Introduction to health behavior change Research Paper

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Health behavior change example

Introduction 

The purpose of this paper is to explore a family case study where there is a functional change in the family and the roles related to a condition affecting one member of the family (chronic disease). Family Systems Theory will then be applied to this case study.

Family Case Study: Mike Bowel Family (there is a member with chronic illness)

Setting: Inpatient acute care facility 

Nursing Goal: to help this family prepare for discharge scheduled for the following day

Family Members: Mike Bowel’s family is a nuclear family

Mike: 52 years old, a father and a construction engineer, full-time employed

Ginny: 44 years old, mother, house wife, suffers stage two cervical cancer. The condition recently became worse despite the radiations and chemotherapy. She has lost hope and is at the verge of becoming traumatized by her condition. 

Newton: 15 years old, the eldest in the family, he is in his high school in a private school in the city

Marie: 10 years old girl, the second born in the family and is in the fifth grade. She is a good student in her class.

Lorenzo: 6 years old, the last-born child in the family on his first year at the elementary school. Goes to a private educational center after school because of the mother’s condition. 

• Ginny was diagnosed with Stage II cervical cancer at age 41. 

Mike Bowel’s Family Story

Ginny has been living a healthy life until three years ago when she was diagnosed with Stage II cervical cancer. She has been experiencing pain during sexual intercourse for some time but did not think it was something serious. She also experienced menstrual bleeding that is longer than the usual and thought it was normal. She has never attended any screening although she admits she has always wanted to go for screening after hearing many stories about cancer. When she visited her doctor three years ago, she was recommended for screening and the bad news was broken to her. 

Currently, Ginny is unable to carry out her duties as a mother and wife because she is weak and experiences pain. She has been in the hospital the last few months and her condition is not getting any better. Her family has had to cope with the health of their mother and they have experienced similar trauma following the changes that occur in the family. The last three years have been the worst for the family as Ginny developed depression after the diagnosis. she has also suffered anxiety, possibly from the stress that comes with the thought of the burden she is putting on her family. 

Health Insurance

Bowel has a health insurance paid by his employer, that covers the whole family. Hospitalization cases are covered 90/10 and the remaining 10% comes from out of pocket. The family also has their eldest sone Newton in a private school which Bowel has to pay the school fees. The other children are also in school and have financial needs that Bowel has to cater for. The family’s finances have been constrained following the increased expenditure from the out-of-pocket money payable to the hospital and after-school educational center that Lorenzo has to attend. The situation has been stressful to Bowel and he is having trouble making his other commitments that he normally does with the extra finances he is left with. Bowel is anxious that he may not be able to take care of his wife when she is discharged from the hospital. 

Family Members

Bowel has been suffering stress due to the current situation in his family. He is supposed to go to work as usual, take care of his children and their daily needs and to take care of his ailing wife. He is also stressed that he may not be able to take care of his wife. He is not sure that he will be able to attend to his wife when she needs him most. He is also stressed that the children might get distracted at school, especially Newton who is in his high school and almost graduating. Bowel is also concerned that the mother in-law is coming to stay with them to help take care of Ginny. However, while this seems like a relief, Bowel feels the financial constraints already do not want additional member in the family. He is confused on what to do and only hopes that things get better soon. 

Newton is older and understands the situation the family is passing through. He sees their father struggle with everything around the house and tries to help whenever he can. He is an obedient child, which is unique character for adolescent kids. On the other hand, he also notes that he is worried about his mom and how the family is going to manage. He understands the financial and emotional restrictions the family experiences and is more worried about the younger siblings. He understands the pain of seeing his mother bedridden and wonders how the younger siblings will be able to understand that mom is not well and needs to rest. 

Ginny is worried about her family. She understands the stress the husband is having and how much he tries to be the best for the family. She is also worried about the kids and do not want them to see her in this condition. she is also concerned that she might not be able to carry out her usually home tasks and that this will be stressful to the family. 

Ginny’s parents live far from the city and her mother will have to move in with them. adjusting from a situation where you were always a guest in a house to a situation where you have to be part of the family and do most of the chores is a major change to this family. Although the children will always be seeing their grandma around, the situation is different and not in the happy family moments that they used to have. 

The entire family has a lot of changes to do to be able to cope up with the situation. Therefore, the nurse has to treat the client (this family) with most sensitivity and help them overcome the trauma, stress and depression that is always associated with the chronic illness.  

Discharge: Ginny will be discharged from hospital tomorrow.

Bowel’s Family Genogram

Theoretical Perspective and Application to This Case Family

Family Systems Theory

Origin of the theory

Family Systems Theory has its roots from the fields of physics and biology perspectives that presents living organisms as interactive systems as explored by (Kaakinen, Coelo, Steele & Robinsom, 2018). Various theorists have explained the concepts of this theory including Hanson (2001), Johnson (1980), Neuman (1995), Neuman and Fawcett (2010), Parker and Smith (2010), Walker (2005), and Wilkerson and Loveland-Cherry (2005). 

Theory Overview

Family systems theory focuses on the exchange of behavior that take place in a given moment of interaction between the members of the family. The theory implies that the patterns of interaction between the members of a family create, maintain and perpetuate the problems and nonproblematic behaviors. the theory seeks to define and generate reconstructive behavioral exchange between the family members (Milberg, Liljeroos, Wåhlberg & Krevers, 2020). More emphasis is on the definition and interrupting the recurring sequence of behavior exchange where the problem is a part. The Family Systems Theory implies that the problem behavior dissipates and the treatment is complete when the problem-oriented patterns are efficiently interrupted. 

Family systems theory is a human behavior theory that considers the family to be a complex social system where individuals interact to influence each other’s actions. The family members are usually linked together to allow the system to be viewed as a whole and not an isolated system. the change in one family member is set to have an impact on the entire system and can result to change in the other family members. As a result, there may be a functional or dysfunctional outcome (Hanson, 2018). According to this theory, family systems are set to maintain stability. The theoretical perspective encourages nurses to view their clients as participating members of a larger family system. 

The key objective of the family system theory is to assist families attain stability by building on their strengths as a family, use the knowledge of the family as a social system and understand how the family is interconnected while that is adapting to the changes brought about by the health, event of a member of the family. 

Concepts Applicable to Family Nursing

• All parts of the systems are interconnected. In this view, when a member of the family is exposed to a certain event, all the others are affected by this same event due to the link between them.
• Two, the whole is more than the sum of its parts. This is to imply that the family is not just a relationship between the parent and the children. All the relationships are seen together. 
• Third, all systems have a kind of boundary/border between the system and its environment. In this perspective, the family boundaries include the permeability that can be closed, flexible or open to information, people and other resources (Jakimowicz, Perry & Lewis, 2021).
• Fourth, systems can be organized into subsystems. Nurses can consider the subsystems of the family such as the husband, mother, father or sibling relationships. Bowels family has subsystems including parents, siblings, parent-child, daughter, in-law and grandparent subsystem. According to Denham, S. A. (2016), a nurse working with this family can focus to reduce the family stress by focusing on the marital subsystem to help Bowel and Ginny have more couple time. alternatively, the nurse can focus on having the sibling subsystem to help the children and their engagements after school.  

Application to the Family

• Based on the interconnectedness of the family, every member is affected by the chronic condition of the mother and her deteriorating health.
• The family structure, functions and processes of this family are impacted which changes the family roles and dynamics
• Everyone on the family has their concerns and need attention from the healthcare professionals. 

In the case of the Bowel’s family, a nurse focus is on the family as a client. Therefore, there are some questions that the members are focused on as a whole. 

Questions

• Ginny, how do you think your family should be involved in your care at home? (Concept 1)
• Bowel and Ginny, who do you consider family members? (Concept 1)
• Ginny, how much did your family help you the last time your condition worsened? (Concept 2)
• What was the lest help you received from your family the last time your conditioned worsened? (Concept 2)
• Are there people outside your immediate family who you see as potential help when you go home? (Concept 3)
• Do you think your family will appreciate a home-nurse coming to help you every once in a while? (Concept 3)
• How do you think your children will feel having their grandmother over to help the family? (Concept 4)

Intervention 

The nurse is expected to assist this family reach its stability through building their strength and use the knowledge of the social system of the family. It is critical to understand how this family is interconnected and how they adapt to the changes resulting from the health event of Ginny. Thus, the nurse is obligated to reduce the family stress by focusing on the marital spouse subsystem to help Bowel and Ginny have their couple time as recommended by Bögels & Emerson (2019). The nurse may also focus on the sibling subsystem where Marie and Lorenzo including the fact that Lorenzo is now forced to attend the after-school education center due to the condition of the mother. 

References

Bögels, S. M., & Emerson, L. M. (2019). The mindful family: a systemic approach to mindfulness, relational functioning, and somatic and mental health. Current opinion in psychology, 28, 138–142. https://doi.org/10.1016/j.copsyc.2018.12.001

Denham, S. A. (2016). Family structure, function and process. In S. M. H. Hanson, V. Gedaly-Duff, & J. R. Kaakinen (Eds.), Family health care nursing: Theory, practice and research (3rd ed., pp. 119–157). Philadelphia: F.A. Davis.

Hanson, S. M. H. (2018). Introduction to family health care nursing. In S. M. H. Hanson, V. Gedaly-Duff, & J. R. Kaakinen (Eds.), Family health care nursing: Theory, practice and research (3rd ed., pp. 3–38). Philadelphia: F.A. Davis.

Jakimowicz, S., Perry, L., & Lewis, J. (2021). Bowen Family Systems Theory: Mapping a framework to support critical care nurses' well-being and care quality. Nursing philosophy : an international journal for healthcare professionals, 22(2), e12320. https://doi.org/10.1111/nup.12320

Milberg, A., Liljeroos, M., Wåhlberg, R., & Krevers, B. (2020). Sense of support within the family: a cross-sectional study of family members in palliative home care. BMC palliative care, 19(1), 120. https://doi.org/10.1186/s12904-020-00623-z