Doing a family assessment

It is vital to take time to assess the family’s structure and style in order to formulate an effective teaching plan. Getting to know your patient’s family and the role they will play in health care management will save a great deal of time in the long run. Treatment plans developed without input from the patient and family are often doomed to failure. As a result, the health care team spends valuable additional time going back to assess the family and often learn about strengths and barriers that were present all along. Both the patient and family members need to tell their story about the illness and the impact it is having on their lives. Try to give them time to share their perceptions about the problems the illness is causing. By taking time to listen to the patient and his family, you are building the trusting relationship that is the basis of patient and family teaching.

A good family assessment requires astute observation skills and the ability to be an active listener. Assessment data can be obtained anytime health care professionals interact with patients and families. Gathering information about family structure, function, and needs does not have to be restricted to structured interviews. Anytime the family is present; you can obtain more information about the family and their role in the patient’s health care management. Informal conversations with the patient and family while you are passing medications, adjusting an intravenous rate, or giving a tube feeding can yield data that will help you complete the family picture. Table 9 shows areas of family assessment that are important to know. Learning the answers to these questions will help you immensely in developing an effective teaching-learning partnership with the patient and his or her family.

Table 9

Areas of Family Assessment

What is the family like?

Who is considered part of the family?
What is the patient’s position and role in the family?
Who has most influence on the patient?
What are the ages and sex of the family members?
What are their occupations?
What is the health status of family members?
Are there physical limitations that would affect a family member’s ability to help with care needs?

What resources are available to the family?

Can the family provide for the patient’s physical needs?
What is the patient’s home like? Does it provide sufficient safety and comfort features?
What is the patient’s ability to perform self-care?
What are the health insurance resources?
What neighborhood or community resources are available?
What connections does the family have with friends, neighbors, church, community organizations?

What are the family’s educational background, lifestyle, and beliefs?

What is the level of education of the family members and their attitudes toward learning?
Do all family members have basic literacy skills?
Are there language barriers to verbal communication?
What is the family’s lifestyle and cultural background?
Does the family have any folk medicine beliefs?
Are there potential conflicts between cultural beliefs and the recommendations of health professionals?
What are the family’s normal dietary patterns?
Does the family seem to be able to take in new information easily and apply what was taught?
Does the family seem overwhelmed as a result of the need to learn new skills?

How does the family seem to function?

Do family members seem to be sensitive to the patient and to each other?
Do family members appear to be able to communicate effectively with each other?
Does the family indicate that they have the ability to accept help from others when it is needed?
How open does the family seem to teaching?
Do key family members have the ability to make effective decisions?
What experience does the family have in handling crisis situations?
How did the family react to crises in the past and what resources did they use to help them?

What is the family’s understanding of the current health care problem?

What do they think has caused the health care problem?
Why do they think the problem occurred now?
What do they think the illness does to the patient?
How severe do they believe the illness is?
What kind of treatment do they think the patient should receive?
What are the most important results they think the patient should obtain from the treatment?
What are the major problems the illness has caused for the family?
What do they fear most about the situation?

What are the patient and family’s teaching needs?

What do the patient and family think are the most important things they need to know?
Do the patient and family know others with the same health care problem?
Do the patient and family understand and agree with the treatment plan?
Are there any physical or cognitive limitations that will be barriers to learning?
Are the patient and family willing to negotiate goals with the health care team?
Are the patient’s perceptions about what to do similar to the family’s point of view?

Source: Rankin, S.H., & Stallings, K.D. (1996). Patient Education: Issues, Principles, Practices, 3rd ed. Philadelphia: Lippincott-Raven, 128-129.

Strategies for teaching family members