My Sisterâ€™s Keeper: Fitzgerald Family (Kate and Anna Fitzgerald, n.d.)
Introduction: Family Structure/Roles ❏ ❏
Brian Fitzgerald (father): He is in his 40s. He works as a firefighter. He understands his children’s situation better than his wife. For example, he understands Anna’s decision regarding not wanting to be an organ donor for her sister. Sara Fitzgerald (mother): She is the wife of Brian. She is in her 40s. She worked as a lawyer and quit her job after her daughter, Kate, was diagnosed with acute promyelocytic leukemia. She is a strong and smart woman. She is very protective to Kate and will do anything in her power just for Kate to stay alive even if that means compromising her role as a mother to her two other children and as a wife to Brian. Jesse Fitzgerald (eldest child): He is a teenager. He is an artistic person. He has dyslexia. Throughout his life, he has been neglected by his parents due to their attention being focused on their ill daughter, Kate. He is a delinquent child and spends his time behaving improperly. His destructive actions are caused by his anger due to the fact that he was not able to help his ill sister, Kate, because of not being a compatible donor for his sister. Kate Fitzgerald (middle child): She is a teenager. At an early age, she was diagnosed with acute promyelocytic leukemia. Her family, especially her mother, focuses all the attention on her. She is a kind sister to her siblings, especially to Anna. She is tired of her sickness and desires to end her suffering by not wanting her younger sister to donate her kidney to her. Anna Fitzgerald (youngest child): She is 11 years old. She was conceived through in-vitro on purpose in order to be a compatible match and bone marrow donor to Kate. She is a loving sister to Kate and follows what Kate wants such as not donating her kidney to her, leading her to sue her mother for medical emancipation.
(Brian Fitzgerald, n.d.)
(Sara Fitzgerald, n.d.)
(Jesse Fitzgerald, n.d.)
(Kate Fitzgerald, n.d.)
(Anna Fitzgerald, n.d.)
Introduction: Condition Description (Acute Promyelocytic Leukemia) ❏ ❏ ❏
Leukemia is defined as a type of cancer with overproduction of non-functioning (immature) white blood cells (WBCs) in the bone marrow. Acute Promyelocytic Leukemia is defined as a type of leukemia which occurs suddenly and which its cells originate from myelocytic pathways. An individual who has leukemia usually suffers from a variety of symptoms such as excessive bleeding (nosebleeds) due to decreased function of platelets.
(Microscopic image, n.d.)
(Ignatavicius & Workman, 2016)
Kate Fitzgerald suffers from acute promyelocytic leukemia. Kate was diagnosed with this type of leukemia when she was still a child. She had been through chemotherapy and radiation before she underwent remission. However, Kate’s leukemia relapses, which ultimately resulted in kidney failure. In the movie, Kate has suffered from excessive bleeding through experiencing a few episodes of nosebleeds. (Sara and Kate Fitzgerald, n.d.)
Introduction: Duvall’s Developmental Stage (Families with adolescents) ❏ ❏
The Fitzgerald family is in the 5th stage of Duvall’s developmental stage. In Duvall’s developmental stage of family with adolescents, the developmental tasks include allowing adolescent children to build their own identities while with the family, allowing adolescent children to start thinking about their future such as their education plan and career, and helping them to increase their role in the family (Kaaniken, Coehlo, Steele, Tabacco, & Hanson, 2015). ❏ The Fitzgerald family did not successfully accomplish this stage of family life cycle. The Fitzgerald children were not able to accomplish the developmental tasks of establishing their own identities and in increasing their role in the family. ❏ Sara was in the way for Anna to develop her own identity. Sara has been deciding for Anna what she would do on her body since the day she was born. Sara kept insisting that Anna will be a donor for her sick sister, Kate. Anna was born to have no choice and decision in life on what she will do with her own body until Kate asked her to not be a donor, leading her to sue her own mother for medical emancipation. ❏ Jesse was not able to increase his role in the family as he was always being neglected since he was a child due to his parent’s attention being focused on his sick sister. He was always out of the house behaving inappropriately and his life was leading to no direction with no better plans for his future.
Culture & Religious Traditions ❏
The Fitzgerald family has a strong familial bond. ❏ They eat together during meals. Sara cooks meals for the family, especially for Kate. During mealtimes, they have funny conversations, they joke around, and they interact with each other so well. ❏ They have family time such as spending time together in their backyard playing bubbles and chatting with each other. They also go out as a family to the pier or beach in order to have some quality time together. ❏ In taking care of Kate, the family is all together and helping each other out. When Kate’s leukemia relapsed and she was admitted to the hospital, every single member of the family (Brian, Sara, Jesse, and Anna) was present to support and be with Kate at that time of need although at home, Jesse does not really help in taking care of Kate as much as Anna does. ❏ Towards the end of the movie, although there are disagreements among the family members, their family remains intact and the love they have for each other remains stronger. The Fitzgerald family has no specific religious traditions that they practice as a family; religious affiliations or any religious beliefs were not implied in the movie.
(Jesse, Kate, Anna, and Sara Fitzgerald, n.d.)
(Brian, Sara, and Kate Fitzgerald, n.d.)
(Anna and Sara Fitzgerald , n.d.)
Strengths & Challenges Strengths: (Anna, Kate, and Jesse Fitzgerald, n.d.)
The Fitzgerald family has a strong familial bond; they remain together despite of being in a difficult situation and in disagreement with each other. They help each other in taking care of Kate.
Kate’s leukemia relapses and gets worse, resulting in kidney failure, which increases the stress within the family. Sara has become single-minded and only sees Kate’s condition, making her relationship with her husband, Brian, and two other children, Jesse and Anna, obscure.
(Kate and Anna Fitzgerald, n.d.)
(Sara and Brian Fitzgerald, n.d.)
Communication (Verbal & Non-Verbal) â??
Generally, the Fitzgerald family converses with one another as they have their family meals. This reflects that as a family, they have some good communication. Anna was also able to communicate her wishes with her mother and father such as telling them that she does not want to donate her kidney to her sister. However, Sara was not a good listener; she kept insisting what she wants for Anna and never listens to what her daughter wants for her life. In contrast, Jesse does not know how to communicate verbally with his family, especially with his parents; he expresses his anger about their family situation through participating in inappropriate behaviors out of the house.
(Sara, Anna, and Brian Fitzgerald, n.d.)
Application of Family Theory: Family System Theory The family system theory is a framework that healthcare professionals use to assess the family as a whole and the individual members as a system that is interdependent and connected. The family system has four components which include: ❏
All parts of the system are interconnected. ❏ This means that as one member of the family is affected, everyone in the family is affected as well. ❏ In the Fitzgerald family, Kate suffers from acute leukemia and as a result, every member of her family is affected. Sara quit her job to provide full time care to Kate. Anna serves as a way to prolong Kate’s life by giving blood donations and undergoing bone marrow aspiration since when she was only five years old. Jesse suffers from neglect and is angry by not being a help to his sick sister. Brian had disagreements with his wife concerning his children. The whole is more than the sum of its parts ❏ This means that the effect of an event in the family as a whole is greater compared to the effect of an event to individual members. ❏ In regards to the Fitzgerald family, when Kate’s condition worsens and she was hospitalized, the whole family was not able to spend time together at the dining table. They do not eat meals as a family anymore. In addition, they have no more family bonding. All systems have some form of boundaries or borders between the system and its environment. ❏ This means the family takes in charge of who or what can come into the family system to limit stressors. ❏ The Fitzgerald family have open boundaries; they accept care for Kate from healthcare professionals and they welcome their relatives into their home and allow them to visit Kate when Kate is in the hospital. Systems can be further organized into subsystems. ❏ This means that within a family, there are subgroups such as parents, siblings, parent to child, and husband to wife and these subsystems will aid healthcare professionals such as nurses in giving holistic care to the family. ❏ For instance, a nurse of Kate can better care for Kate and the whole family if the nurse would be able to assess how Kate’s siblings view their sister’s deteriorating health condition and how Kate’s parents are affected by the situation. (Kaakinen et al., 2015)
(The family system, n.d.)
Application Family Theory: Family Health Interventions & Outcomes ●
Intervention #1: Assist the Fitzgerald family in finding social support groups. Rationale: Having the Fitzgerald family to be able to share their feelings and experiences about their family situation to other people who share the same situation as them may be helpful in decreasing the stress level the Fitzgerald family is experiencing (Gunter & Duke, 2018). ○ Outcome: By the end of the week, the Fitzgerald family will verbalize the desire to join formal support groups to better cope to the family situation. Intervention #2: Discuss respite care program to the Fitzgerald family, especially to Sara, and assist the family in the steps that need to be done if they ever decided to join the program. Rationale: Respite care programs will help in decreasing the family’s stress level since the Fitzgerald family has been undergoing through a lot of stress due to Kate’s illness. If the family, especially Sara, will have a break from being a caregiver for Kate, the stress she and the whole family has may decrease (P. Williams, K. Williams, & A. Williams, 2014). ○ Outcome: By the end of the week, the Fitzgerald family, especially Sara, will verbalize consideration of respite care. Intervention #3: Encourage the parents of the Fitzgerald family to include Kate’s siblings, Jesse and Anna, into Kate’s plan of care. Rationale: According to a study, siblings have the desire to be a part of the plan of care of their family member who has cancer. Therefore, in order for the siblings such as Anna and especially Jesse to not feel neglected by their parents, Sara and Brian should always include them in taking care of Kate (Neville et al., 2016). ○ Outcome: By the end of the week, Sara and Brian will include not only Anna, but also Jesse in taking care of Kate.
References Gunter, M. D. & Duke, G. (2018). Reducing Uncertainty in Families Dealing With Childhood Cancers: An Integrative Literature Review. Pediatric Nursing, 44(1), 21-37. Retrieved from http://ezproxy.csusm.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128049868 &site=ehost-live Ignatavicius, D. D. & Workman, L. M. (2016). Medical-surgical nursing: Patient-centered collaborative care (8th ed.). St. Louis, MO: Elsevier Johnson, M., Pacheco, C., Furst, S., Goldman, S., & Tropper, M. (Producers), & Cassavetes, N. (Director). (2009). My Sisterâ€™s Keeper [Motion Picture]. USA: New Line Cinema. Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Harmon Hanson, S. M. (2015). Family health care nursing: Theory, practice, and research (5th ed.). Philadelphia, PA: F.A. Davis Company. Neville, A., Simard, M., Hancock, K., Rokeach, A., Saleh, A., & Barrera, M. (2016). The Emotional Experience and Perceived Changes in Siblings of Children With Cancer Reported During a Group Intervention. Oncology Nursing Forum, 43(5), E188-E194. doi:10.1188/16.ONF.E188-E194 Williams, P. D., Williams, K. A., & Williams, A. R. (2014). Parental caregiving of children with cancer and family impact, economic burden: nursing perspectives. Issues in Comprehensive Pediatric Nursing, 37(1), 39-60. doi:10.3109/01460862.2013.855843
Image References Anna and Sara Fitzgerald [Online image]. (n.d.). Retrieved from http://images2.fanpop.com/images/photos/7600000/My-Sister-s-Keeper-my-sisters-keeper-7602607-500-294.jpg Anna, Kate, and Jesse Fitzgerald [Online image]. (n.d.). Retrieved from http://www.grouchoreviews.com/content/films/3467/1.jpg Anna Fitzgerald [Online image]. (n.d.). Retrieved from http://1.bp.blogspot.com/-m-ZgsfVgdzU/T9YEXbsTc5I/AAAAAAAAADM/lGzIs8Clodg/s350/12.jpg Brian Fitzgerald [Online image]. (n.d.). Retrieved from https://faradina15.files.wordpress.com/2013/09/33.png Brian, Sarah, and Kate Fitzgerald [Online image]. (n.d.). Retrieved from https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQqmGm8wNF1gfPInt4s0bXpRO5f8-u0mIbZqQuAgJA8noZG-78x Jesse Fitzgerald [Online image]. (n.d.). Retrieved from http://images4.fanpop.com/image/photos/22800000/My-Sisters-Keeper-2009-my-sisters-keeper-22869117-640-480.jpg Jesse, Kate, Anna, and Sara Fitzgerald [Online image]. (n.d.). Retrieved from https://images-na.ssl-images-amazon.com/images/M/MV5BMzkwMDk1ODYwNl5BMl5BanBnXkFtZTcwNTY2MjUyNA@@._V1_SX1500_CR0,0,1500,999_AL_.jpg Kate and Anna Fitzgerald [Online image]. (n.d.). Retrieved from http://i.dailymail.co.uk/i/pix/2009/04/16/article-1170510-047B231E000005DC-17_634x312.jpg Kate and Anna Fitzgerald [Online image ]. (n.d.). Retrieved from http://images.contentful.com/7h71s48744nc/5RZCs46E6scUoU2CKiEckq/a66cc7210e6e81a6f4711e13961c70df/my-sisters-keeper.jpg Kate Fitzgerald [Online image]. (n.d.). Retrieved from https://dblueholic.files.wordpress.com/2010/01/kate.jpg Microscopic image [Online image]. (n.d.). Retrieved from https://cdn-pro.elsalvador.com/wp-content/uploads/2017/01/27011322/1434891415031.jpg Sara and Brian Fitzgerald [Online image]. (n.d.). Retrieved from https://images-na.ssl-images-amazon.com/images/M/MV5BMTI3OTY5Mjc0N15BMl5BanBnXkFtZTcwMjQ1MjE2Mg@@._V1_.jpg Sara and Kate Fitzgerald [Online image]. (n.d.). Retrieved from https://resizing.flixster.com/vxhM-9NwiRQCTbTpmzGrSVTp-Og=/300x300/v1.aDs2NzQzO2o7MTc2NDA7MTIwMDs2NTI7NDMz Sara, Anna, and Brian Fitzgerald [Online image]. (n.d.). Retrieved from https://images-na.ssl-images-amazon.com/images/M/MV5BMTM3MjU4NzEyMl5BMl5BanBnXkFtZTcwMzU1MjE2Mg@@._V1_.jpg Sara Fitzgerald [Online image]. (n.d.). Retrieved from http://www.grouchoreviews.com/content/films/3467/2.jpg The family system [Online image]. (n.d.). Retrieved from https://static1.squarespace.com/static/53d01de8e4b00188fd0c5fd6/t/58064ce6b3db2b7c740f67f4/1476807918602/
NURS 480 Visual Report (The Fitzgerald Family)