N480 Visual Report

Family Assessment Visual Report

The Flynn-Fletcher Family (Flynn-Fletcher family, n.d.).

By Cynthia Nguyen Nurs 480

By Cynthia Nguyen

Introduction The Flynn-Fletcher family consist of Lawrence Fletcher and Linda Flynn-Fletcher, and their children Candace Flynn, Phineas Flynn, and Ferb Fletcher. Phineas and Ferb are planning to have the best summer ever, and do so by building things such as roller coasters, robots, rocket ships, and whatever else comes to their mind. However, their sister Candace is on a mission to get the boys in trouble. Throughout the day, she observes what the boys are doing, and then rushes their mom home in attempt to catch them. However, the boys’ invention of the day always disappears before their mom arrives. Adamant to get her mom to believe her, Candace does this every day of the summer, but is never successful in her efforts.

(Pinterest, 2019.).

Left to right: Lawrence Fletcher, Linda Flynn-Fletcher, Ferb Fletcher, Phineas Flynn, Candace Flynn, Perry the Platypus (pet)

The Flynn-Fletcher Family Lawrence Fletcher (47 y.o.): Dad to Ferb and step-dad to Phineas and Candace, Lawrence used to live in the U.K. before moving to America and meeting and marrying Linda Flynn. He is a historian and deals antique items. He is easy-going and knows about his sons’ wild projects, but does not seem to mind and partakes in some of their adventures.

Linda Flynn-Fletcher (45 y.o.): Mom to Phineas and Candace and step-mom to Ferb, Linda was a famous singer for her one-hit-wonder “I’m Lindana and I wanna Have Fun” before being dropped by her record label. She is now a devoted mom who formed a jazz-band with other moms in her neighborhood. Linda does not know about Phineas and Ferb’s creations and thinks Candace can get annoying and seems delusional for always telling on the boys. However, she is still very loving and supportive of her family.

Candace Flynn (15 y.o.): As the oldest child of the family, Candace has two hobbies: trying to expose her brothers’ crazy inventions, or pursuing her crush Jeremy Johnson. Candace can be very intense and impulsive, and becomes anxious because her mom never finds out about what the boys are constantly up to despite her warnings. She is often very frustrated because her mom never believes her, but still loves her brothers despite always trying to get them in trouble.

Phineas Flynn (10 y.o.): Phineas is a smart and creative kid that is often the “leader” when it comes to his two-man team with his step-brother Ferb, who he is very close to. His overactive imagination helps him think of new inventions, which is brought to life with the help of Ferb. He is outgoing and caring, and includes his friends in partaking in the adventures he goes on with these invention. His main goal is to have the best summer ever.

Ferb Fletcher (9 y.o.): Being the quiet one in the family, Ferb remains calm in stressful situations and thinks quickly. He is very intelligent, and has technological skills that he uses to help Phineas’s ideas come to life. He seems wise for his age and is goal-oriented and focused, but does not take life too seriously and enjoys having as much fun as Phineas.

Duvall’s Developmental Stage The Flynn-fletcher family belongs in both the “families with school-age children” and “families with adolescents” developmental stage due to the ages of their three kids (Kaakinen, Coehlo,Steele, Tabacco, & Hanson, 2015, p. 80). Since Phineas and Ferb are considered school-age children, they should have a more of an authoritative figure in their lives. Although their mom is clueless about their adventures, their dad does know what they are up to and should ensure that they are safe, and set boundaries on what they can and cannot do. He should also inform his wife of the inventions he has seen Phineas and Ferb create, and together, they can find a balance between enforcing rules while also supporting the boys in their creativity and hobby for inventing. Discussing these matters with his wife can also ease Candace’s anxiety, as she will no longer be viewed as delusional by her mom. Task associated with Candace include encouraging her to establish her own identity (Kaakinen et al., 2015, p. 80). She is currently too focused on what her brothers are doing, and have established a role for herself as the tattle-tale. Instead, Candace should seek other interests aside from busting her brothers. Candace should also be considering her future in terms of education and career, and should be held responsible for completing some household chores (Kaakinen et al., 2015, p. 80).

(What do it do? n.d.).

Obsessive Compulsive Disorder (OCD) ●

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DSM-5 diagnostic criteria for OCD ○ “Presence of obsessions, compulsions, or both” (Fenske & Petersen, 2015, p.

598). ○ “The obsessions or compulsions are time consuming (i.e. take more than one hr per day) or cause clinically significant distress or impairment in social, occupational, or other important area of functioning” (Fenske & Petersen, 2015, p. 598). ○ “The obsessive-compulsion symptoms are not attributable to the physiological effects of a substance or another medical condition” (Fenske & Petersen, 2015, p. 598). ○ “The disturbance is not better explained by the symptoms of another mental disorder” (Fenske & Petersen, 2015, p. 598).

Candace Flynn has been diagnosed with OCD because she meets this criteria ○ Candace has obsessive and intrusive thoughts about her brothers and what they are up to, and then consistently plans her day around getting them caught before compulsively telling her mom about it to relieve the anxiety she feels.

This happens every day of every summer.

The obsessions and compulsions create feelings of severe anxiety, distress; interfere with the individual’s daily functioning; and affects different aspects of their life (i.e. school, relationships, etc.) (American Academy of child and Adolescent Psychiatry, 2018).

About 1 in every 200 child or adolescent has OCD (American Academy of child and Adolescent Psychiatry, 2018).

Females are more likely to be have OCD in their lifetime, with the age of development being in their adolescent years (Fenske & Petersen, 2015).

Candace’s family can help her manage her symptoms with the right interventions.

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(Usbdata, n.d.).

Components Affecting the Flynn-Fletcher Family Culture/ Religious Traditions: The Flynn-Fletcher family is not religious, and instead, utilizes scientific reasoning to explain how they are able to carry out their inventions. They celebrate big holidays, such as Christmas, and embrace the cultural traditions with their neighborhood friends, such as the Mexican-Jewish Cultural Festival for example. When getting together for these holidays, the family happily celebrates, and Candace is not obsessing over what her brother is up to. These celebrations serve as a good distraction for her.

Strengths: Each member of the family has a great relationship with all the others, and the family unit as a whole is very tight-knit. The boys never get mad at Candace for trying to get them into trouble, often invites her along to their adventures, and are forgiving of her when she gets easily mad at them. They participate in each other’s hobbies and do things to make each other feel better when one is sad. The members of the family are also self-aware. Candace acknowledges that she is an anxious and high-strung person. These strengths can help Candace better manage her OCD. Challenges: It is very unlikely that Phineas and Ferb will stop creating inventions to help Candace manage her OCD. Additionally, since their dad is fine with what the boys are doing, Candace often feels like she is misunderstood and is not sure if she is over-reacting. Although the family is tight-knit, Candace may feel unsupported due to these factors.

Communication: The communication between Candace and her mom can be improved. Oftentimes, Candace is voicing her concerns about what her brothers are doing, but her mom negates those feelings because she is unable to see those inventions herself. Because this happens so often, Linda often rolls her eyes or ignores Candace when she comes to her with information regarding her brothers. When Linda does respond, she often does so in an irritated or condescending tone. This may make it hard for Candace to open up to her mom. To better their communication, Candace must approach her mom in a calm manner and voice what she is feeling rather than using the interaction as an opportunity to tell on her brothers. Linda, in return, must actively listen to Candace, and stop outwardly showing that she is annoyed in order to show support for her daughter.

(Mexican-Jewish cultural festival, n.d.).

(Candace hugging, n.d.).

(Animation for adults, n.d.).

(YouTube, 2013).

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The Bioecological Systems Theory combines genetic factors with environmental factors to explain the development of individuals and their families (Kaakinen et al., 2015, p. 83).

This model recognizes that individuals and their families interact with five environmental subsystems as they develop (Kaakinen et al., 2015, p. 83).

It is important to consider Candace’s environment because this environment can provide her with more support than her family is currently providing her. Similarly, there are things in the environment that may exacerbate her anxiety and distress. For example, she may be more focused on her brothers to keep her mind off her relationship with her friend and crush, Jeremy, who gives her anxiety when she thinks about him.

Bioecological Systems Theory

(The lake nose monster, n.d.).

Bioecological Systems Theory Applied ●

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Microsystems: “Settings in which individuals/ families experience and create day-to-day reality” (Kaakinen et al., 2015, p. 84). ○ The nurse should assess Candace’s relationship with each member of her family and if they do any activities together. She should assess if Candace has obsessive thoughts about checking up on her brothers, and if she carries out compulsions by actually checking on her brother or telling her mom about what her brothers are doing. The nurse should also assess any feelings of distress or anxiety, and if these feelings interfere with Candace’s ability to carry out her responsibilities at home, in the neighborhood, and at school.

Mesosystems: “Relationships among major microsystems in which persons or families actively participate, such as families and schools, families and religion, and families to peers” (Kaakinen et al., 2015, p. 84). ○ The nurse should assess if religion can be a source of support for Candace or her family during this time. The nurse should also assess if Candace’s friends, Stacey and Jeremy, can also help her manage her OCD symptoms.

Exosystems: “External environments that influence the individuals and families indirectly” (Kaakinen et al., 2015, p. 84). ○ The nurse should assess factors that may indirectly affect Candace’s OCD. For example, Candace’s parents busy schedule making them unavailable when she needs them. Additionally, her brother is able to build these inventions because they have special permits. Those providing Phineas and Ferb these permits could also be indirectly affecting her by giving her brothers a means to start their projects.

Macrosystems: “Broad cultural attitudes, ideologies, or belief systems that influence institutional environments within a particular culture/ subculture in which individuals/ families life” (Kaakinen et al., 2015, p. 84). ○ The nurse should assess if there are any ideologies that Candace holds onto that makes it difficult for her to manage her OCD symptoms. For example, one belief upheld by society is that the oldest child has to look after their younger siblings. Candace may have taken this belief to an extreme.

Chronosystems: “Time-related contexts where changes occur over time and have an effect on the other four levels” (Kaakinen et al., 2015, p. 84). ○ The nurse should assess how long Candace’s obsessions and compulsions have been occurring for, since Phineas and Ferb resumes to creating these inventions every summer.

Nursing Process Interventions & Outcomes: ●

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The Flynn-Fletcher family will encourage Candace to stop engaging in her compulsions when she has an intrusive thought ○ Rationale: Not engaging in compulsions “allow patients to learn to tolerate their anxiety, and ultimately reduce the urge to ritualize” (Thompson-Hollands, Edson, Thompson, & Comer, 2014, p. 288). ○ Outcome: Phineas and Ferb will invite Candace to join their adventure when she voices to them that she wants to call their mom to tell her what the boys were up to.

The Flynn-Fletcher family should help Candace regulate her emotions and tolerate distress ○ Rationale: These skills are considered a part of Positive Family Interaction Therapy, which “demonstrated significant improvements in accomodation, conflict, and cohesion” (Rozenman, Sugar, McCracker, & Piacentini, 2017, p. 10). ○ Outcome: Phineas and Ferb communicate with Candace that it is okay for her to feel anxious and in distress, and encouraged her to accept those feelings rather than relieving them through performing compulsions.

Linda Flynn will not engage in Candace’s compulsions with her (i.e. she should not go to check on the boys with Candace when Candace rushes to tell her about the boys’ latest invention that she insists Linda has to see). ○ Rationale: Family members engaging in the individual’s compulsions is considered “family accommodation,” which can lead to “more severe symptoms and functional impairment on the part of the patients” (Thompson-Hollands, Abramovitch, Thompson, & Barlow, 2015, p. 1). ○ Outcome: Linda Flynn will be able to stop engaging in her daughter’s compulsions by stating firmly that she has to get to jazz-band practice every time Candace approaches her about the boys’ inventions.

References American Academy of Child and Adolescent Psychiatry. (2018). Obsessive-compulsive disorder in children and adolescent. Retrieved from https://www .aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Obsessive-Compulsive-Disorder-In -Children-And-Adolescents-060.aspx Fenske, J. N., & Petersen, K. (2015). Obsessive-compulsive disorder: Diagnosis and management. American Family Physician, (92)10, 896-903.

Retrieved from https://www.aafp.org/afp/2015/1115/p896.pdf Kaakinen, J. R., Coehlo, D. P., Steele, R., Tobacco, A., & Hanson, S.M. (2015). Family health care nursing. Theory, practice, and research (5th ed.).

Philadelphia, PA: FA Davis Company.

Peris, T. S., Rozenman, M. S., Sugar, C. A., McCracker, J. T., & Piacentini, J. (2017). Targeted family intervention for complex cases of pediatric obsessive-compulsive disorder: A randomized controlled trial. Journal of American Child Adolescent Psychiatry, 56(12), 1-20. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875916/pdf/nihms920570.pdf Thompson-Hollands, J., Abramovitch, A., Thompson, M. C., & Barlow, D. H. (2015). A randomized clinical trial of a brief family intervention to reduce accommodation in obsessive-compulsive disorder: A preliminary study. Behavioral Therapy, 46(2), 1-19. Retrieved from https://www.ncbi.nlm .nih.gov/pmc/articles/PMC4748371/pdf/nihms756799.pdf Thompson-Hollands, J., Edson, A., Thompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis. Journal of Family Psychology, 28(3), 287-298. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086156

Picture References Animation for adults. (n.d.). Hail doofania. Retrieved from https://www.animationforadults.com/2015/06/10-essential-phineas-and-ferb-episodes.html Fandom. Candace hugging. (n.d.). Retrieved from https://phineasandferb.fandom.com/index.php?title=File:Candace_Hugging_PnF.jpg&limit =20&showall=0 Fandom. Flynn-Fletcher family. (n.d.). Retrieved from https://phineasandferb.fandom.com/wiki/Flynn-Fletcher_family Fandom. Mexican-Jewish cultural festival. (n.d.). Retrieved from https://phineasandferb.fandom.com/wiki/Mexican-Jewish_Cultural_Festival Fandom. The lake nose monster. (n.d.). Retrieved from https://phineasandferb.fandom.com/wiki/The_Lake_Nose_Monster Fandom. What do it do? (n.d.). Retrieved from https://phineasandferb.fandom.com/wiki/What_Do_It_Do%3F Pinterest. The ferb empire. (2019). Retrieved from https://www.pinterest.com/pin/537054324293004791/ Usbdata. Candace. (n.d.). Retrieved from http://www.usbdata.co/phineas-and-ferb-act-your-age-candace-and-jeremy.html YouTube. (2013). Phineas and Ferb: Mom look [YouTube Video]. Retrieved from https://www.youtube.com/watch?v=9J_sp2_X4Ec