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1. According to the Oxford dictionary, the definition of family is a group of one or more parents and
their children living together as a unit. In todays world people have different definitions of a family
and family structure is ever changing. Family can consist of a household with 1 parent and one
child, to a household that includes stepchildren, elderly grandparents, and those who have been
adopted, and everything in between. As community health nurses it is important to look at a family
as a whole unit and to also consider the members of the family individually. To gain insight into the
role of a community health nurse as it relates to planning care for an individual family, we have
interviewed the Miller family and have put together a comprehensive care plan that addresses
individual concerns as well as sets goals for the family as a whole. For privacy purposes, the first
names of the family have been changed.
The Miller family is of Caucasian race, lives in the urban setting, and has 4 members who live
together. The family consists of the nuclear family (Kate and her children) and also one member of
the extended family ( Kates father) . There are three generations living in the home. This paper will
introduce the family members, Thomas Miller age 65, Katie Miller age 39 (daughter of Thomas
Miller) , Alex Miller age 13 and Kevin Miller age 3 (children of K. Miller).
Thomas Miller grandpa, 65 year caucasian male, Parkinsons disease, Lewy Body dementia
(genetics, his mother had it), COPD. occupation: warehouse retired. Risk of depression and
neglect. Wife died 3 years ago. Devin
^^ occupational therapist (button shirt, etc), physical therapist (fall risk, walker/wheelchair),
respiratory therapist (COPD), home health aid to help with ADLs and home chores, home health
nurse to assess safety and manage medication and assessments of vital signs and cognition,
depression screening
Katie Miller is a 39 year old woman who is a single mother of her two children after going through
a messy divorce with her ex-husband Micheal. The father is no longer in the picture since the
divorce has taken place and was finalized. She takes care of her two children Alex, her 13 year old
daughter, and Kevin, her 3 year old son. She is also the primary caregiver of her father, Thomas.
She has no serious previous health issues but has been using alcohol heavily since a year before
the divorce. This was caused due to constant excessive arguments with her husband and his
infidelity. During the divorce process, she began to withdraw from caring for her family members
and was noticeably falling behind at work. Katie is a warehouse employee at Amazon and works 5
days a week for a total of about 40 hours. While she is working, her eldest daughter Alex takes
care of her younger brother and her grandfather. When Katie comes home from work, she
continues to work in the sense of trying to take care of her family and dread coming home and
having to still work. She is experiencing caregiver strain which she exacerbates with drinking.
Katie is at risk for suicide, depression, liver disease/cirrhosis, job loss, DUI/reckless
endangerment, and death. Due to having many stressors, she is at a very high risk for these.
To help Katie and her family, there are many resources that she could be informed about.
^^AA, support group, group therapy, alcohol assessment, MSE, depression screening, support
from friends and other family members, respite care
Lasheena - Alex Miller-female 13 year old Risk for depression, risk for abuse/neglect, social
anxiety post pandemic, separation anxiety, lack of boundaries for family roles teen was taking
care of toddler sibling while home from school during pandemic
Growth chart leading to depressed mood
^^counseling (1-1), after school programs, support groups, peer activities,
Maria - Kevin Miller is a 3- year-old Caucasian male and the youngest child of a single-parent
household. Kevin lives with his mother, sister, and grandfather. His mother and father recently
separated and are working towards a divorce. Kevin is at risk for potential health problems such as
physical, cognitive, and psychosocial developmental delays. In addition, Kevin is at risk of
developing Parkinsons in the future. He would also be considered part of the vulnerable
populations since he could potentially be at risk for malnutrition, neglect, and abuse. Since the
beginning of 2019 due to Covid-19 Kevin has been cared for by his grandfather and older sister
Alex since his mother is working most of the time and Alex was learning online during the
pandemic.
Until now, Kevin appears to be in a healthy state based on his age he should be up to date with
immunizations for a 36-month-old and getting a yearly seasonal influenza vaccine. Nutrition at this
age is crucial because children at this age establish lifetime eating habits, develop taste
preferences, and physiologic anorexia may occur due to toddlers becoming picky eaters. Adult
supervision should always be provided, finger foods are preferred and encouraged, otherwise cut
food into small, bite-sized pieces to allow for easier swallowing and to prevent choking. This will be
helpful to avoid malnutrition. As for sleep and rest an average of 11 to 12 hours of sleep per day
including a nap is typical for toddlers. It is best to maintain a regular bedtime routine and bedtime
to promote sleep without resistance, bearing in mind that naps will be eliminated the older the
toddler gets. This is the perfect age to introduce flossing and brushing which should be performed
by adults. Teaching Kevin that brushing occurs after meals and bedtime and ensuring there is no
consumption of any substance other than water after brushing before bed. Teaching about injury
prevention with foreign objects, bodily harm, burns, drowning, falls, motor-vehicle injuries,
poisoning, and suffocation is imperative. Safety precautions should be taken in the home to
prevent any of the aforementioned. An example would be to not leave toddlers unattended in or
near any body of water including the bathtub.
At the present time, interventions to maintain Kevin at the expected growth and development for
his age it is recommended to follow this criterion. Maintain routine as much as possible.
Encourage independence and choices. Provide developmentally appropriate activities. Allow
Kevin to learn socially acceptable behaviors. Provide a developmental level of child assessment,
assess motor skills, and level of activity, and observe the childs preferences. Monitor his growth by
using a growth chart and comparing his percentile to that of his age group and the previous
documented visit. Recognize potential child abuse or neglect by observing his appearance and
actions but also performing a physical assessment.
As a result, some of the goals and outcomes planned for Kevin will permit him to continue to grow
and develop as expected for his age. Maintaining him up-to-date with immunizations and visiting a
doctor as required for his age to promote good health. Maintaining a routine schedule which in turn
will allow him to determine what his preferences are by the choices he makes. Allowing him to
learn about the importance of dental hygiene will decrease the possibility of developing dental
caries. Focusing on a specific bedtime with a routine will allow him to develop good sleep hygiene
and promote enough sleep and rest that is required for his age. Ensuring his safety at home will
decrease the opportunity for abuse or neglect as well as malnourishment.
^^day care/preschool, denver assessment, growth chart