The Miller Family NURS 480 Family Assessment: The Last Song Nikki Wilkins
Jonah Miller Jonah, the 10-year-old son, is energetic, happy, and curious. Jonah is looking forward to spending the summer with his father. Steve teaches Jonah how to build stained glass windows and they have a bond over this hobby together. Jonah also learns about love and trust from Steve. He has a good relationship with his mother. Jonah is supportive of his older sister but wants her to rebuild her relationship with their father.
Veronica Miller Ronnie is the 17-year-old older sister. She gets annoyed with her little brother and is often sarcastic and defensive. She is angry at her parents for separating and is having a hard time coping. Ronnie is resentful to her mother for making her spend the summer after graduating high school with her father. She feels abandoned by him after the divorce and struggles to have a relationship with him. Ronnie is rebellious, engages in risky behaviors, and finds herself in troublesome situations. She met a young man named Will she is falling in love with. She is able to let her guard down with Will. Knowledge of her fathers illness first triggers anger, then guilt.
Kim Miller
Steve Miller
Kim, age 47, is the mother of Ronnie and Jonah. Kim feels very guilty that her children are upset from her separation with Steve. She is about to get remarried to another man. She is very worried about Ronnie making poor choices that will negatively affect her future. She wants Ronnie to go to college but Ronnie refuses. Kim has a good relationship with her son and communicates openly with Steve.
Steve, age 50, is separated from Kim. He is Ronnie and Jonah’s estranged father. The children and Steve used to share a passion for music and piano but now have a weak relationship. Steve wants to rebuild his relationship with his daughter. The children are visiting Steve this summer at his house in North Carolina. The children are unaware of his condition and that this would be the last summer they spend with their father. Steve engages in religion and is spiritual. He is able to develop and rekindle a special relationship with his son Jonah. To cope with stress, Steve enjoys playing piano at his local church.
Steves Condition Steve has gastric cancer that has metastasized to his lungs and pancreas. Steve has been given a poor prognosis and has less than a year to live. He shares the diagnosis with Kim, but asks her not to share the news with anyone else, including the children. His treatment plan involves medications that make him drowsy and fatigued. While playing piano one night at the church by himself, he believes that the medications caused him to fall asleep and knock over a candle. This caused the church to set on fire. Steve feels guilt and becomes progressively weaker through the summer and eventually ends up in the hospital where Ronnie and Jonah learn the truth about his health. The doctor explains to Ronnie the goal is to make Steve comfortable for the remainder of his life. It is revealed that Steve made the decision to withhold medication and aggressive treatment so that he would be coherent and able to spend the remainder of his days with his children. His children are first angry, then caring.
Traditions Culture ● Has familial support of immediate family; extended family not local. ● Lack of traditions due to separation. ● This will be the last summer that the children are able to visit Steve. ● Socioeconomic stability. ● Good accessibility to healthcare. Religion ● Steve is religious and believes in God. ● Steve finds peace in making stained glass windows for the church. ● Steve is involved in his church community. ● Jonah, Ronnie, and Kim are not very involved in the church and community in North Carolina where Steve lives alone.
Communication Overall, communication within the family grows from poor to strong. Ronnie struggles the most with communicating with her family. Steves wants a relationship with Ronnie but she refuses to read and open letters that he sends her. She feels hurt by her parents and resents them for that. Jonah is an open communicator and often says whatever is on his mind. Ronnie uses nonverbal communication such as slouching, crossing her arms, and eye rolls to demonstrate her displeasure. She eventually is able have more conversations with her father as the summer goes on. Steve mentions to Ronnie that he had medications the doctor told him to take which made her worry about his state of health. Steve has decided to withhold from the children his condition. When Ronnie and Jonah become aware, their bond grows stronger and they want to support their father.
Challenges
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Both parents are supportive of the children and each other. Steve is patient with his children. Steve wants to rebuild his relationship with his daughter and continue to grow his relationship with his son. Steve has positive psychological strengths such as hope and optimism. Although Ronnie and Jonah argue, Ronnie is a supportive and protective older sister. Steve utilizes spiritual coping mechanisms such as faith and prayer. Steve has a church community in which he feels as if he can rely on. Jonah feels a strong bond with his father and enjoys spending time with him.
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Separated family - Ronnie and Jonah live with Kim, who is a single mother about to remarry. Steve lives alone in a different state. Ronnie has a temperament and has difficulty accepting perspectives of her parents. The children are unaware of their fathers condition. Ronnie and Jonah feel lied to when they learn the truth of their father’s condition. Duvall stage - family with adolescents; this stage comes with adjustment of the parent child relationship to include more independence. This stage is made more difficult with the adjustment in familial roles and Steve’s illness. Ronnie and Jonah find it very difficult to accept their fathers diagnosis when they find out. They are angry, hurt, and confused.
Family Theory Application Family Systems Theory - The goal of using this theory is to help the Miller family reach stability by building on their strengths as a family, using the knowledge of the family as a social system, and understanding how the family is an interconnected whole adapting to changes brought about by a health event of a family member (Kaakinen et al., 2015). This theory will empower the individuals within the family which decreases blame and reactivity (Jakimowicz at al., 2021). The Miller family experiences 3 major life changes that threatens the stability of the family system: the divorce of Steve and Kim, Steve’s cancer diagnosis, and Steve’s death. Overtime, the families ability to adapt to these stressors increases. There are 4 central concepts to the family systems theory: (1) All parts of the system are interconnected, (2) The whole is greater than the sum of its parts, (3) All systems have boundaries between them and the environment, and (4) Systems can be further organized into subsystems and suprasystems. Steve’s takes on the role of the sick person and must give up his typical roles as a father and member of his community. Steve’s cancer is a nonnormative health event that affects all members of the family, especially Jonah and Ronnie because they are living with him for the summer. Ronnie, as the older sister takes on a caretaker role for her father, and mothering role for Jonah. This takes away from her role as teenage daughter. The family has open boundaries that allows members of the community, such as their church community, to help when needed.
Outcomes Goal: maintain and regain stability
1 Jonah, Ronnie, Steve, and Kim will acknowledge their personal and familial strengths and weaknesses by the end of the appointment.
2 Steve will express his feelings and worries related to his diagnosis and change in role by the end of the appointment.
3 Each member of the family will identify stressors and demonstrate healthy coping mechanisms by the end of the appointment.
Interventions Outcome 1
Outcome 2
Assess and support positive psychological strengths such as hope, resilience, and social support.
Be physically and emotionally present for the client while using therapeutic communication techniques.
Acknowledge the range of emotions and feelings that may be experienced when the health of a family member changes.
Support family members during emotional conflict type situations.
Observe for contributing factors of ineffective coping such as poor self concept, grief, lack of problem solving skills, and life changes.
Assess the family’s stress level and coping abilities during the initial nursing interview and assessment.
Provide opportunities for the client to discuss the meaning the situation has for the client.
Empower the family by setting realistic goals and encourage problem solving.
Discuss the power of the client and family to accept the situation.
Outcome 3
(Ackley et al., 2018)
References Ackley, B. J., Ladwig, G. B., Flynn, M. M. B., Martinez-Kratz, M. R., & Zanotti, M. (2018). Nursing diagnosis handbook: An evidence-based guide to planning care (12th ed.). Elsevier. Jakimowicz, S., Perry, L., & Lewis, J. (2021). Bowen Family Systems Theory: Mapping a framework to support critical care nurses’ well‐being and care quality. Nursing Philosophy, 22(2), 1–11. https://doi-org.ezproxy.csusm.edu/10.1111/nup.12320 Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research. F.A. Davis Company. Images: 22 quotes from 'The last song' that show us the beautiful parts of True Love. Quote Catalog. (n.d.). Retrieved October 6, 2021, from https://quotecatalog.com/u/kirstenocorley/2016/09/the-last-song-quotes/. Meredith, K. (2019, October 29). Bobby Coleman (aka jonah from the last song) is all grown up and deserves your attention. POPSUGAR Celebrity. Retrieved October 6, 2021, from https://www.popsugar.com/celebrity/who-plays-jonah-in-the-last-song-46818060. Sutori. (n.d.). Retrieved October 6, 2021, from https://www.sutori.com/en/story/the-last-song--yQu3FYu3Gf7dNNcbqo4UwJZb. The Last Song Picture. The last song picture 28. (n.d.). Retrieved October 6, 2021, from https://www.aceshowbiz.com/still/00005124/the_last_song27.html.