Introduction
The family attitude towards the issues care has a long history in the area of giving care. Parents of any family are usually regarded as a part of a socio-cultural surrounding of a child, as they prepare there child for the future, often independent life. Their assessments are grounded on the purposes of bringing up the child, and often depend on the life experience of both parents, and on living conditions. Families offer the emotional security which a constantly changing workforce of professionals cannot offer (McConkey 2003).
A family care approach to assessment and bringing up could mean that much of efforts that parents apply to bringing the child up usually can not be documented, and may outline in various consequences. What is documented now is what is considered to be relevant to the “child” in a family context. All family experiences are seen to affect each family member. Helping the family to reach solutions could solve the problems of individuals. A family care approach study could be a useful additional parental skill which would help to provide psychological assistance; to better fit needs with what resources are available; to provide research information about what resources are needed and how they should be structured; as well as to provide a resource, at the discretion of the family, for interdisciplinary work. It may be able to ensure that families are supported in the ways that they choose to manage their lives (Williams, 2002).
Nolan and Grant suggest that parents require a relevant practice in order to address all the needs of their children (the needs is meant the bringing up requirements, and the purposes), but first that nurse education will have to change. A family care model could be a suitable practice model but students studying pedagogics would also require counselling, health education and self-care techniques (Nolan and Grant 1998). If families initiate and/or are involved in problem solving and decision making they will be more likely to use and adapt helpful strategies (McConkey, 2003). As parents are often involved in health care they are already altering and/or modifying their practice (Wright and Leahey, 2001) and moving towards a family systems model of care.
Family therapy can be used to change the dynamics of the family system, opening the way for individual change. It can allow family members to understand how their behaviour might be determined by family dynamics, and can be used as a way of understanding personal problems (McMahon, 2000). Family assessment of their experiences may be affected by emotion and/or tiredness so the usefulness of a reflective, problem-solving analytical systematic approach (Kahney, 2002), such as the framework offered by Roper et al. (2001), could be enhanced by extending it to a family systems approach which would include analysis of structural, functional and developmental aspects of the family. This approach could provide an organised conceptual structure and seems a logical step in the development of the holistic parental care system. (Whyte, 2002) It would also seem logical parents (especially young) should also need additional experience and support service to be available (Gilliss, 2001).
Case study
The offered case study (case study four) provides the information on rather happy family, which just has and adolescent son, who is willing to start the self expression process, which is closely connected with parents’ anxiety, worries and, unfortunately, quarrels. But it should be mentioned, that Juan’s parents’ jobs just oblige them to find the common language with their son, as they are dealing with people (lecturer and policeman).
The family assessment scheme may be the following
Structural
- Internal
- Family composition: the family consists of just three members (Juan and his parents Phillipa and Martin). Juan’s grandparents may not be taken into account, as they are living separately
- The rank order is not described in the case study, but it may be supposed that it is classical, especially taking into account Martin’s job
- There is also no information given about the subsystems and the boundaries
- External
- The extended family information is the information about relatives and grandparents. There are grandparents exist both from maternal and paternal sides.
- Context
- Ethnicity. Unfortunately no information is provided on this issue, but the suggestion is that Juan may have the mixture of Hispanic blood, if judging by his name.
- Social class most probably middle. Such decision may be made after analysing the jobs and the living conditions of the family.
Developmental
- Stages
The stage of the family can be characterized as “the family with a young person”. The awkward age of the child is rather difficult for each family, and parents are obliged to find the approach for their child. Philippa and Martin, as it has been mentioned above, are dealing with people and people’s psychology on every step of their work that is why it must not be a problem for them to find the common language with Juan.
- Tasks
No information is provided in the text of the case study, but the fact that could be mentioned on this issue had been already highlighted: these are not to alienate their sun, help him define his place in this life, help avoid mistakes which are common for the adolescents (simply help to differentiate what is good and what is bad, and most preferably explain that some things can be grey, and the rightness of the choice depends on the life circumstances)
- Attachments
The additional attachments of this family are not only bring up Juan, but also give him further education (as he is attending the higher school, he will most probably need to continue his education in college). For the all-round development of the adolescent, the parents should devote him as much time as possible, in order to stay authoritative in Juan’s eyes. Martin and Philippa need to prevent him from entering some gang, form starting using drugs or drinking alcohol.
Functional
- Instrumental
- Activities of daily living
The activities of daily living of the family compose mainly the studying process, and the working activity. Juan needs to study to enter the university or college (for the further education). Being an adolescent, he dates a girl from another school, and some of his free time he devotes to her. The family cares of two pets (the dogs Jess and Pickles), thus, part of the bringing up process which Martin and Philippa may devote to their son is devoted to the dogs (it is well known, that pets require much time to be devoted to: it involves feeding, walking, tutoring and sometimes treating and seasonal vaccinations). Martin and Philippa, working at socially important appointments, usually spend too much time at work (as the lecturer and the policemen are one of the most time demanding professions) due to mainly paper works, reports, protocols and lecture planning.
- Expressive
- Emotional communication
Emotional communication in the family may be estimated from several points. As the jobs of Martin and Philippa are rather emotional, they may come home emotionally exhausted, and may treat Juan unfairly. On the other hand, the presence of the pets in the family signifies that they may help to take away the emotional tension of the family members. But the matter of airing or feeding the dogs may become the point of family quarrels.
The issue of the grandparents should also be regarded. The fact is that, the emotional surroundings in the context of communication with grandparents usually depend on the relations of the child with them. Juan has an opportunity to see or visit his maternal grandparents everyday, as they are living in the same town. And he visits them regularly. The paternal grandparents are visited only once a month. The frequency and the necessity of these visits are usually defined by the parents (as in any family), but to estimate whether these visits are useful for the successful bringing up of Juan, and the changes of the emotional surroundings of these visits may be only in the context of the relations among them and Juan.
- Verbal communication
Unfortunately, nothing is mentioned about the verbal communication in the family, but as it has been already mentioned above, lots of the family circumstances depend on the life experience and often on the jobs of the parents. Thus, Philippa as a tutor should us only literary language in the communications, especially within the family, as it is necessary to make Juan use clear, high level language. Both parents may add some commanding tint to the family communication, as the jobs oblige to be able to rule and command people, thus, thus necessity may be transferred to the family in some measure.
- Nonverbal communication
Nothing is mentioned again about this point in the case study, so, the conclusion can be made on the basis of logical thinking over. The members of any family for the years of living together got used to make some unmentioned signs in order to communicate, especially if something needs to be said confidentially. The same could be with the regarded family. Philippa as a tutor could have studied to catch the mood of the students just looking at their face, so she may define Juan’s mood, which depends on the successes in school or the relations with his girlfriend.
- Problem solving
The problem solving is most of all not so burning problem as it may be in the majority of the families, as Martin and Philippa are mostly concerned about Juan’s relations with his girlfriend. Nothing else matters for this family, or just the other problems are on the background scene for them, which signifies, that everything other is all right.
- Roles
It is not difficult to guess, that Martin is the nominal and factual head of the family. The leader should be strict, unflinching man, able to take various, and often independent decisions. All these requirements are obligatory for the policeman, thus, leader at work is a leader in the family. It should be highlighted, that this family can be regarded as classical in all possible dimensions, except, may be, the amount of children, as classical American family should have at least two children. So, the roles also may be regarded as classical. Philippa acts not only as mother, but also as the family tutor, attempting to help her son get further education.
- Influence
The matter of influence must be viewed from the sociological point. It is said, that community (society) influences the child, but parents play the key role in bringing up the children. This family is not an exception in this matter.
Discussion
The fact that Philippa and Martin want to address the nursing attendance, in no way signifies their inconsistency as parents. They just lack experience in the matters of the boy-and-girl-relations, as Juan is their first son, and most probably, that their friends have not also faced this problem. Problem solving for families using an existing model of nursing could be improved by the use of a family nursing model. Using the Roper et al. (2001) both parents are involved in the assessment and Juan will be able to contribute most as only Juan himself may help Philippa and Martin sort out this issue completely, help them to define his needs and requirements. Extending this model to a family nursing model would have treated the family as the ‘client’ and would have included interviews with all other consenting members. This might have given a better idea of what the family felt they needed to strengthen their coping efforts; how to fit existing resources to their needs; what resources would need to be provided for similar occasions in future; as well as providing a useful resource, at the discretion of the family, for other members of the multidisciplinary team involved in this family’s life. In common with many families with children with the needs changed due to their age, this may be considered as rather lucky, as Juan’s parents do not need to address numerous specialists and experts in the sphere of adolescent psychology, as they are familiar with it due to their jobs.
It could be that this episode itself, with the support of the listening experts, might have contributed to a continuing process of perceptual shifts enabling the family to move forward. The family were all very tired at this time and tiredness might have affected abilities to think clearly (Lazarus 2001:414). A family nursing model could be a suitable practice model to address all the needs of families of children with any problems caused by the awkward age. It does appear as a logical step in the development of the holistic care offered by psychology experts.
Conclusion
Family-centred nursing has a long history in this area and would be enhanced by a systemic model. This has been demonstrated using a recent case study from professional experience. Use of the Roper et al. (2001) model identified ‘time out’ as ‘a way’, but was based mostly on the mother’s opinions. A systemic approach could mean that nurses’ knowledge about the family as a unit could be documented and a collaborative approach to problem solving could be facilitated. What is currently documented is relevant to the ‘client’ in the family context. What could be documented would be relevant to the family as ‘client’. As the child’s well-being is so closely bound up with family health and functioning, this approach has much to commend it.
References
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