Family Assessment 23

Running Head: FAMILY ASSESSMENT 1

Family Assessment

Casey Schuler

Bemidji State University FAMILY ASSESSMENT 2

Family Description

The family discussed in this paper is a blended family. Included is a stepfather (SK), age

50, a mother (LS), age 48, and three children (TS, MS, LS), whose ages are 26, 21 and 18 respectively. The mother is the biological parent of all three children from a previous marriage which ended in divorce from alcoholism in her spouse. The spouse and biological father (GS) has a distant relationship with the children and does not live close. The stepfather also has a child from a previous marriage who was adopted by his uncle and aunt. SK’s previous wife (PK) and youngest child (JK) from that marriage are deceased after an automobile accident. The K family combined 8 years ago when SK and LS had met on an online dating site and fell in love.

The step father SK is a business owner who runs an automotive repair shop. He is the primary breadwinner for the family. The mother LK is retired from her previous job due to disability, but works part time for the public school system preparing food for the lunch programs at various schools. She also helps at the automotive shop doing customer service work when needed.

The children are all about 4 years apart and have only loose bonds due to the age differences. The oldest son TS no longer lives at home and works construction and is not married. The youngest has also moved away from the home due to indifferences with the step father. Her relationship with the family is somewhat strained and she does not live close by either. The middle child, MS has recently moved back into the home and has also just given birth to her first son JS. MS had no complications during the pregnancy. JS is a healthy child and is 6 months old. ED is the child’s father; he is helping to support the child but not living in the home.

In general, the family is described as more focused on their individual lives and careers than on family activities. LK states, “I would like to see us get together for family meals, but it is FAMILY ASSESSMENT 3 so difficult when everyone has their own thing going on”. SK stays busy with running the business and accounting as well as upkeep around their home, which consists of 20 acres in a rural area. TS jokes, “He really loves his yard.” He has been performing auto repair work for over 30 years and has made a good living from it. LK likes to spend time in the large family garden as well as managing the household duties like laundry and cleaning. LK keeps the family unit organized, as well as helping to care the newly arrived grandson in the home. She works part-time as a way to generate extra money for home repairs and spending money.

Extended family outside of the basic family unit is spread out across the state and visits with them are only a couple times a year. The strongest bonds are between the grandmother LK, the daughter MS, and the new grandchild relationship. MS works at a large online retailer as a customer support specialist. She is very busy taking care of her son. She is learning how to fulfill her new role as a young mother.

Family Assessment

The Calgary Family Assessment Model (CFAM) is a recognized template for nurses to use to help conceptualize and organize data gathered from working with families. It can be used to both compile data from a family assessment, but also may be useful when helping a family address a specific health issue. The CFAM can be seen as a branching diagram with three main categories: structural, developmental, and functional levels (Wright and Leahey 2009, Chapter

Structural Assessment

The structural assessment can be broken down into the internal structure which describes the relationship between the family members, the external structure of the family and its FAMILY ASSESSMENT 4 relationships with family and systems, and the context or environment in which the family functions (Wright and Leahey 2009, p. 49-50).

Internal Structure. The family composition of the nuclear family unit consists of a mother and father in a monogamous marriage with three children, one grandchild, two dogs and a cat. The father is the step-father of the three children and the relationship to them is mixed.

The father and mother act as the family’s head and decision makers.

Two of the children have moved from the home and are no longer supported by the stepfather and mother. The eldest daughter lives in the home and is currently dependent on the mother and father for direction and assistance in caring for and raising the newborn. The father of the newborn is not in a relationship with the biological mother. He also helps to care for the child through joint custody and financial support. The son is the oldest child and is active in his own life and career but assists the family regularly by helping maintain his family’s home and property or at the step father’s business. He is not married. The youngest daughter has distanced herself and maintains minimal contact with the family. She is said to be less accepting of the new marriage of her mother to her stepfather. She maintains a monogamous homosexual relationship with her partner.

Two dogs and a cat also live with the family. The dogs are large outdoor dogs which require little care and attention but consume large amounts of food on a monthly basis. It can at times be difficult to afford large quantities of food for them which is often afforded by the mother’s part-time earnings. The cat lives indoors and is approaching eleven years of age. There is a strong emotional attachment to the animals and they are considered family members in the household. FAMILY ASSESSMENT 5

The genogram below (Figure 1) provides a visual model of the family and the relationships to each other on a multi-generational spectrum. Dates of death are noted above the individual for those whom are deceased. The family unit of this assessment is contained within the green dotted boundary line.

Figure 1: Family genogram

External Assessment. Externally, the family assessment falls into two main subcategories. First, the extended family, which includes generations within the family, is reviewed. Second, the CFAM recognizes larger systems such as work relations, other families, and specific agencies such as welfare, courts, or service providers with direct involvement in the family’s function (Wright and Leahey 2009, p. 50-60). FAMILY ASSESSMENT 6

The maternal extended family includes five generations. They consist of the three generations within the nuclear unit, as well as a widowed great-grandmother and a widowed great-great-grandmother on the maternal side. There are some health concerns involved with maintaining independent living for the great-grandmother and assisted living for the great-great- grandmother. All of the third, forth, and fifth generations which includes many siblings and their kin are alive and no major health concerns are noted within the family’s line.

The mother LK’s previous marriage deteriorated from an alcoholic spouse, who is also the biological father of her three children. The relationship between the father and his children is distant. The biological mother and father do not get along well and he did not provide adequate financial support for the children. He lives many hours away and does not travel to see the children. The children do, however, maintain some contact with their fraternal grandmother. She is ninety years old, retired, and still maintains an independent lifestyle. Alcoholism is a noted condition in the biological father’s side of the family which also has affected several of his siblings.

The stepfather’s family is comprised of three generations. His mother, now 86, is still alive and lives alone. She struggles with mobility and has had both knees and both hips replaced from deteriorating joints. She no longer drives. During the interview, family members jokingly describe her as the “bionic woman.” She is widowed and requires assistance from all of her children for rides and certain tasks involving home maintenance. Her husband died at the age of

55 from heart disease. Of the children she conceived, the stepfather, SK is the youngest. His family was large with six older siblings. Three of the older siblings have passed away. The eldest child, a daughter, had passed away in her thirties. She developed mental retardation from FAMILY ASSESSMENT 7 rheumatic fever when she was young and lived in a nursing home for the remainder of her life.

Two of the older siblings passed away in their fifties from a heart attack and a motorcycle crash.

SK’s previous marriage ended as a result of a car crash which killed his wife and youngest child. The older child was adopted by an uncle and aunt after the accident when SK was unable to provide care for him. His biological son is now nineteen years old and lives independently. The relationship is described as shifted to more of an “uncle and nephew” type of interaction after the adoption.

The family often celebrates holidays with both the stepfather’s family and the mother’s family on two separate days. The families have only united for a few occasions such as marriages, graduations, and the birth of the grandchild JS. When they do have events together with both sides of the family present, everyone gets along great.

Because of the involvement in the family’s small business, several members of the shop’s staff also have close relationships and various interpersonal interactions with the family. The business functions to provide financial income for several staff members and their families. The wife’s part-time job has less influence on the family other than that of providing supplemental income. The North Dakota Department of Human Services Child Support Enforcement division is one service the family utilizes for child support of the three children from the biological father.

The local hospital has also been involved with the pregnancy, birth and welfare of the newborn grandchild and his mother. FAMILY ASSESSMENT 8

Figure 2: Ecomap

Contextual Assessment. The context of a family is described as the “whole situation or background relevant to some event or personality.” This might include elements of race, ethnicity, social class, spirituality, and environmental factors (Wright and Leahey 2009, p. 62-

The family is a middle class family of Caucasian American decent. German and

Norwegian lines of heritage are prevalent among all family lines along with some Swedish and

Danish as well. The family Christian with several denominations which include Catholicism on the stepfather’s side and Lutheranism on the mother’s side. They do not attend church regularly but all children have been baptized and confirmed. The children attended a private Christian school for primary and secondary education. FAMILY ASSESSMENT 9

The male members of the family, SK and the oldest son TS have attended a post- secondary educational school for technical training such as an automotive technology or architectural technology and design degrees. None of the family members have attended a 4-year institution within the primary family unit, although, several members of the extended family have completed undergraduate and graduate programs. All members, with exception to the newborn, have graduated with a high school diploma.

All living generations are native to the United States. Culturally, most traditions include those of the typical American Christian such as Christmas, Thanksgiving, and Easter celebrations. The children have been raised with “traditional Lutheran standards and values”, LK says.

As owning and operating a business is the primary source of income for the family, some instability in income occur from variations in the amount of business the automotive shop generates. SK says the winter months are the strongest months, but it costs a lot of money to heat the shop at the same time. The family does, however, remain flexible with additional income generated LK’s part-time salary. The business was purchased six years ago from the previous owner for whom SK had originally managed operations and worked as the master mechanic. The business has seen some growth over the last six years. The business is stable and the family predicts continued growth in the future. The business also serves as the primary source for retirement savings for SK and LK. TS, the eldest son states, “I don’t think I would ever take over the business when my stepdad retires, it’s just not my thing.”

Developmental Assessment

Much like Erik Erikson theorized on the stages of psychosocial development individuals progress through, the CFAM similarly asserts that families also progress through certain stages FAMILY ASSESSMENT 10 of development (Crain, 2011 and Wright & Leahey, 2009). The CFAM uses Mcgoldrick &

Carter’s model of the six stages of the family life cycle (Mcgoldrick & Carter, 1999, p. 2). These stages are:

1. Leaving home: single young adults.

2. The joining of families through marriage: the new couple.

3. Families with young children.

4. Families with adolescents.

5. Launching children and moving on.

6. Families in later life.

Each of these stages are “delineated”, CFAM points out, and “expansion, contraction and realignment” of these stages as members of the family “enter, exit, and develop” is to be expected (Wright & Leahey, 2009, p. 90).

Stage of Development. Eight years ago when SK and LK met, the second stage of family development was begun. The couple began the Joining of Families through Marriage.

Developmentally, Mcgoldrick & Carter (1999) note that the family must make a “commitment to a new system”. This includes the formation of the marrital system and the “realignment of relationships with extended family and friends to include the spouse”. In the same regard, the development also includes the children from previous relationships. Mcgoldrick & Carter (1999) indicate that the remairried family formation has several additional and unique steps in development in addition to simply joining in marriage: FAMILY ASSESSMENT 11

1. Entering the relationship: recovery from loss of prior marriages and recommiting to

marriage to form a family

2. Conceptualizing and planing the new family: accepting fears and patience in

adjusting to new roles, boundaries, andaffective issues.

3. Remarriage and reconstrction: resolution of previous spouces and acepting a new

family model with flexible boundaries.

The family simultainiosly entered into the fourth and fifth stages once the commitment to a new system had been made. The children of this now blended family were 10, 14, and 18 years of age when SK and LS wed. The family at that time was a Family with Adolescents as well as

Launching Children, who as the eldest son was preparing to go to college his senior year of high school. According to the emotional process of transition described by Mcgoldrick & Carter

(1999), the family must increase flexability of family boundaries to include childrens independence as well as accept a multitude of entries and exits as launching children begin to reduce dependence on the family unit.

Now that the children have grown and the youngest child was out of the home at age eighteen, the family has progressed from a Family with Adolescents to solely Launching

Children. SK, the stepfather, is quoted as often stating, “I had them all out of the house for six whole months”, says TS, refering to their middle child moving back in after she had found out she was going to have a baby.

The creation of the new family of the daughter MS has also entered into a Family With

Young Children where, deveopmentaly, Mcgoldrick and Carter (1999) say they are “accepting a new member into the system”. This includes adjusting and making space for a new child as well FAMILY ASSESSMENT 12 as financial planing. The grandparents and parents are also realigning their relationships to include new roles and responsibilities (Mcgoldrick & Carter, 1999).

The following diagram (Figure 3) illistrates the families current relationships between each indicating the level of closeness.The legend provided decribes the levels of attachment between each member of the family as decribed in the assessment.

Figure 3: Family Attachments.

Functional Assessment

The functional assessment portion of the CFAM describes the family’s current interactions with each other and how they perform as a unit. It is also described as the “here and now” portion of the assessment that includes two basic aspects of functioning: instrumental and expressive (Wright & Leahey, 2009, pp. 116-117). FAMILY ASSESSMENT 13

Instrumental functioning. Crucial interactions amongst the family make up the instrumental functioning portion of the assessment. These include basic and routine activities of daily living such as preparing meals, house care, laundry, caring for children, and other unique activities that comprise a family’s function. These are the interactions that define the family.

Tasks or roles may change due to events and challenges that the family faces or specific family members. Assessing the family’s instrumental functioning can reveal details about the families specific functioning during events such as illnesses. It is also effective in revealing the resiliencies that the family may have as well (Wright & Leahey, 2009, pp. 116-117).

In the CFAM, Wright & Leahey (2009) suggest assessing the family across the six stages of health and illness. These inclide the family efforts at (1) health promotion, (2) family appraisal of symptoms, (3) care seeking, (4) referal and obtaining care, (5) acute response to illness by client and family, and (6) adaptation to illness and recovery (Friedman, Bowden, & Jones, 2003).

The family is currently most involved in the efforts of health promotion and LK states she, “takes on most of the responsibility”. She reminds family members of things like check-ups and dental visits and coordinates care for the family as it is needed. LK also monitors the family’s health issues and everyone in the family turns to her with questions and for guidence.

The daughter MS relied on her mother for support and guidance during her first pregnancy as well as help now with the newborn in the home. As the grandparent, LK is active in making sure MS is able to care for her child as a new mother. Having three children of her own,

LK is a good role model for her daughter MS.

LK used work as a government employee but was placed on disability leave after being diagnosed with a benign brain tumor in 2006. This was diagnosed after she had two seizures.

While she was recovering from surgury, the family was able to effectively cover her rolesin the FAMILY ASSESSMENT 14 home as well as adapt as she entered into the recovery stage. The family has also taken steps to advance SK’s career and income through the purchace of the auto shop to make up for the lost income of LK’s original salary. The family tells me that they feel they are very close to the level of fuctioning they had before the surguries. LK says this, “It’s just one of those things that hit you and there is no choice in the matter so you just have to deal with it.” She also notes that her family was “very supportive” during her recovery.

Expressive Functioning. CFAM assesses expressive functioning with nine categories of communication: (1) emotional, (2) verbal, (3) non-verbal, (4) circular communication, (5) problem solving, (6) roles, (7) influence and power, (8) beliefs and (9) alliances and coalitions. If there are barriers in coping with any instrumental issue, communication barriers will also arise.

On the other hand, Wright and Leahey add that even families with no instrumental difficulties, they may still experience a breakdown in communication and expression (Wright & Leahey,

2009, p. 117).

Emotional Communication. The family does not discuss their emotions often amongst themselves but were able, for the purpose of this assessment, able to discuss emotions that they experience between each other. TS and LK explain that they do not usually get too upset with each other. TS notes that when he and his sisters were younger there was some sibling hostility but it isn’t so bad now that they are older and, “everyone can be civil”.

Verbal Communication. Direct verbal communication generally is understood between family members. SK, the stepfather, tends to be sarcastic at times and can’t always be taken seriously. LK is said to have indirect verbal messages at times when she is annoyed but it is always understood. With kids moving away from home, they use texting on a regular basis.

Actual phone calls are less often. FAMILY ASSESSMENT 15

Nonverbal Communication. The family has various non-verbal traits and cues. The interviewees, LK and TS both made good eye contact. LK often touched TS on the shoulder when she was telling stories about him. TS tended to use his hands when he spoke. He sat comfortably, partially slouched down in a large chair. LK would often look to TS for affirmation when she was unsure of details and TS would continue her story. LK tended to do most of the narrating.

Circular Communication. There seemed to be some patterns of arguments that occur from circular communication but overall, communication is strong. Often, LK states that she has to confront SK with issues or bills and he might get irritated and avoid her and the issue, but he eventually takes care of the issue. The following diagram (Figure 2) describes this circular communication between the couple.

Figure 2. Circular communication diagram. FAMILY ASSESSMENT 16

Problem Solving. The family denies any issues with problem solving. Usually, the family uses a team approach and discusses issues amongst everyone in the family. There are disagreements from time to time but debates rarely get heated.

Roles. Roles within the family are well defined. The primary financial decision maker is

LK, even though SK is the primary source for income in the family. She generally makes the decisions related to projects and major purchases that the family makes, where as SK makes the decisions for his automotive business. The role of parent is also primarily LK, as SK provides more of a role model type lead in children’s lives rather than parent. TS, the oldest sibling is also a role model to his two younger sisters.

Influence and Power. SK does hold final say over all decisions in the household but he is generally passive on most issues, says LK, “We all get along pretty well.”

Beliefs. The family lives by Christian values and bases their decisions of strong moral values. They agree that they should all try to treat others as they would like to be treated.

Alliances and Coalitions. While everyone gets along, it appears as though the siblings are not extremely close and do not visit with each other independently. Rather, they gather as a family together with the parents. Most alliances revolve around friends outside of the family.

Strength/Problems List

Table 1. Strength / Problem List

Subsystem Strengths Problems

Marital-  Parents are aware of children’s independence  Trouble with coping with Parental as adults but are understanding of failures and SK’s role as new head of provide encouragement. household among youngest FAMILY ASSESSMENT 17

Subsystem  Roles are considered equally important and child LS. are well established.  SK stays busy with running  Tasks are performed based upon talents and the business and does not strengths. have much time for family affairs.

Parent-Child  All children are equally valued within the  Son is given more Subsystem home. independence that the daughters as a male child.  Grand-parents are actively involved in raising the grandchild JS  “The youngest always got the most attention.”

Sibling  All children get along.  Large age differences in the Subsystem siblings affect relationships.  TS serves as a role model for his younger sisters.

Individual  SK enjoys running his business and  SK stays busy running his Systems supporting the family. business and it is stressful at times.  LK enjoys her part-time job as well as coordinator for the family.  MS is stressed with birth of new child in a non-married  TS has gained independence from his parents setting. and has successfully launched from the home.

Family Summary

The K family is a structurally diverse, blended family which is the product of two past marriages. The children belong to the mother biologically. The older siblings get along with the stepfather but the youngest does not. They have several new sub-families that branch off from the main unit as children have grown into young adults and are now launching from the home.

The eldest daughter has recently begun a family of her own but still lives in the home. The grand child’s father is welcome in the home and provides support in raising the child. FAMILY ASSESSMENT 18

Individuals effectively perform their roles within the family boundaries and the family continues to thrive. The Stepfather SK is the primary wage earner for the household by running his business and LK provides her support in managing the home and day to day issues. They are flexible and adapt to change effectively as demonstrated by their ability to cope with LK’s diagnosis and recovery from a brain tumor in 2006.

Assessment Summary

The family is a growing family of five with one child now bearing a child of her own.

They are a non-traditional, blended family. They are all Caucasian of American descent and practice Christianity of the Lutheran denomination. The father’s previous marriage ended when that wife and youngest child were killed in an automobile accident. The mother’s previous marriage ended in divorce due to alcoholism in her previous spouse. The mother is the biological parent of all three children and the stepfather’s remaining child has been raised by this brother and his wife. They live in a rural area and enjoy the quiet country life at home.

The father owns his own automotive repair business and in heavily involved in running the business. He works six days a week managing the operation and works late some nights totaling sales for the day and working on payroll. The business generates the primary income for the family to pay for their mortgage and utilities. The mother is disabled and works part-time serving food for the public school system. She uses the money for home repairs and groceries.

The parents help each other where they can and are actively involved with one another’s lives.

The mother is the primary parental figure and the stepfather acts as a positive role model for the children more than as a parental figure.

The mother was diagnosed with a benign brain tumor six years ago after experiencing two seizures. This was a vulnerable time for the family who is otherwise free from any serious FAMILY ASSESSMENT 19 health problems. She was forced to retire from her employment position as well as her role as contributing financial provider. The family was very supportive in her rehabilitation. The stepfather has since expanded his career to better support the family and relieve stresses for his wife. Since having the tumor removed, she has made a strong recovery and has been able to resume her role as the primary parental figure and has also resumed part-time employment to support the family with supplemental income.

There are two daughters and an older son, ages 19, 22 and 26 respectively. They get along but do not generally maintain a close friendship due to differences in age. Two of the children have moved out from the home and have successfully launched; they support themselves financially.

The 22 year old daughter has moved back into the home six months after learning she was pregnant. She has now had that child and is busy caring for the infant. She plans to continue to raise the child in the grandparents home until she is financially and emotionally able to function as a single parent in her own home. The child is shared jointly with the biological father and he maintains a positive relationship with the mother and her family.

This family spends most holidays together. The family generally is in agreement with each other except for the youngest daughter who did not cope will with her parents new marriage. She does not get along with the stepfather well but does, however, make it to most holiday meals.

The family is generally healthy with no chronic illnesses. The mother has taken steps to lose weight and shows a positive example to the children to eat healthy and exercise. Most meals while the children were in the house were home cooked. The parents have always tried to urge FAMILY ASSESSMENT 20 their children not to eat too much fast food or unhealthy meals. They are aware of many health maintenance issues such as smoking. The mother reports quitting smoking eight years ago for her children but the stepfather still smokes. This is a concern for the mother who recognizes that her spouse, the stepfather, has lost his father and one brother to heart disease when they were both in their mid-fifties. Neither parent drinks alcohol regularly and the children, all in early adulthood seem to use alcohol responsibly most of the time.

Family Nursing Diagnoses and Intervention

The Calgary Family Intervention Model (CFIM) is a complementary companion to the

Calgary Family Assessment Model. The CFIM examines interventions for family functioning across three domains: cognitive, affective and behavioral. Wright & Leahey (2009) expalin that

“interventions can be designed to promote, improve, or sustain family functioning in any or all three domains, but a change in one area can affect the other domains.” They further assert that interventions can only be offered to the family, but “should not instruct, direct, demand, or insist” on a particular change or way of functioning. A families openness to intervention will greatly be determined by thier historical functioning (Wright & Leahey, 2009, p. 144).

Diagnosis.

The first and most important diagnosis directly relates to the families health promotion.

The wife demonstrates a readiness for enhanced knowledge: smoking cessation related to interest in improving health as evidenced by verbalized statements of interest in smoking cessation programs for her husband.

Second, I recognized ineffective health maintenance related to denial of the effects of smoking as evidenced by continued smoking of one pack per day by the stepfather. FAMILY ASSESSMENT 21

Lastly, there was apparent ineffective family communication related to discord between stepfather and stepdaughter as evidenced by strained family relationships.

Intervention.

For the first diagnosis, LK demonstrated readiness for enhanced knowledge with helping her husband with smoking cessation. Interventions for this diagnosis include sharing with her websites where she can access information related to smoking and smoking cessation.

The Centers for Disease Control and Prevention website contains a great fact sheet which details information about nicotine dependence, the health benefits of cessation, methods to help users quit, as well as a list of helpful resources for the family to use.

The second diagnosis also related closely with the first diagnosis. Ineffective health maintenance is observed due to the stepfather’s continued smoking and inability to permanently quit. The CDC website is also useful for providing information about this to the stepfather.

Because the stepfather was not present during the interview, it was not possible to assess his readiness to accept tobacco cessation information. By providing the family with informational resources, they can learn and discuss matters as they see fit without pressure to accept the information immediately.

Due to discord between the stepfather and youngest step daughter, I was interested in providing the family with information aimed at improving the ineffective family communication.

Interventions I provided included directing them to The National Stepfamily Resource

Center website. The resource center is a dedicated program that can link families to support groups as well as provide information backed by research, as well as helpful links for further informational resources. FAMILY ASSESSMENT 22

I also encouraged the family to be open with each other. I noted a lack of emotional openness between the individuals which can possibly create barriers to understanding each other’s feelings.

Circular Questioning

Wright & Leahey (2009) deferentiate between two types of questions used in assessment to help investigate problems. First, linear questions are used to investigate a problem. Linear questions are often used to begin an assessment and gather information. Circular questioning is then used to explore topics and promote conversation. Circular questions are meant to effect change (Wright & Leahey, 2009, p. 146).

Circular questioning was used to begin dialog about the family issue about the new grandchild in the family. The discussion was directed toward the older brother TS.

Q: [Me] “Were you excited to become an uncle?

A: [TS] “Honestly, I wasn’t. I didn’t really know what to expect.”

Q: [Me] “What were some of your concerns with becoming an uncle?”

A: [TS] “I’m not very experienced with children. I didn’t even know how to hold him when he was born.”

Q: [Me] “Do you feel more comfortable with him now?”

A: [TS] “Definitely. It came pretty quickly.”

Q: [Me] “How do you think you sister (MS) is doing as a single parent?”

A: [TS] “I think she is doing just fine. Our mother has been a great role model for her and she is always there to help answer her questions.” FAMILY ASSESSMENT 23

Desired Outcomes

As this family is already a healthy functioning family, the desired outcomes would be to continue the promotion of health maintenance and effective functioning to support family relationships. Diagnoses made for this family aim to improve function and aim to promote further health prevention as well as to improve the communication between members of this blended stepfamily. This family has demonstrated resiliency and flexibility with issues and external events and efforts were made to further strengthen these abilities.

Family Health Resource List

The National Stepfamily Resource Center and Centers for Disease Control and Prevention websites were used as tools to provide knowledge and resources to the family as a means of promoting optimum family functioning.

 http://www.stepfamilies.info

 http://www.cdc.gov/tobacco/osh/index.htm

GenoPro® 2011 software was used for the creation of diagrams and illustrations to conceptualize data gathered during the family assessment. FAMILY ASSESSMENT 24

References Crain, W. (2011). Theories of Development: Concepts and Applications (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc.

Friedman, M. R., Bowden, V. R., & Jones, E. (2003). Family Nursing: Research, Theory, and Practice (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Mcgoldrick, M., & Carter, B. (1999). The Expanded Family Life Cycle: Individual, Family, and Social Perspectives (3rd ed.). Boston, MA: Allyn and Bacon.

Wright, L. M., & Leahey, M. (2009). Nurse and Families: A Guide to Family Assessment and Intervention (5th ed.). Philadelphia, PA: F. A. Davis Company.