Family Health Nursing Term Paper

Introduction:

     This paper discusses a family case study where there is a change in the family function and role related to a condition that one member of the family is experiencing (chronic disease).

     The Theory that will be applied regarding this family case study is Family Systems Theory. 

Family Case Study: Al-Ahmed Family (a member with a chronic disease)

• Setting: Inpatient acute care hospital.
•  Nursing Goal: Assist the family in preparing for discharge, which is scheduled to take place in the next day.
•  Family Members: Al-Ahmed family is a nuclear family
• Ali: 46 years old; father, a middle-school teacher, full-time employed. 
•  Salma: 42 years old; mother, stay-at-home homemaker, has diabetes mellitus type 2 disease (DMT2), but recently has worsened significantly as she had 4 hypoglycemic episodes of serious decline in her blood glucose level (BGL) in the last four months (BGL: 58-60 mg per dL in each episode)
• Nada: 17 years old; oldest child, daughter, last year of high school in a private school 45 minutes away from home. 
• Hassan: 10 years old; middle child, son, fifth grade, usually a good student.
• Adam: 6 years old; youngest child, son, first year at elementary school just started attending a private educational center after school due to his mother’s illness

• Salma was diagnosed with DMT2 at age 36 after delivering Adam.

AL- Ahmed Family Story

     Salma had uncomplicated pregnancy with Adam until 8 months postpartum when she fainted and was taken to the hospital as a complication of her first episode of hypoglycemia. After she was diagnosed with DMT2, Salma had a well-controlled, slight complications of her illness. However, the last 2 years, Salma has experienced complications of DMT2 which made her tired, fatigue, restless, and experienced stress in her marital roles and relationship (Ali and Salma are having sexual issues) as well as experienced stress in her parental role, as she mentioned.

     Currently, Salma has had a serious hypoglycemic episode. She is hospitalized for having a seizure related to a severe decline in her blood glucose level (55 mg per dL). She has dizziness, weakness in all limbs, blurred vision, Inability to perform her activity of daily living, as she stated. She is experiencing vertigo at times and has periodic tinnitus. Salma will be discharged with a wheelchair to home due to her condition. 

Health Insurance:

     Ali receives health insurance through his work that covers the whole family. Hospitalizations are covered 90/10 so they have to pay 10% of their bills out of pocket. Also, they have their eldest daughter Nada who is in her last year of a private high school that they should pay for. Additionally, Adam, the youngest son, is starting to attend a private educational center after school from 2 PM to 7 pm, and the father has to pay for this center as well. All these costs add heavily to the financial Burden of the family. Ali has shared with the nurses that he is currently unable to take a vacation (without payment) due to his financial condition and commitment. Thus, he is anxious that he will not able to take care of his wife when she is discharged.

Family Members:

      Ali reports being continuously tired from caring for his wife and children, as well as working full-time. He is afraid that Salma when comes home, he will not able to take care of her. He also said he is afraid that he may not hear Salma in the night when she needs help with her condition. He asked the doctor for medication to help him sleep and decrease his anxiety. Although Salma’s mother (Nour) wants to move into their home to help care for Salma and the children, Ali is not sure about this. He said that Nour has hypertension, DMT2, and complains of generalized pain and fatigue that she needs medical attention as well. Ali also asked advice and suggestion from a religious person in the mosque.

      Nada is the oldest child, daughter, last year of high school in a private school 45 minutes away from home. Her mother is proud of her as she is a good student and she is fluent with 2 languages (English and French, besides Arabic). Nada takes one hour and half travels forth and back to home daily to help the family and her mother. Once she is home, she feels depressed and tired. Nada is thinking about relinquish her private school and attend a government school to ease her family financial burden, but the father refused. 

      Hassan is in the fifth grade. He is typically a good student, but his latest school report showed dropped in his grades in most of her classes, and the teachers are complaining of his recent aggressive attitude toward his classmates.

     Adam just started (4 months ago) going to a private educational center after school (from 2 PM to 7 PM daily) because of his mother’s illness. This transition has been difficult for Adam because he had been home full-time with his mother (Salma) until her disease progress. Otherwise, he is healthy.  

     Salma’s parents live in the same town. Her father works full-time engineer and are not able to help. Her mother wants to help and moves to their home, but her medical condition is serious making the situation worse. Salma’s brothers and sisters are away in different cities. 

Ali does not have parents to help and support. His father passed away 5 years ago and his mother passed away 10 years ago because of breast cancer. All Ali’s brothers and sisters are away in different cities. 

Discharge Plans: Salma will be discharged home in the next day.

Figure 1.  AL- Ahmed Family: Family Genogram

Figure 2.  AL- Ahmed Family: Family ecomap

THEORETICAL PERSPECTIVES AND APPLICATION TO THIS CASE FAMILY

Family Systems Theory 

Origin of the Family Systems Theory:

Family Systems Theory derives from physics and biology perspectives that organisms are interactive systems (Bowen, 1978; Kaakinen, Coehlo, Steele, & Robinson, 2018). Nursing theorists who have expanded the concept of systems theory include Hanson (2001), Johnson (1980), Neuman (1995), Neuman and Fawcett (2010), Parker and Smith (2010), Walker (2005), and Wilkerson and Loveland-Cherry (2005).

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Overview of the Family Systems Theory:

     Family systems theory is a method of studying human behavior that focuses on circular interactions among family members as well as between the family and the context(s) in which they live (Keller and Noone, 2019). Family systems theory is a human behavior theory that views the family as a complex social system in which individuals interact to influence one another's actions. Family members are linked together, allowing the system to be viewed as a whole rather than as isolated components. Any change in one family member is likely to have an impact on the entire system, and may even lead to changes in other family members, resulting in functional or dysfunctional outcomes (Keller & Noone, 2019; Kaakinen, Coehlo, Steele, & Robinson, 2018). 

     One of the major assumptions of Family Systems Theory is that family system features are designed to maintain stability, although these features may be adaptive or maladaptive. The family systems theoretical perspective encourages nurses to see individual clients as participating members of a larger family system. 

The goal of using a family systems perspective is to help the family reach stability by building on their strengths as a family, using knowledge of the family as a social system, and understanding how the family is an interconnected whole that is adapting to the changes brought about by the health event of a given family member.

Some concepts of systems theory that help nurses working with families

• Concept 1: All Parts of the System Are Interconnected. When an individual in a family experience at any event, all members are affected because they are connected
• Concept 2: The Whole Is More Than the Sum of Its Parts. The families are not just relationships between the parent-child, but are all relationships seen together
• Concept 3: All Systems Have Some Form of Boundaries or Borders Between the System and Its Environment. Family boundaries include levels of permeability in that they can be closed, flexible, or too open to information, people, or other forms of resources
• Concept 4: Systems Can Be Further Organized into Subsystems. Nurses can think about the subsystems of the family, which may include husband to wife, mother to child, father to child, child to child. Al0-hmed family has the following subsystems: parents, siblings, parent-child, a daughter subsystem, an in-law subsystem, and a grandparent subsystem. The nurse may work to decrease family stress by focusing on the marital spouse subsystem to help Salma and Ali continue couple time, or the nurse may focus on the sibling subsystem of Hassan and Adam and his after-school educational center.

Application to the Al-Ahmed Family

• All members of the Al- Ahmed family are affected by the mother’s progressive chronic health condition and changes. 
• Family structure, functions, and processes of the family are influenced, changing family roles and dynamics. 

Everyone in the family has his or her own concerns and needs attention from health care professionals. 

The focus of the nurses’ practice from this perspective is family as the client. Thus, the assessment questions of family members are focused on the family as a whole.

 Questions to be asked: 

• Salma, how do you see your family being involved in your care once you go home?  (concept#1)
• Salma and Ali, how are the members of your family meeting their personal needs at this time when you are both at the hospital? (concept#1)
• Salma and Ali, can you tell us who you consider members of your family? (concept#1)
• Salma, the last time your condition worsened, what was the most help to your family? (concept#2)
• The last time your condition worsened, what was the least help to your family? (concept#2)
• Who outside of your immediate family do you see as being a potential person to help your family during the next week when you go home? (concept#3)
• How do you feel your family would react to having a home-health aide come to help you twice a week? (concept#3)
• What are your thoughts about how the children will react to having Grandma (Nour) here to help the family? (concept#4)

Intervention

     To help the family reach stability by building on their strengths as a family, using knowledge of the family as a social system, and understanding how the family is an interconnected whole that is adapting to the changes brought about by the health event of a given family member. Therefore, the nurse may work to decrease family stress by focusing on the marital spouse subsystem to help Salma and Ali continue couple time, or the nurse may focus on the sibling subsystem of Hassan and Adam and such as the new transition as Adam is now attending after-school educational center.

References:

Denham, S. A. (2016). Family structure, function and process. In S. M. H. Hanson, V. Gedaly-Duff, & J. R. Kaakinen (Eds.), Family health care nursing: Theory, practice and research (3rd ed., pp. 119–157). Philadelphia: F.A. Davis.

Hanson, S. M. H. (2018). Introduction to family health care nursing. In S. M. H. Hanson, V. Gedaly-Duff, & J. R. Kaakinen (Eds.), Family health care nursing: Theory, practice and research (3rd ed., pp. 3–38). Philadelphia: F.A. Davis.

Kaakinen, J. R., & Birenbaum, L. K. (2018). Family development and family nursing assessment. In M. Stanhope and J. Lancaster (Eds.), Community and public health nursing (7th ed., pp. 550–579). St. Louis, MO: Mosby.

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. FA Davis.

Keller, M. N., & Noone, R. J. (Eds.). (2019). Handbook of Bowen Family Systems Theory and research methods: A systems model for family research. Routledge.