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 Category 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. Developmental Category 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 Category 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. Family Strengths Support Systems 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. Communication 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. Nutrition Eating habits based on moderation and variety can help maintain and improve a person’s health.
Heather values the importance of nutrition through er own reading, information from Brianna’s daycare and the public health nurse. She ensures Brianna has protein and calcium to assist her growth and carbohydrates for fibre and energy. They eat regular servings of fresh fruits and vegetable. Heather is aware of the high incidence of osteoporosis and iron deficiency in women and has increased her intake of calcium and red meat to account for this. It is hoped healthy eating in childhood will help Brianna make healthy choices when she grows up and is living on her own. Weaknesses
Smoking Heather has smoked for seven years. She finds it “comforting” and it “helps to relieve stress. ” Studies have shown people in lower socioeconomic groups are more likely to smoke then those of high social class. Heather is aware of the financial and health consequences of smoking and hopes to give it up in the near future with the help of the nicotine patches available at a reduced cost due to her insurance plan from work. Knowing the harmful effects of passive smoking on Brianna and her own health, Heather is determined to give up this unhealthy and expensive habit.
Financial The smiths are in a lower socioeconomic class due to their reliance on social services for help with living costs. Although Heather works part time she loses some of her accommodation supplement as a result and has to pay part of Brianna’s daycare costs. Their move to the city has meant increased housing costs and the cost of education for Brianna greater, making their choices limited. Community Resource The Elspeth Reid Family Resource Center (ERFRC) is an important community resource for the smith family.
The center offers, parenting classes, 2 hours of free day care and a thrift store and many other services for families of all different types. They provide family support, early childhood education and care, family counseling and parenting education. Brianna attends daycare five days a week while Heather is at work. This is run by two registered teachers and to teaching assistants. This community resource contributes to the health and well being of the Smith’s by providing education that encourages a healthy lifestyle, incorporating physical, mental and social aspects of health. Critical Social Theory
Critical social theory was developed in the 1920s by a number of philosophers, at the Frankfurt School in Germany (Boychuck Duchscher, 1999). This theory provides a philosophical framework that aims to liberate individuals to see the conditions in society that constrain their participation in social interaction. It has been identified that there are three practical elements of critical social theory, which are enlightenment, empowerment and emancipation. These elements are useful for nursing practice as a pragmatic approach is required. The theory suggests critical social theory can only be achieved when all three elements are completed.
Enlightenment involves encouraging individuals to recognize social conditions and constraints that can influence their social reality (Boychuck Duchscher, 1999). The Smiths have utilized the information on nutrition, parenting and safety. This education has encouraged them to acknowledge the importance of physical, emotional and social factors on their health and well being. Accessing and analyzing this information is the first step towards empowerment. Through critical examination of their reality the Smiths can empower themselves to make lifestyle changes that influence their health outcomes.
Heather recognized the need for enlightenment on parenting and communication. Now she has the information and support, she is able to make changes that benefit her family and can move towards emancipation. Emancipation is aimed at freedom from oppression that influences people’s lives. Through the process of enlightenment and empowerment the responsibility in relation to their health needs. They have actively made changes to improve their nutrition and communication, thus influencing their health and well being. Calgary Family Intervention Model
The CFAM’s counterpart, CFIM provides a model for intervention after the family assessment has occurred. In this model, an intervention is described as action or activity a health car provider performs for or with a patent of family with the intent of causing a change (Wright and Leahey, 2000). Change in this respect, mans an alteration or support of behavior that promotes the ability to provide care for a family member. Each intervention in the model is used to produce changes in the family in the way they think, feel and respond (Wright and Leahey, 2000). Types of interventions used in working with families include: 1.
Commending strengths of the family or individual members. 2. Providing information and education. 3. Validating emotions. 4. Allowing them to share the experience of the illness. 5. Encouraging family support. 6. Encouraging members to provide care for the patient. 7. Encouraging respite or relief from car responsibilities when needed and 8. Maintaining family rituals (Wright and Leahey, 2000). Nursing Diagnosis 1. Potential for Social Isolation Related to Care giver stress as evidenced by decreased financial ability to arrange for alternate childcare and distance from family. 2. Increasing utilization of family and community resources.
Interventions This family seems to function more in the Behavioral domain of family functioning because Heather likes to do things and get out and acquire information that may help her in one way or another There are many possible interventions for the nursing diagnosis of Potential for social Isolation. Some interventions include informing Heather of some community activities such as the WIN program where she can meet other parents and child care is provided for the duration of the meeting this could also help with financial aspect too because the WIN program offers a small monthly allowance for groceries or what ever it’s needed for.
Encourage Heather to socialize with coworkers at work and arrange a night out every couple of weeks or so. Encourage family visitations and participation in childcare more often. There are also several interventions for the diagnosis of Increasing utilization of family and community resources. They include suggesting ways to conserve resources or to expand resources through sharing with other families or bartering time and resources. Also by discussing community resources with family to help them know what is available and how to use them, the WIN program could also come into play here.
Interceptive Questions How you ask questions during the interview are extremely important because you don’t want to lead the person on, so using a variety of questions to help you get the information you need is usual a good way of getting accurate information. So examples of different types of questions are as follows: Difference Question 1. Who’s the best in your family to come to your aid when you need it? 2. When you were first divorced and a now a single parent what did members of you family do to help make things easier on you.
Behavioral Effect Question 1. What do you do when your ex-husband is either late picking up or dropping off Brianna? 2. How often do you go out with friends and who watches Brianna? Hypothetical/future-oriented Question 1. When do you think Brianna will start asking questions about your divorce? And what will you tell her? 2. Do you think that Brianna will blame herself for the divorce? If yes how will you deal with it? Triadic Question 1. If Brianna’s father were willing to take her more often then once a month do you think Brianna would want that? 2.
What do you think Brianna’s father needs to do, in order to be more involved in Brianna’s life? Conclusion. The increasing importance of family nursing incorporating the use of an assessment and intervention framework has been identified. The Calgary Family Assessment Model and the Calgary Family Intervention Model was used to describe all the different components of the Smith Family. These components acknowledged the extended family, subsystems, larger systems this family has contact with as well as interventions aimed at helping the family improve the quality of their lives if even only a little.
Their lower socioeconomic status and struggles as a single parent family were described in relation to their developmental life cycle stage, although the CFAM does not clearly define an appropriate cycle for this family. The Smiths used a variety of communication skills to interact with each other and these skills assist in the expression of feelings and problem solving withing the family. The Smith’s support systems, communication skills and nutrition were identified as strengths in relation to meeting their health needs. Smoking and finances were noted as possible weaknesses and interventions were addressed at these problems.
Brianna’s daycare was recognized as an important community resource for this family through its provision of support and education for Heather. The nurses’s role is relevant in family assessment to identify the need for educator, support and enlightenment on the effects of social influences on health. As identified with the Smiths, critical social theory is an important tool for nurses in recognizing, supporting and improving the health of families. Bibliography : References Boychuk Duchscher, J. E. (1999). Catching the wave: Understanding the concept of critical thinking. Journal of Advanced Nursing, 29(3), 577-583
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