N480 Family Nursing: Theory and Practice Fall 2017
Introduction: Billy Elliot is an eleven-year old brought to the urgent care clinic Wednesday October 21, 2017 with an inflamed knee, reduced range of motion, redness, swelling and pain in the right knee. He was accompanied by his ballet teacher, Mrs. Lori Wilkinson. Condition description: Billy is diagnosed with septic joint which is a bacterial infection usually passed through the blood. The infectious organisms associated with septic joint are Staphylococci, Haemophilus influenzae, Gram-negative bacilli and Streptococci bacteria. Symptoms usually include fever, redness and swelling of joints. Any number of joints within the human body can be affected, but usually the young and old are primarily affected. Billy underwent joint aspiration of the fluid in his knee to properly diagnose the infection. He will be admitted for an IV treatment of antibiotics.
Bioecological Systems Theory: The theory evolved from Urie Bronfenbrenner’s Theoretical model of human development; he and Stephen J. Ceci proposed the theory which combines perspectives from the social sciences, anthropologists, economists, political scientists, genetics and biology. The theory considers how 4 levels interact with one another: the microsystem, macrosystem, mesosystem and exosystem. The microsystem is the day-to-day activities Billy conducts. Most of these tasks are done independently. He dresses and feeds himself before and after school, he walks with his best friend to and from school. His grandmother has been diagnosed with Alzheimer’s disease and Billy is expected to care for her too; he day dreams and wonders about the world and all it has to offer beyond his small existence in Northern England. Because Billy is left to look after himself most of the time, his infection could persist to the joint. In fact, it was not until someone in his mesosystem noticed the infection that it was addressed.
Billy’s family genogram
Billy’s father
The mesosystem considers Billy’s relationships with a 24-year-old brother, a father and uncle, extra-curricular activities and how this circle influences the current state of his health and vice versa. Billy’s father is able to afford paying for the membership to the local gym with boxing and ballet lessons. It was his ballet teacher, Mrs. Wilkinson that noticed the swelling and decreased range of motion in Billy’s right knee and insisted upon attention from medical professional. Billy’s infection has become an injury that affects his ability to run with his best friend Michael or practice ballet with Debbie. The macrosystem involves the ideologies of his father and resides in a lower-to-middle class community of Northern England. The fact that the coal industry dictates the local economy affects the socioeconomics of Billy’s home life. Billy’s father, uncle and brother are all employed by the local mine and belong to a union. The family strongly identifies as Catholic.
The exosystem consists of all these forces that affect the previous four systems previously mentioned. For example, Billy has been accepted to the school of performance art in London beginning next Spring. This entity and the miner’s union represent larger entities that affect Billy. Billy’s father is able to pay for a private school education and premium health insurance because he is a unionized employee. Development Stages: Kohlberg’s Moral Development: According to the model, Billy is experiencing the individual and exchange stage (Crane, 1985 p. 119). Billy no longer considers the punishment for using his father’s money to pay for ballet lessons rather than boxing lessons as a valid deterrent. His act of breaking rules or wrongdoing is now connected to the risk of being caught rather than concern for a punishment. Billy considers his personal feelings and logic before taking a risky action rather than considering his father’s feelings or opposition.
According to Erikson’s stages, Billy is practicing a sense of industry more than the sense of inferiority. Billy has no problem trying out new experiences; he is brave enough to try ballet against his father’s objections; he is trying on lipstick with his cross dressing best friend and getting intimate with an age-appropriate girl. He is still learning the social rules and norms of his environment. He is in the sixth grade and enjoys physical activities like running, boxing, jumping, fishing, and ballet. Piaget’s concrete operational stage explains how Billy’s thinking is more logically. He realizes that his thoughts about participating in ballet are different than his father’s thoughts about it. He reflects on his mother’s death, which is an abstract concept; he considers his friend’s feelings and becomes less egocentric. Billy’s Ecomap
Communication: Billy’s communication with his father and brother have deteriorated to yelling, arguing, physical altercations, slamming doors and very limited proactive, productive exchange. Billy’s communication with peers has improved including expression of feelings, physical touch, and expressive body language. Billy’s communication with his grandmother requires the most attention. She requires direct eye contact, the least amount of distraction, simple and familiar words. Her communication is limited and comments can be out of context and misunderstood by the receiver. Communication from medical providers and the administrators of the School of Performing Arts in London require re-interpretation for Billy’s level of understanding.
Billy has fostered a sense of trust with Mrs. Wilkinson and her husband works with Billy’s father, so he has a good mediator in her. Mrs. Wilkinson has become a powerful advocate and mentor to Billy and seems to balance out the hyper male influence within his microsystem. She encouraged him to apply to the Academy of Performing Arts in London and subsequently was accepted. However, the limited and hostile communication that currently exists between Billy and his father and brother diminishes cooperation and understanding of the current infection. Function: According to Orem’s theory of function, Billy is currently needing partial compensation for his universal needs of caring for his health. He needs IV meds until his infection is interrupted and WBC count returns to normal and his lab values return to normal ranges.
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