Assignment 4: Family Assessment: 50% of the Final Grade:
This clinical assignment focuses on the family system and all the subsystems that affect the family, how the family unit copes, and how the nurse can help the family maintain a state of equilibrium. In your text is an outline of the Calgary Model and how it helps in the interviewing and assessment of the family.
Using this model as a guideline choose a family you know to help you complete this assignment; these should not be your own family. Be sure the family is well in that they are not dealing with a newly diagnosed chronic or acute illness. Families with long-standing chronic illnesses, such as controlled hypertension or diabetes, are acceptable. Do not choose a family with acute problems including acute psychiatric illnesses.
Contact the family and explain the project you need to complete and if they are willing to participate. Set up a meeting time to speak with family members who would be most helpful with this project. Have questions prepared concerning all of the subsystems that affect families including ethnic backgrounds, working status of family members, education, etc. You may need to meet with the family more than once. Using the family assessment summary in your text, complete a family assessment.
This assessment must include content on all of the subsystems discussed in class this semester as well as a genogram, a list of family diagnoses including strengths and problems (stressors) related to each diagnoses. Students will need to summarize their project by explaining how the family members and the family unit cope with any problems that may arise; are they able to maintain a state of equilibrium or are they having difficulty maintaining a functional system? What could be done to improve or help with coping of the identified problems? Could some of the coping mechanisms of one family help another family if similar problems exist?Beyond the textbook, students should search for additional resources to help explain the subsystems of the families; for example, their response to illness may be based on cultural background or religious beliefs. Find resources to support this and explain fully.This project should have a minimum of 10 resources in addition to the course textbook.This project should be written in narrative format with appropriate headings to identify each required section. A Safe Assign folder will be available for its submission.=====================================================
Additional helpful informations.=========================Application of the CalgaryFamily Assessment andIntervention Models:Reflections on the ReciprocityBetween the Personal and theProfessionalMaureen Leahey, RN, PhD1,and Lorraine M. Wright, RN, PhD2AbstractMuch has been written about the global implementation of the Calgary FamilyAssessment and Intervention Models (CFAM/CFIM) and the application ofthese practice models in various clinical settings. The purpose of this articleis to provide a brief update on the background of CFAM/CFIM, and thecurrent applications of the models as evidenced in the English-languageliterature. Little has been written about the use of CFAM/CFIM in a personalcontext, however. As originators of the models, we offer our own narrativesand reflections about the reciprocity between the personal and professionalapplications of our models and the ways that our personal experienceshave extended our understanding about the utility of the models for clinicalpractice with families.KeywordsCalgary Family Assessment Model (CFAM), Calgary Family InterventionModel (CFIM), clinical models, personal application1Consultant, Private Practice2University of Calgary, Alberta, CanadaCorresponding Author:Maureen Leahey, Consultant, Private Practice, P.O. Box 303, Pugwash, Nova Scotia, CanadaB0K 1L0.Email: [email protected]/1074840716667972Journal of Family NursingLeahey and Wrightresearch-article2016Leahey and Wright 451When we considered what to present about the Calgary Family Assessmentand Interventions Models (CFAM/CFIM) at the 12th International FamilyNursing Conference (IFNC12) in Odense, Denmark, in August 2015, wethought about discussing how changes in nurse/family relationships, demographics,technology, cultural diversity, genomics, and postmodernism haveinfluenced these two practice models that we developed. However, wedecided such a presentation would not be “news of a difference” or add anynew dimension or expansion about our models. The majority of nursing professors,researchers, and/or practitioners attending the IFNC12 are likely wellaware of the impact of these issues on their practice and application of themodels. Instead, we chose to focus on where we situate ourselves in relationto the models we developed and offer a more personal view.Therefore, the purpose of this article is to provide a brief update on thebackground of CFAM/CFIM and current applications of the models as evidencedin the literature. In addition, we will address the reciprocity betweenour personal and professional application of our family assessment and interventionmodels.CFAM/CFIM: Review of the LiteratureTo our surprise and gratification, much has been written and presented aboutCFAM/CFIM since they first appeared in our family nursing textbook, Nurses& Families: A Guide to Family Assessment & Intervention (Wright & Leahey,1984, 1994). The assessment model, specifically CFAM, was included in thefirst edition in 1984 while the intervention model, CFIM, was not introduceduntil the second edition in 1994. The models have evolved and changed overthe six editions of our textbook and have reflected the shifts in family structure,development, and functioning over the last 30 years. With the increaseof family nursing worldwide, there has been a corresponding increase in theglobal use of CFAM/CFIM. To the best of our knowledge, the models havebeen translated into eight languages and adopted in educational curricula andintervention research in over 26 countries. The International Council ofNurses published a significant document titled “The Family Nurse” and recognizedCFAM as one of the four leading family assessment models in theworld (Schober & Affara, 2001). CFAM and CFIM continue to be adopted inundergraduate and graduate nursing curricula and by practicing nursesworldwide.In the family nursing literature, particularly the Journal of Family Nursing,there have been numerous publications discussing CFAM and CFIM. In2015, a bibliography was developed to identify any and all known Englishlanguagebooks, articles, and media productions which reference CFAM/452 Journal of Family Nursing 22(4)CFIM (www.familynursingresources.com/bibliography.htm). Of course,there may also be references to CFAM/CFIM that we are not familiar withinnon-English journals. Currently, there are six books, 54 conceptual articles,56 data-based research reports, two book reviews, two research instruments,eight media productions (DVDs), and 21 articles on pedagogy in family nursingthat identify and apply CFAM/CFIM (see https://www.familynursingresources.com/bibliography.htm).In considering how widespread the models have become, several questionsarise. First, what is the essence of these models? What differentiatesCFAM and CFIM from other practice models for family assessment andintervention within nursing? Our answer is that CFAM and CFIM haveemerged from our own actual clinical practice and the observation and supervisionof colleagues and nursing students. We refer to this as the clinicalscholarship of practice (Bell, 2003). The models have also benefitted fromknowledge exchange, the circularity of evidence-based practice and practicebasedevidence. To us, clinical practice has always been an intense experiencewhere we engage with families, learn about their illness beliefs andillness suffering, and what they find most helpful that enables and promotesfamily healing (practice-based evidence). Also, we have conducted practicebasedresearch examining live and videotaped family interviews to learnwhat it is that nurses actually do that softens illness suffering. We also offerfamilies ideas and interventions gleaned from others’ research with families(evidence-based practice) and note whether these are useful in particular situations.We find the circular process between evidence-based practice andpractice-based evidence intriguing and enhancing.Why is it important that our clinical models have evolved from actualpractice with families? It is significant because these models link theory topractice in an easy to understand manner. Over the years, colleagues andlearners have offered us feedback that the models are straightforward, comprehensible,and easy to apply. The new International Family NursingAssociation (IFNA; 2015) Position Statement on Generalist Family NursingPractice lists many skills that are useful and helpful aspirations for learners.However, lists of skills and competencies often fly out the window when anurse is in an actual clinical situation with a live family. When nurses possessa thorough grounding in conceptual practice models, they can then practicethese competencies and skills more easily to assist families. They can progressfrom lip service to actual practice. As Benner (2001) argues, practice is away of knowing; it is situated knowledge use.
A third question arising from a perusal of the existing CFAM/CFIM literaturepertains to popularity. What is the most popular aspect of CFAM andCFIM that is applied in practice settings? It has been the 15-Minute FamilyLeahey and Wright 453 Interview (Wright & Leahey, 1999, 2013) that integrates and distills the most important aspects of both clinical models.
ical settings (Bell, 2012). It fitsnurses’ practice in a variety of contexts. The majority of nursing students andeven some practicing nurses comment that they have never seen a familyinterview. Therefore, they often feel anxious about meeting with a family andsometimes will mask their apprehensions by commenting that they do nothave enough time to involve families in their nursing practice. But once practicingnurses embrace the belief that “illness is a family affair,” realize theycan make a profound difference to softening suffering in just 15 min or less,and have observed actual family interviews, they challenge their constrainingbelief of not having enough time. One of the most fascinating outcomes ofnurses involving families in their practice is that they report increased jobsatisfaction (Sigurdadottir, Svavarsdottir, & Juliusdottir, 2015).Opportunities to observe actual demonstration family interviews eitherlive or on DVDs enable learners to increase their confidence and competenceabout conducting actual family meetings. Our DVD titled “How to Conducta 15-Minute Family Interview” (Wright & Leahey, 2000) has been the mostsought after of our eight educational programs applying CFAM/CFIM(Wright & Leahey, 2000, 2001, 2002, 2003, 2006, 2010a, 2010b, 2010c).Another very interesting observation is that of all the ideas utilized in CFAM,the two assessment tools, genogram and ecomap, have been the most frequentlyintegrated into actual everyday clinical practice. The mo
st utilizedfamily nursing interventions from CFIM have been the offering of commendationsand the asking of particular kinds of therapeutic questions.Reflections on the Reciprocity Between thePersonal and the ProfessionalCFAM: Family Life Cycle StageBoth of us are now experiencing the Senior Family Life Cycle Stage. Thetasks for families in later life are typically described as dealing with one’sown and couple functioning in the face of physiological decline, exploringnew familial and social role opportunities, making room for the wisdom andexperience of seniors, and dealing with loss and change. Prior to entering thisfamily life cycle stage ourselves, we had concentrated on the loss aspect versusthe opportunity aspect of this stage. Perhaps this is because neither of ushave grandchildren and because our clinical work focused on people presentingwith health problems. Now, we are focusing more on the positive aspectsof this stage of life, that is, new familial and social role opportunities.454 Journal of Family Nursing 22(4)In describing our lives at this stage, we tend to use the word “preferment”instead of retirement. The term “preferment” was coined by David Epston andadopted by Lorraine Wright to focus on the choice aspect of retirement. Asatisfying and fulfilling “preferment” is doing what you prefer, when you prefer,with the people that you most prefer to be with. Our experience is congruentwith the research that identifies preferment/retirement as a process andinvolves transitioning to a new identity often encompassing new roles, interests,and even social networks. It is not like jumping off a diving board; ittakes time and can be self-empowering, self-reinventing, and self-reflective.Application of CFAM/CFIM: Clinical Situation InfluencingPersonal LifeLorraine offers a reflection on how a clinical situation influenced her personallife for the better.LMW. I was working with an elderly couple in my clinical practice; they hadre-married in their late 70s following the deaths of their spouses. They relatedthat their children were not supportive of them marrying and did not want themother/wife to have to care for the new husband as he was already experiencinghealth issues. But the couple said that they were not worried about theirhealth problems, money issues, or how many more years they might live.Instead they were focusing on how wonderful it was to once again have companionship,share daily trivia, and enjoy mutual activities with a new spouse.Plus they had an interesting belief that their lives had been extended becausetheir paths had crossed in life. This couple were an excellent example of howsocial support invites well-being. The usual focus on loss at this family lifecycle stage was replaced with focusing on their time together and not necessarilyreminiscing or longing for what was.When I met this couple, my own father had recently re-married at 80 yearsof age, and I admit that I was still adjusting to his re-marriage. My father hadbeen very lonely for 3 years following the passing of my mother. So I waspleased that his days of loneliness were over but I still found it difficult towitness my father with a woman who was not my mother. But listening to thisclinical couple helped me to refocus on the benefits of later life re-marriagesrather than simply focusing on what I call my own somewhat naïve andimmature understanding of later life marriages. I too came to adopt the facilitatingbelief that this union would extend my father’s life and indeed it did foranother 12 years before his passing in January 2014, despite him havingchronic health problems. This couple helped me immensely in my personallife as I challenged some of my own constraining beliefs, an area discussed inLeahey and Wright 455CFAM. By using interventions from CFIM such as adopting more facilitatingbeliefs about my father’s new marriage and observing the benefits of later lifemarriages, I more maturely adjusted, supported, and commended his newmarriage.Application of CFAM/CFIM: Personal Situation InfluencingClinical PracticeMaureen offers a reflection of how a personal situation increased her compassionin her clinical practice.ML. My husband and I have been married for 45 years. In 2011, we had asignificant life event! We chose to retire and move from Calgary in WesternCanada to Pugwash, Nova Scotia, in Eastern Canada. This involved movingabout 3,000 miles from a city where we had lived for 40 years and that had apopulation of more than 1 million to a village, my husband’s village of hischildhood, of about 830 souls. This includes Pugwash Junction, PugwashRiver, Pugwash Point, South Pugwash, West Pugwash, and Downtownproper! I resigned from the hospital health service where I had worked managing38 people and teaching and supervising interdisciplinary students andvarious health professionals. I stopped my private practice in marriage andfamily therapy.I wanted a new life. We had designed a modern minimalist home by theocean, and I was ready for change. Change we got! We entered into our newcommunity, reconnected with family members, made new acquaintances,began volunteering, started traveling, and enjoyed new experiences. Butthen, little by little, after spending so much time together, our relationshipstarted to become challenging for me. My husband had not changed. Perhapswhen I was employed, I either had not noticed or dwelt upon things that werenow concerning me.After several “marital conversations” about how things were between us,I finally decided to go back to basics. I looked at CFAM and CFIM, did afamily assessment (through my own biased lens!), and devised an interventionplan. Naturally, as a good wife, I initially looked more at my husband’sfailings than my own! I listed his negative behaviors I did not like. Then, Istarted listing all the positive things about him. I thought about us fromCFAM’s structural, developmental, and functioning perspective and tried toenumerate strengths.Figuring out an intervention plan proved to be a bit more challenging. Inconsidering CFIM, I noticed that I had been using and reusing the same old456 Journal of Family Nursing 22(4)strategies to try to make things better. Time for a change! I tried several newstrategies such as humor, ignoring the negative, praising the positive, acknowledginghis point of view before stating my own point of view, and so forth.Now I am not a very patient person, so I started to look at that trait withinmyself. I tried to get myself to slow down, do one thing at a time. For example,instead of watching the news on television and looking at my iPad, I tried tojust do one thing or the other. I found I tended to walk fast in the house, intenton getting things done so I slowed my pace. I found these interventions helped.I interrupted less often. I focused more on what people were actually saying.These personal changes had a tremendous positive effect on our relationship.I began to talk more slowly to my husband, to whisper when I wantedto get him to look up from his iPhone. I practiced a softened start-up to aconversation instead of launching into something. CFAM and CFIM helpedme and us to become more compassionate. The models actually worked!Things improved significantly. Influenced by my personal experiences, myclinical work changed for the better. I became more patient, listened moreintently to clients, entertained more ideas for interventions, and expanded mycapacity for compassion.Reflections on Expanding and Extending CFAM/CFIM PracticeHaving reflected on our own reciprocal professional and personal experiencesutilizing CFAM/CFIM over many years, we have wondered how ourexperiences have extended our understanding about the relationships betweenfamilies, health, illness, and health care workers to transform practice withfamilies. We have addressed these clinical dilemmas by increasing our competent,curious, and compassionate care of families. Also, we seek more regularand ritualized feedback about whether our work is helping to soften illnesssuffering and promote family healing. Some changes in our own practiceevolution have included a greater appreciation of the patients/family/clientreflections on what has been useful for their particular situation. Reflectivepractice has been extremely useful for us, and we believe it is helpful forclients as well.In our own clinical practice, we try to obtain an early idea of what the client/familydesires from our meetings, their possible constraining illnessbeliefs, and their preferred future in managing their health concerns. We havemoved away from tasks, homework, and similar nurse-initiated interventions.We tend to focus more on discovering and building on the patient/family’sideas and resources for how to manage and/or soften their illnessLeahey and Wright 457suffering. This shifts the conversation from information gathering toward cocreatedconversations. We believe that nurse-family relationships are actualizedin therapeutic conversations. We continue to include genograms,ecomaps, and therapeutic questions not only as useful assessment tools andinterventions but also as conversation expanders, such as encouragement,elaboration, description, impact, and so forth.Although the intervention of commendations within CFIM was always animportant intervention, current brain science has helped us realize even morethe significance of focusing on the positive with regard to family functioningand family strengths to enable sustained change in brain functioning whenexperiencing a serious illness (Wright, 2015 a). Our goal is to help the client/patient/family build a description of their preferred future that will soften suffering.Paradoxically, assisting clients/families to express their preferredfuture often means family members moving to accept “what is” in the presentmoment, even with an experience of serious illness, rather than focusing onthe past or future (Wright, 2015b). Another useful expansion of our practice isthe awareness that struggling with the experience of an illness, that is, strugglingwith “what is,” tends to invite more suffering. Consequently, we are alsoless focused on explanation and technique. We engage with the client equably(but not equally) as joint partners in a relationship to enable healing.In exploring where we situate ourselves now in relation to CFAM andCFIM after the models have been used for over 30 years, we have found ithelpful to ask ourselves additional questions. How have I changed my practiceusing CFAM and CFIM over the last 10, 20 years? How have I changedmyself? Over the last 5 years? 1 year? How have I increased my clinicalimagination? How have I increased opportunities for compassionateconnections?We are pleased to be part of this ongoing exploration.Authors’ NoteThis article is an adaptation of a podium presentation offered at the 12th InternationalFamily Nursing Conference, Odense, Denmark, August 2015.Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research,authorship, and/or publication of this articleFundingThe authors received no financial support for the research, authorship, and/or publicationof this article.