Question

Instructions: Below is the illustration of approaches to family nursing, your task is to discuss each approach in your own perspective/view and relate its significance in working in any given family. Write down your answers in a separate sheet of paper. (see rubrics for scoring)

1. Family as Context

2. Family as Client

3. Family as System

4. Family as Component of Society

TASK 2. FAMILY CASE STUDY
Instructions: All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, list them in order of priority or significance. Do not assume information that is not provided. Write down your answers in a separate sheet of paper. (see rubrics for scoring)

Case Scenario: Mikral Family
Family Members:
• Rafael: father; 52 years old; part-time lecturer at a local university (married Michelle 18 years ago), first marriage.
• Michelle: mother; 50 years old; full-time employed at a government office, second marriage with no children from the previous marriage.
• Cristina: oldest child; 17 years old; daughter, 11th grade.
• Iana: middle child; 14 years old; daughter, 9th grade.
• Isaiah: son; 11 years old; son, 6th grade.
Family Story:
Rafael (52 years old) and Michelle (50 years old) have two teenage daughters, Cristina (17 years old) and Iana (14 years old) and one son, Isaiah (11 years old). They have been married for 18 years. Rafael is a part-time college professor. Michelle has a full-time position as a director at a government office. When Rafael lost his full-time job 17 years ago, the couple moved in with Rafael’s mother (Princess, age 86) and lived with her for more than 5 years until Michelle’s income was sufficient to cover a mortgage and family expenses. Since moving out of Princess’s house, the couple and children visit and have dinner with her every weekend, which has become the family routine. Children are expected to spend the night with their grandmother after the dinner; however, recently Cristina has refused to spend the night at grandmother’s house. Rafael’s sisters and their families live in the same state and visit Princess at least once a month. Princess has chronic health conditions, which cause unexpected emergency department (ED) visits (several times a year). After divorcing her ex-husband, Michelle started to study in a graduate school in a different state, where she met Rafael. Because Michelle’s family lives far away, she barely sees them and sometimes feels isolation and loneliness. Rafael has been a part-time employee at local colleges most of his life. While Rafael has spent most of his time working on computers at home (online teaching), Michelle has worked at a local government agency. Since Rafael has produced minimum income, Michelle provides for most of the family expenses. The house has five rooms: master bedroom, Rafael’s office (he stays at home most of the time), and three rooms for the children. The girls used to share the same room until the family added an additional room last year so the children could have their own room. Since moving to a new room upstairs, Cristina brings her friends’ home frequently and a couple of close friends spend the night with her on weekends and during the summer break. The parents caught Cristina and her friend leaving the house secretly to meet a group of boys after midnight; Cristina was grounded for a month as a result. Last month, Michelle found Cristina and her friend on the street (instead of going to school) while she was driving to work. Cristina’s boyfriend lives nearby, and they meet frequently at the park or each other’s home. Michelle suspects that Cristina might have a sexual relationship with her boyfriend. This is the first marriage for Rafael and second marriage for Michelle. Michelle was a survivor of domestic violence from the first marriage (which lasted less than 1 year). Because Rafael has strong family-centered values, they eat dinner as a family and once or twice a week with Rafael’s mother (Princess). Cristina has started skipping the family dinners frequently, stating that she is not hungry. She also has been experiencing several fainting episodes due to irregular eating habits. She frequently skips breakfast and lunch. The couple noticed that Cristina is eating fast food in her room or eating food after midnight by herself. Cristina’s eating pattern is getting irregular, and Iana has begun to imitate her older sister’s pattern and is refusing to participate in family dinners. Both girls are generally skipping breakfast, although Michelle has made various attempts to get them to eat breakfast. All children are in good health and have pleasant dispositions. The children are generally happy, but loud at home and frequently fight and yell at each other. The girls argue over clothes and cleaning and are frequently cranky and difficult for the couple to deal with. Rafael and Michelle sometimes argue because of different parenting styles: whereas Michelle wants to raise the children in a Christian way, Rafael opposes Michelle’s parenting belief. Cristina is becoming rebellious and fights with Rafael frequently. She is losing interest in her schoolwork. Earlier in their married life, Michelle mainly was responsible for household chores. Cristina expressed resentment against her father regarding his minimal house chore contribution. Over the years, as a result of numerous heated arguments, Rafael agreed to share a significant portion of household responsibilities, including outdoor chores. Still, Michelle spends weekends doing grocery shopping, laundry, housecleaning, and attending to the children. During the weekdays, the couple takes the children to various lessons (piano, violin, cello, art, karate, and soccer), which sometimes causes schedule conflicts and builds marital tension. Rafael and Michelle have mutual friends, but seldom participate in social gatherings as a couple. Michelle usually takes the children to church events, and Rafael takes Isaiah to soccer practices or sports events. Michelle feels social support and comfort by attending church and church related activities; but Rafael considers it as his wife’s over commitment to religion. The family is affiliated with a Methodist church, which they used to attend every Sunday; Rafael stopped going to church 6 months ago. Cristina sometimes refuses to go to church as a family. Because of Michelle’s full-time job and frequent family gatherings with in-laws, and Princess’s frequent ED or hospital admissions, Michelle has limited time to socialize with her own friends. Over the years, Michelle has experienced chronic fatigue and stress from caring for the children and handling family responsibilities. She also experiences insomnia and hot flashes due to menopause. Over the last 3 years, she has gained 30 pounds and is trying to lose weight without success.

Discussion Questions:

1. Illustrate the Mikral family genogram and family ecomap
2. Enumerate all the possible health assessment you can gather from the story. 3. Create a Family Nursing Goal/s for the Mikral Family.
3. Using the different theoretical approaches that can be used for assessing and intervening in the family for health promotion, discuss your implication/inference to each theory base don the given scenario:
a. Developmental and Family Life Cycle Theory
b. Family Systems Theory
c. Bio ecological Theory
4. Develop a Family Nursing Intervention.
5. What are the possible points of your family health teaching you can provide to the family?

Answer 1

2.Medical risk factors

Psychologist assistance should provide. Counselling.

Family therapy

Assistance to improve couple relationship

3. Family nursing goal

(Family therapy theories)

A. According to family theory some systematic and pattern changes are happened in the family because of the Cristina behavioural changes.

B. Emotional system should regain by kids involvement and relations with parents.

C. Biological theory indicates the Michelle’s earlier life events. That make her frustrated.

Make every individual happy within family.

Michelle’s stress should reduce.

Cristina needs behavioural changes.

4. Nursing intervention:

Help Michelle’s to counter the actual problem.

Cristina should undergo counselling therapy make arrangements for this.

5. Educate kids about their role in the family.

Help Rafael to identify Michelle’s health and mental problems.