Family Assessment of
Chao Hu N480 CSUSM
Tyrion Lannister is a dwarf and the youngest child of Lord Tywin Lannister, the head of House Lannister and the richest man in the Seven Kingdoms. His two older siblings, Jaime and Cersei Lannister, share a secret incestuous relationship. His mother, Joanna Lannister, died giving birth to Tyrion, for which his father and sister have always blamed him for her death. Tywin and Cersei share a strong dislike, if not hate, for his existence.
Growing up, Tyrion was abused, unloved and a victim of his condition. In contrast, Cersei is noted for her great beauty and Jaime is known for his excellent sword abilities. Their father, Tywin, has never shown much love for any of his children and is an absentee parent for the most part. He is especially cold, affectionless and demanding toward Tyrion. As a dwarf, Tyrion struggles with prejudice his entire life. His family does not think much of him and his abilities are constantly underestimated. Society labels him as a monster, imp, or half-man and no one seems to take him seriously. Despite his shortcomings, Tyrion is expected to live up to the Lannister name because of his family’s powerful status. Acknowledging the absurdity of his predicament, Tyrion tries to make the best of his situation by embracing his identity and using wit and sarcasm. Occasionally, he likes to indulge in wine, prostitutes and books for distraction from reality.
Achondroplasia, the most common type of short-limbed dwarfism, is a disorder of abnormal bone growth that results in short stature. It is caused by a mutation in the FGFR3 gene, which is involved in converting cartilage to bone (National Human Genome Research Institute, 2017). The average height of an adult male dwarf is four feet four inches. Some features of dwarfism include an enlarged head with a prominent forehead, short arms and legs, short fingers, bowed legs, an average-size trunk and limited range of motion at the elbows. Achondroplasia occurs in about 1 in 15,000 to 40,000 live births. Individuals with the condition generally have normal intelligence and lifespan. Health problems that are associated with dwarfism may include obesity, recurrent ear infections and breathing problems. Serious complications include spinal stenosis, narrowing of the spinal canal that can cause difficulty with walking and hydrocephalus, a buildup of fluid in the brain that can lead to increased head size and brain abnormalities. No treatment is currently available but careful monitoring and social support are recommended (U.S. National Library of Medicine, 2017).
Tyrion is four feet and five inches tall and exhibits the classic characteristics of achondroplasia.
Tyrion Lannister, 32, is the youngest member of the Lannister family and a dwarf. He is well-educated, intelligent, courageous and extremely cunning. Although constantly humiliated for his size by his family and society, he is able to overcome his inadequacies through wit and intellect. He is the moral back bone of the family. He is in the 6th stage, intimacy vs. isolation, of Erikson’s stages of psychosocial development. In this stage, individuals start to explore relationships and become more intimate with others. Success in this stage can result in a happy relationship and a sense of commitment. Avoiding intimacy can result in isolation and depression (McLeod, 2013). Tyrion seeks love and attention but fails to find intimacy with the numerous prostitutes in his life.
Cersei Lannister, 36, is the only daughter of Lord Tywin and the elder sister of Jaime and Tyrion. She has an incestuous relationship with Jaime, her fraternal twin brother, with whom she has three children. She is very attractive, greedy and narcissistic. Her hunger for power has consumed her life and clouded her judgements. She despises Tyrion and blames him for the death of their mother. Her primary role in the family is to uphold her father’s values in his absence. She is in Erikson’s 6th stage of psychosocial development, intimacy vs. isolation. Cersei has been in a committed and loving relationship with Jaime since their youth. Despite cultural and social stigma against incest in Westeros, Cersei believes that they belong together and has deep affection for Jaime.
Jaime Lannister, 36, is younger twin brother of Cersei, older brother of Tyrion and the eldest son of Tywin. He is handsome and praised for his martial skills. His main role in the family is to support Cersei in what decision she makes. Unlike Cersei and Tywin, Jaime tries to be a big brother for Tyrion. He treats Tyrion with kindness, love and respect. He is in Erikson’s 6th stage of psychosocial development, intimacy vs. isolation. Like Cersei, Jaime is committed and faithful and finds a sense of care and safety in their relationship. Despite the complex nature of their relationship that requires them to meet in secret and go behind their father’s back, Jaime’s love for Cersei never falters.
Tywin Lannister, 63, is the head of House Lannister, Lord of Casterly Rock, and the richest man in the Seven Kingdoms. He is a widower and the father of Cersei, Jaime and Tyrion Lannister. Tywin is cold, impersonal and controlling toward his children and others. He loathes his youngest son, Tyrion, for being an imp and blames him for his mother’s death while birthing him. He is in the 7th stage of Erikson’s psychosocial development, generativity vs. stagnation. In this stage, individuals begin to develop a sense of being a part of the bigger picture. This can be achieved by giving back to society through raising children or becoming involved in community activities and organizations. If one does not achieve these goals, it can lead to stagnation (McLeod, 2013). Lord Tywin is constantly concerned with upholding the Lannister status and making sure that the family name lives on. He fails to see that being a part of the bigger picture means that individual members of House Lannister need to be united.
The Lannister are one of the richest and most powerful family in the Seven Kingdoms. They rule over the Westerlands and their official motto is “A Lannister always pays his debts.” The immediate family members consist of Tywin, Cersei, Jaime and Tyrion. They are all members of the Faith of the Seven, the main religion of the Seven Kingdoms. However, only Tywin seems to strictly follow religious laws and traditions. Cersei and Jaime are involved in incest, which is considered cultural taboo. Tyrion does not care much about religion. Although the Lannisters are well-educated, prideful and dedicated in upholding their status, they are a dysfunctional family unit where open and honest communication is rare, problems are not addressed, love is given based on performance and the members’ self-worth and self-esteem are not supported. In addition, the Lannisters rarely spend much time together. Tywin is harsh and critical of his children. Cersei strongly dislikes Tyrion. It doesn’t help that life in the Seven Kingdoms is filled with complexity, secrecy and deceit.
• The Lannisters do not cope well with Tyrion’s chronic condition (dwarfism) • The Lannisters do not effectively communicate with each other • The Lannisters lack a sense of trust within the family • The Lannisters are unsupportive of one another
• The Lannisters are rich and powerful • The Lannisters take pride in upholding their family name • The Lannisters stick with each other despite their individual differences • The Lannisters easily recover from adversity
The Lannisters do not communicate well with one another as a family. There is a general lack of trust and a sense of secrecy between the members. Tywin communicates with his children but is very stern, unsympathetic and overbearing. At times, there is a great deal of back and forth shouting and swearing without a real resolution. In extreme cases, Tywin resorts to using force. Cersei and Tyrion are not very fond of each other and do not communicate often. When angry with one another, they tend to avoid each other or when it is not possible, stare each other in the eyes with mutual feelings of deep hatred and disdain. Jaime communicates well with Cersei and vice versa for the most part, verbal and nonverbal, because of their romantic relationship. Since their incestuous involvement has come under scrutiny recently, they often resort to being sneaky and relying on making eye contact and reading body language.
Duvall examined how families were affected or changed when all members experience developmental changes. According to the Family Developmental Theory, families develop and change over time as they transition from one stage to another. This framework is useful for assessing general experiences and associated tasks the family may face at any stage in the family life cycle. Duvall identified eight stages of family development and its overall tasks that need to be achieved, starting with couples getting married and ending with a member of the couple dying (Kaakinen et al., 2015). The Lannister family would fall in towards the end of the middle-aged parents stage and transitioning into the aging family stage. Tyrion is the youngest adult child in the family. Cersei and Jaime are adult middle-aged parents with three young children. Tywin is a grandparent, unbeknownst to him, and is reaching retirement age.
The Family Systems Theory views family as a dynamic system with family members who are interdependent and influence one another. All parts of the system are interconnected. Thus, illness in one family member affects the whole family unit and whatever influences the family unit also affects the individual members who compose the family. Nurses who think family should understand the importance of family dynamic and the influences that family members have on one another. Caring interventions should be customized to meet individual and family unit needs (Denham, 2016). Tyrion’s chronic condition has put him and his family through many struggles. Cersei and Tywin looks down on him and blames him for his mother’s death. They feel ashamed that he is a dwarf and a disgrace to the family name. Growing up, their lack of support and disparaging remarks put Tyrion at great risk for isolation and depression. As an adult, Tyrion seems to have developed a sense of hatred toward his family as a result of their hatred toward him, creating more tension within the relationships of the family. The Family Systems Theory would help the Lannister family because it recognizes that illness in one family member affects the whole family unit (Denham, 2016). Nursing care for Tyrion and his family should focus on encouraging communication between the family members and providing appropriate support for one another. The nurse can help each member of the Lannister family define a role in supporting Tyrion and suggest strategies that help them cope with stress during troubled times. When assessing the family, the nurse might consider whether the family have communicated to solve problems in the past or who in the family has the most difficult time to make necessary changes (Denham, 2016).
Tyrion suffers from dwarfism and is constantly ridiculed for his size. Because of his condition, he has been abused, mistreated and underestimated his whole life. His family is extremely dysfunctional and unsupportive. Tyrion is emotionally and psychologically wounded but keeps his feelings at bay with occasional self-indulgence and alcohol.
Observe for contributing factors of ineffective coping among the Lannisters, such as poor self-concept, grief, lack of problem solving skills, lack of support, recent change in life situation, maturational or situational crises (Ackley, 2016). Discuss with Tyrion regarding his and his family’s power to change a situation or the need to accept a situation. Rationale: Meeting Tyrion and his family’s informational and support needs can contribute to their empowerment and overall coping ability (Knobf, 2013).
Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage Tyrion and his family to express emotions such as sadness, guilt, and anger within appropriate limits; verbalize fears and concerns; and set goals (Ackley, 2016). Rationale: Active, empathic listening and values clarifying communication techniques guided family-centered care interventions to support parents’ coping strategies (Weis et al., 2014).
Assist Tyrion and his family in identifying specific health and social, emotional or psychological problems and involve them in their resolution (Ackley, 2016). Rationale: Interventions customized to fit an individual’s disorganized lifestyle can reduce their social isolation (Pearce, 2013) Nurse support of clients and their families is effective in establishing a positive outlook, mental well-being, and thoughts of getting well (Mattila et al., 2014).
Outcome: The Lannister family will recognize that they have the power to accept Tyrion and his chronic condition. Tyrion and his family will learn that they can effectively cope within their situation.
Outcome: The Lannister family will appropriately express emotions such as sadness, guilt and anger towards each other, verbalize their concerns regarding Tyrion’s condition and set goals to build stronger relationships with one another.
Outcome: Tyrion and his family will successfully identify specific health, social, emotional or psychological problems that has contributed to their family’s dysfunction. They will work together as a family to address those problems.
Ackley, B. J., Ladwig, G. B., & Makic, M. B. (2016). Nursing diagnosis handbook: an evidence-based guide to planning care (11th ed.). Maryland Heights, MO: Elsevier. Denham, S. A., Eggenberger, S., Krumwiede, N., & Young, P. (2016). Family focused nursing care. Philadelphia, PA: F.A. Davis Company. Kaakinen, J., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family health care nursing: theory, practice, and research (5th ed). Philadelphia: F.A. Davis Company. Knobf, M. T. (2013). Being prepared: Essential to self-care and quality of life for the person with cancer. Clinical Journal of Oncology Nursing, 17, 255–261. Mattila, E., Kaunonen, M., Aalto, P., et al. (2014). The method of nursing support in hospital and patients’ and family members’ experiences of the effectiveness of the support. Scandinavian Journal of Caring Sciences, 28, 305–314. McLeod, S. A. (2013). Erik Erikson. Retrieved from www.simplypsychology.org/Erik-Erikson.html National Human Genome Research Institute. (2017). Learning about achondroplasia. Retrieved from https://www.genome.gov/19517823/learning-about-achondroplasia/ Pearce, L. (2013). Self care success. Nursing Standard, 27, 19. U.S. National Library of Medicine. (2017). Genetics home reference: achondroplasia. Retrieved from https://ghr.nlm.nih.gov/condition/achondroplasia#genes Weis, J., Zoffmann, V., & Egerod, I. (2014). Improved nurse-parent communication in neonatal intensive care unit: Evaluation and adjustment of an implementation strategy. Journal of Clinical Nursing, 23, 3478–3489
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