Calgary Family Assessment Model: Diabetes Home Care Case
This case study presents a comprehensive family home care evaluation of a 66-year-old male with multiple poorly controlled chronic conditions, including Type 2 diabetes, hypertension, hyperlipidemia, morbid obesity, and resolving cellulitis. Using the Calgary Family Assessment Model (CFAM), the clinician examines the structural, developmental, and functional dimensions of the patient's household, which includes his wife and an adult son. The assessment identifies critical knowledge deficits, relative social isolation, family communication barriers, and the potential for family members to actively support disease management. A detailed care plan addresses dietary education, blood pressure and blood sugar monitoring, specialist referrals, and lifestyle modifications, while the paper concludes with a critique of the CFAM's utility in uncovering family-level contributors to poor chronic disease control.
- Presenting Problem and Medical History: Patient background, diagnoses, and home visit context
- Subjective and Objective Clinical Findings: SOAP-style clinical exam and medication review
- Assessment and Care Plan: Diagnosis list and referral and education plan
- Calgary Family Assessment Model Overview: CFAM framework dimensions defined
- Calgary Family Intervention Model: Structural, Developmental, and Functional Analysis: Family structure, dynamics, and communication assessed
- Problem List and Clinical Discussion: Diabetes, hypertension, and social isolation addressed
- Critique of the Calgary Family Assessment Model: Strengths and limitations of CFAM in this case
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What makes this paper effective
- The paper integrates a full clinical SOAP-style write-up with a structured family assessment framework, demonstrating how biomedical and psychosocial data can be synthesized in home health practice.
- The application of each CFAM dimension (structural, developmental, functional) is grounded in specific, concrete details from the home visit, making abstract framework categories tangible and clinically relevant.
- The final critique section shows reflective practice — the writer evaluates both the strengths and limitations of the model in this specific context, rather than simply applying it mechanically.
Key academic technique demonstrated
This paper demonstrates framework-driven case analysis: a theoretical model (CFAM) is introduced, each of its components is defined, and the model is then systematically applied to real patient and family data. This technique shows the reader how an abstract academic framework translates into actionable clinical insight, a core skill in advanced nursing and health sciences writing.
Structure breakdown
The paper opens with a standard clinical presentation (presenting problem, medical history, medications, objective exam findings, and assessment/plan), then pivots to a detailed CFAM exposition and application. The Calgary Intervention Model section is the analytical core, organized around structural, developmental, and functional subfamilies. A problem-focused discussion section follows, addressing diabetes management, hypertension, and social isolation in turn. The paper closes with a reflective critique of CFAM's utility. This two-part structure — clinical record plus theoretical analysis — is well suited to graduate health science coursework.
Presenting Problem and Medical History
The patient is a 66-year-old Caucasian male referred for a home care evaluation due to polypharmacy and multiple poorly controlled medical conditions. He was recently hospitalized on the medical-surgical ward of a local hospital to receive intravenous antibiotics for an ongoing case of cellulitis of the left lower extremity, which was worrisome for progression to osteomyelitis. The patient was treated as an inpatient with a six-day course of antibiotics. During his hospitalization, it was noted that he had a significant knowledge deficit regarding his multiple disease states and that his home situation was unclear. For these reasons, and to facilitate disease and medication management, a family home study was ordered.
The patient's past medical history is significant for the following:
The home visit was conducted on April 2, 2005, during the mid-morning. Present at the visit were the patient, his wife of 40 years, and their 38-year-old son, who lives in the household. The family resides in a 1,200 square foot ranch house in a middle-class neighborhood — a two-bedroom, one-bathroom home purchased five years ago when the patient took early retirement from a local manufacturing plant. The son returned home approximately one year ago after separating from his wife. He is currently unemployed and living in the extra bedroom. His presence in the house is a source of significant stress and the cause of many arguments between the patient and his wife. This write-up was compiled from information gathered over the course of two home visits.
Subjective and Objective Clinical Findings
The patient is a 66-year-old Caucasian male referred to the Home Health Care program for management of polypharmacy issues and evaluation of his apparent lack of education on the management of his diabetes and hypertension. He was recently hospitalized for six days to receive intravenous antibiotics to treat cellulitis of the left lower extremity. Past medical history is significant for poorly controlled Type 2 diabetes, hypertension, hyperlipidemia, cellulitis of the left lower extremity, obesity, and microalbuminuria.
Past surgical history is significant for a right inguinal hernia repair in 1998 with no sequelae. The patient also underwent debridement of a wound on the left lower extremity during his recent hospitalization. The wound is currently healing and requires only a dry dressing. His last funduscopic exam was more than one year ago.
Review of Systems: The patient describes increased fatigue over the past few months. His appetite is good. He denies any other significant physical findings.
Current Medications:
Social History: The patient has been married for 40 years. He is a retired machinist who took early retirement five years ago when his health began to deteriorate. He quit smoking 15 years ago and has a 20 pack-year history. He currently has no hobbies other than some woodworking around the house. He reports being a social drinker, with alcohol intake of fewer than three drinks per week, and denies any prior history of alcohol addiction or abuse. He also denies the use of illicit drugs. He has three children: twin daughters aged 35 who are married and live in the local area, and a 38-year-old son who is separated, unemployed, and living in the home.
Objective Data: The patient is an overweight Caucasian male in no apparent distress. He appears somewhat disheveled and is dressed in an oversized sweatshirt and sweatpants. He was interviewed in his living room in the presence of his wife and son. Blood pressure is 180/92; pulse is 88; respirations are 18. The patient is alert and oriented. His speech is clear and coherent. He is a fair historian but appears to have a limited fund of knowledge regarding his medications and disease processes. His wife is able to offer some collateral information, though she is unable to provide substantially more detail than the patient himself.
HEENT: Normocephalic and atraumatic. Normal facies. Oropharynx is unremarkable. Dentition is poor; the patient has a partial plate he was not wearing at the time of the exam. No cervical adenopathy or thyromegaly is noted. Funduscopic assessment was difficult secondary to pupillary constriction. PERRL and EOMI; no lid lag or edema. Otherwise the exam is unremarkable.
Chest: Clear to auscultation over all lung fields, although breath sounds are slightly distant.
Cardiovascular: Regular rate and rhythm without murmurs or rubs. No carotid bruit auscultated. No jugular venous distension.
Abdomen: Obese. Bowel sounds within normal limits in all four quadrants. No guarding, rebound, or tenderness. No organomegaly, though the exam is limited by abdominal girth. There is a well-healed surgical scar in the right lower inguinal area. There is evidence of an umbilical hernia.
Extremities: A 2×2 cm eschar is located on the medial aspect of the left lower extremity. The dressing is in place, clean, and dry. There is decreased sensation to vibration and pinprick bilaterally in both lower extremities. Feet are warm; skin is pink and dry. Dorsalis pedis and tibial pulses are 2+ bilaterally. Great toenails on both feet are thickened and hyperkeratotic. There is evidence of scale on the plantar surface of both feet. Otherwise the exam is within normal limits.
Neurological: Cranial nerves II–XII are grossly intact. Upper and lower extremity strength is within normal limits and equal bilaterally. Gait is unremarkable. Romberg is negative. Babinski is negative. Deep tendon reflexes are 2+ and brisk in both upper and lower extremities. No tremor is noted.
GU/Rectal: Deferred.
Mental Status Exam: The patient is alert and oriented times three. Affect is appropriate to mood and thought content. Mood is friendly and slightly sad. Thought content and thought processes appear intact. The patient denies current suicidal, homicidal, or physically endangering ideation.
Assessment and Care Plan
Assessment:
Plan:
Calgary Family Assessment Model Overview
The Calgary Family Assessment Model (CFAM) is a method of providing a thorough family assessment in a healthcare setting. The CFAM has three major categories: (1) the structural dimension of family life, (2) the developmental dimension of family life, and (3) the functional dimension of family life. Each category contains subcategories that the clinician can use to evaluate the family situation. Not every category will apply to every family; it is the clinician's role to determine which sections are most relevant.
Section 1 — The Structural Dimension deals with the internal and external structure of family life. Internal structure includes issues such as family composition, gender, rank order, subsystems within the family, and boundaries. External structure encompasses the extended family and any larger systems that may exist within the family unit. The structural dimension is also examined within the context of race, ethnicity, social class, religion, and environmental factors.
Section 2 — The Developmental Dimension deals with the family life cycle. This dimension helps the clinician understand how the family balances stability and change over time. It addresses processes across the family's life span that are associated with growth — such as chronic illness of a family member, work issues, and relocation. It is also important to remember that subsets within the developmental dimension may be psychological in nature, such as issues related to intimacy and grief.
Section 3 — The Functional Dimension relates to instrumental and expressive functioning within the family. Instrumental functioning is specific to the routine activities of daily living, such as preparing meals, eating, sleeping, hygiene, and attending to health needs. Expressive functioning is related to communication — including emotional, verbal, and nonverbal communication — as well as problem solving, roles within the family, and family beliefs.
For the purposes of the CFAM, a family is defined as who they say they are. It is critical that the clinician performing the assessment not impose their own beliefs about what constitutes a family. The patient's concept of family may include not only those living within the household but also past, present, and future emotional attachments.
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