Family of Diversity Cultural Assessment Kristal T.

Abstract
The family discussed in this paper is of German/Islamic ethnicity. They are a multigenerational family living under one roof, and making the best of what they have. Living in the household is the mother (HW), the father (AW), paternal grandmother (JW), and two children (EW & RW). The mother has some issues that she is working through from her upbringing, and the father is somewhat distant. One of the children has a severe illness that dictates how everyone lives. Both the mother and father suffer from depression, and they feel that this affects their quality time with the children. The mother was extremely open in discussing her family, while both the father and mother in-law were more distant. Both of the parents work, and leave the upbringing of the children to the paternal grandmother. Overall the W Family is pretty Americanized, with only small parts of their culture coming up in daily life.

Family of Diversity Cultural Assessment
Family Description The family discussed in this paper is a multigenerational family. Included in the household is the father (AW), age 37, mother (HW), age 32, paternal grandmother, (JW), age 69, and two children (EW, RW), whose ages are 6 and 4 respectively. Both AW and HW are the biological parents to the children, with this being their only marriage. HW is a 1st generation immigrant with her parents emigrating from Tehran, Iran to England, and then to America when she was under 10. AW’s grandparents were German immigrants, so he was born in the United States in the South.
Both AW and HW have doctorates and are business owners. They share a law practice, and are both practicing lawyers with little free time. Any free time HW has she said that she tries to get outdoors with the kids. She enjoys hiking, biking, walking, and even fishing. AW says that he only likes to spend his free time drinking beer while watching football. The paternal grandmother JW helps with the children so that AW and HW can work. The W Family is considered to be upper middle class, which they say they are very fortunate for since they were raised so poor. There is no set religion in the W Family as they are atheists. They are teaching their children to view religion in an overview way. They teach them what other religions believe, but that even if they have differing views they are to respect what others believe. HW tells me that one of the ways she does this is by explaining to her children that even if they don’t believe in Santa other kids do, and that if would be really upsetting to those children if they told them that there is no Santa. HW was raised in a hodgepodge of religions, her father was raised Shi’ite Muslim in Tehran, Iran, and as a teen he would walk by a church and in a window they would have a Persian bible. Every day they would turn the page and he would come back and read it, and then he converted to Christianity. At this point his father kicked him out of the house. Years later he goes to Germany for the free University and met her mom. She was raised Lutheran so they were both Christian together. They went to Bournemouth, England and crossed paths with missionaries, and converted to Mormonism. At this point they decided to move to Salt Lake City. When HW was 3 here and her siblings were relocated from England to Salt Lake to follow the book of Mormon. Years later HW left the church, but she was raised in a blend of Mormon, Christianity and Islam because her father never wanted to commit to believing in one thing over the other and then point out to his children things that were consistent between the religions. HW says that her family does not get along or approve of her marriage to AW, and that this has put a strain on her relationship with her family. AW was raised in a catholic home by his mother. His father died when AW was very young and his mother never remarried. Since JW moved in with the W Family, she has changed her religion to adapt their views of Atheism. Neither AW nor JW were willing to discuss more of his family, other than to say that they live in the South. HW and JW have a very good relationship, HW says that JW has always been very welcoming and nice to her.
Developmental Stage and History of Family
The Calgary Family Assessment Model (CFAM) is a recognized template for nurses to use to help conceptualize and organize data gathered from working with families. It can be used to both compile data from a family assessment, but also may be useful when helping a family address a specific health issue. The CFAM can be seen as a branching diagram with three main categories: structural, developmental, and functional levels (Wright and Leahey 2009, Chapter 3).
Structural Assessment
The structural assessment can be broken down into the internal structure which describes the relationship between the family members, the external structure of the family and its relationships with family and systems, and the context or environment in which the family functions (Wright and Leahey 2009, p. 49-50).
The internal structure of the W Family is a multigenerational family that consists of a mother and a father in a monogamous marriage with two children, and paternal grandmother. The mother and father act as the family’s head and decisions makers with the grandmother taking up when they are working. The children are given a voice in decisions as the parents are trying to instill independence and free thinking.
The W Families developmental stage is that of a family with young children. HW has expressed that she would be fine having her children live in the house for as long as possible, but AW would like them out when they are 18. They have decided that this will be up to the children and they can stay as long as they have jobs and are getting good grades in school. HW was raised in a family that was expected to stay home until marriage. She says that she is the black sheep of her family because she did not do this, and her family is not welcoming to AW.
Environmental Data
The W Family lives in a 4 bedroom home, with everyone having their own rooms. HW says that even though the children have their own rooms they will typically co-sleep with her and AW. They decided to get a one story so that there would be no stairs that could hurt JW’s knees. They have a large backyard that is set up for the children to play in, but no pets. HW says that they do not have time for pets right now, but it is something they will revisit when the children are older.
They live in an upper middle class neighborhood, that they feel is safe. They have EW enrolled in a public charter school that works closely with them regarding EW’s allergies. The W Family feels they have a good support system. The mother in-law is their main source of social support. AW is pretty antisocial and does not have many friends. HW has developed a social support system that is based on play dates for her children, but these do not happen as often as she would like. Even though they do feel that they have a good support system, HW thinks that they should work on developing new relationships.
Family Structure and Communication Patterns The verbal communication within the household is only English. HW days that her parents decided when she was a baby that they would only teach their children English. They wanted to give what they felt was their children’s best chance for the future. HW says that she feels sad that they did not teach her the native tongue, she thinks that if they had she would feel more connected to her culture. AW’s family also only speaks English, but unlike his wife, he has no feelings of regret over not learning another language. The communication patterns within the W Family is very open. HW insists that her children have a voice, since she grew up in a very strict household with no say in anything. This made her want different for her children. They talk to the kids, but keep it appropriate so that their children do not have worries. They do not believe in letting the kids know about any stresses that could upset them. They HW and AW support each other’s parenting styles. They can calm each other down if they are upset. The W Family’s concept of time management is very lenient. HW used to be on German time, where 30 minutes early was considered late. After having children she is on “American” time, meaning that she is 10-15 minutes late everywhere she goes. She decided when she had children that she would not yell at them when they were leaving so they didn’t start their day bad. She says she would rather be late than to have her kids upset. Both AW and HW have a shared calendar that they consult before planning anything. AW and HW are not really focused on the future. They are both pretty depressed people, so even though they hope for the best for their children they say that “life is life and you can’t control it”. HW says that she just hopes to instill a love of learning in her children. The only form of planning they do for the future is they have set up saving accounts for both EW and RW.
Family Functions
The cultural beliefs of the W Family are the free thinking movement. They want their kids to be able to come to them with any decision they make, so that HW can help or steer them to a good one. She wants EW and RW to be able to make informed decisions and do what they want. She says that if they decided to eat meat, she would hope that they come to her so she can help them find humane sources. She does not want them to feel guilty for any choices that they make. She tries to give them a good support network so that they are not tempted to fall for seductive stuff like Mormonism, which she feels is exclusive. She hopes that her daughter likes herself enough that she will not change if a boy or girl that she likes wants her to.
The roles in the W Family are pretty secure and strait forward. They are both sources of income since they are practicing lawyers, and own their own practice. Both AW and HW are the decision makers in the family, but AW is the main disciplinarian with the children. HW grew up in a very abusive home so she is afraid of being too hard on the kids if she disciplines them so she leaves this up to AW. When HW gets upset she might yell at the kids, and then she feels guilty. She remembers how good she was as a kid because she was afraid of her father. She wants her kids to be good because they are, and not because they are terrified of her and AW.
The family is not in sync when they are trying to solve the problem. HW is a talker and wants to sit down and talk through their problems, while AW will go off and sulk for a few days. Both children seem to follow in AW’s footsteps and go to their rooms when they are mad or upset. JW would also like to talk through problems, but AW isn’t good at this.
The family’s physical and recreational practices are trying to get of the house as much as possible. There schedules do not permit this much, but they like to go bike riding, walking or even just to the park when able. JK likes to take the kids to the park after school for a few hours several times a week.
HW is mainly responsible for all the planning, shopping and preparing the meals. She feels that this is mainly because of EW’s illness, because she feels that she is more careful than AW is. She says that the chore was more even before having kids, but after she took it over because it was easier. She does have a google shopping list on both her and AW’s phone, which she fills out so if AW goes to a store he can get what she needs.
The W Family are vegetarians due to what they feel are ethical concerns. They feel that factory farming is bad, doesn’t treat the animals in an ethical manner. They eat veggies, fruits and grain, and mainly cook their own food. They have to be careful and cook most things because EW is severely allergic to nuts, and anything produced with nuts. This dictates a lot of what, how, and why they eat what they do. HW says that they do cook a lot of Islamic and German foods at home, but with alterations for EW’s allergy.
Peanut and nut allergies are the leading cause of fatal and near-fatal food-induced anaphylaxis in the United States (Oh, 2005, p. 1). EW has this severe of a nut allergy. She is among the small number of children who have to carry injectable epinephrine wherever she goes. Everyone in her family, including her little brother have been taught how to inject and use the EpiPen. EW was not diagnosed until she was almost two years old, and she spent that time be covered in rashes and having breathing problems. Her mother said that EW’s allergy is so severe that she will go into anaphylaxis shock if she touches something that someone else touched with a nut, even if this was already cleaned. Her family has made her environment as safe for her as possible, they have even found a school that will be extra cautious so she can have as normal of a life as possible.
In the CFAM, Wright & Leahey (2009) suggest assessing the family across the six stages of health and illness. These include the family efforts at (1) health promotion, (2) family appraisal of symptoms, (3) care seeking, (4) referrals and obtaining care, (5) acute response to illness from the client and family, and (6) adaptation to illness and recovery (Friedman, Bowden, & Jones, 2003).
HW understands and defines illness as any textbook would. Although, she says that her family is really weird about air conditioning, and won’t use it because it is fake and can make them sick, but that she finds this amusing. HW worries an unusual amount about losing her children, their heartbreak, and even false friends. She says that she tries not to let this get in the way of how her children live. They understand illness in a scientific way, except for AW who worries constantly that he will die at 40 since his father did. This unfortunately puts extra stress on his wife and mother.
The W Family does not have the best sleep habits. The kids are no longer napping, which upsets HW, because they get up at 5 am. She tries to have them in bed and asleep by seven, but they typically wake up and end up in HW’s bed. Both HW and AW have problems falling asleep and staying asleep. They had a home invasion a few years ago that they attribute to the sleep problems, HW says that any sound at night wakes her up.
Being that the family is very fact/science based they are understanding and ok with medications. HW says that even though she is good at giving the children what they need she would rather avoid medications as much as possible. HW’s family was more superstitious than she is, so they would try to avoid medication as much as possible, so some of this has rubbed off on her.
The families’ medically based preventive measures are pretty typical of American. They get whatever their insurance will pay for. They have full medical, dental and vision benefits, but HW says that she has a deep seated fear of the dentist, so she does not go as much as she should. She remembers that when she was a child, her mom took her to a dentist who would not let HK into the room, and this dentist held her nose closed so she would keep her mouth open. She remembers kicking and screaming, so this has scarred her into not going to the dentist as much as needed. She does take her kids twice a year for dental checkups. HW is not good at taking care of herself, she makes sure the kids have physicals and well-check, but she forgets about herself. Both HW and AW believe in vaccinations and believes if there is no health reason then everyone should be vaccinated.
The W Family has a long list of family health problems. Several of HW’s family have an autoimmune disease, this seems to run in her family. HW has a family history of: strokes, clinical depression, high BP issues, and obesity, rheumatoid arthritis, and food allergies. HW herself suffers from psoriasis, and her daughter EW has eczema and a severe nut allergy. AW has cholesterol, obesity, and strokes in his family. Both AW and HW have clinical depression. HW’s father had Polio when he was a child, and this affected his height. As of right now RW does not have any health concerns or allergies. The family’s beliefs and perceptions about birth and death practices are not totally based on their cultural beliefs. HW is pro-choice, and believes that life begins at conception. This caused some strife when she and her husband were expecting EW, because AW wanted to screen for Down’s and possible terminate if it was positive, while HW would never consider doing this. HW says that she was raised to believe that there are little children waiting on a cloud for their forever family, but that she no longer believes this. She does feel on a personal level that the medical society is intervening too much with things that women have been doing for centuries, but on a scientific level she says she understands the need for hospitals and nursing staff. HW says that she has not experienced much death, but that she does want to follow the Islamic practice of being buried the next day, but instead of being buried she wants to be cremated.
HW and AW do not believe in having any sociocultural events impacting their children. They feel that they are too young to know about anything that can be sad or upsetting. HW has a brother that is fighting in Afghanistan, so they do talk a little about this, but not too in depth. AW does not like Christmas, because his father died on Christmas day when he was a child. Even though AW does not celebrate Christmas HW loves it. It is her favorite holiday of the year, because “in the dark of winter everyone gets together to celebrate family, life and light are wonderful”. She also celebrates the German tradition of Christmas Eve, Persian New Year, and Advent calendars, St. Nicholas Day, and she also celebrates the basic holidays like Halloween, Easter, and Thanksgiving.
Family Stress and Coping Mechanisms
There are several stresses that affect the W Family. HW feels that she expects too much of her children and that this can be a stressor. She feels that she compensates for how poor she grew up by buying her children more things. HW struggles with teaching her kids to be respectful and appreciating what they have, but not making them feel guilty. EW’s allergies are a large stressor for the family. They have to be so careful not to have any form of exposure that can make EW sick.
The coping mechanisms that the W Family uses are not particularly healthy. HW uses food as a coping mechanism for both good and bad stress, she will find herself getting up in the middle of the night for a snack when she is upset. This stresses her out since obesity runs in her family. AW uses alcohol and will leave for a few days when he gets stressed or upset. HW says that he will stop drinking after a while, and say that he can’t do that anymore because it is not good and then will relapse. Both of the kids have a habit of throwing fits and raging when they are upset, but afterward they are fine.
Circular Questioning
Wright & Leahey (2009) differentiate between two types of questions used in assessment to help investigate problems. First, linear questions are used to investigate a problem. Linear questions are often used to begin an assessment and gather information. Circular questioning is then used to explore topics and promote conversation. Circular questions are meant to effect change (Wright & Leahey, 2009, p. 146). I used both circular and linear questions during the interview to get them to open up to me as much as possible. The wife HW was more receptive to answering questions than her husband or mother in-law.
Family Summary The W Family is structurally diverse, generationally mixed family, which is the product of two different cultures coming together. Their overall communication could use some work, but they are very focused on what they believe is best for the children. All the adults living in the house place their focus on the kids and their well-being. Both parents are the wage earners for the house, with HW and JK also managing the home and day to day issues. They are adaptable, which is demonstrated by their ability to cope and provide as normal a life as possible with EW severe allergy to all nuts.

References
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