NRS-429N Family Assessment Part II Solved

NRS-429N Family Assessment Part II Solved

Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
2. Based on the information gathered through the family health assessment, recommend
age-appropriate screenings for each family member. Provide support and rationale for your suggestions.
3. Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
4. Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.

Family Assessment Part II

Family health assessment is the process utilized by healthcare providers in collecting information from a given family concerning health promotion and disease prevention activities. The assessment involves the examination of several health patterns and life choices that affects the health outcome of the family. Several environmental factors, termed as social determinants of health (SDOH), are normally taken into consideration when conducting family health assessments (Runyan, 2018). This paper elaborates on the SDOH affecting a family and routine age-appropriate screening recommended for the family, in addition to the assessment and application of appropriate health models.

SDOH Affecting Family and Family Health Status

SDOH refers to the factors within an individual’s environment with the capacity of affecting the health status of the individual (Runyan, 2018). Such factors tend to determine the conditions in which a person was born, grew up, works, and grows old. Based on the family health assessment results, Mrs. K’s family is of Hispanic-American descent from an upper-middle-class economic standard. The family has access to education, a healthy diet, and healthcare services hence promoting their general health. However, some of the SDOH that seems to affect the family are stress upon the family when Mrs. K’s mother’s arthritis worsens and inadequate physical exercise as a result of reduced energy given that most family members are aged. Stress can lead to several mental disorders such as anxiety and depression, which compromise the quality of life of the individual. Consequently, reduced physical exercise can worsen most of the conditions that the family is already suffering from such as hypertension, hyperlipidemia, and arthritis. Evaluating such SDOH will help the nurse formulate the most effective plan for promoting the health of the family.

Age-Appropriate Screening Recommendations

Routine health screening is essential in health promotion among all individuals, but the screening tests might differ depending on the parson’s age. Mrs. K’s family is made up of 3 elderly between the age of 60 to 95 years and young adults age 21 and 24 years old. For the young adults, I would recommend routine screening such as cholesterol check, given the family history of hyperlipidemia, full-body skin check for examination of suspicious skin lesions or moles, diabetes screening, pelvic and breast lumps examination for the daughter, and testicular examination for the son (Roy et al., 2020). The daughter should also be screened for vaccinations such as HPV in addition to cervical cancer screening. Blood works such as Complete Blood Count, Liver Enzyme Markers, Plasma Glucose, Complete Metabolic Panel, Sexually Transmitted Disease Tests are also recommended annually for both the two children. Psychological screening such as depression screening is also necessary given that the family is stressed when Mrs. K’s mother’s arthritis worsens.

For the three elderly, most of the earlier age annual routine screening is normally continued with additional tests, given that advanced age predisposes individuals to several health complications. The annual routine screening as discussed earlier includes BMI check, blood pressure, cholesterol check, skin screening, diabetes screening, immunization, depression screening, blood works, breast examination, cervical cancer screening for the women, and testicular screening for the husband (Roy et al., 2020). Additional screenings will be prostate screening, osteoporosis, flu vaccine, and colorectal cancer screening.

Assessment of Health Model

            Looking at Mr. K’s health status, the most appropriate health promotion model to use is the Calgary family assessment model (CFAM) together with the Calgary family intervention model (CFIM). The model employs the utilization of short-form interviews giving a clear picture of the conditions affecting the family. The information gathered is analyzed in such a way that the nurse will categorize the things that are relevant to the family’s health status in a multidimensional aspect to reflect on the dynamics of the family (Kläusler-Troxler, Petry, Lanter, & Naef, 2019). The structure of the models also promotes the evaluation of both internal and external components of the family, in addition to contextual components. These two models help the nurse develop personalized interventions to help meet the family’s health needs.

Application of Health Model

            Utilization of the CFAM/CFIM health models requires the nurse to assess the family structure to determine the type of internal relationship among family members. This assessment will help the nurse understand existing family needs and problems such as stress and how they feel about each other’s health conditions. In application of this model, it is also necessary to evaluate both the external and contextual family structure to familiarize with problems associated with these structures (Kläusler-Troxler, Petry, Lanter, & Naef, 2019). Lastly, the CFIM tool will be utilized in coming up with personalized interventions for the promotion of the family health status.

Conclusion

Generally, the health outcomes of most families are affected by several internal and external factors in a given environment. Such factors, termed as social determiners of health are utilized when conducting family health assessments for health promotion purposes (Roy et al., 2020). Models such as CFAM and CFIM are also utilized to ensure that personalized interventions are employed in improving the general health status of the family.

 

References

Runyan, C. N. (2018). Assessing social determinants of health in primary care: Liability or opportunity. Families, Systems, & Health, 36(4), 550. https://doi.org/10.1037/fsh0000377

Roy, S., Moss, J. L., Rodriguez-Colon, S. M., Shen, C., Cooper, J. D., Lennon, R. P., … & Ruffin IV, M. T. (2020). Examining Older Adults’ Attitudes and Perceptions of Cancer Screening and Overscreening: A Qualitative Study. Journal of Primary Care & Community Health, 11, 2150132720959234. https://doi.org/10.1177/2150132720959234

Kläusler-Troxler, M., Petry, H., Lanter, R., & Naef, R. (2019). Implementing Family Systems Nursing through a participatory, circular knowledge-to-action research approach in women’s health. International Practice Development Journal, 9(2), 5. https://doi.org/10.19043/ipdj.92.005

 

Social determinants of health are factors within one’s family and community that affect their access to healthcare services. Arthur’s family was interviewed in the previous project. The assessment showed the existence of significant health-related needs for the family. Nurses and other healthcare providers should collaborate with the family in developing healthcare plans to transform their lifestyles and behaviors. Therefore, this paper examines the social determinants of health affecting Arthur’s family, age-appropriate screenings for the family members, and appropriate health model that can be used to develop a plan of care for the family.

Social Determinants of Health Affecting the Family

As noted above, social determinants of health are factors within one’s environment that influence their access to healthcare services. The factors include those in places where one was born, work, grew, aged, and died. The interview with Arthur’s family showed the existence of several social determinants of health affecting them. One of them is the lack of awareness about their health needs. Education is an important aspect in health that increase population’s awareness about health risks and how to avoid them. However, Arthur’s family is not aware of the health risks associated with sedentary lifestyles. The family members rarely engage in active physical activity despite being obese and Arthur suffering from hypertension (CDC, 2022). Arthur and his son consume high amount of high calorie foods, which increases their risk of health complications such as cancer, hypertension, diabetes, and stroke. Therefore, their lack of awareness about the health risks of their lifestyles and behaviors is a crucial determinant of the family’s health.

The other social determinant of health seen in Arthur’s family is the affordability of healthcare services. Despite Arthur and his son suffering from hypertension and obesity respectively, they rarely visit the hospital for assessment and treatment. The family noted experiencing financial hardships, which makes it difficult for them to access and utilize the healthcare services that they need. The American healthcare system is among the most expensive in the world (Palmer et al., 2019). As a result, families from low socioeconomic backgrounds often experience challenges in affording the healthcare services they need for their health and wellbeing.

The other social determinant of health evidence from the family assessment is social and community contexts. Arthur’s family demonstrated the lack of adequate family support system during the assessment. This could be seen from the family members failing to provide their daughter her desired social support when she experienced a relationship failure. The family also does not discuss about issues related to sexuality and relationship due to the influence of their religious beliefs (Palmer et al., 2019). The wider social and community system also does not support healthy habits for its members. This can be seen from the easy access to fast foods for the family members and the lack of community systems to increase the population’s awareness about the importance of healthy lifestyles and behaviors (CDC, 2022). Therefore, Arthur’s family social and community contexts act as their social determinants of health.

Age-Appropriate Screenings

Arthur’s family members should utilize different age-appropriate screenings for their health promotion. The age-appropriate screenings for John Arthur include eye examinations, hearing tests, blood pressure screening, skin, dental, and testicular examinations. Age-appropriate screenings for Cate Arthur includes skin, dental, blood pressure, hearing, and eye examinations. The age-appropriate screenings for Chris Arthur includes eye, blood pressure, hearing, dental, and skin examinations. Mr. Arthur’s age-appropriate screenings include blood pressure, testicular, blood glucose, cholesterol, colonoscopy, and prostate screening tests. The age-appropriate screenings for Mrs. Arthur include ovarian cancer screening, mammography, bone density, cholesterol, blood glucose, blood pressure, pelvic, and cervical cancer screenings (Fragala et al., 2019). These screenings are important for early detection and prevention of potential health problems that may affect the family members.

Health Model for the Family

A health model that can be adopted to assist in creating a plan of action for the Arthur’s family is the transtheoretical model. Transtheoretical model is a theory of change used to facilitate behavioral change among the target populations. It promotes long-term behavioral change through multiple adaptions and actions over time. The model postulates that people are in different stages of readiness to embrace healthy lifestyles and behaviors (Castrucci & Auerbach, 2019). As a result, the nurse should create awareness about the change and provide enabling factors for the process. The transtheoretical model asserts that change occurs in steps that include precontemplation, contemplation, preparation, action, and maintenance. This model is appropriate for the family since it will promote sustained lifestyle and behavioral change among the family members (Pennington, 2021). Since change occurs in steps, it would be possible to implement strategies that will prevent family members from relapsing to their unhealthy habits.

Steps for a Family-Centered Health Promotion

The transtheoretical model provides several steps that must occur for the delivery of family-centered health promotion. The nurse should create awareness among the family members for the change in the precontemplation stage (Pennington, 2021). The family members should be made to understand the health risks associated with their behaviors and the need for a change. The nurse should facilitate them to develop interest in changing their behaviors in the contemplation stage. She should also help them to explore strategies that they need for their optimum health and wellbeing in the preparation stage (Liu et al., 2018). The nurse should then guide them in implementing new, healthy lifestyles and behaviors in the action phase. The focus is on ensuring incremental adoption of healthy lifestyles and behaviors and assisting the family members not to relapse to their unhealthy behaviors. The last stage in creating sustainable change is maintenance where family members have stabilized the desired healthy behaviors (Prochaska, 2020). Therefore, the transtheoretical model of change provides an effective approach to assisting the family achieve their desired health promotion goals.

Conclusion

Overall, Arthur’s family experiences significant social determinants of health that affect their healthcare access and health-related outcomes. The nurse should work with the family in identifying the effective ways to promote the optimum health of the family members. The transtheoretical model of change can be applied in assisting the family to achieve its health promotion goals. The model provides steps for achieve sustained behavioral change in the family.

 

 

References

Castrucci, B., & Auerbach, J. (2019). Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog, 10(10.1377).

CDC. (2022, May 9). Social Determinants of Health | NCHHSTP | CDC. https://www.cdc.gov/nchhstp/socialdeterminants/index.html

Fragala, M. S., Shiffman, D., & Birse, C. E. (2019). Population health screenings for the prevention of chronic disease progression. Am. J. Manag. Care, 25, 548–553.

Liu, K. T., Kueh, Y. C., Arifin, W. N., Kim, Y., & Kuan, G. (2018). Application of transtheoretical model on behavioral changes, and amount of physical activity among university’s students. Frontiers in Psychology, 9, 2402.

Palmer, R. C., Ismond, D., Rodriquez, E. J., & Kaufman, J. S. (2019). Social Determinants of Health: Future Directions for Health Disparities Research. American Journal of Public Health, 109(S1), S70–S71. https://doi.org/10.2105/AJPH.2019.304964

Pennington, C. G. (2021). Applying the transtheoretical model of behavioral change to establish physical activity habits. Journal of Education and Recreation Patterns, 2(1).

Prochaska, J. O. (2020). Transtheoretical model of behavior change. Encyclopedia of Behavioral Medicine, 2266–2270.

 

In part I of the assessment, I interviewed Family N, a nuclear, African American family comprising six members. The age of the family members includes Mr. N, 58; Mrs. N, 55; firstborn (female), 30 years; second-born (male), 26 years; third-born (male), 23 years; and fourth-born (female), 15 years. During the interview, strengths were noted in the functional health patterns of Nutrition and Activity/Exercise, but problems were identified in Values/Health Perception, Sleep/Rest, and Role-Relationship. The purpose of this paper is to discuss the SDOH affecting family N and create a plan of action to incorporate health promotion measures for the family.

SDOH Affecting Family and Family Health Status

            Social determinants of health (SDOH) are the non-medical factors that positively or negatively affect individuals’ health outcomes. All the family members have at least completed their high school education. Their literacy levels have enabled them to understand measures to maintain good health  (Hahn, 2021). For instance, Mrs. N observes healthy dietary habits since she understands the health risks of unhealthy diets like high-fat and salty foods. The family’s annual household income is adequate to provide them with decent housing, healthy foods, and access to healthcare, which have significantly led to better health outcomes.

Additionally, employment has positively affected the family and its health status. The family has access to private health insurance provided by Mr. N’s employer, which enables them to access health services that they would be limited from accessing without insurance. Furthermore, the family lives in a rural neighborhood, enabling them to grow vegetables and fruits and source food from the farm (Islam, 2019). This has contributed to positive health outcomes since they can access healthy foods. The security in the neighborhood also enables them to walk to work, which promotes their physical health.

Age-Appropriate Screening Recommendations

Mr. N will be recommended to undergo screenings for hypertension, lung and colorectal cancer. The USPSTF recommends hypertension screening for adults 18 years and above. It also recommends yearly screening for lung cancer using low-dose computed tomography (LDCT) in persons 50 to 80 years with a 20-pack-year smoking history and those currently smoking (USPSTF, n.d.). In addition, the USPSTF recommends colorectal cancer screening for adults 50 to 75 years. Screening recommendations for Mrs. N will include breast cancer, hypertension, colorectal cancer, and cervical cancer. The USPSTF recommends biennial mammography screening in females 50 to 74 years, and she is thus a candidate (USPSTF, n.d.). Furthermore, cervical cancer will be indicated because the USPSTF recommends cervical cancer screening every three years using cervical cytology alone or every five years with high-risk human papillomavirus (hrHPV) test alone.

The firstborn daughter will be recommended screenings for hypertension and cervical cancer using cervical cytology or hrHPV test. Recommended screening for the 26 and 23-year-old sons includes hypertension and HIV. The USPSTF recommends HIV infection screening in adolescents and adults 15 to 65 years (USPSTF, n.d.). Screening for major depression will be recommended for the 15-year-old.

Assessment of the Health Model

The Health Belief Model (HBM) can be used to create a plan of action in health promotion for family N.  HBM was developed to explain why individuals engage or fail to engage in preventive health measures. The model asserts that an individual’s belief in a diagnosed illness and their perception of a treatment’s effectiveness predicts their chances of behavior change (Zhao et al., 2022). HBM variables include perceived severity, susceptibility, barriers, benefits, self-efficacy, and cues to action. HBM can be used to identify if the family perceives a threat of developing a chronic illness to be serious. HBM will also identify if they feel they are susceptible to diseases, have the confidence to adopt the recommended preventive measures, and if they perceive that there are more benefits than barriers to adopting the preventive measures.

Application of Health Model

            Applying the HBM will be guided by the variables: susceptibility, severity, benefits, barriers, and self-efficacy. In perceived susceptibility, the family members will be assessed on their perception of being at risk of developing chronic illnesses and measured using the five-point Likert scale (Shitu et al., 2022). Perceived severity will include assessing the family’s perception of the seriousness of chronic illnesses. The family will then be asked about their perception of the benefits of adopting healthy lifestyles to assess perceived benefits. Perceived barriers will be assessed by asking about the family’s perception of the factors limiting them from adopting disease-preventive measures (Shitu et al., 2022). Self-efficacy will be measured by assessing the family’s confidence in adopting the recommended preventive interventions. The interviewer will establish a rapport with the family at the beginning of the interview and use respectful language to maintain effective communication.

Conclusion

Various SDOHs have influenced family N’s health, including the education level, income, employment, and neighborhood. The SDOH have positively impacted the family’s health as they understand the impact of lifestyle practices and have access to insurance, healthy foods, and healthcare services. The recommended screenings for the members include hypertension, lung cancer, colorectal cancer, cervical cancer, HIV, and depression. HBM since it will help understand why the family members have adopted or failed to adopt certain preventive measures.

 

 

References

Hahn, R. A. (2021). What is a social determinant of health? Back to basics. Journal of public health research, 10(4), 2324. https://doi.org/10.4081/jphr.2021.2324

Islam, M. M. (2019). Social Determinants of Health and Related Inequalities: Confusion and Implications. Frontiers in public health, pp. 7, 11. https://doi.org/10.3389/fpubh.2019.00011

Shitu, K., Adugna, A., Kassie, A., & Handebo, S. (2022). Application of Health Belief Model for the Assessment of COVID-19 preventive behavior and its Determinants among Students: A structural equation modeling analysis. PloS one, 17(3), e0263568. https://doi.org/10.1371/journal.pone.0263568

United States Preventive Services Taskforce (USPSTF). (n.d.). A and B recommendations | United States preventive services Taskforce. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-and-b-recommendations

Zhao, Y. C., Zhao, M., & Song, S. (2022). Online Health Information Seeking Among Patients With Chronic Conditions: Integrating the Health Belief Model and Social Support Theory. Journal of Medical Internet Research, 24(11), e42447. doi: 10.2196/42447