December 6, 2018 “Brittany’s Journal Assignment” Student ID 3254628

The idea of this reflective journal is to explore my own values and beliefs relating to
family nursing and health promotion, how they impact decision making processes and use of
professional judgement. At first, I thought it would be easy to divide the patients I would chose
and not chose. However, once I started looking past the initial assumptions I made based on the
small bio provided, I began to think more carefully of my choices. I thought about what the
world of nursing would look like if we were able to choose our patient assignments, as compared
to being assigned specific patients. Unfortunately, I can see certain patients not receiving the care
they should. By having patient assignments, we do not always get the ideal patients. Some
patients are more appealing to some nurses, in the same way that some patients present
challenges of different degrees. Nurses are expected to be able to identify their own values and
beliefs, and often set them aside in order to remain
professional. However, we still have our emotions.

For each patient chosen for this journal, I will

include my assumptions regarding their situations, the
guiding framework used, tools and models used as a part
of a part of my assessment, and the family health
promotion models I would incorporate.

Figure 1. Nurse thinking

Patients I would choose Fiona Friday (16-year-old)

If I was given a choice in selecting my
patient assignments, I would choose 16-
year-old Fiona Friday in her second
trimester of pregnancy attending the
prenatal clinic, 29-year-old Ernie Erbach
suffering from various issues related to
polysubstance abuse attending the drop in
clinic,and 10-year-old Ian Harris who
discloses to the school nurse about abuse.
Figure 2.
Pregnant teen
My Assumptions:
-Dysfunctional home environment
-poor family and personal relationships
-lack of sexual wellness education
- baby’s father is not involved
Framework: Developmental and Family Life Cycle Theory
(Kaakinen et al., 2018, p.41-45) to help understand family
changes and experiences.
Assessment:
-Genogram and Ecomap in order to gain insight to her family
history (structure and health history), relationships, and
current living environment (supports and stressors)
(Kaakinen et al., 2018, p.127-130)
-Calgary Family Assessment Model (Kaakinen et al., 2018,
p.122-123) to identify how she and those around her feel
about her pregnany.
Family Health Promotion:
-Family Resilience Framework to identify her network’s plan
to help overcome upcoming challenges and their ability to
rebound from crisis (Kaakinen et al., 2018, p.154). Discuss
prenatal care and resources available.
 16-year-old Fiona coming to the prenatal clinic is likely a huge first step for her. At this time, she
needs positive affirmation that she is taking a step in the right direction for both her and her
baby. Having worked in a clinical setting, I have seen the importance of patients being treated as
equals. If she can see that judgements about her age are not the main concern regarding her
appointment, perhaps she will seek further assistance from the clinic once she realizes that
supports are there for her.

Figure 3. Man and polysubstance abuse

Ernie Erbach (29-year-old)

Assumptions:
- May be homeless and/or not have a job
- May have troubles with the law
- May not have a support system in place
Framework:
-Family Systems Theory (Kaakinen et al., 2018, p. 38-
40) to address both individual and family needs
Assessment:
-Genogram and Ecomap to gain more information
about family life and current living environment
Having worked Ian Harris (10-year-old)
(Kaakinen et al., 2018, p. 127-130).
in a correctional
- Family Assessment and Intervention model Assumptions:
facility as a
(Kaakinen et al., 2018, p. 121). What has lead to the -Type of abuse (physical, sexual,
substance use?
nurse, I worked
emotional)
Family Health Promotion: with many
-Poor social circumstances
- Developmental Model of Health and Nursing patients that - Who the abuser is (stepfather?, non
(Kaakinen et al., 2018, p. 156) Identify struggle with family member?)
stressors/concerns, set goals and provide resources. poly-substance -Are the siblings or other members in
abuse. I would household also being abused?
choose 29-year-old Ernie as a patient because I have worked Framework:
with many patients similar to him. Although I do not know -Family Systems Theory (Kaakinen et al.,
more of his current situation, by him reaching out for 2018, p. 38-40) to assess individually
assistance from nursing staff means that he is working and as a family unit.
towards taking better care of himself. Being present and Assessment:
adhering to scheduled appointments suggest that he is -Genogram and Ecomap (Kaakinen et
thinking about the future and will likely be more receptive al., 2018, p. 127-130) to gain more
to resources offered to him. insight to family structure and
environment. How and when did family
My last choice would be 10-year-old Ian. Abuse situations dynamics shift? How is his relationship
are sensitive in nature so they need to be addressed tactfully with members of the household?
and professionally. I am fortunate to be married to an Family Health Promotion:
R.C.M.P. officer and my sister is a child-family service -Model of the Health-Promoting Family
worker. This has allowed myself to have a better (Kaakinen et al., 2018, p. 156-157) to
understanding of the legal system and victim services. As a identify what health promotions are
nurse, we have a duty to report. I feel that I would be able to currently taught to children. Identify
identify the appropriate steps in having the abuse allegations Ian’s understanding of abuse, how to
further investigated and followed up with. stay safe and who he can talk to.
 Patients I would not choose

If I was given a choice of which patients I would not select for assignments, I would
choose not to have 5-year-old Charlie Heron admitted for respiratory distress, 13-year-old Dixie
Cup admitted to psychiatrics for depression, and 78-year-old Bernetta Bold who is being referred
for homecare assessments.

Charlie Heron (5-year-old)

Assumptions:
- Supportive and loving home
- Did his health history prevent travel?
- Only child
Framework:
-Family Systems Theory (Kaakinen et al.,
2018, p. 38-40) to assess Charlie as an
individual as well the the family as a whole.
What role do the grandparents play in his
life? How is communication between family
Assessment:
-Genogram and Ecomap to gain insight into
family history and current living
environment (Kaakinen et al., 2018, p. 127-
130). Hopefully the grandparents can
provide some insight. Are the parents able
to be contacted? Is this first illness?
-Family Assessment and Intervention Model
(Kaakinen et al., 2018, p. 121) to look at
basic family structure and identify any
problems.
Family Health Promotion:
-Model of the Health Promoting Family
(Kaakinen et al., 2018, p. 156-157). Is this
the first time Charlie has been sick? How
does the family manage illness? Provide
education and offer resources.
Figure 5. Depressed teenage girl
Figure 4. Boy in respiratory distress
Dixie Cup (13-year-old-girl)
Assumptions:
- May not find me relatable
- Teen angst/ hormones
- Parents visiting appear to want to offer
support, but may have limited mental
health understanding
Framework:
-Family Systems Theory (Kaakinen et al.,
2018, p. 38-40) to assess Dixie as an
individual as well as the family as a whole.
Assessment:
-Genogram and Ecomap to gain insight
into family history and current living
environment (Kaakinen et al., 2018, p.
127-130). What are the stressors in her
life? What is her relationship like with
family members? Has trauma occurred?
Family Health Promotion:
- Model of the Health Promoting Family
(Kaakinen et al., 2018, p. 156-157). How
much understanding does Dixie and her
parents have regarding mental health?
What are their values and beliefs towards
mental health? Provide education and
offer resources
Although I have some experience working with pediatrics, my concern would be taking care of
him in the emergency department. While pediatric patients tend to respond more quickly to
treatment, their status can deteriorate quickly if early signs of distress are not assessed and
addressed. Working in an emergency department can be chaotic at times. I would worry that I
would not be able to devote the time needed appropriately to 5-year-old Charlie. If he appeared
well, I would likely focus my attention towards another patient at that time and potentially miss
early signs of distress. I feel this could cause great distress for the grandparents caring for him, as
it may be seen as neglectful on my part if something were to happen and it could have been
avoided. This would create distrust between health care provider and patient. I would also hope
to have more emergency nursing care under my belt to be assigned this kind of patient, in the
case that his status deteriorates.

I would have difficulties caring for 13-year-old Dixie because I personally find I have a hard
time relating to teenagers and mental health. Because I don’t know other factors contributing to
her situation, I find I can be quick to make my own assumptions. I worry that I would not be able
to provide the appropriate patient to nurse relationship that this patient would need and may
possibly avoid seeking help in the future based on this experience.

Bernetta Bold (78-year-old)

Assumptions:
- Depressed, not receptive to care
- Grieving, failure to thrive
-Must need higher levels of care if home
care assessment is ordered
Framework:
-Family Systems Theory (Kaakinen et al.,
2018, p. 38-40) to assess Bernetta as an 78-year-old Bernetta would also be difficult for
individual as well as the family as a whole myself based on my assumptions. At first glance, I
Assessment: would assume that she is not going to be receptive
- Genogram and Ecomap to gain insight into to care. This in turn means that she could likely
family history and current living take up a lot of my time and energy. She is also
environment (Kaakinen et al., 2018, p. 127- working through grieving the death of her
130). What supports does she have in place? husband. I currently have family that is not coping
What is her relationship like with other well with the loss of a close family member, so I
family members? What levels of worry I would become too attached to the family.
involvement can family provide?
Fortunately, her family appears concerned for her
Family Health Promotion:
well-being and seem to want to be involved in her
- Developmental Model of Health and
care. Having a home care assessment includes
Nursing (Kaakinen et al., 2018, p. 156)
various other resources that would be involve a
Identify stressors/concerns, set goal and
multi disciplinary team to developing a plan of
expectations and provide resources.
care based on patients needs. This is not a process
that occurs overnight unfortunately and involves a
lot of time and energy. I personally find the system itself and processing patients can be
frustrating to deal with, so that would add to me not wanting to take on this patient.
As with any nursing theory, there is not a “one size fits all” model. The health promotion model
that I am most drawn to is the developmental theory, which bases emphasis that the individual
evolves within the family unit. Family changes over time, as does each individual within the
family. I feel this can be applied to a majority of families, no matter their cultures and varying
dynamics. Another theory that I found complimented the developmental theory is the bio
ecological systems theory, in the sense that their environment influences the individual- which is
also continually changing. Kaakinen et al. (2018, p.48) explains the importance of internal and
external influences on the family and on the person being a vital part of the bio ecological
systems theory…different systems surrounding the family affect it differently.

Reflecting on my choices

Although I didn’t think the patients I chose as assignments had similarities, I did note that
these patients presented themselves with the intention to seek further treatment options. To me,
this demonstrates that these patients might be more willing to utilize any resources that I can
offer them. I find there is a difference in the types of patients when they are coming to a clinic on
their own accord, versus being treated in a hospital setting. Stressors can be high in a hospital
environment for both patients and families, which in turn can evoke decisions being based on
emotions. There is not always the time to absorb the information that is presented to them. When
patients reach out to a clinic, I find they have generally done a little of their own research and
have some idea of the intentions of their appointment. I also noted that the patients that I chose
are in vulnerable situations. I have experience working with patients of vulnerable natures so I
feel I can guide them appropriately to resources that would benefit them. Of the patients that I
would rather not have, I noted the common theme to be that I couldn’t give them the time that I
think they needed. This is something that I find very frustrating because I feel that I can not do
my job to the level that I expect of myself. My own lack of nursing experience also played a
factor in not selecting certain patients. The patients presented with very specific diagnosis that
would require some level of speciality training. For example, the patient recently diagnosed with
cervical cancer. Having no oncology training, I do not feel I would be able to provide accurate
information. There is a higher level of patho and pharmacology that I would need to learn. But,
as there were varying types of patients we could choose from, there is the same diversity in the
world of health care. As a nurse, I need to be receptive to all types of patients and move forward
with an eagerness to learn. The best way to grow as a nurse is to be open to new experiences and
learn what I can so I can bring it forward in my care. By examining one’s values and beliefs
through critical reflection, assumptions in practice can be challenged to facilitate a preliminary
shift in attitude, which is part of transformational leaning (Melrose, Park & Perry, 2013).

At first I thought it would be easy to pick the patients I would want to care for. I found it
was the opposite. I did my “quick pick”, but then once I started to think more about what would
be involved for their care, I found myself second guessing myself. I found I was quick to make
assumptions, in the same way that we do a quick glance over at a patient. It is said that you make
a judgement within the first 10 seconds of meeting someone. This assignment took me longer
than I originally anticipated, as I think putting my thoughts into a journal helped me to reflect on
my own nursing practice. I believe this assignment has helped me become more aware that I
need to become more aware of my patient’s whole situation before making assumptions. A
nursing instructor once told me “You need to look at the whole person, not just the hole in the
person”
 References

Figure 1. Nurse thinking. (n.d.). [Digital Image]. Retrieved from https://goo.gl/images/L6JS7p

Figure 2. Pregnant teen. (n.d.). [Digital Image]. Retrieved from https://goo.gl/images/juVFoV

Figure 3. Man and poly substance use. (n.d.). [Digital Image]. Retrieved from

https://goo.gl/images/6f8SA2

Figure 4. Child in respiratory distress. (n.d.). [Digital Image]. Retrieved from

https://goo.gl/images/tmf2uL

Figure 5. Depressed teenager. Retrieved from https://goo.gl/images/ZhapGF

Figure 6. Sad old lady. Retrieved from https://goo.gl/images/SGGZWX

Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing.

Theory, practice and research (6th ed.). Philadelphia: F. A. Davis.

Melrose, S., Park C., & Perry, B. (2013). Teaching health professionals online: Framework and

strategies. Edmonton, AB: AU Press.