APPENDIX TABLE OF CONTENTS
- THE FAMILY IN QUESTION
- MAJOR HEALTH ISSUE EXPERIENCED BY THE FAMILY
- FAMILY STRUCTURE AND FUNCTION
- STRUCTURAL ASSESSMENT
- DEVELOPMENTAL ASSESSMENT
- FUNCTIONAL ASSESSMENT
- FAMILY STRENGTHS
- FAMILY STRATEGIES
- SUPPORT SYSTEMS
- NURSING INTERVENTIONS
- REFLECTION & CONCLUSION
- NOTES
- A GENOGRAM OF THE FAMILY
- AN ECOMAP OF THE FAMILY
Family Health Assessment
1. THE FAMILY IN QUESTION.
Mohammed and Nora are from northern Saudi Arabia. They arrived in Brisbane with their children on November 15, 2005. They’ve been married for 15 years and have two children, Maram, 11, and Sami, 4. Mohammed is a 34-year-old lecturer at Health College and is currently pursuing his post-graduate thesis at the University of Technology in Queensland. Nora is a housewife, aged 27. Mohammed’s mother is a divorcee, and his father in Aldyer, Saudi Arabia, has three wives. Nora has a good relationship.
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2. MAJOR HEALTH ISSUE EXPERIENCED BY THE FAMILY.
As stated above, Sami has chronic bronchial asthma, which was discovered at birth. Mohammed used to suffer from asthma; however, it disappeared many years ago. Besides following their family doctor’s orders in Saudi Arabia, the parents were treating their child with a well-known type of herb, called Magar in Arabic, which is believed to improve asthma. When they traveled to Australia, they had to change their doctor and stop using traditional treatment. Sami’s case intensified when they arrived in Australia, which worried his parents very much. However, their doctor told them that this was a result of the change in the environment. He advised them to live in a house without trees around, which were found to increase the severity of Sami’s asthma During the winter they also took great care of their child, when he gets more affected.. Therefore, they handle smells and odors, such as perfumes with caution.
Assesses of Sami will improve as he grows older.
3. FAMILY STRUCTURE AND FUNCTION.
The best form in which the family should be assessed, according to Wright and Leahey (2005), is to use the Calgary Family Evaluation Model (CFAM). The CFAM categorizes the assessment of the family into three main parts, namely systemic, developmental and functional assessments, each of which is discussed separately below..
i. STRUCTURAL ASSESSMENT.
The sections below describe the sub-dimensions of internal structure, external structure and meaning (Wright & Leahey, 2005)..
Internal Structure:
The internal framework includes the categories of family composition, the gender of the persons in the family, the sexual orientations of the parents, the rank hierarchy, the sub-systems of the family and the family members ‘ personal boundaries..
Family Composition. Mohammed’s family is a nuclear family consisting of the father, the mother, and two offspring. They are married under Shari’a or Islamic law.
They still keep in contact with their respective families. When they were in Saudi Arabia, Mohammed’s parents were living in the same house as his family.
Gender. The fact that Mohammed is a man and Nora is a woman can place the partners at odds, and this could cause stress, not to mention the fact that they have to care for Sami—who is sick—according to Wright and Leahey (2005, pp. 63).
However, this family has a good organization of care for its ill child. Mohammed’s role is to ensure that Sami takes all of his required medication and that his medical needs are provided for. Also, he helps his wife in caring for the child within the home.
Nora is usually watching Sami closely to make sure that if there are any immediate changes to his health, he can be taken in to be seen immediately by a medical professional.
Since Mohammed and Norah share the same cultural and religious values and traditions, it puts less stress on their relationship as a couple.
Sexual Orientation. Mohammed and Nora both have a healthy, loving, committed heterosexual relationship within the boundaries of marriage.
Rank Order. Nora has never had a miscarriage or an abortion. Mohammed and Nora have two offspring. Maram, who is 11, is the first child in the family, and she does not have any health problems. The second is Sami, the 4-year-old son. He has chronic asthma, which means that he receives more attention from his parents in addition to the attention he receives for being the youngest. In this regard, Mohammed and Nora are quite loving and understanding parents. They are united in their quest to ensure Sami’s well-being. Although the age difference between the children is about four years, they have a close relationship.
Sub-systems. As is the case in the majority of Arab families, this family has its different subgroups. For example, women do certain things, while men do other things. In Mohammed’s family, there are several subsets of people.
While Mohammed is male, the husband, and fulfilling a parental role, Nora is the female, the wife, and also performing a parental task. Maram is classified as a sibling. However, she is also a female and a child. Sami is classified as being a sibling, yet he is also a male and a child. The entire family operates well within each of these groups, and they all have excellent communication between themselves. The parents share the workload about how they take care of the household and in the division of child-rearing responsibilities. In some ways, Mohammed is more responsible for supporting the family, while Nora’s realm of expertise lies in making sure the household runs smoothly.
Boundaries. Every member of the family has excellent personal limitations, and they all feel relatively comfortable with each other. The parents cooperate well in their roles and functions. They also discuss the various challenges and developments facing their family. More attention is given to the children’s issues, particularly that of Sami’s health condition and the prognosis of his disease. Maram also has a role in caring for Sami. Sometimes, she takes on adult responsibilities. For example, she shares her parents in caring for Sami and gives him medication (from the puffer) under the supervision of the parents. Therefore, they do not have sharply delineated physical boundaries.
External structure:
Family Structure. Although the family now lives in Brisbane, they keep in contact with their extended family in Saudi Arabia through telephone and e-mail communications.
Nora contacts her parents by phone almost once per week. Nora calls her sister practically always. Mohammed has a great relationship with his mother, especially, although he generally maintains good relations with his entire family. He contacts them by phone almost twice per week. Also, he reaches his brothers and friends through e-mail. The family wants to visit Saudi Arabia sometime soon, perhaps within the next year. The extended family is available if Mohammed’s family needs help.
Larger Systems. More extensive systems include the public health care system, the extended family network, and other governmental organizations or agencies that could assist in the family’s support system. Several agency professionals are involved with the family. The local healthcare center doctor and Maram’s teacher in the Islamic school in Brisbane are good examples. They regularly interact with the family. About Sami’s health, Mohammed’s family has regularly-scheduled visits to the physician for the sake of Sami. As stated earlier, the family has moved from Saudi to the Australian healthcare system; therefore, they had to change their family doctor. Initially, they found it mostly different from the previous system; however, they have become accustomed to using it.
Context:
Ethnicity. Ethnicity plays a significant role in interrelation dynamics within the family, not only how the family works and plays together but verbalizes emotions. This fact of ethnicity must be taken into consideration by the health care practitioner. Since their new country’s health care practices differ from those in Mohammed and Nora’s native country, the way medications are prescribed entirely distinct. This may affect how Mohammed and Nora cope with Sami’s condition while living in Australia.
According to Sami’s mother, living in Australia has influenced her beliefs about when to consult with health professionals. In Saudi Arabia, it was usual to take the child once or twice per week to the hospital to receive treatment. This is different from what they had experienced before coming to their new country, as Mohammed and Nora used only to take Sami to the doctor when he was sick.
However, the medical practices of Australia (where the family lives now) dictate that Sami should come in to get regular check-ups even when he is not sick, so his condition can be closely monitored.
They give him medication at home based on a precise treatment plan.
Race. It is paramount for the values of a family to be taken into consideration by the health care worker (Wright & Leahey, 2005). Both Mohammed and Nora are of the same racial and cultural background (they are both Arab). Notwithstanding, as a result, they share the same cultural attitudes as well as language.
Social Class. Mohammed and Nora are both from Saudi Arabia, which has particular peccadilloes about beliefs and living situations. Both partners are from an upper-middle-class social status. The family receives a monthly stipend from the Saudi Cultural Mission in Australia (SCMA). Also, the SCMA pays the tuition fees for Mohammed’s study and Maram and pays for their health insurance. As such, Mohammed’s family is economically stable and financially secure.
Religion and Spirituality. The doctrine of this family is Islam, which is recognized as the main factor shaping the culture and way of life among its adherents. Everyone in the family (save Sami) says prayers. Prayers are answered five times a day. The prayers are from the Qur’an (the holy book of Islam). Based on Islamic directions, they do not drink alcohol or eat pork. In addition to the medical treatment, they believe in prayer as a method to relieve the intensity of their child’s illness.
Environment. Mohammed, Nora, and the children have good relationships with their neighbors.
Mohammed has his method of transportation, which is a vehicle. Occasionally Nora will utilize public transit (i.e., taking the bus) when Mohammed is indisposed. The family had no situation that they had to get to The bus stop in front of the house.take Sami to the hospital using a taxi, bus, or even an ambulance..
ii. DEVELOPMENTAL ASSESSMENT.
This family is in the stage of “Families with Young Children,” which is the third stage. During this stage, the adults are caregivers to a younger generation. The parents have to take all responsibilities and respond to the demands of their children. According to Wright and Leahey (2005), this stage consists of three family tasks, which include: creating space for their offspring, helping each other with chores; and adjusting relationships with other members of the family to include traditional roles. The family is comfortable and compatible with all these tasks. The parents have their personal needs met as well as being able to fulfill their parental obligations. They involve their children in the family. Both Mohammed and Nora have excellent relations with their respective extended families. They also balance the housework and their relationships exceptionally well. Although Sami is sometimes sick, both parents are capable of managing his condition and illness well.
iii. FUNCTIONAL ASSESSMENT.
The functional assessment deals with how the clients interact with each other daily (Wright & Leahey, 2005).
Instrumental:
Daily Life Activities. This is a snapshot of what Mohammed’s family life is like daily. First, the family usually says the proper orations and makes the proper ablutions in the morning. Then, they eat breakfast. The father then goes to the university by car, while Maram goes to school by bus. In the evenings, the father and Maram return home. The family usually celebrates the end of the day by having dinner together. If they are lucky, they will watch a film, play a board game, or do some other activity. At bedtime, either Nora or Mohammed gives the puffer to Sami.
Expressive:
Emotional communication the family has an excellent emotional connection.
The members of the family are straightforward in that they will share their feelings about any circumstance, including occasions that are not particularly happy ones. Everyone listens to the concerns of others. Nora looks at Mohammed’s stressors regarding his study. He, in turn, listens to his wife and pays much intention to any hardships she faces.
They also try to articulate their feelings for each other and, in general, maintain a positive outlook on life. It could be argued that this family is an ideal one, as its members understand and respect each other.
Verbal communication. Both parents communicate effectively with each other and with their children. The brightest and direct member when communicating verbally is Mohammed. Parents prefer to have one-on-one contact with people. However, they do not mind receiving phone calls or e-mail messages—non-verbal communication. Non-verbal communication is an element of communication that occurs in frequency under the culture of the communicator. As a nurse, I was aware of this when interacting with Mohammed’s family. The most distressed member of the family when talking about Sami is his mother.
The family does not have any problems with circular communication, which occurs when neither side can get their point across because each is arguing circularly.
For example, when Nora becomes angry about the absence of Mohammed at the university for a long time, she starts to criticize him. Mohammed avoids conflict by leaving home for a few hours. After Mohammed returns, Nora and Mohammed will discuss the situation in a relaxed atmosphere.
Problem-solving. The relationship between the parents affects how they deal with their child’s illness. If one of the parents recognizes changes in Sami’s health, he or she tells the other immediately, and they take Sami to the doctor. In case Sami were to have an attack, both parents know how to react to the situation quickly. Nora is usually the first to notice any change in Sami’s condition because she spends the majority of her time with him.
About each partner’s commitment to taking care of Sami, both parents take care of the sick child; however, Nora takes the dominant role since Mohammed is busy with his studies. She is most cases gives Sami his medication and creates a healthy environment for him.
Influence and Power. Nora is better than Mohammed or Maram at getting Sami to take his medications.
Beliefs. The family is Muslim. Mohammed and Nora pray to God (in Muslim, God’s name is Allah) for Sami’s health.
They believe that Sami’s being sick is a challenge to their faith. Besides this, they believe in the traditional treatment, which they have stopped since arriving in Brisbane. Both of the parents also believe in the importance of Western medical treatments.
Alliances and Coalitions. Although the children have a good relationship with each other, in many cases, Sami will most likely come along and start fighting with Maram. The girl always tries to avoid competing with Sami because of his asthma. Nora is the most likely person to get in the middle of the fight. However, in some cases, Mohammed stops them from fighting. In terms of the parents, they have a good relationship with each other as well as maintain a good relationship with the people they know. For example, they can ask questions and communicate with their doctor at any time.
4. FAMILY STRENGTHS.
Generally, the family gets along well.
Cooperation among the family members in caring for Sami is critical.
A deep understanding of the child’s condition is essential.
The family is continually educating itself about asthma and asthma-related research and new information about the disease.
The family has a good relationship with other people and parties.
Relations with the extended family are more than adequate in nature and positive.
The members of Mohammed’s family are comfortable in their current environment.
5. FAMILY STRATEGIES.
It is essential that Sami’s family follow the family physician’s instructions to the letter. They pay great attention to Sami’s appointments for health assessment. Regarding the home environment, they keep the house clean and empty of strong sprays, perfumes, and smoke, etc. In addition to administering Sami’s medication on time, Sami’s parents also ensure that the floors are clean and that he is not exposed to pets of any kind at any time.
These changes have an impact on the family function, as they are additional loads on the family. However, thanks to their cooperation, they manage these changes well.
i. SUPPORT SYSTEMS.
The family’s support systems are family physicians. The close families in Brisbane also provide significant support to this family. They understand Sami’s condition and his parents’ concerns, so they provide them with a favorable atmosphere when they come to visit.
ii. NURSING INTERVENTIONS.
Mohammed and Nora have been adequately briefed about Sami’s condition and the protocol necessary to ensure his continued health.
Additionally, the parents have been provided with the option to attend events that would help assist the family to live healthily, notwithstanding their son Sami. They keep in contact with the family and provide them with the required advice and follow-ups. They document any changes in Sami’s condition and inform his doctor when they arise.
iii. REFLECTION AND CONCLUSION.
As a student who evaluated this family, knowing and connecting with Mohammed and his family was an invaluable experience.
Hoping to become a nurse within my local environs, this has been a great module to gain more experience working with the community. New theoretical frameworks have been introduced to me, as well as new methods of working with families such as these, which come from differing ethnic backgrounds.
Family nursing is a subject that can be approached in a variety of ways. It is now apparent to this author that intercultural awareness can serve as a useful tool in dealing with people from all kinds of different backgrounds, working in the health care environment. Any treatment plan should consider these essential aspects.
6. NOTES.
9/10/09—Family profile. The father, Mohammed, is 34 years old.
The mother, Nora, is 27 years old.
The daughter, Maram, is 11 years old. The son, Sami, is four years old.
9/12/09—Health issue Sami has chronic bronchial asthma, which was diagnosed at birth.
9/14/09—Nora maintains a good relationship with her extended family.
About her older sister, Nora maintains an excellent relationship. She always talks about Sami’s condition and her life in Australia. Mohammed has a secure connection with his family. In general, Mohammed’s family is very close.
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7. A GENOGRAM OF THE FAMILY
The line with two slashes through it means “divorced.”
A box signifies a male, and a circle means a female.
A box with a house in the middle of it signifies the two people are cohabiting.
8. AN ECOMAP OF THE FAMILY
