Reflective Report: Patient Selection and Assessment in Family Nursing

This report reflects on a family nursing assignment, where the author analyzes patient scenarios and makes decisions on patient selection. The author discusses the decision-making process, considering factors such as geriatric depression, adolescent depression, and child abuse. The report outlines the assessment and health promotion strategies that would be implemented for selected patients, including interventions for mental health support and trauma-focused psychotherapy. The author also explains why certain patients were not selected, based on factors like lack of parental consent, polysubstance abuse, and marital conflict. The report applies Peplau's theory of interpersonal relations to the selected cases and Orlando's nursing process discipline theory to the unselected cases, highlighting the importance of understanding patient needs and behaviors.

Introduction
Family nursing is the art and science
of nursing that has developed over the
years and encompasses the nursing
aspect of delivering care services that
are focused on a family, which
functions in the form of a unit
(Deatrick, 2017). In this reflective
assignment, I shall discuss about three
patient scenarios that I would or would
not select in my practice.
Patient scenarios to select
If I were given the chance to select
patient assignments from the list, I
would have selected the cases of (i)
Bernetta Bold, (ii) Dixie Cup, and (iii)
Ian Harris. While the first case study
revolves around isolation in a
septuagenarian widow, following the
death of her husband, the second case
is related to an adolescent who had
been admitted to the psychiatric unit
for depression management. This girl
reportedly became more upset after
being visited by her parents. The third
case is related to a 10 year old boy who
disclosed about being subjected to
abuse.
My decision making process has
been influenced by the fact that while
the first two are related to poor mental
health, the third case of child abuse
generally leads to the onset of
childhood trauma that often triggers a
plethora of psychiatric problems. There
does not occur any health without
mental health (Crowe, Averett, Avent
Harris, Crumb & Littlewood, 2019). My
theoretical knowledge has helped me
realize that in order to attain optimal
health, it is imperative for all people to
accomplish mental, physical and social
wellbeing. I selected the
aforementioned three case studies
since poor mental health creates an
influence on the pattern in which
people feel, act and think.

Bernetta Bold was suffering from
geriatric depression due to the death of
her husband. Spousal bereavement
has been identified as a major aspect of
life stress that commonly makes the
older adults vulnerable to problems
that appear at a later stage in their life
like chronic stress, depression, and
decreased life expectancy (Lee, Lee,
Chun & Park, 2017). Concerning the
second case scenario of Dixie, it was
assumed that depression symptoms in
the teenager manifested in different
manner due to development of bodies,
peer pressure, lack of understanding
parents and change in her hormone
levels, which in turn result in her social
isolation and created an impact on her
personal, social, family, and school life
(Stapley, Target & Midgley, 2017). Ian
might have encountered the Cinderella
effect, the phenomenon where different
kinds of child with treatment and abuse
are committed by step parents, due to
prejudice towards close relative, and
the disagreement between
reproductive partners of devoting their
time to care for an adolescent, who is
an related to one partner (Cabezas,
2016).
Family nursing assessment will
comprise of four components that are
listening to the family members,
engaging then participatory dialogue,
identifying patterns and advocating a
positive change and action. In the first
place, Betty’s children and Dixie’s
parents will be invited for a discussion
where they will be inquired about
reviews about the client, their
willingness to provide assistance, and
decisions about staying together. The
Geriatric depression scale and Hamilton
depression scale and will be used in
both cases, respectively (Durmaz,
Soysal, Ellidokuz & Isik, 2018; Kyle et
al., 2016). A focused depression
assessment will also be conducted in

presence of the family members, where
the number of symptoms, their
frequency, onset, and duration will be
noticed. Nursing assessment will also
involve obtaining and reviewing the
medical, psychological, and
physiological history of the family,
following which both the clients shall be
assessed for associated metabolic and
systematic processes. Family health
promotion will involve increasing social
support by identifying the underlying
reasons behind depression (Von
Cheong, Sinnott, Dahly & Kearney,
2017). The family members of both
Bernetta and Dixie will be asked to
spend adequate time with them. Efforts
will be taken to monitor and promote
physical comfort and nutrition, while
eliminating any inappropriate sleep
patterns. Not only will their strengths
and capabilities be identified and
reinforced with the help of family, but
the latter will also be encouraged to
provide her emotional support through
supportive listening, display of
empathy, hope installation and
pleasant reminiscences. The clients
shall be provided assistant in order to
enhance their emotional and physical
functioning through recreational
therapy (McCormick, Austin & FDRT,
2018). They will also be administered
antidepressant medications, following
the prescription of the physicians. For
the third case, a parenting or family
functioning assessment shall be
conducted to recognize the needs and
strengths of Ian’s family. While Ian will
be assessed for his wellbeing, school
readiness, development, mental health,
and trauma, the parental health,
parental substance use behavior, family
functioning, family history and
parenting skills and competencies shall
also be checked. On identifying the risk
factors, the first priority will be to
ensure his safety and appropriate

medical care will be asked for, if Ian
displays signs of injury or
consciousness alteration. He will also
be subjected to trauma-focused
psychotherapy, while his parents will be
asked to participate in child-parent
psychotherapy programs (Itzin, 2018).
If required, help will also be taken from
child abuse national help lines.
Patient scenarios to not select
If given an option, I would not have
selected the patients Charlie Heron,
Ernie Erbach, and Gary Greenwich.
While the first case involves acute
respiratory distress in a child, the
following cases are associated with
polysubstance abuse and separated
parents, respectively. The decision
making process was influenced by the
fact that a drop in the oxygen levels
compromises other organs and would
require consent of parents for keeping
the child in ventilator for facilitating
breathing (Zeng et al., 2019). Since
the parents were not present, it would
have become difficult to obtain their
consent. The second case involved
polysubstance abuse and was not
selected since in order to treat such
patients it is expected that the former
should inform about every drugs and
medications that they are consuming,
while confirming that none of them
interact negatively with one another.
The third case was not selected since
although there were no apparent signs
of poor physical or mental health. In the
case of Charlie, it was assumed that the
grandparents might not be able to get
a sound understanding of the
treatment. For Ernie, it was anticipated
that different issues associated to
polysubstance abuse might have
altered the physical as well as cognitive
functioning and he might not be in a
sound state to clearly comprehend the
clarifications provided to his health
related concerns. Assumption in the

third case was that there might have
been a marital conflict that resulted in
separation of the parents.
Paediatric respiratory distress
assessment would involve
implementation of the ABCD approach
that focuses on airway, breathing,
circulation, and disability (Khemani et
al., 2019). The assessment would also
encompass listening for wheezing
signs, while looking for accessory
muscle usage, tracheal tug, and nasal
flaring. The family history would also be
thoroughly checked to identify any
respiratory illness. Health promotion
would include educating the
grandparents on the need for oxygen
therapy and ventilators (Zeng et al.,
2019). Heart monitoring, chest X-ray,
and blood test would have to be
performed, apart from Fowler
positioning and administering artificial
surfactant. Ernie would be assessed
using the DSM-V diagnostic criteria and
checking his prescription charts. His
close associates would be interviewed
to gain a sound understanding about
onset of polysubstance abuse,
frequency, dosage, behaviour changes,
and underlying factors. Health
promotion would involve continuous
supervision for vital signs and
administered medications for
counteracting particular withdrawal
symptoms and mood fluctuations. His
family members and friends would be
encouraged to modify his substance
abuse behaviour by providing
emotional support and continuous
medical monitoring. The patient would
also be subjected to cognitive
behavioural therapy that would help in
modifying his thoughts and changing
his behaviour (Wu, Schoenfelder &
Hsiao, 2016). For the third case, both
Gary and his wife shall be asked to
participate in interview sessions to
understand the reason behind their

separation, their strengths weaknesses,
and emotional state. Health promotion
would include cognitive behavioural
therapy (CBT) and emotive behaviour
therapy (REBT) for resolving marital
conflict, since emotions form the core
of numerous marital problems
(Rostami, Karimisani, Fathi & Karimi,
2019).
The three selected case studies were
guided by Peplau’s theory of
interpersonal relations. The four
components of the theory are person,
environment, health, and nursing.
Principles related to human relations
must always be implemented to
problems that are faced by patients
and this theory focuses on nursing
being a therapeutic process, such that
it is a healing art (Fernandes & Naidu,
2017). The attainment of goal through
this theory is accomplished with the
usage of a series of steps, following a
definite pattern of orientation,
identification, exploitation, and
resolution. The theory also elaborates
that nurses have six major roles of a
teacher, stranger, counsellor, resource
person, leader, and surrogate. Hence,
an environment must be created for all
patients that build trust, following
which knowledge must be imparted,
while providing encouragement and
guidance to make changes.
The three cases that would not have
been taken were guided by
Orlando’s nursing process discipline
theory. It highlights that the major role
of a nurse is to explore and address the
immediate needs of a
patient. However, the care that a
patient requires might not be what it
seems. Therefore, nurses are expected
to use their own thoughts, perceptions,
and feelings for exploring the
underlying meanings of patient
behaviour, which in turn helps in
finding out the kind of distress the

patient is in, following which
appropriate care can be delivered
(Alligood, 2017). Consequently, the
major aspects of the theory encompass
presenting behaviour, professional
nursing, immediate reaction and health
improvement.
Conclusion
Hence, the reflection helped me
explore my beliefs and values
connected to family nursing and health
promotion and the impact they created
on my professional judgment and
decision-making processes.
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