Family Genetic History (Nursing program)

Name Family Genetic History Intake Form Purpose The purpose of this assignment is to understand the implications of genetics on an individual’s health and potential risk for disease. You are to obtain a family genetic history on a non-related adult participant. Important – When taking a family genetic history it is very important that the information be accurate. Please inform your participant that they have the right to refuse to share information with you. If the adult participant exercises this right, please write in the appropriate spot “Does not want to disclose information.” Directions Please refer to pages 52-54 in your textbook for how to obtain a family history. The guidelines and grading rubric for this assignment will be found in your assignment folder. This assignment is worth 11% of your course grade or 150 points. Family Genetic History (50 points) Develop a family genetic history that includes, at a minimum, three generations of your chosen adult’s family, including grandparents, parents, and the adult’s generation. If the adult has any children, include them as the fourth generation. **PLEASE NOTE: This assignment is to reveal the potential impact of the family’s health on the adult participant. You do not need to identify anyone who is not biologically related to the adult except for a spouse or significant other. You do not need to use symbols, but instead write brief descriptions for each person using the chart below. Each description should include the following information: first name, birthdate, death date, occupation, education, primary language, and a health summary, including any medical diagnoses. Indicate if any information is not applicable or unknown. Remember if the individual does not want to disclose the information please write “Does not want to disclose” in the appropriate line. Here is an example of part of a completed form: Family Member Paternal grandfather First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Paternal grandmother First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Description NS 1920 1979 Retired as a truck driver 6th grade English He was diagnosed with heart disease, diabetes, and hypertension. He died from a heart attack. DT 1928 1988 House wife Does not want to disclose English Diagnosed with chronic obstructive pulmonary disease, heart disease and obesity. Died from heart failure. Name Genetic History Form Family Member Paternal grandfather First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Paternal grandmother First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Father First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Father’s siblings (write a brief summary of any significant health issues) Maternal grandfather First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Maternal grandmother First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Mother First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Mother’s siblings (write a brief summary of any Description Name significant health issues) Adult Participant First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Adult participant’s siblings (write a brief summary of any significant health issues) Adult participant’s spouse/significant other First and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Adult participant’s children (write a summary for each child, up to four children)

Child #1 first and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Child #2 first and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Child #3 first and last initials: Birthdate: Death date: Occupation: Education: Primary language: Health summary: Child #4 first and last initials: Birthdate: Death date: Occupation: Education: Primary language: Name Health summary: 2. Evaluation of family genetic history (45 points)

Evaluate the impact of the family’s genetic history on your adult participant’s health. For example, if the adult participant’s mother and both sisters have depression, hypertension, or cancer, what might that mean for the adult participant’s future health? 3. Planning for health maintenance/promotion (50 points) Plan changes based on the evaluation of the adult participant’s family’s health history that will promote an optimal level of health now and to promote health in the future. Provide evidence for health promotion activities (consider Healthy People 2020 goals, health.gov and other types of evidence) Include what information you would provide to the adult participant regarding the results of the family genetic history. Family Genetic History Guidelines and Grading Rubric Purpose The purpose of this assignment is to understand the implications of genetics on an individual’s health and potential risk for disease. You are to obtain a family genetic history on a non-related adult participant. Course Outcomes

This assignment meets the following course outcomes: 1. Examine communication patterns used in the care of culturally diverse individuals and families (PO 1) 2. Analyze evidence-based resources and scientific principles to support clinical decision making. (PO 3) 5. Utilize nursing judgment in development of individualized plan of care incorporating a holistic framework across the health-illness continuum (PO 5) 7. Integrate professional awareness of the effect of genetics, culture and healthcare disparities on the health of individuals and families. (PO 9) 8. Demonstrate scholarly written communication supported by current evidence (PO-9) Points This assignment is worth 15% of your course grade or 150 points. Family Genetic History (Nursing program)

Due Date The Family Genetic History Assignment is to be submitted by Sunday 11:55 pm ET in Week 3. Please see the course syllabus regarding the policy for late assignments. Any questions or concerns should be directed to your instructor via email within your course. Important Disclaimer Important – When taking a family genetic history it is very important that the information be accurate. Please inform your participant that they have the right to refuse to share information with you. If the adult participant exercises this right, please write in the appropriate spot “Does not want to disclose information.” Directions 1. Refer to Chapter 4 pp 52-54 in your Jarvis textbook that discusses family history. 2. Download the Family Genetic History Form located in the resources file of your course. 3. Complete the family genetic history using the information from your non-related adult participant. The focus of this assignment is on health and health risk therefore you do not need to include nursing/medical detail. Please be sure to read chapter 4 or the 1 assigned readings in Week 2 to consider the potential impact of genetics and family health history on an individual’s state of health and health risk. 4. This paper does not require APA format except for a title paper. However, it is expected that the student will use proper writing and grammar techniques. References are to be documented in APA format. 5. If it provides more insight for you, you may use the draw function in word to demonstrate the relationships among the family genogram. However, this is not the focus of this assignment. Rather, the student is expected to gather health information and analyze potential health risk for the participant who provided the information. Grading Criteria Criteria Family Genetic History Points 50 5 % Explanation Develop a family genetic history that includes the adult participant’s grandparents, parents, the adult participant, the adult participant’s spouse or significant other, and any children that the adult participant may have.

You do NOT need to use symbols or other drawing elements, but instead describe each person mentioned and their relationships. Evaluate the impact of the family’s genetic history on your adult participant’s health. For example, if the adult participant’s mother and both sisters have depression, hypertension, or cancer, what might that mean for the adult participant’s future health? Evaluation of Family Genetic History 45 4.5 Planning for health maintenance/promotion 50 5 Plan changes based on the evaluation of the adult participant’s family’s health history that will promote an optimal level of health now and to promote health in the future. Provide evidence for health promotion activities (consider Healthy People 2020 goals, health.gov and other types of evidence) Include what information you would provide to the adult participant regarding the results of the family genetic history. Writing Style 05 0.5 Use proper grammar, syntax and spelling with appropriate medical terminology Total 150 15 2 Assignment Criteria A (135- 150 points) Exemplary All required criteria included; no errors (45-50 points) B (120 – 134 points) Accomplished Three or four generations included in the history; information is provided about each person but lacks detail about relationships and/or health information (40-44 points) C (105 – 119 points) Developing Two generations included; no relationships described or no health information provided (35-39 points) F (0 – 104 points) Beginning No history or fewer than two generations included; no relationships described or no health information provided (0 – 34 points) Evaluation of Family Genetic History 45 points Evaluation complete; thoroughly covers all required elements (41-45 points) Evaluation addresses only two of apparent health risks within the history (36-40 points) Evaluation addresses only one of apparent health risks within the history (31-35 points)

Evaluation missing (0 -30 points) Planning for health maintenance/promotion 50 points Plan for health promotion incorporates all areas of risk within the family genetic history, demonstrating critical thinking; answered all required questions. Provides evidence to support plan. (45-50 points) No grammar, spelling, or syntax errors. Writes in complete sentences. APA format where appropriate. (5 points) Plan for health promotion demonstrated basic understanding of the family genetic history; answered all but one of the required questions (40-44 points) Family Genetic History (Nursing program)

Plan for health promotion demonstrated basic understanding of the family genetic history answered two of the required questions (35-39 points) Plan for health promotion does not demonstrate basic understanding of the family genetic history or is missing (0-34 points) No more than two errors of any type (4 points) Three or more errors of any type Three or more errors of any type Family Genetic History 50 points Writing style 5 points Total points = 150 3 … Family Genetic History (Nursing program)