Increasingly nursing is recognizing the significance of the family to the health and well being of individual family members (wright &Leahey, 2000). Hatrick (1998) suggests family nursing in undergraduate nursing education will provide nurses with theoretical and practical skills to work effectively with families. This paper will demonstrate the assessment of one family using the Calgary Family Assessment Model (CFAM) as well as the Calgary Family Intervention Model (CFIM). The CFAM will provide information on the structural, developmental and functional components of the family. The family’s strengths and weaknesses are identified, and the role of a community resource in this family’s life is described. This discussion will demonstrate the relationship these concepts have on health and nursing in the family. All member of the family interviewed for this assignment agreed to participate but their names have been changed to ensure confidentiality.
The Calgary Family Assessment Model
The CFAM is an integrated conceptual framework developed by Wright and Leahey for use when interviewing and making assessment of families. The CFAM consists of three major categories: structural, developmental and functional. Each category contains its own subcategories that may be relevant or appropriate depending on the family being assessed. This assessment focuses on the interaction among all of the individuals withing a family.
Structural assessment aims to identify who is in the family, relationships among family member and those outside the family, and the family’s context. (Wright and Leahey, 2000). The Smith family is a white single parent family consisting of Heather and her two year old daughter Brianna. Brianna’s father has not lived with them for a year and a half and currently lives two hours away, as do Heather’s family. Brianna has weekly contact on the phone with her father and stays with him one weekend a month.
Heather’s parents divorced when she was thirteen. Her father has remarried and has three daughters from his second marriage. There is no rivalry between Heather and her half-sisters. Heather’s mother and elderly grand-parents have weekly contact with the Smiths and are readily available to them both. Support may be financial, emotional or help with childcare. Heather described the relationship with her grandparents as very special. Heather sets the family boundaries at present and feels confident they both have support thru friends and family to discuss any problems that may occur.
Heather and Brianna belong to many subsystems within their own family. They both belong to an only child subsystem, a female subsystem and a parent child subsystem. There are larger systems this family has meaningful contact with. These include Heather’s work, Brianna’s daycare, the local health center and the gym. These subsystems all contribute in some way to the health and well being of this family (Wright and Leahey, 2000). As a single mother Heather encompasses the traditional gender roles of both male and female. This involves child-rearing and nurturing as well as financial and disciplining roles.
The Smiths moved to the city a year ago hoping to improve choices and opportunities for themselves. Heather works 20 hours a week in a hotel and Brianna is in subsidized daycare 25 hours a week. They live in a large renter house and have a large dog for security. With one income and increased cost of living in the city, the Smiths remain in a lower socioeconomic class. Heather hopes to attend university in the future, but accepts it will be a struggle to meet the rising costs of housing, education and travel for herself and Brianna as a single parent family. Heather expressed no religious or spiritual beliefs that she and Brianna maintain.
The focus of this category is on the developmental life cycle stages of the family including the emotional process and changes within family roles (Wright and Leahey, 2000). The Smiths are presently in stage three of the family life cycle, which focuses on families with young children (Santrock, 1997). However, this is relevant to a middle class North American family and assumes there are two parents. The CFAM does not clearly define a life cycle for a single parent family. This model fails to consider differing lifestyles, cultures, population and economics that may affect a family. This highlights a possible need for an updated model that can be adapted to any family situation.
There are six stages in this developmental framework. Theses include leaving home, marriage, families with young children, families with adolescents, entries and exits from family system and families in later life. Within each stage there are specific tasks the family undertakes. At stage three these are, making space for children, joining in household tasks and activities and involving extended family in parenting and grand parenting roles (Wright and Leahey, 2000).
Heather’s life changed considerably after the birth of her daughter. She adjusted her life to meet the responsibilities and needs of parenthood. Brianna’s father found the adjustment in lifestyle difficult resulting in their separation. Heather continues to provide for Brianna thru parenting, financial support and performing household tasks. Brianna’s father pays weekly payments that are included in Heather’s income. Both parents, contribute to Brianna’s development as a person.
Extended family members provide emotional support and some financial support to Heather and Brianna. Heather feels she has a closer bond with her parents and grandparents now. She encourages Brianna’s involvement with her father. This has involved a realignment of Heather’s relationship with him to provide healthy role models for Brianna. Brianna spends more time with her mother, thus they have a stronger relationship then she does with her father who is under involved with Brianna at present. Heather hopes this will improve.
Functional assessment focuses on interaction and communication among family members. Two main aspects are instrumental and expressive functioning. Instrumental functioning refers to the routine activities of daily living (Wright and Leahey, 2000). Much of this is attended to by Heather. As Brianna’s main care giver she is responsible for ensuring her own and her daughter’s food, hygiene and sleep requirements are met. If Heather is working or unwell she ensures Brianna’s instrumental needs are met by a friend or extended family member. She encourages Brianna’s independence with her own self care such as brushing her teeth with a little help, to remove some pressures of being a solo parent.
Expressive functioning focuses on patterns of interaction among family members through various means of communication (Wright and Leahey,2000). Heather stated she feels able to express her feelings with Brianna. This was helped by a parenting course and anger management where Heather learnt new ways of expressing her emotions. They showed Heather the impact of circular communication patterns and how they influence relationships. She now uses therapeutic communication skills such as time out and eye contact with Brianna. Use of nonverbal communication was evident throughout the interview. Brianna would watch her mother’s body language and facial cues for approval. If Brianna wanted attention she used a combination of touch, speech and eye contact with Heather.
The Smith’s expressed effective problem solving techniques. Heather discusses any problems with a close friend. For further support or advise she approaches teachers at Brianna’s daycare, her family, doctor or public health nurse. A possible cause is identified and a plan of action implemented. Heather and her friend later evaluate the situation and seek more help if necessary. Heather stated she finds this effective and this removes some of the pressure of being a the main care giver and a first time parent.
As a single parent Heather’s role extends beyond being a mother. She appreciates the influence her role may have on Brianna and encourages the relationship with her father and extended family so she can experience a variety of social influences. Since third move to the city, Heather feels the parent child bond with Brianna has strengthened. This is expressed through showing affection, verbally and non verbally as well as with praise for each other. This bond is likely to be stronger as they share a mother child bond and live together away from extended family.
Heather uses mostly traditional medicine and trusts the advice of her doctor and public health nurse. Having community Based services and easy access to health services for Brianna and herself makes this the perfect option. Heather occasionally uses alternatives from a health shop for herself, but finds this way to expensive and as a result her choice is limited.
Supportive relationships and adequate social networks are beneficial to health and well being. This is highly relevant to the Smiths who have a wide network of friends, extended family and social agencies. Friends and family provide emotional and sometimes financial support. Brianna’s daycare encourages her educational development and gives Heather the opportunity to work. They also help Heather with parenting education and nutritional advice. The local medical center attends to the Smith’s physical needs and offers education and advice on health issues such as smoking. All of these support systems contribute to the health and well being of the Smith family.
It was evident from the expressive functioning category of the CFAm that the smiths use a variety of communication skills. This is important due to the developmental age of Brianna who may express feelings and emotions in different ways to a grown child or adult. Heather attended a parenting course that aided communication skills to improve their relationship. These skills assisted Heather in completing and anger management course. Heather is now more able and confident in expressing her family’s health needs and requirements to benefit them both.
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