FAMILY ASSESSMENT N480 – Family Nursing Theory & Practice Dr. D. Bennett, PhD, RN By: Colleen Gudehus
Family System: “Bill” is a 36 years old man whose single-income provides the home he owns with his wife, a stay at home mom, and their three children, the oldest boy of 12 and two daughters aged 7 and 4. Diagnosis: Adult onset MS, effects adults between 20-40 years of age. The disease follows two trajectories. The type Bill is experiencing is that of a relapsing remitting MS, which occurs in 80% of patients, in which symptoms arise then diminish. The other is progressive relapsing MS(which 50% of patients with relapsing remitting MS, convert to within 10 years of their disease’s onset). (Holland, Gray and Pierce, 2011).
Multiple Sclerosis: (MS)
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A non-fatal, chronic and progressive disease which effects how nerves transmit signals within the central nervous system (CNS)
Signs and Symptoms: Being that MS effects the CNS, a neurological decline in ability becomes apparent. The most common effects of the disease are fatigue, balance and weakness and manifest themselves as “insomnia, pain, spasticity, inability to use one’s arms and/or legs, altered bowel and bladder function, and sexual difficulties.” In addition, the impact the disease has on a person’s overall function leads to an associated comorbidity of depression (Holland, Gray and Pierce, 2011, p. 36). Bill’s initial symptoms prior to being diagnosed, were of a sudden, inexplicable fatigue and then temporary blindness.
Strengths and Challenges of the Family Once the couple sought the care of the nearest Neurologist at a hospital 3 hours away, Bill began receiving therapeutic and medicinal care. Bill’s wife leaned more heavily on her Catholic faith and the friends/family in their community. She initially went to work as a kitchen aide in the elementary school where her two eldest children attended. Her youngest daughter who is very shy and attached to her mother was put into a daycare and is having a very difficult transition thus far, causing the mother tremendous guilt and worry. In addition, she’s gone back to college in order to attain a higher paying job causing her to be away from home even more and increasing her stress/workload. (A.E. Cole, personal communication, October 10, 2016) The children were told of their father’s disease after the middle daughter announced at the dinner table that she wanted to do a fundraiser for her school for something called “MS Society”. They say they “knew something was wrong” because their dad was sleeping more often and “getting angry” more easily, causing them to need to be quiet in the mornings while getting ready for school. The eldest boy, because he needs to be home in the afternoons to watch his younger sisters, couldn’t attend practice for his school sports so he had to drop them. To “help his mom out”, he has also accepted the new responsibility of making sure the household chores are attended to and that the dinner his mother prepares each morning, is put into the oven on time. The children aren’t fully able to process the challenges that their parents are facing but they have expressed that their parents aren’t talking at the dinner table anymore. They also expressed disappointment in not being able to go on class/family trips, even though “all their friends” are going. (W.J. Cole, personal communication, October 10, 2016)
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Individual members, perceive illness as a threat to the family’s basic functioning, to it’s energy and strength resources causing them to develop natural defensive mechanisms in order to adapt (Kaakinen, Gedaly-Duff, Coehlo, and Hanson, 2010. p. 88). With MS patients, they don’t know the timing of their actual or potential relapse, what causes one, the progression their disease and/or their loss of control. Assessing the concerns of the patient and the interaction among the family who are dealing with MS should be a priority for the nurse to guide their nursing process. Using the Family Assessment and Intervention Model to identify and potentially alleviate some of the stressors on the family as well as the Family Systems Stressor-Strength Inventory (FS3I) which takes into account the ways in which individual members, and the family as a whole, is typically changing and interacting over a space of time provides the nurse with valuable diagnostic tools in which they can identify and encourage the family’s strengths and problem-solving abilities. Once the nurse has identified the strengths/stressors she can then support the family by building a family care plan. The use of which has proven to provide stability throughout the different phases of chronic illness (Kaakinen, et al. 2010).
Family Assessment and Intervention and the Cole Family
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By implementing the use of this model and helping the family to see the benefits of utilizing each other’s individual strengths, such as the mother seeking support and spiritual guidance from her community/church, helping their son to balance the responsibilities he’s facing at home with school and sports, as well as providing the his sisters, who are in the initiative v. guilt and industry v. inferiority phase of Erikson’s psychosocial model, with tasks that would help them channel their energy toward goals and skills rather than wondering how and why this is happening to their father, allows the children grow up with as little tension and stress as possible. In the meantime, the nurse can evaluate Bill’s strength and energy given specialist’s recommended therapy and treatment plan and support his developing sense of newfound purpose (ie: his interest in remaining an honorary member of the volunteer fire department, working part-time for a friend, etc).
References Burks, K.J. (1999). A nursing practice model for chronic illness. Rehabilitation Nursing, 24(5), 197-200. Holland, B. E., Gray, J., & Pierce, T. G. (2011). The Client Experience Model: Synthesis and Application to African Americans with Multiple Sclerosis. Journal Of Theory Construction & Testing, 15(2), 36-40. Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health Care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. Knight, J. (1990). The Betty Neuman Systems Model applied to practice: a client with multiple sclerosis. Journal Of Advanced Nursing, 15(4), 447-455. doi:10.1111/j.1365-2648.1990.tb01838.x