.
SMART goal 2	The family should change the budget to ensure to eat a healthier balanced diet.
SMART goal 3	In three weeks, the alcohol and other drugs abused should be abandoned.
SMART goal 4	The pressure levels must be maintained at average levels.

Family SMART goal 1

The family will start a physical exercise program where both parents and children will have a jogging exercise for thirty minutes in the evening. Jogging and vigorous physical activity are prerequisites for managing weight and improving mental preparedness and can improve blood flow. Heart health will be guaranteed in the end. If Mr. Brown is allowed to exercise alone, he will get bored, and in the future, he may not be able to improve his heart, and obesity may affect him and complicate his heart condition even more. The exercise routine is important not only for him but also for the entire family because it is one of the ways to manage the condition.

Family SMART goal 2

The family will put up resources to ensure they take a healthy and balanced diet. For example, Mr. Brown's love for snacks should be replaced with fruits, whole grains, and vegetables. He will be encouraged to avoid cholesterol-rich foods because excess cholesterol can be detrimental to human body organs, such as heart and blood vessels. Eating a healthy diet is an essential factor; it prevents heart disease.

Family SMART goal 3

Giving up smoking and alcohol is an essential factor for a heart condition. Smoking and alcohol consumption increases the risk factor for the sickness, and a person may be at risk of many other illnesses unless the risk condition is not taken care of. Since the patient takes wine every day after dinner and takes beer occasionally with friends, the third healthy goal is to give up all alcoholic drinks and replace them with other beverages such as the freshly blended fruit juice, which are healthier and lead to more health benefits.

Family SMART goal 4

Blood pressure is an essential feature in a person's body that must be maintained at all times because once blood pressure fluctuates, it leads to a challenge in the discourse. There are numerous ways of reducing blood pressure, and the first is by taking the medication to maintain blood pressure in the correct range. It is also important to ensure that the stress levels are kept as low as possible by maintaining positive relationships at home.

The four objectives are paramount for the lifestyle changes required to make life more comfortable. Mr. Brown hails from a family with a gene for heart conditions and obesity and must therefore lead a lifestyle that shuns away all the risk factors associated with the heart diseases. The four intelligent objectives are likely to improve Mr. Brown's health, the heart condition is expected to strengthen, and the pressure levels will stabilize.

Nursing intervention

Since Mr. Brown is under medication for blood pressure and has shown indications of obesity and depression, the best nursing intervention to be conducted with the family is monitoring the progress of the heart conditions. As Mr. Brown takes his medication and considers the required lifestyle changes, he should periodically visit the health center for his need to be monitored. The nurses must also ensure that the patient converts the objectives into habits that will ensure that he lives a better quality of life as expected. Therefore, the nursing action is meant to ensure that regular checkups are made on the patient and results are compared to the intended objectives.

The nurse: patient ratio is limited, and a nurse may not have the ability to spend more time on a single patient as there would be others waiting to be served. The collaboration between the nurses and the family members forms a formidable force that can be used to speed up the process of healing. Mr. Brown must be reminded to take his medications on time and be reminded to stick to the physical exercise and the other objectives that have been set such as eating a balance diet. Since a nurse may not be able to stay with the patient for a longer time, if the family is educated, they will carry out the roles of a nurse and the healthcare challenges are noticed and acted upon to improve the quality of health.

Family response and follow-up.

The significant role of the family is to ensure that all the instructions issued by the nurse are followed to the latter and that all the conditions that are given are met. In the case of Mr. Brown, the hospital, through the nurses, requires that the patient stop taking alcohol and stay healthy at all times regardless of the condition affecting him. The family members are responsible for ensuring the four goals are achieved for better health outcomes. The family is therefore required to maintain a stable and reliable communication with the nurses because they are supposed to offer answers to any question that may arise in the process of treatment and conducting the lifestyle changes.

Conclusion

Families are important elements that make people stronger and able to cope with the daily challenges. The medical field also underscore the fact families serve an important role and ensure that a patient is treated well and discharged. As the medical platform changes to move towards evidence based practice and people centered care, the families comes in handy. The role of nurses is to take care of patients and follow up to a point of complete recovery. Because of the nurse; patient ratio, the nurses need to involve the families themselves to ensure their patient is taken care of at all times. Mr. Dan Brown has a supportive family and his recovery process will be accelerated.

References

Asen, E., Dawson, N., McHugh, B., Minuchin, S., & Cooklin, A. (2018). Multiple family therapy: The Marlborough model and its wider applications. Routledge. https://www.researchgate.net/publication/345136158_Multiple_Family_Therapy_The_Marlborough_Model_and_Its_Wider_Applications

Crandall, A., Weiss-Laxer, N. S., Broadbent, E., Holmes, E. K., Magnusson, B. M., Okano, L., ... & Novilla, L. B. (2020). The family health scale: reliability and validity of a short-and long-form. Frontiers in public health, 8, 587125. https://doi.org/10.3389/fpubh.2020.587125

Haase, C. L., Eriksen, K. T., Lopes, S., Satylganova, A., Schnecke, V., & McEwan, P. (2021). Body mass index and risk of obesity‐related conditions in a cohort of 2.9 million people: Evidence from a UK primary care database. Obesity Science & Practice, 7(2), 137-147. https://doi.org/10.1002%2Fosp4.474

Ramos, C. F. V., Araruna, R. D. C., Lima, C. M. F. D., Santana, C. L. A. D., & Tanaka, L. H. (2018). Education practices: research-action with nurses of Family Health Strategy. Revista Brasileira de Enfermagem, 71, 1144-1151. https://www.scielo.br/j/reben/a/tvXfDVGfJZnd86qCb6h63FQ/?lang=en&format=pdf

Sarma, S., Sockalingam, S., & Dash, S. (2021). Obesity as a multisystem disease: Trends in obesity rates and obesity‐related complications. Diabetes, Obesity and Metabolism, 23, 3-16. https://doi.org/10.1111/dom.14290

Shajan, Z., & Snell, D. (2019). Wright & Leahey's nurses and families: A guide to family assessment and intervention. FA Davis. https://books.google.co.ke/books/about/Wright_Leahey_s_Nurses_and_Families.html?id=lsOHDwAAQBAJ&redir_esc=y

Appendix 1: Mr. Brown Family Genogram

Appendix 2: Healthcare routines for a healthy lifestyle

Appendix 3: Exercise to avoid obesity and heart conditions