Family Systems Nursing - Case Study Example

Running Head: Family Health Assessment Student’s Name: Instructor’s Name: Course Code and Name: University: Date Assignment is due: Family Health Assessment Introduction Today, the professional capabilities of nurses working with families always impact profoundly on the success of the management measures undertaken. It is necessary, however, for the family to participate in this care. Nurse need to encourage families to continue being a part of provision of health services (Wright & Leahey, 2005). Family nursing focuses on the family in conceptual, holistic and systematic terms (Friedman, Bowden & Jones, 2003). This means that the family should be focused on as a complete system and not as a separate assessment of each person (Lindgren, 2007). It is possible for numerous tools to be applied, although the Calgary family assessment Model (cfam) remains by far the most widely used global-based tool for nurses who are exploring various aspects of the lives of various families (Anderson, 2000). This paper is an assessment document that describes the composition of a Saudi family that is presently living in Australia. The assessment document will present the major issues that the family is facing. Thirdly, structural, functional, and developmental aspects of the assessment will be presented on the basis of the Calgary family assessment Model (cfam). Fourthly, the paper will address the strengths, strategies as well as the support system that the family uses in order to overcome the health issues that they are facing. Lastly the paper will dwell on a reflection on my experiences and the lessons I learned after working with this family. Description of the family The family under assessment is a medium-class family that is comprised of Ibrahim and Mays, the couple, and their two children, Yusuf and Ahmad. Ibrahim and Mays are 39 and 32 years respectively while Yusuf and Ahmad are 10 and 8 years respectively. Yusuf has already been diagnosed with bronchial Asthma while Ibrahim’s father suffers from a heart disease and he is on treatment. Ibrahim’s mother passed away last year of lung cancer. May’s parents are very highly educated. Therefore, they have always maintained their regular checkups at least every year. The parents came to Toowoomba in 2006 in order to continue with their Information Technology (IT) education at the University of Southern Queensland (USQ). This is the family that I will focus on in my study. Ibrahim is a high school teacher while Mays stays looks at their home, taking care after the children whenever they are not at school, particularly Yusuf, whose Bronchial asthma requires close monitoring. Major health issue and changes being experienced in the family The family has been experiencing significant causes of stress, particularly since the death of Ibrahim’s mother due to lung cancer. The stress has been aggravated by the diagnosis of Yusuf, who was found to have bronchial asthma. This is a chronic, hereditary disorder of the airways, whereby many cells and cellular elements have a critical role to play. After the mother’s death, Ibrahim and his wife were worried about their son’s fate, considering that both mother both suffered from a respiratory condition. Moreover, the heart condition that Ibrahim’s father suffers from is debilitating, and everyone is worried about the poor old man. The entire family appears to be overwhelmed by serious illnesses. Ahmad is worried about his elder brother as well as his grandfather. Ibrahim worries about his son’s condition and wonders if the child will ever be completely healed. Family structure and function The Calgary Family Assessment model (CFAM) was used in the process of assessing the developmental, structural, and functional aspects of Hossam’s family. Assessment of the Family structure and function using The Calgary family assessment Model (cfam) CFAM is a multidimensional framework that is integrated on the basis of systems, communication, cybernetics and change theoretical foundations that are influenced by biology of cognition and postmodernism (Teno & Clarridge, 2004). The three aspects of CFAM: structural, developmental, and functional aspects are critical to the understanding of CFAM (Bomar, 2008). The main benefit of using CFAM is that the tool has many categories, each of which is beneficial for purposes of obtaining data relating to the family, its communication, and interaction patterns. Nurses are normally required to use proper subcategory-based tasks when they in the assessment stage. Use of very many categories may make the nurse become overwhelmed by the information that he has collected, whereas use of very few subcategories can make the data collection task appear incomplete. Three groups of CFAM: Structural, developmental and functional Structural assessment Nurses are often required to examine the structure of the family from among other aspects, the structural perspective (Duhamel, 2004). In this stage, examination is done in the internal structure, external structure, as well as the context of the system (Tanyi, 2006). Only then can nurses claim to have carried out an inclusive assessment. The internal structure entails six subcategories, namely gender, composition of family, subsystems, rank order, sexual orientation, and boundaries (LeGrow, 2005). The internal structure 1. Family composition The family is composed of five members: the father, Ibrahim, 39 years old; the mother, Mays, 32 years old; their two sons: Yusuf and Ahmad, aged 10 and 8 years respectively, and Ibrahim’s father. Within the last year, the family has lost one of its members, Ibrahim’s mother, because of lung cancer. Gender In terms of gender, the roles of the mother and father are clearly cut out, mainly on the basis of the Islam culture. Both of them offer parental care to Yusuf and Ahmad, their sons, who they love too much. Mays takes care of the child during the day since Mr. Ibrahim is always busy with his work. 2. Sexual orientation Both the father and mother have not complained of any sexual problem. Additionally, they conduct their sexual activities in the normal way. 3. Rank order In terms of rank order, the members of the family are ranked according to their ages, that is, grandfather, father, mother, and the Yusuf, and Ahmad. The distance between the two siblings is short since they are only two years apart in terms of age. 4. Subsystems All family members are ordinarily expected to portray some adjustments on the requirements of various subsystem levels (Rimsza, 2004). The father and wife are members of the husband-wife subsystem while the son and father belong to the male subsystem level. Another subsystem comprises of father and mother as parents and Yusuf and Ahmad as the children. This brings about the parent-child subsystem. Then there is the child-child subsystem, which describes the relationship between Yusuf and Ahmad, the children. Then there is the relationship between Ibrahim and Mays on the one hand, and Ibrahim’s father on the other. This is a parent-children relationship. Each of these members is doing his duties well within the various subsystems. The relationships that exist among the members of this family are well-structured and strong. Furthermore, the mother and the father are doing their best in order to give the best to their house and to Yusuf and Ahmad, as well as their father. Boundaries Boundaries protect the differentiation that exists within the system and its subsystems. Moreover, they inform the family systems or subsystems, which are ordinarily rigid, diffuse, and permeable. Reduction in family differentiation is often considered a clear indication that a rigid boundary is in place (Tapp, 2005). A rigid boundary emerges when various subsystems become disengaged, moving away from other members. A permeable boundary emerges when certain rules are changed or modified in response to the benefits and needs of every family member. In this family, the roles and functions of both parents are being undertaken in a cooperative matter. Similarly, the parents are always regularly discussing issues relating to children, particularly the health condition of their son and the prognosis of the condition. Moreover, the couple used to discuss various matters whenever they became stressed by their child’s illness. The External structure The two main aspects of external structure assessed are the extended family and larger subsystems (Feeley, 2006). The larger subsystems assessed include ethnicity, race, social class, religion and spirituality, and environment (Pillitteri, 2009). 1. Extended family With regards to relations with the extended family, Ibrahim and his wife have a close relationship with their Ibrahim’s father, who they stay with him in the same house. Ibrahim says that he and his wife always keep in touch with May’s parents each Friday, Sometimes, adds Ibrahim, they even chat with him using Ibrahim’s laptop. Owing to the condition of Ibrahim’s father, he and his wife have taken the responsibility of looking after him, including overseeing his medication and checkups. Both Ibrahim and his wife relate well with their siblings, who visit their house at least once a month in order to assess the condition of Yusuf and his Ibrahim’s father. Larger systems The larger systems of Ibrahim’s family involve the Ibrahim’s work systems at the high school, some Saudi families and clinics where Yusuf receives treatment. The members of this family have a positive relationship with this large system. They visit their families and share food at the mosque. a. Ethnicity The care provider should be keen on the issue of ethnicity, which plays a crucial role in the family’s sense of belonging. I asked the family to describe their traditional practices regarding wellness and illness. Additionally, I explored the impact that new culture has on family adjustment. Ibrahim is from Saudi Arabia while Mays is white, from Caucasian origin, Russia to be precise. Since marrying Ibrahim, she converted to Islam. b. Social class The values and lifestyle choices of this family are similar to those of a conservative Saudi Arabian middle class family. They do not have financial problems since Ibrahim’s parents, by virtue of their ‘highly-educated’ status, were able to secure good jobs, save a lot of money for their own use as well as for their children’s well-being. c. Religion and spirituality Muslims believe that reading the Holy Qur’an and saying players bring about treatment of diseases. The family, being of Islamic faith, believes that illness is predetermined. Ibrahim is not in denial or despair about the illness of their son. Mays, however, tells me that sometimes, she goes through her moments of doubt about Yusuf’s chances of surviving the respiratory condition, but she prefers to keep these thoughts to herself. Both parents and their children are confident that Ibrahim’s father is strong-willed and that with proper care and medication, he will overpower his heart condition. Environment The home environment for this family is spacious, comfortable, and cosy. d. Race Ibrahim is Semitic, Mays is Caucasian, but both of them have been adjusting towards adherence to the Muslim-based belief systems. Developmental assessment In the context of this family, the main focus of the developmental stage for a nurse is the progress of the child and Ibrahim’s father’s heart condition. In typical situations, the nurse assesses the way in which the marital system is being adjusted in order for the child’s developmental needs to be accommodated (Logue, 2007, Hanson, 2001). The parents are united in childrearing, household tasks, and arrangements with the extended family in order for parenting roles to be included. Functional assessment In this stage, assessment efforts ought to be directed at an exploration of how the family members behave towards each other (Wright, 2005). This is what I did. I found out that Ibrahim and his wife relate with each other in a cooperative manner in issues like eating, washing clothes, and watching TV. The functional issues assessed include influences and power, verbal communication, problem solving strategies, and beliefs. In terms of influence, Yusuf and Ahmad are influenced more by Mays than Ibrahim. This is because they spend more time with her than with him. Functional assessment is categorized into two: instrumental and expressive. Instrumental 1. Daily life activities: The family’s day starts with breakfast. The mother then takes the child to child care. The father goes to work after dropping the two boys at school. Ibrahim’s father stays home all day long, except for occasional strolls to the nearby shopping center with his friends. They have dinner together in the evening. Sometimes they watch the TV while Yusuf and Ahmad play the playstation. They sleep at 11pm after father has given Yusuf the medication. Expressive 1. Emotional communication The father and mother accept their situation and they listen to each other. Both of them share their worries and anxieties. Yusuf and Ibrahim’s father influence their emotions a great deal. Ahmad worries about his elder son as well as Ibrahim’s father for their agonies and pains as a result of their conditions. 2. Verbal and non-verbal communication Most of the time, both parents are communicating effectively. Ibrahim says he perfectly understands his wife. Ibrahim sometimes becomes distressed after his son’s condition’s deterioration. Ahmad sometimes becomes extremely irritable, especially when both the two ill family members are going through their worst moments with the illness at the same time. Language problems tend to arise often since Mays understand Russian and some very little Arabic. On the other hand, the father understand Arabic but very little Russian. Mays influences Yusuf and Ahmad to learn more Russian than Arabic. 3. Circular communication: The parents said that they have never used circular communication previously. 4. Problem solving: The husband and wife are always able to manage their problems easily since they have a strong relationship. 5. Roles: Parents shares roles within the family. The father takes care of the two children’s learning needs, transport to school, while Mays takes care of them whenever they are at home. Ibrahim takes care of Yusuf’s and his father’s health needs whenever he is at home. When he is away, Mays takes care of everything. 6. Influence and power: The mother impacts strongly on the behaviors of Yusuf and Ahmad since he is close to these boys most of the time. 7. Beliefs: Ibrahim and Mays are typical liberal Muslims. Ibrahim understanding the Islam culture more than Mays. Mays White heritage shows in her interpretation of the Islam culture. 8. Alliances and coalitions Ibrahim says he and his wife are in a good relationship with the doctors who treats the child as well as the one who treats Ibrahim’s father. The family’s current health needs The family’s current health needs are focused on condition and treatment and treatment of Yusuf and Ibrahim’s father. The father says that he and his wife are in need of health education on signs and symptoms of bronchial asthma. They say they need an oxygen cylinder since their child often complains of sudden, severe bronchial attacks. However, they appear to understand the heart condition of their father pretty well. Challenges faced by the family because of the sickness of one of their members The father told me that whenever his child or his father worsens, he cannot work at the high school. He also indicated his worries about the financial repercussions of the medications of these two family members. Language problems are deep-rooted in this family, to the extent that they appear to be fuelling transient conflicts into a full-blown crisis. Mays understands Russian perfectly well but she hardly knows any Arabic. By spending most of the time with the boys, she has influenced them into learning more Russian than Arabic. Ibrahim is worried that his children may grow up knowing very little Arabic, which is tantamount to a loss of their cultural heritage. At the hospital, Yusuf tries hard to speak good Arabic in order to impress his father. however, the doctors do not understand Arabic. His father has translate the boy’s speech into English. However, it is difficult for the father to describe the son’s feelings in an accurate manner. In other words, some meaning is lost in the process of translation. This problem is aggravated by the fact that Yusuf does not understand Arabic very well. Whenever Mays takes his son to the hospital, communication breaks down completely since she neither understands English nor Arabic. Sometimes she has to resort to sign language as well as past health records of his son’s medication process. The family’s core strengths The family possesses various strengths, among them a strong family relationship, an intention attention to their child’s condition, combination of western medical treatments with traditional medication and a cordial relationship with their physician. Strategies used by the family and the impacts of health problem on family functions The parents use support systems and reflection in order to manage and resolve the condition of their child. They attend their medical appointments on time. They are always timely and cautious with the medication schedules of Yusuf as well as Ibrahim’s father, and they always avoid all substances that can irritate Yusuf’s chest condition, or their father’s heart condition. Support systems The outpatient clinics, Islamic committees and Saudi families are the core support systems used by this family. The school, according to Mays, is also a source of support, through provision of special care on his condition and helping out when mum and dad are busy. Reflection It was a great experience and a pleasure to interact with Ibrahim’s family. I learned many issues concerning family nursing after working with Ibrahim’s family. First, I have learnt that culture plays a critical role in every family’s health practices. Secondly, I have learned that one family member’s health impact on the health of all other family members. Thirdly, a health assessment undertaking is incomplete until a complete family health assessment such as this one has been carried out. Lastly, I learnt that support systems are as important as relationships among family members in terms of impact on a family’s health. Conclusion Nurses have an important role to play in providing healthcare as far as the family perspective is concerned. Family members need to be targeted by nurses in efforts to draw out clear relationships between the family-functions perspectives and medical-based perspectives. This assessment proves that the family is a good source of supportive tools in healthcare. References Anderson, K. (2000). The Family Health System Approach to Family Systems Nursing. Journal of Family Nursing, 6(2), 103-119. Bomar, P. (2008). Promoting health in families: applying family research and theory to nursing practice. New York: Saunders. Duhamel, F. (2004). A Constructivist Evaluation of Family Systems Nursing Interventions with Families Experiencing Cardiovascular and Cerebrovascular Illness. Journal of Family Nursing, 10(1), 12-32. Feeley, N. (2006). Nursing Approaches for Working with Family Strengths and Resources. Journal of Family Nursing, 6(1), 9-24. Friedman, M.M., Bowden, V.R. & Jones, E.G. (2003). Family Nursing: Research, Theory and Practice, 5th ed. Upper Saddle River, NJ: Pearson Education. Hanson, S. (2001). Family health care nursing: Theory, practice and research (2 Ed.), Philadelphia: F.A. Davis publishers. Logue, R. (2007). Maintaining family connectedness in long-term care: An advanced practice approach to family-centered nursing homes. Journal of Gerontology Nursing, 29(6), 24-31. LeGrow, K. (2005). Development of Professional Practice Based on a Family Systems Nursing Framework: Nurses’ and Families’ Experiences. Journal of Family Nursing, 11(1), 1 38-58. Lindgren, C. (2007). Nurses' and family members'. Perceptions of nursing home residents' needs. Journal of Gerontology Nursing, 28(8), 45-53 Pillitteri, A. (2009). Nursing care of when a child has a respiratory disorder. London: Routledge. Rimsza, M. (2004). Complications of corticosteroid therapy. Retrieved, October 24, 2008, from: http://archpedi.ama-assn.org/cgi/content/abstract/132/8/806. Tapp, D. (2005). The Ethics of Relational Stance in Family Nursing: Resisting the View of “Nurse as Expert.” Journal of Family Nursing, 6(1), 69-91. Tanyi, R. (2006). Spirituality and family nursing: spiritual assessment and interventions for families. Journal of Advanced Nursing, 53(3), 287–294. Teno, J. & Clarridge, B. (2004). Family Perspectives on End-of-Life Care at the Last Place of Care, 291(1), 108-128. Wright, L.M. & Leahey, M. (2005). Nurses and families: A guide of family assessment and intervention (4th ed.). Philadelphia: F.A. Davis Company. Appendix - LIST OF FAMILY ASSESSMENT TOOLS Assessment tool Purpose References Calgary Family Assessment Model (CFAM) Assessment based on strengths critical to healthy family functioning. Addresses family structure, development, and function. Wright LM, Leahey M: Nurses and families–a guide to family assessment and intervention, Philadelphia, 1984, FA Davis. Chronicity Impact and Coping Instrument: Parent Questionnaire (CICI:PQ) Assessment of parent perception of the effect of chronic childhood disorder on family and how families cope with the problems associated with the child’s condition. Hymovich D: The chronicity impact and coping instrument: parent questionnaire, Nurs Res 32, 1983. Family Assessment for School Nurses and Other Professions (FAT) Assessment of home and environment; family interaction styles; child’s growth, development, and health history; and family health and social history. Holt S, Robinson T: The school nurse’s family assessment tool, Am J Nurs 79(5), 1979. Family Health Protective Behavior Assessment Tool Assessment of specific health behaviors for each family developmental stage. Dandzari JK, Howard JR: The well family: a developmental approach to assessment, Boston, 1981, Little, Brown. Feetham Family Functioning Survey (FFFS) Assessment of accomplishment of family tasks and functioning of families with normal or impaired child. Identifies specific areas of dysfunction during a period of stress. Feetham S, Humenick S: The Feetham family functioning survey. In Humenick S, editor: Analysis of current assessment strategies in the health care of young children and childbearing families, New York, 1982, Appleton-Century-Crofts. Friedman’s Guidelines for Function Assessment of the Family Assessment of variables (communication, role, power, values, and coping) and the effect on affective, socialization, and health care functions. Friedman M: Family nursing: theory and assessment, ed 2, New York, 1986, Appleton-Century-Crofts. Home Observation for Measurement of the Environment (HOME) Assessment of family influence through the child’s environment. Assesses animate and inanimate aspects of the environment that support development. Identifies family strengths and weaknesses. Caldwell BM: Home observation for measurement of the environment, Little Rock, 1979, University of Arkansas. Appendix B- Family profile Ibrahim is 39 year old. He has an MA (Education)from Harvard University. He is a Ph.D. Student at Griffith university. He works as a high school, where he is the principal, where he reports at or before 7.30 am. Before then, he drops the boys at school. Mays is aged 32, also a Harvard graduate in BA (psychology). Three years ago, she stopped working as a social work in order to take care of the children, particularly Yusuf, owing to his Bronchial asthma condition. Yusuf is 10 years old, in grade four, and suffers from bronchial asthma. Ahmad is aged 8, in grade three, and in perfect health condition. Ibrahim’s father is aged 65, a PhD from Massachusetts Institute of Technology and a former university professor, a job he quit five years ago after his heart condition became worse. He stays with the Ibrahims, who take care of his health needs. Appendix C- Symbols used in Genogram and Ecomap ------------Male ------------Female ________________ ________________ ________________ ________________ ----------- Very strong relationship ________________ ________________ ________________ -------------- Strong relationship ________________ ________________ ---------------Attachment is available ________________ ---------------Weak relationship --------------- Presence of stressor Appendix D- Ecomap University Appendix E- Genogram Clinical notes During the first meeting the meaning of the family was explained, how it normally works and how it would work in case a family member suffered from a chronic disease.  In the second meeting, focus was on family theory, whereby various theoretical approaches to the family were adopted. The structural functional theory was used to explain the experiences of a family where one of the members suffers from a chronic disease. The third meeting was on family assessment, whereby the Calgary family assessment model was used to assess the family’s response when one of its members was suffering from a chronic condition. During the fourth meeting, focus was on the various therapeutic interventions adopted in the family where one of the members, ten-year-old Yusuf was suffering from bronchial asthma. In the fifth meeting, attention was shifted towards communication issues existing between Yusuf and his family members, as well as among all the other four family members as a result of Yusuf’s illness. Read More