The Calgary Family Assessment Model presents a detailed means of assessment whereby the whole range of structural, developmental and functional aspects of a family’s condition and foundation are put into consideration for the purposes of assisting in certain intervention processes. This model provides a simplified framework that assists nurses when in the business of interviewing particular families. The model gives clear overview on the real family members and the significant relationships between them including their duties. The model also assists in obtaining information concerning family support and communication networks. The whole information is obtained from the family through oral interview. Various tools are applied which help in organizing data concerning the family under analysis. These tools include the use of genogram and ecomap. The nurse has got the ability of giving advice on what seems relevant for the family on particular situations (Wright and Leahey, 2009).
Through the application and implementation of the CFAM, it is possible to understand the family concerns and the negative images resulting in conflicts and painful feelings. Some of the concerns could be prevented or solved with the full support of family members. Therefore, through this it is possible as a nurse to improve the cognitive, affective and the behaviors of the family members putting them within right context (Wright and Leahey, 2009).
Using the structural components of the model to describe the family
Concerning the family composition, the family comprises of Mr. Peter who is deceased, Eliza the wife. They have seven children, six daughters and one son David who is the last born in Peter’s family and is currently nineteen years of age. Sheila is one of David’s sisters and is twenty years of age, a year older than David. There are also grand children. Family composition could be useful since it helps in describing the family’s status, source of support and history on how family has been managed. The issue of gender could be used to explain some behaviors within the family, David is the only son and is all surrounded by ladies, the mother and the six sisters. He has no source of male authority over him after the father’s demise. Sexual orientation may not apply to the family since from the description of the family there is none who is bisexual.
The issue of extended family may not apply since in this context only the family members are mentioned. On the larger system, David has got friends at school one of David’s friend is Sam who proves to be of great assistance to him especially when it comes to class work. He assists David with class notes whenever he misses classes. The other external member of the family is known as Mary James whom David dates. Mary is survived by both parents who are migrants from Africa. The lady has got a son known as Kerri, the father being Mr. Tom. The family is further influenced by the teachers from the school where David attends, the school keeps on updating David’s mother on his progress at school which seems not encouraging at all due to his poor performance and bad behaviors (Wright and Leahey, 2009).
Within the larger systems, the family members have close relations with each other and a well- functioning network. This is revealed by the fact that although David’s sisters have left home, they often make frequent visits. David has stressful relations at school, because he often misses classes. He is involved in sporting activities like ice hockey and fastball and also works out quite often in the school gym to keep fit. The Father to the family, Peter, died of heart attack couple of years past. Mary who is currently dating David was first diagnosed with spotting and edema during her first pregnancy and currently the doctor found out that the blood pressure was so high. However, her parents on the other hand are healthy, Mary is pregnant the second time and decides not to tell them due to fear of embarrassing the family once again. Mary enjoys being the only daughter in their family.
Eliza lives on the pension she receives from where David’s father used to work before his death. Peter’s family has a Canadian background, while Mary’s Parents were born in Africa and even Mary herself but later they migrated to Canada. They are committed Christians of catholic background, and feels that the children within Canada enjoys too much freedom. On social context, David uses some of his spare time to smoke cigarettes and drink beer together with his peers. This character has become stressful for the family, leading the elder sister to comment that David still needs to do a lot of growing up. These habits also interfere with his education life since he barely has time for class work (Wright and Leahey, 2009). Race and ethnicity may not apply since there in no clear description on the family’s background. On religion Mary’s family are Christians and believe so much on biblical principles concerning sexuality.
Description of the family’s developmental stage tasks using the developmental component of the model
Despite all the problems that occur within families, it is believed that much strength to overcome challenges lies within the relational ties that exist. As the family undergoes certain experiences certain important changes occur through out the life cycle. Peter’s family passed through some developmental stages especially after his death. The family had to go through the transition of accepting to continue with life without the head of the family which is the father. Eliza had to take the full responsibility of a parent by providing financial support and also making some follow up on their only son’s progress at school. She works out on how to strengthen David and Mary’s transition stage to being middle aged responsible adults by accepting to take care of Kerri as the two get time alone to talk out issues concerning their lives. Nursing intervention involved in this case acts as important source of help that could enable easy support to individual members as well as pointing towards completion of family developmental tasks throughout the lifecycle (Wright and Leahey, 2009).
David the youngest son within the family dates Mary James who already has a sixteen month old son called Kerri. The two wishes that one day they would spend life together as husband and wife. In the process David impregnates Mary of which she sees as another added form of torture to her life. Mary on the other hand has got a friend called Sal who also happens to have a son little bit older than Kerri, Sal tries to advice Mary out of her frustrations of being pregnant and also concerning David’s assaults. Mary’s Parents, who happen to be immigrants in Canada accepts to take care of their daughter together with their grandson Kerri.
Despite impregnating Mary and both still in the dating stage, David is not planning to leave their home any soon since he is still a student. The financial responsibility of taking care of Mary and Kerri had been taken by their Parents. The second pregnancy has left Mary with lots of depression since in the first instance it was an embarrassment to her family who happen to be devoted Christians, though they finally accepted her. Mary is struggling to get out of the emotional trap that has beset her. David needs to work on how he should possibly develop his work and financial independence which could allow him to take care of Mary and the children instead of wanting to pass on the responsibility to Eliza (Wright and Leahey, 2009).
Decisions have to be made on how the two families could be joined through the friendship between David and Mary. There is need for the two to commit to the new family system and accept the realignment of the family with the extended family and accepting responsibility. Mary has to accept the pregnancy and not champion the idea of termination just because of shame. David has good intentions by accepting to shoulder the responsibility of taking care of Mary and Kerri. Eliza is doing well by accepting to join the two in rearing their child. However, David and Mary besides their wish of staying together should also refocus on midlife marital and career issues (Wright and Leahey, 2009).
Using the functional component of the model to describe any instrumental or expressive symptoms that may suggest that this family is experiencing a problem
The move by David’s mother to kick him out of home owing to his poor class attendance at school clearly depicts some emotional torture on the side of the family and Eliza in particular. In order to make up for his emotional stress David always goes out on a drinking spree together with his fellow peers, this calls for emotional maturity. David agrees to support Mary together with her child in order to keep them from any trouble posed by Tom, Kerri’s father. Also the telephone conversation between Mary and David ends in emotional stress which makes Mary to speak hatred over David for making her pregnant this clearly reveals some level of emotional torture. She hangs on David after denying his responsibility for the pregnancy. This verbal communication leads to direct confrontation which at the end of it all reveals clearly the affected and source of the problem. Mary thinks of terminating her second pregnancy which she thinks would be another form of embarrassment to her religious background. This makes Mary to think of going for evening drinking spree together with her friends, for the sake of seeking solace (Wright and Leahey, 2009).
This intervention process entailed challenging constraining beliefs from Mary’s parents who are devoted Christians and David’s family who happen to be pagans. New dimensions are described that shows David’s family ability to stand up to financial and emotional challenges they might face owing to the absence of David’s father. Eliza receives pension which is the only source of the family’s financial support. The set-up shows the real influence of illness and parenthood on the family and also the influence of family ties on the present problems. The family members are not able to map their influence on the illness brought by the complications. These associated problems such as anxiety, depression and hopelessness could be easily managed with the involvement of parental and physician guidance (Wright and Leahey, 2009).
Family members, particularly Eliza, David and Mary, could be able to see choices about how much influence they were willing to allow emotional illness problems to exert in their lives. Further, David after rejecting Mary on the telephone conversation gets fresh idea from Eliza on how to best keep their peace by accepting the responsibility of taking care of the unborn child and Kerri. David and Mary could now see increased and varied options in terms of their own responses to the pregnancy and the associated emotional problems. Successful dealing with the pregnancy and illness problems in their place gave chance for more possibilities to victory and, at the same time strengthened possibilities for change. When both family members became conversant of their own ability to take a stand against emotional problems and associated diseases, the basic changes became more apparent. Thus change invited change. This process assisted each family to heal from the suffering that had arisen in the context of living with a chronic condition. In other words, these interventions were effective in influencing change in a desired direction (Wright and Leahey, 2009).
Identification of any gaps in information that would be helpful in the process of working with this family
There is need for developing trust and comfort with the kind of family set-up. Developing trust based on the level of attention given to family members affected and showing genuine and equal interest to each person’s perspective. The other gap is in showing respect to both families beliefs, like in the case of Mary’s parents who are staunch Christians. There is need for maintaining appropriate emotional and cognitive distance from the problems and wrangles affecting the family, in order to have that ability of offering new dimension through which the family could find the desired direction (Wright and Leahey, 2009).
Information on the family’s composition should be paid much attention based on economic status, lifestyle, manner in which the family communicates and the person within the family set-up that they believe should be consulted first. There is also need to explore the type of environment in which the family is based; this reveals characteristics of the home and the community as a whole hence exposing the issue on how accessible the family is to health care, learning institutions as well as environmental risks. The other gap might be the family’s coping mechanisms to certain values and strategies and also the source of the family financial support. The nurse at the same time should raise concern in relation to the ages and current health status of the general family members, this assists in knowing the manner in which the family had managed health complications in the past (Wright and Leahey, 2009).
The nurse should seek for appropriate therapy that should be implemented which could make the families well prepared to tackle any future challenge. What are the key possible avenues that the family could use to keep out of problems? How should the nurse identify resources and supports that could assist the family in addressing the expected and unexpected life experiences?
The issue this family is facing
The problem with the family could be defined within particular context of relationships amongst family members and between the families and the nurse. The problems that particular members of both families are struggling with have led to both physical and emotional gap between the members. There is the existence of seemingly unbridgeable differences concerning the manner in which both view the problem at hand. There is difference in perspective about the existence of the problem, the ownership of the problem and the level of attention that should be given to the same problem. This can clearly be seen on the issues surrounding Mary’s pregnancy. This calls for the dire need of bringing the families together. David and Mary are barely out of their teen age, therefore requires lots of support to help them cope with their challenges (Wright and Leahey, 2009).
Problems and strengths of the family under mentioned systems
Reinforcing a nurse-family partnership under professional family system is a core consideration towards strengthening and supporting families. The partnership between the family and the professional nurses develops once the nurse is in close contact with the family. This relationship develops and strengthens over-time into trustworthy tie based on mutual respect and open communication between the professional and the family. The only problem that may occur at this level is language barrier. The whole family system implies that everybody within the family is involved in the care of the two clients (Wright and Leahey, 2009).
In the community whole system which involves the extended family, there exists adequate protective factors one of which is the existence of strong family networks. This is because the treatment includes the aunts, uncles, close friends within the peer groups, cousins and even the grandparents if they still exist. This makes it easier for the children to be monitored when out of their parent’s site. Like in this case, the teachers and David’s close friends help in monitoring his movements and studies and keep the parent up-dated. They take primary leadership roles within the family where parents are unable to perform. At times conflicts may arise within the extended networks due to disagreements in beliefs (Wright and Leahey, 2009).
Within the parental system, Eliza seem to protect his son so much to the extent of not being realistic with her threats of chasing David away from home due to his unbecoming behaviors at school. David knows it very well the love his mother has towards him. On the side of Mary, the parents accept to take care of her together with Kerri, despite messing up with the family Christian values. She is the only daughter therefore must be protected at all cost (Wright and Leahey, 2009).
On the side of parent child system, Mary loves Kerri to the extent of protecting and keeping him away from his beastly father. Mary and Sal share the responsibility of taking care of their children whenever one of them is away on other duties. This is made possible owing to the fact that they share the same apartment. On individual system, though separated for some time, Tom seeks legal system to help him get custody of Kerri and even gives financial support on a monthly basis; this seems possible since Mary enjoys being a mother to Kerri. Mary longs to finish school faster so that she can have good time with her son and give him good life he deserves (Wright and Leahey, 2009).
Appropriate interventions the problems within the domain of family functioning
Although there is strong support on the application of experiential intervention, important knowledge about the family is necessary and their desire to cooperate fully as partners within the family. The relational agreement between the family and the professional caregivers is of prime importance. There is need for open discussions on the mutual concerns of the family members which includes adequate resources that could help in handling various sicknesses. The case of David and Mary wanting to pass on their responsibilities of care to other family members cannot help in the removal of their sense of burden however much they try to reduce the emotional stress. The more appropriate intervention on this is to involve all the family members in the care of David, Mary and Kerri. The family is identified as a resource as well as recipient of health care. This is because nurses are able to learn a lot out of their experiences with the families through the shared knowledge (Wright and Leahey, 2009).
However, there is need to include all the family beliefs and concerns in the process of administering care to any particular family member. This makes it easy to recognize diversity that exists and absence of pretence within the families despite different backgrounds. Understanding of the differences that exists in the family beliefs and values has tremendous effects on the nursing interventions. The family should be given the right to choose on the level through which they want issues handled within the partnership. The active involvement of the family in giving care at will should be identified with (Wright and Leahey, 2009).
The discussions should be open to any member associated with the family such that meaningful care giving roles are identified and administered appropriately. Awareness should also be created on the basis of strengths and resources of both families. This dimension belongs to the cognitive domain of functioning within the family cycles. In this issue the cognitive domain could be realized on the manner in which the children from both families react to certain consequences of their actions. Understanding of these reactions is important since they are as a result of some developmental stage in life, of which holds some significant part of family life. Assumptions should not be made on the issue that all young men and teenagers have the same emotional feelings and challenges (Wright and Leahey, 2009).
Research reveals that all the assessments performed in the process of healing emotional and physical illness within families and especially individuals are never adequate. More sophisticated and advanced health interventions methods should be applied. The shared knowledge between individual family members and the nurses should be well translated to provide appropriate information that could assist families in the process of coping and overcoming chronic conditions.
Wright, L. & Leahey, M. (2009). Nurses and Families: A Guide to Family Assessment
And Intervention. (5th Ed.). Philadelphia: Davis.
Appendix II: Genogram