Question

1. Describe the purpose of the genogram as a tool in the Calgary Family Assessment Model.
2. Describe the purpose of the ecomap
3. Name the three major categories of CFAM and describe2 subcategories of each
4. Write a one sentence holistic definition of a family( personal/ unique definition)
5. List four types of families/ family compositions you might encounter in practice.
6. Describe the relationship of the family structure to family function.
7. Compare and contrast family health promotion as compared to individual health promotion.
8. Compare and contrast open, closed , and permeable boundaries.

Answer 1

Calgary Family Assessment Model

According to Wright and Leahey (2009), “The Calgary Family Assessment Model (CFAM) is an integrated, multidimensional framework…” (p. 47). This model is widely used among nurses for assessing a family in the goal of resolving issues among the family. CFAM is composed of three major categories which include: structural, developmental, and functional. As a nursing student, CFAM was used for assessing Mrs. P.L. who holds the chronic illness of multiple sclerosis (MS).

Structural assessment

As stated in Wright and Leahey (2009), 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 (Appendix A). According to Butler (2008), by viewing at least three generation levels, genograms highlight the family in a broad manner, by showing the individual’s ages, gender, and deaths, for example.

Wright and Leahey (2009) 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. As stated in Weigel (2008), 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 (P.L.’s Genogram, Appendix A). 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 (Wright & Leahey, 2009). 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.

Calgary Family Assessment Model

According to Wright and Leahey (2009), “The Calgary Family Assessment Model (CFAM) is an integrated, multidimensional framework…” (p. 47). This model is widely used among nurses for assessing a family in the goal of resolving issues among the family. CFAM is composed of three major categories which include: structural, developmental, and functional. As a nursing student, CFAM was used for assessing Mrs. P.L. who holds the chronic illness of multiple sclerosis (MS).

Structural assessment

As stated in Wright and Leahey (2009), 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 (Appendix A). According to Butler (2008), by viewing at least three generation levels, genograms highlight the family in a broad manner, by showing the individual’s ages, gender, and deaths, for example.

Wright and Leahey (2009) 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. As stated in Weigel (2008), 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.

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. (article, knows what to do, understand what she has to do) living with MS

As stated in Wright & Leahey (2009), 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. In addition, she believes that her husband does not notice when she gets upset. She also admits that she does not find holding her emotions back lead to greater distress.

When it comes to circular communication, P.L. avoids conflict to refrain from confrontation. She refrains because she claims it helps her deal with the situation. As mentioned earlier, she has difficulty voicing her opinion and trouble vocalizing emotions which can be a difficult time for her when confronted. P.L. feels she will yell and get mad if she wants to voice her opinion and know that it does not help by yelling.

Her problem solving strategies include thinking and reflecting. She will think on what she feels and how she will say what she want to say. When conflict arises, she leaves someone else to problem solve and mentions that she has always been a good listener. When asked what her roles were in her family, she replied being a mother, teacher, listener, and friend.

When it comes to influence and power, she is asked what she feels her responsibilities are as a mother, grandmother, sister, and wife. She replies that her role as a mother was to teach her children to be individuals. As a grandmother, she felt she had a big influence on the grandchildren, and says that she had the same relationship with her grandkids as with her own children. As a sister, P.L. says that she is distant from many siblings, always felt like a loner and was bullied. As a wife, she tells us she has the same love for him than with anyone else.

What she believes since she has learned from being diagnosed with MS is that she was relieved; the doctors had put a label on it and they would take care of it, if something had to be done. The most helpful information she has found out about dealing with MS is looking in a medical book she owns, as well as the Internet and information sheets her daughter would print. She was happy that a name could be put on her condition so that she knew what it was that she was living with. In addition, she believes that her belief in God has helped her cope during difficult times and claims that God helps her do all the things she wants to do and gives her the opportunity to go about her day every day.

Lastly, she believes that her and her husband’s message went across to the children. If there are arguments between family members, P.L.’s husband would be more likely to help resolve the issue or attempt to intervene. When asked if she thinks she has any influence on how close or distant her family is, she says that their love holds them together, and that it is carried on through the generations. She also enjoys that her family is in Cornwall, and that her children have their own lives.

Rolland’s Conceptual Framework

As Rolland (1987) states, chronic illnesses can be categorized according to four key dimensions that have an impact on the family system: onset, course, outcome, and degree of incapacitation. It is important to understand Rolland’s conceptual framework in order to identify where the person with a chronic illness is precisely situated on the two-dimensional matrix