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Introduction
Matters concerning family health are receiving substantial attention in the contemporary decades, following a growing number of unpredicted health issues. Community health assessment and family health assessments have become common techniques utilized within the health care systems across the world purposely to promote good health (Willemse & Kortenbout, 2012). Through the performance of Community Health Nursing (CHN), health care departments globally are enhancing family and community health. Due to the rising demand for community and family health assessment, several health assessment tools and models have emerged. Healthcare experts utilize the Friedman Family Assessment Model in assessing the health demands of community and family (Bomar, 2004). The model combines structural-functional family theory and the general system theory in reducing the scope of family health assessment (Kaakinen, Gedaly-Duff, & Coehlo, 2009). In this view, this essay seeks to provide a family health assessment of an Amish family using the Friedman Family Assessment Model, analyze family data, and develop a plan of care for the family.
Identification of Data
Johnstons family is the name of a nuclear family of the Amish people, who reside in the state of Pennsylvania in central parts of the United States. The Amish family comprises five members, who have lived in Pennsylvania (PA) for approximately twenty-five years, and have remained deeply rooted to the Amish culture and religion. Forming majority of the marginalized communities around Pennsylvania, the Amish people have a unique religion that abhors medical care (Willemse & Kortenbout, 2012). The Amish community has their own unique religious convictions that strongly uphold cultural conservatism and communal cohesion. The Amish families earn a very low-income because they survive as peasants and subsistence farmers, while a few of them engage in industrial duties. Similar to other families, Johnstons family earns a meager salary of almost $100 per month. Johnstons family, being from the Amish, remains bound to ethnic regulations, which govern family interactions and other social relationships.
Developmental Stage and History of the Family
Being a family that earns low level of income, the Johnstons family lives in a low social class, where both parents are only able to secure low class houses around Pennsylvania. Both parents grew up under the influence of cultural and religious beliefs of the Amish community. They both originated from poor families and their levels of education do not go beyond the secondary level. The family is frequently unable to handle several pending bills that keep recurring due to their financial constraints. This nuclear family of five members began in Pennsylvania some 18 years ago and the parents have not relocated to a new place. The firstborn child of Johnston lost both limbs during childhood due to polio infection. According to the parents, their children are receiving basic education with minimal hope of progressing to secondary and tertiary levels, as the family is still struggling to survive.
Environmental Data
Johnstons family resides along the northeastern part of Pennsylvania, where the majority of the households live in the lowest economic status. The northeastern part of Pennsylvania remains dominated by different ethnic communities of small-scale peasant farmers, some dairy farmers, and poor families. The Amish community dominates most of the northeastern region of Pennsylvania, where divorce and family planning are not part of the larger community. The entire community around the northeastern PA speaks mixed languages of Pennsylvania Dutch, German, and some English, although Pennsylvania Dutch is more dominant. Nobody around the Amish community seeks the western medication as the religious doctrines prohibit them from seeking medical care or even taking any form of prescribed medication (Weyer et al., 2009). Death is a common phenomenon among the Amish as women deliver at home and do not seek medical care. Intermarriage is rare since the Amish people marry within their lineages and normally disregard the western civilization.
Family Structure and Functions
The communication patterns among the family members is poor because the father is abusing drugs, and thus unable to provide for the family. Owing to poverty, drug abuse, and diseases, the family of Johnston is undergoing a great psychological ordeal. As the father is grappling with drug abuse, the mother is struggling to provide for the family, while children are fighting to access education under stressful conditions. The family structure among the Amish community is that father is the head of the house, whereas the mother and children are subordinates. Hence, the mother and children have no immense power in decision-making. The values that the family upholds among the Amish relate to the cultural and religious beliefs.
Whereas Johnstons family lives in a nuclear family with little association with the majority of the Amish community, its religious and cultural beliefs are undeniable. The parents provide parental care, basic education, and healthcare despite their financial challenges. Nonetheless, the church and its religious doctrines frequently dominate social lives of the Amish population, and thus, Johnstons family is not exceptional (Weyer et al., 2009). As parents have a noble duty of instilling certain values of the family in their children, evading the religious dogma is an unacceptable practice among children.
Stressors and Coping Strategies
Since the firstborn child lost limbs owing to polio infection, the parents are struggling to provide special care and education. The poverty conditions of the family and drug abuse by the father are other stressors, which the family is struggling to overcome. Despite such stressors, the family is able to cope well because the wife is working very hard to make her family happy. In this view, the wife is an important asset of internal copy strategy. Moreover, the Amish community is a benevolent community because it has support systems that help the needy and the sick in the society. In contrast, the community forms an external coping strategy. Weyer et al. (2009) state that the nature of support systems that are present in a given society is dependent on cultural and religious beliefs. Thus, the Amish culture and religion have integral support systems that help the vulnerable and the poor in the society.
Analysis and Discussion of the Data
Normally, family health assessment aims at improving the health status of socially marginalized and unfortunate families, especially in America, as a nation of immigrants (Haxton, & Boelk, 2010). The assessment selected the Amish community because it forms the minority groups, which experience discrimination in the United States. Friedmans approach of family assessment involves the analysis of the family background information, a form of practice that is paramount in family nursing (Haxton & Boelk, 2010). The cultural beliefs of individuals normally influence their perceptions of healthcare, and sometimes determine the patients response to medication (Willemse & Kortenbout, 2012). Johnstons family can barely eliminate itself from the conservative ideologies designed and motivated by their religious doctrine. The religious principles dominate the entire family practices, including their health affairs, their social interaction, and their cultural behaviors. Holding to the church philosophy that a community member should not seek medication presents unique challenges to the health care fraternity, as none of them takes medication or even seek health care support,
Poverty in the Amish community, as evident from the case of Johnstons family, is a crucial barrier that prevents Amish from accessing medical care. Poverty as a socioeconomic problem affects the ability of patients to manage treatment costs, receive health insurance coverage, or cater for health related needs. A family surrounded by a community with conventional ideologies that interfere with healthcare decision-making remains vulnerable to incessant poor health. Healthcare experts receive challenges in making healthcare decisions that contradict religious philosophies, as the American constitution encourages individual autonomy over religious obligations. Low education, poverty, and ethical beliefs in many American states are significant factors that influence access to healthcare. Apart from obstructing the modern medication strategies, the Amish beliefs have instilled hopes on community members as they provide medical advices and remedies. The Amish community has a great influence on the autonomy of individuals, which denotes that families have little or no power in their own social lives.
A Plan of Care for the Family
First Phase of the Plan
This phase is a six-month coaching program that intends to develop awareness about the need to embrace good health. During this stage, the assessor will help the members delineate between cultural interferences and the importance of good health within the family. Since there is a critical lack of the knowledge regarding the imperatives of modern medical interventions, sensitization is appropriate (Bassuk, Volk, & Olivet, 2010). The sensitization about good health associated with medical care interventions will involve providing the family members with appropriate education concerning the importance of modern lifestyles, modern healthcare interventions, and implications of cultural ideologies (Bassuk et al, 2010). Educational materials, including books, healthcare reports, and pamphlets, will assist in sensitizing the family about culture, its implications on health affairs, and the imperatives of good health. Counseling of the family members to change their perceptions on religious beliefs and adopt modern lifestyles is necessary to empower the Amish community.
The Second Phase
This phase will require medical diagnosis to assess the underlying health problems available within the family. After proper sensitization and mutual consent about the medication program, the assessor can deploy family diagnosis as the first practical intervention that aims at introducing the family to the modern healthcare (Bassuk et al, 2010). The family nurse can induce modern treatment interventions, including screening, vaccination, and other treatment techniques to make the family familiarize with the system practices. The family nurse from this phase can identify a certain disease in the family, apply necessary interventions towards curing, and make a follow-up, until the treatment objective is successful. Each successful assessment and treatment intervention is paramount in instilling confidence upon the family members concerning the modern treatment practices (Bassuk et al., 2010). Therefore, the use of coping strategies such as the influence of the wife and the existence of support systems in the community are central.
Conclusion
The Amish community is one of the marginalized immigrant communities in the United States, which possesses strong religious and cultural ideologies that influence members attitudes towards medical care. The Amish church dislikes modern healthcare interventions and it has massive influence on families within the entire community. Poverty, religious doctrines, low socioeconomic status, and cultural ideologies provide healthcare workers with numerous challenges in making healthcare decisions. A plan of care for the family should involve proper sensitization of families on the importance of modern healthcare interventions, before introducing diagnostic and treatment approaches to any Amish family.
References
Bassuk, E., Volk, K., & Olivet, J. (2010). A Framework for Developing Supports and Services for Families Experiencing Homelessness. The Open Health Services and Policy Journal, 3(1), 34-40.
Bomar, P. (2009). Promoting Health in Families: Applying Family Research and Theory to Nursing Practice. Elsevier Health Sciences, Atlanta: United States.
Haxton, E., & Boelk, Z. (2010). Serving families on the frontline: challenges and creative solutions in rural hospice social work. Social Work Health Care, 49(6), 526-550.
Kaakinen, J., Gedaly-Duff., & Coehlo, D. (2009). Family Health Care Nursing: Theory, Practice, and Research. New York: F.A. Davis Publishers.
Weyer, S., Hustey, V., Rathbun, L., Anna, S., Ronyak, J., & Savrin, C. (2009). A Look Into the Amish Culture: What Should We Learn? Journal of Trans-cultural Nursing, 14(2), 139-145.
Willemse, J., & Kortenbout, E. (2012). Undergraduate nurses experience of the family health assessment as a learning opportunity. Health SA Gesondheid, 17(1), 1-9.
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