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A genogram depicts inter-generational family maps to provide a picture of what is occurring across families and across generations, providing a broad framework with which to view family, emotional and social relationships. (Keneddy.V.2010). Whereas in the ecomap, systems with which the family has no contact may also be included, if the family needs to develop a relationship with the system. These tools are graphic representations of family structure and social relationships which helps nurses to do a successful family nursing assessment which results in identifying health problems in the family from generations and provide interventions.
Components of Genogram:
The family genogram is a format for drawing a family tree that records information about family members and their relationships during at least three generations (McGoldrick, 2016). The genogram gives a graphic representation of the family composition and the basic relationships in at least three generations, elaborated through symbols. It helps nurses and families to think systematically about families and impact of health-related issues on family structure and function and able to plan for interventions. Nurses establish a therapeutic relationships with the families through the process of asking questions by using a family nursing assessment to identify health problems and helps in family therapy. An example of a genogram is illustrated in figure 1. Male is noted by as square and female is noted by a circle. Marriage is represented by a line connecting the two (husband and wife). Children are noted as oldest to youngest, left to right. Plus, symbol in box or circle represents physical illness as shown in the figure 1. Both fathers have diabetes type II and Uday and his mother is suffering with hypothyroidism which passed from generation to generation.
Components of Ecomap:
Ecomap is a graphical representation that shows all the systems at play in an individual’s life. It is a flow diagram that maps family and community process over time. It helps the family assessment tool consisting of a graphic representation of a family relationship with its environment. They provide a visual map of the family’s connections to the external world. Each individual family members connections to social support systems. An example of an ecomap is illustrated in figure 2. The lines between these circles represent assessments of the quality and flow of the relationships between these systems. A solid line represents a strong relationship, such as the lines connecting Uday and Raghu’s extended family and with the Sree’s brother’s family and Uday’s sister’s family. Zig-zagged line shows a stressful or conflictual relationship. A stressful relationship is seen between Uday and Sree’s work environment. Families differ in their ability to accept help from others outside of the family system. Each family has a boundary that defines those who are part of the family and distinguishes these people from those who are not part of the family. By considering these boundaries nurse could analyse what and who are the supportive sources to the family.
Family nursing assessment:
Nurses collect an accurate data of the families by using Family nursing assessment incorporating genogram and ecomap as a collective tool to identify health problems and plan the interventions. It also gives direction for nurses whether they have obtained enough information on problem and strength identification, or whether gaps exist that require additional data (Kaakinen.J,2018). The family nursing assessment is done by step by step which Uday family information have been gathered by the following steps.
Assessment of the family story:
Uday family story shows that family life has changed due to his hypothyroidism. Uday was found to be healthy but he gained weight. His family history has diabetes to his father and mother is suffering with hypothyroidism. Sree’s father is also diabetic and she is risk to get in future.
Analysis of the family story:
Uday is taking medication regularly but he needs to do exercises. Uday and sree having difficulty adjusting and the shift in their family roles, more concerned about adjustment to the new baby.
The nurse together with Uday and Sree, review the family genogram (figure 1) which helps the couple visualize the family. Uday decided to do exercises and diet modification to reduce his weight. Uday and sree will talk with his sister family about sharing childcare.
Yovonne plans a follow-up call to check in with Uday and Sree. At next visit Yovvone will check Uday and Sree to see whether their priority concerns remain same or decreased or increased. She will observe how they are caring the baby (bath and feeding).
Yovvone reflects herself that her therapeutic communication in data collection by using tools was excellent. She showed a validated family concern for weight gain of Uday how this stresses the family.
The genogram and ecomap both framed as an analytical tool in relation while performing family nursing assessment, which aims to understand how the family of a young person with chronic disease and new addition to the family, faces the disease and its implications, forming care, and creating support networks to help them through this process.
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