Family Assessment, Genogram, and Ecomap

Stanhope, M. & Lancaster, J. (2014). Foundations of Nursing in the Community, Community Oriented Practice. (4th ed.). Mosby/Elsevier: Chapter 18: Family Development and Family Nursing Assessment: Use G.2 Friedman Family Assessment Model (Short Form) found on pages 612.

A genogram is a graphical representation of family structure. In its more complex forms, it can include representations of emotional relationships. Many family therapists, social workers, medical personnel and other professionals are trained to develop genograms to record family structure and to take note of family systems issues, including patterns of behavior, tension, or dysfunction. Clergy can often make good use of simple genograms when interviewing new members, wedding couples, or bereaved family members.

In a standard genogram, each generation is portrayed on different level, from oldest at the top to youngest at the bottom. Males are represented by squares, females by circles. Marriages are represented by horizontal lines. A single slash through a horizontal line represents a separation; a double slash, a divorce. An X indicates the person is deceased. See Stanhope, page 338.

Parenting is represented by vertical lines. There are three different kinds of vertical lines: solid for biological parentage, dotted for adoption, and thinner dots for foster parenting. The vertical lines for twins or multiple births come from the same point on the horizontal. Pregnancies are indicated by triangles. Stillbirths, miscarriages and abortions can be represented by half-size triangles cancelled.

Colored, wavy, curved, choppy and other forms of lines are can be used between figures on the genogram to indicate nature of interpersonal relationships, including abuse, manipulation, or other troubled relationships and emotional cut-offs. (You need not learn these symbols; their use is varied among different authors and practitioners. You may even wish to develop your own. Some can be found at http://www.genopro.com/genogram/emotional-relationships/ )

Complex families can be difficult to map in a genogram. Standard rules for a genogram can be found at http://www.genopro.com/genogram/rules/

Complete an ecomap for this family. Read “Environmental Risk Assessment”, pg 339-341, and example on pg 340.

Assignment:

1. Draw a 3-generation genogram and ecomap representing the family on which you conducted your Friedman Family Assessment. (This can be your own family)

2. Complete the Friedman Family Assessment, using the Friedman Family Assessment Model found on pages 672-673 in your Stanhope and Lancaster text. Include a genogram, and ecomap, reflecting the family concepts in Chapter 18. Use APA format 6th Ed.

3. Use Rubric for Family Assessment to evaluate your paper before submission.

4. Submit your completed assignment.

 

Rubric for Family Assessment

Measures

Possible Points

Earned Points

Genogram includes codes and lines to reflect composition by persons and relationships for three generations (page 331)

25

 

Ecomap context of family including environmental data (page 335)

10

 

Relationships defined/identified including identifying data, developmental stage and history of family

15

 

Family characteristics (p 309, Box 18-3)

10

 

Family structural and functional assessment including stress and coping (pages 308)

15

 

Friedman Family health assessment (page 318-319)

20

 

APA 6th ed. format

5

 

TOTAL

 

100

Family Assessment, Genogram, and Ecomap

Student’s Name

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Family Assessment, Genogram, and Ecomap

Family nurse practitioners should possess assessment skills that they can use to gather data from families and be able to identify their developmental stages and factors that might be increasing their risks of having poor health outcomes. According to Stanhope and Lancaster (2014), family nursing assessment gives nurses an opportunity to identify the health needs of families and guides them to develop nursing interventions to address those needs. The Friedman Family Assessment tool is one of the instruments that direct nurses through the assessment process (Stanhope & Lancaster, 2019; Walton & Tiede, 2020; Susanto et al., 2018). The purpose of this assignment is to draw a genogram and ecomap of a 3-generation family and utilize the Friedman Family Assessment Model to conduct a family evaluation. The concepts that the assessment will cover include; identifying data, developmental stage and history of the family, environmental data, family structure, family function, as well as family stress, coping, and adaptation.

Friedman Family Assessment

IDENTIFYING DATA

1. Family name:

• Mark’s family

2. Address:

• Texas City

3. Family composition:

• • Mr. Mark’s family comprises grandparents, parents, two uncles, one aunt, and children. Mark’s parents are alive while his wife’s parents are both deceased. Mark has two brothers who are alive. His wife’s sister is alive too. Mr. Mark is married to one wife and they are blessed with two children: a girl and a boy, who are now teenagers. The figure below shows the genogram of Mr. Mark’s family.

Figure 1: Genogram of Mr. Mark’s family

4. Type of family form:

• An extended family comprising of grandparents, aunties, uncles, parents, and children.

5. Cultural background:

• Mark’s family are Whites.

6. Religious background:

• Members of Mr. Mark’s family are Christians of the Catholic denomination.

7. Social class status:

• Middle class.

8. Family’s recreational or leisure activities:

• Grandparents hardly participate in community activities. Parents take part in sporting activities. Children love swimming and hiking.

DEVELOPMENTAL STAGE AND HISTORY OF FAMILY

9. Family’s Present Developmental Stage

• Childbearing families with adolescents.

10. Extent of Developmental Tasks Fulfillment

• Mark and his wife have the responsibility of caring for their children and elderly parents

11. Nuclear Family History

• Mark and his wife are 46 and 41 years respectively. They gave birth to their son and daughter 16 years ago and 14 years ago respectively.

12. History of Family of Origin of Both Parents

• The late parents of Mrs. Mark’s wife lived in New York City and they were Christians all their lives. Mr. Mark’s parents have been staying in Texas city their entire life. They have been Christians too.

ENVIRONMENTAL DATA

13. Characteristics of Home

• Rented one-bedroom house.

14. Characteristics of Neighborhood and Larger Community

• Mark and his family live near a shopping center. There is a textile factory nearby. The roads are tarmacked. There are several rental houses nearby with people living in them.

15. Family’s Geographic Mobility

• Mark’s family does not own a car. Children walk to school and parents use public transportation while going to work.

16. Family’s Associations and Transactions with Community

• Mark is working as an accountant in a nearby factory. His wife is a nurse and she is employed at a hospital in the city. The family used health centers and hospitals frequently, especially the grandparents. The two children go to school every day.

17. Family’s Social Support Network (Ecomap)

• The social support network of Mr. Mark’s family comprises family members, friends, and a number of resources on the community. The Ecomap below illustrates the social support network of Mr. Mark’s family.

Figure 2: Ecomap for Mr. Mark’s Family

FAMILY STRUCTURE

18. Communication Patterns

• Mark’s family utilizes functional communication patterns. Grandparents are able to express their needs to other members of the family and children freely share their issues with parents and grandparents.

19. Power Structure

• The power of the family lies in the hands of Mr. Mark. However, he remains submissive and respectful to his parents. Mr. Mark involves his wife in most of the decision-making processes.

20. Role Structure

• Mark is the family’s breadwinner. His wife takes care of the family by performing activities of daily living. Their daughter and son occasionally help with house chores.

21. Family Values

• Mark’s family is guided by family values that were set by his parents.

FAMILY FUNCTIONS

22. Affective Function

• Mark and his wife are emotionally connected and they live together as husband and wife. They play the role of caring and nurturing for their children together.

23. Socialization Function

• Being a middle-class family, the family of Mr. Mark is likely to experience family rearing challenges due to financial challenges. The two children have adequately adapted to the child-rearing practices used by the family. Both parents are socializing agents for their children. Children are highly valued and the family’s child-rearing patterns are influenced by cultural beliefs. The home environment is not adequate for children’s needs to play due to the small space available for them.

24. Health Care Function

• The family believes that disease can attack anytime and trust that seeking healthcare services from the hospital can relieve them of the complications caused by diseases. The family does not have clear dietary patterns but strives to have three meals per day. Plans for shopping are developed by both parents. Parents sleep for about 5-6 hours per night. Both parents and children engage in sporting activities. The family maintains dental hygiene, no member consumes alcohol or cigarettes, and they all obtain yearly medical exams as preventative measures. Mr. Marks’ family has health insurance that caters for medical bills.

FAMILY STRESS, COPING, AND ADAPTATION

25. Short- and Long-Term Familial Stressors and Strengths

• Short-term stressor: Insufficient finances for child-rearing
• Long-term stressor: Ability of grandparents to stay healthy without developing chronic illnesses as time goes by.
• Major strength: Good jobs for Mr. Mark and his wife enable them to sustain the family today.

26. Extent of Family’s Ability to Respond, Based on Objective Appraisal of Stress-Producing Situations

• Mark joins his wife in tackling family stressors.

27. Coping Strategies Utilized (Present/past)

• The family relies on support from friends and families to cope with stressors.

28. Dysfunctional Adaptive Strategies Utilized (Present/past; extent of usage)

• and Mrs. Mark occasionally ignore issues presented to them by their children.

Conclusion

Friedman Family Assessment Model enables nurses to collect relevant data but a family regarding the identifying data, developmental stage and history of the family, environmental data, family structure, family function, as well as family stress, coping, and adaptation. From the Friedman Family assessment, it is evident there are a number of issues that are predisposing the lives of Mr. Mark’s family members to the risk of developing negative health outcomes. The nurse should identify interventions that target these issues to be able to effectively address family needs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Stanhope, M. & Lancaster, J. (2014). Foundations of nursing in the community, community-oriented practice. (4th ed.). Mosby/Elsevier.

Stanhope, M. & Lancaster, J. (2019). Public health nursing e-book: Population-centered health care in the community. 10^th ed. Elsevier Health Sciences.

Susanto, T., Arisandi, D., Kumakura, R., Oda, A., Koike, M., Tsuda, A., Kimura, R., Tabuchi, N., & Sugama, J. (2018). Development and testing of the family structure and family functions scale for parents providing adolescent reproductive health based on the Friedman Family Assessment Model. Journal of Nursing Measurement, 26(2):217-236. doi: 10.1891/1061-3749.26.2.217. Epub 2018 Aug 1. PMID: 30567941.

Walton, K. M., & Tiede, G. (2020). Brief report: Does “healthy” family functioning look different for families who have a child with autism?. Research in Autism Spectrum Disorders, 72, 10.1016/j.rasd.2020.101527. https://doi.org/10.1016/j.rasd.2020.101527