Introduction
The many socioeconomic and health challenges facing families in the 21st century have strengthened the need for stakeholders develop and implement family assessment approaches aimed at offering relief to the myriad of issues affecting the proper functioning of the family. Comprehensive family assessment, according to Aarons et al (2007), is the ongoing practice involving the provision of a framework for informing decision-making through identifying, evaluating, and reflecting on the various issues that affect the wellbeing of children, teenagers, and their families. Through undertaking a family assessment of the Anderson family, this paper purposes to demonstrate how one of the strengths-based approaches to family assessment, known as the Resiliency Model, may be used to assist the Anderson family in identifying and employing their strengths to manage the various health and social issues affecting them.
The Anderson’s are currently experiencing difficulties in meeting their financial obligations due to the adverse effects of the recent global financial meltdown. The couple decides to employ a coping strategy to their financial strain by working long hours, but this intervention only occasion work-life conflict. Recently, Joel, the third born member of the family was diagnosed with Type 1 diabetes. Although the family has a number of strengths that they could rely on, they seem completely unaware of them. Through the employment of strengths-based approach to family assessment, the care provider can assist the Andersons to identify their strengths and capacities that could be used to water down the stressors (Kruger et al, 2010).
Understanding the Stressors Afflicting the Andersons
The Anderson family is faced with a variety of stressors. On the social front, the parents are unable to meet the goal of retiring early, and have difficulties meeting their financial obligations due to the recent financial crisis that ostensibly affected their investments. Additionally, working for long hours and having to juggle their children’s extracurricular activities is leading to work-family conflict since the parents lacks adequate time to perform other duties outside of work, including sharing with each other, sharing with children, or socializing with friends. On the medical front, Joel has just been diagnosed with Type 1 diabetes, a chronic ailment that requires time and resources to manage.
According to Graham et al (2009), the above issues can be justified as stressors since they cause differing levels of psychological or physical stress to a point where these issues do not only affect the concerned parties as individuals, but also those around them as may be witnessed in the case of the Andersons. Accordingly, the accumulation of these issues and events inarguably reduces the quality of family adaptation, thereby qualifying to be termed stressors (Hauser, 1989; Tardon et al, 2005).
This paper will specifically investigate how the medical issue (Type 1 diabetes) is bound to influence Joel’s bio-psycho-social development and the functioning of the family unit. According to Hauser (1989), a wealth of family literature “…assumes that a breakdown in family functioning occurs as a result of the presence of family stressors, the use of inappropriate coping strategies, and misperceptions or misallocations of the family resources and support” (p. 99). Leon & Armontrout (2007) suggests that some external and internal factors such as poverty, illness, and drug abuse often contributes to emotional challenges, intellectual constraints, developmental difficulties and other challenges children face. Parrish (2010) argues that some life-threatening illnesses and conditions such as disability not only affect the child’s biological and social development, but also their psychological orientation especially in terms of socialization and development of certain skills. This has obvious ramifications on the family as members are forced to make both internal and external adaptation, not mentioning the fact that parents of such a child are characteristically faced with an assortment of responses, including anger, guilt, fear, distress, and fatigue (Tardon et al., 2005). The above influences compromise the functioning of the family unit.
Identifying the Strengths Demonstrated By the Andersons
One of the strengths that could assist the Andersons to manage the stressors is that the family is large enough to delegate duties in caring for Joel, whose medical condition would certainly require a lot of time sacrifices. Although the family is currently faced with some financial constrains, there is strength in that the couple is formally employed and will therefore be capable of meeting Joel’s financial obligations in terms of effective management of his health condition. The social and sporting activities indulged in by the children will assist them to let off steam caused by Joel’s condition. Still, the family can depend on friends in the neighbourhood for social and spiritual support. Lastly, the availability of a diabetes nurse educator will offer more support for the family in terms of showing them how to manage Joel’s medical condition.
The above factors can be perceived as strengths since they can effectively be used to form the groundwork for family nursing interventions. Stanhope & Lancaster (2006) argue that by using systematic processes such as the family strengths assessment models, such family strengths can be used as building blocks for successful interventions. In particular, the Resiliency Model of Family Stress can be used in the Andersons case to ensure the above named factors are transformed into positive outcomes for the family. According to Twoy (2006), the resiliency model mainly puts its focus on ways through which a family internally deals with problems or challenges between its members, and also evaluates ways in which the family externally deals with challenges through interactions involving the family as a functional social unit and the wider community. Bellin & Kovacs (2006) proposes that the role of a nurse practitioner utilizing the resiliency model should be to provide suitable professional support in assisting the families to identify and build upon the factors that make members more resilient in the face of adversity.
A Critique of Literature on Current Evidence-Based Management Strategies
The term evidence-based management strategy refers to preferential employment of some health or social interventions for which methodical experiential studies has inarguably provided evidence of their statistically significant efficacy as treatment procedures for specific health or social issues (Guillet, 2002). For a particular intervention to be perceived as evidence-based, investigations must be carried out to provide quantifiable evidence that supports or rejects the use of this intervention. Further, McWilliams et al (2007) & Orsulic-Jeras et al (2003) asserts that evidence-based management strategies involves intricate and meticulous decision-making processes which are not only founded on available evidence, but also on the patient or family’s fundamental characteristics, situations, experiences, and preferences.
Many evidence-based management strategies in the nursing practice take cognizance of the fact that care is individualized and ever changing, and must therefore be used to develop individualized instructions of best practices aimed at informing and guiding the improvement of whatever professional duty is at hand (Orsulic-Jeras et al, 2003). In the case study, the diabetes nurse educator has a task of creating an enabling environment through which Joel’s condition will be properly managed and the Anderson family will continue to function normally. Current literature demonstrates the hardships involved in the management of Type I diabetes. According to Ballard (2009), the patient must be given individualized counselling and education aimed at enlightening the patient and his family about the pathophysiology of the medical condition and the signs, symptoms and the procedures to look for when evaluating hypoglycemia.
Many evidence-based management strategies for the treatment of diabetes take note of the fact that most patients may become unconscious when the level of blood sugar decreases beyond allowed limits (Guthrie & Guthrie, 2002). As such, glucagons treatment is normally given, and family members educated on how to inject the patient should he or she become unconscious (Ballard, 2009). Some tested interventions for the management of diabetes also recommends that patients use either the glucose tablets or gel that is readily available at the local drugstore if the blood glucose decreases. Alternatively, the patient may drink some orange juice or consume candy to stabilize blood glucose and avoid becoming symptomatic, a condition characterized by trembling, diaphoretic instances, and confusion (Guthrie & Guthrie, 2002).
A body of literature regarding the management of Type 1 diabetes demonstrates that gaining a better comprehension “…of the earliest symptoms of not only the general symptoms of hypoglycemia such as hunger, perspiration, nervousness, and confusion, but also their individual initial symptoms may help prevent severe hypoglycemia episodes from occurring” (Ballard, 2009, para. 23) In addition, better management allows such events to be effortlessly managed with a glass of juice or snack. In equal measure, diabetes education touching on meal scheduling, carbohydrate counting, and insulin management have been shown to assist patients accomplish more positive outcomes in terms of gaining tighter glycemic control (Ballard, 2009). Lastly, the patient and the family members should be educated on the need of follow-up to keep the medical condition under control (Mertig, 2007).
The Andersons have been completely devastated by the news of Joel having being diagnosed with Type 1 diabetes, and the family will certainly experience instances of stress, depression, self-denial, and tension in the absence of adequate knowledge about how to manage the condition (Mertig, 2007). However, there exist several strengths-based approaches the family can use to cope with the stressors arising from Joel’s condition. Most of these approaches employ the social constructivism theories to promote wellbeing (Taylor, 2006). These approaches are formed on the basic understanding that treatment methodologies must include a major focus on each patient’s strengths rather than relying on just symptoms, and that every individual has value, meaning, and personal strengths (Bellin & Kovacs, 2006). The strengths based approaches are also formed on the basis that “…clients and families have not only rights but insights into their problems” (Taylor, 2006, p. 19).
According to Twoy et al (2006), families with a child diagnosed with a serious medical condition are inarguably exposed to stressors arising from internal sources within the family as well as external sources when the family is advocating for health, social, and educational services for the child whose condition demands specialized treatment. As such, one of the recommendations should be for the stakeholders to realize that Type 1 diabetes is a medical condition that first and foremost needs medical intervention. It has been noted, according to Taylor (2006), that most medical professionals are gravitating more towards social constructivism and other humanist approaches in attempting to offer interventions to medical conditions, which is not right for the practice. Although strengths-based approaches such as resilient model will assist the family to remain focused and united (Bellin & Kovacs, 2006), focus should first be put on managing the medical symptoms of Joel’s illness. As such, the best practice should be to involve all the concerned stakeholders in translating a treatment regimen for diabetes into a comprehensive plan of care that Joel and his family could follow.
The Anderson family has a lot of strengths both within the members as a family unit and between the family and the society. As such, the family should also be linked up with a community practitioner who will assist them to employ their strengths in the management of Joel’s condition. It is well known that “…a stressor affecting the wellbeing of one member will likewise influence the psychosocial outcomes of other members” (Bellin & Kovacs, 2006, p. 210). The family must be assisted to balance the psychosocial difficulties such as depression, anger, and denial. According to Graham et al (2009), the act of being in control of the factors that occasion difficulties is evidence of general positive outcomes.
The Role of the Nurse
The nurse practitioner has a central role to play if the Anderson family is to apply the discussed strengths-based approach to manage the medical condition facing Joel as well as the stressors this condition occasions to members of this family. According to Tyler & Horner (2008), “…building the interventions with family-identified …strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions” (p. 199). Bellin & Kovacs (2006) are of the opinion that many families are oblivious of the strengths, and only concentrates on their weaknesses to further put their lives into disarray. As such, the nurse practitioner should intervene and not only identify the strengths of the Andersons as a family (Kruger et al, 2010), but also demonstrates how the various strengths could be used to bring positive outcomes in terms of actively managing the diabetic condition and ensuring that various stressors are effectively eliminated (Parrish, 2010).
Education is of paramount importance in the management of diabetes (Mertig, 2007), and deficient knowledge of its management, lack of social support, and lack of connectedness are known to contribute to a lot of stress in families faced with this medical condition. The nurse practitioner should not only serve as the fountain of the needed education and information, but also ensure that the family has the capacity to apply the information to achieve positive outcomes (Leon & Armantrout, 2007). According to Mertig (2007), the nurse practitioner can act to connect the family to the larger community that will ensure an inflow of material, emotional, and spiritual support. This will not only empower the family to think proactively and positively even in the face of adversity in terms of Type 1 diabetes, but will enhance the self-awareness and self-esteem of members (McWilliams et al., 2001).
Conclusion
This paper has effectively demonstrated the importance of families faced with problems and challenges to utilize their strengths in the management of the issues surrounding them. The role of the nurse practitioner is critical in supporting the family members to identify their strengths and build upon them to achieve positive outcomes (Mertig, 2007). The paper has also actively demonstrated that some medical condition such as diabetes needs first and foremost to be treated medically, and constructivism approaches such as using the resilience model should be used to collaborate the treatment procedures as well as offering the family a platform to remain resilient and accommodate each other in the face of adversity (Bellin & Kovacs, 2006; Tardon et al, 2005). The paper, more than anything else, demonstrates that for the family to effectively manage some health and social conditions, it must remain united through adequate and sustainable interventions from the nursing practitioner.
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