Family Wellness Diagnosis, Nursing I opted to interview a family of two parents (married heterosexuals) who have two children. Both children are in their late teens. Both parents work. She is a freelance writer and he is a sales clerk at a retail home goods store. Both are in their late forties. He is about 5'11; she is 5'6." Their heights and weights appear appropriate though he claims that at 180 he feels a little overweight. She is about 140. She is originally from Guatemala and he is from the mid-west of the U.S. The children are both boys. Bruce, age 19, is away at college. The other, Erick, graduated from high school last year and has been working at a local golf course while waiting to decide what he wants to study at a community college. I spoke with Bruce over the telephone for about 15 minutes. He confirmed that he is close in height and weight to his brother (5'8" and about 165), though he says he's a better eater than his brother. All members of the family have been told at some time in the past that they seemed to have periodic episodes of borderline high blood pressure. The adults say the work regular hours, though the wife has more flexibility with her schedule but she says she is committed to trying to keep a regular work schedule. All of the members of the family expressed some concern about how they don't seem to do much together as a family on the time they have free of work.

No family members took regular medicines, though the father said he was trying to take aspirin regularly (low dose) to help his heart. The parents drank red wine on a regular basis with their meals but drank little otherwise. Bruce said he would drink more beer with his meals but did not usually drink much. Erick said he was too young for alcohol but didn't like it anyway. The father admitted that he smoke an occasional cigarette at work but seldom more than one or two. No other drugs or medicine was used. The father and mother both said their families had histories of heart or blood pressure issues.

The family all had their bi-annual basic physicals within the last few months. None have any specific health issues, but all expressed a similar interest in developing better eating, exercise and activity patterns. I related this to the desire of nurses to want to help with general wellness plans and the identification of appropriate goals to change behavior (Care Plan, no date: 41-42). This allowed me to form my questions toward actions where the family could make changes together (Life Nurses, 2009). The question guide is attached.

Values, Health Perception:

All family members agreed there were no identified family health values or plans except that they all thought health was important.

They all mentioned that they talked about each other's health issues when something happened.

All members asked about their blood pressure and heart health when they went to their doctors.

The father mentioned that he got hurt sometimes at work from moving large pieces of wood and construction equipment.

The wife worried about her husband getting more seriously injured.

The boys were not concerned about any of their health issues.

Nutrition:

All members appear healthy. No signs of excessive weight or poor skin or body appearance.

Food was a common family topic of discussion.

Meals appear to be well balanced, including variations of American and Guatemalan foods.

Positive awareness of eating good mix of meats, vegetables, fruits, etc.

All members said they ate evening snacks sometimes.

The parents drank read wine with some meals. Bruce said he drank more beer as he was getting older. Otherwise he did not really drink much alcohol though he drank lots of soda.

All members said they were eating more fast food and quick meals at local restaurants, and they each said that they thought this was part of why they were gaining weight.

Sleep/Rest:

Father sleeps 5 to 6 hours, generally without much interruption. He says he is tired more after work but doesn't nap or sleep when they watch TV.

The mother says she sleeps poorly when she has big projects due but otherwise sleeps well.

The boys report no sleeping problem and say the usually go to bed by midnight and awake by 7 to 8.

This pattern was started by their parents and they have chosen to maintain it.

Elimination:

No issues or problems in bathroom habits or practices were reported.

Activity/Exercise:

Both sons engaged in regular games of soccer. Bruce played more basketball at college. Erick played regular rounds of golf, which he started after he got his job. He played at least one round per week.

The father also played occasional soccer game and liked badminton, though it was harder for him to find opportunities.

The wife said she...

When asked, she said she did sometimes walk the few blocks to the grocery store, but mostly to break her work pattern to think.
No other family members related their daily activities to exercise.

Cognitive:

All members have graduated from high school and have an interest in college. All appear to think and process information in ways relating to their interests and education.

The mother reads regularly for her writing work; the father reads just work related materials.

Bruce reads classroom assignments. Erick prefers online games and sports magazines.

The family often watches TV together at night when they are not out with friends or neighbors.

Sensory-Perception:

All family members wear corrective glasses for nearsightedness.

Father believes his vision is getting worse as he gets older. Mother's vision has not changed much in recent years. Boys have regular checkups but have no vision issues other than minor correction.

No family hearing issues.

No hand or foot sensitivities.

Salt and spice intake seems to be getting more important for both parents as they get older. Both note that they prefer spicier foods than in the past. Father had reduced salt intake in the past but has not maintained that practice.

Self-Perception

All family members present with good self-concepts and desire for doing better in life.

No concerns with discussing personal or family issues with another person.

Role Relationships:

Role relationships ideas were new idea to family members.

All discussed the role of the father as outside worker and mother as home person.

Mother sees herself as different from women in family who were more traditional Latinas.

All members report having friends and associates who are like them except Erick who talks about making friends with older and wealthier people at golf job.

Sexuality:

No family indications of sexual diseases or physical problems.

Parents report normal and regular sexual activity. Both see sex as pleasure and for family, but there is no interest in more children.

Parents talked openly about their sexuality being time together and relaxation.

Boys each indicated beginning interest, some dating behavior, but that they were committed to waiting until later in life.

Coping:

Interviews suggest family members do not exhibit stress issues.

No family member related stress to blood pressure issues.

Talking and sharing is part of stress reduction and family sharing pattern.

NURSING WELLNESS DIAGNOSES

Because there were no known medical issues, my review was a more subjective assessment of the conditions of the family with the goal of developing a diagnosis of possible problems and potential health solutions (Doenges and Moorhouse, 2003: 42). My approach is by way of using a focused assessment of the expressed interest of the family to develop stronger eating and nutrition patterns and to have a family commitment to exercise and good health because of some known heart or blood pressure concerns. I based the format on the Case Plan information I found on the internet.

DIAGNOSIS 1: Family is interested in establishing better eating patterns and family commitment to shared healthy eating experiences. GOALS: Plan meal and food experiences. Set calendar of opportunities to eat together. Share information about different kinds of foods they each want to try. RATIONALE: Keep records of ideas. Share thoughts through conversations and on family social media files. EVALUTION: Initially keep records of ideas and suggestions on a weekly basis. Mother agrees to write ideas and share them in family files to be sent to each other. Suggestions noted. Then each person will identify their eating ideas and how the family can get together. Family agreed to conduct regular blood pressure and health assessments on themselves, and to more openly discuss eating habits with each other. Family will buy each other blood pressure cuffs.

DIAGNOSIS 2: Family is particularly interested in exercising more and supporting each other. GOALS: Discuss in family sessions ways that normal activities can involve more walking and playing of sports together. Idea presented to connect family eating opportunities with walks or sports outings. Youngest son thinks family would like golf for walking and time together. RATIONALE: Integrate exercise into daily activities so it doesn't seem secondary. Include it as part of larger family experiences. EVALUATION: Document types of ideas for each other to do during their normal routines. Encourage mother to walk more during work as a break from work. Encourage father to spend more time with friends who play sports. Integrate sports and exercise into days…