Nursing Family Assessment
Nursing Family Assessment
McGill Model
Abstract
The family at a national and international level is perceived to be an indispensable partner in the promotion of health. The community nurses in their day to day practices get involved in family healthcare. The goal of the community nurses is to assess the family’s health as being a multi-layered and inclusive experience. The community nurses play a role in promoting solidarity based on a family oriented approach that involves balancing the instruction to family life as well as protecting their privacy. The paper present the use of Development Model of Health & Nursing (McGill Model) to evaluate the health needs of a mock family health needs. This paper will show the relationship based on mother reliance health promotion as a family and the mother’s health in promoting healthy lifestyle practices. My mock family is headed by a single mother who is responsible over his two sons.
Introduction
The promotion of family health is a process through which the family work towards the sustenance and improvement of social, emotional, spiritual, and physical good of the members of a family unit (Ford-Gilboe, 2002). This is when families develop positive patterns for decision making and problem solving patterns concerning their health matters. These patterns are integrated within their lifestyle patterns and the way which the family members react to challenges of illnesses and health (Allen & Warner 2002). The family plays a significant role in managing chronic illnesses of children, (Knafl et al. 1996, 2000; Chambers 2000) and the family has a considerable influence to health practices and health of children. Therefore, the family should be at the center in the process of promoting health among its members. This is regardless of the family situation or the family structure.
This study will show how health promotion can be done in a single mother family of Mrs. Johl. Female headed, one parent families has (Duffy, 1986) and have shown that the lack of social support and role overload are the main barriers to the key prevention behaviours. This study will show the challenges that Mrs. Johl has to go through in rearing for her two son’s ages 21 and 17. Based on McGill model, I will show the personal strength of the mother form the strongest predictor in the effort to promote family health (Ford-Gilboe et al. 2000). This means that the strength of the mothers takes up a leading role in health work than other external resources such as community services, social support, and community finances. This clearly suggests that the strength of the mother forms a critical aspect in the promotion of family health.
Conceptual models in nursing
Nurse theorists have come up with a good number of conceptual models in nursing that provide formal explanations on the actual definition of nursing. The four concepts that form the basis of nursing models are the environment, nursing, health and person (Fawcett, 2004). The nursing models do present these nursing concepts in different ways. Nursing education, research, and practice in Canada have mainly been influenced by the nursing model by Moyra Allen, which is today known as the McGill Model of Nursing (Allen & Warner, 2002). This is a model that deals with the promotion of health interactions among nurses, families and individuals. The aim of nursing is to promote and work with family and patients strengths towards the attainment of life goals. The issue of health promotion is as a process that requires collaboration among all the members involved. In the process of promoting health, the nurse has the responsibility of helping families to develop healthy living and to explore issues that affect their health. Based on McGill Model, the nurse’s goal is to acknowledge the strengths and capabilities of clients together with their families. The nurse also has to work with them in an active way so as develop, strengthen, and maintain the healthy potential of all members of the family. The Developmental Model of Health and Nursing is a refinement and extension of McGill Model of nursing. Based on this model family health can work when supported by the health potential of the family. This is possible through resources, motivation, and strength in the unit of the family and the members. Through nursing action, the health potential of the family is.
McGill Model of Nursing (MMoN) recognizes the ontology of personhood. This means that an individual has the inherent freedom to be involved in their personal health experience and to take the responsibility to make the right choice. Based on this nursing model, individuals are reflective, mindful, flexible, and reciprocal human beings. This means that they are architects of their own personal experience (Gottlieb & Gottlieb, 2007, p 47). This means that as human beings, we are intrinsically towards coping, attachment, and regulation. This is because these are the necessary aspects for human survival (Gottlieb & Gottlieb, 2007, p 47).
The MMoN theory also shows the aspect where the person cannot be separated from the environment. The work of the nurse is to promote better ways of fitness between the clients and environment because this is the only way which successful adaptation is (Gottlieb & Gottlieb, 2007, p. 48). Based on the MMoN, an individual is as being invariably situated within the context of the family. This family forms the unit of concern. Even though, the nurse might be dealing with the health concern of a single member of the family, the nurse should perceive the health needs of the individual through the lens of family relations and should recognize the reciprocal influence that members of a family unit have towards each other. This means that the family and the individual are to be open systems that constantly interact with one another, as well as, other environmental systems. This perspective explains the relational nature in human experience and development and emphasizes that people live within a network of meaningful relationships.
Integrating McGill model on family care
Mock Family
Johl family members are Mrs The family I have come up with is the Johl family. The members are Mrs. Johl. Age 54 and two sons, Bill, 21, who still lives at home works full time as a mechanic and helps with some of the house expenses, and Paul 17, who is in high school, grade 12, sometimes skips classes, average student. Mrs. Johl is a widow whose husband passed away from liver failure. She lives in Vancouver, (East Vancouver) B.C., Canada, in a two storey house, she lives upstairs and rents their two bedroom suite, does not work, and she is on disability income. Mrs. Johl. Has financial worries, family stress and coping with her health issues of high blood pressure and chronic back pain. She is profoundly concerned about her boys. She feels isolated and lonely after the death of her husband. She attends church sometimes and rarely goes out. She has a few friends. Furthermore, she is about her older son’s drinking and substance use. He has a girlfriend and a lot of the times he stays at her place. She is extremely supportive and helps him with his drinking problem. Mrs. Johl and the girlfriend get along remarkably well. She is happy about their relationship.
Section I the family’s health goals and concerns, their current strengths, coping strategies, resource utilization and health goals and concerns
The nurse interaction with the family members
Three interviews were done with the nurse. The nurse managed to speak with Mrs. Johl. Older son did not attend, and younger one only attended the 2nd and the third interview. Based on the interview, the nurse established that Mrs. Johl is attentive to the health care needs of her children (Herrmann et al. 1998). The nurse used a problem –focused strategy to establish the health care needs of Johl family. She is a mother who does not rely on social networks that would have assisted her cope up with her health concerns and the challenges of parenting. This makes her have a weak support system that makes her be by herself at most times. She is always in worries such as financial worries, concerned with her personal health issues of chronic high blood pressure, and coping with family stress. All this challenges make her not being in the position of providing effective parenting (Burke & Liston 1994).
Understanding the parenting practices of Mrs. Johl forms a critical part in understanding the family experiences and how her ability to cope up with the loss of her husband can help in promoting the entire family health. The Developmental Model of Health and Nursing (Ford-Gilboe 2002a; Allen & Warner 2002) provides us with a perspective that will help in understand the health promotion of Johl family led by a single mother. The DMHN model emphasizes on family strength as a way to attain positive health. This means that health should be seen as part of Johl family characteristic and has formed part of the lifestyle of this family. This means that activities that impact on the member’s health are over a period of time and are through the daily practices of this family life. Ford-Gilboe (2000), Ford-Gilboe et al. 2000), and Chambers (2000) in their studies of single parent families have shown support to the theoretical relationship found in McGill Model or the DMHN. They show that health potential, also known as resilience is the core aspect that forms health promoting lifestyle practices and is also the key to the attainment of health work. Both health work and resilience form the main foundation to the development of health behaviour competence.
Based on the DMHN model it is possible to establish knowledge concerning Johl family health and promotion. Based on this model, the health of a family is by four distinct factors that are interrelated. These are health potential, health work, health status, and health behaviour competence (Ford- Gilboe 2002). The central aspect of this theory is health work, which means a process of active involvement on family health concerns. Within this process, families establish ways of making use of their strengths and to cope with challenges they face on an everyday basis. They also make use of their resources in order to attain their family and individual development. Mrs. Johl and her family members do not demonstrate high levels of health work. This is because they are not actively involved or even interested in issues concerning their health. Paul who attended the interview said that most time he was worried of his future, and the family challenges affect him in school. He sometimes goes to school without anything in his stomach and he stays at home so that he can do other small jobs to bring food to the table. This is especially because he feels remorseful leaving her mother alone at home.
Also, the disability of her mother to walk makes Paul feels like it is part of his duty to ensure that somebody is always around to take care of her. For her mother, she is preoccupied with financial challenges. The monthly income from the rooms she rents and the disability income all go to paying Paul’s school feels, there is difficulty in paying for electric bills, putting food and other basic necessities. Johl family is primarily a low-income family that is with unique challenges on matters of health. The effort is to improve or maintain the overall mental- and physical wellbeing of members. This is mainly in the case of the Older 21 boy is into alcoholism, and the stress that the mother has towards the financial challenges is aspects the members of Johl family have to cope. There is also the challenge on the need to recover from the chronic high blood pressure as for the case of Mrs. Johl.
The home visit to the family of Johl is a no-cost social service and health education program that aims to assist the members of the family and every individual. The objective of this home visit is to provide support to the single mother, Mrs. Johl who had lost her husband after suffering from lung failure. She comes from a low- income economic status for she does not work and only relies on her disability income and the rent fees she gets from her rented section of her house. The aim of the visit is to link the family members to the appropriate healthcare providers and drug abuse and prevention programs. In this visit, the nurse also aims to ensure that the family is coping well to family changes after the loss of one of the family member who was upon as the bread winner. The nurse further aims to increase parenting knowledge to Mrs. Johl. This is based on the best approach and strategy to use to assist her family members with improved health development.
The first visit to Johl family was about engagement. The nurse introduced herself and her partner to Mrs. Johl whom they found at home. The nurse explained to her about their concerns on family health and explained the whole process for their home visits. The nurses informed Mrs. Johl that they were planning to hold interviews with all her family members so that they can a help her on the challenges she faces as a parent and to highlight the health needs of all members in this family. The nurse informed Mrs. Johl that she can welcome Bill’s girlfriend to the session. The nurses together with Mrs. Johl scheduled their first interview session for the coming week on Monday at 4:45 pm. The coming visit would work around health issues together with other commitments of the family members. By the end of the first encounter session with Mrs. Johl, the community nurses had managed to develop a trusting relationship.
Assessment
McGill Model is as a guideline in the five inquiry questions of this model.
What is the family dealing with?
Johl family has a wide range of challenges to face. This is a low income family that faces financial problems. Paul schooling takes the largest share of Mrs Johl income. The family relies on little income from renting their two bedroom suit and form disability income. Bill who is a full time mechanic can sometimes contribute to the household expenses, but often is preoccupied with his drinking habits.
Mrs. Johl faces personal issues concerning her health. She has chronic back pain and high blood pressure and is disabled. She is with worries most of the time because of loneliness, financial worries and worries of her eldest son’s drinking habits. She is jobless and relies on disability income for her upkeep. She is and does not involve in social support groups and has few friends.
The family also faces the challenge of alcoholism. Bill a full time mechanic is into drug and alcohol abuse. He spends a lot of time out of home. Even though, he earns wages or salary, little cash goes to catering for family expenses. He spends the rest in his drinking habits. This could be a failure of coping up with the challenge of loss of his father and lack of proper parenting guidelines. Paul is with the lack of mental well-being. He is struggling with his academic career, but with no adequate resources. He is with her mother’s health condition which could be a source of his average performance in school.
What is essential to the family and broader issues that might explain the family’s focus?
The family is working together to ensure the safety of the mother. For instance, Paul is willing to remain with his mother and going to school for the sake of his future life. Also, Bill is contributing some share to the family needs and expenses. Much support towards the family is from Bill’s girlfriend. She is a caring person whom Mrs. Johl loves. This is despite her other commitments such as her job. The aim of this family is to achieve emotional and physical health to all members.
How are they going about that?
The family recognizes the importance of showing support to one another this can be seen in the support that Bill contributes to the family needs, how he is by his girlfriend on his alcohol abuse problem. Paul is also supportive towards his mother. Bill’s girlfriend supports Mrs. Johl and mother supports Paul in his education. Each of these members has a time to show support. Paul takes care of his mother after school hours. On the days that his mother shows signs of intense backache, he decides not to go to school so as to offer his mother with the needed support. Bills girlfriend also comes to offer Mrs. Johl the support she needs at her free time. She may also do house cleaning and other chaos that Paul cannot do such as cleaning the floors and washing clothes. Paul cooks and sweeps the floor on a daily basis. Bill is also supportive. He buys food such as vegetables and milk on a daily basis. He pays for electricity bills but not often. On bad days, he drinks too much to a point of loosing cash. He also buys drugs for her sickly mother when she gets worse.
What are their potential resources and how do they best learn?
The family has high potential to do what is best for each one of them. They can offer each other moral support and to be actively involved. This will enable the family learn ways of coping with the challenges that affect their health. This is possible when each of the members makes use of their resources and strengths to achieve the goals of the family and their personal goals. With effective use of resources, active commitment, and proactive involvement on matters of health, Johl’s family members can establish a problem-solving approach that will help them to manage health challenges.
One of the most essential resources is family participation. Mrs. Johl will be to show power and control over her life by instilling positive thoughts to her sons. This first begin by her thinking positively. The family can also be urged to offer Bill the support he needs with the aim of helping him out of his drinking habits. Financial resources of the family should be well planned so that Mrs. Johl can start a small business just near her home. This is a business that she thinks she can so best such as a shop, grocery store, or saloon. These are businesses that need small capital. The business can also be boosted through affordable loans. Mrs. Johl will also be encouraged to join other support groups in the society that encourage and support widows like her. With such activities, she will preoccupy herself with meaningful activities and frees herself from worrisome thoughts and loneliness.
What other resources could still be mobilized
Other resources include having coaches and mentors who act as role models to the success of the family. This means that Paul and Bill can be referred to mentors who will guide them and give them hope. Family participation is a fundamental aspect in health work because it determines the potential of the family to attain good health (Ford-Gilboe 2002).
The health potential of the family acts as a reservoir of the members capabilities and this include resources, motivation, and strength among them (Ford Gilboe, 2002, Allen &Warner 2002). The strengths of the family members are part of their internal capabilities that show the patterns of family interaction and their individual characteristics (Ford-Gilboe, 2002). The strength of the Mrs. Johl as a single mother can be seen in her high degree of vision, hope, and foresight. Her strength will mean that she can have a proper detailed plan that creates a positive future to her family members. She is responsible to provide his sons with a right passage to adulthood through cultivating their skills, moral sensibilities and assigning them with obligations. With the little resource that Mrs. Johl has she can manage to cultivate a positive feelings and direction to her family members through adopting new traditions of her care giving.
An additional resource that the family members need is resilience. Resilience is the personal strength that each person in a family can develop because it is a form of personal strength that helps one copes up with the diversities of life. Resilience is an aspect that can lead to health potential. Resilience is a complex term that has in different forms of perspectives. Resilience is an aspect that shows personal process, outcome and capacity (Woodgate 1999). Studies on resilience on adolescents and children (Lindenbergetal.1998, Resnick 2000), have shown that is an attribute that arises from the effects of living in a poor environment. Studies among older women on resilience have held the position that this is an attribute that arises from personal capacity. Development of resilience is an aspect that will assist an individual to cope with life challenging situation, and the daily normative stresses such as, single-parenting (Ford-Gilboe ET al.2000) and loss of a family member (Wagnild &Young1990). The attainment of resilience in life defines the ability of an individual to make it through life. For the case of Mrs. Johl and her sons, they have the ability to develop resilience as one of their vital resources for it will help them practice perseverance, and have a balanced perspective towards life. There will have a sense of self purpose, be self-reliant, and realize that each one of them has a unique path in life.
Resilience according to O’Leary is an aspect that empowers one to move beyond recovery and survival to address the actual realities of diversity. Resilience from the mother’s side means the attainment of positive health work to the whole family.
Goals
The main goal of Johl family is to acquire competence in health behaviour. This means that the health work outcome can be demonstrated through the effectiveness of the family to maintain and pursue lifestyles changes that are pertinent to each one of them (Ford-Gilboe, 2002). Attaining health promoting lifestyle takes a multidimensional pattern of perceptions and actions that are self initiated. These changes serve to enhance and maintain the level of self-actualization and wellness level and also an individual fulfilment.
The goal of the family members is to develop positive self-concept through adapting healthy life practices. They should aim at achieving social and self –efficacy support. They will also aim attaining quality social and physical environment and healthy lifestyle practices.
Section II Pan Family
This is a family plan that facilitates developmental, growth seeking behaviours with a realistic goal and the specific strategies that might be mobilized for the family to attain their capacity for health that is meaningful to them. The Johl family members should have the desire to support one another in order to establish a trustworthy, responsible, and independent kind of life among them. They should have open communication patterns that will help them to solve problems as a family. The family members and the community nurse will work together in decision making necessary for individualized care through the appropriate support and structures. This is with the aim of providing the entire family member with the exceptionally best form of care. The nurse should not simply focus on an individual without examining the person within the context of the family. This is because the family acts as a unit of care.
Empowerment partnership is also another consideration for Johl’s family. Empowerment partnership happens between the family and the nurse based on a mutual, trustworthy, and respectful relationship. Within this relationship, they can share experience, knowledge, skills, and knowledge and this makes the family members and the nurse be empowered to learn and grow together as partners in family health promotion. This form of relationship ensures that families are and supported within the expected and unexpected events in life. The family, members will be with guidelines and expert recommendations on how to move through life challenges. The goal is to empower Johl’s family through recognizing that the assessment of the family is essential and acknowledges and respects the role of the family within the health care situations. The importance of the assessment is to negotiate the role of the family and nurse. Also to establish the degree to which the family desires to be involved (Gaudine, 2005).
The Developmental Model of Health and Nursing (DMHN) focuses on the establishment of an empowering partnership within the capabilities and health process of the family. This includes the potential for the family to change and grow. It is necessary for the nurse to assess the event context by identifying if assistance is by the nurses to support and strengthen the family. The family health assessment should include information that addresses the perception of the family towards life events, the environment conditions, family structure, and the strength of a family. These aspects are unique to every family. Identifying these aspects form the basis of establishing the unique issues of the family and to form the potential solutions to the family challenges.
It is essential to know the resources and support the families that will help them address their life challenges. The resources can be identified in three main categories. These are the interfamilial, extra familial, and interfamilial. The support can be from within the family that members offer one another as a family. Members of the family need to be given a chance to speak out their needs and experiences because this provided a way to establish the resources to address these needs. Support comes from encouragement, information and interpersonal relationships that people have within the family.
There should be a plan for nurses by ensuring that they are with a caring workplace that supports the family-centered practice. This is possible when the nurses are to the assessments and values in family-centred care. This means that it is entail for the nurses to be skilful, knowledgeable and have proper judgement on family needs. The nurses have to always be provided with appropriate resources such as staffing and time. They are to develop and implement family centered policies and practices and develop programs that support work life balance.
There is the need to advocate for reforms in Canada’s public policy through lobbying policy makers to discuss on issues that affect the family and the position of low income families. This means that there is to lobby for consistency in availability, delivery, and funding of family care programs and support in the whole of Canada.
Conclusion
This paper has critically analyzed the healthcare needs of Johl family based on the Developmental Model of Health and Nursing (DMHN) model. The model provides a perspective that enables us to understand areas of health promotion in a given family. The main focus is to establish the strength of this family. The family members can gain resilience for them to succeed in all changing events in everyday life.
References
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