Patient's Diagnosis & Interventions Using CFAM / CFIM Approach
Patient's Diagnosis & Interventions USING CFAM/CFIM Approach
Patient's Diagnosis & Interventions
CFAM / CFIM Approach
The Calgary Family Assessment Model (CFAM)
Strengths of the Family
Weaknesses of the Family
Calgary Family Interventions Model (CFIM)
Diagnosis, Goals & Interventions
With the advent of new research in nursing, nursing practices are becoming more sophisticated and extensive. From mere patient care, nursing practice has moved onto complete patient care which involves eliminating elements other than illness, causing distress to the patient. Where prior nursing practices emphasized on treating the medical reasons causing the illness, the new model focuses on providing a living environment to the patient who is conducive for him / her. The given research paper is based on the evaluation of a patient by using CFAM / CFIM model presented by Lorraine M. Wright and Maureen Leahey. The given model allows nurses to analyze patient's state with reference to patient's living conditions and prevailing relationships with family. The research further focuses on performing patient's diagnosis, prescribing interventions on the basis of long-term and short-term objectives. The intention is to make patient overcome the illness and eliminating the factors causing distress and trauma. From family's perspective, the objective is to create the situation conducive for desirable change and then overcoming the actual problems.
The Calgary Family Assessment Model (CFAM)
CFAM and CFIM stands for the Calgary Family Assessment Model and the Calgary Family Intervention model respectively (Wright & Leahey, 2005). CFAM and CFIM are based on nursing models derived from several other theories such as systems theory; communication theory, and change theory (Wright & Leahey, 2005). Where other frameworks presented theoretical applications, CFAM / CFIM presented practical mode of interventions. The model emphasized on using graphic representation for practical references. Creation of genomap and ecomap (2009) is an extension of this model. The overall goal of this model is to evaluate the patient as a unit of a family system and also analyze the impacts of family life and social structure on the well-being of the patient.
For this purpose, this nursing model suggests that the nurses should interact with the family and then identify the causative agents resulting in patient's distress. The overall goal is to increase the family's resources through a variety of nursing interventions, which may include providing information and education, externalizing problems, confirming/normalizing emotional reactions, encouraging the family to talk about their experience with the illness, and mobilizing family support (Wright & Leahey, 2005). Discussing the factors other than medical interventions with patient's family ensure that the family makes contribution to the recovery phase of patient and they are also provided with solution for the problems which are troubling the whole family as a nucleus. Hence, taking the family structure and their living style with environmental factors in accounts and finding the foundation of health problems can act as the useful intervention by the nurse.
There are three essential dimensions of family evaluation which includes the following:
Family structure defines the dimensions of the family with reference to internal and external components and also in the frame of context. The internal dimension defines the role and status of the patient in the family. For this purpose, factors like sub-systems, gender role, boundaries, sexual orientations, boundaries etc. are used. External orientation sheds light on the relationship with the family, relatives, social knots etc.
With the help of CFAM / CFIM, this research paper is meant to perform diagnosis and provide suggestions for suitable interventions for Mrs. Jones. Mrs. Jones is a 78-year-old woman. The patient diagnosis is performed by keeping the family problems in consideration (Wright & Leahey. 2005; Wright, Watson & Bell, 1990). She has been admitted to an elderly care ward after a history of falls. Mrs. Jones lives in a flat with her daughter and son-in-law. She is mainly house-bound but is taken out most weeks by her family. She is content with these arrangements and has refused further social support reporting that she is happy with her own company. Her family does her shopping, washing etc.
She has a history of hypertension. Mrs. Jones appears to have a good understanding of her condition. This has been well controlled on bendrofluumethiazide (bendrofuazide) 5mg in the morning. She is normatensive on admission and her blood pressure appears to have been stable over a long period of time. Since her daughter and son-in-law are employed, therefore, she has to use frozen meals for lunch which she cooks in a microwave oven. There is no carer to help her. These frozen meals are her choice of food at lunchtime and a dietician was involved in selecting the correct range of meals. However, her family faces difficulty in arranging meals of her choice due to their busy schedule.
She suffers from osteoarthritis in her hips and takes paracetemol 1g four times a day. She mobilizes without any assistance which has been diagnosed as a cause of her problems. She has a wound on her shin where she fell which became infected and is slow to heal. She has a history of urinary stress incontinence which was fully assessed a couple of months before. She follows a routine to minimize incontinence but does wear pads. She is running low of these. Mrs. Jones takes alendronate 10mg daily to prevent fractures, she has mild osteoporosis. This is proving effective and no change is planned for this. She takes these 30 minutes before food in the mornings while sitting up.
During her 10 day stay in hospital she is found to have postural hypotension as a result of her diuretic. This is believed to be the cause of her fall. The physicians found from her medical history that her blood pressure becomes raised if she stops her diuretic so she will continue on her bendroflumethiazide when she goes home. She has been started on co-codamol 8/500 two tablets every 6 hours to manage her pain better and her paracetemol have been stopped.
Mrs. Jones is keen to go home. The MDT would like to keep her in a little longer but Mrs. Jones thinks she is well enough so the doctors agree to discharge her ten days post-admission. Apart from the wound and the analgesia, there are no planned changes to her care. Mrs. Jones has complained about lack of care from her family. Mrs. Jones does not share a very cordial relationship with her daughter. According to the interviews conducted earlier, it was observed that Mrs. Jones daughter Matilda is married. Matilda and her husband Walden is Mrs. Jones only family. They are both employed. Since Mrs. Jones has multiple health issues, therefore they face a lot of difficulty dealing with her. Due to this, their own relationship is getting strained. Matilda is not willing to transfer her to elderly homes but is worried about her marriage and career.
Considering the dynamics of this family, it can be observed that this family can be related to various subsystems as per CFAM / CFIM model. Matilda herself belongs to a single child sub-system whereas Mrs. Jones and Matilda both belong to female health system. Similarly, Matilda acts as the financial support for Mrs. Jones as her husband doesn't share very cordial knots with Mrs. Jones. Therefore, she has adopted a traditional role of a man in Mrs. Jones life. Boundaries in this family are very clearly defined and the roles and responsibilities are well-assigned. As far as rank order is concerned, Mrs. Jones son-in-law is the head of the house but he has given reasonable liberty to Matilda so that she can make decisions for Mrs. Jones. And, Matilda in turn, takes Mrs. Jones opinion into account prior to actually making any decision.
External system of this family is rather limited. Mrs. Jones has one sister and few other cousins who come to over to meet her only on occasions. However, she does wants to see them more. The larger system further includes few neighbors and social institutions. Matilda and her husband perform shopping for Mrs. Jones and also have special arrangements made for her meals but Mrs. Jones does not have direct interactions with these social units. She does visits hospital and a local clinic quite often for regular checkups.
Context of the family defines race, ethnicity, social class, neighbors etc. Considering Mrs. Jones case, although being a Catholic Christian, her family's background and religious beliefs tend not to have much impact on lifestyle. It's her relationship with her daughter which serves as the source of complexity for her medical condition.
CFAM / CFIM theory suggests that a family goes through various developmental stages. According to various family-based theoretical models which act as the foundation for CFAM model, the family development begins with a young adolescent leaving home (Weber & Kelly, 2009). Then, family system combines by the…