Multinational Family Assessment and Care Plan

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Multinational Family Assessment and Care Plan Essay

Family Composition
A family under the evaluation consists of three members: a mother, a father, and their son. This nuclear family is considered multinational as the 31-year-old mother is Chinese and 38-year-old father is American. Each of the family members performs a certain role. In particular, the father acts as the leader and manages the decision-making process. However, he understands that his wife’s opinion also matters, especially when it comes to some difficult decisions like a car purchase. Working as a senior manager for a middle-sized company, the father acts as the primary provider of the family. At the same time, the mother has no income. She cares for home and volunteers in the community help center. Their 14-year-old son studies at school.

Psychological and Physical Conditions
Among physical conditions that impact family function, one can note inappropriate living situation. The house they live in is an old building that was constructed with the use of asbestos. Currently, it produces dust causing discomfort in the family members. Multinational Family Assessment and Care Plan Essay. However, the family has no chances to move because of their unstable financial situation that, in turn, causes a number of psychological factors that affect the functioning of the family. The fact that they cannot afford more suitable housing causes frustration in the father and stress in two other members of the family.

Developmental Issues
Speaking of accomplishment of age-appropriate developmental tasks, it is necessary to emphasize that the family passes the teenage child stage. The mother consciously cares about family welfare preparing food and clothes and discussing everyday issues. In his turn, although the father has to work overtime to provide the family with necessary financial resources, he tries to communicate with them asking for their expectations and concerns. In this connection, it is possible to state that the son has enough attention from parents and develops appropriately. In general, the developmental states of the family members create no stress. Multinational Family Assessment and Care Plan Essay.

Genetic Predisposition
The background information of the family shows that several relatives had chronic diseases related to the heart. Some representatives of the family had a tendency to corpulence suffering from overweight and obesity. At the same time, there are no registered cases of infectious diseases such as HIV or AIDS.

Hospital Admission
The immunization status of the family is characterized by timely vaccination. The mother suffers from chronic arthritis experiencing pain in joints that especially increases at night. She visits her doctor once a month to receive a consultation and further recommendations. The father visits the psychologist to prevent working burnout caused by overtime. Their son has some problems with concentration and learning. However, no definite diagnosis was made by his physician. The boy currently passes through a number of examinations. Also, he suffers from sudden onsets of breathlessness from time to time. As a rule, these attacks are followed by hospital admission and a new wave of stress in parents.

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Family Communication
As it was mentioned earlier, communication is an integral component of the family’s everyday life. The mother acts as the main communicator encouraging others to share their beliefs, ideas, and experience. Having enough time to spend it with her husband and son, she provides the family with a strong basis for the future effective collaboration. The father tries to support her initiative in spite of the fact that he tends to come home late.

As a result, the relationships between them seem to be trustful, open, and close. The only alarming signal is that the son enters the teenage years and shows some extent of age-related refusal to communicate with parents under the influence of his peers. This is expressed in refusing to tell about his daily activities or progress at school. In response, the mother uses the consensual model of communication valuing open conversation and conformity to the family experience.

Decision-Making Process
In this family, it is considered that the wife is the key provider of communication and decision-making. She identifies necessary issues that need to be resolved stimulating the process of decision-making. However, she cannot decide herself as this is the responsibility of the father.Multinational Family Assessment and Care Plan Essay. These roles are clearly stated in the family. There is no evidence of violence as the appropriate authoritative forms of discipline are used. Each member of the family understands their responsibility area. Therefore, it is possible to state that the family has certain skills and tools for effective communication and copes with crisis well if required. There is no role in overload or role conflict.

Cultural and Religious Factors
The multinational families tend to experience some difficulties on the basis of their different cultural backgrounds. In this connection, it seems appropriate to point out key features of Chinese and American cultures. For example, the Chinese use the indirect style of communication while Americans the direct ones. The direct style is associated with the expression of the true intentions of the person. It is a peculiarity of the American culture that leaves little room for understatements.

Americans tend to call a person on straight and clear conversations. Such style takes great care to preserve the position of the speaker during the conversation. In its turn, the indirect style enables people to hide their desires, needs, and goals during communication. In such cultures, preference is given to indirect and ambiguous communication that is dictated by the importance of respecting the other person’s position. As for the religious factor, it is not likely to affect the family as all the members consider themselves atheists.

External and Internal Support
The core family goal focuses on the provision of adequate and timely communication that is expected to ensure close relationships. With this in mind, the family tries to establish and maintain appropriate communication with relatives and friends. This strategy promotes help from the mentioned groups that is undoubtedly beneficial for the family. For example, parents can count on their external support in some cases. Multinational Family Assessment and Care Plan Essay.

Identified Diagnoses
Considering the above assessment, it is possible to specify the following nursing diagnoses: stress overload, anxiety, and risk for allergy response. It was revealed that stress overload in father is caused by the excessive working time necessary to ensure the family’s well-being. Anxiety occurs in all family members due to the impossibility to improve their living conditions and obtain new housing. This leads to continued concern about the problem and dissatisfaction of the basic human needs. According to Blair (2012), not only adults but also children are affected by the mentioned issue. Furthermore, the evaluation shows that the son is under the risk of allergy response as a result of continuous dust appearing at home. His sudden onsets of breathlessness are likely to be the result of inappropriate living conditions.Multinational Family Assessment and Care Plan Essay.

Care Plan for Future Wellness
The first problem of stress requires using some strategies and techniques to prevent stress overload. Clark and Pelicci (2011) state that the majority of working people believe that their work interferes with their personal lives. At this point, the experts suggest solving these problems radically or symptomatically. The radical approach is based on the change of attitude to the problem and attempts to assess the situation objectively. The symptomatic approach focuses on a set of measures to reduce stress overload by often change the type of activity, frequent walks, and prioritization of goals.

The second diagnosis of anxiety needs to be addressed as well. Anxiety reduces the stock of emotional energy and interferes with daily life. McGrandles and Duffy (2012) recommend applying one or several of the following interventions: psychological treatment, pharmacological, and self-help. For example, relaxation training can reduce anxiety as relaxation in the body and the mind cannot be combined with alarm. If a person learns to relax during stressful situations, he or she can significantly reduce the frequency and intensity of anxiety.

The third problem is a risk for allergy response that is based on the experience of the son. Estes (2013) considers that a multifaceted treatment program should be used. Multinational Family Assessment and Care Plan Essay. Currently, exposure control and elimination of household allergens in the immediate environment of patients are treated as the first stage of treatment and prevention of these diseases. The daily airing of apartments, frequent laundry washing, removing carpets from the house, as well as lower humidity levels, are necessary. In case the complete removal of the potential allergen is impossible, it is essential to consider changing wall coverings. Thus, patients with sensitization to household allergens require constant and careful monitoring of allergen exposure.

References
Blair, S. L. (2012). Economic stress and the family. Bingley, UK: Emerald.

Clark, C. S., & Pelicci, G. (2011). An integral nursing education: A stress management and life balance course. International Journal for Human Caring, 15(1), 13-22.

Estes, M. E. (2013). Allergic rhinitis, environmental triggers and treatment modalities. Nursing for Women’s Health, 17(6), 525-531.

McGrandles, A., & Duffy, T. (2012). Assessment and treatment of patients with anxiety. Nursing Standard, 26(35), 48-56.

The purpose of this paper is to expand on the interview conducted with a selected family while using the Calgary Family Assessment Model (CFAM) to create a nursing diagnosis, teaching plan as well as strength-based nursing interventions based on Calgary Family Intervention Model (CFIM). The selected family was referred to the nursing student by a close friend and colleague. The initial meeting took place at the Roger’s home where informed consent was signed, and a relationship of trust was established by introducing myself, followed by a brief explanation for the meeting (Kaakinen, Coehlo, Steele & Robinson, 2018). A 15-minute interview using the CFAM (structural, developmental and functional assessment) as a data collection guide was used to gain a better understanding of the family’s story. The Roger’s family consists of Sandra, who is a single mother of two children, Ashton and Jordon. Since the estrangement of the children’s father, Sandra has a difficult time asking for help outside of extended family and close friends which in turn increases her stress levels and causes a significant impact on the family.Multinational Family Assessment and Care Plan Essay. Because of this, Sandra often struggles with the many disadvantages of single parenthood, despite the family’s strong emotional bond. With the help of the grandmother, Mary, the family can meet many of the daily challenges. Since Sandra’s recent diagnosis with Fibromyalgia (FM), she is struggling with her management of increased stress due to the disease process which is affecting her activities of daily living (ADLs) and the functioning of the family. Findings within this assessment represent a glimpse of this family and are subject to change. For confidentiality purposes, pseudo names were used throughout the paper.

Structural Assessment

The structural assessment, according to Wright and Leahy (2013), examines the members of the family, and their connections by reviewing the internal structure, external structure and family content.

Internal Structure

The Roger’s family internal composition consists of a self-identified heterosexual 41-year-old mother Sandra as well as her two children Ashton and Jordon. Ashton is a 13-year-old adolescent female just graduating grade 8 and Jordon is a 6-year-old boy graduating from kindergarten this year. Aside from Sandra, Ashton and Jordon have strong emotional ties to their grandmother, Mary, who is recently retired at 68 years of age and an integral part of their lives by assisting with childcare and accommodations when needed. In terms of gender, Sandra facilitates both mother and father roles since the birth of Jordon in 2014.Multinational Family Assessment and Care Plan Essay. During the interview, the differences in ages between the two children were noted. Also, to understand the families rank order and the impact on the children’s development, the family was asked if the difference in birth spaces between children were involuntary or were the pregnancies planned. Sandra indicated by verbalizing that “Her pregnancy with Jordan was accidental and the biological father, Michael, has been estranged since the announcement providing no emotional or financial support to the family until recently” (S. Rogers, personal communication, May 30, 2019). Within the past few months, 41-year-old father, Michael, has attempted to reconcile with his family. Sandra also explained how the unexpected estrangement contributed to the current subsystems within the Roger’s family by leaving Sandra to be the primary parental subsystem for each child and the grandmother, Mary, accepting the role when Sandra was unable to. This estrangement has also left Ashton to take on more of an adult role, at times, by assuming a surrogate-spouse subsystem in the absence of the father (Wright and Leahy, 2013). A long history of trauma has affected Sandra’s boundaries, both internally and externally. Over the years, Sandra has developed difficulties with establishing trusting relationships outside of her extended family and close friends, especially since the estrangement of the children’s biological father. Her boundaries are closed/rigid, and she has a difficult time accepting or asking for help, which often increases her fatigue and stress levels. The genogram for this family is in Appendix A of this paper.

External Structure

The external structure includes extended family and larger family systems (Wright & Leahey, 2013). Sandra is the youngest of three siblings, and unfortunately, their relationship has been severed due to its toxicity. Whereas Sandra’s ambiguous relationship with her father has been the cause of childhood trauma, and although she still has contact with him periodically, he has been absent for the majority of her adult life. Currently, her father resides within the same urban centre but will only contact Sandra and her children when he needs something. The remainder of the extended family lives in Ontario and have minimal contact with her and the children; however, Mary goes to visit them yearly. The lack of extended family in Sandra’s life often leads to her dealing with problems alone, especially when larger support systems are problematic and not accessible.Multinational Family Assessment and Care Plan Essay. Since becoming a single parent family, financial resources have drastically reduced. The previous unsettled battles with the Provincial Family Justice system regarding defunct child support payments were exceptionally frustrating. Combined with, Sandra’s battles with her family physician regarding her FM symptoms that were disregarded, prior to diagnosis by a new family physician helped to create hesitancy, resistance and distrust in our provincial/regional services provided to her and her family.

Additionally, the lack of understanding and work schedule discrimination that have been imposed by numerous employers because of her sociological status is relevant to the number of jobs Sandra has held within the past six years. Not to mention, the time and energy needed to ensure that Ashton and Jordon are in activities, spend time with their friends, and get homework done for school often leaves Sandra very little time for her wellbeing. Sandra stated that her “close friendships have been a saving grace and play a vital role in the comfort and emotional support” (Rogers, 2019). The ecomap of this family is in Appendix B of this paper.

Context

Sandra considers her ethnicity as North American culture, whereas her children’s ethnicity is deemed to be indigenous because of their fathers’ Cree ancestry. Sandra has taken the necessary steps to ensure that both children have been legally identified as indigenous and issued a status card, so they are recognized as aboriginal by society. Conversely, the children take taekwondo as their weekly activity attend a Catholic school; have chosen to learn French as a second language and know very little about their indigenous heritage. When asked about social class, Sandra responded that “there were times when money was tight and being a single parent everything has to count because you have to juggle your time, money and work” (Rogers, 2019). Sandra felt that she is often looked on by society as low to lower middle class due to her the education level, and her children’s ethnicity or race. Multinational Family Assessment and Care Plan Essay. However, she is always thankful to be able to clothe, feed and care for her children to the best of her ability thanks to the assistance of Mary and the various supports available to her within her community such as low-income housing. Michael’s efforts to reconcile with the family by upholding his financial obligations and finally paying his allotted monthly child support payments has lightened the financial burden on the family. Sandra considers herself spiritual; however, she does not choose to attend a place of worship. Sandra believes that spirituality has many perspectives. Her ideology of spirituality is that happiness, strength and blessings in life are gifts from a higher power that are unique to each of us.

Development Assessment

As previously indicated, Michael, has been estranged from the family following the announcement of Sandra’s pregnancy until recently. The complexities involved with childrearing by a single parent can be very challenging. According to Wright and Leahey (2013), single-parent families must accomplish most of the same developmental tasks as families consisting of two parents, with limited resources. Sandra has accepted the role of both mother and father; therefore left to tackle responsibilities involving the emotional, psychological and developmental growth of each child as well as her own.

Functional Assessment

The functional assessment, according to Wright and Leahy (2013), consists of two parts instrumental and expressive functioning. It looks at the interaction between family members and the operation of everyday life for the family.

Instrumental Functioning

This section covers family routine, activities of daily living such as cooking, cleaning, shopping (Wright & Leahy, 2013).

When asked how she manages the daily challenges, Sandra stated: “I am not sure how I do it, but every day is different, and some are harder than others.” (Rogers, 2019). On days that Mary, the grandmother is there to assist with the before and after school childcare, she does assist in household duties and prepares supper.Multinational Family Assessment and Care Plan Essay. As a single parent, Sandra has the sole responsibility for all day-to-day aspects, and although Ashton does help out, Sandra tries to avoid exploiting her efforts. In regards to family decision making, the family acknowledges having a shared responsibility consulting each other in many family decisions.

Expressive Functioning

The Expressive functioning of CFAM Models includes nine subcategories such as: “emotional communication, verbal/nonverbal communication, circular communication, problem-solving, roles, alliances and coalitions of the family” (Kaakinen et al. 2018, p124). Sandra admits to habitually finding herself unable to relinquish the self-destructive behaviours of not always discussing her emotions when needed in fears of being judged. These emotional barriers have increased stress levels and contributed to her health problems. Sandra has sought professional support to facilitate relief for her anxiety and stress caused by these behaviours.

Despite this, the interactions between the children and her demonstrate that they have strong communication skills and a good relationship. The children are affectionate toward Sandra, and Sandra frequently speaks about their feelings and opinions. Jordon has a mild form of ADHD (Attention deficit hyperactivity disorder) that requires Sandra to repeat instructions, and ensure her verbal and non-verbal communications are clear and directed, so Jordon remains focused. Jordon is encouraged to use his inside voice when speaking verses yelling. Also, lots of facial expressions, eye contact and gestures are often used when Sandra is busy and cannot give Jordon his required attention. Whereas, Sandra mentioned that more Therapeutic communication is used with Ashton because she is in her adolescent years.Multinational Family Assessment and Care Plan Essay. When youth experience circular communication as a result of increased, anger and defiance problems in family functioning occurs (Liermann & Norton, 2016). Sandra believes that is it important to try and maintain communication because with positive communication emerges positive relationships.

The family believes that they can solve problems with perseverance and communication. The challenges faced sometimes vary according to circumstances, but when in doubt, grandma, Mary is called to help. When considering the subcategory roles within the family, as mentioned previously, Sandra has maintained the roles of both mother and father within the family unit. Sandra also values Ashton’s contribution and assistance in preserving family function but does watch to ensure that she does not take on the parental role. Despite this family’s challenges, they function very well as a unit. Influence and power, as well as beliefs, were not assessed during the interview.

In terms of the family’s alliances and the coalition, they fall into a triangular alliance with Grandmother, Mary, deemed helpful and unhelpful at times when boundaries/ roles are being challenged because of intensified tensions.

Rogers’ Family Nursing Diagnosis and Interventions

According to Kaakinen et al. (2018), the family reasoning web is useful in analyzing data from the family assessment into meaningful data groups. The nurse asked the family to identify their strengths and weakness so that competent care could be implemented (Silva, Moules, Silva, & Bousso, 2013). The family determined that their strengths were respect and love for one another, and their weaknesses were poor knowledge of disease process, together with decreased activities of daily living (ADLs) which is affected by ineffective stress management. These recognized areas were used to collaborate with the family appropriate family-based nursing diagnosis and interventions based on the CFIM (Calgary Family Intervention Model). There was two family nursing diagnosis and two interventions identified. Multinational Family Assessment and Care Plan Essay.

The first nursing diagnosis identified is deficient knowledge related to lack of information related to disease process, as evidenced by patient’s inquiry about the management of daily challenges needed for health recovery, maintenance and health promotion (Gulanick & Myers 2014 p. 115). Education provided to patients and their families within this cognitive domain by healthcare professionals plays a substantial part in patients obtaining the best possible health outcomes. Patients with FM often rank cognitive dysfunctions such as memory and mental alertness high in terms of the disease process; however, they also experience pervasive pain and tender points, extreme fatigue, accompanied by anxiety, and sleep problems (Årestedt, Benzein, & Persson, 2015). By working with the patients to increase knowledge, deficient nurses can assist in health promotion and alleviate frustrations associated with the disease process. Setting goals and discussing management of symptom expectations with therapeutic communication by healthcare professionals not only establishes trust, but self-management strategies personalized to that individual enhances better quality of life (Wayne, 2016 p. 1).

The other nursing diagnosis is ineffective coping strategies related to her recent diagnosis of FM as evidenced by increased stress and anxiety (Ladwig, Ackley & Makic, 2019). Based on the CFAM assessment, Sandra is having a difficult time managing her stress levels. Sandra’s stress levels and decreased activities of daily living (ADLs) is directly related to FM and the vicious cycle of non-restorative sleep, pain and increased anxiety (Davis et al. 2017). By recognizing the need for appropriate strategies through active listening, commendations and empathetic communication, we established a supportive environment. Healthcare professionals can teach patients how to focus on the present, let go of any emotional barriers, and how to use available resources (Gulanick & Myers 2014). Multinational Family Assessment and Care Plan Essay. By doing so, Sandra will recognize her strengths, which can facilitate improved coping and reduce stress. FM is a very complex disorder with no apparent cause and no cure; I commended Sandra for her strength and perseverance in overcoming her daily challenges associated with this disease process.

Teaching Plan Rationale

The information attained from the CFAM (Structural, developmental and functional assessment) data collection we created a recommended teaching plan for the Roger’s family. Sandra’s FM symptoms are currently increasing because of the stress associated with her inability to complete ADLs. Because Sandra is stressed, the children will also be stressed based on the concept of the family system theory by (Kaakinen et al. 2018). The author believes that the family is a system, all parts are interconnected and what affects one area will ultimately affect the other parts of the system (Kaakinen et al. 2018). Once Sandra can achieve a state of wellbeing by managing her symptoms of FM, the family’s functions and processes will also benefit. The teaching will focus on Sandra reducing or maintaining her stress levels, which in turn will reduce symptoms associated with her illness and enhance the wellbeing of the entire family.

Mindfulness-based Stress Reduction Techniques

A Mind-body therapeutic approach called Mindfulness-based stress reduction (MBSR) will teach Sandra how to reduce her stress-related symptoms of FM. This practice integrates mindfulness meditation, in addition to, complementary Mind-body therapies such as body scanning, hypnosis, reflexology and several other relaxation techniques (Chadi et al. 2016). MBSR focuses on calming your emotional- related brain activity, which has been linked to the reduction of pain, stress and anxiety, through increased self-awareness and body sensations (Cash et al., 2015). Multinational Family Assessment and Care Plan Essay. According to Koçak & Kurt (2017), MBSR provides effective treatment for treating symptoms related to FM and is frequently recommended as an alternative approach to traditional remedial therapies. This teaching plan will teach MBSR techniques to Sandra and assist her in identifying stressful events, increasing her ADLs; by reducing symptoms of FM and the impact on the family. The Teaching Plan for this Family is in Appendix C of this paper.

Conclusion

In conclusion, the CFAM Model has been used to assess the Roger’s family. Although the family assessment and interventions in this paper are just a current snapshot of the Roger’s family the CFAM and CFIM has allowed the nurse to recognize, interpret and implement change strategies for the family to promote positive family outcomes (Wright & Leahy, 2013). The Roger’s family have a strong family bond based on good communication and an excellent relationship. The Roger’s family identified their strengths as respect and love for one another and their weaknesses as ineffective stress management and decreased ADLs related to Sandra’s recent diagnosis of FM. Nursing diagnoses were developed to address some of the family concerns. The nursing diagnoses were: deficient knowledge related to Sandra’s current diagnosis and Ineffective Coping Strategies, which exacerbates symptoms of the disease process. In the area of health promotion, the CFIM Model was used to develop family centred interventions. Both individual and family strengths were commended, along with therapeutic communication maintained. Finally, to assist in the family’s wellbeing, as well as a reduction in the symptoms of FM exacerbated by increased stress, a teaching plan was presented to Sandra. Multinational Family Assessment and Care Plan Essay.

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References

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Barstable, S.B. & Quigley, L.G. (2019). Behavioral objectives and teaching plans. In S. Barstable (5th ed.), Nurse as Educator: Principles of Teaching and Learning for Nursing Practice (pp. 423-458). New York, NY: Jones & Bartlett Learning
Cash, E., Salmon, P., Weissbecker, I., Rebholz, W. N., Bayley-Veloso, R., Zimmaro, L. A., … & Sephton, S. E. (2014). Mindfulness meditation alleviates fibromyalgia symptoms in women: results of a randomized clinical trial. Annals of Behavioral Medicine, 49(3), 319-330. Retrieved from . Multinational Family Assessment and Care Plan Essay.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4802162/
Chadi, N., McMahon, A., Vadnais, M., Malboeuf-Hurtubise, C., Djemli, A., Dobkin, P.L., Lacroix, J., Luu, T.M., Haley, N. Mindfulness-based Intervention for female adolescents with chronic pain: A Pilot Randomized Trial. J Can Acad Child Adolesc Psychiatr, 2016;25(3):159–68. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5130089/
Davis, K., Sargent, L., & Menzies, V. (2017). Community-Based Care of the Fibromyalgia Patient: Strategies to Promote Self-Management. Home healthcare now, 35(7), 364-372 Retrieved from https://nursing.ceconnection.com/ovidfiles/01845097-201707000-00003.pdf.
Golombok, S., Zadeh, S., Imrie, S., Smith, V., & Freeman, T. (2016). Single mothers by choice: Mother–child relationships and children’s psychological adjustment. Journal of Family Psychology, 30(4), 409. Retrieved from https://psycnet.apa.org/fulltext/2016-07216-001.html
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