Today, the professional capabilities of nurses working with families always impact profoundly on the success of the management measures undertaken. It is necessary, however, for the family to participate in this care. The nurse needs to encourage families to continue being a part of the provision of health services (Wright & Leahey, 2005). Family nursing focuses on the family in conceptual, holistic and systematic terms (Friedman, Bowden & Jones, 2003). This means that the family should be focused on as a complete system and not as a separate assessment of each person (Lindgren, 2007). It is possible for numerous tools to be applied, although the Calgary family assessment Model (cfam) remains by far the most widely used global-based tool for nurses who are exploring various aspects of the lives of various families (Anderson,2000).

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This paper is an assessment document that describes the composition of a Saudi family that is presently living in Australia. The assessment document will present the major issues that the family is facing. Thirdly, structural, functional, and developmental aspects of the assessment will be presented on the basis of the Calgary family assessment Model (cfam). Fourthly, the paper will address the strengths, strategies as well as the support system that the family uses in order to overcome the health issues that they are facing. Lastly, the paper will dwell on a reflection on my experiences and the lessons I learned after working with this family.

Description of the family:

Ibrahim and Hossa are a couple aged 31 and 27 respectively. Together, they have 2-year old baby-boy named Hossam Ibrahim who has five siblings (three sons and two daughters). Ibrahim is pursuing a Ph.D. in information systems at Griffith University. He is also a part-time taxi driver, a job he starts at 6:30 pm to 8.30 am twice every week.

Hossa finished her primary school three years ago. Presently, she is studying English at TAFE Institute. She has three siblings: one sister and two brothers. She is planning of continuing her studies next year at Central Queensland University. Hossam has been having Bronchial Asthma since birth. He goes to a child care every day at 8 pm and comes back at 5 pm. His mother says that he received vaccination doses up to the time when he was aged two. Hossam’s family relocated to Australia in 2004, since his father wanted to finish his higher studies at the Australian university.

Major health issue and changes being experienced in the family

The family has been experiencing significant causes of stress, particularly since Hossam’s birth, mainly because he was diagnosed with Bronchial Asthma. This is a chronic, hereditary disorder of the airways, whereby many cells and cellular elements have a critical role to play. After being diagnosed with this disease, his parents feared that he would die. They would become extremely frightened whenever they heard his chest sound.

The family believed that the smell of perfume could have an effect on the child’s breathing, so they stopped using it. Hossam’s health problem also complicates the stress condition of the parents, who do not know what will happen to their child in the future. They are afraid that the steroidal treatments that their child is taking may bring about complications such as adrenal insufficiency, pancreatitis, steroid myopathy and cataracts after the discontinuity.

Assessment of the Family structure and function using The Calgary family assessment Model (cfam)

The Calgary Family Assessment Model (CFAM) was used in the process of assessing the developmental, structural, and functional aspects of Hossam’s family. CFAM is a multidimensional framework that is integrated on the basis of systems, communication, cybernetics and change theoretical foundations that are influenced by the biology of cognition and postmodernism (Teno & Clarridge, 2004). The three aspects of CFAM: structural, developmental, and functional aspects are critical to the understanding of CFAM (Bomar, 2008).

The main benefit of using CFAM is that the tool has many categories, each of which is beneficial for purposes of obtaining data relating to the family, its communication, and interaction patterns. Nurses are normally required to use proper subcategory-based tasks when they in the assessment stage. The use of very many categories may make the nurse become overwhelmed by the information that he has collected, whereas the use of very few subcategories can make the data collection task appear incomplete.

Structural assessment

Nurses are often required to examine the structure of the family from among other aspects, the structural perspective (Duhamel, 2004). In this stage, the examination is done in the internal structure, external structure, as well as the context of the system (Tanyi, 2006). Only then can nurses claim to have carried out an inclusive assessment. The internal structure entails six subcategories, namely gender, the composition of family, subsystems, rank order, sexual orientation, and boundaries (LeGrow, 2005).

The internal structure

The family is composed of three members: the father, Ibrahim, 31 years old; the mother, Hossa, 27 years old; and the son, Hossam, 2 years old. This family has never experienced any previous composition changes as a result of death. In terms of gender, the roles of the mother and father are clearly cut out, mainly on the basis of Islamic culture. Both of them offer parental care to Hossam, who they love too much. Hossa takes care of the child during the day since Mr. Ibrahim is always busy with his work and studies.

Both the father and mother have not complained of any sexual problem. Additionally, they conduct their sexual activities in a normal way. In terms of rank order, the members of the family are ranked according to their ages, that is, father, mother, and child. It was irrelevant to assert the distance between the siblings since there is only one child in this family.

All family members are ordinarily expected to portray some adjustments on the requirements of various subsystem levels (Rimsza, 2004). The father and wife are members of the husband-wife subsystem while the son and father belong to the male subsystem level. Another subsystem comprises of father and mother as parents and Hossam as the child. This brings about the parent-child subsystem. Each of these members is doing his duties well within the various subsystems. The relationships that exist among the members of this family are well-structured and strong. Furthermore, the mother and the father are doing their best in order to give the best to their house and to Hossam, their only child.

Boundaries protect the differentiation that exists within the system and its subsystems. Moreover, they inform the family systems or subsystems, which are ordinarily rigid, diffuse, and permeable. Reduction in family differentiation is often considered a clear indication that a rigid boundary is in place (Tapp, 2005). A rigid boundary emerges when various subsystems become disengaged, moving away from other members. A permeable boundary emerges when certain rules are changed or modified in response to the benefits and needs of every family member. In this family, the roles and functions of both parents are being undertaken in a cooperative matter. Similarly, the parents are always regularly discussing issues relating to children, particularly the health condition of their son and the prognosis of the condition. Moreover, the couple used to discuss various matters whenever they became stressed by their child’s illness.

The External structure

The two main aspects of external structure assessed are the extended family and larger subsystems (Feeley, 2006). The larger subsystems assessed include ethnicity, race, social class, religion and spirituality, and the environment (Pillitteri, 2009). With regards to relations with the extended family, Ibrahim says that he and his wife always keep in touch with their parents each Friday, Sometimes, adds Ibrahim, they even chat with their sisters and brothers via internet messenger. Ibrahim’s and Hossa’s parents offer them support. Ibrahim has a close relationship with his father, being the eldest son in that family. In most cases, they do not inform their parents when Hossam’s condition is expected to worsen. The relationship between Hossa and his siblings is a strong one. She always uses the webcam to show Hossam to them every day.

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The larger systems of Ibrahim’s family involve the father’s work systems, some Saudi families and clinics where Hossam receives treatment, and the Islamic committee in Gold Coast. The members of this family have a positive relationship with this large system. They visit their families and share food at the mosque.

The care provider should be keen on the issue of ethnicity, which plays a crucial role in the family’s sense of belonging. I asked the family to describe their traditional practices regarding wellness and illness. Additionally, I explored the impact that the new culture has on family adjustment. Both parents are of the same origin and race. Their beliefs regarding how to manage their child’s illness are therefore similar.

The values and lifestyle choices of this family indicate that this is a Saudi Arabian middle-class family. They do not have financial problems since they are fully sponsored by the Saudi cultural mission in Australia while the father is engaged in part-time work. The family is also under insurance cover from Overseas Student Health Cover Services (OSHC).

Muslims believe that reading the Holy Qur’an and saying players bring about the treatment of diseases. The family, being of Islamic faith, believes that illness is predetermined. Therefore, they are not denial or despair about the illness of their son. However, husband and wife pray five times daily, asking Allah to heal their son. The home environment is spacious, comfortable, and cozy.

Developmental assessment

In the context of this family, the main focus of the developmental stage for a nurse is the child’s progress (Hanson, 2001). The nurse assesses the way in which the marital system is being adjusted in order for the child’s developmental needs to be accommodated (Logue, 2007). The parents are united in childrearing, household tasks, and arrangements with the extended family in order for parenting roles to be included.

Functional assessment

In this stage, assessment efforts ought to be directed at an exploration of how the family members behave towards each other (Wright, 2005). This is what I did. I found out that Ibrahim and his wife relate with each other in a cooperative manner in issues like eating, washing clothes, and watching TV. The functional issues assessed include influences and power, verbal communication, problem-solving strategies, and beliefs. In terms of influence, Hossa has more influence on Hossam’s behavior since she is always close to her, unlike her husband,

The family’s current health needs challenges faced, and the family’s core strengths

The family’s current health needs are focused on Hossam’s condition and treatment. The father says that he and his wife are in need of health education on signs and symptoms of bronchial asthma. They say they need an oxygen cylinder since their child often complains of sudden, severe bronchial attacks. The father told me that whenever his child shows signs of dyspnea, he cannot go to the university or to work. He also indicated his worries about the side-effect of the use of corticosteroids for treating their son. The family possesses various strengths, among them a strong family relationship, intention attention to their child’s condition, a combination of western medical treatments with traditional medication and a cordial relationship with their physician.

Impacts of a health problem on family functions and strategies used by the family

The parents use support systems and reflection in order to manage and resolve the condition of their child. They attend their medical appointments on time. They are always timely and cautious with Hossam’s medication schedules, and they always avoid all substances that can irritate his chest condition, mainly perfumes and odors.

The Saudi cultural mission, outpatient clinics, Islamic committees, and Saudi families are the core support systems used by this family. The childcare center, according to Hossa, is also a source of support, through the provision of special care on his condition and helping out when mum and dad are busy.

Reflection

It was a great experience and a pleasure to interact with Ibrahim’s family. I learned many issues concerning family nursing after working with Ibrahim’s family. First, I have learned that culture plays a critical role in every family’s health practices. Secondly, I have learned that one family member’s health impact on the health of all other family members. Thirdly, a health assessment undertaking is incomplete until a complete family health assessment such as this one has been carried out. Lastly, I learned that support systems are as important as relationships among family members in terms of impact on a family’s health.

Conclusion

Nurses have an important role to play in providing healthcare as far as the family perspective is concerned. Family members need to be targeted by nurses in efforts to draw out clear relationships between the family-functions perspectives and medical-based perspectives. This assessment proves that the family is a good source of supportive tools in healthcare.

References

Anderson, K. (2000) The Family Health System Approach to Family Systems Nursing, Journal of Family Nursing, 6(2), 103-119.

Bomar, P. (2008) Promoting health in families: applying family research and theory to nursing practice, New York: Saunders.

Duhamel, F. (2004) A Constructivist Evaluation of Family Systems Nursing Interventions with Families Experiencing Cardiovascular and Cerebrovascular Illness, Journal of Family Nursing, 10(1), 12-32.

Feeley, N. (2006) Nursing Approaches for Working with Family Strengths and Resources, Journal of Family Nursing, 6(1), 9-24.

Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003).Family Nursing: Research, Theory and Practice, 5^th ed. Upper Saddle River, NJ: Pearson Education.

Hanson, S. (2001). Family health care nursing: Theory, practice and research (2 Ed.), Philadelphia: F.A. Davis publishers.

Logue, R. (2007)Maintaining family connectedness in long-term care: An advanced practice approach to family-centered nursing homes, Journal of Gerontology Nursing, 29(6), 24-31.

LeGrow, K. (2005) Development of Professional Practice Based on a Family Systems Nursing Framework: Nurses’ and Families’ Experiences, Journal of Family Nursing, 11(1), 1 38-58.

Lindgren, C. (2007) Nurses’ and family members’. Perceptions of nursing home residents’ needs, Journal of Gerontology Nursing, 28(8), 45-53

Pillitteri, A. (2009) Nursing care of when a child has a respiratory disorder, London: Routledge.

Rimsza, M. (2004) Complications of corticosteroid therapy. Retrieved, October 24, 2008 from: http://archpedi.ama-assn.org/cgi/content/abstract/132/8/806.

Tapp, D. (2005) The Ethics of Relational Stance in Family Nursing: Resisting the View of “Nurse as Expert” Journal of Family Nursing, 6(1), 69-91.

Tanyi, R. (2006) Spirituality and family nursing: spiritual assessment and interventions for families, Journal of Advanced Nursing, 53(3), 287–294.

Teno, J. & Clarridge, B. (2004) Family Perspectives on End-of-Life Care at the Last Place of Care, 291(1), 108-128.

Wright, L. M., & Leahey, M. (2005). Nurses and families: A guide of family assessment and intervention (4th ed.). Philadelphia: F.A. Davis Company.

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