Grape family

The Grape Family: Family Assessment Visual Report

Ben Ferguson California State University, San Marcos NURS 480

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Introduction Family Structure and Dynamics The Grape family lives in the small town of Endora, Iowa. The family has been shaken since the passing of their father 14 years ago and it continues to hurt certain members. “Children living in a single mother household are more likely to suffer from economic deprivation and less effective guardianship” (Bjarnason, Bendtsen, Arnarsson, Iannotti, Lofstedt, & Niclasen, 2012).

Bonnie​, the mother of the house, has given up on life since the passing of her husband 14 years previous. She spends the majority of her time sitting in front of the television and eating which has caused her to become morbidly obese. Her constant mourning and depression has made her incapable of caring for her children so they have learned to take care of themselves and one another. Bonnie is supportive of her children and loves them very much but lacks the motivation to climb out of her depression and be a more involved mother.

Arnie​, the youngest child, has a developmental disability (Autism) and requires extra attention from his siblings. Arnie Loves being around his family and looks up to his older brother Gilbert. He is hard to handle at times because he likes to run away to try and climb the water tower, which he is fixated on.

Arnie is almost 18 and lacks the intellect of those his age who do not have autism. He has trouble forming complete sentences and sometimes indicates understanding when in fact he doesn’t.

Gilbert​ has been the man of the house since the passing of his father. He takes on responsibilities of making repairs to the family home and taking care of Arnie. His watching out for Arnie is for both care and protection, and Gilbert is heard saying the phrase “Nobody touches Arnie” many times. Gilbert has a tough time balancing taking care of Arnie and his personal life.

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Amy​ is the oldest sister and is the motherly figure of the family.

She, along with Gilbert, helps to take care of the house and everyone in it since their mother is unable to care for them. She runs the house and the family respects her for it.

Ellen​ is the youngest sister, and is the one who helps least with the family.

She usually pushes the buttons of her other siblings and is considered a normal teenager. She is rough with Arnie when trying to keep him in line and is not sensitive to his developmental problems.

Family Stage and Function Fitting the Grape family into Evelyn Duvall’s stages of Family Development is difficult because they are stuck between two stages.

They are out of the 5th stage since the oldest child is in her twenties but they are not quite in the 6th stage because all of the children still live at home. Bonnie’s grief and depression from her husband’s death forces the children to stay home and take care of one another and their mother. Because of this they are unable to move to the 6th stage where the children begin moving out of the house. What also makes it difficult is Arnie’s condition. He is unable to care for himself and will need a caregiver his entire life. The siblings all pitch in towards his care which also contributes to them all still living at home.

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Arnie’s Condition Autism Spectrum Disorders are complex neurodevelopmental disorders of unknown etiology that involve alterations in social interaction and verbal impairment with repetitive, restricted, and stereotype behavioral problems (Perry et al., 2014). The cause is unknown but researchers are investigating links between hereditary, genetics, and medical problems. There is a high risk of recurrence of ASD in families with one affected child. Children with ASD demonstrate several characteristics, primarily in social interactions, communication and behavior (Perry et al., 2014). ASD manifests in a range of symptoms, and the number and type can differ drastically and range from mild to severe (Pfeiffer, Coster, Snethen, Derstein, Piller, & Tucker, 2017). The hallmark characteristic of ASD is the inability to maintain eye contact with another person (Perry et al., 2014). Speech and language delays are also common in children with ASD. Early recognition and intervention can help to improve the outcomes for these children.

Families with children with ASD have reported that their children’s unusual responses to sensory stimuli restricted participation in daily living activities and created social isolation for both the parents and the child Pfeiffer et al., 2017). Some children improve and are able to achieve independence but most require life-long adult supervision (Pfeiffer et al., 2017).

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Culture and Tradition The Grape family has a tradition of watching the trailers come through town every year as the tourists are on their way to the Airstreamer’s Club gathering. Arnie loves watching them drive through the town so the family makes sure to get him a good view. Everyone is close and takes care of each other. They are seen moving the dining room table into the family room so that the whole family can eat together since their mother Bonnie is unable to move from the couch. The entire family is supportive or Arnie and his condition. Although some members of the family get annoyed of him from time to time, the family surrounds him with love and support. Meaning to family life is aided by traditions and rituals carried out amongst the family and sometimes from generation to generation (Kaakinen et al., 2015).

Communication Practices: A family that possesses healthy communication skills will show trust, respect, support, and willingness to help one another (Kaakinen et al., 2015). The Grape family shows many examples of verbal communication in their yelling at one another, constant teasing, and also supportive comments like “Nobody touches Arnie” or the mother, Bonnie, calling Arnie “sunshine.” Their non verbal communication consists of hitting one another, constant eye rolling from the youngest sister Ellen, and many hand gestures to one another, especially when Gilbert is trying to explain something to Arnie.

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Strengths and Weaknesses Strengths: The major strength that the family has when caring for Arnie and his condition is the love and support they all show for him.

Arnie is the one holding this family together.

Gilbert has put his personal life on hold in order to be the primary caregiver and protector for Arnie. He is the ďŹ rst to stick up for Arnie when a family member is being too harsh on him and helps to restore his conďŹ dence when something upsets him. Bonnie, although she is unable to move from the couch, consoles Arnie if Gilbert is not around and he is upset.

Weaknesses: The biggest challenge that the Grape family has when caring for Arnie is the fact that he needs 24-hour supervision. If left unattended, Arnie runs away to try to climb the town water tower. Caregiver burnout is also a weakness and is seen when Gilbert forgets Arnie in the bathtub and ďŹ nds him shivering in cold bath water the next morning. His communication skills are lacking because of his Autism which makes it hard for Arnie to survive on his own, even though he is 18-years-old.

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Family Theory In the family systems theory the family as a whole is stronger than each individual who makes it up. “In mammals, togetherness force produces a fusion that ensures survival” (MacKay, 2012). MacKay also states that in times of crisis, the togetherness force produces a visible fusion in which people forget their individual differences and pull together for a higher good. A single member of the family must sacrifice his or her individuality and replace it with a joining with the needs of the group to promote survival.

The Grape family was struck hard by the passing of their father. No one took it harder than the mother Bonnie, but the children have all come together to be the primary caregiver to both Bonnie and Arnie. Arnie’s condition , as well as their mother’s depression are what help the family stick together and become the one powerful unit.

They all take part in the daily care of their family members and they stick up for each other in the process. Arnie would be unable to survive if it wasn’t for his family. Their mother would not survive if the children did not take over the household and manage her care as well. Together they all live under the same roof and help each other to survive and live a better life.

Family Problems 1. Caregiver Role Strain​ is seen within the Grape family. Gilbert is the primary caregiver for Arnie and is sacrificing a lot of his own personal time to watch after his younger brother. He leaves Arnie in the bathtub in the middle of his bath and finds him the following morning.

2. Ineffective communication​ burdens the Grape family. Many times there is poor communication between family members on who is supervising Arnie. This breakdown in communication allows Arnie to run away and put himself in danger by climbing the town water tower.

3. Impaired Social Interaction​ is seen by the family because they spend a lot of their time caring for their mother and Arnie. The time spent caring for each other within the family home takes away from their social lives outside of the house.

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Intervention and Outcome #1 ● Encourage Gilbert to maintain his own priorities and goals in order to keep himself happy. By taking time for himself, Gilbert will have the opportunity to work on and maintain his own well being. In a study done by Kim, Shaffer, Carver and Cannady, 8 years into a family member being the primary caregiver they began suffering from poorer mental health and greater psychological stress (2016). ● Gilbert will take at least 1 day a week to take time off from caring for Arnie. On this day another family member will take charge of watching Arnie so that Gilbert can recharge and have a life of his own outside of the family home.

Intervention and Outcome #2 ● Assist the family in forming a schedule for who gets to be the primary caregiver for Arnie and Bonnie each day. With a schedule in place each member of the family will know who is responsible for each day of the week, hopefully leading to less confusion and easier communication throughout the household. Knowing which family member has what days will improve communication amongst the household and help to provide better care. The nurse should serve as a coach to help the family stay organized. “Coaching methods can be used to help families improve their health” (Ackley & Ladwig, 2014). ● The family members will each have a few days each week where they are the responsible caregivers, reducing the confusion amongst them and ensuring at least one of them has a watchful eye on Arnie and Barbara, to better care for them and keep them both safe.

Intervention and Outcome #3 ● In conjunction with Interventions 1 and 2, each member of the family will have days to themselves. On these particular days off, the family members should be encouraged to take time away from the house and form relationships with friends and members of the community. ● Each family member will have at least one friend or member of the community they make time for each week away from the house. This person should be someone whom they can confide in and trust.

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References: Ackley, B.J. & Ladwig, G.B. (2014). ​Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care​. Maryland Heights, MI: Elsevier.

Bjarnason, T., Bendtsen, P., Arnarsson, A. M., Borup, I., Iannotti, R. J., Löfstedt, P. & Niclasen, B. (2012). Life Satisfaction Among Children in Different Family Structures: A Comparative Study of 36 Western Societies. ​Children & Society​, ​26​(1), 51-62. doi:10.1111/j.1099-0860.2010.00324.x Doherty, W. J. (1991). Family Theory and Family Health Research: Understanding the family health and illness cycle. ​Canadian Family Physician​, ​37​, 2423–2428.

Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015). ​Family Health Care Nursing: Theory, Practice, and Research​ (5th ed.). F.A. Davis: Philadelphia.

Kim, Y., Shaffer, K. M., Carver, C. S., & Cannady, R. S. (2016). Quality of life of family caregivers 8 years after a relative's cancer diagnosis: follow-up of the National Quality of Life Survey for Caregivers. ​Psycho-Oncology​, ​25​(3), 266-274. doi:10.1002/pon.3843 Perry, S.E., Hockenberry, M.J., Lowdermilk, D.L., & Wilson, D. (2014). ​Maternal Child Nursing Care​ (5th ed.). St. Louis, MO: Mosby: Elsevier.

Pfeiffer, B., Coster, W., Snethen, G., Derstine, M., Piller, A., & Tucker, C. (2017). Caregivers' Perspectives on the Sensory Environment and Participation in Daily Activities of Children With Autism Spectrum Disorder. ​American Journal Of Occupational Therapy​, ​71​(4), 1-9. doi:10.5014/ajot.2017.021360

Pictures: Family: https://oshmatters.wordpress.com/2014/09/25/blog-whats-eating-gilbert-grape-cyber-m anagers/ Bonnie: https://rajeshnaik.com/movie-what-is-eating-gilbert-grape-1993/ Arnie: https://oshmatters.wordpress.com/2014/09/25/blog-whats-eating-gilbert-grape-cyber-m anagers/ Gilbert: https://www.rottentomatoes.com/m/whats_eating_gilbert_grape/ Amy: http://www.filmweb.pl/person/Laura+Harrington-2533

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Ellen: http://www.fanpop.com/clubs/whats-eating-gilbert-grape/images/5047094/title/whats-ea ting-gilbert-grape-screencap Family 2: https://www.movieberry.com/what_s_eating_gilbert_grape/ Arnie in Tree: http://whatseatinggilbertgrape.weebly.com/arnie-grape.html Gilbert and Arnie: http://www.fanpop.com/clubs/leonardo-dicaprio/images/15239871/title/leonardo-dicapri o-arnie-grape-whats-eating-gilbert-grape-screencap Arnie on Water Tower: http://www.supertran.net/2010/07/movie-whats-eating-gilbert-grape.html