Health assessment is an elaborate evaluation of an individual's healthcare status and needs by conducting research on his or her family history and creating a plan to address these needs through the healthcare system. Health assessment involves procedures such as heritage assessment to pinpoint potential areas of interest through the family's genogram. Heritage assessment is an important tool in nursing that enables health practitioners to maintain and restore the patient's culture and beliefs. Through the heritage assessment, the providers can evaluate and assess the cultural health methods (Brown, & Stoffel, 2010). For this health assessment, the focus will be on Mr. Tonny Ochali, who is a 46-year-old African American from Nashville, Tennessee. The heritage assessment only goes up to four generations through the paternal side as represented in the genogram.
Like most Americans, Tonny has his ancestral roots outside the American sub-continent. His grandfather immigrated to the United States after the First World War from the East African country of Kenya, which by then was a British colony. Genograms tend to focus on a particular family behavior such as immigration patterns, occupations, or relationship between family members. Such focus on family behavior assists the medical practitioner to trace how a specific family problem develops over several generations (Tavernier, 2009). Tonny's paternal genogram reveals some healthcare concerns within his family tree that could pose a challenge to him and his future generations, if not addressed. Based on the genogram and the health assessment, the interviewee's family has four healthcare concerns that include hypertension, cancer, and like many African American families, diabetes.
Diabetes is a significant problem among the African American community. According to Marshall (2005), genetic traits are among the contributory factors to the high cases of diabetes among the African American communities. As reflected in Tonny's paternal genogram, his family has a history of diabetes. The disease has appeared thrice within the previous four generations. His grandfather, who immigrated to the United States succumbed to diabetes. Although his parents have so far been spared from the disease, his aunt Clair was not. Based on the health assessment, Tonny is quite isolated from most members of his family. It is also important to note that only the family tree that follows his grandfather Owen are the ones that live in America. The others from his granduncle and grandaunt, still live in Africa. It goes to show that the relationship between there family and diabetes is one that extends beyond the family borders. The genogram only follows the paternal side, and the nurse would be unable to tell if there is some contribution from the maternal line of the family. Based on the genogram, the most recent victim of diabetes is Tonny's only brother, Luke. Once more, the narrowed down family information available in the genogram is a limiting factor as it is not clear whether the family history of diabetes proceeded to the fifth generation, or it decided to skip.
On the other hand, it is observable that the family has a case of hypertension, which may or may not has been as a result of diabetes. Joann (2018) states that there is a significant relationship between diabetes type 2 and hypertension. The reason for such a link is still unknown to medical practitioners, but scientists believe it may be related to conditions such as obesity, high inactivity, chronic inflammation and consuming a diet that is high in fat and sodium. Diabetes type 2 is the most common and a significant number of the diabetic population, are not aware that they are suffering from the condition. Therefore, it very possible that Tonny great grandfather was suffering from type 2 diabetes mellitus and was unaware of the existence of the disease. Unlike diabetes, hypertension has skipped two family generations up to the fourth generation. Tonny; s sister, Pam, has high blood pressure. The heritage assessment form handed out to Tonny indicates that he visits his family members less than once a year. There is the probability that his hypertensive sister could also, but there no way to verify that information at the moment.
Finally, the genogram has one case of cancer that took the life of Tonny's uncle. Tonny's uncle died from liver cancer, and it is the only reported case of the disease in the four generations in the genogram. Despite being an isolated case, it is still crucial for providing health information concerning Tonny's family health needs.
Based on the genogram, there are at least 3 three health risks to which Tonny and his family could potentially face. The first one is diabetes, which is the most prevalent disease in the family. Diabetes seems to transcend every generation of the family and is likely to affect Tonny's children if it hasn't done so already. Then there is hypertension, which although it's not as prevalent as diabetes, it still poses a high risk due to its significant relationship with diabetes. Finally, there is liver cancer, which took the life of one of the family members within the four generations leading to Tonny.
The genogram, combined with the health assessment provides five health promotional teaching opportunities. The assessment findings have revealed the importance of knowing family's genogram as a way of identifying potential health risks that run through the family. The identification of a family's health risk is, therefore, an opportunity for health promotion. There is also health promotion and screening. According to Kumar and Preetha (2012), promotion through screening is one of the tools for conceptual approaches and strategies for health promotion in a population. The plan could be particularly useful for the diabetic community because most of them are unaware of their condition. There is also the family participation in the intervention process, which would create favorable conditions for the emergence of their skills and eventually behavior (Centre, 1970). For example, in this case, the health promotional plan needs to have room for the subject's participation to allow him to change his behavioral practices slowly. There is also the maintenance of a healthy lifestyle. For example, the health assessment reveals that the subject consumes large quantities of beef, which may not be suitable for his health. Finally, there is an action on risk factors. After identification of the risk factors, health promotion should focus on addressing them.
Health assessment is an integral part of nursing due to the information it reveals about the patient. Heritage assessment and genogram have been an essential part of the evaluation and are crucial for the identification of health risks. The genogram and health assessment for Tonny's family reveal that diabetes and hypertension are the primary health risks in the family. The assessment has also identified health promotional opportunities, especially in the areas of screening, action on risk factors, and the subject's participation in the creation of a health plan. The actions could go into improving health for the patients and the community.
Brown, C., & Stoffel, V., (2010). Occupational therapy in mental health: A vision for participation. Philadelphia, PA: F.A. Davis Company.
Centre, I. C. (1970, January 01). Health education for young people: Approaches and methods. Retrieved June 8, 2019, from https://www.ncbi.nlm.nih.gov/books/NBK7118/
Joann, J., (2018, February 16). The Relationship Between Type 2 Diabetes and High Blood Pressure. Retrieved June 8, 2019, from https://www.healthline.com/health/type-2-diabetes/hypertension
Kumar, S., & Preetha, G., (2012). Health promotion: An effective tool for global health. Indian Journal of Community Medicine,37(1), 5. doi:10.4103/0970-0218.94009
Marshall, M. C., (2005). Diabetes in African Americans. Postgraduate Medical Journal,81(962), 734-740. doi:10.1136/pgmj.2004.028274
Tavernier, D. L., (2009). The genogram: enhancing student appreciation of family genetics. Journal of Nursing Education, 48(4), 222-225.
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