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Family Assessment
Sydonie Stock
NURS 341

A family assessment is a vital part of a childs health assessment. Looking at the family
dynamics will help the nurse determine possible risk factors to address in the child. Also, if the
family practices a different religion or follows another culture, examining how the family works
together will help the nurse know who to address (patriarchal or matriarchal) during the childs
health exam. Looking at the family will tell the nurse a lot; is this child part of a traditional
family with a mom, dad, and siblings, or is the child being raised by a single parent, the
grandparents, or by a same-sex couple? This information will lead the nurse to recognize
potential areas to address.


Family Assessment
Family assessments look at all aspects of the family life. With an assessment, the nurse
can determine potential problems the family is facing now, or could face in the future. If the
child is raised by a single parent, finances will more than likely be limited, reducing the amount
the family can afford healthy fresh food. If the child is raised by a grandparent, there may be a
struggle getting the child active because his/her caregivers may not be able to run around and
play like a younger parent. If the child is raised by a same-sex couple, the child may face
hardships in school. It is not our place to judge another familys lifestyle, but the childs
classmates and their families might judge them. Making the family aware of this and getting
them in touch with resources that will help their child manage through school would be one
possible goal.
Family Composition
The family I chose to assess is comprised of C. H., age 7, his mom, S. H., age 28, his dad,
M. H., 34, and his grandparents, early 60s. The C. H.s parents are divorced and live in separate
states, making the binuclear (Ricci, 2009, p. 12). C. H. lives with his father in Wyoming during
the school year and visits his mother and grandparents during the summer, trading off holidays
between the two households. I am currently S. H.s roommate in Big Rapids and had the
pleasure of meeting C. H. when he came to visit for the summer.
Stage of Family Development
According to Duvalls developmental theory this family is in Stage IV, families with
school aged children. Three tasks that go along with this stage are: 1) encouraging [the childs]
educational achievements, 2) encouraging the child to form relationships outside the family, 3)

parents need to learn how to adjust to the child going to school and spending time away from
home (University of Nebraska, 2012).
Childs Developmental Tasks According to Erikson, C. H. is in the Industry versus inferiority
stage. The task for this stage is to gain a sense of self-worth from involvement in activities
(Ball et al, 2012, p. 78). This means C. H. should join school, church or community groups in
order to form lasting relationships and develop his self-esteem. Using Piagets model, C. H. is
in the concrete operational stage. He is capable of mature thought, which means he is able
to reason and make decisions based on past experiences (Ball et at, 2012, p. 78). A task for this
stage would be having the child included in decisions made about his health and future.
Grandparents Developmental Tasks In their early 60s, C. H.s grandparents are in Eriksons
Generativity vs Stagnation stage. They are established in their careers, they have raised their
children, and now look forward to the times they have with their grandson. His grandmother, at
least is active with their church and both are well within the boundaries of generativity (McLeod,
Home and Community Environment
S. H. lives in Big Rapids, renting a modular home duplex. It has been well maintained
and is kept fairly clean. Along with five other modular home duplexes, there are also single
family homes, both one story and two in the neighborhood. The house is within walking
distance of two parks. S. H. works nights as an ED tech in Reed City, and has a few shifts a
month as an EMT with Big Rapids ambulance service. S. H. would be considered lower middle

M. H. is a manager of a machine shop for oil fields in Wyoming. S. H. has never been to
his house, and C. H. only said it has a big back yard butting up to woods where he and his friend,
Matt, play all the time. M. H. is also middle class.
C. H.s grandmother is a receptionist at her church, and his grandfather is an operator in a
machine shop. They live in West Branch, Michigan. S. H. describes their house as an old
colonial farm house, well maintained, very nice. She describes their socioeconomic status as
middle class
Cultural/Religious Traditions
S. H. is a non-practicing Catholic, M. H. and C. H. are practicing Catholics, and C. H.s
grandparents are Baptists. They are all Caucasian, Americans, without subculture influences.
They all believe in immunizations and vaccines and C. H. is a healthy young boy.
Family Functions
Not everyone in the family has the same role in regards to C. H.s development.
Security/Survival C. H. mainly relies on his father for security, since he lives in Wyoming the
majority of the time.
Emotional Support/Affection All care-givers, M. H., S. H., and the grandparents, are
responsible for providing emotional support and affection, but again, since C. H. is with his
father the most, M. H. is the main source. S. H. and C. H. talk on the phone almost every night
when he is not with her, so she does maintain the maternal bond with him.
Social Development M. H. helps C. H. enhance his social development by giving him the
freedom to make friends. C. H. told me about his best friend in Wyoming, Matt, whom he
spends every weekend with, either at C. H.s house or at Matts house. While C. H. is with his
grandparents, he participates in summer camps. This year he is going to two, a day camp and a

Baptist bible study camp through their church. By getting him active with other kids his age, his
grandparents also help form C. H.s social development. S. H. does not have access to those
services, and because she works so much, she doesnt have much time with C. H. When she
does have him, S. H. wants to spend as much time with him as she can.
Self-Esteem Since C. H. spends most of his time with his father, M. H. is the main source of C.
H.s self-esteem. By allowing C. H. to go off on his own to camp, S. H. and his grandparents are
encouraging him to be self-confidant and self-reliant.
Household Chores/Responsibility C. H. does not have any chores at any of the three houses.
His only responsibilities are homework during the school year.
Role Strain
Some could argue there is more role strain in a binuclear family than in a traditional,
nuclear family. As the primary caregiver, M. H. could have strain being a single father of an
active, energetic seven year old. S. H. could have a couple types of strain. Since she does not
see C. H. every day, she misses him while hes away. Also, since they do not interact directly
daily, C. H. could rebel and misbehave while he is in her home. Luckily, during his short time
with S. H., I have not witnessed any rebellious behavior. The grandparents could have role strain
since he lives so far away. They only get to see him every once in a while, and, like the potential
strain with S. H., C. H. could act out while he stays with them.
During C. H.s time with S. H., I did not hear her raise her voice to him. She does scold
him and counts down from three, but she hasnt yelled at him. When shes on the phone with M.
H., she is polite. I have not heard any arguments between the two parents. She has spoken to C.
H.s grandparents since hes been with them this summer, and again, has always had a polite,

quiet conversation with them. If one of the caregivers has a problem, they will call the other and
talk through what to do. For example, S. H.s work schedule is keeping C. H. from coming back
to her house, so he will spend the rest of the summer with his grandparents. So, she called his
grandparents to see if she could visit at their house on her days off.
S. H. and M. H. have agreed that the discipline appropriate for C. H. is time-out. S. H.
states that C. H. is usually pretty good, and when he does get in trouble, he goes in time-out for
10 to 15 minutes. During C. H.s time with S. H., he was never put in time-out, so his father is
the parent most responsible for implementing the discipline.
Even though C. H.s parents are in different states, they make sure to stay on the same
page on their parenting styles. Whenever one has to make a big decision regarding C. H., they
will call the other parent to make sure they agree. Also, S. H. talks to C. H. almost every night.
This helps reinforce the fact that she is his mom and he has to listen to her and obey her when
she tells him to do something.
Potential Problems
Like I mentioned earlier, one potential problem is C. H. rebelling against his mom and
grandparents because in his normal daily life, they arent there to give him orders. As he gets
older and more involved with school and friends, he might resist leaving Wyoming each
summer. This would cause a strain in his and S. H.s relationship, and with his grandparents.
Since S. H. does not play the parent role all the time, if C. H. does rebel, she might not know
how to react to bring him back under control. This could be a problem as C. H. gets older.
Nursing Diagnosis for C. H.

Relocation stress syndrome is a physiological and/or psychological disturbances that
result from transfer from one environment to another. Since C. H. moves houses so often
during the summer, it is difficult to make and maintain friendships, resulting in possible
alienation, feelings of aloneness, anger, or separation anxiety from any of his caregivers
(Ladwig, 2011, p. 617).
Nursing Assessments and Interventions The nurse or family can assess for this syndrome by
observing how C. H. reacts to the change in environment. He may show signs of depression,
show signs of, or verbalize, feelings of loneliness, pessimism, or insecurity. This syndrome
could result in loss of C. H.s self-esteem and sense of identity (Ladwig, 2011, p. 617)
The nursing interventions should include assessing if the family thinks C. H. should or
could be included in discussions or decisions about his housing locations (p. 618). If C. H. is
included in the decision making, he will be more likely to react favorably to the change. If C. H.
can maintain as much continuity with the previous schedule as possible he will have a
smoother transition from one home to the next (p. 619). S. H. and M. H. divorced over two years
ago, but C. H. may still have unresolved feelings about the change. He should be encouraged to
verbalize concerns he has about the split and the move to another state (p. 620).
Nursing Diagnosis for Grandparents
Readiness for enhanced relationship is a pattern of mutual partnership hat is sufficient to
provide each others needs and can be strengthened (Ladwig, 2011, p. 611). In the case of this
family, C. H.s grandparents are looking for a stronger relationship with their grandson.
Evidence that the grandparents want a deeper relationship with C. H. would be encouraging
conversations with their grandson and expressing desire to spend more time with him.

Nursing Assessments and Interventions The nurse and family members can assess this by
observing the grandparents interaction with C. H. An intervention for this diagnosis would be
to encourage C. H. to spend time with his grandparents. His grandparents could also call him
and talk on the phone when he is at either of his parents houses. A third intervention could be
for the grandparents to take vacation time and visit him in Wyoming during the school year.
Nursing Diagnosis for Family
According to Ladwig and Ackley (2011), readiness for enhanced family processes is
defined as a pattern of family functioning that is sufficient to support the well-being of family
members and can be strengthened (p. 359). Proof that this family functions successfully lies in
the relationships between the family members. S. H. and C. H. participate in activities (going for
walks and playing in the park) that support the growth of family members. Both S. H. and M. H.
talk on the phone with C. H. each night he is not with them. This shows that communication is
adequate. Also, family functioning meets needs of family members (p. 359). This is
demonstrated by the fact that C. H. expected to spend most of his time in Michigan with his
mother, but has changed to staying with his grandparents for the rest of the summer.
Nursing Assessments and Interventions The nurse and family can assess the strength of the
family unit. The nurse or family member should look for evidence that family members respect
on another, relationships are generally positive, and look for family roles that are appropriate
for developmental stages (Ladwig, 2011, p. 359).
Nursing interventions include using family-centered care and role modeling for holistic
care of families (p. 360). This means any care for one person in the family needs to include
care for the rest of the members. Even though the family is spread out over two states, they are
still close to each other through phone calls, this makes them a strong unit and must be treated as

such. Another intervention is for the nurse to spend time with all the family members, allowing
each to express their feelings, using the potential conflict over S. H. and M. H.s divorce as an
example (p. 360). If C. H. does start acting out and the family decides to go to counseling, they
should get family-centered care in order to find and treat, not only the main cause, but all the
issues arising from the problem (p. 360).
Ball, J., Bindler, R., & Cowen, K. (2012). Principles of pediatric nursing: Caring for children
ed). Upper Saddle River, NJ: Pearson Education, Inc.
Ladwig, G. & Ackley, B. (2011). Mosbys guide to nursing diagnosis (3rd ed). Maryland
Heights, MO: Mosby/Elsevier.
McLeod, S. (2008). Erik Erikson: Psychosocial stages - Simply psychology. Simply Psychology -
Articles for Students. Retrieved from:
Ricci, S. (2009). Essentials of maternity, newborn, and womens health nursing (2
Philadelphia, PA: Lippincott, Williams, & Wilkins.
University of Nebraska-Lincoln extension. (2012). Families across the lifespan: The normal, to-
be-expected, satisfactions and challenges couples and families experience. Retrieved
from University of Nebraska, Lincoln: