Sample of Family Assessment

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Please note: this is a Sample Family Assessment and should be used
   only as a guide. Your assessment is expected to be much more
                              complete.

                      FAMILY ASSESSMENT #1

                      The John and Mary M. Family

           Family Members interviewed: John, Mary, Alan, and Brenda




                                     Introduction
                               I. Chronic Illness Report
                                     II. Genogram
                         III. Stages of the Family Life Cycle
                                      IV. APGAR
                                     V. SCREEM




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                                                 Introduction

John (55) and Mary (53) M. are patients of my preceptor, Martha Jones, M.D.

Interviews were initially conducted with John and Mary in the preceptor’s office. With

Dr. Jones’ approval and John and Mary’s consent, a second interview was conducted

during a visit to their home. At that time, John and Mary and their daughter and son-in-

law, Brenda (30) and Alan R. (32) were also interviewed. Mary has IDDM II, has had to

take early retirement, and has had one amputation below the knee. Her husband,

daughter, and son-in-law share the care giving responsibilities for Mary.




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                                     I. Chronic Illness Report

                                       History of the Illness

        Mary is diagnosed with Type II Diabetes. She has had this since adolescence. As she has aged;

she has suffered from more health problems associated with diabetes. She has hypertension, which is

treated with medicine. She has some depression, and is treated with medicine and supportive counseling

from her physician. She has peripheral neuropathy. She has had circulatory problems, which have

resulted in the amputation of her left leg below the knee. Martha Jones, M.D., is her primary care

physician. She helps care for Mary on a daily basis, though Mary does go to Macon on occasions to

consult with an endocrinologist there about management of her diabetes. She understands that her

illness is progressive, but also understands the importance of good health maintenance. She is careful

about her diet and tries to exercise with the help of rehabilitation services.



                                 Impact of the Illness on the Individual

        Mary’s daily functioning has changed in that she is no longer able to work and is not as

ambulatory as she was. She states that what she misses most from before she was ill is her teaching and

her mobility. She has learned much about her illness that has been helpful, including the importance of

taking her blood sugar levels regularly, the importance of diet and exercise, and the importance of

managing her stress. She knows that the future likely holds more complications for her and possibly a

shortened life span, but she tries to maintain a positive attitude with the help of her family and her faith.



                                   Impact of the Illness on the Family

        A number of changes have occurred in the family since the illness began. As mentioned before,

Mary’s daughter Brenda moved with her husband and daughter from Atlanta and bought a house down

the street so that she could be more helpful with Mary’s care taking. There is some concern about

Brenda’s stress level, since she has to care for her husband and daughter take her mother to medical



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appointments and check on her, check on her grandmother in the nursing home, and continue her career

as an RN in the county hospital. Brenda admits she is too busy, but also feels assured that she is a part

of the family “team”. Both John and Alan help with the various care taking responsibilities.

        It is clear that the family has organized around the illness. Besides Mary, Brenda has been most

affected by her mother’s illness. Susan has been least affected – in fact, she enjoys going to her

grandmother’s house and visiting in the afternoons after kindergarten. The family states that generally

they support each other by their actions.

They are affectionate toward each other, but do not spend a lot of time talking about their feelings. They

try to focus on positive things. The family appears to be coping quite well. Under the circumstances,

they do not see anything they could do differently right now.




                           Meaning of the Illness and Family Resources

        The family understands that diabetes is an unfortunate illness that may have a hereditary

component – Mary’s father had severe diabetes. They know it is manageable, but that there is no cure.

Most of the time they feel “stronger than the illness” in the sense that they care for Mary and feel she

gets good care from her doctors. However, they become very concerned in times of crisis such as the

time when Mary’s foot became gangrenous and had to be amputated. The family has no spiritual beliefs

about the illness as such – they do not believe God caused Mary to have this illness. They do find their

faith and sense of God’s presence a comfort, and pray regularly for Mary to be as healthy as she can be,

and for relief from pain. The strengths of the family are numerous – strong love for each other, good

educational, financial and medical resources, good community and church support. They feel that their

caring for each other and enjoyment of life keeps them going. Little Susan is the apple of everyone’s

eye.




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             Impact of the Patients with Chronic Illness on the Physician and her Office

Dr. Martha Jones’ office is an excellent resource for disabled and chronically ill patients.

Dr. Jones has remodeled her office to make it quite accessible. There are wide

handicapped parking spaces in front that accommodate vans and wheelchair lifts easily.

There is a ramp that is not too steep that leads to the front door, and the doorway is large enough to

easily accommodate a wheelchair. The waiting room has an area without chairs to accommodate

persons in wheel chairs. The sign-in desk is low enough for a person in a wheelchair to sign in. Dr.

Jones has two of her eight exam rooms that are larger than the others to accommodate persons in

wheelchairs. She has purchased a

lifting apparatus for one of the rooms to help lift disabled patients onto the exam table.

        Dr. Jones trains her staff about how to deal with disabled and/or dying patients both informally

and formally. Informally, she will often talk to her staff about how to interact with a terminal patient

and their family when a given patient comes in. Formally, she encourages continuing education for her

staff. Dr. Jones states that she has dealt with her own issues around illness and mortality. She says her

father died after a brief illness from a melanoma when she was a child. She feels a desire to care for

patients and their families came partly from her experience with that illness and loss. She says that it is

her job to provide care and support for families in sickness and through terminal illness.

        She uses the biopsychosocial model as a loose framework for how she works with families.

Medically, she diagnoses and treats illnesses, but she also takes the time to talk to her patients about how

they’re doing, and holds family conferences as needed. Dr.

Jones utilizes community resources to help care for her patients, and has trained her nurse to do so, also.

They keep an United Way community service book in the office, along with a copy of the monthly

Support Group page from the county newspaper. When she is very busy, which is most of the time, Dr.




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Jones asks her nurse to sit down with the family and find appropriate community resources for them

such as the American Cancer Association or the Family Counseling Clinic.

        Dr. Jones is sensitive to cross-cultural and ethnic issues. In addition to a sizable

African American population, the county also has a growing Hispanic population form the migrant

workers who pass through during harvest season. One of her support staff has a working knowledge of

Spanish and Dr. Jones uses her for a translator if she has to care for Hispanic patients who know little

English.

        Dr. Jones is aware of how chronic illness affects sensitive issues, especially in a small rural

community, and is careful to understand her patients and protect their confidences. She has lunch in her

office occasionally with a friend, another physician in town who was a colleague in their residency

program. She also goes to professional meetings where she both learns more about medical practice

updates, and participates in Balint groups.




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                                   Time Line of the Illness

                                         (See attached)
        Mary is in the middle of the middle phase or chronic or “long haul” phase of her illness. She

was diagnosed as an adolescent, and deals with her diabetes daily with an established and familiar

regimen.




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                                  The Typology of the Illness

                                          (See attached)

        Mary’s diabetes is classified as a gradual, possibly fatal, shortened life span, progressive illness.




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               II. Family Assessment Report




                      GENOGRAM

              The John and Mary M. Family




        Insert your three generation genogram here.




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                                 Stages of the Family Life Cycle


        The John and Mary M. Family are presently in the family life cycle stage of the family in

later life. They are young to be in this stage. However, Mary’s illness and having her children at

a younger age make this stage appropriate. This is a second marriage for Mary, the only one for

John. Mary was married for the first time at 18. She reports her father was an alcoholic and

sick, and she feels she married young to get out of the house. She and her first husband had son,

Harold, now 35. Harold is an alcoholic who has been married and divorced. He is estranged

from his parents.

        Mary and John have been married for 33 years. They have one daughter, Brenda, who is

an RN. Brenda states she feels her mother’s chronic struggle with diabetes influenced her choice

for a medical career. Brenda is married to Alan, a CPA, and they have one child, Susan age 4

years. Brenda and Alan live near Mary and John, and provide help and support for Mary as

needed.

        In terms of the issues associated with the family in later life, John and Mary struggle with

maintaining their own functioning and interests in the face of physiological decline (Manual, p. 28, a).

Mary has suffered from IDDM II since adolescence. In recent years, her health problems have become

numerous and severe enough to force her to take early retirement from her career as a math teacher in

the county high school. She suffers from retinopathy, peripheral neuropathy, and hypertension. She has

had to have one foot amputated above the ankle. Her husband, daughter, and son-in-law have attended

family education courses on diabetes, and all work together to provide medical and emotional support

for Mary. Brenda and Alan are an example of the pull a chronic illness has on a family system – they

were living in Atlanta but chose to move back to Burke County to help with Mary’s care. They live in a

house a few doors down from John and Mary. This is also an example of the middle generation taking a

more supportive role (manual, p. 28, #6, b.).




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        Mary becomes depressed at times about her declining health. Her family physician, Martha

Jones, M.D., placed Mary on a mild dose of antidepressant medication, which also helps her peripheral

neuropathy. Dr. Jones provides support and brief counseling for Mary and her family, as it is needed.

Mary has begun rehabilitation, and attends a diabetes support group. She tries to develop interests and

activities that give her meaning and keep her connected to others. She and John attend their church

when she feels like it. She also serves as the telephone contact person for the local Soccer Moms group,

which keeps her active and interested in her granddaughter Susan’s activities.

        Brenda has had to learn to support her mother without over functioning for her (manual, p.28,

c.). When Mary’s foot was first amputated, Brenda “hovered”, going to see her mother morning, noon,

and night, trying to do everything for her. Brenda and Mary discuss a critical moment when Mary

became upset with Brenda for her over involvement. Brenda agreed to call more and drop in less. She

also learned to ask her mother what she needed, rather than just arbitrarily do things for her.

        Mary admits she thinks about her own mortality at times. When asked to reflect on her life, she

was quite positive. She feels her teaching and family are good things thatshe has done (manual, p.28,

d.). She did not talk too long about this, stopping when she noticed her family becoming tearful.

        Though the family life cycle stage for John and Mary is The Family in Later Life,there are also

some features of stage 5, Launching Children and Parent moving on. Most significant is dealing with

disabilities and deaths of parents (manual, p.28, #5, a.). Mary’s mother 74 and is in a nursing home.

She has Alzheimer’s disease. Mary and Brenda visit her from time to time, thought she no longer

recognizes them.




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                                               APGAR

John, Mary, and Brenda each completed a family APGAR (see attached).

The APGAR's showed that overall John, Mary and Brenda feel good about how their

family cares for and supports each other. It is worth noting that the two primary

caregivers feel the stress of being stretched too thin with all their responsibilities.




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                                             SCREEM

SOCIAL: The social network of Mary and John is not as extensive as before Mary’s amputation, since
she is unable to get out as much. However, it is still an adequate network. John and Mary enjoy their
visits from Brenda, Alan, and Susan. Mary takes delight in keeping up with her granddaughter’s social
activities. John still attends weekly county Rotary and Chamber of Commerce meetings. Their life-long
friends from the community continue to call and visit.

CULTURAL: Culturally, the family is middle class/ professional. Mary is a retired teacher; John is a
CPA who is self-employed as a tax accountant for individuals and farmers in the community.

RELIGIOUS: This family considers their faith to be an important part of their lives. They are life- long
members of a local congregation. Mary is disappointed that she is no longer able to be as active in
church as she used to be. They see their faith as a resource in difficult times.

ECONOMICALLY: This family is a comfortable middle-class family. Mary has an income from her
retirement as a teacher. John is self-employed as a CPA who works with local farmers and others. They
did mention that they have had to lower their standard of living slightly due to Mary’s decreased income
and the expensive co-pays and deductibles they have to pay, since John is self-insured.

EDUCATIONAL: John and Mary have an above average educational level. Both are college
graduates and John has a professional credential as a CPA. They are interesting to talk with, and seem
to have a fairly good understanding of Mary’s illness management.


MEDICAL: The medical resources of this family are mixed. They rely on their family physician and
the county hospital to provide care for Mary. However, as mentioned before, John is self-employed and
self-insured. That means his insurance policy costs him more than an employed person’s group policy
would, and that his deductibles and co-pays are more than those of a good group policy.




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