Nursing process using relevant theoretical model

Family Health Nursing

(Family Stress Management)

Case Identification 

Father: Morris King           Age: 56 years old             Occupation: Architect

Mother: Sophie James       Age: 49 years old              Occupation: Housewife 

1st son: Joseph King           Age: 11 years old              Occupation: Student 5th grade

1st daughter: Nelly King    Age: 9 years old                Occupation: Student 3rd grade 

2nd son: David King           Age: 7 years old                Occupation: Student 1st grade

Nationality of the family: Americans 

The Case

This is a nuclear family that has three children and they had settled on this number of children for now. However, Sophie got pregnant unknowingly and they now have issues between her and the husband. The two had agreed that they were not adding another child to the family because of the hard economic times and the financial constraints they have. Sophie does not want to discuss anything about the pregnancy and considers it a blessing. Morris, on the other hand, feels Sophie has betrayed him and she is going to make things harder for the family. Morris feels Sophie intentionally got pregnant and they now engage in harsh arguments every day. The love, peace and harmony in the family has now dissolved in the thin air. 

The family lives in a rental apartment with two small rooms. Sophie and her husband got married immediately after graduating from college and they have lived peacefully since then. Things started to become tough recently and they have struggled to manage through the economic hardships with their current wage. They have been making decisions together, solve any issues between them well until this pregnancy. Since the news of the coming baby, the communication patterns between the couples changed. They have resolved to shouting at each other all the time causing the main stressor. Moreover, they are experiencing financial strains die to the dependence on the husband’s sole income and the hard economic times. 

Applying Nursing Care Plan Using a Relevant Model

Assessment 

Family stress turns to be problematic when the level of stress goes beyond the resources in the family and its coping abilities. Therefore, there is a need for early assessment of the family stress to prevent the escalation of the matter which might disrupt the family function (Rizki, Nursalam, Rahmat & Chan, 2018). The nurse is charged with the obligation to examine the roles of the family members, power structures within the subsystem of the social support of the family and caregiving as well as communication patterns. One of the critical parts of the roles of the nurse is to assess the verbal and nonverbal communications were there is interaction within the family system that links the members together (Kaakinen, Coehlo, Duff and Hanson, 2015). Observation and interviews can be used as approaches to help the nurse’s assessment of the family. This will include observing the communication patterns such as openness, emotional bonding, use of space and active listening, respect and willingness of the members to meet each other’s needs. 

The observation and interview will seek to find answers to the following questions:

• Does the family communication adopt an open and direct approach with clear meanings?
• Do you think the communication system support and affirm the family members?
• Does the communication pattern reflect the family interactions?

Further, the nurse will assess the strengths and challenges of the family functioning that needs awareness of the family system and dynamic entity. The nurse should help the family to assess their responses to stressful events and condition (can be an altered communication pattern) experienced within the family (Tsai et al., 2018). At the same time, the nurse will reinforce the family strengths and adaptations that can be achieved. The nurse should as well help this family assess the resources in the external environment including the extended family and social support and the community resources that will help manage the stressor. 

Hence, it is critical to ensure the assessment includes a periodic and continuous evaluation of the constructive patterns of communication and interaction, the purpose and effectiveness of the coping styles and the physical health of the family member. 

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Nursing Diagnosis

The key stressor in the family is ineffective communication and coping due to the additional pregnancy that comes in the midst of a financial crisis in the setting. The nurse diagnosis will in this case is: compromised family coping related to the intense stressor as evident through the negative communication pattern. The stressor is the unplanned pregnancy and financial issues and the adverse communication pattern in the case is shouting at each other. 

Planning 

The plan designed for this case should be sure to include the family members in efforts to empower them and increase their self-efficiency. In this plan, the nurse should seek to:

• Determine the willingness of the family member towards the implementation of the plan
• Find commitment to all members to participate
• Engage in brainstorming of all the possibilities depending on the family preferences and values
• Discuss the possible results for the individual members and family at large
• Work with all the family members to help each other strive towards the goal
• Provide the guided instruction, teach the family emotional, intimacy and physical negotiation as well as communication strategies
• Guide the family through the issue and refer them to other professionals where necessary

Implementation 

The implementation phase of this model includes the nurse acting as a teacher to the family and enhance their unity and time spent among the family members

Evaluation

In the evaluation phase, the nurse should:

• Determine the affective function of the family, interaction and communication patterns, the function and coping style used and the physical health of the family members
• Figure if the family is able to share feelings of happiness, hopefulness, confidence and optimism as well as satisfaction.
• Find out whether family meeting is important for this client
• Determine whether the family works to restore equilibrium

Using The Textual Model of Family stress (Boss, 1987; Boss et al., 2017)

According to Boss, a family is normally affected by the external and internal ecosystems. Moreover, the outcome and cause of the stressors are mostly related to the internal and external context. Boss, Bryant & Mancini (2016) complements the insights from Hill’s ABC-X model suggesting that the family experience of stress is triggered by the interaction of the stressor even or situation (A) interacting with the family resource (B), the meaning or perception of the event (C) and the level of stress (X). 

In this case study, the family experiences stressors within the internal (unplanned pregnancy) and external (support from the extended family) and resources (coping skills) which influence the results of the experiences as stress (compromised family coping).  The ABC-X model is driven by the emergence of concepts such as family resilience that suggests the family may come out better after a successful face-off with the hardships together, learn how to cope with the stressors and emphasize on the social contexts that may support them as determined by Ghanouni & Hood (2021). 

Hill (1958) implies that the coping resources are internal to the family and relates to the values of the family and the nature of the relationships within this setting. the individual-level psychological resources including the self-esteem and familial resources such as family integration and mutual adaptability can allow the family to cope with the stressor. The available resources can as well be included as the extended family and the community support. 

Therefore, in case of this family, the intervention includes teaching and encouraging them to use the available resources from the community such as attending the support groups to release the tension and learn coping skills from people who have experienced the same. 

ABC-X Model

References

Boss, P., Bryant, C. M., & Mancini, J. A. (2016). Family stress management: A contextual approach. Sage Publications. 

Kaakinen J, Coehlo D, Duff V and Hanson S (2015). Family health care nursing: theory, practice, and research. 5th ed. F. A. Davis Company. 

Rizki, F., Nursalam, N., Rahmat, H., & Chan, C. M. (2018). Predictors of family stress in taking care of patients with schizophrenia. Jounar Ners, 13(1), 72-79. 

Tsai, K. M., Dahl, R. E., Irwin, M. R., Bower, J. E., McCreath, H., Seeman, T. E., ... & Fuligni, A. J. (2018). The roles of parental support and family stress in adolescent sleep. Child development, 89(5), 1577-1588. 

Ghanouni, P., & Hood, G. (2021). Stress, coping, and resiliency among families of individuals with autism: A systematic review. Review Journal of Autism and Developmental Disorders, 8(3), 389-402.