Essay on "Family Intervention"

Essay 7 pages (2452 words) Sources: 4

[EXCERPT] . . . .

United States is characterized as a nation of immigrants. Culturally, the United States is in somewhat of a conundrum regarding immigration. As a nation, we know that the types of jobs many immigrants take (cooking or dish washing in food service, hotel and janitorial work, agricultural work), are those that most Americans would not choose -- therefore we know we need someone to take those jobs. On the opposite side, we remain concerend about the fiscal costs for social services, education, and children born in the United States who are then, legal citizens. Latinos now constitute about 16% of the U.S. population, the second largest ethnic grou p in the country, or just under 50 million people (Bureau, 2008). There has been a continual Latino presence in the United States since the 16th century, earlier than any other ethnic group with the exception of native Americans. 64% of this population group are from Mexico; 9% from Puerto Rico; and 3% each from El Salvaro, the Dominican Republic and Cuba. The other 18% are from other areas or of unspecified origin (Center, 2008).

Family Background -- the Hernan Family - Developmental stage, family functions & acute/chronic stressors. Luis and Maria brought their family to the United States because of the chronic unemployment in Puerto Rico. They both graduated from Secondary School, although monetary and family responsibilities prohibited them from college or advanced trade school. Luis was a mechanic and bus driver in Puerto Rico, and was able to take his Class CU.S. Certification. He is a full-time driver for the city's Metro Bus Service, which is a medium income job, and because it is a City Government position, has decent benefits. Maria worked in a poor-quality "sewing" shop in Puerto Rico, but managed to find a position with a Dress Shop/Tailor catering to the Latino immigrant community. She specializes in wedding gowns, but is only paid hourly -- her job has no benefits. Jorge is a typical teenager, bright in some subjects, lazy in others. However, he does have chronic asthma, and is thus prevented from too many outdoor or physical activities. Isabel is quite studious, straight a's, but yearns to belong.

The Hernan family structure is fairly strong, more matriarchal than patriarchal, though. Maria handles the finances, and organizes the home. She does not yet drive, which causes some stress and concern regarding getting the children where they need to go, particularly with Jorge's asthma. The parents are conservative Catholic, and cannot understand why their children seem to be drawn more to the secular side of American culture. They are economically able to afford cable television, and each child carries a cell phone, as does Luis. Education is a strong priority in the household, and both children have expectations and consequences to poor grades and poor social performance. While the parents want their children to understand their heritage, they are supportive, to a degree, of the children's desire to acculturate into mainstream American culture.

Family Assessment & Diagnosis Using Marilyn Friedman's Model of Assessment -- Within any healthcare situation, numerous factors are part of the assessment process; not just in the identification of family needs, but in the manner in which the immigrant family presents special challenges in the U.S. healthcare situation.

The Friedman Model of Family Assessment is based on numerous other medical, psychological, and social theories, including both developmental and systems theory. For Friedman, the family is a social system, but one that is a subsystem of society at large. The model provides guidelines for family nurses as they interview families about structure, functions, socialization, coping mechanisms, and attitudes towards medical care. It also focuses on the internal and outward stimuli regarding problem areas within the family structure, and ways to identify and mitigate dysfunctional systems (Brandel, ed., 2011; Kerson and McCoyd,2010 ). It is important to note that the strength of the Friedman model regarding immigrant families is its ability to encounter non-traditional family structures and cope with alternatives to the nuclear family model. Instead, Friedman suggests that there are many functional types of families that do not fit a "mold" but that require a skeleton of analysis in order to provide better healthcare options for that individual grouping (Friedman, 2005). Table 1 provides a further example of the manner in which Friedman suggests a family assessment be organized:

Table 1 -- Friedman Family Assessment Model

Common Traditional Family Forms

Common Non-Traditional Family Forms

Nuclear Family -- one parent, living in the same household: a) first marriage or, b) blended or step-parent families

Unmarried parent and child living alone, usually mother and child

Nuclear Family -- husband, wife and children living together: a) first marriage or, b) blended or step-parent families

Unmarried couple and child living together -- usually a common law marriage

Nuclear family -- husband and wife living alone; childless or no children living at home: a) single or b) dual career

Cohabiting couple -- unmarried couples living together

Single-parent family; female or male head of household as a result of divorce, abandonment, separation, or death.

Same sex persons living together as partners

Extended family -- parents, grandparents and children living together

Extended family -- same sex persons with grandparents or additional family members

"Empty nest" families -- older couples living alone: a) children at college, or b) children have family of their own

(Adapted from Friedman, 2002)

Overall Family Structure Assessment - Within the framework of nursing, a family is represented as a group of individuals, typically related, but not always, that exists to meet the needs of its members. Regardless of the composition of the family, it performs several essential functions:

Nurturing and nourishing the young.

Economic survival and support for family members.

Safety of family members from threats to survival, especially as concerns the young, the old or disabled.

Transmission of cultural beliefs, traditions and values to the next generation.

Provision of care and support for family members in times of health and illness.

Providing a setting for love, companionship and intimate relationships.

In many societies, the family is part of the larger system of society, and supported by social welfare and law enforcement agencies, religious institutions, schools and health services in carrying out its functions. Typically, families operate with some degree of dysfunction; it is unlikely that most family structures are 100% functional, rather it is the degree of dysfunction that concerns the healthcare provider. For example, the term 'dysfunctional' is used to refer to families who may not be coping or functioning well in society and who exhibit low self-esteem, both as individuals and as a family group. Dysfunctional family communication patterns perpetuate low self-esteem and are often characterized by 1) self-centeredness, 2) the need for total agreement and/or 3) a lack of empathy (International Council of Nurses, 2002).

In the particular family modeled for this essay, the immigrants are Puerto Rican; nuclear family -- the Hernan Family - mother, father, 16-year-old son, 9-year-old daughter; children born in Puerto Rico; grandparents and large portion of extended family remain in Puerto Rico. Immigration to the United States was done for economic reasons; mother and father are marginally educated, but not professionals. Children had some English language training in school, and are reasonably proficient in English; parents are moderately proficient in English.

Figure 1 -- Eco-Map

Figure 2 -- Genogram, Hernan Family

Key -- Female

Male

Deceased X Age =

Table 2 -- Family Issues (Gracia, 1999)

Strengths

Weaknesses

Nuclear Family; strong bond, both parents home evenings and weekends; take part in school and learning activities

The children have surpassed their parents in intellectual pursuits and language acquisition and usage

Solid marriage, family dinners, family outings

Luis often defers to Maria, who tends to be controlling; Maria expects her children to behave as she did regarding parental authority

Decent, middle class economically; healthcare plan, above poverty level

Children are torn between traditional Latino family and, especially because they are above the poverty line; blending in with American children of higher income levels

Strong moral and religious views; expectations of good grades and moral behavior in school

Jorge is rebelling and wanting to experiment more; has a decent group of friends, and is not predisposed to drug abuse, but is entering the sexual experiment phase; Luis is worried about his son's masculinity

Table 3 -- Family Diagnosis

Issue

Commentary

Rigid, authoritarian mother

As children age, may become an issue of contention as teens rebel against authority; especially authoritarianism for simply the reason of "I said so"

Concerns over Jorge's masculinity

Because of Jorge's asthma, he is not involved in team sports, and tends to be a more reserved, intellectual young man. His peer group is, like him, mostly slender, androgynous young men into video games, odd color and style combinations, and a more European "look." Both parents are uncomfortable discussing sexual issues openly with their children

Maria's dependence on alternative transportation

Maria often feels trapped; she needs to get her American driver's license so that she can be more independent and… READ MORE

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