The Calgary Family Assessment Model, Research Paper Example

Abstract

Family assessment in modern nursing practice can be challenging if the correct approaches are not undertaken. Theoretically, there are a number of models informing this intervention depending of the convictions in schools of thought. In this assessment the Calgary model will be applied and scrutinized for it efficacy in arriving at favorable diagnoses.

Nursing: Family Assessment using the Calgary Family Assessment Model (CFAM)

Introduction

In the following pages of this document the writer will conduct interviews with a family, which has experienced obvious changes in structural, developmental and functional patterns.  The rationale for referral; a diagrammatic description of the family’s composition in the form of a genogram; pertinent history; assessment of strengths / problems and finally a summary of interviews will be discussed.

The family interviewed has initials JM-husband /father; TM-Mother /wife; OM- Daughter-First child; JM (Jr) – 1st Son; MM -2nd Son and WM last child 2nd daughter. They reside in an urban community with fairly stabled social conditions. It is a three bedroom family dwelling house with two bathrooms.

Janice Wright and Maureen Leakey’s (1994) Calgary Family Assessment Model (CFAM) was applied in obtaining data for this family assessment. Strategies embodied in this model allow the nurse to practice assessment and intervention by addressing the family from a more professional perspective.  Precisely, guidelines given in the model embrace a framework that emphasizes structural, developmental, and functional aspects of nursing care and is based upon a theoretical premise that inculcates systems, cybernetics, communication, and change theory adapted from wider concepts integrating ‘postmodernism, feminism, and biology of cognition’ (Wright & Leahey, 2000). Consequently, as these similar systems are incorporated into this model the family is perceived as an individual system related to these other systems surrounding it. Importantly, the advantage of this model is its uniqueness of allowing practitioners to apply a number of theories to facilitate the assessment process. Therefore, in this family assessment procedure the systems/change theory; functionalism; and the resilience method would be applied in utilization of this model (Wright & Leahey, 2000).

Rationale for referral 

The rationale for referral embodied a series of functional issues within the family structure.  JM and TM were married for 19 years becoming intimate at high school. With strong parental values their parents insisted on marriage since it was the right thing to do from a religious perspective. However, it was discovered that there were episodes of unfaithfulness within the marriage.

Structure and Rewards System

TM constantly blurted out that it makes no sense since she feels burdened raising her family almost alone. Five years into the marriage she found out that JM had four children with three women and two of them had taken him to court for child support. As such, economically, she had to carry the financial weight of her family because a part of JM’s income goes towards this venture of supporting three children outside of the home.

Communication patterns

Even though respect for JM is obvious in his role of father and husband respectively, the children tend to lean towards TM for moral support and she the same. There is a bound between mother and children. Reports are that many times in the home conversations were dominated by children or mother and JM was actually excluded or simply voiced no opinion.

Resiliency Risk Factors

JM appears to be at risk of isolation within the family structure. Other members of the household likewise seem alienated from father and husband, respectively. Also, forgiveness issues are evident among head of the household and other family members.

Family composition/genogram 

Family attachment diagram

Pertinent history

JM is a 42 year old Bus operator for the county bus service and works beyond an 8 hour shift many days.TM is a 38 year old registered nurse at a private hospital enterprise within the country. OM- 18 is about to graduate high school moving into college; JM (Jr) -16 and MM -15 are also in high school, but will graduate later. WM is 10 years old and is in elementary school.

From the structure model it is exclusively a nuclear family. Socially, JM and TM admit that with the economic downturn even though they both have substantial salaries, adjustments in spending towards recreational activities had to be made since making mortgage payments; repaying car loans and  providing for school aged children at school took priority.TM and the children attend church regularly while JM is an agnostic.

Both JM and TM were raised in extended families with siblings, both parents and grandparents residing in the same household. The family socio-economic disposition could be considered middle class since JM‘s parents worked outside the home and lived relatively comfortable lifestyle; providing the above basic necessities of life for their children.

TM’s parents were extremely religious Pentecostals, prophesying and speaking in tongues very often. Alternatively, JM was raised in a sedate Catholic tradition environment and did not frequent church ceremonies as his wife’s TM family. Also, TM’s 62 and 62 year old parents displayed a family health history of diabetes and hypertension. JM’s parents were healthy and doing extremely well for their ages of 65 and 66, respectively.

Strengths & problems

Structural

Structurally, this family can be considered strong from the perspective of them being together in the same household. When taken in the context of Calgary model whereby family functions as an integral part of other systems within the society, it is still structurally consolidated.

However, the problem lays in internal communication and integration behind the structure, home. As such, a communication problem between father /wife and father /children must be resolved. This can be approached from a nursing intervention perspective or social worker referral strategy.

Developmental

Developmental issues are very obvious as it pertains to maintenance of that nuclear family structure; restoration of communication and TM carrying the economic burden of her family while JM continues his extra-marital affairs. Depression can occur in JM from being an isolated object in home and TM can also be predisposed to psychotic manifestations due to stressful relationship.

Functional

In applying functionalism along with systems/ change theories to Calgary model, it is evident that this family is functional as a subset of a wider structure, being integrated in the whole. Systems theory in itself is considerably useful as an interdisciplinary approach towards research, assessment, diagnoses, implementation and evaluation. Precisely, it brings together sociology; psychology, public health, nursing process as well as philosophical assumptions that are beneficial when the holistic concept is attempted (Buckley,1967).

Sociologically, the unit exists as part of family structure type in the society, supportive of each other. Psychologically, members feel secured to operate within that structure, mother, father children depend on each other emotionally. From a public health point of view there may be dysfunctional functions that can initiate emotional domestic violence. Nursing process intervention would be to assess, diagnose; implement and evaluate from a philosophical index.

Summary of the Interview  

According to Van Hook (2008), interview is the most essential aspect of family assessment in the context of nurse practitioners because it is a scientific guide towards exploring risk and protective factors within the family structure and communication models. It encompasses asking key questions; allowing family members to enact roles that offer clues in validating assumptions; observation of nonverbal expressions while integrating a verbal conversation within nonverbal observation (Van Hook, 2008).

When combining these principles espoused by resilience method with the Calgary assessment model to the interview of JM’s family it did relieve my fears of asking too many sensitive questions, which requiring responses when all family members were present. Instead the non-verbal expressions from subtle cues offered enough information to make an assumption thereby creating a diagnosis.

Also, through this application it became possible to access information which may not have been delivered verbally. For example, had questions such as, ‘how is the relationship with your husband,’ or ‘are you happy with your family,’ been asked; the obvious answers might have been ‘good/ bad;’ ‘yes/ no’ respectively. ’ Thus, when using resilience strategies in perceiving risks and protective factors, a number of other content surfaced.

Therefore, the rationale for integrating content and process as well as linear and circular questioning demonstrate the impact of resilience method in family interviews. It provides the framework for deductions regarding social control measures exerted within the structure by parents and dominant children characters (Van-Hook, 2008). Conclusively, allowing family members to engage in a series of linear and circular questioning, much tension was removed from finger pointing individuals creating problems. Precisely, a collaborated responsibility approach for risks identified was brought to the limelight.

Techniques relevant to the resilience method were used during this interview. They included gaining the family’s confidence and cooperation. Specifically, it entailed a family group discussion on an issue of interest to every family member.

As the visiting nurse my responsibility was to moderate the discussion. This was conducted in the family’s home at a time most convenient to them. Content and process; linear and circular questioning; generous listening without interruption at intervals and offering nonverbal cues were integral portions of technique applied.

Conclusion

From this interview with JM’s family,  applying the Calgary model of assessment as well as theoretical  perspectives derived from functionalisms, systems theory  and the resilience method; many conclusions can be made as well as recommendations tendered. One conclusion which can be very useful towards enhancing integration among father and rest of family members is that both JM and TM should seek professional counseling if they want to save the marriage.

Jacob Appel (2009), a Bioethicist and medical historian captioned an article in the 13th December, 2011 Huff Post Politics Internet Newspaper, first posted, October 2009; headline, ‘Hate the Husband? Sue the Mistress!’ This was his attempt at feeding the public updates concerning former Mississippi Congressman’s affair with his college sweetheart and the reactions of his wife by suing her husband’s mistress under a somewhat antiquated law of, “alienation of affection” (Appel, 2009). Incidentally, this former congressman was an ardent Christian.

In applying this scenario to JM’s family, predictions are that the marriage could continue until children are grown and leave the home. After this it depends on whether there is a relationship worth keeping between JM and TM. Pertinent questions to be addressed are whether the relationship between JM and TM transcends their children and what will be left of it after children leave the home; or would TM be bold enough to take her mistresses to court and remain married. More importantly, could she seek to end the marriage and have JM pay child support for her four children too? These are the possible outcomes facing the marriage and family.

References

Appel Jacob (2009). Hate the Husband? Sue the Mistress! Huff Post Politics Internet News Paper (October, 2009).

Buckley, W. (1967). Sociology and Modern Systems Theory. New Jersey: Englewood Cliffs.

Van-Hook Patricia. (2008).Social Work Practice with Families: A Resiliency-Based Approach. New York: Lyceum Books.

Wright, L.M., & Leahey, M. (2009). Nurses and families: A guide to family assessment and intervention (5th ed.). Philadelphia: F.A. Davis.