a family assessment of
THE HARDINGS
Samantha Cole | NURS 480 Visual Report | April 2, 2022
introduction
The Hardings are grieving the loss of Ted, husband to Jen and father to Charlie and Henry. Jen is hyperfixated on finding the driver responsible for hitting her husband and leaving him for dead on the side of the road. At a bereavement support group, Jen meets and befriends Judy Hale, who claims to be grieving the loss of her fiance, Steve. Jen and Judy quickly bond over their mutual suffering and loneliness. Judy eventually moves in with the Hardings and also bonds with Jen's two sons. Their friendship is threatened when Judy's lies about her fiance's death are exposed and she confesses to her involvement in Ted's death. Steve's manipulative and abusive behavior toward Judy becomes apparent. In a fit of drunken rage and insults, Steve confronts Jen and accidentally reveals that he is the one responsible for Ted's death. Filled with anger, Jen bludgeons him to death in her backyard. This transgression and the eventual cover-up force Jen and Judy back together. Judy rejoins the Harding household and their friendship grows deeper and messier.
Jen is a recently widowed mother of two sons. She is a real estate agent in Laguna Beach, CA. When she was young, her mother died from breast cancer and she admits to never having properly processed her loss. She is rude and crude in her delivery and she is able to add humor to dark situations. Heartbroken in her grief, she copes by attending a bereavement support group, listening to loud heavy metal alone in her car, working out, drinking wine, and staying up late commiserating with her new best friend Judy.
40
Jen Harding, mid- s
PSYCHOSOCIAL DEVELOPMENT: Jen is in the Generativity vs. Stagnation stage. Jen has achieved a lot both personally and professionally that give her gratification and self-worth. Having a family and an established career anchor her during this deeply challenging loss.
Judy is an arts & crafts teacher at an assisted living facility. Judy was driving the car that hit Ted the night he died. She wanted to call for help, but her emotionally abusive fiance manipulated her into leaving him to die on the side of the road. Judy is outwardly optimistic, caring, and quirky, but she is also deeply insecure and grieving the loss of multiple miscarriages. She currently lives with The Harding family in their guest house and has formed a bond with Jen's sons. PSYCHOSOCIAL DEVELOPMENT: Judy is also in the Generativty vs. Stagnation stage, but unlike Jen, she lingers in stagnation. She has tried desperately to start a family without success, preventing her from having any self-worth or attaining a developmentally appropriate level of maturity.
40
Judy Hale, early s
Charlie Harding,
16
Charlie is Jen's older son. He is an angsty and selfish teenage boy with an attitude. He likes playing video games and learning how to drive. Since his dad's death, he he has a hard time focusing on homework and has become a source of stress to his mom when he starts skipping school and moves in with his grandma. PSYCHOSOCIAL DEVELOPMENT: Charlie is in the Identity vs. Role Confusion stage. This crisis of adolescence is amplified by his grief, as he begins to explore reckless activities, such as selling his dad's prescription pills and carrying around his grandma's loaded gun.
Henry Harding,
12
Henry is Jen's younger son. He is a middle school student who has always done well in school, but has struggled in his grief. Unlike his brother, Henry has a sweet and affectionate relationship with his mom. He is kind, caring, imaginative, and has recently joined a Christian choir. Since his dad's death, he occasionally has bad dreams, and he has befriended a bird ("Dad bird") who he believes is his dad's spirit. PSYCHOSOCIAL DEVELOPMENT: Henry is in the middle childhood stage of Industry vs. Inferiority. As he finds his place in the world, he joins the school choir, and later is too scared to do his solo for fear of failing.
development
FAMILIES WITH ADOLESCENTS The task associated with this stage is increasing flexibility of family boundaries. For example, Jen must allow Charlie to have more independence (Denham et al., 2018).
structure
SINGLE-PARENT FAMILY Judy is also part of the Harding family household, but is not a blood relative or domestic partner.
traditions
Charlie and his dad used to play their favorite video game together, but since his death, it is no longer fun for Charlie. Unbeknownst to Jen, Ted used to take Charlie out for driving lessons. Ted used to wake Henry up every morning. Now "Dad bird" wakes him up. Early in their friendship, Jen and Judy had a tradition of watching The Facts of Life over wine and Entenmann's cookies.
family roles
Now the oldest male in the house, Charlie thinks he is the "man of the house", but Jen reminds him that he is still a child. Since Ted's death, Jen has claimed the provider, housekeeper, and child care roles.
culture & religion
They are a white upper middle class family living in Laguna Beach. Jen does not believe in god, however Harry has chosen to be baptized as a Christian and Jen was supportive.
CONDITION:
grief
DENIAL
This is a stage of shock and clinging to the lost loved one as a coping mechanism (Townsend & Morgan, 2018). Jen first experiences this in the initial first days of his death when she wears Ted's clothes and drinks from his used glass of water to feel close. In Henry's struggle to cope, he clings to his dad in his belief that a bird that keeps visiting his window is his spirit.
..
The Kubler-Ross Model identifies five stages of the grieving process that we may move back and forth through. According to Townsend and Morgan (2018), healing from the grief of an unexpected death like Ted's could take longer than healing from anticipatory grief. Below, the five stages are outlined with examples of these behaviors in each member of the Harding family.
ANGER
This is the "Why me?" stage where anger is directed at self or others (Townsend & Morgan, 2018). Jen lashes out on her friends, sons, strangers, and even the police. Charlie doesn't think it's fair that their dad had to die. He often takes his anger out on his mom. Henry is also often quick to anger when things aren't the way he wants them to be.
BARGAINING
This stage is often associated with guilt (Townsend & Morgan, 2018). Jen feels guilty for Ted's death because they had a fight the night he died.
ACCEPTANCE
DEPRESSION
This stage is associated with intense emotions and starting to realize this person isn't coming back (Townsend & Morgan, 2018). Jen's emotions fluctuate in intensity as she moves through the grieving process.
This is the final stage of the grieving process when new reality is accepted (Townsend & Morgan, 2018). Acceptance in Jen's case requires forgiving Judy. Jen doesn't forgive Judy for her involvement in Ted's murder, until she herself kill's Steve. In her new reality, the tables are turned and Jen is now faced with having to come clean.
strengths
FAMILY
FORGIVENESS: Judy and Jen have been able to see beyond the biggest mistakes of all, but the family as a whole is very forgiving. LOYALTY: Charlie defends his little brother and Jen puts her family above everything and everyone else. Judy even confesses to a crime and went to jail for a crime Jen committed to prove her loyalty. RESILIENCE: Despite being challenged over and over again, the whole family does what they need to do to move forward in their personal growth. EMPATHY: Judy and Henry in particular are able to put themselves in someone else's shoes to understand what they are going through.
challenges
FAMILY
KEEPING SECRETS: Jen and Judy are harboring the most complex secrets and even some serious crimes. At one point Judy says, "My secret is crippling, and I think it's taking a toll on my health." TEMPER: Jen's inability to control her anger and other emotions leads to dramatic outbursts. She is likely to explode at any moment - at her kids, her friends, strangers, and the police. RECKLESSNESS: Each family member in their grief has done something careless and uncharacteristic of themselves that leads to serious consequences. UNHEALTHY BOUNDARIES: Despite good intentions, Judy tends to become obsessive in her relationships and cross lines.
family life course theory The Harding family's loss was sudden and unexpected, and they now find themselves transitioning from a nuclear family to a single-parent family. Family life course theory acknowledges that families change over time and analyzes how the family evolves through these life transitions individually and as a unit (Denham et al., 2016). Applying this concept to the Harding family, it is clear the family is affected as a whole. But Jen, Charlie, and Henry are also experiencing this transition in their own individual ways. For example, Jen's mother died when she was young and she admits to never having properly grieved. This event early in her life has likely had an influence on how she copes with the death of her partner. Grieving any death of a loved one is devastating in itself, but unexpected death can cause "unanticipated stressors" (Denham et al., 2016, pg. 88). An example may be Charlie's substance use. He has started drinking, smoking marijuana, selling his dad's prescription pills, and carrying around a concealed weapon. The way that he chooses to cope with loss now, could have implications for future coping.
communication VERBAL
NONVERBAL
The Hardings aren't a family of few words. In the beginning of their relationship, Judy and Jen spent hours talking to each other on the phone. As a family, they do a lot of their talking and listening around the table at meal times. Jen in particular has as many verbal outbursts as she does moments of emotional vulnerability. Jen and Charlie's conversations are often laced with profanity and sarcasm, but with Henry, Jen is very reassuring with her words. After a nightmare, she tells him, "You are not alone, you will always have me."
The Hardings may have a difficult time using words to communicate love, but they are able to do so through physical affection. Having bonded with Charlie and Henry, Judy also shows her love and affection through hugs, physical touch, and with her cooking. Overall, Jen has an off-putting and dismissive attitude with most people that aren't close to her, which she uses as a protective shield. She uses facial expressions such as eye rolling and shrugging to communicate resentment or anger.
THE NURSING PROCESS
problems
Complicated grieving related to loss of significant person Risk for spiritual distress related to complicated grief process
Labile emotional control related to significant loss
interventions
Nurses who "think family" communicate with individuals and family to set goals, strategize, and evaluate outcomes (Denham et al., 2018).
Educate the clients and their support systems that grief resolution is not a sequential process and that the positive outcome of grief resolution is the integration of the deceased into the ongoing life of the griever. Rationale: "Every person is unique and will experience loss and grief differently" (Slade & Ho, 2020, pg. 9). Determine whether the client is experiencing depression, suicidal tendencies, or other emotional disorders. Refer the client for counseling or therapy as appropriate. Rationale: As a nurse it is important to differentiate between normal signs of depression due to grief and someone who is struggling with depression (Oakley & Maani-Fogelman, 2021). Offer instruction of alternative coping strategies. Rationale: Emotion regulation strategies, such as mindfulness and movement, are essential for healthy psychological functioning (Shafir, 2016).
expected outcomes
Client progresses through the grief process in a healthful manner toward resolution. Client and family will attend counseling or therapy in dealing with grief-associated issues
Client will improve coping strategies.
REFERENCES: Denham, S., Eggenberger, S., Young, P. & Krumwiede, N. (2016). Family-focused nursing care. F.A. Davis: Philadelphia. Feldman, L., Ferrell, W., McKay, A., Elbaum, J., Applegate, C., Smith, C. (Executive Producers). (20192022). Dead to me [TV series]. CBS Television Studios; Netflix. Oates, J. R. Maani-Fogelman, P. A. (2021) Nursing grief and loss. StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK518989/ Shafir, T. (2016). Using movement to regulate emotion: Neurophysiological findings and their application in psychotherapy. Frontiers in Psychology 7(1451). doi: 10.3389/fpsyg.2016.01451 Slade, J. D. & Hoh, N. Z. (2020). Employing Watson's theory of human caring with people experiencing loss and grief. International Journal for Human Caring, 24(1). http://dx.doi.org/10.20467/10915710.24.1.4 Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidencebased practice (9th Ed.). F.A. Davis: Philadelphia.
IMAGE REFERENCES: [Family dinner at the Harding household]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm3295262465/
[Judy touching Henry's forehead]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm2634856193/
[Jen comforting Judy]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm1302311937/
[Charlie and Jen sitting on the couch]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm1028370689/
[Henry, Jen, and Charlie Harding]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm957200129/
[Henry getting baptized]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm734960385/
[Jen embracing Charlie and Henry]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm4255036417/
[Judy and Jen looking at each other smiling]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm3050616577/
[Judy smiling at Henry]. Netflix. https://www.netflix.com/title/80219707
[The Harding family holding hands at Ted's birthday memorial]. IMDb. https://www.imdb.com/title/tt8064302/mediaindex
[Steve yelling at Judy] IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm1768011265/ [Jen with a casserole dish]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm3897581568/ [Judy holding an art canvas]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm778745601/ [Charlie holding his laptop]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm1986115073/ [Jen and Charlie kissing Henry on the cheeks]. IMDb. https://www.imdb.com/title/tt8064302/mediaviewer/rm810266881/
[Jen yelling at Judy]. Netflix. https://www.netflix.com/watch/80234668? trackId=14170286 [Judy screaming in the car]. Netflix. https://www.netflix.com/title/80219707 [Jen crying alone in the car]. Netflix. https://www.netflix.com/watch/80234668?trackId=14170286 [Judy lying in bed talking on her cellphone]. IMDb. https://www.imdb.com/title/tt8064302/characters/nm0004802 [Jen lying in bed talking on her cellphone]. IMDb. https://www.imdb.com/title/tt8064302/characters/nm0000775