Family Assessment Term Paper. Chronic Obstructive Pulmonary Disease (COPD): A Family Assessment

Chronic Obstructive Pulmonary Disease (COPD): A Family Assessment
Name
Institutional Affiliation
 Chronic Obstructive Pulmonary Disease (COPD)
        Chronic Obstructive Pulmonary Disease (COPD) is ranked the fifth in major causes of death among adults (Pauwels & Rabe, 2004). COPD is a prevalent progressive and incurable disease among adults worldwide. Scholars have developed increased concern about the disease because of the increase in the number of deaths rising from this illness. Today, scientists’ have settled on smoking as the major cause of death for the disease. According to COPD Chronic diseases are persistent, and they cannot be cured through medication or vaccines. Additionally, the word “chronic” means that these diseases do not just disappear, hence creating a need for necessary interventions in their management. According to Lipinska and Kuna (2014), people can manage to live with this illness for a long period if there is proper care in its management.  The management of a disease refers to all the process surrounding how an individual lives with a disease, the immediate family members perceives it, and the health care providers” (Lipinska & Kuna, 2014).  People with COPD face functional limitations and will become helpless at a particular stage of their life. This is because COPD is progressive and its severity increases with time. 
     COPD is a general term referring to a group of three disease: emphysema, chmronic bronchitis, and asthma. COPD is characterized by increasing breathlessness as the person ages due to inflammation of lungs that causes obstructed airflow from the lungs. The difficulty in emptying air out of the lungs makes the person feel tired and at times helpless because the individual is using a lot of energy to empty the lungs (American Thoracic Society, 2013). According to American Thoracic Society (2013),  about fifty percent of cigarette smokers are expected to develop COPD in their lifetime. This is a significant population considering that most people are addicted to smoking. Even though the symptoms of COPD sometimes improve after the patient stops smoking cigarettes. Additionally, regular medication can diminish the severity of the disease in addition to attending pulmonary rehabilitation centers. However, shortness of breath and fatigue may never go away, and at times they can increase. However, patients can learn to manage this condition individually or with the help of caregivers leading to a fulfilling life in the last days of the patient. 
People diagnosed with COPD live in a world full of uncertainty, especially because they do not know how long they are to live with this disease. At times, all the diseases under COPD can attack an individual, and in severe cases, cancer and heart diseases may also crop up as opportunistic diseases due to COPD (Lipinska & Kuna, 2014). The family of the affected individual experience a lifetime of emotional, social, and financial distress because of this disease. In other cases, the family may be forced to sell its fortune to cater for medication of the affected individual, even when they know that the disease will not go away.
       This study will present a case scenario of an individual with COPD. The present research focuses on an individual developmental, family developmental assessment, and holistic family assessment using Duvall and Miller (1985) tool displayed in Appendix A.  The study will also discuss and explore aging issues and models of care and nursing roles related to COPD illness.
Case Scenario
       Desmond King is a 68-year-old married Native American male who was diagnosed with COPD at the age of 66.  King was born and raised in South Dakota.  King is currently a widowed, retired coal-fired work plant employee. The patient lives alone, and his primary goals are to regain a sense of hope and avoid living in nurse placement home care. King has been a smoker for the past fifty years.  King states that while growing up, he had a broad sense of growing up as an independent self-fulfilled person in the family. King had watched his father abuse his mother who had culminated to his mother committing suicide at a mere age of thirty-one. He viewed his father as the sole cause of his mother’s death and never wanted to live in his father’s house. In fact, he ran away at the age of seventeen and lived with his uncle until he graduated from college with a Bachelor’s degree in Social Work. His goal was to have a stable family and raise an exemplary family. He was a happy and outgoing individual living with his family until the age of twenty when he felt that his uncle was not giving him enough money. He decided to join a group of friends that introduced him to smoking and later on became addicted. His habit was, however, a secret and nobody realized it. At the age of twenty-three, the client volunteered coal plant in Hawaii, but later on got permanent employment where he had spent a good part of his life before he retired at the age of fifty.
       King leads a lonely life, and he describes it as unsatisfactory. His life changed when his first and only wife eloped with an African-American man after he had secured the job. They had been married for just one year and had not sired a child. Life became stressful after losing his wife, and he stayed four years without getting attached to opposite-sex until the age of thirty when he married Shirley Sanders. Sanders died after their fifteen years of marriage. They had had three children, all girls. The children are now married and hardly visit him, except for the financial support he receives in his bank account. 
       King is currently attending a public rehab and is under Fredrick Reeds whom he describes as caring and concerned. He is also on emphysema and chronic bronchitis medication which he says that he is uncomfortable with.  Currently, the client is experiencing decreasing PFS & blood gases; oxygen therapy prn; coughing; fatigue; anorexia; sense hopelessness/impending doom; less interested treatment regimens, and feels that he is losing the battle against the disease. His goals is that he will gain a sense of hope and live a successful life in the remaining days.
Individual Developmental Assessment
Individual Developmental Tool and Character’s Developmental State
        The Harvighirst’s (1972) Developmental Tasks Assessment tool was utilized to obtain an accurate level of tasks for King.  Havighurst's theory thrives on the assertion that development is a continuous process taking place throughout entire lifespan. It occurs in stages where an  individual moves in stages from one to the next through resolution of tasks that emerge in every state. People that have completed developmental tasks gain a sense of satisfaction and pride. The society also recognizes them as contributive members. Failure to complete a developmental task results to a feeling of failure and the society cannot respect or uphold such individuals. According to harvighirst’s (1972) Developmental Tasks, King is in the Task of Late Maturity (60 years – death). 
Expected Individual Developmental Tasks for this Stage
King is expected to achieve and acquire tasks for his individual development (Havighurst, 1972).  The expected tasks are: adjust to decreasing physical strength and health, adjust to reduced income, adjust to death of spouse, establish explicit affiliation with own age group (elder of society), and adopt/adapt social roles tin flexible way. 
Examples of King’s Status with Individual developmental Tasks
 King has not met the expected tasks in this developmental stage (60 years-death) (Havighurst, 1972).  Due to his physical condition, King is struggling with social and civic responsibilities and duties.  King fears that the society will have a negative perception of if he is placed under home nursing care. He is also that one time his children will stop supporting him, yet he does not have a means of income. He did not make reasonable savings when he was still working. As a matter of fact, sometimes he regrets wasting his fortune when he was still energetic and active.   These fears make his life lonely and sometimes he contemplates suicide. He feels like he has no meaning in life. 
Family Development Assessment
Family Developmental Tool and Family’s Developmental Stage
The Duvall Family Developmental: The eight-Stage Family Life Cycle and Developmental Tasks  (Friedman, 1998) assessment was used to acquir King’s Family Developmental Stage.  According to The Duvall Family Developmental Theory, King is at Stage VIII: Aging Families (retirement to death of one or both spouses) (Friedman, 1998).  The Major Family Goal of Stage VIII Disengagement (Friedman, 1998).
Expected Family Developmental Tasks for this Stage
            Stage VIII of Duvall’s (Friedman, 1998) family development expects these developmental tasks: Maintain a satisfying living arrangement, adjust to a retirement income, establish comfortable household routines, maintain marital relationships, nurture spouse, adjust to loss of spouse, maintain intergenerational ties,  care for generational aging relatives, keep interest in things and relatives outside the family, and  continue to make sense of one's existence (life review and integration)   (Friedman, 1998).              
                                                                                                                                                                                                                                                                                                        Examples of Family’s Status with Family Developmental Tasks
            King is currently struggling to meet the developmental tasks for Stage VIII: Maintain a satisfying living arrangement (Friedman, 1998).  King is surviving on the support he receives from his children who he is afraid that one day they will abandon him.  His condition does not allow him to make comfortable living because he cannot attend to tasks. As a retired coal-mine worker, he has been forced to spend the little savings he had on medication. He does not have close relatives near him, except his daughters who are married far in the North. Additionally, Kind does not belong to any social group in the society. Immediately after the diagnosis of COPD, King decided to research the disease and seems to have accepted his status. He is well-informed on the management of the disease and hopes that he will manage it with the help of a physician. 
Holistic Family Assessment
Define Family Assessment
The Wong and Eaton (2001) Family Assessment tool was used to assess King’s family (see Appendix A).  This tool allows the nurse to observe and evaluate the dynamics of King’s family.     
Summary of Family Assessment and Ecomap Findings
The Wong and Eaton’s (2001) Family Assessment tool enabled to view a more clear assessment of King’s family by utilizing structural and functional assessment areas.  The structural assessment includes family composition, home and community environment, occupation and education of members, and cultural and religious traditions (Wong & Eaton, 2001).  The functional assessments areas include family interactions and roles, power, decision-making, and problem-solving, communication, and expression of feelings and individuality (Wong & Eaton, 2001). 
            Structurally, the immediate members consist of Desmond King, 68-year-old and his three daughters; Jaclyn 41-year-old, Janet  37-year-old, and Viola 33- year-old (Wong & Eaton, 2001).  King is distant with his daughters, occasionally communicates with them over the phone. King lives alone with no immediate family members in his household.  King currently rent an apartment within a complex.  Adequate space is noted with safety features including a back door, smoke and carbon dioxide detectors.  The apartment appears clean (Wong & Eaton, 2001).  King is a college graduate with a Bachelor’s degree in Social Works.  King does not have a source of income except the retirement pension plans and financial support from his daughters.  King has a firm belief in God because he states he reads the Bible and listens to hymns.
            Functionally, the King Family unit is cool and distant.  These characteristics appear to be the result of them being far apart where the daughters are married in the North (Wong & Eaton, 2001).  King makes all the decisions concerning his life (Wong & Eaton, 2001).  King primarily initiates communication with his first two daughters except Jaclyn who keeps communicating with King. 
             King’s ecomap (see Appendix B) shows that the strongest bonds are with his daughter Jaclyn and his therapist, Mr. Reeds.  King gives and receives most energy from Jaclyn and his therapist.  King receives moderate support from his two other daughters.  There is no negative energy flow with his family members.  Reading the Bible and listening to hymns gives King a strong sense of self-worth and fulfillment.  King’s ecomap illustrates that he gives and returns energy to several sources. 
Describe Two Uses of Family Assessment Findings
          The family assessment findings (Wong & Eaton, 2001) for King will be beneficial in helping him understand the disease process of COPD and his relationships with family members.  Understanding the need of continuing therapy sessions with Mr. Reeds will increase his awareness and progress of his illness (Wong & Eaton, 2001).             The family assessment findings indicate King’s need for resources to help with the cost of treatment plans and other local non-profit organizations (Wong & Eaton, 2001).  An example to help with costs of therapy would be to attend a self-help group and become self-reliant.  King can join a local self-help group where others are experiencing the same issues and can help with feelings of isolation and stigma. In the social group, King will realize that he is not the only one struggling with the condition.  
Aging/Geriatric Issues and Models of Care
Two Aging Issues for Desmond King
According to HealthinAging.org (n.d.), aging population tend to face different challenges. As their lungs age, they are likely to develop one or multiple conditions associated with COPD. When lungs age, adults become vulnerable, and they may have a health problem that can lead to another condition or injury if not properly managed. Desmond King, 68-year-old Native American male with th...