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(Jack, John and Billy posing (n.d.))

The Tremont Family

Introduction The Tremont family is a multi-generational family that consists of Jack and his wife Bette, their two children (John and Annie), and their grandson (from John) named Billy. Annie is married to her husband Mario and they both live nearby Jack and Bette in Los Angeles. John is divorced and works as a business man in New York. Billy is a college student and lives with his mother. Jack and Bette are both retired and live in Los Angeles, where they have a very routine life that consists largely of eating breakfast, collecting coupons, going shopping, running errands, gardening, and watching television. Bette does almost all of the household chores and sees herself as the caretaker for Jack. She doesn’t let him drive anymore, she picks out his clothes for him to wear each morning, and she makes his breakfast. She is a strong-willed woman who can be very bossy and intimidating. Since John lives far away and avoids seeing his ageing father, the family overall has grown farther apart over the last few years because they don’t get together as a family that often to do anything. One day Bette has a heart attack and this is the event that brings the whole multi-generational family together again both physically and emotionally because they have to come to L.A. to help take care of Jack and Bette. Not long after, Jack is diagnosed with bladder cancer.

(John and Jack at meeting, (n.d.))

(John, Jack and Billy modeling clothes,(n.d.))

(Jack and Bette kissing, (n.d.))

Meet the Tremonts John Tremont Jack’s son. John is divorced and works as a business executive in New York. He doesn’t have much contact with his son or his exwife. John has also avoided contact with his parents for several years because he doesn’t like to see his father becoming so old and dependent.

Jack Tremont Retired 79 year-old aerospace worker who did manual work in the industry his entire career. He didn’t like his job but worked hard to support his family. He is physically not very capable due to his age so his wife does almost everything for him and she is very controlling and bossy. Jack has bladder cancer. (John, (n.d.))


Annie Tremont Jack’s daughter. Annie is married to a man named Mario who doesn’t get along with Bette well. They live nearby Jack and Bette and visit them routinely. She keeps an eye on Jack and Bette’s health condition as they age and keeps John informed.

Bette Tremont Jack’s wife. Bette has always been a homemaker taking care of their children and now she takes care of Jack. She likes to do things her way and also expects her family members to do things her way as well.

(Annie, (n.d.)) (Bette, (n.d.))

(Billy, (n.d.))

Billy Tremont Jack’s grandson (John and his ex-wife’s child). Billy is currently a college student but isn’t that interested in college anymore and is thinking about moving to Mexico to join his friends to work and live there. He is not close to John because John and his mom divorced when he was little and he blames John for considering money more important than family.

Family Developmental Stage According to Duvall’s developmental and family life cycle theory, families develop and change over time. Duvall says there are eight stages of traditional family life cycles. Families experience transitions from one stage to another (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). Jack and Bette are at the “Ageing Families” stage of the life cycle. They are both retired and play the role of grandparents. They both have a severe chronic illness. Betty just had a serious heart attack and not much later Jack was diagnosed with bladder cancer. At their age they are expecting each other to die and one of them to be left to live alone. Their friend’s are always talking about people who have recently died.

Strengths/Challenges StrengthS

- Bette loves Jack very much and is willing to take care of Jack as much as she possibly can. - John is a great teacher to help Jack learn to do household chores, drive a car, and do other things within his physical limits to increase his independence. - John is very proactive at talking to the doctors about Jack’s health conditions and trying to protect him from harm. - Jack’s family members (except Bette) were very supportive when he tried to increase the pleasure in his life by doing things like daycare, wearing crazy clothes, and learning Japanese.


- Jack’s son John lives and works in New York with a very busy schedule so he doesn’t have much time to visit. - Jack’s grandson is in college and has his own life with his friends so he doesn’t visit often. - Jack’s daughter Annie lives nearby and likes to visit, however, her husband Mario doesn’t get along with Bette. - Bette does everything for Jack which limits Jack’s opportunities to be physically active and independent. - Bette had a serious heart attack right before Jack’s cancer diagnosis so she could no longer do much for Jack like she used to.

Communication Verbal

- John and Annie are honest with each other when discussing the health issues of their parents. - Jack and Bette always hide their health problems from each other because they don’t want to cause worry. - John didn’t want the doctor to tell Jack he has cancer because Jack has a cancer phobia since his brother died from cancer.


- When Bette became frustrated at Jack’s attempt to speak Japanese at the dinner table she threw several bowls of food on top of his plate to display her anger. - When Jack came back from the hospital in his delusional state after his shock episode he often used his hands to communicate what he wanted, for example, a glass of water. - Jack and Bette kiss each other all the time, especially at emotional times, which shows how deep their love is. - Eventually Bette wore a Japanese robe to bed to show that she finally supported Jack’s study of Japanese culture. - At the reception for Jack’s funeral John and Billy wore the crazy clothes they bought with Jack to show support for him. It also shows how John and Billy grew closer together than before.

Family Systems Theory Family Systems Theory is a framework that helps the nurse understand, assess, and think about the family as a system (Kaakinen, Coehlo, Steele, Tabacco, & Hanson, 2015). 1.) all partS of the SyStem are interConneCted When Betty had a heart attack the family members were all brought together to L.A. When Jack was diagnosed with cancer John delayed his return to work so he could be with Jack; Billy changed his plan of moving to Mexico and stayed to help care for Jack until he died. Due to her concerns about Jack’s condition in the hospital Betty ignored her doctor’s advice to remain stress free and went to the hospital to see Jack and find out about his condition. 2.) the whole iS more than the Sum of the partS The family was as a whole was made closer by Jack’s cancer. For the past several years they didn’t spend many holidays together or communicate as much as they had in the past. Now with Jack’s cancer they were all together and working as a team to help Bette and Jack. John became much closer with his son and had much deeper conversations. The family all bonded by supporting Jack’s desire to learn Japanese culture and wear crazy clothes. 3.) all SyStemS haVe Some form of boundarieS or borderS between the SyStem and itS enVironment The family had a boundary of not wanting the word “cancer” to enter the family system. Jack’s brother had died of cancer, even after several surgeries, so Jack was terrified of the thought of cancer. John didn’t tell any family members about Jack’s cancer diagnosis and he told the doctor to not mention the word “cancer” to Jack. Unfortunately, the doctor told Jack he has cancer which caused Jack to go into a coma. 4.) SyStem Can be further organized into SubSyStemS The family has several subsystems: grandparents (Jack, Bette), siblings (John, Annie), husband-wife, parent-child, inlaws, and grandparent-grandchild.

Problems/Interventions problem #1: The Tremont family members don’t communicate openly enough when Jack and Bette have health problems. Bette tried to hide her recent heart attack episode from Jack. John, Billy, Annie and Mario tried to hide Jack’s cancer diagnosis from Bette. interVention: Assess each family members’ coping skills individually; have group sessions with the Tremont family to help them develop deep open communication skills that they can apply to family issues such as Jack’s cancer and Bette ’s heart attack. rationale: Family is an interdependent system that can influenced by communication, or lack thereof, between the family members. Open communication interventions provides individuals in the family opportunities to better understand each other and the chronic illness condition, as well as the associated stressors (Distelberg, Williams-Reade, Tapanes, Montomery & Pandit, 2014). outCome:  All the Tremont family members would be able to have deep open communication and would be able to identify the stressors on the family caused by both Jack and Bette’s health conditions and create a solution plan. problem#2: The Tremont family doesn’t have tight family bonds as Jack wished. All the family members are living their own busy lives, they don’t get together often. Jack was diagnosed with schizophrenia because he had created and enjoyed his own fantasy world with a “perfect family life as he wished” to make up for his lost feeling in the real life. interVention: Assess the family’s stability, and educate the family members on the family system theory and the importance of family bonds as well as the effect on family members’ health and recovery.  rationale: Family relationships and interactions help the family members identify and recognize the value of their family. These bonds can lead to significant and positive improvements in the family support and stability (Tanninen, Haggman-Laitila, Pietila, & Kangasniemi, 2016). outCome: The Tremont family members would rebuild and tighten their family bonds and work with each members’ schedule and get together on a regular basis as one of their top priorities.    problem #3: Bette has a very strong personality with little warmth. She likes people to think, talk and act in her way. As a cancer survivor, Jack felt he was reborn when he was released from the hospital after his cancer surgery. He would like to enjoy his life and seek happiness by doing something that he had never done before such as baby sitting the neighbors’ children, learn Japanese, and wear funny clothes. All the family members were very supportive except Bette because she thought he was crazy.  interVention: Assess the Tremont family functioning, identify the strengths and weaknesses within the family system. Suggest Bette go to a therapist together with her family to address her controlling personality. rationale: Assessing the family functioning including the strengths and weaknesses can help the family members learn to adapt to the illness in the family. A change in family functioning can change the trajectory of a patient’s illness. Learning to adapt to the illness and promotion of the patient’s autonomy can help the recovery progression. When a family experiences an illness, many relationships within the family will change and the roles the family members play will often be different as well. The changing roles may cause more burden for some family members, especially those living in the same household as the person with the illness, so these unequal demands need to be acknowledged by the family (Cipolleta, Marchesin, Benini, 2015). outCome: Bette would realize that her controlling personality had being affecting the whole family support for Jack’s cancer after seeing the therapist with the family members and learn the adaption skills within the family system to provide better support for Jack. 

References Annie [online image]. (n.d.). Retrieved from Bette [online image]. (n.d.). Retrieved from Billy [online image]. (n.d.). Retrieved from Cipolletta, S., Marchesin, V., & Benini, F. (2015). Family Functioning as a Constituent Aspect of a Child’s Chronic Illness. Journal of Pediatric Nursing, 30(6), e19-e28. Distelberg, B., Williams-Reade, J., Tapanes, D., Montgomery, S., & Pandit, M. (2014). Evaluation of a family systems intervention for managing pediatric chronic illness: Mastering Each New Direction (MEND). Family Process, 53(2), 194-213. Jack and Bette kissing [online image]. (n.d.). Retrieved from,1310819.html?page=3 Jack, John and Billy posing [online image]. (n.d.). Retrieved from Jack [online image]. (n.d.). Retrieved from John [online image]. (n.d.). Retrieved from John and Jack at meeting [online image]. (n.d.). Retrieved from,1310819.html?page=3 John, Jack and Billy modeling clothes [online image]. (n.d.). Retrieved from,1310819.html?page=3 Kaakinen, J.R., Coehlo, D.P., Steele, R., Tabacco, A., & Hanson, S.M.H. (2015). Family Health Care Nursing: Theory, practice, and research (5 th edition). Philadelphia, PA: F.A. Davis Company. Tanninen, H.M., Haggman-Laitila, A., Peitila, A.M., & Kangasniemi, M. (2016). The content and effectiveness of home-based nursing interventions to promote health and well-being in families with small children: a systematic review. Scandinavian Journal of Caring Sciences, 30, 217 - 233.

Dad-The Tremont Family  

Nurs 480 CSUSM

Dad-The Tremont Family  

Nurs 480 CSUSM