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Introduction
The family usually provides an individual with emotional and social relationships in the most important moments of their life. It is a group of people bounded not only by their kinship but also by the other relations and bonds made to participate in the lives of each other. Still, in the case of chronic disease, the members of a particular family might be not prepared to cope with the problems caused by the suffering of one of their relatives. It is generally recognized that different values, backgrounds, and beliefs of the families make them respond differently to the consequences of chronic disease.
Involvement of the family in the process of care of a family member with chronic illness is crucial to secure a decent quality of life to a sick person. Therefore, a nurse practitioner should pay attention to the diversities of various families and use this information to provide better health care to a patient. It is advisable to utilize Calgary Family Assessment Model to investigate external and internal relationships in a family, as well as its strengths and weaknesses. For this assignment, a family with a member who has a chronic disease was interviewed. The names of the family members were changed to keep their privacy.
Structure of the Family
It is generally recognized that the Calgary Assessment Model helps to organize information and can be used as a template to make a family assessment. Some researchers state that the Calgary family assessment model is focused on assessing developmental, structural, and functional levels of family life (Sigurdardottir, Svavarsdottir, & Juliusdottir, 2015). Thus, this model includes three categories such as family structure, family developmental stage, and its functional status. It also uses such instruments as genogram to provide a graphical representation of the bonds and medical problems in a selected family.
Each family has an internal and external structure with a medical history of the family members, as well as family context including sexual orientation, ethnicity, race, social class, religion, and environment. It is necessary to indicate relations between the family members to develop knowledge and skills in making necessary interventions. Some researchers also confirm that the development of collaborative, nurse-family relationships in the healthcare setting and community is critical to improving health outcomes (Smith, & Jones, 2016, p. 204).
The family that participated in the given assessment includes a mother Janet and her son Nick aged ten, who suffers from diabetes type I. Janet and her husband Henry are divorced. Henry has problems with alcohol addiction. He has no job and was never very supportive. Janet forbids him to communicate with their son because she believes that the father might have a bad influence on him. She believes that the chronic disease their son suffers from is his fault. Nick has to take medicines regularly to control the level of sugar in the blood. Despite his illness, Nick is a very advanced child and likes to study, although his mother is worried that he might not receive appropriate assistance in managing his disease at school. Janet works as an IT specialist and earns well enough to ensure her son has the best medical care possible.
Thus, the analysis of the internal structure of the family shows that Janet appears to be the main caregiver. Some researchers state that the role of the caregivers causes impacts that might be negative, especially if there is no proper guidance from a health care professional (Da Costa et al., 2016). Thus, it is crucial for Janet to receive some assistance from a nurse practitioner to improve her sons quality of life. It is also important to make the rules of the family flexible. For example, Janet has to give his son more freedom because now she tends to control his life.
The external structure of the family usually includes the family members from a current generation and the family of origin, as well as the larger systems. In this family, the grandfather was healthy but died in a car accident, and the grandmother has no any chronic diseases although she is elderly. Janet has a sister whose name is Julia. She is two years older and occupied as a housekeeper. Julia is married to Andrew who works as an accountant. In her adolescence period, Julia used to suffer from depressions and received special treatment. Now she is happy in marriage and has two children, Kim aged twelve and Frank aged seven. They do not have any specific problems with health. The children are in strained relations because of the difference in age and sex.
Janet has no time to communicate with the neighborhood, although they live in a prosperous suburb. She is focused on her son and does not have any romantic relationship at the moment. Her son has some friends in school, but he cannot communicate with them a lot because his mother prefers him to stay with her on the weekends.
The family context can be defined as its background. The family under assessment is Caucasian American. Janet and Julia state that they have Irish roots. They do not have any individuals with homosexual or bisexual orientation in the family. All the family members are Catholic and find great relief in visiting the church and leading spiritual life. They celebrate major Catholic holidays such as Christmas and Easter together. The family belongs to the middle social class. Adult members of the family have a stable and rather high income. Janet and Andrew can be referred as white collars, their environment consists of the people with the similar interests and income as well. They live in a prestigious city suburb, and their children attend a respective school. Janet owns a four-bedroom house. She tends to stay in the city to be closer to the family of her sister who is emotionally connected to her.
Family Developmental Stage
The developmental stage of the family provides life cycle stages and identifies the developmental tasks appropriate for the stage the family entered. It is possible to say that Janet, Julia, and her husband have entered the senior stage because they are in their forties and have children who will become teenagers soon. Some researchers believe that the tasks for families in later life are typically described as dealing with ones own and couple functioning in the face of physiological decline, exploring new familial and social role opportunities (Leahey, & Wright, 2016, p. 453).
Janet still has an opportunity to get married again, which means she might have more children if she finds a proper couple in the nearest future. Her previous life cycle stage was spoiled with the bad experience of having a husband with alcohol addiction, and now she is careful in her choices. Janet does her best in meeting psychological and physical needs of her sick son focusing on him. She also has strong emotional bonds with her sister. Thus, it is possible to state that the developmental tasks appropriate to the stage of the life cycle she entered have not been fully met.
Attachment bonds between the key family members can be described as warm and friendly. Janet and her son have a strong emotional bond as well. Nick is in good relations with Kim, and they both dislike her brother.
The relationships between the members of the family and their medical history are shown at the genogram below. This genogram is a visual representation of the information about the family provided in the paper. The basic purpose of it is to assist family interventions, assessment, and planning.
Family Functional Status
The functional status of the family shows how the family members describe their relations and communication with each other. The expressive functioning includes such aspects as emotional, verbal, non-verbal, and circular communication.
The emotional communication of the family includes Janet being friendly and open with her sick son and cold and distant to her former husband who is not allowed to visit the son. Nick appears to remember his father rather vaguely; he never asks a mother about him as he knows that she dislikes him. Janet is also emotionally bonded to her sister.
Janet believes that direct verbal communication is usually understood by her son. Although, sometimes she has problems in dealing with him when it comes to his association with friends. Janet also has non-verbal communication with her son. She notices when he is tired and upset or feels not well. She knows all his bad habits, and the fact that he might forget to take medicine or suddenly feel sick makes her worry. Thus, she always tries to remind him of it and keep him close. She even bought him a cellphone to control him when they are apart. The circular communication between Janet and her son might be identified as Janets constant attempts to protect the boy from any harm. Sometimes, his mothers behavior irritates Nick, especially when he wants to communicate with friends. Thus, he is burdened with the fact of his chronic disease. Some researchers state that in this case some programs of cognitive-behavioral intervention might help because they are focused on teaching to use the coping strategies and are able to prevent children who suffer from chronic illness from a number of psychosocial problems (Sigurdardottir, Garwick, & Svavarsdottir, 2017).
Nevertheless, the family solves the problem of chronic disease in a pro-active way. The mother plays important role in managing her sons disease. She has the power to influence the process and her sons state of health. The son starts to understand the disadvantages of his situation as well. The family is very spiritual and believes that God will help them manage the illness as he helped Janets sister to manage her depressions, although they accept that diabetes is a life-long burden.
Conclusion
The family who participated in the assessment contained a boy with a chronical disease and his mother who is divorced and has a strong emotional bond with her sister. The mother appears to be concentrated on her child. The given assessment emphasized the aspects a nurse should pay attention to when visiting various families and providing them health care. It is believed that family-level interventions for families experiencing illness that addressed the relationship between family members seemed to be more helpful to family members than educational interventions that focused solely on information (Bell, 2015, p. 105). Thus, it is crucial to realize the relations between the family members to provide better health care.
References
Bell, J. M. (2015). Growing the science of Family Systems Nursing: Family health intervention research focused on illness suffering and family healing. In F. Duhamel (Ed.), Families and health: A systemic approach in nursing care (3rd ed., pp. 102-125). Montreal, Quebec, Canada: Chenelière Éducation.
Da Costa, S. F. G., de Oliveira, R. C., da Silva Monteiro, G. R. S., Fernandes, M. A., Zaccara, A. A. L., da Nóbrega Morais, G. S.,& da Silva Abrão, F. M. (2016). Family structure assessment of patients in palliative home care. International Archives of Medicine, 9(230), 1-12.
Leahey, M., & Wright, L. M. (2016). Application of the Calgary Family Assessment and Intervention Models: Reflections on the reciprocity between the personal and the professional. Journal of Family Nursing, 22(4), 450-459.
Sigurdardottir, A. O., Svavarsdottir, E. K., & Juliusdottir, S. (2015). Family nursing hospital training and the outcome on job demands, control and support. Nurse Education Today, 35(7), 854-858.
Sigurdardottir, A. O., Garwick, A. W., & Svavarsdottir, E. K. (2017). The importance of family support in pediatrics and its impact on healthcare satisfaction. Scandinavian Journal of Caring Sciences, 31(2), 241-252.
Smith, P. S., & Jones, M. (2016). Evaluating an online family assessment activity: A focus on diversity and health promotion. Nursing Forum, 51(3), 204-210.
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