Calgary Model of Family Assessment

This model for assessing families allows nurses to use interviews to do an assessment of families. Wright & Leahey (2013) defines the Calgary Family Assessment Model as a three-category theory containing developmental, functional and structural categories and subcategory topics. The theory is essential for nurses in analyzing the strengths, weaknesses and the resources a family need. Through the theory, a nurse manages to assess the perspectives of the family, identify their problems and assist the family with the problems and challenges they are facing (Holley, 2007; Stanhope & Lancaster, 2014). The chronic illnesses this paper aims at understanding and assessing include; diabetes, fibrosis, metabolic myopathies and asthma. For confidentiality, the family members’ names have been changed. The sick person is 30-year-old Albert Douglas Jr. and his girlfriend is Nina. They have a 7-month son called Abel. The mother is Victoria mom. The essay aims at using Calgary Family Assessment Model to analyze the experiences of a family living with chronic illnesses. 

The structural part of the model is further divided into internal and external contexts (Wright & Leahey, 2013). This allows the nurse to know who the members of the family they are assessing are, the connections that exist between the members of the family and the people who are not family members and the context of the family. The internal context of the family consists of such factors as the composition of the family, sexual orientation, gender, subsystems, rank order and boundaries ( Leahey & Wright, 2016). Assessment of the composition of the family lets the nurse to know who the patient considers to be family and whether they are related biologically or it is just people who influence the life of the family ( Bell & Wright, 2015; Swartz, 2014). 

Family Assessment 

The head of Albert’s large family is their 50 years old possessive mother Victoria. Albert’s girlfriend Nina is 25 years old and their son Abel just turned 3 years old. The family of Albert own two cats named Lucky and Lucile. Albert met Nina when her son was one year old and they have been together since. The family lives together and Nina has a day time job. His mother Victoria takes care of Albert and his step son. At home, Albert spends most of his time with Abel. The comfort and care Albert receive at home ensures that he is cared mentally, physically and emotionally. 

Structural Assessment 

Albert’s family is not conservative and does not practice old patriarchal rules where the wife stays home to take care of the family. The women in the family Victoria and Nina are tasked with caring for Albert and Abel and ensuring that eat healthy nutritious food. The couple is heterosexual and answered a few questions regarding their sexual orientation. Albert has taken over the job of raising Abel since the mother is always away working. At two years old, Abel is actively learning and is able to provide responses for questions asked. Victoria taught Albert at a young age to be morally upright and open- minded. Many times, Albert’s sickness has taken a toll on him and he suffers bouts of psychological anguish. While Albert’s family has no specific order of ranking, his health is a priority and the main factor considered in decisions made. Abel as young as he is only plays around and helps his dad with small tasks like arranging the bookshelf and folding clothes. Albert performs small tasks such as arranging and maintenance around the house. He performs his tasks slowly but eventually gets them done. All the members of this family have different tasks each to accomplish. 

Internal Structure 

Since he came into Albert’s life, his son Abel has developed a deep relationship with him thus creating a strong bond since he is at home almost all the time majorly taking care of the little boy. Albert says that he focuses his attention on Abel to try to forget his illness. He also teaches him how to speak English and how to read books. When she is not at work, Nina spends her time with her son and boyfriend. His mother Victoria has guided Albert throughout his life as he struggles with his illnesses. They have developed an attachment that grows day by day as they live together. These subsystems within the family have a contribution to make towards the family`s health. 

Abel stays at home with Victoria his grandmother and this has allowed him to relate with her closely and feel secure while with her at home. The family has held a group discussion to set up boundaries in the family. One such a boundary is the interaction of Abel with the medication Albert takes. Drugs only worsen the health of Albert and so he does not take them, he instead depends on medicinal marijuana to fight the attacks which have proven successful. It has therefore been decided that Abel should not interact with it. Abel understands marijuana and pipe but has not seen it used. If he is asked what it is, he will say it is his dad’s medicine. Abel watches the television for 30 to one hour every day. 

Extended Family 

Albert and Victoria do not interact much with members of the extended family. Kelvin is Albert’s cousin who is their closest relative his best friend. He takes his time to know how Albert is doing by calling regularly and visiting. Kelvin and the best friends of Albert are always there when his health decreases due to his illnesses and that is why his friends to him constitute his extended family. He says that many of his high school friends have disappeared but the few remaining are now part of his family. 

Genogram of Albert’s Family 

Albert is the only member of this family who has a serious health condition; he is suffering from metabolic myopathies, diabetes, cystic fibrosis and asthma. 

Large Systems 

The external organizations that are now part of the life of Albert include volunteer testing research projects, the medical marijuana access regulations, the government and the cystic fibrosis foundation. The reason Albert has joined volunteer research testing projects is because he believes that he can help them help people who develop the illnesses he has in the future. 

Ecomap of Albert 

Context Assessment 

This constitutes religion, environment, ethnicity, social class and race. Albert’s family has a British background, a Caucasian family. The family holds no spiritual beliefs and is not religious. Albert’s personal health perspective is that it is overrated. According to him, the economic class of his family is lower because his mother and girlfriend only earn a meager income but the cost of running the home and his medical expenses is very high. He left high school before graduating and does not think he will go back soon. The family has moved three times over the past four years as his illness progresses and the need to access a wheelchair. Each move, he says, has made his experience and environment better, he now lives in an area that is built up well and there he has access to financial, educational and most importantly medical facilities. 

Developmental Assessment 

The six stages in family development are home leaving, marriage, families that have young children, families that have adolescents and entries and exits from the system of the family. When Albert met Nina and she came into his life, she came with a son Abel and these places him in the third stage of the life cycle of the family. This is the stage of families that have young children. Each stage comes with things the family needs to do to ensure development in the home. Stage three involves adjustment of life due to the inclusion of children, joining in the household and financial tasks and establishing closer relationships with members of the extended family so that the roles of grand-parenting are included. 

The personal development of Abel is contributed to by Albert and Nina. Victoria supports the family financially, physically, emotionally and mentally. Nina and Victoria work to provide financial support and also keep the household in order. Everyone, including Albert when he feels better is involved in the completion of daily activities. The father of Abel is not in this family and so he takes Albert as his father. A strong and caring relationship has developed between father and son as they spend most of the days together at home. 

Functional Assessment 

This involves an assessment of how individuals behave towards each other in the family and how illness influences the family. It has expressive and instrumental functioning as the sub-categories. 

Instrumental Functioning 

This is made up of interactions occurring within the family. These are the routine activities like preparing meals, eating, taking care of children and sleeping among others. Albert’s muscles are constantly contracting due to the severe cystic fibrosis and metabolic myopathy that he has. Diabetes makes Albert’s nutritional requirements challenging as he needs to take at least 20, 000 calories per day. Victoria prepares daily meals for the family. She has the responsibility of ensuring that the nutritional requirements of Albert are met and keep the nutritional health of Nina, Abel and herself in mind. 

Albert has to take shakes for meal replacement as prescribed. Cystic fibrosis causes build-up of mucous fluid and clogging of body organs like the respiratory system. Albert and Nina sleep in the basement while Victoria sleeps with Abel upstairs so that the coughing fits of Albert at night are not heard. The medicine of Albert is placed everywhere he goes so that he can access it quickly in case of an attack. The bathroom is at the house`s top floor and it is sometimes a challenge for Albert to get there especially when his muscles have severe spasms. 

Expressive Functioning 

This enables the nurse to assess the interaction patterns among the members of the family via various communication means (Vespa, Lewis & Krieder 2013). The family of Albert communicates in many ways among themselves in the family. It has nine communication categories: - 

Emotional Communication 

Albert’s illness causes him to express the emotion of sadness and being disappointed because he is not able to be physically active. Stress is likely to cause the body of Albert challenging attacks. 

Communicating Verbally 

Albert must communicate verbally with his mother Victoria and girlfriend Nina so that they can come in and help him when his day is in a bad situation. 

Communicating Non-verbally 

Both Nina and Victoria have to be attentive to the way Albert communicates non-verbally so that they can know when he needs intervention. 

Style of Communication 

The people in the family communicate in a circular manner as they decide on the things that should be done in the family. These include things such as purchase of medication and many other things that the family needs to do. 

Solving Problems 

As Albert’s condition progresses, the family uses the skills they have in solving problems to come up with solutions to challenges that arise such as finding a house that is accessible with a wheelchair and places that can be contacted in case the family needs help. The family lives in the middle of a city that is well developed and so they are in a position to access hospitals and clinics that can attend to the health needs of Albert and those of the family. Some of support systems that are needed to contribute to the social wellbeing and health of the family are physical and social facilities as well as shopping centers. 

Family Roles 

The roles of the members of the family are not well defined. Victoria takes care of Abel as Nina is at work to provide financial support for the family. Victoria also works to provide financial support for the family. Abel helps in the small chores in the family such as keeping away his toys and washing the dishes. Albert helps with maintenance in the household when he feels up to the task. 

Decision making power 

In this household, decision making is shared by Albert, Nina and Victoria. There is no one who can be say to have the final say in all matters although Nina makes most of the decisions to do with financial matters because she is the one who provides most of the finances needed in the family. 

Family Beliefs 

The family does not hold any religious or spiritual beliefs but they believe that God protects them. However, Albert tries to instill in young Abel moral values like to treat others the way he would like to be treated. He also teaches him to fear God and avoid doing evil. The family believes that when one is not sick, they are healthy. They also believe that when one is sick, it is important to take medication to control the condition and this is what happens for Albert. 

Relationship with Extended Family 

Although the family members get along well, the relationship with the extended family is not very close. The only close member of the extended family who Albert considers to be his best friend is Kelvin who frequently gives him calls and visits him to know how his condition is progressing. Abel and Albert have a very close and caring relationship. Nina and Albert also love each other a very much. Victoria loves his son, daughter in law and step grandson and cares for them. 

List of strengths and Problems 

Subsystem	Strengths	Problems
Marital-parental	The parents know the needs of their child and understand their roles and responsibilities towards him.  Roles are well established.  Tasks that are performed depend on one`s ability and the condition of their health.	Albert is sick and cannot provide for the family and so his girlfriend has to bear the burden of being the financial supporter of the family.
Parent-child	The child is highly valued.  Victoria is involved in actively in bringing up her grandchild Abel.	Nina has little time with her son Abel and so she is not in a position to connect with him as a mother.
Individual	Nina is contented working and providing for the family.  Victoria enjoys taking care of Abel her grandchild and so does Albert his step-father.	Nina is so busy with her job and she finds it a bit stressing at times.

Family Summary 

The family consists of Victoria her mother who is 50 years old, Albert who is 30 years old suffering from chronic illnesses, Nina the girlfriend of Albert who 25 years old and Abel their son who is 3 years old. The family of Albert does not hold the conservative gender roles where the wife has to stay at home to clean and cook as the man works to provide financial support. There is a strong bond between Albert and Abel. Albert and Victoria do not interact much with members of the extended family. The external organizations that are now part of the life of Albert include volunteer testing research projects, the medical marijuana access regulations, the government and the cystic fibrosis foundation. 

Assessment Summary 

This is a young family in the third stage of development. The family is Caucasian family with from a British decent. The family holds no religious beliefs. Nina got Abel from a previous relationship which ended tragically. Victoria the mother of Albert teaches in a high school. Albert was diagnosed with diabetes, cystic fibrosis, metabolic myopathies and asthma two years ago. Albert and Nina have only one son who is approaching three years of age and has not yet started attending school. His health is good. When Nina is not at work, she spends her time bonding with her boyfriend Albert and their young son Abel. 

Diagnosis and Intervention 

Diagnosis 

Albert is willing to take medication that will help check his current medical condition. This is evidenced by his speech and the fact that he makes sure he follows all the prescriptions he gets form the doctor. 

Intervention 

Nina willfully provides finances to purchase the medicine that her boyfriend Albert requires. The interventions are access to the cystic fibrosis foundation where the family gets information on how to manage Albert’s sickness. 

Desired Results 

This family positively takes medical interventions and so the desired outcome will be continuing to promote health maintenance. The diagnoses made aim to improve the functionality and promote Albert’s condition. 

References 

Bell, J. M., & Wright, L. M. (2015). The Illness Beliefs Model: advancing practice knowledge about illness beliefs, family healing, and family interventions. 

Boterhoven de Haan, K., Hafekost, J., Lawrence, D., Sawyer, M. and Zubrick, S. (2014). Reliability and Validity of a Short Version of the General Functioning Subscale of the McMaster Family Assessment Device.  Family Process , 54(1), pp.116-123. 

Crain, W. (2011). Theories of Development: Concepts and Applications (6th ed.). Upper Saddle River, NJ: Pearson Education, Inc. 

Coady, N., & Lehmann, P. (Eds.). (2016). Theoretical perspectives for direct social work practice: A generalist-eclectic approach . Springer Publishing Company. 

Holley, U. (2007). Social isolation: a practical guide for nurses assisting clients with chronic illness. Rehabilitation Nursing, 32 (2), 51-56. doi:http://www.ncbi.nlm.nih.gov/pubmed/17432633 

Leahey, M., & Wright, L. M. (2016). Application of the Calgary Family Assessment and Intervention Models: Reflections on the reciprocity between the personal and the professional. Journal of family nursing , 22 (4), 450-459. 

Stanhope, M., & Lancaster, J. (2014). Foundations of Nursing in the Community (4th ed.). St. Louis: Elsevier. 

Swartz, K. (2014, April 1). Health Care Reform: Health insurance & the affordable care act . Retrieved from WebMD: http://www.webmd.com/health-insurance/nc/north-carolina- health-insurance-marketplace?page=2&state=NC 

Vespa, J., Lewis, J., & and Krieder, R. (2013). America's Families and Living Arrangements:2012. US Departmen of Commerce. Retrieved from http://www.census.gov/prod/2013pubs/p20-570.pdf 

Wright, L. M., & Leahey, M. (2013).  Nurses and families: A guide to family assessment and intervention