Theoretical Foundations in Family Nursing - Essay Example

Theoretical Foundations in Family Nursing Assignment Family: Ovarian cancer wife/mother aged 33 with 3 children aged 5 to 10 years old Challenges faced by the assignment family Being diagnosed with ovarian cancer at such an early age for this lady brings about a lot of challenges not only to herself but also to her family members. Cancer by itself is a disease which no one would like to be diagnosed with. It affects not only the patient but also the family members, relatives and even friends. From the view of the disease itself, the lady would first face the possibility of surgery as well as treatment with many types of drugs. This may weaken the lady and she would not be able to work and take care of her family. The treatment itself may be very expensive and it may also require many visits to the hospital, something which is inconvenient. When she is not working, she is also unable to earn and if her employers are unkind, they may even ask her to resign or she would be put on unpaid leave. From the perspective of her husband, he may have to take leave from work as well to take care of his wife in case there are no relatives who stay nearby. With him taking leave, the family income would be compromised as well. Financial burden causes a lot of stress to families. Other than cancer causing a long period of sickness where she may not even have the strength to carry out daily functions, the most worrying thought about ovarian cancer would be that it might end up in death. Firstly, this lady is a mother with 3 young children, the youngest being 5 years old. The role of a mother in the upbringing and the development of children cannot be denied and this will be compromised if the mother passes away. A mother not only provides emotional support and a role model for the children to look up to, but she is the one who also provides them with love and affection. If the children consists of daughters, then, the role of a mother is even more important as her daughters have someone to share thoughts and growing up issues which they may not be so comfortable talking to with their fathers, for example the issue of menstruation. In addition to this, the lady is also a wife and she is the pillar of support for her husband. Having to lose a life partner is a very distressing event, and this would be worse at such a young age. Besides these, the diagnosis of ovarian cancer would be faced both by the lady and her husband with great distress, and this might also lead to psychological complications such as depression and anxiety. The meaning of Systems Theory as a theoretical foundation for family nursing and how it can be used for the care of the assignment family The Systems Theory is also known as the family theory. Basically, from the word itself, it means that family nursing practices must look at the entire family as a whole system, not just the patient itself. As mentioned earlier, a disease does not only affect the patient but also her family members. This theory is based on the family as a unified organized system and as one, it will react to any events together (Worden, 2003). Not only is the system made up of many parts, these parts also form relationships with one another and have unique patterns of interaction (Nichols & Schwartz, 2001). Thus, in the case of the assignment family, the nurse must firstly look at the family as a whole, assess the structure, for example who is the person who brings in the money, who is the one who takes care of the household chores, who is the one who does the cooking etc. After all these have been identified, the nurse would then start her intervention program which is made to suit each of these family members. Discussion on the 3 categories of the Calgary Family Assessment Model (CFAM) and how each category would contribute to the assessment of the assignment family The CFAM is divided into 3 categories or rather dimensions, which are the structural, developmental and functional dimension. The structural dimension, also known as the structural assessment is divided into 3, internal, external and context component. The internal component means the people who are in the family and how they are linked to one another. External means the connections which the family has to other people outside the family and context means the background of the family which is related to them. The internal structure is made up of the family composition (the family), gender (the set of roles which are carried out by the males and females), sexual orientation (heterosexual, gay, lesbian, bisexual, transgender), rank order (positions of the children within the family), subsystems (smaller groups within the family) and boundaries (for protection of subsystems). The external structure is made up of extended families which include the parents, siblings, spouse, children and relatives whereas the larger system includes groups are work and school. Context includes ethnicity, race, social class, religion and the environment which the family lives in. In relation to the assignment family, we can first link the people who are in the family to one another as well as those outside the family, rank the positions of the family members and also explore extended links for example the relationships formed with other people in schools as well as the work place. The second dimension which is the developmental dimension is made up of the cycles which the family goes through and this is divided into stages, tasks and attachments. Stages include leaving home, having children and joining other families. Tasks and attachments are duties which the individual unit makes throughout the different stages mentioned earlier and attachments are the relationships formed. The usage of the second dimension in the assignment family can be made where we can note what each one of them are going through, be it at work or school. For the time being, the family may not want to have any children and it does not seem that anyone would be leaving the home. The third dimension is the functional dimension. The functional assessment includes instrumental routine A.D.L and is subdivide into expressive functioning which involves emotional communication, verbal communication, non-verbal, circular, problem solving, roles, influence and power, believes and alliances and coalition. In emotional communication wide range of feelings and emotional difficulties of families are expressed. The verbal communication on the other hand includes direct and indirect conversation. The non-verbal communication takes in the account, body posture, eye contact, touch, gesture, etc. Circular communication – involves reciprocal communication between people that takes into account three components as emotional state, behavior, and cognition. The problem solving is influenced by family as who identifies the problem and solution pattern, etc. The roles involve formal verses informal in family basis. In this model nurses make use of genogram the family diagram or depiction of family tree that easily describes the problem that runs in the family, that is difficult for the members to point out. Many stigmatized illness and behaviors such as alcoholism, mental disorders, and hereditary diseases are brought into picture that helps in easy diagnosis of the diseases. (Gilliss, C 1989). The assignment family’s assessment in relation to the third dimension is seeing how the verbal and non-verbal communication skills are used within the family as well as their problem solving methods. Wright and Leahey’s concept of the stages of the Family Life Cycle, the stage this family is in and the effects of this concept on the handling of the family The stages of the Family Life Cycle explained by Wright & Leahy include leaving home, joining families through marriage, families with young children, families with adolescents, launching children and moving on and families in later life. The concept seen here is a family based unit which is progressing through time and is given chance to change and grow along the way. This is the growth concept and allows a family unit to grow instead of remaining within the original members of the family. This concept also helps nurses to anticipate the certain conditions both medical and non medical that are common in that stages. This family is in the families with young children stage. Using this concept, this stage of family allows acceptance of new members (children) into the system and the family unit must now make space for the children. The parents will have lesser time for one another and intimacy might be decreased. Space is created not only in the sense of the space in the house but also within the family unit. The parents will now join in bringing up the children, dividing their finances to allow money to be saved for the children and these children can also be involved in household tasks. Another relationship will also be formed with the extended family, which is the role of grandparents. Family Interview There are many important issues which must be taken into consideration when preparing for an interview. Firstly, as the interviewer, I must know who I am going to talk to and in this case, it would be a family. I must know who are the members of the family, their occupation as well as ages as these things would affect the type of questions which I would ask. It would be good if I had a background history of the family especially when it comes to the medical part of the interview. This would be so that I can read ahead about the disease as some diseases present with unique features and complications. Next, I would think of all the questions which I would write down and go over these questions with someone more senior or who has experience if this is the first time I am doing an interview. This is so I would not ask sensitive questions as my interview may also be my first contact with this family. Some of the tools which I may bring along, other than a pen and a lot of paper would be a recorder so I can review the interview later and note down anything which may be missing from my hand written notes. However, to use this, I would need the permission of the family. My preparation would also include finding out more about the cultural beliefs and practices of the family. This may also help me in understand why the patient or her family members do things in certain ways for example the type of medication which they choose or if they would go for traditional medication like herbs. In the case of a resistant or non-compliant family, the interview would be difficult. However, this does not mean that the family cannot be interviewed, but the approach would be different. In families like these, it is important to inform the family the objectives and purpose of the interview, the importance of it and what could be done for them from analysis of the interview. Resistant or non-compliant families should never be asked very sensitive questions unless a good relationship has been built. For every suggestion given, there must also be a logical reasoning which will help the family become more compliant. In general, an interview can be divided into 4, engagement, assessment, intervention and termination and all these stages can be applied to my assignment family. In regards to engagement, this means that the interviewer begins the interview by first introducing himself/herself to the family, get to know the names of the family members in return, inform them of the reason of the interview and ensure that the people being interviewed are concentrating. It would be good if the interview is 2 way and is like a dialogue as this would put the family members at ease. Assessment is when one goes deeper into the interview and starts analyzing the answers and with the answers given, asks further questions to learn more about the family. Next, based on the answers given, the interviewer will then analyze the answers and form a method of intervention (if needed) which is specific to the family and their problems. This is important because although problems may be similar, no single family is similar to another. The final stage of the interview is termination. This is when the interview ends. It is important for the interviewer to allow the family members to ask any questions and the family should also be told the outcomes of the interview. Finally, the interview ends and there should be a follow up as well. Discussion of quotation “One of the simplest and most powerful interventions for families experiencing health problems is use of interventive questions.” Interventive questions are intended to actively affect change in any or all three domains discussed earlier. The quotation means that interventive questions are very simple questions but yet, if offers a very important role in helping the family understand and overcome a problem as well as its effects especially when the problem is health related. The person posing these questions should have a sound knowledge of when, where, how and with what purpose to post the question. This would ensure a higher level of success. In practice there are 2 types of questions usually used. The first are linear questions that tend to inform the health professional about the disease condition and to investigate family members’ description and idea of problems. For example in this case, one of the question which can be asked would be “When did you (the wife/mother) feel weak or felt an abnormal lump at your stomach?” or “When did you notice your wife looking pale or not her active self?” Circular questions on the other hand helps the interviewer rate the family’s understanding of the problems, in this case, an example would be “How are you (the child) responding to mummy being sick?” or “Has your work (the husband) been affected in anyway ever since your wife became sick?” Thus, by using this strategy, I would allow the family members, even the young children to note how they feel, how things have changed in the family and hopefully, these realizations can help every one in the family cope better. Understanding the disease process both medically and psychosocially is definitely beneficial. A lot of times, health care workers concentrate so much on the disease itself that they do not see that a person is actually suffering mentally and emotionally as well. This should not be practiced as health is defined not only as wellness of the physical component but also mentally. Conceiving child abuse or neglect and dealing with the problem In this assignment family, the presence of child abuse may seem unlikely but it should never be put aside. This is because after a while, many stresses for example financial problems may cause parents to neglect or even abuse the child. If a case of child abuse/neglect is suspected in the family, the best method would be to utilize interventive questioning to then either neglect the suspicion or to act. It is important for us to act so that this does not continue but an abused/neglected child may have problems in adulthood later on ( Kempe & Helfer, 1997). As a nurse, my first stage of action would be to first watch for the warning signs that could suggest possible harm. This is a very sensitive issue and if approached wrongly, may lead to conflicts with the family. Some of the signs that abuse or neglect must be highly suspected is when the child tells that they have been abused, if the child tells about the abuse happened to another child ( as the young person may be referring to themselves), or when physical evidence that the child has been abused has been seen. The next stage will be to interact with the child and parent separately in a specific manner to open them up. The session could be started with the child with a calm mood, interacting in the appropriate understanding of age, by providing a child friendly environment and interacting in a calm, sensitive way. The thoughts in the child’s mind can be effectively brought out by providing support and listening to the child. The parents or care givers when being questioned should be done in a non-judgmental way. Based on the interview, then, further action should be taken which may include calling the welfare service. References: Gilliss, C (1989). Family Research in Nursing. In C.L. Gilliss, B.L. Highley, B.M. Roberts, & I.M. Martinon (eds.), Towards a science of family nursing (pp.37-63). Menlo Park, CA: Addison Wesley. Kempe HC. & Helfer RE., et al (1997) editors: The Battered Child. 5th edition, Chicago: Chicago University Press. Nichols, M. P. & Schwartz, R. C. (2001). Family therapy: Concepts and methods (5th ed.). Boston: Allyn & Bacon. Worden, M. (2003). Family therapy basics (3rd ed.). Pacific Grove, CA: Brooks/Cole-Thomson Learning. Wright. L.M. & Leahey. M. (2005), Nurses and Families. A Guide to Family Assessment and Intervention, 4th edn, F.A. Davis Company, Philadephia Read More