Family Health Assessment for Crow Lake - Essay Example

Family Health Assessment for Crow Lake The most important aspect of any assessment is that it is able to give the nurse a better understanding of the functionality of the individual or family that the nurse has identified as needed assistance. For this health assessment, the Friedman Family Assessment Model (FFAM) has been chosen. This assessment is easy to use and gives the nurse a deep understanding of the family as the family members relate to each other and to the world. There are many uses of the FFAM in the scope of understanding a family. This assessment will give a general history of the family and it can give insight into any health problems that may appear which can also lead to any questions that may be important to ask during the course of the assessment. Within this assessment there are six categories: "identifying data, developmental stage and history, environmental data, family structure, family functions, family stress, coping and adaptation" (Friedman, Bowden & Jones, p. 583). In reading the case study in Crow Lake and understanding the family structure, this paper will focus on family structure, family function and family coping because the Morrison family has many challenges that will fit well into these categories for observation. At the beginning of the novel, there is a family that is excited about the fact that their oldest child, Luke, was accepted at Teachers College. The excitement is because he was bright enough to get accepted and he will be the first to go to college in the family. The children in order of their birthing are Luke the oldest, Matt the second oldest, Kate who is younger than the boys and Bo who is very young when the story begins. The parents add to the family and it seems in the beginning that they love their children though they do not show affection openly. Unfortunately, the reader finds that the family is going to be broken because the parents die in a car accident as they are going to the next town to buy a suitcase for Luke. At the time of this opening, Luke is 19, Matt is 17, Kate is seven and Bo is only a year and a half old. While the parents were alive, they were active in their community. Much of their activity was through their Presbyterian church and everyone knew them. The death of the parents brings a flurry of activity from various relatives, and particularly from their Aunt Annie and the other family members. Although the father worked at a local bank, he did not leave a lot of money for the children. Aunt Annie thinks that he best thing she can do is split the children up, sell the house and use the money to help the children live with other family members. However, Luke has other ideas and talks to his fathers lawyer to see whether he can become head of the family. He finds out that he is old enough to do this and therefore makes the decision not to go to college. Family Structure The family dynamics for the Morrisons is that they have been taught to be dysfunctional in their communication styles. Luke is the least communicative of all as he frequently would leave the family without telling his parents where he was going. In the process of becoming the head of the family, he "disappears" one morning sending Kate into trauma about whether he will come back. Although the family talks to one another, it is generally out of anger or very superficial. As an example, Matt cannot express the fact that he is frightened when Luke leaves so he masks it with anger. Their parents have not prepared them for what might happen to them if the parents were gone so the children have no way of really understanding what has happened. The outside influences that are affecting communication started with the parents. They taught their children not to express emotions and they created a dysfunction and an immaturity in them. Aunt Annie wants to be the head of the family when she comes and she struggles with Luke in the beginning because she sees herself as the adult and feels that he should listen to her. Power Structure The power dynamic has also changed within the family. Luke takes responsibility for all decision making although Aunt Annie is there as the person who is the external influence affecting the family power patterns. Aunt Annie wants to be obeyed and wants to be the one in charge. She does not see how a 19 year old boy can be capable of running a family or a household. However, after talking to the lawyer she has no recourse but to allow the children to take care of themselves. The role structure of the family has had to change because the parents are no longer available. In this case, Luke becomes the head of the family and takes care of Bo and Kate because they are much younger than Matt. Kate stays in the role of younger sibling because she is still very young at this point. She helps with Bo, but Bo is a very small child and must learn to listen to Luke since he can be seen as a father figure. Matts role is somewhat undetermined and I believe that is why he is frustrated. He would like to be the head of the family but he is too young. There is a constant struggle between Matt and Luke because Matt sees the practical side of the world. Luke has somewhat of a fatalistic idea of what life is shown by the fact that he does not get involved in helping Laurie Pye. Matt sees that the family needs one person to work full-time and chooses to be the one to do it, but Luke has an idealistic view of things; he wants Matt to stay in school and to later go to the university. There did not seem to be any external influences affecting the power structure or the role structure. It seemed that the family left these children alone, although Aunt Annie received letters from Kate. In terms of family values, the largest value seemed to be that they should fend for themselves and not take charity. This was apparent in that they did not ask neighbors for help, although the community helped by sending food on a regular basis and by attending to the children for holidays. For the most part, their values seem to give them an opportunity to move forward with their lives. Education seems to be another important value although both boys have had to quit their education in order to take care of the family. They have a work ethic and understand that in order to keep being in charge of the family, they need money for food and other things. The family seems to be isolated from the rest of the world to a point because they struggle to keep going. The strengths of the family are that they are staying together despite the odds. They also are resilient in that they are working against several stressors. According to Black and Lobo (2008), all families encounter stress in some way and "a stressor is a demand placed on the family that produces, or has the potential to produce, changes in the family system" (p. 36). This is true for the Morrisons because of the financial strain put on the family. It is clear that Matt is always pushing for dominance but Luke pushes back to assert his authority. It seems that the struggle is trying to determine whether the family will stay resilient or whether they will have to make changes to support them. There are many areas of concern for this family. The first concern is that they have not dealt with their grief about losing their parents. True to the nature of the family, this is something that they cannot talk about. The family is in need of grief counseling so they can make sense of what happened to their parents. According to the National Association of School Psychologists (n.d.), there are several reactions that children can have to grief: emotional shock is where the children were in the beginning because their parents death came so suddenly. Bo may be experiencing regressive behaviors in that she has become more difficult to work with throughout the story. She also needs to be close to someone as she is being potty trained. Both Matt and Luke had explosive emotions with each other which seems to indicate that they are not doing well with how things are going. However, according to the National Association of School Psychologists, this is a natural aspect of grief for children. Kate has the feeling that her brothers will die one day, which is a fatalistic view of the future. This could be resolved with grief counseling. Also, later in the story, it is difficult for Kate to become involved with a young man because she cannot express her feelings. It is my belief that she is worried that if she gets to close to someone, the person may die. This also could have been helped if she had grief counseling. Another concern is that Luke has to take care of the family and as Aunt Annie said in the beginning, he is not equipped with the skills to do this. He does not know what it takes to continually manage a family and the stress level of doing so is evident in everything they do. He is constantly on edge and worried about what will happen in the family and Matt is constantly pushing him to do something. These situations cause more stress and the family seems like it should break at any time. Family Functions When the parents die the children are thrust into a sea of emotion. They have not been taught how to express any emotion. Kate jokingly says that this is the familys eleventh commandment: "thou shall not emote." This has kept the family going for many years though at the time of the loss of their parents, it is not serving them well. Affective Function The family dynamics within the family unit have had to change. Luke, as the oldest has taken on responsibility to be the head of the family. He is basically looking after his two sisters because Matt is almost his age and does not relate to him as a father figure. Kate is looking for stability and she would rather have it with her brothers than to have to stay somewhere other than their home. She sees Luke as the father figure and she knows that Matt will keep them safe because he is so intelligent. The family has adapted to their fate at this point because it is the only thing they can do at this time. Without the aid of counseling, it seems very difficult for the Morrison children to have mutual nurturance. They are having trouble surviving and keeping track of their own needs. In looking at Maslows Hierarchy of Needs, it seems that the family is getting their basic needs met and the need for belonging, but individual needs are not being met (Simons, Irwin, and Drinnien, 1987).. The family does not have outside nurturing except for basic needs. They are given food by the neighbors but they are not receiving time to talk with people outside the family and they seem to be isolated away from others. There is mention of having friends their own age outside the family but they do not seem to bond with anyone so the separateness/closeness may be another issue that would need nurturing for them to be able to use it. Socialization Of Children Function When Luke first began to work with the family, he tried to do what his mother had done for the children. The challenge for Luke is that he has no child-rearing experience, and this area is the major focus of the Friedman Family Assessment Model. He has a relationship with Bo, but he does not know what to do exactly. This would be an area of assessment that needs to be seen and perhaps they would need to have parenting skill classes. Although the neighbors are there to help the children with food, but this did not seem to influence the child-rearing. The orientation in the home towards childrens development needs does not have an influence in the Morrison home. In other words, there did not seem to be any real understanding for the environment and whether it was conducive to child development. We do know that the older children read to Bo, and the children often go down to the ponds to look at nature. These two activities can be part of understanding development needs. They did have time for playing and this would help in the family cohesiveness, but the children needed more guidance than was provided. Health Care Function Because they live in a small town where the doctor makes house calls, it is sure that their healthcare needs are met as long as they understand when they need a doctor. As an example, when Matts shoulder was dislocated by Luke, they knew to immediately go to get the doctor. Also, they lived in a community where everyone knew everyone else. This meant that they had their needs met on a medical and also a social level. The pastor came to the house with the doctor and the sheriff when the parents died so that everyone could be aware of what was going on and console the children on different levels. The doctor also took on different roles as needed. For example, when Matt and Luke fought, the doctor told them that they must find other ways to work out their aggression. He talks to them like a father figure, and he brings them back to understanding that if they are going to take care of the girls, they have to be more responsible. It seems that the family was considered healthy by the people who were outside the family as well as by the children. There was limited knowledge about health, but they did understand when to call the doctor. The neighbors helped to keep them healthy in that they brought food over time to the children to make sure they ate well. From the novel, there is no mention of health history or lifestyle practices so this would be something to be assess. There is no mention of healthcare coverage, so this may have been a time when this was not a problem. The families probably paid the doctor for each visit or paid for his salary. This would be important to know to make sure the children were getting everything they needed. Again, the family was strong in their resilience and this is one of the things that brought their strength. Black and Lobo suggest that family systems work "when its members feel good about the family, their needs are being met, and the development of relationships flows smoothly" (p. 39), The Morrison children are struggling to find their way and their roles in the family, but they are held together by their love of one another and their need to stay together rather than to be separated. They feel good about the family together and their basic needs are being met. These situations are important to understanding their strengths. Family Coping The major stressor on the family is that they are attempting to live together without parenting skills. Luke is attempting to carry the family without help, although their community comes to the rescue eventually and helps the boys take care of the girls in a better way; they also help them with housework. Although the children cannot show that they are happy to have the help, it is difficult for them to verbalize this fact. Because they are able to stay together, they have less stress about what would happen with each of them. They are not able to verbalize this importance but it is one that carries them throughout the experience. Family Coping Strategies The family was stagnated in that they could not express their emotions. Without this expression, individuals and families are broken to a point and dysfunctional. This happened for the Morrison children because they are never able to express themselves fully. Luke attempts to keep the family together but he is struggling and each time that Matt confronts him on an issues, he has trouble dealing with it. The basic reason is because the children were not given a way to express their emotions or to communicate effectively with each other. Family Adaptation The family is forced to adapt to a variety of situations. They must first adapt to the fact that their parents died, then to Aunt Annies coming into the house to take care of them and then to Lukes becoming head of the family. In each of these situations, the children had to quickly adapt without having to think about it. Luke at least understands that he must work to help the family and that he is ultimately responsible. He also understands that the children must work together to stay together. Bo is the youngest and needs the most, which means that Matt has some responsibility to Bo, but Kate, perhaps because she is the oldest girl, assumes most of the responsibility for Bo. Mrs. Stanovich begins to help the children keep house and take care of Bo, which is very important because the family is having trouble with potty training Bo. The family does occasionally face difficulty but they are always able to get through the tougher times, and usually have someone to help them. All three children eventually grow up and make their own way in life. Kate becomes a teacher and really would have wanted all her siblings to turn out as she did because education was important to the family. However, each one has found their way differently. Over time, each child was able to adapt to their circumstances. The strengths of the family in this area is that they all were able to cope well. They were able to make a way for themselves in the world and they kept in touch with each other. None of the children married which is interesting but not surprising. When two people marry, they have to be able to communicate and nurture one another, which were traits that the children could not relate to and did not know how to use. References Black, K. and Lobo, M. (2008). A conceptual review of family resilience factors. Journal of Family Nursing. 13 (33). doi: 10.1177/107484070312237 Feeley, N. and Gottlieb, L.N. (2000). Nursing approaches for working with family strengths and resources. Journal of Family Nursing. 6 (9). doi: 10.1177/107484070000600102 National Association of School Psychologists. (n.d.). Helping children cope with loss, death, and grief: Tips for teachers and parents. Retrieved April 17, 2010 from http://www.nasponline.org/resources/crisis_safety/griefwar.pdf Simons, J.A., Irwin, D.B. and Drinnien, B.A. (1987). Maslows hierarchy of needs. Retrieved April 23, 2010 from http://honolulu.hawaii.edu/intranet/committees/ FacDevCom/guidebk/teachtip/maslow.htm Read More