Question

in need of help of a clinical example of the Calgary Family Assessment Model as the nurse

Answer 1

#. This model is widely used among nurses for assessing a family in the goal of resolving issues among the family. A family assessment does this in ways that can help a family prevent and solve problems. It aims for a full understanding and unbiased view of the family—not just its problems, but also its strengths, values, and goals.

#. Theoretical foundations of CFAM and CFIM: Underlying ideas

- Postermodernism

- Systems theory

- Cybernetics

- Communication theory

- Change theory

- Biology of cognition

#. Postmodernism

- rejecting notion that knowledge primarily comes from science and technology, and that progressive technology leads to a better world

- nurses consider illness narrative and family experiences as legitimate, not just medical narratives and treatments

#. Systems theory

family is considered a system, a complex of elements in mutual interaction

#. Cybernetics (science of communication and control theory)

- family systems possess self-regulating ability

- each member behavior affects another member and in turn, that member's response is affected

- feedback processes can simultaneously occur at several levels with families

- wife criticizes, husband withdraws = simply cybernetics

Communication theory (study of how individuals interact with one another)

- all nonverbal communication is meaningful

- 2 channels for transmission: digital and analogue

- interaction patterns can be complementary (one gives, other receives; status unequal) or symmetric (both have equal status)

- 2 levels of communication: content and relationship

#. Change theory

- understanding alone does not lead to change

- change does not always occur equally in all family members

- facilitating context for change is nurses responsibility

- change can have many causes

#. change is dependent on:

- perception of problem

- structure of problem

- context

#. biology of cognition

- the world we see (reality) is not the only world but the world family members bring to each situation

- resist the "sin of certainty" (the notion that there is only one correct way to manage health, illness, loss and disability)

#. CFAM categories

- structural

- developmental

- functional

Structural :-

- internal

- external

- context

Functional :-

- instrumental

- expressive

Developmental :-

- Stages

- Tasks

- Attachments

Structural --> Internal --> Family Composition

- may or may not: include children, be related, live together

- there is commitment and attachment

- family nourishes, protects and socializes its members

Structural --> Internal --> Gender/sexual orientation

- power issues embedded in gender

- male/female roles, although changing, form a large part of our identity

Structural --> Internal --> Rank Order

- position of children in family with respect to age and gender

- order, gender, and distance b/w children are important factors to consider, can be significant across family development life cycle

Structural --> Internal --> Subsytems

- based on generation, sex, interest, role, function or history

- everyone belongs to several subsystems

Example :-

Structural assessment

Structural assessment is an important category of CFAM as it examines the structural component of the family. These structures can be more closely identified using the three aspects comprised of the internal structure, external structure, and context. To further understand the structure of P.L.’s family, a genogram was made of her family.

Wright and Leahey state that internal structure includes six subcategories which include: family composition, gender, sexual orientation, rank order, subsystems, and boundaries. P.L. was asked about her family composition. She answered that her family is composed of her husband whom she lives with, as well as her children who are adults now and live their own lives. When asked about who she would consider her family not related biologically, she responds that it would be her neighbour whom she gets along with quite well. According to P.L., she believes that family is love, understanding and composed of people who can talk with one another. The concept of family and what family means differs from person to person. With P.L., love and understanding are the most important components to her.

P.L. believes that a person is a person no matter which gender they are; we are all people and decide who we want to be. When it comes to the rank order of her children, she has three living children (boy aged 45, girl aged 40, and girl aged 36) and has had three miscarriages. When P.L. is having tough times, her husband takes over and she also talks to him with problems she might face.

External structure is divided into extended family and larger systems. When it comes to P.L.’s extended family, she mentions that she stays in close contact with one of her sisters by visiting at her house every Saturday. To stay in contact with her other siblings, she uses the phone. She also told us that she had a girlfriend whom she was very close to, however, was diagnosed with MS at 43 years old and unfortunately passed away. She was paralyzed neck down and it was a sad moment for P.L. When it comes to P.L., she tells us she was diagnosed with MS at 37 years old and there was no need for adjustments. She also has Menière’s disease; her last episode was three years ago, and Menière’s does not affect her as much as MS does.

Contextual structure is the family background with includes ethnicity, race, social class, spirituality (or religion), and environment .When asked about her ethnicity, she replies that she was never a cook, but when it comes to traditions, P.L. makes meat pies on the occasions. She also tells us that her mother taught her how to sew and as well passed on her tradition of reading to P.L. She emphasizes that she loves reading with passion.

With social class, P.L. mentions that she moved every three years with her family when she was younger because her father was in the military. Presently, she has been living in the same house for 35 years and says she has no issue or difficulties. She feels that she is in a safe environmental neighborhood. P.L. also says that she is a Catholic; she does not go to church, but prays every night. She loves God and thanks him before going to bed in wishing that nothing more will happen to her. She wishes to God to not get into car accidents as well.

Developmental assessment

Developmental assessment is the second category of the CFAM. Along with the structural assessment, this component is also essential as it explains the family’s developmental life cycle.Families progress through certain stages of development similar to Erik Erikson’s Theory of the psychosocial development. There are six stages in the developmental life cycle according to the CFAM and it is clear that P.L. is in the last stage because she is now a grandmother and her children have left the household onto the building of their own lives. Developmental assessment also includes tasks and attachments depending on the developmental stage the family in situated in.

P.L. is in the sixth stage of the developmental life cycle which is named “Families in Later Life” .Looking back over her life, P.L. says that marriage gave her the most happiness along with her children being all grown up, healthy, and well in their skins. In addition, P.L. feels very fortunate that her MS is not presently severe. Need to add more

Functional assessment

Functional assessment is the last major category of the CFAM. This component deals with how the individuals in the family deal with one another, known as interaction. The two basic aspects of family functioning include the instrumental and expressive. Instrumental functioning is about routine activities in daily living. For P.L’s health, she tries to walk on the treadmill she owns for about five minutes daily. P.L. mentions that she hopes to shovel the snow until she passes away. Knitting, crocheting, and cleaning the house are all things that P.L. loves doing and mentions in the interview many times how much she loves her house.

She does not like using her illness of MS as an excuse for certain symptoms, but as a precaution, she makes sure not to stand on her feet for too long (preventing postural hypotension). P.L. claims that she has no trouble performing activities of daily living (ADL) unless she is having an episode from the illness. She explains to us when she knows to take it easy. When she wakes up in the morning and sees the image of a cloud in her mind, this signifies her MS and it is a signal for her to be careful. This black imaginary cloud is the only barrier that can stop her from doing things. Last time she has seen this cloud was six months ago and last a couple hours.

She also mentions that she knows her left leg is not as strong as the right one, and takes appropriate measures. P.L. claims she has not been sleeping well, and could be due to her habit of drinking liquids before bed (not alcohol). Although she has not been sleeping well, in the morning she feels rested. There are nine aspects included in expressive functioning which were all covered during the interview (emotional, verbal, nonverbal, and circular communication, problem solving, roles, influence and power, beliefs, as well as alliances and coalitions). When asked how she would rank her emotional state, P.L. responded that she is easily bothered, and quite emotional. She is content with where children are at in their lives and is not worried about them. She says, “No news is good news”. P.L. understands that she cannot hold her children on a string, and has to cut it at one point.

When it comes to verbal communication, she has trouble saying what bothers her, so she keeps it to herself. P.L. will not initiate communication because as a child she had no discussions with her parents. Her parents would always tell her to play outside, but her siblings were busy doing their own thing most of the time. Communication was inexistent in her life as a child, and says she would lose herself deep into a book, and deal with her problems by herself. As mentioned earlier, she will not voice opinion and when asked if she would like to better her communication skills, she responded with a quick “yes”.

She emails and calls her son and youngest daughter frequently. P.L.’s ways of showing happiness is to keep mentally active like going on the computer and playing games. This would be nonverbal communication. She tells us she is usually happy all the times unless something bothers her .