Chronic Health Challenges Living with a chronic health challenge is different for each individual. The purpose of this assignment is to achieve a better understanding of family centred care and how copping with a chronic health challenge effects both the individual and their family. By conducting two interviews using the Calgary Family Assessment Model (CFAM) as well as Rolland’s Chronic Health Challenge Framework the student nurse is able to identify different areas of the patient’s life to which their chronic health challenge may be affecting them. Within the CFAM there are three main categories which contain multiple subcategories. Each individual subcategory will allow the student nurse to extract relevant information that will assist on determining the family strengths and weaknesses. When conducting the interview, the student nurses did not ask any questions regarding gender, sexual orientation, social class, and all subcategories under expressive. In order to maintain confidentiality throughout this assignment all names have been changed. The individual interviewed will be referred to as Ben, his partner as Alice and his four children will be named Rachel, Lexi, Angel and John. These alternate names will also appear on the genogram and ecomap found in appendix A and appendix B. Ben has multiple chronic health challenges, throughout this assignment will we be discussing his two main chronic illnesses; chronic obstructive pulmonary disease (COPD) and Parkinson’s disease. Structural; Internal Family composition Wright & Leahey (2009) stated that family is defined as “a group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one another’s lives” (p. 73). As stated by Ben “family is your ancestry, it is where you come from and with who you share your life with”. Ben had stated that he did not have a strong connection with his parents or his siblings when he was a child. His father had unfortunately passed away early on in his life and that made it difficult for Ben to give affection to his own children. In 1966 Ben and Alice got married forming a nuclear family and had four children, three daughters; Rachel, Lexi, Angel and one son; John. Sadly, Lexi passed away at six-months of age due to sudden infant death syndrome also know as SIDS. According to Goldberg, Rodriguez-Prado, Tillery, & Chua, (2018) the causes for SIDS is still unknown but there are some risk factors that increase the likelihood of SIDS. Ben also stated that his five grandchildren (four granddaughters and one grandson) were also apart of his immediate family, see genogram in appendix A for a visual representation of Ben’s family. Rank Order Out of Ben’s children Rachel who is in her early 50’s is the eldest, she was born within 4 years of Ben and Alice getting married. Lexi would have been the second eldest child/daughter but she unfortunately passed away as an infant, she would have been in her late 40’s. Angel is the youngest daughter and is in her mid 40’s and lastly John is the youngest child and in his early 40’s. Out of Ben’s four children, Rachel and her partner are the most involved with assisting Ben and Alice. The couple makes it a priority to visit Ben and Alice every weekend so checks up on them as well as assist them with tasks. Subsystems Ben is a part of many subsystems, he is a brother, a husband, a father and a grandfather. As a child Ben did not have a good relationship with his siblings, they would often argue and not get along. As they grew older their relationship matured and a friendship developed. After Ben got married his relationship with Alice evolved over time and they became closer as a unit, learning to adapt to each other strengths and weakness. Ben had a difficult time adapting to fatherhood and found it quite difficult to show his affection for his children when they were young. Now that they are adults, Ben’s relationship with his children has greatly improved. Boundaries When Ben’s children were younger, he had a difficult time expressing and showing his affection to his children. Alice was the main caretaker of the house and children while Ben was away at work. Since Ben has retired and his children are grown, he has a better relationship with them. He is able to be present in their lives more so now then ever before. Structural; External Extended family Ben has a vast knowledge of his ancestry and family ties. As a child and young adult, Ben would be sent to stay with his aunts and uncles periodically. He developed a close bond with three of his uncles on his mothers’ side and still maintains that bond today. Ben has a large extended family, one uncle and seven aunts on his fathers’ side, and four uncles and three aunts on his mothers’ side. Throughout the years Ben has lost touch with many of his extended family members but still remains in close contact with a select few. Larger systems Larger systems such as the seaway valley community health center (SVCHC) and the patient support program have become a huge support in assisting Ben with his chronic health challenges. The SVCHC assist Ben in communicating with his respirologist via telemedicine, smoking cessation and chest physiotherapy. Due to his smoking history, Ben suffers from chronic respiratory infections. The SVCHC is able to assist Ben with treatments and educate him on preventative measures in order to avoid further respiratory infections. Ben has also become a patient in the patient support program experimental Immunoglobulin trial. According to Comeford (2017) the goal of this immunoglobulin trial is to improve Ben’s immune system in order to decrease the number of respiratory infections he acquires (p.627). As stated in Touchy, Jett, Boscart, & McCleary (2019) older adults are already at an increased risk for infections due to their age-related changes and therefore Ben’s risk for infection is even greater (p.84).Structural; ContextEthnicity and Race Ben and his family are caucasian and from European decent. His great grandfather on his mothers’ side was born in England and immigrated in 1901 to Canada Nova Scotia. His father’s family immigrated to Canada in 1634 from France. Ben was born in his childhood home near the town of Cornwall. His four children were all born in Cornwall expect for Angel, who was born in Sudbury. Ben’s family was often referred to as gypsies due to their horse-trading business in the town of Cornwall. During the second interview Ben showed the student nurses the newspaper article that a family friend had published in the 1990’s referring to them as gypsies. Religion and/or spirituality Ben and his family are roman catholic; however, he and his partner Alice no longer practice. When Ben was a child, he and his parent and siblings were very involved in the church. Now, Ben does not feel the need to practice his religion like he once did as a child. Environment Over the course of Ben’s life, he has moved multiple times, for two brief periods of time Ben and Alice lived away from their hometown. Currently Ben and Alice live in a one-story bungalow house located in close proximity to town. Their house is far from the road giving them privacy and allowing them to have minimal noise from passing cars. They are good friends with their neighbours and enjoy the location of where they currently reside. Developmental; Stages According to Wright & Leahey (2009) there are six stages of the family life cycle in the CFAM. The first stage is leaving home, followed by the joining of families through marriage, family with young children, families with adolescents, launching children and moving on and lastly families in later life. Ben and Alice are currently in the sixth and final stage; families later in life. Ben had a difficult time adjusting to retirement. He no longer participates in many of his friends get to gathers, and spend the majority of his time at home watching television, doing chores out in his garage, or going to doctors’ visits. Developmental; Task Ben does not participate in any activities within his community. In the past Ben and Alice would often meet with friends at a local coffee shop and every month they would play cards at a neighbouring friends house. Now they do not participate in those activities anymore. Ben’s tasks revolve around yard maintenance and snow removal while Alice is in charge of maintaining the house and preparing all meals for both Ben and herself. Developmental; Attachments Since Ben has retired, he has had the opportunity to travel and visit his ancestor’s homelands. He has travelled to England and France as well as the Philippines. As stated previously Ben did not have a close relationship with his children when they were younger. Now that they are adults, he has a better relationship with all three of his living children. Rachel and her partner visit every weekend, he frequently talks to Angel and John on the telephone and they visit every few weeks. Functional; Instrumental Activities of Daily Living (ALD’s) As Ben has gotten older the majority of his activities of daily living have become more difficult for him to complete. Due to tremors related to his Parkinson’s he has a difficult time with fine motor skills such as writing and doing up the buttons on his shirt. According to Ben, he had stents inserted into his legs a few years ago and they have greatly helped his mobility. He is now independent with personal care (bathing, dressing, and grooming) and does not need to rely on his walker as much. With assistance from the SVCHC Ben has been able to decrease the frequency of respiratory infection and has improved his overall lung function. This has allowed him to take few breaks when ambulating and gives him more independence with his personal care and allows him to continue on managing the yard work and snow removal. In Rolland’s framework, he emphasizes the importance of the bond between an individual’s chronic health challenge and its effect on their family (Rolland, 1987). In Rolland’s framework (1987) there are four main guides used to estimate “the most psychosocially significant” coalition between “the illness and the family” (p.1). Those four guides are; onset, course, outcome and incapacitation. According to Rolland (1987) Ben’s COPD is considered a gradual progressive life shortening illness and his Parkinson is considered a gradual progressive nonfatal illness (p.3). The onset is the speed at which the illness first appears and how quickly the family must adapt; for Ben both his COPD and his Parkinson’s were gradual, allowing him and his family more time to adapt. The course, is the progression of the illness’s severity; in Ben case the course for both chronic illnesses is progressive meaning that the illness’s will gradually get worse over time. The outcome, is what the expected degree of the illness, unfortunately for Ben, COPD is a life shortening illness where as his Parkinson’s is a nonfatal illness. Lastly incapacitation is the impact the illness will have on the patient’s cognition, both COPD and Parkinson’s will affect Ben cognitive function over time, therefore the family will notice subtle changes in Ben personality and alertness. Within Rolland’s framework he described three phases at which individuals with chronic illnesses will go through; crisis, chronic and terminal. Ben has been living with these chronic illnesses for many years, according to Rolland’s time phases of illness Ben is considered to be in the chronic phase, “it is an era that can be marked by consistency, progression, or episodic change” (Rolland, 1987, p.4). During this phase Ben’s illnesses will become progressively worse. His lung function with decrease due to his COPD and he will gradually lose muscle function, have increasing tremor and tire easier from his Parkinson’s. The CFAM and Rolland’s Chronic Health Challenge Framework assisted the student nurse in achieving a better understanding of family centred care and how copping with a chronic health challenge effects both the individual and their family. The student nurse is able to identify different areas of the Ben’s life to which his chronic health challenges may be affecting him and his family as well as determine his family’s overall strengths and weaknesses in relation to his chronic health challenges.