The Waters Family
Clarisse Canturia – NURS 480 - CSUSM
Meet The Waters
The Waters family consists of Augustus “Gus” Waters and his biological parents, John and Lily. They are a nuclear family living in the suburbs of Indianapolis, Indiana. John is a lawyer at a firm and Lily is an event planner. Gus just finished his senior year of high school via online classes. Gus was diagnosed with osteosarcoma two years ago. This turned the family’s lives upside down. John and Lily both cut back their workload to be there for Gus. Gus got his leg amputated and now has a prosthetic leg. The Waters were able to make adjustments in their lives accordingly while Gus remained in remission. Unfortunately, the cancer came back three weeks ago. The Waters have been trying to remain strong through this difficult time. They need each other now more than ever.
Gus Waters Gus is an adventurous, fun, and intelligent 18-year-old. He fears oblivion and is obsessed with making a mark on the world. He also has a tendency to symbolize a situation at hand. Gus has a strong relationship with his best friend Isaac, and his girlfriend Hazel. All three can relate to each other because they all have cancer and go to a cancer support group together. Gus was diagnosed with osteosarcoma at the age of 16. His right leg was amputated to stop the cancer from advancing to the rest of his body. He has a prosthetic leg and sometimes shows it off. Gus had been in remission for two years until three weeks ago when he felt pain in his hip. He went in for a PET scan, which lit up like a Christmas tree. The cancer was back and had spread everywhere in his body, including his liver and the lining of his chest. He was given only a couple months to live.
Osteosarcoma Osteosarcoma is also called osteogenic sarcoma and it is a type of cancer that produces immature bone (Ryan & Sorens, 2012). The cause of it still remains unknown. The most common areas where osteosarcoma develops include the end of long bones and/or around the knee (Ryan & Sorens, 2012). There are subtypes of osteosarcoma: high-grade, intermediate-grade, and low-grade. After finding out the grade, it can be staged (IA, IB, IIA, IIB, or III). Gus has high-grade osteosarcoma (the fastest growing type) with metastasis to his liver and lungs. Since it has metastasized, his cancer is considered to be a stage III. Osteosarcoma is common among children and young adults, affecting teenagers the most during their growth spurt. It is more common in males, African Americans, and Caucasians. Signs and symptoms include pain (usually around the knee or upper arm) and swelling. Since normal, active children and teenagers experience normal bumps and bruises that cause limb pain and/or swelling, a visit to the doctors may not happen right away, thus delaying the diagnosis. Osteosarcoma can be diagnosed via imaging tests such as a bone x-ray, MRI, CT scan, chest x-ray, bone scan, or PET scan. Biopsies can also be done (American Cancer Society, 2017). Treatments consists of combination chemotherapy and surgery. Individuals who have osteosarcoma without metastases have a 70% survival rate (Ryan & Sorens, 2017). If it has spread to the lungs and other organs, the survival rate drops down to 15% to 30% (American Cancer Society, 2017).
John Waters John is 46 years old and very easy going. Prior to Gus’s first encounter with osteosarcoma, John used to work long days at the law firm. Finding out that his son had cancer the first time around completely changed his outlook on life. He cut back his hours and the number of cases he was working on in order to be there for his family. Since then, John makes sure to be home on time for dinner. John and Gus have always had a close relationship. They share a special bond through basketball. John is trying to be strong for his family, especially since Lily has been an emotional mess.
Lily Waters Lily is a 43-year-old event planner who usually always has a smile on her face. She brings positive energy wherever she goes. Like John, she also cut back on working once she found out about Gus’s condition. Over the past two years she has been a little more overprotective of Gus than usual. She may take one or two events here and there, but her main focus remains on being there for Gus. She also helped Gus when he was taking online classes for school. Lily has been an emotional wreck lately due to Gus’s current health status. She is not ready for her son to go and she is having a hard time accepting that he is dying.
Developmental Stages Duvall’s Family Life Cycle Duvall has eight stages in his Family Life Cycle. The stage the family is in is based on their oldest child. Gus is the only child in the Waters family. He is still an adolescent at age 18, which puts the Waters family in the families with adolescents stage (5th stage) (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). In this stage, John and Lily are allowing Gus to establish his own identity. Even though Lily has become more overprotective of Gus due to the recent circumstances, John is helping her realize that Gus needs to live life to the fullest with the time he has left. Adolescents in this stage should be thinking about the future, their education, working, and potential jobs. Their roles also increase in family, cooking, repairs, and power base (Kaakinen et al., 2015).
Erikson’s Developmental Stages Family Member
Stage
Gus Waters
Identity vs. Role Confusion: Gus feels like he has already established his identity. He knows who he is, his roles in society, what he wants, and has his own beliefs. He also has his own great group of friends that include Isaac and his girlfriend, Hazel.
John Waters
Generativity vs. Stagnation: John has reached generativity. Even though he cut back his hours at work for Gus, he is still productive at work. He donates money to cancer research organizations and is trying to get involved within the cancer community to better understand Gus’s condition. This helps him with his own emotions.
Lily Waters
Generativity vs. Stagnation: Like John, Lily has reached generativity. She still coordinates events for work while taking care of Gus. She has always been involved in community activities, as they help her with her heightened emotions. She has joined a local support group for parents who have children with illnesses.
Family Structure Culture, Function, & Religion The Waters are a nuclear Caucasian family residing in a modern suburban area located in Indianapolis, Indiana. They live in a community where everyone knows each other and they all do community activities together. The community is full of support and help is offered when needed. John has been working the hours of 9 A.M.-5 P.M. four days a week. Since Lily is only working on two events for work, John remains the primary source of income. He is the one paying for Gus’s medical bills. He will spend his time with Gus watching sports or playing video games. Although Gus is still able to perform all his activities of daily living independently, Lily watches over Gus to make sure he is okay; she is completely invested in his health. During the day, Gus will go to the park with Hazel, watch T.V., read, or spend some quality time with his parents, Isaac, or Hazel. Gus’s energy has been low so he only does activities that require minimal exertion. The Waters always have dinner together every night. Both Gus and his parents attend a cancer support group weekly. They also attend a Christian church for mass every Sunday. John and Lily are relying on their faith more than ever now that Gus is dying, while Gus is having a hard time coming to terms with dying.
Communication The Waters have always been respectful to each other. There are times when Gus gets mad and acts like a “typical teenager” by rolling his eyes or giving some attitude, but he always ends up apologizing for his behavior afterwards. Other than that, the Waters try to communicate with each other by talking in respectful tones—they are the type of family that does not yell at each other when they get mad or frustrated. They show that they love and care about each other through nonverbal communication more than they do through verbal communication. The Waters try to be honest and open with each other when they can, but sometimes it is hard to say it out loud. Gus has trouble communicating how he feels, John tries to hide his emotions because he is trying to be strong for his family, and Lily cries a lot when she tries to express how she feels. Nonverbal communication includes hugging, cooking for each other, making it on time for family dinners, giving each other a pat on the back, and spending quality time with each other. Lily loves to show affection while Gus and John find other ways to show that they care.
Family Structure (continued) Family Strengths and Challenges Strengths • • • • • • • •
They really care and love one another John and Lily have been really supportive towards Gus and have cut back work hours in order to be there for him Gus makes sure to spend quality time with his parents because he knows how much that means to them John and Lily have been attending a support group to better understand what Gus is going through They have family dinners together every night They attend church every Sunday together Their faith John encourages Gus to go out and have fun
Challenges • • • • • • • •
They have trouble expressing how they really feel and just keep it bottled up Hard time accepting that Gus is dying Lily is always worrying and crying, which worries Gus and John Lily can get overly protective of Gus, which sometimes prevents him from doing things he really wants to do Their coping mechanism John and Lily are heavily invested in Gus’s deteriorating health that they sometimes forget that they have their own needs, too John is really hurting inside but puts on a strong exterior for his family Gus is having a hard time expressing his needs to his parents because he does not want to upset them. He feels like they will not understand
Family Systems Theory
What is it? When using the Family Systems Theory, families are recognized and assessed “as an organized whole and/or as individuals within family units who form an interactive and interdependent system” (Kaakinen et al., 2015, p. 76). This theory is based on four concepts.
Application to the Waters Family Concept 1: All Parts of the System Are Interconnected
Gus’s terminal illness affects everyone in the family because they are all connected. What affects Gus affects John and Lily in multiple ways. The effect on John, Lily, and Gus will vary in intensity and quality (Kaakinen et al., 2015).
Concept 2: The Whole Is More Than the Sum of Its Parts
Not only are the Waters individually affected by Gus’s terminal illness, but the family as a whole is also “affected by this unexpected (nonnormative) family event” (Kaakinen et al., 2015, p. 77). John and Lily are constantly wondering what will happen to them as a family (whole) once Gus dies.
Concept 3: All Systems Have Some Form of Boundaries or Borders Between the System and Its Environment
Boundaries can be closed, open, or flexible. The Waters have a flexible boundary, in which they “control and selectively open or close to gain balance or adapt to a situation” (Kaakinen et al., 2015, p. 77). The Waters welcomes visits and support from their friends and neighbors that they know within their community, but turn down visits from neighbors they do not know.
Application to the Waters Family (continued) Concept 4: Systems Can Be Further Organized Into Subsystems
Examples of Subsystems that apply to the Waters include husband to wife, mother to child, and father to child. John and Lily are working together to keep the family strong and close while they all go through this devastating event. They are also working together to ensure that Gus gets the quality care that he needs (Kaakinen et al., 2015).
Interventions & Outcomes Intervention #1 Use verbal and nonverbal therapeutic communication approaches including empathy, active listening, and confrontation to encourage Gus, John, and Lily to express emotions such as sadness, guilt, and anger (within appropriate limits); verbalize fears and concerns; and set goals (Ackley & Ladwig, 2017, p. 288). Rationale: Family members of patients with cancer “experience multiple stressors with respect to physical care provision, time and scheduling issues, pressure to provide emotional support, and decision-making around the treatment plan, as well as financial burden of caring giving” (Jeong, Shin, Kim, Yang, Shin, Park, An, & Park, 2016, p. 84). Quality communication between the patient and their family/caregiver influences quality of life and well-being for both the patient and the family/caregiver (Goldsmith, Wittenberg, Platt, Iannarino, & Reno, 2016). Outcome: Gus, John, and Lily will be able to fully express their thoughts, feelings, and concerns to each other without judgment. By doing this, they will have a better understanding of each other’s needs.
Intervention #2 Assess the strengths and deficiencies of the family system (Ackley & Ladwig, 2017, p. 276). Encourage the Waters to draw forward their family strengths in order to improve Gus’s care and quality of life (Svavarsdottir & Sigurdardottir, 2013). Rationale: “Thorough and comprehensive assessments offer valuable information regarding how problems evolve within the family context over time, and allow for anticipatory care and guidance to help family members acquire and maintain support and coping strategies” (Ackley & Ladwig, 2017, p. 276). Outcome: John, Lily, and Gus will collectively identify and draw on their family strengths when deciding on the appropriate care that will improve Gus’s quality of life (Svavarsdottir & Sigurdardottir, 2013).
Intervention #3 Provide education to the Waters regarding active coping strategies to use in their situation. Refer them to appropriate resources for assistances as indicated (i.e. counseling, psychotherapy, financial assistance, spiritual support) (Ackley & Ladwig, 2017, p. 277). Rationale: “Active coping strategies, including planning, giving priority, reappraisal, waiting, and acceptance, were predictive of better quality of life and lower levels of depression and hopelessness in cancer clients” (Ackley & Ladwig, 2017, p. 277). Outcome: John, Lily, and Gus will each find active coping strategies that are specific and appropriate for them. John and Lily will make an appointment for counseling and look for resources that offer spiritual support. Gus will invite his cancer support group over for spiritual support.
References
Ackley, B. J., & Ladwig, G. B. (2017). Nursing diagnosis handbook: An evidence-
based guide to planning care (11th ed.). St. Louis, MO: Mosby: Elsevier. American Heart Association. (2017). About osteosarcoma. Retrieved from https://www.cancer.org/cancer/osteosarcoma/about.html Goldsmith, J., Wittenberg, E., Platt, C.S., Iannarino, N.T., & Reno, J. (2016). Family caregiver communication in oncology: Advancing a typology. Psycho-Oncology, 25(4), 463-470. Jeong, A., Shin, D.W., Kim, S.O., Yang, H.K., Shin, J.Y., Park, K., An, J.Y., & Park, J.H. (2016). The effects on caregivers of cancer patients needs and family hardiness. Psycho-Oncology, 25, 84-90. Kaakinen, J.R., Coehlo, D.P., Steele, R., Tabacco, A., & Hanson, S.M. (2015). Family health
care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. Ryan, S.S., & Sorens, M. (2012). Osteosarcoma: An introduction. Retrieved from http://sarcomahelp.org/osteosarcoma.html#tpm1_1 Svavarsdottir, E.K., & Sigurdardottir, A.O. (2013). Benefits of a brief therapeutic conversation intervention for families of children and adolescents in active cancer treatment. Oncology
Nursing Forum, 40(5), 346-356.
Images
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