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Little miss sunshine Nurs 480 ISSUU Visual Report By Quang Phan
Family Introduction - The hoover family
The Hoover Family.
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The Hoover family is not the most traditional or functional family you’ll
see, but they are sre loving. The household consists of Richard (38), and his wife Sheryl (36). They have 2 children, Dwayne (son, 17) and Olive (daughter, 8). Grandpa (Richard’s father, 71) also lives with the family, as well as Uncle Frank (Sheryl’s brother, 42). Although the root cause of stress of the entire family is among each individual, Uncle Frank’s mental condition seems to play a huge influence on how the family functions.
Meet Frank.
Frank is Sheryl’s brother who had just recently moved into their apartment. Frank is
a gay professor, Once deemed to be one of the smartest scholars of Marcel Proust, but now suffers from depression. After previous attempts of suicide, his only option is to be cared for under his sister Sheryl, and become a part of the Hoover Family. Frank is also in the Generativity vs Stagnation stage. In the beginning, he is very slow to adjust within the household, as family members put him very awkward situations regarding his depression. He does however, slowly begin to interact with all family members minimally, but mostly to Dwayne (since he is nonverbal). He resides in the Stagnation stage, both due to his depression and inability to cope. He still feels very isolative from the family. Sheryl places great effort in trying to bring Frank back into society naturally, and to boost his mood. It will take a lot for Frank to move from a “life is meaningless and pointless” emotion to a satisfied, fulfilling and purposeful feeling.
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Developmental Stages ❏
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Sheryl and Richard are both in the Generativity vs. self absorption/stagnation stage of Erikson's. Being the main providers of the family, they prove to be vital role for the family. While Sheryl is an loving individual, who continues to support and bond family members together, she is in the Generativity state. Richard is on the brink of transitioning from generativity to stagnation, due to his dream of becoming of successful motivational speaker but is facing bankruptcy ❏ within his business. Grandpa Hoover is currently in the Integrity vs. despair state. Grandpa is retired, and lives in the house due to his previous eviction from the retirement home. He displays an aggressive behavior, using foul language around the family, ❏ as well as being extremely found of his granddaughter, Olive. He is also a heroin drug addict (the reason why he got evicted). Grandpa resides in the state of despair, viewing his life as worthless, and how it's come to this point.
Dwayne, the eldest son of the family, is in the identity vs. role confusion stage of erikson's. He really struggles to find his identity, of who he wants to become. His dream is to become a fighter pilot, however soon later find out that he is color blind. By the end of the movie, he becomes weary of what life have to offer, and accepts it. He is obsessed with the philosopher Nietzsche. Dwayne jumps between the two states throughout the movie. Olive, the youngest daughter of the family, is in the Industry vs Inferiority stage of erikson's. She is a little girl with a big heart, and is just simply loving. She hates when her family fights, and tries to be that balance to put the family in a positive, uplifting mood. Due to her desire to be the next Little Miss Sunshine Pageant, she resides in the state of industry. Her strong passion just lights up the family as a whole, and ends up being very beneficial to the family structure and functioning.
Family functioning
This family is dysfunctional in a social, affective, and perspective. Interactions between members are awkward, and sometimes offensive to each other. Richard is part of the reason why family interactions are always tense - he has the mindset of winning, and always brings up the blunt truth, which can be very uncomfortable. Grandpa hoover displays an aggressive attitude, cursing in all communication, being disrespectful and rowdy to the older family members (not olive). Dwayne is a rebel, and chooses not to talk, nor do anything with his family and just wants to be alone. In a cultural perspective, they are coherent in doing events in a unit - such as having dinner and going to the Little Miss Sunshine pageant, despite having a dysfunctional structure. Economically, the family begins to struggle as Richard and his “9-step motivational success steps” business comes to a distraught, bankruptcy. Sheryl is forced to bring Frank to the household due to the inability to pay for health insurance.
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Strengths
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Weaknesses
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Culture/Religion
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Overcome obstacles and engages in events as a whole family unit, allowing Frank to comfortably set in his own role into the family. Sheryl displays the typical mother figure, being respectful to all and making sure all members are on the same page. She also put efforts to save face her brother (Frank) when he is in an awkward situation with Richard. Olive’s kindness and whole hearted personality gives Frank a spiritual uplift to bring a smile. Also, Dwayne’s presence give Frank a reason to live, and someone to talk to. Family members deal and cope with their own problems individually and in their own way, and no one really acknowledges Frank’s Tense situations constantly arise - and no solution is really thought out. There is always arguments between family members, but each family member reasonably expressing themselves do not happen. Conflicting personalities in the family - from people who don;t talk at all, to people who talk non stop, and behaviors from both ends of the spectrum. The family has no identified religion. The family comes together in the time for dinner and meal times. They also come together during the mourning of the death of Grandpa. Despite individual family member issues, as the movie progresses, family members come together to cope with each others problems, displaying family growth and adaptability. Frank begins to become very close and connect to a family member, Dwayne, (after realizing that he will not be able to fly due to color blindness)
Communication
Non-verbal: Dwayne acts through non-verbal communication for the majority of the movie. He chooses not to interact by voice, but rather by his facial affect and through his written notes. Frank often displays a flat affect, and is seen as sad throughout the movie.
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Verbal: All family members speak english. Sheryl, communicates in a confident and calm soothing tone, while Richard talks in a condescending tone, acting like he is the big man of the house being the motivator he is. The family interacts through a ton of arguments, and hectic situations. Grandpa Hoover verbalizes through an aggressive tone, with foul language, but acts appropriately to Olive. Olive communicates through interest and curiosity, being very loving and caring, with her smiles.
Family health system model Definition ●
Denham defines the Family Health System Model as a model which views family health as a whole system, which then guides nursing practice (Denham, Eggenberger, Young, Krumweide, 2015).
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“Family health is systematic, process based, and includes individuals and the family unit interaction, where the health of a single individual affects the entire family” (Denham, Eggenberger, Young, Krumweide, 2015).
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Changes within individuals health conditions could cause greater demands physically, emotionally, and economically. Although each individual family member of this movie persist their own health related issue, we will focus on how Frank’s depression influences family interaction and function.
Components
How Frank’s depression illness impacts and influence each component of the FHS.
Interactive processes (relationships, communication, support, nurture)
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Frank chooses to only interact primarily with Dwayne, due to his choice of being mute. He feels comfortable communicating with him only, as other interactions (such as with Richard and Grandpa Hoover) turns out to be a disaster, putting himself in the same depressive state, or making it worse.
Developmental processes (family transitions, task completion, individual development)
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Initially, Richard and Grandpa are absolutely against transitioning to Frank’s condition, and actually seems to continue bullying him. Grandpa pokes fun about his sexuality of being gay, and Richard reminds him that he is a failure in life, not a winner. However, on the bright side, Olive and Sheryl try to respect his condition, and accept Frank into the family as a normal, loving individual.
Coping processes (problem solving, resource use, handling of stress and crisis).
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When it comes down to a problem or situation, Frank’s condition actually does NOT get in the way of the family reaching a solution. He helps the family cope, such as helping reach the registration desk for Olive, carrying out Grandpa’s dead body to get to the pageant on time, and pushing the car to get it started. He also aids Dwayne in understanding that, if you’re color blind, you cannot fly jets. It seems Frank’s depression has caused him to grow sensitive to family issues, allowing him help.
Integrity processes (values, beliefs, identity, rituals, and spirituality)
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Frank is a firm believer that he is the #1 expert, and scholar in the world on Marcel Proust. He holds this in high regard and is very proud of it, as he mentions it a couple times throughout the movie. It seems to uplift his spirits as he talks about Marcel Proust. He identifies as gay, which is seen to be strong part of who Frank is. As he encounters a previous lover (a colleague) at the gas station with someone else, he feels ashamed and anxious. He believes in also speaking of the truth, bringing reality to both Dwayne’s colorblindness, and Richard’s bullying attempts.
Health processes (health beliefs and behaviors, illness stressors, caretaking)
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Due to Frank’s depression, he is very isolative, and non-engaging. He never chooses to strike up a conversation with anyone in the family but Dwayne. Although in the beginning, Sheryl was keeping close watch on him for any signs of suicide. As Frank becomes more accustomed to the family, experiencing family situations/stressors, he reassures everyone that he is not going to suicide. He seems to have found a purpose in helping the Hoover family reunite and become a true, coherent, interactive family.
Family health - nursing interventions 1.
Assessment: 1.1.
1.2. 1.3.
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Assess the entire family using the 15-minute interview, which can engage all family members, guiding them on viewing the perceptions of the illness experience that is happening within their family (Ackley, 2014). Assess the family’s stress level and coping abilities during the initial assessment (Ackley, 2014). Identify the personal relationships between family members, as well as personal strengths. (Ackley, 2014).
Diagnosis: Dysfunctional Family Processes r/t inadequate coping skills AEB being different from other people, chronic low self-esteem, hopelessness, disturbed family dynamics, and reduced ability of family members to relate to each other for mutual growth and maturation.
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Plan 3.1.
3.2. 3.3.
Outcome #1 - Identify 3 healthy coping behaviors that family members can employ to facilitate a shift toward improved family functioning by the end of 2-hour meeting Outcome #2 - Report of treating impaired family member as normally as possible, and avoiding overdependence by next week. Outcome #3 - The family will meet physical, psychosocial, and spiritual needs of all family members by next visit.
Family health - nursing interventions cont. Interventions 1. 2.
3.
Refer the family to family therapy - to restore healthy family dynamics appropriate environment and support for full recovery. (Ackley, 2014) Motivate family members to speak openly about illnesses, which will let open communication - improving quality of life and allowing families to (Ackley, 2014) Provide family-centered care to explore and use all available resources
and to provide family members have reach solutions. appropriate for the
situation counseling, social services, and self help groups. (Shivalli, Markjra, Akshaya, Qadiri,
2012) 4. 5. 6.
Encourage family members to find meaning and purpose in serious illness (Ackley, 2014). Consider the use of focus groups to provide insight to family perceptions of illness and or disease prevention (Ackley, 2014) tailoring the services to fit family needs and preferences and also ensuring that services are apt for a family's culture and traditions. (Shivalli, Markjra, Akshaya, Qadiri, 2012)
Evaluation Relating to the outcomes, they were officially met in the perspective of Frank, and the entire family. Frank was able to successfully find his purpose of living, thus creating his own coping mechanisms to deal with his depression. Him being helpful, working with the family made him feel that he had a purpose to life, as well as gain the respect of all family members. Richard was finally able to display some respect to Frank, not calling him a fialure anymore, and treating him as if he was a normal person.Despite losing the pageant show, the family comes together and deals with the stress as a whole unit, reassuring that Olive did her best. The experiences the families dealt with aided in forming new coping measures, identifying strengths and weaknesses for each family member, and allow the individuals to find meaning in one another (despite health illness).
References Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care (10th ed.). Maryland Heights, Mo.: Elsevier. Denham, S. A., Eggenberger, S., Young, P., & Krumwiede, N. (2015) Family-focused nursing care. Philadelphia: F.A. Davis Co. Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health care nursing: theory, practice and research (5th ed.). F.A. Davis: Philadelphia. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing care. Maryland Heights, MO: Mosby Elsevier. Shivalli, S. Marjra, J. P., Akshaya, K.M., Qadiri, G. J. (2012). Family centered approach in primary health care: experience from an urban area of mangalore, india. The Scientific World Journal, http://dx.doi.org/10.1155/2015/419192