Families emerge as critical stakeholders in the provision of effective patient-centered care. They also represent a vital source of influences on individual health and wellbeing. In fact, the relationship between families and health or illness is reciprocal and interdependent. The purpose of the current assignment is to perform a written assessment and analysis of a family based on professional or personal acquaintance. The paper will include a detailed review of the internal and external factors underlying the health, wellness, and behavioral choices made by the selected family. It will also include an assessment of the family's functional status and provide recommendations for further improvements in family health.
Description of Nuclear Family or Variant Family Form
The object of the current analysis is the family of A.'s. It comprises a mother, a father, and two young children. J., a young man in his thirties, is a Latino. He is currently finishing his graduate education in cinema production. He works as a journalist on a local television channel. His wife, L., was born in Turkey. She has been living in the United States for the past 13 years. She is 29. M. is a nursing student. She also works as a nurse in a local long-term care facility. The couple has two sons, D. and A. They are 9 and 8, accordingly. Both are known for being particularly successful in their school studies. From the developmental perspective, the A.'s can be described as a family with school-based children, since their oldest child is aged between 5 and 13 years.
Sociocultural Data: Cultural/Ethnic Assessment, Social Class Status
The family of A.'s represents an interesting object of sociocultural analysis. The uniqueness of the family is in that L. and J. originate from different cultures. J. was growing up in a predominantly Hispanic neighborhood in Texas. By contrast, L. was raised in Turkey. Her native language is Turkish, although she speaks fluent English. While J. is of Latino/Hispanic ethnicity, his wife L. is Caucasian white. They also adhere to different religions – L. is a Muslim, whereas J. follows the Catholic tradition. Their children are being raised as western-oriented Catholics, even though both D. and A. speak some Turkish. Neither of the two children has ever visited his mother's native country. Nor has L. had any opportunity to go to Turkey after moving to the U.S. to live with her husband. Her immigration experiences have already given place to acculturation. Cultural conflicts within the family are rare. From the perspective of social class, the A.'s can be described as a middle-class family, which comprises white-collar professionals.
Fig. 1. Genogram
Fig. 2. Ecomap
Environment: Physical Setting (Home, Neighborhood, Community)
The family lives in a decent, middle-class neighborhood, which is clean and relatively safe. The house itself is quite old, since it was inherited by J. from his grandfather. The A.'s have invested considerable resources in renovating the house to meet their own needs and the needs of their children. The A.'s spend most of their time at work. They do not maintain any close ties with any neighbors. Their community is made of predominantly white-collar middle-class and upper-middle-class workers, who maintain the same level of wellbeing with the A.'s.
The A.'s are an example of a functional family, whose members enjoy continuous, regular, effective communication that helps them improve their health and wellbeing. They discuss all major and minor events that occur in their daily lives. The children do not seem to have any secrets from their parents. They are not afraid of sharing their school problems with parents. The latter, in turn, try to find enough time to listen effectively to their children and find a solution that satisfies all parties. The only problem is that L. does not always acknowledge her feelings openly. Being born in a religious Muslim family, she was taught to cope silently with her problems. Even though J. tries to promote an atmosphere of openness, he cannot always overcome these cultural barriers. At the same time, J. cannot always maintain reasonable communication boundaries. Friedman are right: complete self-disclosure and honesty can be particularly disruptive for even the strongest marital relationships. Amidst these communication conflicts, children are the first to suffer.
Power Structure; Hierarchy; Power Bases; Coalitions
The family of A.'s is rather flexible in the distribution of powers among its members. Formally, as a husband and a father, J. holds a leadership position and resides at the very top of the family hierarchy. L. goes next. Finally, their two sons are positioned at the very bottom of the hierarchy. However, the distribution of power varies, depending on the situation. For example, J. retains his leadership in financial questions. Meanwhile, his wife L. assumes formal and informal leadership in everything that pertains to cooking and household chores. In many situations, the two sons are also given additional decision making freedoms. For example, J. and L. empower their two children to plan weekends. Expert power remains the key source of family members' power. Formal and informal leadership shifts to different family members, based on their expertise in any given situation.
Role Structure: Relationships (Formal & Informal)
The role structure in the family of A.'s is free of any peculiarities. J. fulfills the formal role of a father and a husband, coupled with an informal role of a breadwinner and a guide. Other family members typically rely on J. in making the most difficult decisions. L.'s formal roles of a wife and a mother are further combined with an informal role of a counselor. She assumes primary responsibility for resolving any conflicts within the family. Children also play an informal role of leisure organizers and decision makers. All these roles are functional, and all family members successfully cope with them, except for L., who still cannot learn how to be more proactive in her family roles. Looking at her mother, L. saw only submission to the unequivocal male power. Her mother could not utter a single word of disagreement with the decisions made by the male members of their family. L. cannot always find enough courage to argue with J., D., and A., even though they welcome and encourage openness. She would silently agree with a decision, if she does not have enough strength to argue.
Values: Norms and Rules
The key values of the family include physical health, emotional wellbeing, ethical integrity, and group decision making. The key rule followed by all members of the A.'s family is that all decisions must be made collectively and for the benefit of every member. Moreover, every member of the family has equal rights and opportunities to express his or her opinion and contribute to the final decision. Quite often, A.'s even organize so-called "group family meetings", when they have urgent issues at hand and need to resolve them effectively. In such atmosphere, no family member seems to be discriminated against or denied his or her freedoms. The spirit of equality translates into greater effectiveness in school and at work, creating a strong base for pursuing the most challenging material goals.
Spiritual activities do not occupy an important place in the lives of J., L., D., and A. They spend most of their time at work or in school, meeting for the evening supper to discuss the most relevant events. However, these suppers, group family meetings, and collective decision making function as essential spiritual components of the family's functional status. It has positive effects on all aspects of family functioning and translates into enhanced health and wellbeing of its members in the long run.
Socialization: Child Rearing Practices; Intra-Family Support; Social Network; Recreational/Leisure Activities
J. and L. provide as much support and affection to their children as they reasonably can. It means that D. and A. can always approach any of their parents or both with their problem and receive an immediate feedback. In their child rearing practices, D. and A. rely on the principles of independence, autonomy, and equality. Thus, they respect the right of their children for having free time, having small secrets, and managing their personal affairs in ways they deem to be the most suitable for them. Neither J. nor L. help the children to cope with their homework. In this way, they want to raise children who assume complete responsibility for their school successes. At the same time, the two children are responsible for organizing family leisure activities. At times, the whole family leaves to spend a weekend in a new place.
Adaptation: Role Conflicts/Overload/Changes; Coping Strategies and Problem-Solving Skills
The family easily adapts to the changing conditions of life in a middle-class community. One of the key stressors facing the A.'s is workplace overloads. J. sometimes spends 20 hours in a row at work. However, such occasions are rare. D. and A. are used to see their parents a few hours a day, except for the holidays and vacations which they spend together. In case of a serious dilemma, joint problem solving becomes the most reliable internal coping mechanism. In fact, the family itself functions as an effective internal support network, which does not favor scapegoating or the use of myths. Simultaneously, they rarely or never apply to the benefits of external support networks, which is why they may limit themselves in their decision making and problem solving opportunities.
The family does not have any history of major or serious illness. Consequently, they do not engage in any specific procedures to promote health or prevent illness. The A.'s believe that physical health is a complex product of genetics and emotional wellness. This is why they emphasize the importance of being emotional stable and satisfied with life. Their preventive efforts include going to the pool from time to time, going to the country once in a while, and attending community events. None of the family members smokes or drinks. They do not eat snacks or junk food. L. cooks everything from healthy products she buys in the nearby mall.
To maintain the family's functional status, the A.'s should address the existing communication difficulties and, at the same time, become more active promoting their health and preventing disease. From the standpoint of the Health Promotion Model, the family should develop a better understanding of the perceived barriers of health promotion and acknowledge the existence of perceived barriers to disease prevention. They need additional information regarding the advantages of physical activity and healthy nutrition to develop positive feelings about its health outcomes. It is also strongly recommended that L. is exposed to new, positive role models to learn advanced communication and self-expression skills. The internal social network is strong enough to support her in her developmental achievements.
The family of choice displays the patterns of functional communication. It relies on a strong inner social support network. However, family members' participation in health promotion and disease prevention activities leaves considerable room for further improvements. Additional interventions are needed to develop a better understanding of perceived benefits and barriers to pursue health and wellness in a long-term perspective.