Nanda nursing diagnosis for endometrial cancer

A FAMILY HEALTH ASSESSMENT

FAMILY HEALTH ASSESSMENT 13

Family Assessment Project:

The assessment is the first and most important phase of the nursing process. It is the step where evidence is collected and coordinated. A family assessment explores the family dynamics and provide the nurse with valuable information on the family’s overall health. Information obtained during the assessment can be used to resolve family issues and improve the health of each member (Staccini et al., 2015). Furthermore, the family health assessment seeks to provide a clear comprehension and balanced perspective of the family and not just its challenges, but also its achievements, principles and priorities. Since there are diverse aspects of a household, the evaluation is an active learning phase for volunteers and families alike.

This paper is mainly focused on researching and assessing a family of choosing, utilizing the nursing method to provide holistic treatment to the family unit. In order to determine how family dynamics influences the family as a collective entity and how the family affect each person, the undergraduate nurse conducted a thorough evaluation of the family and the different family members on social dynamics, transitional phases and interpersonal interactions. The nursing student may also delve deeper into how critical the welfare of a family is for its members' wellbeing, and likewise.

More critically, this evaluation would provide proper care for the selected family and include awareness content on effective coping strategies / skills relevant to the loss of a family member. The assessment would also help to inform the family on preventive health care as well as throw light about its costs, potential threats of non - adherence and strategies to tackle it.

Family Profile:

As culture has changed, so does the "standard family" concept. Traditionally, the family image consists of the parents (mother and father), a child or children that are all biologically connected. The picture portrayed by the "Pure American Family" involves a nice little house with blue window panels and a white picket fence in the center of affluent middle-class America. Although households that match this standard tend to exist, more of today's modern American families have only a single mother or father fill the positions of the respective parents.

Grandparents, uncles, aunts, older brothers, foster parents, working parents, co-laws and/or step-parents help in parenting positions, as it truly does take a village to bring up a child. The children in such groups might or might not be biologically compatible to the parents and families, if in consideration the children are not biologically linked they are normally adoptive infants, foster kids, or step-children. Groups like this are also labeled "infused family members". Cultural shifts greatly effect social interactions, even though people are increasingly impacted by family changes. Therefore, scholars understand that families experience turmoil during traditional and normal points of transformation, and thus there is a need for change in order to restore equilibrium within a household.

This theoretical research is focused on the perspectives of middle-class white Scandinavian nuclear households, comprising of a husband, his spouse, their kids and immediate family. According to White, Martin & Adamsons, (2018), the principle of family formation focuses on the stress-induced shifts that arise over time within communities. Historically, family growth researchers have proposed that families progress through time by probabilistic, symmetric quantities, forms, and pacing of phases associated with ontogenetic stage hypotheses of human infant development ( e.g., Piaget's cognitive development phases) (Martin, 2018). As per Crapo, (2020), the commonly quoted paradigm of Duvall (1957) has been introduced into the research, describing family formation in terms of eight periods of development. These eight stages follow the family as they travel throughout the lifespan, categorizing them in various groups based on family dynamics.

Stage one is the initial stage where a couple is at the conception of their relationship and without children. At this point they may begin conversation of family planning and resolve relationship issues pertaining to in-laws. At stage two is often described as the childbearing stage. It is where the first child is born. At this stage the couple must adapt to their new role as parents and build on their communication skills. The goal at this stage is to have a stable and well-balanced family unit. Stage three is observed when the child is beginning preschool (3-6 years old) the goal is to give that child a safe environment where they can thrive. Regarding the parents they will strive to establish a mutually satisfying relationship. Family dynamic may also change at this stage because as new member is introducing in the family role change may be necessary. At stage four (6-14 years of age) the eldest child is a teenager and begins to socialize with friends, building lasting relationships also while the parents are working on their own relationship. Stage five (13-20 years of age) is where communication is paramount, this is where parent and child work on their communication skills. Ethical and moral standards are established and the husband and wife work on their marital relationship. Stage six is where the first-born child leaves the family home yet still maintains ties with the family. New members may also be introduced at this point as the first-born child may seek new intimate relationship. Stage seven also called the middle years can be particularly challenging for parents as the parents are now considered empty nesters, they must now adjust to their independence. Children are no longer living at home and have started their own new life. For the parents, their goal now establishes physiologically and psychologically wellbeing. Stage 8 is the final stage it is when both parents are retired or deceased. The developmental task at this point includes adjusting to reduced income due to retirement, adjusting to change in living arrangements and adjusting to loss of spouse.

The family being examined here under research, is defined as both a "family with teenage children" and a typical or nuclear family structure. In addition, according to the psychosocial theory phases of Erikson, eight phases of growth are observed over the lifetime of an individual, beginning from infancy and progressing to late adulthood (Newman & Newman, 2017). According to Syed & McLean, (2017), the eight stages of psychosocial growth in Erikson suggest that challenges or problems require resolution emerge at each point, whereas good performance of each role contributes to a sense of accomplishment and a personality of wellbeing. Inability to carry on certain duties causes thoughts of inefficiency.

The Rodgers family discussed here is a conventional traditional nuclear household, composed of the following persons in the eight stages of psychosocial and cognitive development that Erikson established. Steve is 45 years of age, he is the biological father to Tony and his sibling, he was employed as a full-time teacher. Married to loving wife Peggy for ten years. Unfortunately, Steve was identified with Stage 4 metastatic lymphoma and died some four months earlier. When considering the stage of Erickson’s psychological development, we can agree that he is at the stage of Generativity VS Stagnation (middle aged) up until the time of his untimely death. At this point in his life he would be endorsing stage five of Duvall's Eight Stage Family Life Cycle where his children are school age and he is busy socializing his children while maintaining a meaningful relationship with his wife. Peggy is Steve’s beloved wife; she is 37 years of age which places her at Erickson’s (young adult) Intimacy VS Isolation stage of psychosocial development. She works happily as a regional bank manager. Peggy is also at stage five of Duvall's Eight Stage Family Life Cycle. Tony is the first of the Rodgers’s children he is 15 years of age currently attending high school and an active member of the high school football team. Considering his age, he is classified as a teenager experiencing Identity VS Role Confusion of Erickson’s stage of psychosocial development. In Duvall's Eight Stage Family Life Cycle Tony is seen at stage four, establishing meaningful relationship with his family and friends he would also be building ethical and moral values at this time. Bruce is 13 years of age and is the second child in the Rodgers’s family he is experiencing Erickson's Identity VS Role Confusion.

When I conducted the interview, Peggy and her two sons were present and were fascinated by the family assessment project. Peggy is listed as being a thirty-seven-year - old East Asian / American woman and the youngest of the four children in a family that belongs to both a mother and a father. She holds a bachelor’s degree in Accounting Management, full-time working, with compensation at a nearby bank. She currently resides with her two sons, Tony and Bruce, not far from the home of her father, where she had been brought up as a child along with her four remaining siblings.

She often cases for her elderly parents and visits them regularly at her childhood home. It is customary for the family in the family to care for the elderly parent as such, she brings them meals and makes it a point of duty to clean their home at least once per week. Though her parents are extremely appreciative of her efforts they often encourage her to focus on the needs of her immediate family. As they believe they are fully able to manage their household and all activities of daily living.

Tony and Bruce share a good relationship as brothers as they adhere to almost the same age category thus having many things in common. Steve and Peggy have both intended to raise their kids by putting highest emphasis on the family and sustaining a romantic relationship with the correct degree of devotion to each other. They have the perception of the sort of love that ties a family closely together. Peggy was happy to express that Steve was a very committed father and partner, before he died he worked as a full-time high school instructor. His carrier lasted over almost sixteen years until four months ago with his untimely death. Peggy is Steve’s beloved wife, she is mother to Tony and Bruce, she is thirty-seven years old and serves as a permanent employee in the local bank. Tony and Bruce took comfort in the fact that their mother and father remained together through more than twenty years but married only fifteen years earlier, since they became sweethearts in high school and became inseparable before their father's passing. They often brag to their high school friend that they are the only couples that stuck together for so many years.

The Rodgers family are proud catholic religion. They all joined the weekend service at their church regularly on every Sunday without fail, and then continued to the residence of Tony and Bruce's grandparents for dinner and quality bonding time. They look forward to these Sunday meeting as it provides them with the opportunity to share news of their previous week, usually finishing the evening with a tough games of scrabbles. Including both the sides, as mentioned Peggy's parents are observed to be in reasonable condition, health-wise. Steve's dad, nevertheless, smokes cigarettes, and has always been a chain smoker as per Peggy. According to Peggy, with his growing age, Steve's father was also diagnosed with Asthma and other co - morbid conditions. Despite his father's unhealthy behavior, Steve had even taken up his dad's smoking addiction and used to consume about four packs of cigarettes a week before being diagnosed with lymphoma. According to Peggy, she frequently alerted Steve of the dangers involved with smoking and told him about his father's failing quality of life. However, Steve declined to heed the signs, and maintained his cigarette addiction without intending to stop sometime early, and this, thereby, became very upsetting for the family. In addition to drinking, owing to his diets rich in fat and carbs, and lack of physical activity, Steve became obese too. Hypertension, and hyperlipidemia were both reported.

Steve's illness started with symptoms of night sweats but then progressed deeper with intense tiredness and unexpected extreme loss of weight. He also had frequent recurrent fevers and spent more than a couple of days administering self-treatment with OTC fever reducers and home remedies, and then agreed to arrange an appointment to see his primary care physician (PCP) after his health was unbearable with serious abdomen and significant fatigue. As per Peggy, Steve was subsequently diagnosed with Stage IV non-Hodgkin metastatic lymphoma, which had developed outside of the lymphatic network to a remote portion of the body, such as Steve's lungs and stomach. Steve was initially initiated on lymphoma care with traditional composite chemotherapy protocol of doxorubicin and cyclophosphamide drugs and later progressed to introducing rituximab to the chemotherapy regimen. Steve's health declined quickly, leading to his loss of communication skills. He started to give up easily by missed therapy appointments while he was supported by family members who were still really helpful and willing to assist. The family also requested their religious leaders and relatives for help. Often stating that faith and prayer assisted then though the difficult days. Steve struggled for a year with lymphoma before eventually passing away four months ago.

The subsequent consequence of Steve's sudden demise has prevented Peggy from continuing throughout life, she expressed that she often finds it challenging to get out of bed or even conduct ADL. She felt lost and had no idea how to go on. As her husbands condition got worst the family dynamics began to unravel. She did not feel comfortable consulting with her extended family and friends regarding her struggles and as of a result the entire family began to suffer. Moreover, Peggy shared that she doesn't really feel as though she can relate to her relatives and often kept her feeling to herself. She expressed that her husband’s passing was the ultimate breaking point.

Her children endorsed similar struggles not sure how to express their anger and frustration they often rebelled by breaking the rules and getting in trouble. The attributes of her family started to evolve; into something she didn't even know existed. Tony the eldest of the Rodger’s boys, displayed the most aggression, as he often gets into fights at school and even with his younger sibling. Peggy's attempts to recover her son remained in vain, with Tony allegedly cultivating a core overflowing with rage and bitterness extending to the whole family structure after his father's death. He was insensitive and disinterested in everything connected to family affairs. Moreover, he started avoiding his brother all together as well and with all the stressful conditions and abandonment from his own brother and mother during their bereavement, had left Bruce go silent and become distant from everyone. Since Tony's sorrow and bereavement contribute to his time away from schooling, thereby, the education authority decided this year that he was not going to attend school for the year and shall join back next year. The abrupt separation of Steve's parents from their families was exacerbated to her plight was another hit which was tremendously hurtful. This worsened her condition further, leaving her with a radical sense of alienation from her once caring relatives. Peggy made it crystal clear that this only contributed to her anxieties, since she had zero indication about the security and the safety of her family. Though her parents acknowledged her loss Peggy felt that they were not as helpful because they often spoke that they missed the woman she once was.

Application of Developmental and Family Life Cycle Theory:

Since the family is a nuclear family and is at the "families of teens" level, because of their two children, Tony and Bruce, who are now in middle school. The roles needed for this family involve encouraging teens to develop their own identity while also being part of the family, while worrying about the future, schooling, jobs; and growing the role of teens in the home, cooking, fixing, and power structures.

Family and Nursing Theories:

Family Systems Theory Applies to the Rodger’s Family:

The Theory of Family Systems can be utilized to discuss each entity's particular interests within the household, and the society holistically. In this theory all members of the family are interrelated and connected. The action or outcome of one member is greatly affected by the others. This is more so evident when Steve passed as the entire family dynamics began to change in the most negative way. For example, the close brotherly bond that was shared between the two brothers was broken as Tony started fighting with his younger brother. This caused Bruce to enter a period of isolation and stopped communicating with the entire family. Peggy also entered a stage where she did not feel comfortable communicating with her parents and friends regarding her grief as such this caused major isolation placing a tremendous strain on the family dynamics. The picture-perfect family as we know it began to unravel. The nurse caring for this family should understand that the family is seen as both a closed and open system. They work closely together for a common goal interacting with each other and also the outside community. Though death of a family member is common in family systems it can place tremendous stress on the family dynamics, causing an imbalance within the system. The nurse should approach this family with caution, she should understand that grief is expressed in many different ways depending on the stage of development. Care recommendation should include a consultation with a grief counselor. The nurse should also express to each member that anger is an expected part of grief. Further suggestion includes enlisting the help of the family pastor as he is a member of the open system. Further evaluation of this family shows that they are a closed system as they have not consulted with any outside professional regarding their grief, nor have Peggy seek the guidance of her parents or in laws to assist her though this challenging time.

Family Systems Theory: Conceptual

Family as a single entity is such that what impacts the family collectively influences specific individuals and often encompasses the entire society, related to the occurrences to the individual members. Treatment is primarily about the circular relations between people from the family system, resulting in stable or unstable outcomes. Family nursing is an important aspect of health caring for people of all ages; from an infant to geriatric wellness. Nurses are responsible for determining individual wellbeing as a whole, and recognizing regions of poor safety and risk indicators.

They conduct out the therapies and interventions, which aid in addressing the health issues found in patients and in the entire population. According to Kaakinen et al., (2018), this is the responsibility of family nurses to improve their patients' wellbeing on a daily basis over the life cycle of the patients, and that tends to establish a positive bond between health care professionals and their patients. Community care is less patient-focused than it is for the traditional family. The family care center is more involved with social health than with the actual patient. This adopts a family strategy to programs relevant to wellbeing. A family practitioner typically performs the functions that a specialist does (Minuchin, 2018). They will administer the medication prescribed for the patients and are thus needed to undergo any comprehensive preparation, knowledge and expertise appropriate for such functions. Nurses may be operating in hospitals, in private workplaces such as hospice centers, services, elementary schools and residences to provide support to their patients.

GORDON’S FUNCTIONAL HEALTH PATTERNS:

As stated in Temel & Kutlu, (2015), Marjorie Gordon has suggested functional health trends to serve as a guidance guide from a detailed nursing database of specific client assessment knowledge. All these 11 sections render an appropriate and normal method feasible for coping with the knowledge variety and motivating nurses to assess the quality of health and human activity to prepare the culturally competent nursing treatment for patients (Karaca, 2016). While investigating and evaluating the patient, the questions raised by the consultant in the assignment rubric were included in gathering appropriate and applicable details for each of the 11 functional health trends.

Health Perception–Health Management Pattern:

Edelman, Mandle, & Kudzma, (2017), claimed in their book that understanding of fitness and beliefs are based on the interpretation of an individual's wellbeing and their ideas and principles. The whole family was followed up with their primary practitioner regularly. They trusted in proactive health treatment and modified their ways when the husband, Steve was hospitalized with high blood pressure, followed by metastatic stage IV non-Hodgkin lymphoma and eventually passed away after a year of battling cancer. Steve had become obese, and acknowledged that he was unfit. However, the children are being safe and vaccinated up with the latest. Both attend for their regular scheduled follow-ups to their doctor, and also frequently participate in athletics and aerobic activities. Bruce, the younger boy, has always had a love for dancing and he dances to feel healthy as well. Each Sunday, the family attend mass while the sons enjoyed and took part in the choir. In comparison, generally, Peggy and her two sons are shown to be well and healthy, and resided in a pleasant and serene community.

Nutritional–Metabolic Pattern:

Mann & Truswell, (2017), described nutrition as the phenomenon of nourishing or being nurtured, in particular it can be defined as the mechanism through, which a living creature integrates food and utilizes it for development and tissue regeneration. Documenting Peggy's account, it was observed that the Rodger family liked cooking with sauces and trying different products and recipes. They prepare recipes that are enjoyable, then use cookbooks to try various concepts. They even maintained a greenhouse, and planted annually. In addition as a family they loved home brewing. The family had served together in the home field and the neighborhood area. Steve and Peggy used to share morning coffee every day until Steve died. The sons are reported with normally two snacks, to get three meals a day. The weakness of the late husband was chipped beef and thereby, Peggy doesn't feel like purchasing it.

Alongside with their sons, Steve and Peggy used to enjoy evening meals and dinner at restaurants on weekend days. Once they came home from work, Peggy and Steve used to get wasted on beverages, hard liquor too. The family is still holding their dental consultation set on different days. They refuted anything like that of a skin rash or sores, and confirmed their food pantry that they were safe, possibly the best-nourished with sufficient food supply. While taking a tour of the property, it was observed that Peggy had multiple empty beer bottles and other empty alcoholic liquor bottles, in the kitchen. On being asked she eventually admitted that she had been on hard liquor since her husband's passing, as such, more than six bottles a week, in order to relieve the pain.

Elimination Pattern:

Peggy reports that she has been struggling with constipation. She has doubled her consumption of fiber- and fiber-rich diet in recent days. She thinks she's often suffered with this affliction since she was young. She, however, claimed her husband occasionally had to wake up during the night while he was alive, to use the toilet. The family does not face any issues with waste disposal, neither are infested with any rodents. However, there were no compost practices at her home. On further inspection, it emerged that their home has working bathrooms with a very well-secured pot, wash basin and bathtub with furnishings.

Activity-Exercise Pattern:

When Peggy was further asked, he claimed that her husband liked to cook and this was what he wanted most to do to keep himself occupied in his spare time. He has even sometimes accompanied her wife on a stroll. Peggy recalled that Steve enjoyed the whole family's company and would go camping and hiking together with his two children. Nevertheless, after Steve's passing, the family hadn't gone fishing or hiking, so when the explanation for not going anywhere was asked, she answered that they loved Steve every day and still lament his passing. Peggy also listed that she used to take a stroll three days a week, and that she used to persuade her husband to follow her after him being detected with high blood pressure. The family now takes fitness seriously, however, and understand the need to remain fit and keep healthy.

Sleep–Rest Pattern:

The family gets around 6 to 8 hours of sleep in the night according to the documents provided. Peggy typically arrives from work along with her kids to their home, around 4:00 pm. Their daily regular sleep time is at 9:00 pm each night, and at weekends usually at 10:00 pm. Until lately, they did not experience anything like addressing issues with their sleeping cycle, however, after Steve's abrupt death, they had faced insomnia, which in turn contributed to Peggy's alcohol addiction. The kids stated that they used to love getting to bed at a decent hour and awaking happy in the old days but they no longer feel like sleeping since the death of their father. Throughout the conversation, Tony and Bruce chorused together that sleeping has been turned out to be a disaster and horror-full for them. The house was well fitted, and are usually kept tidy. Both sheets, bedding, pillow cases and comforters are kept tidy. Every room's windows and doors are observed to be painted white, and all rooms are well fitted and decorated with picture frames.

Sensory-Perceptual Pattern:

The nurses believe that their understanding of the sensory perceptions of the Rodger family remained unchanged. Peggy verified that her taste bud is hypersensitive, so she can say her wine the smallest detail and still have the power to select flavors that no one else can. She likes to feel and drink the wine with a blindfold, and as per Peggy, it's a game they use to play together as husband and wife, when Steve was alive. Neither Peggy nor her children were found using either vision or hearing aid or prescription after being questioned.

Cognitive Pattern:

All three members of the family are found to be alert, date, position and individual focused. There was no emotional disorder, as well as no language difficulty. The family is questioned about the individual making crucial family decisions on behalf of the family. All the kids claimed that before it was their Daddy / Steve, but, since the death of their dad, it's their mum, Peggy, who makes the call.

The family was questioned whether they had memory issues, while they recalled something, however, they just smiled and chuckled that everybody faces this kind of issue. Eventually, they finally listed the times that their keys were missing, or they forgot about the place where they had parked their car, or where they had placed their assignments.

The Rodger family, though, reported that they do not have any difficulty with writing, reading, or auditory skills, and they also stated that they believe that they do not possess any neurological deficiencies, and are all synchronized.

Self-Perception–Self-Concept Pattern:

Observation reveals that Peggy appears to deal with the pain of missing her spouse and uses alcohol as coping strategies. She denies having a problem with this but because of her self-esteem. Although it posed to be a problem for her and she ended up feeling obese and stressed, until she began eating healthy, and practiced regular exercise habits, contributing to the recent times, where she looks active and happy. In fact, Peggy has also undergone a shift in attitude, nutrition, and fitness routines. She mentioned during the interview that she had always loved her life, but after her husband's abrupt passing, she ceased to exist and struggled to survive.

Role–Relationship Pattern:

Peggy reported that since her husband's demise, she remains depressed by being the primary caretaker of her children. According to Peggy, being both a mother and a parent to his two teenage sons is rather difficult and demanding. Finally, as she was chatting, Peggy breaks down saying that she would rather allow her late husband, to be in command of their families like it always had been. She admitted, however, that it is a full qualitative change in position for her and that these are the moments she loves her husband the most.

Sexuality–Reproductive Pattern:

Peggy agreed sex is a critical aspect of life. She said sex aids in reviving the spirit and was the rekindling element in her marriage. She discussed how sex has helped to bind her and her husband to become one. Peggy always claimed they cherished one another, and were supportive of one another. She also clarified that soon after the delivery of her second baby, Bruce, she had a complete hysterectomy, and that she did not need to rely on any contraception regime. Peggy also noted that her children are being constantly educated about sex education at home as well as in the church.

Coping–Stress Tolerance Pattern:

The stressful event the Rodger family is enduring is the impact of Steve, their beloved father, husband, and son's tragic loss. As mentioned earlier in the family evaluation, which defined the psychological state of resilience of the Rodger family, preceded by Steve's death. The Rodgers also discussed that they typically cope with the many sources of stress, since they face together as a family. The latest threat element, though, is the loss of Steve, is considered to be beyond them and difficult for them to cope. The family claims devotion as a tool for their coping mechanism.

Value–Belief Pattern:

According to TAIR & POPOVA, (2019), trends of self-belief rely on the understanding of the individual's wellbeing and their interests and values. The Rodger family also identified their ideals that are rich in African culture and honoring their culture and history whenever possible. We read the Bible and trust in God's word, and have maintained good health. They often claim it to be the will of Jesus that her husband had been afflicted with lymphoma, and succumbed at such an early age.

ISSUES AND PROBLEMS:

According to Doenges, Moorhouse & Murr, (2016), nursing evaluation is a specialist assessment that is based on scientific evidence being utilized to evaluate possible or actual experiences and responses to medical conditions and life processes. A nursing diagnosis is a therapeutic decision that affects a patient, family, society or alliance's response to survival / wellbeing mechanisms, or accountability for that response (Ladwig, Ackley & Makic, 2019). A clinical evaluation provides the idea that clinical action must be sought to produce outcomes for which the nurse is accountable.

Diagnostic criteria in nursing are designed to depend on evidence collected through the clinical evaluation and to support the patient utilize the treatment program. The North American Nursing Diagnosis Association (NANDA) is considered one of the strongest institutions responsible for global definition, integration and management of regulated nursing diagnoses (Kim & Choi, 2015). The five phases of the clinical process include preparation, treatment, preparing, execution and preparation. The nurse needs to be solid and strong analytical thought capabilities during the diagnosis phase (Alfaro-LeFevre, 2016).

Description of the Issues and Problems:

The Rodger family is still finding it hard to cope up with the sudden loss of their father and husband. The mother, Peggy, is clearly more depressed, with the extra obligations, economical obstacles and other difficulties linked to dealing with and adjusting to the daily life following the loss of her husband. Moreover, as Peggy described, the kids began developing strange behaviors, shortly after their father's death, which made their mother feel exhausted. Peggy also noted that her in-laws had started to ignore her, which made her puzzled at the abrupt shift in these people's behavior. Both of these combined left Peggy with a sense of emptiness as well as loneliness and eventually forced her into drinking, which in turn served as her coping strategy for adapting and grappling with many of the differences, thus making her condemn the effects of the harmful health hazards, including her mental health problems.

Anticipatory Guidance and Facilitated Health-Related Behavior Changes:

Analyzing the tension element for Peggy is extreme. There are additional pressures prevalent for the Rodger family, in Peggy's reluctance and inadequacy to deal with family stability, much less to partake in social interactions or to be there for her kids. Certain stressful situations entail Steve's parents becoming distant as well as aloof and possessing inadequate knowledge about their emotional and physical well-being. The internal and external assets of the Rodger family remain to live to a differing degree, in the wake of their absence of the core family system. As a family system, the remainder of the family could provide their unity in finding warmth and reclaiming the power that had once characterized them. Internally, in relation to their wellness-promoting and prevention tests, the Rodger family provides a guide with respect to their outstanding wellness, and their commitment to consuming a diet that is compacted with minerals and vitamins and is minimal in saturated fats and calories. Working out that, one can see advantages in their incorporation of typically leveraging physical activity within their day-to-day workouts.

Vaguely, they do have a mechanism in their religious tradition that has become a part of their belief and operating framework. In addition, they seek consolation and help from the families within the prayer group along with their devotion and weekly mass practices for, which they render ritual and loyalty to becoming committed Catholics. While the Rodger family has grown to be optimistic, through Steve's abrupt loss, the head of kin, they have also had their opportunity to cope with the pain of tragedy. Steve's death incident struck the family too hard, and thereby affected their basic family roles and organization, leaving them weak and helpless. As Giger & Haddad, (2020) had stated, the family appraisal and intervention model has aided to project how strong the degree of care and mitigation for Peggy, her two sons, and the physician has become. Nonetheless, this family also possesses multiple virtues which, if appropriately focused and enhanced by, with counseling and various backups, will certainly yield effective results in the midst of horrendous pain and grief.

Collaborated with the family in addressing complex situations and challenges:

The nurse practitioners will promote trust so that Peggy can succeed in determining the best solutions to behavioral issues. As per Ollendick et al., (2016), behavior management program that is relevant and meaningful for Peggy could be implemented, which will recognize family expectations and principles, resources and opportunities for close relatives that may execute the strategy, as well as the talents , skills, interests, and dislikes of the kids. A behavioral plan that is logically reasonable but not a strong practical match for the household can be dismissed by family members, applied incoherently or inaccurately, or not maintained over time. When a nurse professional collaborates with Peggy to gather knowledge used to develop a therapeutic treatment program, they will incorporate their awareness of relational patterns and social well-being details to provide positive and meaningful benefits for Tony and Bruce, together with their difficult habits and help them to deal with the situation of the sudden death of their father. Therefore, despite the intended family's expertise and tools who would execute the program, a behavior management strategy has to be simple and effective to enforce (Ward, 2016). Behavioral intervention approaches can be constructive and targeted at avoiding challenging behavior vs. responding to challenging behavior as well as concentrating on developing different behaviors and balancing the challenging behavior intent or role.

Coordinated referrals as well as ensuring effective communication among services/agencies:

According to Monterio et al., (2016), positive communication is indeed the secret to helping Peggy outside the alcohol recovery facility and provider's borders, in the broadest possible sense. Some of the greatest obstacles of any collaboration or network-based approach comes as one of the various organizations decides to use a separate measurement method to capture the same results. This, at best, provides a fractured image of Peggy, at its worst, and it causes disappointment and uncertainty for her, and as a result may drop out of therapy. The biggest advantage of cooperation between health departments is better consumer and therefore neighborhood wellbeing.

Periodical Evaluation of the Effectiveness of Nurse’s Referrals, Interventions, and Education:

The counseling and other services offered to Peggy will also only be useful to Peggy for herself, but in the course of leaving drinking, the benefits received would still be available to the family to incorporate to act as further assistance to Peggy. Throughout the whole family's educational cycle and, however, with a corresponding request, each parent was encouraged to pose troubling questions and any remarks they wanted to produce. At educational periods and where services were available, every household participant was often encouraged and commended for the effort to collaborate collectively not only to better the welfare of the individual but often the wellbeing of the family as a whole. During the sensitization process, it was noticed that virtually all of the services that was offered for the family to use were complementary and near from where they reside. There were a few services available that payments would be required; nevertheless, that might not be a issue for the family. This was also stated that growing target that the family had set was huge targets to attain that would require time and a lot of effort. Nevertheless, irrespective of the challenges they growing both experience in the process of these next critical improvements, the consequence would be worth it for their physical and emotional health as well as for their general wellness as a family and individual.

Plan of Care:

Nursing Diagnosis: Clinical depression

Related to: death of the patient’s husband sudden demise

Secondary to: high blood pressure, Cardiovascular disease or liver disease

As evidenced by: (Le Strat, Le Foll & Dubertret, 2015)

Collaborative Nurse-Patient goal (short term - need a measureable timeframe): 4 to 6 months.

Nursing Outcome Criteria:

Nursing Interventions w/ rationale (Cite source for rationales):

1. Denial

1. Appropriate treatments for this family provide both individualistic and social counselling for grief (Harris & Winokuer, 2019). Provision will be made for the child to provide sufficient knowledge and guidance on the topic of grieving, its symptoms and potential consequences on the baby.

2. At the other side, the family members should be acquainted with the various aspects in which people may be of help by appropriate channeling and communication of their sorrow (i.e. journaling, tale telling, exercise, etc) (Brinkmman, 2019). However, it can be recognized that the most important outcomes are achieved where measures are designed to be patient-specific.

3. It is also important, when providing treatments to create a recovery plan, to identify the people or families to which care is being provided. Since denial is one of the best and most persistent signs of alcohol dependence, it can offer insight into Peggy's ability to contribute to long-term behavioral improvement and modify the illusion that the individual still thinks she will improve (Worden, 2018).

4. Members of the family are aided to take part in some of the drills specially crafted. Such activities are intended to help create a healthy base to connect and encourage each other, and will not only help them meet their milestones of general recovery and health reconstruction, which will also begin to guide them in positive strides when they embark on adulthood. This is also critical that they would then be better willing to resolve some further challenges, if they ever show back against them again.

2. Ineffective Individual Coping

1. By utilizing the Family Appraisal and Intervention Model in combination with the accompanying Family Structure Stressor-Strength Inventory method, the family and nurse have the added advantage of incorporating both objective and subjective knowledge to evaluate the degree of evasion and appropriate action. As a consequence, the family became deeply engaged in the judgments and debates about the overall determining factor of an all-encompassing recovery program in this context (Kaakinen et al., 2018).

2. In the continued dialogue with Peggy, she decided to receive assistance with the previously mentioned treatments on the recovery program for her children, in addition to seeking support to help them regain their usual family responsibilities and everyday home-living tasks.

3. The final stage of the initiatives to be implemented would concentrate on the services accessible to people coping with alcohol abuse and the support they require (Englander et al., 2017). Peggy wants this knowledge mainly to support her that or delay her drug indulgence.

4. In the continued dialogue with Peggy, she decided to receive assistance with the previously mentioned treatments on the recovery program for her children, in addition to seeking support to help them regain their usual family responsibilities and everyday home-living tasks (Zimmermann et al., 2016).

FINAL SYNTHESIS:

Summary of my Identified Family Themes, Problems/Issues, Teaching, Interventions and Evaluations:

Owing to the sudden loss of a family member, the period I was able to spend studying and interacting with this family was indeed limited but frenetic and jammed on period too. Improvement was observed within the family by following the treatments selected by the psychologist, and choices they took that influenced their wellbeing and safety as a whole. Peggy started utilizing the tools given to initiate the alcohol reduction measures. This decision was advantageous not just to her wellbeing but also to the whole family that depends on her. Peggy discussed that at moments when things became unbearable, it was hard not to resort to liquor, but she verbalized how she realized it was a cycle and it would take a bit of time. The family also stated how thankful they were for the grievous services offered. They discussed how they started to meet with a grief counsellor once a week to help them to promote proper recovery, as well as enabling them to share their feelings regarding their loved one's death in a constructive, safe way.

Summary of How my Therapeutic Relationship Progressed with the Family:

Each member of the Rodger family proceeds to work regularly to apply and leverage the knowledge and services given to them. Additionally, although alcohol abstinence is a daunting challenge to achieve, each family member strives to help and motivate each other every day as they collaborate with support groups, counselors and each other. The family all seem eager, motivated and determined to make improvements in their life that will allow them to live alongside each other in a safer and happier way.

Reflection on the Meaning of this Experience and the Process of Learning and Lessons Learnt:

While the entire project of evaluation was succinct in the midst of COVID 19's terror, and it was a hurried job. A ton has been gained about this, and it has made a number of applying strategies possible that growing family member might utilize and take advantage of. I understand that this role has given me the ability to grow a great deal in this field of my career, while at the same time strengthening contact and support for particular members of the family. Until initiating this task, I was really concerned that I wouldn't grasp how to support the family I assessed, but after more personal reading on the project criteria as well as learning about their evaluations with other participants of the class, I was more comfortable about my abilities to execute a effective care plan for a family unit. I know that nursing, particularly family nursing, is a very wide-ranging task with several responsibilities, but I definitely appreciated the hours spent focusing on this project and the moments I was able to spend with the family that I studied.

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