A nursing assessment of a family is the basis of nursing interventions.

Stanhope and
Lancaster (2008) state, By using a systematic process, family problem areas are
identified and family strengths are emphasized as the building blocks for interventions
and to facilitate family resiliency (p. 567). The following paragraphs will describe a
typical family. The family consists of a mother, a father, a 10 year old daughter, and a
six year old son. The family chosen was interviewed individually and as a family.
This family consists of SM, CM, daughter EM, and son DM. The family lives in a three
bedroom brick house, with three entrances, nine steps to enter the front of their home,
8 steps to enter from the garage and four steps to enter the back door. The back yard
is fences with a four foot wood privacy fence. Their home is in a quiet neighborhood
with an elementary school across the street where DM attends. Mom can watch DM
play on the play ground at school from their back deck. Their daughter, EM, attends
middle school. The familys neighbors are all young couples with ten children ranging
from age four to thirteen. Their mortgage is $998.00/month. They have city water and
sewage. They gas heat, gas logs and a heat pump. Their house is kept clean and well
maintained since CM only works part-time at a local physicians office. CMs, part-time
position allows her to stay home when the children are ill or school is out. When you
walk in the front entrance it is a split level home. You can either go up six steps up to
the bedrooms or walk straight in to the main level or go down eight steps to the garage
and down eight steps to the basement. On the main level you enter the great room
which is carpeted floors and consists of a couch, love seat, and an oversized chair,
television and fire place. Connected to the great room is their dining room and kitchen
which have tiled floors. The dining room has a table that seats six, and a tall cabinet
containing dried and canned foods. The kitchen has a refrigerator, a dishwasher,
microwave, and lots of counter, and cabinet space. Out of the kitchen is the main
hallway which is tiled. Leading up the stairs to a full size bathroom and two bedrooms
on the right on the left is the master bedroom and bath. The hallway bathroom is
decorated in soft beige and red colors with simple wall hangings. The bedroom on the
left is the bedroom of CED, the 5 year old daughter, and the bedroom on the right is
the bedroom of LRD, the 3 year old son. Back down the stairs is the lower level. When
you first go downstairs you see and big open family room that has a couch and two
lazy boy recliners. The downstairs is all carpeted. To the immediate right is a second
full bathroom and next to that is the master bedroom. Opposite the master bedroom is
the fourth bedroom which was converted to a toy room for the children. The downstairs
is where the family spends most of their time. There is a big screen television and there
is a game station connected to the television. BAD has taken the time to child proof
their home using child safety locks on all cabinets, and electrical outlet covers. The
children have a lot of toys, and it seems they do not have a lot of storage, yet their
home is kept very tidy.
The family does not interact much with their neighbors or community. BADs family
lives in another state, and MLDs family lives in another town about an hour away. MLD
has a car that he drives to and from work, and BAD uses a van to take CED to school,
and to run errands. MLD smokes cigarettes, but he steps outside when doing so to
protect the children especially CED since she has asthma. He also does not smoke

when in the car.

The family is not limited in food choices; they just do not seem to choose balanced
meals when eating. The only income that they have is what MLD earns from his job
and so the family chooses foods that are cheap and accessible, such as canned foods,
frozen foods, and snack food such as chips and cookies. The only vegetables they had
were canned vegetables. BAD does try to make a balanced dinner, but still uses frozen
meals that are easier to prepare.
BAD is a 29 year old Caucasian female. She is 64 inches and 225 pounds. Her hair is
uncombed and unwashed. She stated that since losing her job, and being diagnosed
with thyroid cancer, she does not feel the need to look presentable every day. She said
when she does leave the house that she does do her hair and makeup. She needs
surgery to remove her thyroid, but the family has already used up their allotted
insurance money for the year, so they are waiting until January to have the surgery.
MLD is 33 year old Caucasian male. He is 68 inches and 195 pounds. He is well kept
in appearance and has on slacks and a button down long sleeve shirt. He has just
gotten off work. He said he usually works overtime, 12 hour days, to make extra
income for the family. MLD also takes night classes two nights a week and is working
on getting a bachelor in business to advance at his company.
The two children are CED, and LRD. CED is 5 years old and is in kindergarten. LRD is
3 and will start kindergarden when he is 6. CED has childhood asthma, and has to
have a breathing treatment every night before bed. She also has 2 rescue inhalers and
has to take a pill every day. LRD is a healthy 3 year old boy with no diseases at this
time. He has however had several issues with ear infections, and BAD said he might
have to have tubes in his ears next year.
BAD enjoys taking care and playing with her daughter and son, CED, and LRD. She
also enjoys listening to music, drawing, and watching movies. She is not very active,
thus leading to her obesity. The family has recently gotten a video game, which is a
dancing game and she says she has since lost 10 pounds. BAD does not like cleaning,
and therefore MLD does so when he gets home from work. BAD does the cooking and
laundry. BAD does not have a good sleep pattern and has admitted she has bouts of
insomnia. She does not exercise regularly and does not take the children out often,
and so the children are at risk for childhood obesity. When interviewed individually,
BAD stated that she is unhappy with her current sexual activity and feels that it is
because of her weight. Before their daughter was conceived and born, BAD said the
couple was sexually active several times a week. Since having both her children, she
has gained over 80 pounds and cannot seem to get motivated to lose the weight. She
stated that MLD does not make comments about her weight but does make comments
that they are not as sexually active as before. She has had several illness since having
children and believes that now she has been diagnosed with thyroid cancer, that her
husband, MRD, is upset with her. She said she is willing to try a new diet and exercise

routine in order to feel happier about herself, and states that this might make their sex
life as it was before.
When MLD was interviewed he stated that he is overwhelmed at work, and feels under
a lot of pressure to be the sole provider for the family. He also admitted that he wishes
he could come home and the house be tidy, but he usually is the one to clean when he
gets home from work. He is taking classes two nights a week, and mentioned that he
might take some time off school to work even more at work. MLD stated that his wifes
weight does not bother him, he just wants her to be healthier, and wishes she would
take the children out more often to get some fresh air and exercise. He hasnt noticed
any other problems with their relationship, but states he is scared of losing his wife with
her new diagnosis.
Family Structure/Functions
This family is the typical family that consists of a married couple and their children.
They have a five year old daughter and three year old son, and a 7 year old large dog.
BAD and MLD have the same expectations for their children in terms of importance of
education. They both expect them to complete high school and attend college. They
want them to do more with her life than they were able to do with theirs at this time.
The family does not attend church and when the topic of religion was brought up they
both wanted to change the subject matter.
Communication seems to be an issue within this family with BAD feeling secluded due
to her weight and MLD working long hours and overtime. BAD feels that MLD gets on
her a lot, and therefore has just about stopped communicating with MLD. BAD feels
that she is always trying to talk to MLD about their relationship but he doesnt want to
talk about it. MLD feels there is nothing wrong with their relationship and therefore
does not want to talk about it. He has stated that he does use sarcasm when talking
with BAD because he is uncomfortable talking about their relationship when he doesn't
feel anything is wrong. In times where decisions need to be made about the children or
their household, BAD and MLD make the decisions together after first talking about the
possible outcomes of each possible path.
Family Functions
According to Stanhope and Lancaster (2008) The two primary functions of families in
the twenty first century are relationship and health care functions (p. 555). This family
is having problems in their relationship between mother and father and also with their
health because BAD has been diagnosed with cancer, and CED has childhood
asthma.
Developmental Stages

According to Stanhope and Lancaster (2008) Duvalls Developmental Stages of the

Family are based on the age of the eldest child (p. 560). This family would fit into
Stage III, which is the family with a preschooler stage. BAD and MLDs main focus in
this stage is providing adequate housing, nutrition, activity, and safety for each person
in the family, along with socialization of CED and LRD. BAD and MLD need to focus on
maintaining a healthy relationship between the two of them to promote a well balanced
life for CED and LRD. They also need to accomplish forming a relationship with their
community. Communities offer a lot of activities, companionship, and educational
opportunities that would be very healthy for CED and LRD, and her parents.
Nursing Diagnoses
Three nursing diagnoses were identified using the family assessment data that was
obtained from this family, and Duvalls Developmental Stages of the Family. The
nursing diagnoses are listed below, in order of importance, the first being the most
important to the third being the least.
Imbalanced nutrition: more than body requirements, related to metabolic needs, as
evidenced by poor dietary habits and sedentary lifestyle.
Family process, interrupted, related to loss of income and poor communication, as
evidenced by tension among parents.
Activity intolerance, related to excess weight, as evidenced by verbal reports of not
exercising regularly.
Nursing Interventions
After reviewing the families level of education, and their knowledge on nutrition I was
able to come up with nursing interventions that correlate with the diagnosis.
Problem: Imbalanced nutrition: more than body requirements, related to metabolic
needs, as evidenced by poor dietary habits and sedentary lifestyle:
Nursing Interventions:
The nurse must identify what the family knows about possible results of unhealthy
eating and sedentary lifestyles.
The nurse must educate the family about possible diseases, illnesses, and injuries
related to unhealthy nutritional intake and sedentary lifestyles.
The nurse must educate the family on healthy food choices.

The nurse will provide example of a well balanced, healthy meal plan for one week
along with recommended activities to begin an exercise routine.
Family interventions:
The family will use the Food Pyramid and education provided by the nurse to create a
grocery list before each shopping day, with only healthy food choices and food to
create well balanced meals.
The family must strictly adhere to the shopping list.
The family will begin to increase their activity levels, including CED and LRD in all
activities, making the activities fun for them.
The parents will only give CED and LRD sugary snacks, juice, soda, and chips
sparingly.
Evaluation:
After three weeks, I met with the family to assess for the needed changes to meet their
goal of a healthier lifestyle. BED and MLD were very open to the changes when it
came to their diet. The children however were not as open. They did not like several of
the healthy meals prepared, but after realizing what the children liked and disliked the
couple were able to come up with other healthy solutions. Upon looking through their
cabinets and refrigerator, very little canned foods and frozen meals were found. The
children are now drinking low fat milk and sugar free fruit juice. BAD and MLD have cut
back on drinking sodas and when they do they have switched to diet sodas instead.
BAD and MLD have bought several healthy cookbooks and have highlighted the meals
they would like to try. One of these books is a childrens cook book to help get the
children involved in the healthy meal planning. BAD and MLD have increased their
activity levels. BAD walks CED to school in the mornings, and walks with LRD in the
afternoon to pick of CED. The family has also worked out together with a game that
they play in the living room. MLD continues to work long hours and overtime frequently
to make ends meet financially, not allowing him to exercise as often with the family. He
stated that once BAD finds a job he will be able to cut back on his hours and maybe
join the local YMCA with the family.
Problem: Family process, interrupted, related to loss of income and poor
communication, as evidenced by tension among parents.
Nursing Interventions:
The nurse must assess the cause of the poor communication and educate them on the

importance of good communication.

The nurse must assess each persons coping strategies and support systems.
The nurse will educate the family on resources available to them for counseling to help
save their relationships.
The nurse will encourage the family members to show empathy for each other to help
foster healing.
Family interventions:
BAD and MLD will make time at least twice a week for family time. This time will allow
them to catch up with what has been going on in each others lives and to also talk
about their feelings and talk about anything else.
BAD and MLD will include the children during one or two of these times to let them feel
included and to help establish good communication with them.
The family will set aside time for a family activity each week, whether it be a game
night, movie night, a walk, or some other activity.
Evaluation:
BAD and MLD both talked openly together about their relationship whereas on the first
meeting they talked separately. The family as a whole have had several game nights
the past few weeks where they exercise by dancing. BAD and MLD have both agreed
that their communication has increased and improved and both agree that they still
have a lot to work on. BAD is currently looking for a job, and states that she thinks that
will take a lot of stress off of her and MLDs relationship.
Conclusion
This paper was developed to provide a family assessment and prioritized nursing
diagnoses. Along with the diagnoses, nursing and family interventions were placed and
also an evaluation of the family and how they reacted to the interventions. After
evaluating the family after the interventions were started, the problems have been
greatly reduced and some have been completely solved.
References:
Stanhope, M., & Lancaster, J. (2008). Public health nursing: Population-centered
health care in the community (7th ed.). St. Louis, MO: Mosby Elsevier