Question

Marge is a single parent who dropped out of high school to marry Andrew when she was 17 years old and pregnant. After 6 years of marriage and two children (Stacy, age 5 years, and Monica, age 2 years), Marge divorced Andrew because of his drinking, affairs, and lack of support of her and the children.

Andrew has a job delivering newspapers and spends free time drinking beer with friends. He only sporadically provides monetary support. Marge and the girls live in a small apartment. Because she has only a minimum wage job, Marge relies on food stamps and other types of assistance. Babysitters and rent are major expenses, and Marge continually worries about being able to pay rent. She would like to earn her GED to get a better job, but she lacks the time and resources to make that happen. Andrew sees the girls only occasionally—usually when Marge asks him to keep the girls so she can work extra shifts. He dislikes spending his time babysitting the girls and openly verbalizes his frustration with the “whiny girls.”

Marge’s parents live close by but believe that Marge deserves her situation. They were very against her leaving school to get married, and they consider Andrew a “deadbeat.” They have declined to help Marge financially, citing concerns for their own retirement. They also do not help with babysitting, and they accuse Marge of “spoiling the girls.” Marge has always believed that her parents liked her older brother, Dominic, better. He is married and has three children, who spend a great deal of time with Marge’s and Dominic’s parents. Dominic rarely interacts with Marge because they “don’t have anything in common.”

Recently, after the girls spent time with their father, Marge noticed bruises on the arms and the buttocks of Monica. When she asked the girls what happened, Stacey said, “Daddy got mad when Monica wet her pants and spanked her.” A week later, while at a health clinic getting Stacy immunized for school, Marge shared with the nurse practitioner details of her life and situation: lack of money, lack of support, working too many hours, fear of losing her apartment, and now Andrew hurting Monica. She said she does not know what to do and began crying.

Case Analysis

Marge and Andrew, while married, were in the stage of “families with young children” in the “family life cycle,” whereas their parents are in the stage of “families in later life.” However, since the divorce, Marge and the children form the family unit. Both Marge and Andrew are in the developmental stage of young adults.

The interactions among all the family members are dysfunctional. Marge’s parents appear to favor her brother and his children while giving little support or encouragement to Marge. Exploration of the origins of this situation is necessary before any practical suggestions for resolution of differences can be offered. Family therapy involving Marge, Dominic, and their parents would be ideal but is unlikely to occur.

The nurse practitioner must be cognizant of the laws of the state where he or she practices and must report the alleged abuse. Marge may need to consult with legal aid to change visitation rights for Andrew so that she can keep the children safe. Referral of Marge to a counseling center where she could obtain assistance with planning to obtain a GED, prepare for a higher paying job, and obtain financial assistance would be a short-term solution. Marge must also plan for child care; she might be able to find a day-care center for low-income families for Monica.

This is a family with serious problems with interrelationships. There are many long-term problems with few or no short-term solutions. Counseling individually and as a family is necessary to attain more healthy interactions but may be unlikely to occur. It will take great resolve and work on Marge’s part to achieve her goal of a healthy relationship with her parents and brother.

Questions

1. If the nurse practitioner had assessed Marge’s family using the Calgary Family Assessment Model what meaning would you assign to the conclusions

2. What is the law regarding mandatory reporting of suspected child abuse in your state? Are nurses mandated reporters? Members of what other professions are mandated reporters? What constitutes “suspected child abuse?” How would you feel about reporting alleged child abuse in this case?

Answer 1

Answer: If the nurse practitioner assessed Marge's family using Calgary Family assessment model then it means that the nurse has followed all the procedures to intervene about the patient's family. This assessment model enable the nurse know about the family structures, relationship as well as the stage at the family is. This assessment provide nurse to enhance information. To know the depth of the problem so that the nurse can solve it such as family ability to perform task etc.