CSUSM, NURS 480
INTRODUCTION: THE SULLIVAN FAMILY The Sullivan family lives in Beaufort, North Carolina. The Sullivan family is a traditional, close-knit, religious family. The Sullivan family is a three member family made up of Hegbert Sullivan, his daughter, Jamie Sullivan, and Jamieâ€™s boyfriend, Landon Carter. Mr. Sullivan is forty five years old, a widow who has raised Jamie all of her life. He is six feet tall, with brown hair and brown eyes. He is a very kind, caring father and mister. He enjoys spending time at the church, participating in community events, and caring for his daughter. He is the head of the household and provides for his daughter Jamie. Mr. Sullivan is in the Generativity versus Stagnation stage. He is in the Generativity stage and expresses that he is proud of his life and high greatest accomplishment, raising a very responsible daughter.
Jamie Sullivan is a young, seventeen year old adolescent, who has leukemia and has been informed her body is no longer responding to treatment She is five feet, six inches tall, thin, pale with long brown hair and dark brown eyes. She is in the Identity versus Alienation stage. She has established her sense of identity by accepting herself for her unique qualities. She is currently seeking to be autonomous from her father by accepting that her time of passing is near and choosing to make her own medical decisions. She is content with her life and has chosen to make the most of the time she has left. She places a lot of value on her religious beliefs and has a close relationship with her father and boyfriend. Jamie helps with house chores, such as cooking and cleaning, enjoys learning about astronomy, tutoring her peers, and signing in the church choir. She demonstrates full development of Formal Operations stage by being able to understand complex algebra and calculus, subjects she tutors at her high school. She is physically mature and demonstrates fully developed gross and fine motor skills as she dances gracefully with Landon on their dates. Landon Carter is a seventeen year old, high schooler who is adventurous and outgoing. He enjoys listening to music and spending time with Jamie and his friends. He is five feet, ten inches tall, lean, with dark brown hair and dark brown eyes. He has developed his sense of identity by making his own decisions about his personal life and career choices. He also demonstrates achievement of Formal Operations by being able to judge how his actions will affect himself and his peers. He chooses to participate in the high school play as an alternative to being suspended from school. After finding out Jamie has stopped responding to treatment, he is a support to her and her father. He tries to maximize Jamieâ€™s quality of life by helping her fulfill her wishes before she passes. He appears to be physically mature and demonstrates fully developed gross and motor skills by being able to play basketball with great skill the tutoring group.
JAMIE’ S CONDITION: LEUKEMIA
Jamie was born prematurely, and was diagnosed with anemia after screenings revealed she had low iron and red blood cell counts as an infant (Perry, Hockenberry, Lowdermilk, & Wilson, 2014). Her anemia was being monitored and treated by her pediatrician, but eventually developed into leukemia at the age of twelve. She continuously kept getting very ill when she would get a cold with fevers, prolonged infections, enlarged lymph nodes, and an enlarged spleen (Perry et al., 2014). Blood tests showed immature leukocytes and low blood counts (Perry et al., 2014). A biopsy of her bone marrow revealed underdeveloped white blood cells (Perry et al., 2014). The condition is related to low blood cell counts in the bone marrow due to the body’s inability to create normal, healthy blood cells (Ignatavicius & Workman, 2016). Jamie had been undergoing treatments with chemotherapy to overcome the disease, but currently her body is not responding to the benefits from treatments anymore. She has chosen home care to treat her symptoms at home and wants to pass away in the comfort of her bedroom. Signs and symptoms of leukemia: Weakness, fatigue, tiredness, easily bruising, pale skin, cold extremities, swollen lymph nodes, continuous infections that are prolonged, loss of appetite, enlarged spleen and liver, increased bleeding, and weight loss (Perry et al., 2014). Risk factors of leukemia: “Abnormal chromosomes, viral infections, exposure to chemicals and drugs, genetic conditions such as Fanconi’s anemia, family history of leukemia” (Ignatavicius & Workman, 2016, p. 806).
CULTURE/RELIGION: The Sullivans are very religious. Mr. Sullivan is the town’s mister and Jamie is in the church choir. They go to church every Sunday and are directly involved in everything that happens at the church. Landon has also started going t o church with the Sullivans since he started dating Jamie but is not as involved. They uphold their religious traditions by reading the Bible and maintaining a God centered focus about life. They accept Jamie’s illness and seek to make decisions about their lives that revolve around their religious beliefs. The Sullivans use Biblical scriptures and their relationship with God to cope wi th Jamie’s illness. STRENGTHS/CHALLENGES: The Sullivans are a very close family; this is their greatest strength. They see each other as a support system by providing each other emotional, social, and financial support. They celebrate their accomplishments togethe r and help each other get through life’s obstacles. They also have established roles and expectations from each other (Kaakinen , Coehlo, Steele, Tabacco & Hanson, 2015). Another strength that the family possesses is their spirituality. The family embrace s hope amidst Jamie’s deteriorating health (Kaakinen et al., 2015). Their spirituality helps the family maintain closeness and endure difficult times together (Kaakinen et al, 2015). Their biggest challenge is accepting Jamie’s decision to stop treatment of her terminal illness. Mr. Sullivan, Landon, and Jamie are faced with accepting that Jamie is at the end of her life.
COMMUNICATION: The Sullivans are very open and verbally communicate with each other. Mr. Sullivan has allowed Jamie to make her own decisions about her condition as she sees fit. He understands that she is old enough to weigh the risks and bene fits that arise from the choices she makes in her life. Jamie shares her reasons for choosing to stop treatment with her father an d her boyfriend. Both her father and her boyfriend accept her decision. However, they are both affected because they realize that they cannot do anything to change her mind or to help her become healthy again. The family also demonstrates non verbal communication by showing comforting physical touch, such as hugging, when the members appear worried.
FAMILY THEORY: DEVELOPMENTAL & FAMILY LIFE CYCLE THEORY According to this theory, the Sullivan family is in the families with young adults: launching stage (Kaakinen et al., 2015). This theory focuses on Jamie Sullivan. Mr. Sullivan has to adapt to Jamie’s new role once she marries Landon. This stage includes allowing Jamie to make her own decisions about the course of her future which includes letting her decide to get married (Kaakinen et al., 2015). Allowing Jamie to marry Landon causes stress to both her father and her boyfriend because they have to adjust their roles in the family. Mr. Sullivan has to allow Jamie space and alter his family role to provide Jamie and Landon independence and ability to function as a couple. Transitioning to this stage creates disequilibrium among the family and leads the Sullivans to focus on preserving a “supportive home base” for the newlyweds (Kaakinen et al., 2015, p. 80). Their decision to get married happens on time since both Jamie and Landon wait until they graduate high school to get married. It is a cultural norm for them to wait until they finish high school to marry. According to this theory, this change would be considered a normative change because it occurred in an expected sequence of events (Kaakinen et al., 2015).
CHRONIC ILLNESS FRAMEWORK The Chronic Illness Framework is appropriate for the Sullivan family because they are directly being affected by an “illness type, time phase of the illness, and family functioning” (Kaakinen et al., 2015, p. 87). The illness type consists of the ill ness onset, course of the disease, the outcome of the disease, and the extent of incapacitation (Kaakinen et al., 2015). The onset of Jamie’s leukemia is gradual. Jamie’s father has had time to adapt to changes that have ascended from Jamie’s deteriorating health and has also obtained education about the course of the disease. Landon, on the other hand, has to learn to adapt since he is very unfamiliar with the disease and has not been involved in Jamie’s life long enough to understand how the disease affects her directly. Her leukemia is relapsing and is this is evident because she is not responding to treatments and enters a period of exacerbation (Kaakinen et al., 2015). Due to unknown periods of potential flare -ups from the disease, Mr. Sullivan and Landon are very concerned and stressed because they are not sure how long Jamie will live after this exacerbation. The disease proves to be greatly incapacitating on Jamie and her family ability to function. Jamie’s energy decreases greatly as the disease progresses impairing her mobility. This causes Landon and her father to take over total care for her and help her perform activities of daily living. The Sullivans find themselves at the terminal time phase of the disease. They arrange home care for Jamie and enter the grieving process. Jamie and her father are accepting of the prognosis of the disease; however, Landon is in denial and expresses anger and frustration when he feels unable to help Jamie. All of the members of the family are confronted with accepting the loss. Family Functioning has to be modified to provide maximum care for Jamie. Her illness causes stress to both her father and her boyfriend. The illness demands that her family care for her since she becomes too weak to care for herself. Although the family becomes stressed by the illness demands, their unity and close bonds help them deal with these stressors.
INTERVENTIONS & OUTCOMES Problem #1: The Sullivan family do not know enough about the terminal phase of the disease. They know Jamie’s exacerbation is more serious this time but are unsure what this means. Intervention: The nurse caring for Jamie should educate the family members and address concerns about the disease (Simoneau, 2013). Rationale: “Nurses play an important role in patient education, they can explore how much information is desired and help the patient access accurate and comprehensible information” (Simoneau, 2013, p. E18). Nurses should assess the degree of education the family is lacking and proceed to educate within her scope of knowledge (Simoneau, 2013). The nurse should also refer the family to the primary physician if the family has specific questions about the disease that are outside her scope of practice. She can also refer the family to outside resources that will aid in their education. Outcome: The family will verbalize their confidence in their ability to manage the disease and identify resources that are accessible where they can obtain more information (Ackley & Ladwig, 2014). Problem #2: The Sullivan family is experiencing increased anxiety and stress due to the uncertainty of the outcome of the disease. Intervention: Assess the family’s degree of anxiety and stress and refer the family members and patient to counseling services, home care, and social services as needed to help decrease amount of perceived stress and anxiety. Focus on the family strength related to their religion and spirituality to help cope with the effects from the illness (Kaakinen et al., 2015). Rationale: “Spirituality plays an important role in adaptability to leukemia and coping with its resulting mental trauma. Research has confirmed the effects of spirituality on decreasing anxiety” (Moeini, Taleghani, Mehrabi & Musarezaie, 2014, p. 89). Outcome: The Sullivan family will express a stronger connection with each other and verbalize ways they will utilize their religion to help cope with their stress and anxiety. Problem #3: The Sullivan family does not know how to integrate Jamie’s care into their normal lives. Intervention: The nurse should assess the degree of care Mr. Sullivan and Landon can provide for Jamie and how much care Jamie can provide for herself. The nurse should also ask questions about what their normal daily routines consist of. Rationale: “Understanding the patient experience and educational needs is the key to proper information transfer and customized delivery of the highest-quality care” (Simoneau, 2013, p. E18). The nurse should promote normalcy in the family by integrating management of the disease in a way that helps emphasize the normal routines and traditions of the family (Kaakinen et al., 2015). Outcome: All of the family members will verbalize ways they can promote as much normal functioning within the family as possible. The family will decide not let negative effects from the disease weigh down their daily lives ( Kaakinen et al., 2015).
REFERENCES Ackley, B. J., & Ladwig, G. B. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care (10th ed.). Maryland Heights, MO: Mosby. Ignatavicius, D.D. & Workman M.L. (2016). Medical- surgical nursing: Patient-centered collaborative care (8 th ed.). St. Louis, MO: Elsevier. Kaakinen, J., Duff-Gedaly, V., Hanson, S. & Coelho, D. (2015) Family health Care nursing: Theory, practice and research (5 th ed .). F.A. Davis: Philadelphia. Moeini, M., Taleghani, F., Mehrabi, T., & Musarezaie, A. (2014). Effect of spiritual care program on level of anxiety in patients with leukemia. Iranian Journal of Nursing and Midwifery Research, 19(1), 88-93. Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal Child Nursing Care (5th ed.). St. Louis, MO: Mosby: Elsevier. Simoneau, C. (2013). Treating chronic myeloid leukemia. Clinical Journal Of Oncology Nursing, 17(1), E13-20. doi:10.1188/13.CJON.E13-E20
IMAGES Image 1 http://images4.fanpop.com/image/photos/20300000/Jamie-and-Landon-jamie-sullivan-20325439-500-363.jpg Image 2 http://rememberthewalk.weebly.com/uploads/2/0/0/8/20083695/2310482.png Image 3 http://letmetastethesea.files.wordpress.com/2011/12/jamie-sullivan-913899794.jpg Image 4 http://www.magicalquote.com/wp-content/uploads/2014/03/Landon-Carter.jpg Image 5 http://3.bp.blogspot.com/-VEYKwn09nUA/TnepSJzmEhI/AAAAAAAAE_o/D5JjrlEcsJM/s400/awtr3.jpg Image 6 http://www.media2.hw-static.com/wp-content/uploads/a-walk-to-remember-movie-still-mandy-moore-as-jamie-sullivanpeter-coyote-as-rev-sullivan-and-shane-west-as-landon_1100068-400x305.jpeg Image 7 http://images4.fanpop.com/image/photos/19200000/Jamie-Landon-jamie-and-landon-19262170-852-480.jpg Image 8 http://3.bp.blogspot.com/-3EL7mwsiOnc/T-ckTSd243I/AAAAAAAABpg/NjsPuMRAKno/s640/casamento1.jpg Image 9 https://i.ytimg.com/vi/C1bPfIkP1JQ/hqdefault.jpg