One of our main objectives as future nurses is to understand individual patients is to first gain an understanding of family background. Working with family from a systems perspective, the nurse is able to gain an understanding to the ways in which family members interact, what the family norms and expectations are, how effectively members communicate, who makes decisions, and how the family deals with needs and expectations (Edleman & Mandle, 2002). In the concept of systems theory, a family can exist within a community (suprasystem) and at the same time have smaller relationships within that family (subsystems). By composing a genogram, or family tree, one can see information on family relationships, health patterns, occupations, and religion. By composing an ecomap one can see information on how a family and its members interact with larger systems or smaller subsystems. The term family can be defined as a group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one anothers lives (Wright & Leahey, 2000).
My girlfriend Reynelyn and I conducted this interview with her mom, dad, younger brother, older sister, and the immediate family of her fathers side. The families that I chose to conduct my interview and research on are the Agbayani and Pascual families. By using the concepts of systems theory, genograms, and ecomaps, I will be giving you an analysis of her family and its relationships, health patterns, habits, customs, traditions, and how the members of the family interact with one another and also the outside community.
Family Description & Structure
Even though the Agbayani family is of Filipino descent, they can be seen as similar as any other working class nuclear family living in the United States. Reynelyns household and immediate family consist of her father (Rodrigo), mother (Lorna), older sister (Heidi), younger brother (Leo), and herself. Her extended family on her fathers side live in Seattle and her extended family on her mothers side live in Ilocos Sur, a provincial state in the Philippines. Both of her parents have jobs and are the main providers for the family. Some of the money that her parents make is used to help her fathers parents and relatives here in Seattle and some is also sent to the Philippines to help the family of her mothers side. Reynelyn and her sister use some of the incomes they make to help out with bills and house payments. In Filipino culture and tradition it is highly considerate for the young members of the family to return portions of their earnings to their roots. This example can be seen in both of her parents giving money to her grandparents and both her and her sister giving portions of their paychecks to help her parents.
Since Extended family is a big part in many Filipino families, we try to live as close as possible as we can to each other in the Philippines as well as the United States. This kind of kinship and bonding can be demonstrated in her family. Most of the relatives on her fathers side of the family live two miles down the street from them. The members of her fathers extended family that live in that household consist of her grandmother, grandfather, cousins, three uncles, and two aunts. Reynelyn and her immediate family are always in contact with their relatives. They spend and average of 25 to 25 hours a week together at their house or the house of her grandparents. During family gatherings they cook enough food to serve 10 to 20 people, have 1 or 2 tables open for gambling (cards and mahjong blocks), and gather around the couch to talk and socialize. The children are either watching television, playing basketball, singing karaoke, and are even allowed to gamble.
Themes & Rules
One of the main themes with her family is religion. As observed in the genogram, you can notice that all of the family members from either side belong to the Iglesia Ni Cristo (Church of Christ). Some of the rules associated with the Iglesia Ni Cristo include: going to church twice a week, participating in missionary work, no premarital sex, and not dating anyone outside the religion. Another main theme present within the genogram is smoking. Most of the males in the Agbayani side of the family smoke and combined with hypertension, this could lead to serious consequences and complications in the long run. Since smoking isnt illegal and since they have the money for it, it isnt really taken into consideration. The members of the family that dont smoke usually try to encourage the other members of the family to stop smoking. Since they are a traditional Filipino family, they dont go to outside sources (such as counseling or support groups) for help, instead they try to keep inside and deal with it only as a family. Another small and interesting theme is the fact that all the childrens names of her grandparents on her fathers side of the family start with the letter R and the fact that all the childrens names of her grandparents on her mothers side start with the letter L. There is no general rule to this theme and the only reason Filipinos do this is make it easier for parents and relatives to keep track of the children.
Analysis of Family Health Status
Hypertension seems to be one of the only health problems that has roots in both sides of the family. The probable reason for this is although Filipino diets are lower in fat and cholesterol and because meat is expensive and scarce in the Philippines, the salt content is off the charts. Salt is used as the main preservative because of lack of adequate refrigeration in rural parts of the Philippines. The part of the family that resides here in Seattle is getting treatment and are educated enough to make the right food choices and how to maintain their health. The mothers side of the family, in the Philippines, are the ones that should be taken into greater consideration because lack of money, lack of treatments, and lack of knowledge could put this part of her family in jeopardy.
Another health issue that has been brought to my attention from the genogram was eczema. Eczema seems to have all of its roots in the Agbayani side of the family. Since most of the members of the Agbayani family live in the U.S., they are able to find the resources and education to take care of this. There is another genetic component that was discovered and it seemed only to affect the males in the Agbayani family. This issue is that of male pattern baldness. When talking with her father, he described how himself and his brothers started to lose their hair and develop receding hairlines around the age of 22 to 25. Apparently there is no urgency in this matter by all of the males except for the youngest brother (Ronald). Ronald is a student, considers himself as a young adult, and feels that his hair, as well as, his looks is very important for himself and his self-esteem. He is currently taking over the counter treatments such as Rogaine. Hair is such a big issue to him and I was informed that he was considering of getting hair transplant surgery as soon as he saves enough money. The first nursing diagnosis made was impaired adjustment r/t failure to change behavior and it was to address the area of smoking. An intervention would be to have each member set new goals that would help them slowly quit (nicorette gum or nicotine patch). The second diagnosis was disturbed body image r/t change in appearance and this was to address the cases of eczema. An intervention for this would be to encourage them to continue their personal care routine and continue to take their topical medications. The last diagnosis was ineffective health maintenance r/t deficient knowledge regarding treatment and control of the disease process and this was to address HTN. An intervention for this would be to provide the family a list of resources such as libraries, support groups, and internet sites since they are to busy to take time out of their busy schedules to attend hospital check-ups.
Conclusion
By completing this assessment of Reynelyns family, I was able to learn about health issues and other important things that could help her and the family out in the future. I was also able to share the genogram and the ecomap with her brother and sister, her mother and father, and herself. They were able to use both of these visuals as screening tools to see what issues were currently taking place and what they could expect to see develop in the future. By completing this assessment with the family, I was able to come to the conclusion that a nurse alone cant help a family and that the family helped itself, as well as, the nurse to get the necessary information to provide treatment and education that would improve the health and the relationships within the Agbayani and Pascual families.
