FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN Introduction George (60) and Linda (55) H.

are considered as a modern middle class family with two daughters Emma (22) and Jane (26). The family was interviewed and examined by the clinician Amber Lee, M.D. The family originates from Germany, and they lived in diaspora area in the USA for around 23 years. Thus, they describe themselves as bicultural and English speaking. George (60) was born in Germany and is retired. He suffers from Alzheimers disease and has his health state worsening. Linda (55) is working as a teacher of German language in local school. She suffered from heart attack at the age of 48 when her husband was diagnosed with Alzheimers disease. She undergoes regular cardio examination. George and Linda are married for 34 years. Emma (22) is studying at the university, and has no problems with the health. She does not live with the parents already. Jane (26) has graduated from the university and received the bachelor degree in engineering. She rather often suffers from depression because of parents health and because she cannot find job. She lives in the same house as her parents. Three generational genogram of the family Thus, it is worth paying attention to pedigree of the family, since it is considered to be as some comprehension of the generation. Moreover, using this system it is possible to conduct genetic investigations in order to find out which illnesses were inherited and which were earned during the life span. According to Galindo (2006), in order to find these details out, it is worth forming of the genogram, which is the graphical representation of the family. Graphical scheme may be ascendant (from ancestors to descendants) or vice versa descending (from descendants to ancestors). For the H. family it was decided to form the ascending genogram for three generations.

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Therefore, it is worth mentioning that genogram is recognized as one of the methods of the family psychotherapy, which uses graphical representation of the information about the family itself. Referring to McGoldrick (2008), this method was offered by Murray Bowen in 1978 and it still serves for conducting of analysis of the family history from the point of system theory. The basis for this method is recognized in assumption that families copy and reproduce themselves. This concept provides explanation for coincidence of the life situations that are repeated in several generations. It also explains main patterns of relationships with other people and patterns of emotional reactions towards different situations, and describes family myths and rules. According to Thomlison (2009), genogram is recognized as effective diagnostic, analytic and therapeutic means, since it might help specialist find solutions to a range of problematic cases, as investigation of the problem and its reasons for appearance, formulation of hypothesis concerning existent problems, planning of the therapy and its outcomes. Method of genogram is indispensable for description of multiple relationships in complex

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN systems, such as family or generation. It is also successfully implemented in the work with individual clients, pairs and families. Hence, it is possible to investigate family diseases and find out certain tendencies of particular family members towards different pathologies. In this case scheme provides diagnosed diseases and malfunctions of the family members. Such information might be vitally needed in certain cases. For example, in the H. family genogram there is vivid presence of systematic pathologies concerning Alzheimers disease in the male representatives from the fathers side, which may signify the tendency of male representatives to suffer from this illness. There is also evidence that female representatives are more likely to suffer from cardiovascular disease. Moreover, the index person, who is Linda (55), is also observed in this interdependence, since from her antecedents there is a clear line of cardiovascular diseases probability which is accompanied with the cancer possibility for females. Taking into account these details, it is possible to assume the probable health tendencies for the next generations. This issue would also make family members prepared for this probability and be acknowledged about the ways of treatment. Usefulness of such gathering of information is vivid. Taking all the different details about the family members and placing them into one scheme is the first step of analysis, which can reveal critical issues and provide possible methods for their solution and elimination for the future generations. General Family System Stressors Family Member/Age George/60 years old General Stressor Score 2,21 General Stressors/Analysis 1 Health state/Illness (Alzheimers disease); 2 Financial status/Unemployment; 3 Marital status/Serious spousal

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN arguments Linda/55 years old 3,76 1 - Health state/Illness (heart attack, depression, anxiety) and concerns with husbands and daughters health; 2 - Financial status/Low income; 3 - Marital status/Serious spousal arguments; 4 Family state/Misunderstandings with children Emma/22 years old 1,98 1 - Health state/Illness (concerns with fathers, mothers, and sisters health); 2 Tiredness at university; 3 Financial status Jane/26 years old 2,12 1 - Health state/Illness (concerns with fathers and mothers health); 3 Financial status/Unemployment; 4- Social status/Depression Amber Lee/clinician 2,01 Taking into account these details, the index person with the highest influence of the stressor is Linda (55), since she has the highest stressors score and minds more points of stressors. stressors following: Thus, issues the core general the

deal

with

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN 1- Health state; 2- Financial status; 3- Family state (spousal relations and relationship with children). Therefore, each family member is influenced by the health state of the father and more or less by the health state of other three family members. According to the stressors scores, established for Linda, she suffers more than others in the family as far as she keeps in mind all three elements of health state problems relating not only to fathers/husbands health state

(Alzheimers disease), but also Janes health state (depression), Emmas state (tiredness), (cardiovascular and system her own

problems).

Moreover, she is the only member of the family who earns money for living; therefore, she is also recognized as the one put under stress circumstances by working for the whole family.

Additionally, stress level is also vivid in terms of family status problems,

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN since there were found evident serious cases of misunderstanding with the spouse as well as with children. Specific Family System Stressors Family Member/Age George/60 years old Specific Stressor Score 3,5 Comments/Analysis His health state/Georges suffering from Alzheimers disease with

permanent worsening of his health state has large impact on the family in psychological way Linda/55 years old 4,6 Health state of husband/Worsening condition of husbands health impacts psychological state and physiological one, leading to need to regular examinations of cardiovascular

system, associated with probability of repeating heart attack because of stress; Health state of daughter/Depression of daughter leads to psychological state and physiological health problems and need for regular examinations of cardiovascular system Emma/22 years old 2,1 Health state of father/Worsening

condition of fathers health impacts

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN physiological depressions Jane/26 years old 2,6 Health state of father/Worsening state and leads to

condition of fathers health impacts physiological depressions Amber Lee/clinician 4,2 By conducting examinations and state and leads to

interviews with each family member, it was found out that due to health state of father (Alzheimers disease) and being acknowledged of its

outcome (death in 80-92%), daughters do not want to stay at home, feel depressed and angry. They tend to express themselves in rather nervous and unsuitable way. Moreover, Linda and George also tend to communicate less due to worsening of Georges health state and inability to talk normally, as well as due to Lindas feeling depressed and trying to calm down because of need to control cardiovascular disease, as far as she is the only family member who earns money for the family living. The

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN clinician explained that there is a crucial need for communication and understanding which would lead to mutual support and solution of

depression. Moreover, in case of depression disappearance, the problem with cardiovascular disease of Linda might become less dangerous and would not necessitate regular

examinations.

Additionally,

communication would also help father feel more comfortable and needed in the family. This strategic approach should solve psychological instability within the family and assist in improvement of the health state. Scope of Family Health Problem Referring to McGoldrick (2011), heart attack is observed as the reason for around 500 000 deaths in the USA each year, and this number constantly grows. Moreover, it is already established that this disease is the core reason for the deaths among female representatives, although many scientists still presume that the core reason is breast cancer. However, due to statistical data, it is established that there are more deaths among females from the heart attacks than from all the cancer types gather together. Besides, American sociologists admit that 13% of women understand that cardiovascular diseases might be their killer #1. According to Rigazio-DiGilio (2005), everything that causes influence on heart

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN and/or blood vessels, like emotional crisis, hypernutrition, increased physical activities might become the releaser for development of cardiovascular diseases, including heart attack. People with high risk of development of heart attack have corresponding family past medical history of cardiovascular diseases, which is observed in their genograms. They are smokers, drug addicts, have sedentary mode of life, might suffer from diabetes mellitus, arterial hypertension, high cholesterol level in blood, and face loads of stress situations. Family and Clinician Perception The main stressor is Lindas need to control her state of being regarding the cardiovascular disease, since she faces different complicated situations regarding the need to provide health assistance for her husband, need to earn money for the family, and need to help daughters deal with depressions, associated with fathers Alzheimers disease. Thus, common topics expressed by children are most often associated with father health state and insufficient funds within the family. This factor also influences health state of Linda and makes it worse. Taking into account this current situation, the spousal relationship between George and Linda are also worsening since they do not support each other and behave on their own. In order to solve this situation, children should understand what influence their actions and words have on their mother and father. Moreover, one of the daughters should take care of her ongoing depressive condition and find the job in order to help mother earn money for the family. Differences in Perceptions The matter is that the clinician observes more problems than the family itself does. Therefore, family should not only take into account the problem of financial status, but also the need for mutual support and help in order to find solution to the problems with health and provide assistance for father, since the conditions are worsening. Overall Family Functioning

FAMILY SYSTEM ASSESSMENT AND HEALTH PROMOTION PLAN In general, the Hs family is admitted to function worse since there are no mutual understanding and cooperation. As the time passes, the family became rather separated from each other due to different stressors they faced. The common themes they tend to express in the interviews dealt with health state worsening and financial problems. Overall Physical Health Status Overall physical health state is rather stable, besides Lindas one. Georges health state due to Alzheimers disease is quite predictable and constantly worsens. Lindas health state is always changing due to a range of influencing stressors that she has: children depression, husbands health and financial issue. Children health state is normal, besides psychological temporal depressions due to worsening of fathers health. Overall Mental Health Status There were no mental disorders found, except for slight depressions. Wellness Inventory Results Linda, as index person, showed rather low scores in physical actions (22%), correct nutrition (20%), and emotional awareness (15%). Thus, it is recommended to make more physical exercises, radically change nutrition budget, and use different meditation methods for emotional calming down and relaxation. Conclusion In general, the assessment described the influence of stress factors on the family on the whole, its relations inside and behavioral changes in society. The index person was Linda (55), who suffered most due to her own instability of health associated with emotional stressors from different angles within the family: husband and children.

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References Galindo, I. & Boomer, E. (2006). A Family Genogram Workbook. Educational Consultants. McGoldrick, M. (2008). Genograms: Assessment and Intervention. Norton Professional Books. McGoldrick, M. (2011). The Genogram Journey: Reconnecting With your Family. Norton Professional Books. Rigazio-DiGilio, S. A. (2005). Community Genograms: Using Individual Family and Cultural Narratives with Clients. Teachers College Press. Thomlison, B. (2009). Family Assessment Handbook: An Introductory Practice Guide to Family Assessment. Brooks Cole.