N480 The Blind Side

NURSING 480: Visual Report

THE BLIND SIDE

ELIZABETH HAQUANG MARCH 20, 2019

THE TUOHY FAMILY The Tuohy family began as a nuclear family consisting of Sean, Leigh Anne, and their two children Collins and Sean Junior (SJ).

Sean and Leigh Anne met in college at Ole Miss where Leigh Anne was studying Interior Design and was a cheerleader. Sean on the other hand attended Ole Miss on a basketball scholarship where he later was drafted into the NBA to play basketball professionally. After graduating, Sean proposed to his college sweetheart, Leigh Anne, and they now have two beautiful children Collins and SJ. Collins and SJ attend Briarcrest Christian School in Memphis Tennessee, where they meet a 16year old boy named Michael Oher. Michael Oher, also know as Big Mike, was encouraged to apply to this Christian School to play football because of his size. On numerous occasions Leigh Anne, Sean, SJ, and Collins individually interact with Michael, and through each interaction, the family discovers more about Michael's past and struggles with homelessness and abandonment. As time progresses, the Tuohy's offer Michael their home all out of love and kindness. Eventually, the Tuohy family take in Michael and adopt him as their own. Ultimately, the Tuohy's are no longer a nuclear family, but are now a considered a blended family.

STRENGTHS - The Tuhoy Family is very family oriented - All family members attend sports games and events to support one another - The Tuhoy Family is very wealthy and well educated.

As a result, they have a number of resources available - The Tuohy Family has a stable income - The Tuohy Family stands up for one another when conflict occurs -The Tuohy Family is extremely loving and generous.

They often donate to a number of organizations -The Tuohy Family will sit around the table for meals and converse about their day - They respect, love, and care for one another

WEAKNESSES - Michael is quiet, reserved, and often struggles with communication -Michael has trust issues as a result of being abandoned -Michael has a low education and literacy level because he attended over 11 schools -The Tuhoy Family does not always express how they feel during difficult or sad times -The Tuohy Family is biracial, and because they live in the South, racism still exists -Michael has pressures to succeed in playing football and attend Ole Miss

MEET THE TUOHY'S MOTHER

LEIGH ANNE TUOHY (4O YERARS OLD)

Leigh Anne Tuohy's is devout Christian, wife of Sean Tuohy, a mother of 3, and the person who is most responsible for helping Michael Oher achieve his success. Leigh Anne plays an important role in all aspects of her husband and children's lives as she is a decision maker and provider for the Tuhoy Family. Professionally, Leigh Anne is an interior design and finds great passion in what she does.

Additionally, Leigh Anne is an incredibly passionate mother and is what every mother should be. Leigh Anne attends all of her children's sports events and ensures all of them are happy and are well fed. She goes above and beyond of what is expected even with children that are not her own (before adopting Michael). When Leigh Anne meets Michael Oher, the homeless 16 year old, she notices Michael is without food, clothing, and shelter. She offers her home to him and buys him basic necessities. As Leigh Anne spends more time with Michael she says on multiple occasions that she feels compelled to help, though she never explains why. Her and Michael form a tight bond and becomes Michael's, "voice of reason." Nevertheless, Leigh Anne is successfully in the generatively vs stagnation stage as she continues to help raise her children, be involved in non-profit organizations, and overall create a nurturing environment for herself and family.

FATHER

Sean Tuohy is devout Christian, husband of Leigh Anne Tuohy, and a father of 3. Sean plays an important role as a supporter, provider, and father. Although he is not as outspoken as Leigh Anne he acts as a constant father figure to his wife and children. Additionally, Sean is much more reserved and easy going than his wife. He is constantly there to support Leigh Anne when she is overwhelmed with Michael and his struggles.

Professionally, Sean is a successful businessman and entrepreneur as he owns a number of fast food companies such as Taco Bell, KFC, and Freddy's. Sean ultimately is successfully in the generatively vs stagnation stage, as he continues to support his wife, provide for his family, and raise his children .

SEAN TUOHY (42 YERARS OLD)

MEET THE TUOHY'S ADOPTED SON

MICHAEL OHER (17 YERARS OLD)

Michael Oher is a troubled African American boy. Michael is one of twelve children and grew up in a broken home in the inner-city of Memphis Tennessee. His biological mother, Denise, is an alcoholic and drug addict who was unable to care for him because of her addictions. As a result, Michael was left poor and without guidance all throughout his life .

Growing up in an environment of drugs, alcohol, and violence, Michael at a young age was taken by Family Services, and a ward of the state, was placed in several different foster homes. After running away several times, Michael ends up homeless leaving him to stay with a friend. Due to Michael's unstable childhood, Michael has not been able to receive a proper education. He has attended over 11 different schools and has a low level reading level. However, when Michael attends Briarcrest Christian School he meets the Tuhoy Family and his life takes a turn for the better.

Ultimately Michael Oher is unsuccessfully in the identity vs role confusion stage. Because of his childhood and exposure to drugs, violence, and alcohol at a young age, Michael is not where he should be in relation to other teenagers. Michael continues to struggle with anxiety, abandonment, and trust issues.

Collins is the biological daughter of Leigh Anne and Sean Tuohy. Collins, a popular 16 year old, is a cheerleader and volleyball player at Briarcrest Christian School. As a teenager in high school, Collins faces ridicule and embarrassment when her family first adopts Michael. Collins does not welcome Michael with warm arms; however, as time progresses Collins warms up to Michael and eventually treats Michael as her own brother.

Additionally, Collins becomes a supportive role for her brother Michael when he is constantly being rejected by his classmates and teammates.

Overall, Collins is successfully in the identity vs. role confusion stage as she is making the transition from childhood to adulthood. Collins is learning to become more independent and is beginning to look in the future in terms of relationships, families, and careers.

SON

SJ TUOHY (4O YERARS OLD)

DAUGHTER

COLLINS TUOHY (16 YERARS OLD)

SJ is the youngest family member of the Tuhoy family. SJ is a very outspoken and is an incredibly happy kid who accepts and friends Michael from the beginning. SJ’s role throughout the film does not change. He acts as if Michael is his brother even though they just met. Additionally, SJ becomes a huge support system for Michael as he helps Michael train for football and helps in the decision of which college to attend. Also, because of his goofy personality, SJ lightens the mood in all scenes that are difficult for the Tuhoy Family. Nevertheless, SJ is successfully in the industry vs inferiority stage. His self esteem is high and he is constantly being encouraged by his family and siblings.

DUVALL'S DEVELOPMENTAL STAGE Assessment of the Tuohy Family using the Traditional Family Life Cycle Developmental Framework, demonstrates that the Tuohy Family is currently in stage five families with adolescents. The oldest child Michael is between the ages of 13 and 20. As a mother and father, Leigh Anne and Sean are helping their children establish their own identities.

Additionally, they are allowing their children to grow as individuals and become more independent. Leigh Anne and Sean are constantly pushing their children to chase their dreams and think about the future such as college and future careers. Although they are providing their children with increased responsibilities, Leigh Anne and Sean are learning to deal with teenage self-esteem issues. Nevertheless, both parents are providing Michael. Collins, and Sj with a number of opportunities for teenage growth, while ensuring they all are on the right path towards success.

FAMILY COMMUNICATION VERBAL The Tuohy Family communicates very openly with one another. All members of the family share their opinions and thoughts without hesitation. Additionally, family conversations tend to be positive, encouraging, and fun.

Despite the positive family dynamics and effective communication the Tuohy family has developed, communication was not that easy for them in the beginning. For example, when Michael Oher first entered Leigh Anne, Sean, Collins, and SJ's lives, Michael was reserved and quiet. Michael would not look directly at anyone nor would he interact with them. He would only talk if he was being forced to or if he was encouraged by Leigh Anne.

Additionally, Michael struggles with voicing his opinions and speaking about his past with homelessness and abandonment throughout the whole course of the movie. Another example that exemplifies their struggle with communication is seen in Leigh Anne. Throughout the whole course of the movie Leigh Anne struggles with learning about Michael's childhood. Every-time she finds herself saddened with Michael's stories, she closes herself and does not speak to Sean about her feelings. Instead, Leigh Anne walks away or hides herself in her room so Michael does not see she is upset.

NONVERBAL Leigh Anne, Sean, Collins, and SJ exhibit "open" body language and display signs of physical affection. All family members are able to do the following: maintain a stooped posture, demonstrate eye contact, and show signs of happiness and love such as smiling, hugging. or kissing. Michael on the other hand exhibits "closed" body language throughout the whole course of the film. Michael is unable to maintain eye contact and is constantly touching his face, tapping his fingers, looking at the ground, and rubbing at his thighs. These nonverbal signs demonstrate a lack of confidence and comfortability.

CULTURE & RELIGION Religion plays an important role in the Tuhoy Family. The Tuhoy Family is Christian, where they attend church regularly and pray prior to meals. Additionally, Sean and Leigh Anne's three children attend a Christian School.

The Tuohy Family is heavily involved in their community. Sean and Leigh Anne are huge contributors to the Football Program at Briarcrest Christian School as they help fundraise and coach players. Additionally, the Tuohy Family is well known throughout their town because Sean is a businessman who owns all the local KFC's and Taco Bells in Tennessee.

The Tuohy Family experience racism and a backlash once adopting Michael an African American boy.

MICHAEL'S PROBLEMS: ANXIETY Michael Oher grew up in the inner-city of Memphis Tennessee. He was extremely poor and was exposed to violence, alcohol, and drug abuse at a young age. His biological mother, Denise Oher, was an alcoholic and drug addict who was unable to take care of him. As a result, Michael became a ward of the state and was ripped from his mother's arm and forced into foster care. When placed into foster care, he longed for his mother and continually ran away from his foster parents and foster homes in hopes of finding her again. Eventually, Michael was unable to locate her leaving him homeless and without a support system.

Michael throughout his life was forced to take care of himself at a young age. He had no guidance and had to learn to be independent, which is where his trust issues, lack of communication, and anxiety stems from. Anxiety according to Stonerock is described as, "A psychological state characterized by apprehensive expectation or fear" (Stonerock, Hoffman, Smith, & Blumenthal, 2015). Michael's struggle with anxiety is especially apparent once he attends Briarcrest Christian School and when he meets the Tuohy Family. In his past, no one cared for him and he had no one to rely on. Michael was often left wondering when his next meal would come from and where he would find a warm place to sleep.

Nevertheless, when the Tuohy Family offers their home to Michael, he experiences stronger feelings of anxiety and discomfort. Michael is in an unfamiliar setting and has never had a family to confide in. Additionally, he has never had someone take care of him or love him the way the Tuohy Family does for him. The Tuohy Family provides him with endless love and support, which scares Michael. Michael has not had an easy upbringing, so when asked about his childhood, Michael experiences severe anxiety. His anxiety is accompanied by sweating, trembling, hyperventilation, and feelings of impending danger.

FAMILY THEORY BIOECOLOGICAL SYSTEM THEORY: ASSESSMENT Microsystem: The microsystem focuses on factors in which the patient and their families are said to experience in their day to day reality (Kaakinen et al., 2015, p.84). The nurse can begin her assessment by asking Michael to describe her anxiety. For example, the nurse can ask Michael what his triggers are, how he deals with those triggers, how long is anxiety lasts, and what are ways in which he can calm himself down.

Additionally, the nurse should ask Michael what his day to day routine is and if his anxiety has affected any of his family members. If so, the nurse can follow up and ask how his family members are coping with his anxiety.

Overall, by doing so the nurse is able to establish a generalized baseline of what triggers Michael, how the patient currently copes, and how his anxiety has affected his relationship with his new family. After, the nurse can begin to develop a plan of care that is effective for the patient and his family.

Mesosystem: The mesosystem focuses on the patient's relationships among major microsystems. For Michael this includes family, friends, football teammates, teachers, and coaches. In order to provide care for Michael, the nurse can ask him about his relationships with these individuals and what they mean to him. Additionally, the nurses should ask about Michael's feelings regarding religion because his adopted parents are Christian and he attends a Christian school. The nurse can also assess Michael's feelings about playing football. Does he even want to play, does he like the sport or is he just doing it to make his family happy? Nevertheless by doing the following, the nurse is able to holistically establish a plan of care that meet's the needs of Michael religiously, emotionally, and physically.

Exosystem: The exosystem focuses on external environments that influence the patient and their families indirectly (Kaakinen et al., 2015, p. 84). For Michael, this is his community in the inner-city of Memphis.

Although Michael is not directly active in this community that is associated with violence, drug abuse, and alcohol addiction these individuals and environment are a trigger for him. This environment also affects Michael's willingness to open up to the Tuohy Family about his childhood. For example, when Michael brings Leigh Anne to Denise Oher's apartment complex, Michael experiences signs of anxiety. He begins sweating, rubbing his thighs, and shakes. The nurse can ask the patient about his source of support as a child and if his past is affecting his new relationship with his new family. The nurse can also ask if Michael is embarrassed to open up to the Tuohy's about his past with having a drug and alcohol abusive mother who was never around.

Macrosystem: The macrosystems level refers to the general cultural attitudes and ideologies that can influence the culture of the family (Kaakinen et al., 2015. p.84). The nurse can assess how living in an environment where racism still exist affects Michael's condition and as a family unit. The family is constantly dealing with racial slurs and stereotypes because the Tuohy Family adopted an African American boy.

Chronosystems: The chronosystem level takes into account the changes that have occurred over time, which may have an effect on the previous four systems mentioned (Kaakinen et al., 2015. p.84). The nurse can ask Michael how he is making the transition from being homeless to living with the Tuohy Family and how it has affected his anxiety. The nurse can also ask how Michael is making the transition of being provided an education. Furthermore, the nurse should ask the family and the patient about his actions of running away from home and how it can alter his family's development.

INTERVENTIONS AND OUTCOMES 1. INTERVENTION The nurse will set up a family meeting to facilitate open communication among all members of the Tuohy Family, in order to openly discuss Michael's struggles with anxiety. Additionally, the nurse will educate the family about Michael's signs and symptoms and triggers (Bandelow et al., 2017).

RATIONALE: Patients who have anxiety disorders require supportive talks and attention to the emotional problems that are associated with the anxiety disorder (Bandelow et al., 2017). Scheduling talks with the family and patient can help both parties better deal with the problem as both become more educated about the disorder.

OUTCOME: By the end of the family meeting, Michael and his family will be able to verbalize the signs, symptoms, and triggers of Michael's anxiety. The family will also be able to verbalize and show their compassion and support of Michael's needs.

2. INTERVENTION The nurse will encourage the family to use the presence of touch (with permission) and continual verbalization to remind Michael that he is not alone (Bandelow et al., 2017).

RATIONALE: Being supportive and approachable promotes communication and allows patients to understand that they are not alone. The presence of touch can help calm a patient down and can relieve pain, anxiety, and fear (Bandelow et al., 2017). The patient, Michael, will understand that his family is there to support him through his struggles even when he is not able to verbalize his own feelings.

OUTCOME: By the end of the family meeting, the Tuohy Family will be able to demonstrate ways to support Michael through non-verbal and verbal gestures during times of anxiousness.

3. INTERVENTION The nurse will teach the patient to use exercise (running, playing football, etc) as a coping mechanism to relieve his anxiety (Stonerock et al., 2015)

RATIONALE: Exercise has been shown to enhance mood, improve energy levels, and promote quality of sleepy. Exercise can be a proactive way to release pent-up tension and reduce feeling of fear and worry (Stonerock et al., 2015). Additionally, it can help reduce tightness and tension through the body by producing endorphins, the body's natural mood-enhancing chemical (Stonerock et al., 2015).

OUTCOME: By playing football and attending weekly practices, Michael will be able to reduce feelings of anxiety. Michael will be able to remain free of panic attacks and will use exercise as a coping mechanism when he becomes triggered about his childhood and new family life.

4. INTERVENTION The nurse will encourage the patient to meditate and take deep breaths when he experiences feelings of anxiousness during stressful situations (Cettina, 2018).

RATIONALE: Mindful meditation and deep breathing has been shown to induce relaxation.

Mindful meditation harnesses areas of the brain that control cognition, regulate emotions, and decrease negative thought processes (Cettina, 2018). Meditation has also been effective in cases of post-traumatic stress disorder (PTSD), an extreme form of anxiety characterized by intrusive thoughts, nightmares, and flashbacks following a traumatic event (Cettina, 2018).

OUTCOME: Through mindful meditation and deep breathing exercises, Michael will decrease his anxiety and increase his self-awareness. Michael will able to recognize his triggers and learn to prevent or avoid them. Additionally, Michael will become more in tune with his body and learn to incorporate meditation into his daily routine.

IMAGE REFERENCES Family photo [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily- collins-theblind-side.html Leigh Anne Tuohy [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily-collinsthe-blind-side.html Sean Tuohy [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily-collins-theblind-side.html Michael Oher [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily-collins-theblind-side.html Collins Tuohy [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily-collins-theblind-side.html SJ Tuohy [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily-collins-the-blindside.html Sean & Leigh Anne [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily-collinsthe-blind-side.html Michael Sitting Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lily- collins-theblind-side.html Michael & Leigh Anne [Online Image]. (n.d). Retrieved from https://www.alamy.com/stock-photo/lilycollinsthe-blind-side.html Michael Listening to Leigh Anne Read [Online Image]. (n.d). Retrieved from https://www.alamy.com/stockphoto/lily-collins-the-blind-side.html

REFERENCES Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93-107.

Cettina, L. A. (2018). Meditation, not medication, to relieve anxiety. Nursing, 48(9), 44–47. doi: 10.1097/01.NURSE.0000541390.29234.0b.

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. (2015). Family Health Care Nursing: Theory, Practice, and Research (5th ed.). Philadelphia: F.A. DavisCompany.

Stonerock, G. L., Hoffman, B. M., Smith, P. J., & Blumenthal, J. A. (2015). Exercise as Treatment for Anxiety: Systematic Review and Analysis. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 49(4), 542-56.