Family Genetic History Form
NOTE: Please do NOT remove any of the text on this form. Fill it in and submit in its entirety to aid in its grading. Thank you.
Your Name: Date:
Your Instructor’s Name:
Purpose: This assignment is to help you gain insight regarding the influence of genetics on an individual’s health and risk for disease. You are to obtain a family genetic history on a willing, nonrelated, adult participant.
Disclaimer: When taking a family genetic history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do NOT need to disclose information that they wish to keep confidential. If the adult participant decides not to share information, please write, “Does not want to disclose.” If you find that the client is unwilling to answer several questions, you will need to find another client who can provide more information.
Directions: Refer to the Family Genetic History guidelines and grading rubric found in Doc Sharing to complete the information below. This assignment is worth 150 points.
Type your answers on this form. Click Save as and save the file with the assignment name and your last name, e.g., “NR305_Family_Genetic_History_Form_Smith”. When you are finished, submit the form to the Family Genetic History Dropbox by the deadline indicated in your guidelines. Post questions in the Q & A Forum or contact your instructor if you have questions about this assignment.
1: Family Genetic History (60 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. Each description should include the following information: first name, birthdate, death date, occupation, education, primary language, and a health summary, including any medical diagnoses. An example is below.
| Family Member | Description |
| Paternal grandfather First and last initials: | RL |
| Birthdate: | 1921 |
| Death date: | 1981 |
| Occupation: | Retired as a coal miner |
| Education: | 6th grade |
| Primary language: | English |
| Health summary: | He was diagnosed with chronic lung disease, diabetes, and hypertension. He died from a heart attack. |
| Paternal grandmother First and last initials: | ML |
| Birthdate: | 1932 |
| Death date: | 1998 |
| Occupation: | House wife |
| Education: | Does not want to disclose |
| Primary language: | English |
| Health summary: | Diagnosed with chronic lung disease from smoking cigarettes. Died from heart failure. |
This example points to common problems among this generation on both sides of the family. Consider the implications this would have for the adult participant’s health if these were that person’s family members.
Complete the family genetic history form below. Indicate if any information is N/A (not applicable) or unknown. Indicate any information the person did not want to disclose by noting “Does not want to disclose.”
| Family Member | Description |
| 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 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: | |
| Health summary: |
2. Evaluation of family genetic history (30 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 diabetes, hypertension, or cancer, what might that mean for the adult participant’s future health?
3. Planning for future wellness (45 points)
Plan changes based on the evaluation of the adult participant’s family’s health history that will promote an optimal level of wellness both now and in the future. Include what information you would provide to the adult participant regarding the results of the family genetic history.
Guidelines and Grading Rubric
Purpose
This assignment is to help you gain insight regarding the influence of genetics on an individual’s health and risk for disease. You are to obtain a family genetic history on a willing, nonrelated, adult participant.
Course Outcomes
This assignment enables the student to meet the following Course Outcomes.
CO #3: Utilize effective communication when performing a health assessment. (PO #3)
CO #5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO #6)
Points
This assignment is worth a total of 150 points.
Due Date
The Family Genetic History Assignment is to be submitted at the end of Week 2. There is a MS Word document form in Doc Sharing that you need to download, fill in, and submit to the Family Genetic History Dropbox by Sunday, 11:59 p.m. MT at the end of Week 2. Post questions to the weekly Q & A Forum. Contact your instructor if you need additional assistance. See the Course Policies regarding late assignments. Failure to submit your paper to the Dropbox on time may result in a deduction of points.
Disclaimer
When taking a family genetic history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do not need to disclose information that they wish to keep confidential. If the adult participant decides not to share information, please write, “Does not want to disclose.” If the client fails to disclose answers to several items, you will need to find another client who is willing to share.
Directions
- Refer to the examples in Chapter 4 of your textbook that discuss development of a genogram.
- Download the NR305_Family_Genetic_History_Form from Doc Sharing. You will document the adult participant’s family genetic history using this MS Word document.
- Complete the family genetic history using the information that the adult participant is willing to share with you. The focus of this course is on the normal healthy individual so your paper does not need to contain much medical/nursing detail. Refer to your textbook or the Internet to learn what impact the family’s health history may have on the adult participant’s personal state of wellness both now and in the future.
- Save the completed form by clicking on Save as and add your last name to the file name, for example, NR305_Family_Genetic_History_Form_Smith.
- Submit the completed form to the Family Genetic History basket in the Dropbox by Sunday, 11:59 p.m. MT at the end of Week 2. Please post questions about this assignment to the weekly Q & A Forums so the entire class may view the answers.
This paper does not require APA formatting, but you are expected to write clearly and use proper grammar and spelling.
Developing a pictorial genogram using symbols to identify certain relationships (e.g., divorced, sibling, deceased, etc.), may provide more insight, however, drawing may be difficult to accomplish with MS Word, therefore you are not expected to use symbols, lines, or other drawing elements. Instead, describe the relationships among the various people in the adult participant’s family’s genetic history. Remember, the goal is not to learn how to draw with Word, but to gather information about the family and recognize its significance to the adult participant and that person’s health.
Grading Criteria
| Category | Points | % | Description |
| Family Genetic History | 60 | 40 | 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. |
| Evaluation of Family Genetic History | 30 | 20 | Evaluate the impact of the family’s history on the adult participant’s health. For example, if the mother and both her sisters have diabetes, hypertension or cancer, what might that mean for the future health of the adult participant? |
| Planning for Future Wellness | 45 | 30 | Plan changes based on the evaluation of the adult participant’s family genetic history that will promote an optimal level of wellness both now and in the future. |
| Scholarly Writing | 15 | 10 | Use proper grammar, spelling, and medical language. |
| Total | 150 points | 100% | A quality paper will meet or exceed all of the above requirements. |
Grading Rubric
| Assignment Criteria | A Outstanding or highest level of performance | B Very good or high level of performance | C Competent or satisfactory level of performance | F Poor or failing or unsatisfactory level of performance | |
| Family Genetic History (60 points) | All required criteria included; no errors (57–60 points) | Three or four generations included in the history; information is provided about each person but lacks detail about relationships and/or health information (55–56 points) | Two generations included; no relationships described or no health information provided (51–54 points) | No history or fewer than two generations included; no relationships described or no health information provided (0–50 points) | |
| Evaluation of Family Genetic History (30 points) | Evaluation complete; thoroughly covers all required elements (27–30 points) | Evaluation addresses only two of apparent health risks within the history (23–26 points) | Evaluation addresses only one of apparent health risks within the history (19–22 points) | Evaluation missing (0–18 points) | |
| Planning for Future Wellness (45 points) | Plan for wellness incorporates all areas of risk within the family genetic history, demonstrating critical thinking; answered all required questions (42–45 points) | Plan for wellness demonstrated basic understanding of the family genetic history; answered all but one of the required questions (39–41 points) | Plan for wellness demonstrated basic understanding of the family genetic history answered two of the required questions (36–38 points) | Plan for wellness does not demonstrate basic understanding of the family genetic history or is missing (0–35 points) | |
| Scholarly Writing (15 points) | No grammar, spelling, or syntax errors. Writes in complete sentences. (15 points) | No more than two errors of any type (14 points) | Three or more errors of any type (13 points) | APA, grammar, spelling and/or punctuation contain multiple errors (0–12 points) | |
| Total Points Possible = 150 points | |||||
Answer Preview
The participant is currently seen to be in very good health but there is need to be cautious considering the family that he is from. For the mother and father, they were both considerably healthy…
(1525 Words)