Healthcare has been experiencing tremendous transformations in the recent past, and this can be attributed to the changing health needs of the people. To adapt to these changes, the models of care delivery, care services, and even the personnel, have changed as well. Also, there is an increasing need to provide patient-centered and culturally sensitive care, as cultural diversity continues to pose a challenge to the delivery of holistic care. One approach of delivering care services is by focusing on a family, identifying the specific health needs of such families, and developing plans of treatment that are focused on the specific health needs identified. To facilitate family assessment, the Calgary Family Assessment Model, CFAM, was developed in 2000 (Wright & Leahey, 2013).
Lorraine Wright and Maureen Leahey developed this model to facilitate the evaluation of families’ health needs. The CFAM focuses on the structural aspects of a family, its developmental aspect, and functional aspect (Leahey & Wright, 2016). The structural assessment of the family involves an evaluation of the internal, external, and contextual needs of a family. The developmental aspect of family assessment focuses on evaluating stages, tasks, and attachments in the family, while the functional aspect evaluates activities of daily living and forms of expression in the family.
This paper will perform a family assessment of the family of *Jane, a 40 year old African American married mother of two children, 16 and 18 year olds. The woman was diagnosed with stage 3 cancer of the colon. The assessment of the family will be facilitated by the CFAM. The evaluation will help develop understanding about the meaning of the illness to the family, how the illness affects the functioning of the family, and the kind of support that the family requires in order to effectively cope with the disease.
Structure
The structural dimension of family assessment evaluates and assesses the internal, external, and context composition of the family (Leahey & Wright, 2016). The internal subdivision of the structure of a family consists of the composition of the family, the gender, sexual orientation, rank order, subsystems, and boundaries of the family members (Leahey & Wright, 2016). The external subdivision of the structure of a family evaluates the extended family and the larger systems, while the context subdivision of the structure assesses the ethnicity, race, social class, religion, and environment of the family.
This particular family is made up of the mother – Jane, father – John, and their two children, Roy and Isabel. The father is the head of the house and the breadwinner, although before disease struck, the mother used to work and contribute to sustenance of the family. The first born, Roy, is a male aged 18 years and he just completed his high school education. He is currently working in a nearby store to help his father with the accumulating household and medical bills. The second born is Isabel, a 16 year old girl who is still in high school currently attending a nearby public high school. The family has maintained a close relation with its immediate and distant relatives, including the grandparents and aunts to the children from both Jane’s and John’s sides. The extended family provides the much needed moral and financial support to this family.
The medical history of the family indicates that the paternal aunt to Jane died of breast cancer, while Jane’s father died from cancer of the lung. Jane’s family has been relatively healthy, with each of the member occasionally visiting the hospital for checkups and treatment of minor injuries and diseases. Jane’s diagnosis is the worst the family has experienced. The disease has not only rendered her jobless, but she now also depends on the family even for some activities of daily living. This has taken a toll on Jane and her family.
Sexual orientation refers to an individual’s sexual identity based on the gender to which that person is attracted (Jacob & Tennenbaum, 2013). Everyone in Jane’s family can be described as heterosexual, as they admit to being attracted to members of the respective opposite sex. The family has deep roots as African Americans. Jane and John hail from African American families, but John’s grandfather was Italian. The family, therefore, associates more with African American culture, as the Italian ethnicity has long worn off. Jane’s family can be categorized as middle social class, as the family lives above the poverty level, but below the highest social class. Children attend normal public schools, and the family has just enough for their spending.
The family subscribes to Catholic faith, which Jane admits has been passed down several generations. Jane was not a catholic, but she changed religions after getting married to John, a staunch catholic. They have raised their children based on the Catholic faith. The family lives in an African American neighborhood whose houses are not very modern. However, the area is well served with infrastructure, social amenities such as schools and hospitals, as well as clean water. However, there are industries not far from the residence that emit foul-smelling fumes.
Family Developmental Stage
The family developmental stage is a dimension of family assessment that involves assessing the stages, tasks, and attachments to the family (Carlson & Carlson, 2014). The developmental dimension refers to the phase of progress that defines a particular family. For example, most young families can be categorized under the child bearing stage, while older families can be categorized under retirement stage. The tasks involved at each stage of development are different, and so are the attachments. The life cycle theory posits that a family evolves through development stages that are predictable (Wright & Leahey, 2013). The growth and development experienced by families is much similar to that experienced by individuals.
Family development passes through eight distinct stages – beginning family, child bearing, families with preschool children, families with school age children, families with teenagers, and families with young adults, middle-aged parents, and families in their later years (Leahey & Wright, 2016). Families at different developmental stages perform different tasks. Each stage not only presents new perspectives and opportunities for the families, but may also present challenges that may have the potential to alter the functioning of the family. This particular system can be categorized under families with teenagers’ category. The family has two children aged 16 and 18 years. Although the first born is almost exiting the teenager bracket, he cannot be considered a launching young adult yet.
According to Jacob and Tennenbaum (2013), this developmental stage is characterized by efforts to balance between freedom and responsibility for the teenagers. Teen age is a stage where the children experience tremendous changes including maturity and the need to become autonomous. Balancing responsibility and freedom at this stage is every parent’s requirement. It is also during this time that most parents start to refocus on their marriage and careers. This is because as the children assume more responsibilities and freedom, parents may find that they have a lot of time on their hands, and decide to invest the time in marital issues and/or career. Other tasks involved in this stage include developing the right relationship with the children.
The developmental tasks appropriate for this stage have been met. For example, John is advancing his education at a local university, and although Jane would have loved to do the same, the disease is limiting her. The family has also met the developmental task of balancing freedom with responsibility, as they have allowed their first born to take on a job so as to assist the family financially. Also, the attention of parents on their children is slowly fading away as the children mature. Since teenagers are less demanding compared to younger children, many parents find that they have a substantial amount of free time. Refocusing on career and marital issues are other tasks common among most parents to teenagers.
The developmental aspect of family assessment also investigates the attachment bonds between the family members. The attachment bond refers to the type of emotional relationship between family members. Human beings need emotional support and connection with those close to them, while at the same time maintaining some form of autonomy. According to Carlson and Carlson (2014), an individual must balance the two life forces: “togetherness and the capacity for intense intimacy in relationships and individuality, and the capacity for independent thinking and goal oriented action” (Wright & Leahey, 2013). The emotional bond between family members is crucial, particularly when the family is going through major changes caused by life’s unexpected turns.
The attachment bond between the key family members in Jane’s family can be described as strongly attached. Each family member, including the extended family seems to know their role in supporting each other at all times, including when celebrating, as well as when mourning or going through tough times. The key elements of attachment are evident among the family members, for example, understanding between the members even during disagreements, provision of comfort, and sharing of important information. According to Jane, this attachment and inclusivity of family members has really helped in dealing with her sickness. She has received immense emotional support, which she believes would not have been easy were it not for familial support.
Family Functional Status
The third dimension of assessment based on the Calgary Family Assessment Model is the functional aspect of family assessment. Functional assessment basically investigates the ability of a family to effectively perform important functions such as activities of daily living and communication or expression (Carlson & Carlson, 2014). Families have varying delineation of roles and activities that each member can perform. The most basic outline is the role of the patents versus those of the children and the extended family. Since Jane’s diagnosis, the performance of activities of daily living has changed. Jane enjoyed cooking for her family before her sickness and she always made sure that breakfast and dinner are served on time.
The progression of the disease and the treatment she is receiving has left her weak and nauseous most of the time, rendering her incapable of performing easy activities of daily living such as cooking for her family. In addition to cooking, Jane assumed the responsibility of general house cleaning with the help of her children. Since her diagnosis, the rest of the members of the family have taken over these roles wholeheartedly, but this has left Jane feeling ‘useless’ since she cannot help around the house. The caring nature of a woman had Jane take care of her children and husband, but now the roles have been reversed, as she is the one receiving care from her family. Jane’s children, her husband, and even the extended family admit that her supportive nature and contribution to family’s activities of daily living has played a significant role in bringing the family together.
Communication in this family can be described as mainly verbal, although there are times when nonverbal and emotional communication has dominated the family’s expression. Verbal communication is the most sober form of expression in the family, since it is free from heightened emotions. As parents to teenagers, Jane and John have learnt how to look out for nonverbal expressions from their children and devise ways to verbally communicate during such times. The different forms of expression enable the family to efficiently resolve internal conflicts and disagreements.
The most prominent problem solving technique utilized in this family is crisis management. Proactive problem resolution has also highlighted problem solving episodes in the family. Proactive problem solving approach is encouraged in the family as it is believed to promote inclusivity and expression. Proactive resolution of problems also reduces the likelihood of tension between the family members. The resolution of issues hasn’t been affected by Jane’s diagnosis. The roles of the family members have changed, not only as a result of the disease, but also as a result of changing developmental stages.
John is the breadwinner now, although is firstborn son also helps out. John and Jane maintain the role of major decision-making, and sometimes make major decisions without involving the children. The children have become more autonomous as they advance in age, and may engage in some personal activities without necessarily seeking approval from parents. Despite this adjustment, the parents have not relinquished their rights as advisors and providers to the children and have the power to influence the children’s decisions. The family’s beliefs about health and illness are consistent with their spirituality, as well as with their cultural belief. The family believes that disease is one of the many tests of life, and they also believe that everything happens for a reason. Despite the progression of the disease, the family is hopeful that Jane will be healed. The beliefs do not limit the members of the family from seeking medical intervention.
Conclusion
Family assessment is an approach used to gather data about the structure of a family and the relationship and interactions between the members. The data gathered via family assessment is essential in informing the diagnosis, plan of care, interventions and management of illnesses. Nurses utilize this approach to deliver patient-centered and holistic care to its patients. The Calgary Family Assessment Model is one of the tools used to perform family assessment.
The assessment of families using the CFAM helps identify the necessity of interventions as the nurse and the family members explore the main issues affecting the family, other than disease. The assessment facilitates the identification of strengths and weaknesses in a family, and based on the findings, a nurse can deploy the best interventions. This paper assessed the family of Jane, a 40 year old woman diagnosed with stage 3 colon cancer. The disease has affected many aspects of the family’s life, including its functionality and development. The diagnosis has also changed the family’s belief about health and illnesses. It has revolutionalized the family’s attachment and bonds, roles, as well as the beliefs.
It is evident from the assessment that illness has taken a toll on the family. The children and John fear losing mother and wife respectively, while Jane feels like she is missing out on the most important part of her family’s developmental stage. She however draws comfort and surety from the love and support of the family members, including the extended family.
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