11.6: Family Assessment and Nursing Interventions
By the end of this section, you will be able to:
- Obtain a comprehensive family assessment
- Analyze the subjective and objective family data
- Develop a plan of care based on the family assessment
Typically, nursing care of the person who is pregnant is family centered because the family plays a vital role in providing support to that person. However, family functioning may also lead to challenges in maintaining the health of the pregnant person, affecting the pregnancy outcome.
Three theoretical perspectives describe and explain the concept of family based on systems, structure and function, and developmental stages of a family (Demarco & Healey-Walsh, 2020). The system perspective focuses on family function as the interdependency of the people identified as members of the family. The structure and function perspective of family centers on how the structure of the family delineates how the family functions. The developmental perspective of family is based on the tenet that a family progresses through stages of expected development. Two of the stages of expected development, the perinatal period and parenting, change the interdependency of family members and how the family functions This section explains how to assess the family based on the current characteristics, roles, functions, and expectations of the family and how to analyze the assessment data to develop a plan of care to support the family and provide identified interventions (when indicated) during the perinatal period.
Family Assessment
The purpose of a family assessment of a pregnant patient is to determine if the household is a safe and nurturing environment for the patient and the newborn. The family assessment of a pregnant person begins with asking the patient whom they consider a member of their family. For each family member, the nurse asks the patient for the same personal and sociocultural data. These data include, but are not limited to, name, age, gender, race, spiritual and religious orientation, highest level of completed education, language(s) spoken and preferred language, current employment, current health status, and health-care beliefs. The next part of the family assessment focuses on characteristics of the family as a whole. Data describing the roles of each family member, the communication pattern used within the family, the power structure, the value system, safety practices, and lifestyle practices are gathered. The data are obtained from the patient, significant other, and key family members. The characteristics of the family’s living environment are also part of the family assessment. The nurse obtains data about the housing, neighborhood, water and food sources, and meal planning. This information is obtained to determine if the family’s physical and safety needs are met. The family’s safety and health activities commonly practiced by the entire (or majority) of the family members are also assessed. These activities include locking doors at night, wearing helmets when bike or motorcycle riding, hygiene, frequency of house cleaning, and participating in outdoor family outings. Developmental data include the number of generations living in the household, committed relationships, family members enrolled in grades K through 12 and postsecondary education, and career goals met. Figure 11.8 provides an example of a form to complete when performing a family assessment.
Family Assessment Analysis
The information in the family profile is used to determine the organizational structure of the family biologically, legally, and socially. The family profile determines if the family is multigenerational, blended, single parent, cohabiting, same sex, gender fluid, or traditional. The roles of each member of the household delineate which member provides the most financial, emotional, and social support to the pregnant patient. The current health status of each family member indicates if there are any health risks to the pregnant person and the fetus and any stress on the family as a whole. All this information helps to build the foundation for the family characteristics that promote healthy relationships, such as communication, values, and spiritual support.
The analysis of the habitat data provides answers about the physical environment of the household. Is the dwelling overcrowded? What is the crime rate in the neighborhood? Is the water supply safe and constant? Are convenient and cost-effective food sources accessible? Who prepares and cooks the meals? Are the meals nutritionally sound? Is there reliable transportation? The answers to these questions help to determine any risks for the development of complications during the pregnancy, such as nutritional anemia , dehydration, and communicable diseases.
Both the family profile and the habitat data help to determine the safety and health practices of the family. Does the family lock their doors and windows at night? Are seat belts used consistently? Are immunizations up to date? Does the family do outdoor activities? Is the family dysfunctional? Is there family violence? Do the family members communicate effectively? Can the family problem-solve?
The nurse uses the analysis of the data to understand the complexity of interrelationships of the pregnant person and each of the family members. Once analysis of the data is complete, the nurse asks the family to discuss how the new baby is going to change these interrelationships and how the family is going to affect the health of the newborn.
Plan of Care
Together, the nurse, the pregnant person, and the family identify the priority problem and develop the plan of care . The nurse uses their knowledge of community resources and the family uses their knowledge of the strengths and resources of the family members to assist the pregnant person in integrating the newborn into a healthy environment. Figure 11.9 provides an example of a care plan form.