Introduction
Cancer can cause families immense stress and uncertainty; this has the ability to affect the process of treatment for the concerned patient. In Rolland’s model on the phases of illness, it is assumed that these stresses can be managed through the use of psychosocial maps. In other words the model provides a framework for understanding how belief systems, life cycles and multigenerational legacies interplay in a health condition. Through this model, coping and adaptation are made possible thus improving the quality of life of the cancer patient as well as the family dealing with the challenges. The paper shall apply these principles to a case study of Veronica Andrews and her family.
How illness can impact the family
The case under analysis involves a married woman with three children. In this model, Rolland & Walsh (2006) affirm that an illness like cancer has the capability of causing immense emotional and financial strain on the concerned families. This will be especially pronounced when the said disease does not cause immediate or short term death of the patient. For the case of Veronica, there is a possibility that her family may have to live with her illness for a very long time. Consequently, they must be prepared to cope with all the demands that are come with caring for a cancerous patient. This family must make adjustments to the possibility that cancer can affect their quality of life. However, it had its own life cycle-prior to Veronica’s illness; the family was operating normally with Veronica using her organizational skills to take charge of her home. However, after commencement of the illness and subsequent treatment, Veronica could no longer perform those roles. This implies that her husband had to step in and her children had to adjust as well. The developmental stages that this family was undergoing had to be abruptly interrupted. Additionally, the very nature of cancer is that it has its own life cycle. There are instances when the patient will go through immense pain and suffering and there are also situations when she will be completely immobilized. Unless the latter family thinks of Veronica’s illness as a crucial part of their development, then they may end up being stuck in an impractical position.
A number of challenges will have to be faced by all the members of this family. For instance, her three daughters are all below the age of thirteen. They are probably struggling with their own growth and development. The introduction of another stressor is likely to make things harder for them. This is probably the reason why they have been acting out in school. The five year old is particularly vulnerable as she is still in need of strong maternal influence. Additionally, these children are dealing with the possibility that they might loose their mother for good. On top of this, they were probably used to having their parents available but this is no longer possible. Consequently, the older children i.e. the eight and twelve year olds are probably finding that they have to perform more household chores or that they have to exercise greater responsibility in the home.
Veronica’s husband Archie also has his own dynamics. Marital roles are continually strained during prolonged illnesses such as the one that Veronica has. Carrying out the role of mother and father may be a huge challenge to this individual especially due to the personality differences between himself and his wife. (Rank, 2009) This implies that the marital relationship may be disturbed and something has to be done in order to foster a strong bond with his wife.
Rolland asserts that when an illness commences, there is a timeline that the family usually goes through. The first phase is the pre diagnosis phase before a family knows what is ailing their member. In this case, it is likely that Veronica’s family was going through immense anxiety before the diagnosis because they were hoping that she did not have a fatal or chronic disease. The family does not require such a high rate of change at this point. After diagnosis, the family must go through the initial adjustment period where they have to reorganize their family identity and embrace the fact that this illness will change the way their family functions. (Rolland & Walsh, 2006)
The next phase is the course where the disease starts progressing or the chronic long haul phase. For Veronica’s case, her family has to endure periods of immense suffering when she’s completing treatment and adjust to periods of relative calm. These sporadic changes may have the most painstaking effect for this family as they need a high level of adjustment. If they do not have that quality then changes are that there will be increased tensions between them. (Rolland, 2005) This could probably be why the children were behaving strangely in school. The psychosocial dimensions involved at this point are actually immense. It is likely that the instances of memory loss, fatigue, nausea and weight gain fell within this category and each instance required a different emotional, psychological and even physical adjustment by her family. It is likely that Veronica’s husband is having a hard time adjusting to his new challenges as a father because he has not yet mastered open communication with his children and his wife. Additionally, the children and everyone else in this family needs to embrace and anticipate loss. This family has not yet accepted uncertainty as part of their life cycle and they need to do so in order to cope sufficiently with their mother’s/ wife’s illness. It should be noted that in this long haul section, a family may tend to feel trapped by a never ending problem. Veronica’s family seems to have started defining their identity based on the illness of their mother. This may be a problem because the children and her family still need to feel normal. They seem to lack autonomy yet this is a critical part of coping in the chronic long haul section. The latter family needs to work on maintaining that aspect. Additionally, it is likely that members of this family are going through a myriad of emotions some of which have been buried. Her husband needs to discuss and let out his insecurities about heading his household. Her children need to let out their fears concerning the perpetual helplessness and absence of their mother. The issue of possible death may also be causing this family immense sorrow. They need to open those pathways of communication and discuss these issues. Otherwise, they will simply come out in the future in a worse state. In order to foster the reproduction of these feelings, it may be necessary for the concerned nurses to help this family in opening up with another through discussion of these buried emotions.
The terminal phase can either be abrupt or certain. (Guglielmetti, 2007) When it is abrupt, then sudden death can occur. Alternatively, the uncertain outcome arises when a family may not be well aware of when death will occur but the possibilities have been addressed by the family. Rolland asserts that when families try to bury these uncertainties then it can add onto the burden of already coping with an ill member. In Veronica’s case, medical personnel have not ascertained the outcome of her illness, however, her husband and three children are already considering the possibility of this occurrence. These insecurities are definitely showing through the way they are handling other day to day challenges such as school work or household responsibilities. In other words, the latter family will go through the pre-terminal phase before they can enter the loss and mourning one. When the family gets to this point, then they must place a strong emphasis on supporting Veronica as a terminally ill patient. She may have to make a number of preparations before has departure. All unresolved issues within this family must be addressed adequately because they do not know when they might lose her. At this stage, Veronica may still be capable of carrying out certain activities; the family needs to assure her and they need to help her live her last moments as fully as she can. In the event of her death, her husband and children need to reorganize themselves as the possibility of a return of their mother has been completely eradicated and they need to reorganize themselves.
All the latter phases in Roland’s timeline are critical in indicating which dynamics a family may be going through. (Lee & Korneluk, 2004) However in the transitional phases there may be instances when the concerned family has not yet adjusted or is stuck in the previous phase. For instance, in Veronica’s family, her husband and children may not have adjusted to the chronic long haul phase i.e. that their mother’s illness is going to be present for a long time to come. Therefore, nurses and health care practitioners could suggest family therapy for them so that they are ‘unfrozen’ out of their present state. They need to be perpetually guided on how they can reorganize their adaptive structures every time Veronica moves into another phase of her illness. These facilitations need to put in mind that the roles of the members, their communication processes, organizational patterns and belief systems need to change with every phase.
Conclusion
It is likely that Veronica’s family can grow stronger as a result of her illness. However, in order to do this then clinicians will need to step in and help them embrace resilience. They need to be more flexible and accept that certain things may no longer be possible after their mother’s illness. This may make them stronger and better prepared to care for Veronica.
References
Rolland, J. & Walsh, F. (2006). Facilitating family resilience with childhood illness and disability. Current opinions in pediatrics 18(4), 527
Guglielmetti, C. (2007). Congestive heart failure. Web.
Rank, J. (2009). Loss, grief and bereavement. Web.
Lee, C. & Korneluk, Y. (2004). Children’s adjustment to parental physical illness. Family psychology and clinical child review 1(3), 179-193
Rolland, J. (2005). Cancer & the family. Journal of cancer for clinicians 104(11), 254