The current study deals with the analysis of the case-study family’s structural, health, developmental, and functional issues. This information is crucial for robust family planning and nurse activities. Thus, it must be properly structured and assessed, considering family strategies, development approaches, health problems, and social environment.
First, the overall data on the family will be discussed to identify the main issues concerning family structure, practices, and problems. Then, proceeding from the analysis of the relevant family data, a genogram is created to explicate the structural relationship between family members, which is a crucial tool for nurses in managing their activities in a given family. In the following section, the Calgary Family Assessment Model (CFAM) is developed based on the available and relevant information on the family.
The main tools of this model are applied to family structural, developmental, and functional dimensions to provide a comprehensive outlook of family internal and external relationships, social environment, health and social problems, developmental strategies, and emotional background (among the significant variables). The analysis will be grounded on various literature and theories devoted to these issues. Finally, the analysis of nurses’ role in providing services for the family is provided. Proceeding from the general requirements and guidelines for the nurses, the case for this specific family situation is developed with relevant instructions for the nursing practices.
The family under analysis has one distinctive feature – a family with a newborn (a girl named Felicity, four weeks old). James and Naomi Brown also have a son, Steven, who is three years old. Naomi didn’t experience any health problems or difficulties during the birth of her daughter, who was born generally in the hospital. The main issue concerns the changing social environment, which deeply influences family living circumstances. The thing is that two weeks after the birth of the daughter, the family moved to a small town far away from the place of their previous living where Browns had friends and permanent social and interpersonal relations. They moved to this small town because James secured a quite well-paid job in the mine. The couple doesn’t know anyone in the town, which presents a social and communicational problem further discussed through CFAM.
The social and communicational issues arising from moving are more articulated in the case of Naomi, who had close relations with her mother and father, two sisters, and a brother who lived close by before their moving. For James, changes do not seem to be important for his family’s overseas lives. His mother died from breast cancer long ago, and his father is remarried to a woman with two young children aged 8(Brent) and 5 (Alice). The changes deeply affect the relationships in the family. Steven suffers mental stress and frustration after six months of normal condition. Naomi misses her family and often complains to James about moving to this town. Moreover, Naomi fears that her milk will not be adequate for Felicity’s breastfeeding and that Steven will be angry for not paying due attention to him. To sum it up, the outline of the family’s current conditions shows that it faces some difficult social, environmental, strategic, and communication challenges, which must be taken into consideration by a person who provides services for a newborn child.
The first step in creating a comprehensive framework of family assessment is developing a family genogram. Genograms are used to present structural relationships between family members, though not reduced to genealogy tree attributes but providing relevant information on health and social issues. Genograms are helpful for nurses and family practitioners because they “can be used to reframe behaviors, relationships, and time connections within families, as well as detoxify and normalize families’ perceptions of themselves” (Kuehl, 1995, p. 39). They are the preliminary tool for nurse orientation in family relations, which is necessary for adapting her/his behavior in terms of the family’s peculiarities. For instance, some types of genograms such as spiritual genograms are used to increase nurses’ confidence and self-awareness (Halevy, 1998). The current study provides a genogram filled with available information on the family composition, which is further analyzed through CFAM (structural section).
As genogram shows the structure of family relations is considerably wide and differentiated and thus a great deal of attention must be paid to comprehensive analysis of the overall fabric of structural relations in this family. Therefore, the link of genogram to the CFAM must be provided. CFAM is widely recognized tool for the assessment of various facets of family relationships (Schober & Affara, 2001). It was reconfigured from the framework of family assessment designed by Tomm and Sanders (1983) and after that substantially revisited in 1994 and 2000 to meet new practical and methodological challenges. The CFAM consists of three interrelated subcategories – structural, developmental and functional each dealing with a relevant family constitution parameter. Structural section is directly linked to the above genogram but analytically widens it. If a genogram provides nurse with a certain mapping of family structure, Structural section of CFAM further differentiates it to provide nurse with reflective insights into family relations. The main issues of inquiry concerning each subcategory are taken from the research of Mandleco and Potts (2007).
What concerns family composition Brown’s family consists of father, mother, 4 week daughter Felicity and 3 years old son Steven. Naomi has parents, two sisters and one brother. Jack’s mother died and his father is married to another woman having common children. The Browns recently moved to a small town 800 km. away from their previous setting. The relationship of Jack to the other children of his father is vague but we may propose that it is quite positive due to natural causes of his father remarriage. Naomi according to the available information maintains warm relations with her parents, brothers and sisters.
What concerns gender relations in this family they are quite clear articulated. The family moved to unknown town since Jack decided to change his job to a better one. According to the available information the power relations in the family is on his side and the bulk of family responsibilities are reserved for Naomi. As Conger et al (2004) claim the gender relations in the family direct developmental strategies, family practices and other orientations and thus, its analysis must be the primary interest of nurses and other family practitioners for this knowledge provides necessary tools for behavior and family assessment.
Another structural element of CFAM – sexual orientation is irrelevant to this particular case given the age of children and recent marriage.
Rank order of the family under discussion is presented in the genogram and the further information may be provided concerning health and communicational issues. The birth of Felicity was normal and Naomi never had abortions. The communication with Steven, their eldest child seems to have been adequate before their moving to the small mining time. But here we observe the change in his behavior – he is becoming more unstable and nervous. This situation must be tackled through the mechanism of child’s adaptation to the new conditions, fitting him into communication with other children, which can be realized in the process of socialization (Harrow et al, 1998). The subgroups division in the discussed family is considerably articulated. Naomi breast-feeding her youngest daughter and preoccupied with the problems of Steven who is stressed by new family conditions. James is totally preoccupied with his new job and seems to ignore the problems arising from family’s moving to a new place. So Steven and Naomi are the subgroup the most affected by the stress problems. Naomi talks with James with Steven’s problematic behavior but according to the giving information this haven’t already has an effect on some positive changes. The stress situation in the family may be conceptualized from the standpoint of “critical family events” (Harrow et al, 1998). According to this model, stress occurs when critical events are taken place (moving to another city, worsening of parents relations etc.). In this particular case stress situation is connected with the fact that moving to a new town coincided with Naomi giving birth to Felicity, which makes subjective perception of changes even more pronounced. Steven also suffers from lessening attention to him on the part of his mother. And only James who stands aside from these problems according to the information provided in the case is psychologically stable. The case lacks necessary information on Boundaries subcategory, but the most relevant was already provided in the previous section. What concerns extended family relations as was noted above James doesn’t maintain permanent relations with his relatives since they are living abroad, while Naomi before moving to new town was quite close with her relatives (parents, brother and sisters) who were always near. Steven also frequently visited his mother’s family but the situation radically changed after their moving.
CFAM development section is application to the case-study
Developmental section of CFAM consists of the relevant information concerning developmental stages, approaches and attachments. It is important to note that there is no single family development patterns and models. As Dominus (2004, p. 30) argues, “The natural sequential phases of old and new generations-the younger cohort’s rise, the start of the older’s descent-may no longer fall so neatly in sync, creating tension and confusion”. Family development is conditioned on “critical family events”, which can be predictable and unpredictable, positive and negative. According to Anderson & Goolishian (1988) the knowledge of family development history is important for nurses who then can easily orient in the history of the family, which provides them with necessary information. The proponents of the theory of family life cycle such as Duvall (1997), Carter and McGoldrick (1998) claim that family development occurs in successive cycles which provide families with new challenges. For instance, the early stages of life-cycles as in the case of discussed Brown’s family are characterized with frequent gender conflicts and the fight for recognition. Various stress situations connected with breeding of children frequently occur. Some stages of “family socialization” – for instance changing permanent place of living to find more profitable source of earning are often accompanied with communicational and behavior problems both for parents and their young children. To avoid this various coping strategies were developed by such theoreticians as Minuchin (1974), Haley (1977) aimed at creating necessary conditions for moving smoothly from one life cycle and developmental stage to another. The family analyzed according to the bulk of research is at the early stage of family development characterized by maturation problems. What concerns the level of attachments the most “attached” subgroup formed around Naomi who due to clear circumstances spends the bulk of her time for her children, while James according to the given information seems to be detached from Naomi’s preoccupations.
CFAM functional section in application to the case-study
Functional assessment represents the analysis of family relations and falls into two categories of instrumental and socio-emotional relations. There exist a considerable correlation between daily activities performed in the family and psychological environment in the family. As in the given case, when wife (Naomi) is the only one who gives care for the children, it easily leads to stress and psychological problems in the family, thus care giving responsibilities must be divided between wife and husband (Lowenstein and Gilbar, 2000). The role division in this family thus is relevant. Circular communication, which is according to Watzlawick, Beavin, & Jackson (1967) relates to reciprocal communication between people bears negative connotation since Naomi’s permanent complaining of her hardships leads to her husband getting worried and angry. This reciprocal communication therefore doesn’t result in any concrete problems’ resolution as James has the main influence and power in the family. The alliance and coalitions are not likely to form because children are rather young to articulate their attitudes to family relations.
Nurses’ role
Nurse’ “program of actions” must be firmly based on the positive family assessment. Thus, nurses must discuss with family member all important categories and sub-categories which will provide them with necessary information family’s problems and challenges. It is important that nurse has good knowledge of family background, history and the relations between family members. But nurses must remember that their understanding of the family situation depends not on the objective knowledge but on her/his own perspective and perceptions (Levac, Wright, & Leahey, 2002, p. 12). This would help he/she to avoid “authoritative” actions and viewpoints that could harm. Nurses must pay special attention to the interrelation between psychological and instrumental process. For instance, Fiese and Wamboldt (2000) advocate the view that nurses must follow family routines and practices in order not to damage the stable fabric of family relations. This is relevant both to “critical family events” and resoling children health and education problems. Nurses must try to stick to the family definitions but at the same time seek to foster the development of better practices and family relations. All the nurses’ guidelines discussed above are considered to be the most adequate and efficient by the referred family therapists and researchers.
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