Running head: MOVIE FAMILY CARE PLAN

Movie Family Care Plan
Marcheta Hays
University of Phoenix

Movie Family Care Plan
Introduction

The intent of this paper is to assess and develop a care plan for a selected patient and their family. Attention will be directed to the family structure and function and the interactions between the patient and the family.
SW is a single white female living New York City. She is a successful playwright in her thirties and her health status is free from disease or illness. There are no current physical manifestations of illness for SW; however she has had periods of psychotherapy for unresolved childhood issues and ineffective copying mechanisms.

Family Members
SW
Age- mid thirties
Sex –female
Marital Status – engaged to CM
Ethnicity- Caucasian
Religion- Catholic
Education- College degree
Occupation – Professional playwright
Interests and Hobbies – unknown

VW
Age- 60-70
Sex –female
Marital Status – married to SJW
Children – 3 female, 1male
Ethnicity- Caucasian
Religion- Catholic
Education- some college
Occupation – homemaker
Interests and Hobbies – socializing with life-long friends the Ya-Yas

SJW
Age- 60 -70
Sex –male
Marital Status – married to VW
Children – 3 female, 1male
Ethnicity- Caucasian
Religion- Catholic
Education- some college
Occupation – Farmer
Interests and Hobbies – unknown

CM
Age- mid thirties
Sex –male
Marital Status – engaged to VW
Ethnicity- Caucasian
Religion- unknown
Education- College degree
Occupation – Professional role
Interests and Hobbies – unknown

Ya-Yas
Age – 60 -70
Sex – all female
Marital Status – current status unknown but all three were married at one time
Ethnicity- Caucasian
Religion- Unknown
Education- some degree
Occupation – homemakers
Interests and Hobbies – unknown

Family Profile

SW’s childhood was spent in Southern Louisiana in a traditional nuclear family consisting of both of her parents, two younger sisters and a younger brother. All family members are of the Caucasian race. Her mother is housewife and her father is a large cotton farmer and they were of the Catholic faith. Family dynamics were complicated with her mother’s bouts of substance and alcohol abuse, her mother’s own unresolved family issues and a frequently absent father. SW often found herself as the caretaker for her siblings during times of her mother’s illness of addiction to alcohol and the resulting treatment. While affection was in abundance, there were several periods of physical and emotional abuse that SW and the other children were subjected to. The family appears to function well on the surface with a group of life-long friends and other social acquaintances. However, long standing, unresolved issues and ineffective coping among the family has resulted in destructive behaviors and ineffective communication patterns between SW and her mother, VW. New misunderstandings between SW and VW have escalated, and the relationship is even more strained, as both, mother and daughter are codependent on each other’s compulsive outbursts of destructive behaviors. SJW, the father appears to have a close bond and good communication patterns with his daughter, SW. However, many of the family issues seem to have been swept under the carpet and not truly addressed, nor resolved, but accepted as part of the old Southern lifestyle. SJW is the head of the household and makes the financial decisions for the family. Though out the years, VW’s compulsive behavior and substance abuse has made the role distribution difficult for all family members. SJW primarily remained in the background and only took over family–child decision making duties when VW was unable to perform the duties.
The families’ economic status allows for a comfortable lifestyle. Basic self-care requisites of air, food, water, and healthcare needs are being met for all family members without any self-care deficits in those basic needs. Both, SW’s and the family home appear to be well kept and contain all of the household needs for a comfortable lifestyle. There were no safety hazards to be seen and preventive measures were practiced as seatbelts were worn when in a vehicle. Both households are large enough to allow privacy for the individual family members. The community neighborhood was not visible, although while VW and her friends drove through the community, it appeared safe, open, and friendly.
The husband and wife relations of VW and SJW been strained for many years of their marriage. The couple has had separate bedrooms for many years. They appear to coexist in the household as husband and wife but lack physical or sexual affection towards each other.
SW and CM share open affection to each other. Their physical and sexual relationship is healthy and natural appearing, as they cohabitate together in the state of New York.
All family members appear to be well educated. Other than SW having completed college, the actual educational level of all family members is unknown. English is their primary language and all family members can communicate well in the spoken and written word. The actual health status of each family member is unavailable. All appear to be currently in good health. However, as a recovering alcoholic with a history of an involuntary admission to a mental health facility for substance abuse and physical aggression to her children, VW continues drink alcohol on a daily basis. The continued use of alcohol and denial of family issues has caused stress between SW and VW. SW has had many years of psychological therapy attempting to come to terms with her feelings regarding her relationship with her mother. The health status for VW’s life-long friends, the Ya-Yas is not all clear. All but one, of the group of women appears to consume alcohol on a daily basis and she is a recovering alcoholic. Two of the three women smoke, including one who needs oxygen for breathing difficulties.

Family developmental Stage
This family is in two different development stages. SW and CM are in Erikson’s Intimacy and Solidarity vs. Isolation. They are seeking companionship and love through a satisfying relationship. They have committed themselves to marriage and starting a family. VW and SJW have reached Erikson’s Integrity vs. Despair stage of development. While able to look back on their lives, SJW appears to be content and feels fulfillment for a meaningful life, however VW cannot. A misleading magazine article has caused further ineffective coping skills and resentment between SW and herself. Her old unaddressed family and personal issues have caused her despair and she struggles to find acceptance of her perceived failures.

Self-care Requisites Deviations
Through the interventions of the Ya-Yas and CM, the ineffective communication and coping mechanisms of mother and daughter are brought to attention. While their methods are unorthodox, unknown family issues are discussed and made clear to SW, shedding new light on multiple misconceived notions about her childhood and her mother’s past behavior.

Nursing Diagnosis

1. Family coping, disabled, related to significant person with chronically unexpressed feelings of guilt, anxiety, hostility and despair as evidenced by verbal and physical aggression directed at family members

2. Self-Esteem, Situational Low related to development of a negative perception of self-worth in response to calling off wedding and the possible inability to be a good mother to her future children.

3. Spiritual Distress, actual, related to alteration in behavior and mood as evidenced by anger, crying, withdrawal, preoccupation, anxiety, hostility and apathy directed to her daughter.

4. Family Process, interrupted related to situational crisis as evidenced by escalated rage between mother and daughter after publication of daughter’s interview.

5. Family process, dysfunctional related to inadequate coping skills, lack of problem solving skills, and addiction.
Goals
The main goal is to improve communication within the family, improve understanding and the ability to communicate between mother and daughter, father and mother pairs; enhance coping skills and techniques for each family member and the whole family as a whole; reduction of stress and an involvement of all family members in a trustful, open relationship.
Interventions
1. Promote honest, open conversation between all family members. Teach and promote the use of active listening techniques for a better understanding of each other’s issues and concerns. Teach and encourage the use of open ended questions for letting other family members have the chance to express concerns and explain their behaviors; promotion of open discussion and identification of points of misunderstanding for clarification of the internal feelings of all family members.
2. Allow the patient to express worries and concerns toward her future role as a wife and mother; promote positive feelings and attitude toward these roles; help the client to ascertain why and how she can maintain self-esteem; encourage support person (friend or fiancé) to participate in conversation and expression of feelings toward future changes in roles and responsibilities of a new family
3. Identify factors that are contributing to ineffective coping (stress, fears, depression, guilt, passive acceptance of traditional behaviors, anger toward someone); involve significant others in the discussion and problems solving tasks; allow the client to define and express her values and expectations in relation to her connection and communication with her daughter; respectfully ask her for validation of her input in the relationship with her daughter; encourage contacts with support person or friends; encourage seeking spiritual calmness through church or prayer; assist with development of problem solving behaviors and open expression of thoughts and concerns rather than acting out.
4. Encourage open conversation between mother and daughter for clarity and clear messages from both sides; encourage honest and clear expression of thoughts and worries toward each other; promote discussion of behaviors to help to identify why these behaviors are destructive and not effective.
5. Promote honest, open conversation between all family members regarding their feeling toward the alcohol addiction issue; assist with identification of problems that are “resolved” with alcohol consumption; promote verbalization of behaviors and identification of negative effects of these behaviors; teach relaxation technique for stress reduction and enhancement of coping skills; help to identify support systems within family, in the community, or others and utilize them as needed.
Evaluation
To evaluate the interventions outcome, the nurse should reassess the communication patterns within the family, between family and friends and between parent-child pairs and husband-wife pairs of family members who had prior difficulty in engaging in effective conversation, meaning SW and VW as the primary source of conflict; evaluate utilization of support system by all family members, their ability to engage in reflective conversation, and ability to solve problems effectively.
Conclusion
Although SW has many unresolved issues and ineffective coping mechanisms, it would be very difficult for the heath care professional to assist her to reach a good outcome based on individual treatment. A good patient outcome can only be reached with family focused care. The ineffective coping mechanisms and communication skills have hindered the family development for many years. Her mother’s unresolved grief of her first love and own dysfunctional family, negatively affected her marital relationship, resulting in substance abuse and physical aggression to her resented children. This resulted in SW doubting her ability to have a successful family. All family members have been affected by the unresolved issues and ineffective coping so all must be considered in the plan of care for healing to start and move toward the self care requisite of normalcy.

Reference Cox, H. C., Hinz, M. D., Lubno, M., Scott-Tilley, D., Newfield, S. A., & McCarthy Slater, M. et al. (n.d.). Clinical applications of nursing diagnosis: adult, child, women’s, psychiatric, gerontic, and home health considerations (4th ed.). (J. C. Brandt, Ed.). Philadelphia: F.A. Davis Company.