Nurs 480 Grape Family Assessment

The Grape Family Obesity and the Bioecological Systems Theory

CALIFORNIA STATE UNIVERSITY SAN MARCOS, SCHOOL OF NURSING

NURS 480 JESSICA FERRIER

Introduction Bonnie Grape- Mother and widow. Used to be the prettiest women in town. After her husband Albert committed suicide, she stopped leaving the house. Became depressed and started eating to compensate. Her son Gilbert had to work extra hours to feed her.

She became morbidly obese and has not left the house in 7 years. She does not leave her seat on the couch, except to use the restroom. When she does ambulate she needs a cane for assistance The family brings the dining room table over to the couch for meals to accommodate her. She is the town joke, kids often peer into the windows to see her.

She is very caring and compassionate, especially towards her son Arnie.

Albert Grape- Father. Committed suicide in the basement. Built the families home.

Gilbert Grape- Son of Bonnie and Albert Grape. Took over the father role in the household after his father died. Takes care and has the majority of the responsibility for his disabled brother Arnie. He keeps Arnie out of trouble by playing games with him and occupying his time with repetitive actions. Works in the local grocery store and repairs the family home as needed. Doesn’t always get along with sister Ellen. Takes care of everyone else before himself. Tends to go out on drives when he becomes angry.

Introduction Amy Grape- Daughter of Bonnie and Albert Grape. Became the mother figure after her fathers death. Does the cooking and cleaning in the house. She used to be a cook in an elementary school cafeteria, but now she cares for her mother and family.

Arnie Grape- Disabled son of Bonnie and Albert Grape. 17 years old, on the verge of becoming 18. He likes to climb the town water tower and trees. He also loves to play hide and seek with his siblings. After being left in the bath overnight, he now refuses to go near water or take a bath. Doesn’t understand the consequences of his actions or the difference between right and wrong. He often screams, giggles, and sings repetitive sayings. He also makes inappropriate comments, especially about his deceased father. His diagnosis is unclear.

Ellen Grape- The 15 year old daughter of Bonnie and Albert. She wants to be a normal teenager and often acts out towards her family, especially Gilbert. Ellen resents Gilbert for acting like her father figure, often making snide comments towards him. She works at the local ice cream parlor and plays the trumpet. She doesn’t help around the house and gets frustrated easily while caring for Arnie.

Obesity • Bonnie Grape used to be the prettiest women in town. After her husband committed suicide, Bonnie began overeating. She has not left the house in 7 years.

She only walks to and from the restroom. Her children bring her blankets at night to sleep on the couch. They also bring the dinner table to the couch for Bonnie to eat with them. Her son, Gilbert, works at the grocery store and has easy access to food to bring home. In addition, Amy Grape stays at home to cook and clean for her mother.

Bonnie is 5’9 and weighs 600 pounds, a BMI of 88.6. The floor of the house is starting to cave underneath her due to her weight.

Amy, Gilbert, and Ellen are all embarrassed of their mothers weight gain.

• Obesity: an excess amount of body fat (National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), 2012) • It is measured using the body mass index (BMI) • A BMI greater than 30 is considered obese.

• A BMI greater than 40 is considered extremely obese.

• In 2010, 1 in 20 adults was considered extremely obese (NIDDK, 2012) • Obesity often occurs when a person consumes more calories than they can burn (NIDDK, 2012).

• Calories are needed for essential daily functions; however, if the calories cannot be burned off, the calories are stored as fat (NIDDK, 2012).

• Genes, eating habits, emotions, and income are all factors in creating obesity (NIDDK, 2012).

Developmental Stages and Functions Family Member

Erickson’s Development Stage

Bonnie Grape

Generativity vs. Stagnation: Bonnie is in the generativity stage of development. She has seen her son turn 18 and her other son find love. She dies at peace that her family will be able to take care of each other.

Amy Grape

Intimacy vs. Isolation: Amy is in the isolation stage. She does not leave the house very often because she has to take care of her mother. Her only relationship is with her family.

Gilbert Grape

Intimacy vs. Isolation: Gilbert is in the intimacy stage. He has been intimate with a married women. He now has found a women that he connects with on a deeper level.

Arnie Grape

Identity vs. Role Confusion: Arnie is in the role confusion stage. He has a developmental disorder and therefore has the mind of a child. This makes his role in the family unclear to himself.

Ellen Grape

Identity vs. Role Confusion: Ellen is in the role confusion stage. She understands her role within the family but struggles to fill it. Due to family stressors she cannot understand herself.

Culture • The Town: • The Grape family lives in the small town of Endora.

• Everyone knows everybody; every town event is a spectacle • Lack of technology • Lack of healthy food options: ice cream parlor, burger barn, 2 supermarkets

• Food: • The family tends to choose to eat items such as: • Burgers, • Steak • Potatoes • Bacon • Corn • Cake • Ice cream

• Family activities: • Eat dinner together • Watch television together • Plan celebrations together • All have specific roles to benefit household function

Strengths and Weaknesses Strengths • • • • • • •

Table time Strong sense of family bond Role division Sense of play and humor Spend free time together Understand the health of Arnie is limited Highly depend on each other

Weaknesses • Lack of support for one another • Often criticize each other and say, “we gotta do better” • Eating habits • Communication tense between family members • Education of right and wrong • No religious core • Don’t admit when they have problems or need help • No rituals or traditions • Lack of compromise

Communication • The Grape family communicates by: • Verbal • Yelling and screaming • Snide comments • Inappropriate speech (comments and jokes) • Bonnie is soft with Arnie, calls him “sunshine” • Nonverbal • Inappropriate hand gestures • Eye rolling • Hitting or grabbing one another

Healthy family communication skills include: • Trust • Respect • Active listening • Empathy • Support • Open and honest • Willing to solve problems (Kaakinen, 2015)

Bioecological Systems Theory • The bioecological systems theory focuses on how different environmental systems interact to affect the development of an individual or family unit (Kaakinen, 2015).

• The 5 systems are: 1. Microsystem- Everyday reality of an individual or family 2. Mesosystem- Direct interactions/ relationships that effect the microsystem 3. Exosystem- the external environment that indirectly influences the microsystem 4. Macrosystem- the greater society and cultural influeces that effect the microsystem 5. Chronosystem- time related events that effect the other systems

The Grape family: 1. Microsystem- The Grape family: Bonnie, Amy, Gilbert, Arnie, and Ellen.

2. Mesosystem- Gilbert and Ellen’s employers, the town police officers, Gilbert and his mistress, her kids, and her husband, other town members (especially curious children), and health status of Arnie and Bonnie.

3. Exosystem- the town of Endora, the water tower, food mart, Lamson’s grocery store, insurance coverage, family home, the cemetery, Burger barn.

4. Macrosystem- lack of healthy food, everything is scandalous, no secrets among the town and its members, laws, lack of new technology.

5. Chronosystem- fathers death, Arnie’s 18th birthday, Burger Barn placed in town, Bonnie’s death.

Ecomap

Friends

- - <- -

Other town members

Finances/ work

- ---

- - -> <- - -

Family home

Health status/ insurance

Police officers/ law

Healthy food options/ choices

Strong - - -> Weak Tense

Direction of energy flow

Problem:

The mother of the family has bad eating habits. This is resulting in the family following her bad habits. These bad habits include overeating and not making healthy food choices.

Interventions: 1. Controlling stimuli that cause overeating, such as watching television with frequent food-related commercials. A study demonstrated that watching television was associated with eating unhealthy snacks (Lipsky & Iannotti, 2012). (Ackley, 2014).

2. Work with the family to change the food that is available in the home, eliminating sugary drinks and foods with a high saturated fat or trans fat content. Foods with increased sugar cause dental cavities, are empty calories and can cause obesity; high-fat foods with saturated fat and trans fats cause high cholesterol levels and obesity (Kline, 2009).

3. Help strengthen family ties by encouraging family members to set goals for connecting and communicating well with each other and using good coping strategies to deal with family stress (Samuel-Hodge, 2016). Social support such as effective communication and conflict management can positively encourage a patient to achieve their goals (Samuel-Hodge, 2016).

Outcomes:

1. The patient and family will agree to incorporate increased exercise into their daily lives by end of shift (Ackley, 2014).

2. The patient and family will design dietary modifications that can help them maintain a healthy lifestyle by end of shift (Ackley, 2014).

3. The patient will lose weight at a reasonable time period throughout the year (Ackley, 2014).

References • Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook: An evidence-based guide to planning care (10th ed.). Maryland Heights, Mo.: Elsevier.

• Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., Hanson, S. (2015) Family health Care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia.

• Kline, A. (2009). Pediatric obesity in acute and critical care. AACN Advanced Critical Care, 19(1):38– 46. doi: 10.4037/15597768-2008-1006.

• Matalon, D. (producer), Teper, M. (producer), Ohlsson, B. (producer), & Hallstrom, L. (director).

(1994). What’s Eating Gilbert Grape. United States: Paramount Pictures.

• National Institute of Diabetes and Digestive and Kidney Disease (2012). Overweight and Obesity Statistics. National Institute of Health. Retrieved from: https://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx • Samuel-Hodge, C.D., Holder-Cooper, J.C., Gizlize, Z., Davis, G., Steele, S.P., Keyserling, T.C., Kumanyika, S.K., Brantley, P.J., Svetkey, L.P. (2016). Family partners in lifestyle support: family-based weight loss for African American adults with type 2 diabetes. Obesity, 25 (1) 45-55. doi:10.1002/oby.21700.

References (Pictures) Cover image- https://s.yimg.com/ny/api/res/1.2/ZKgPCdXgyl66Is6nAByOHg-/YXBwaWQ9aGlnaGxhbmRlcjtzbT0xO3c9NjMwO2g9NDIwO2lsPXBsYW5l/http://media.zenfs.com/deDE/blogs/demovies/ddpimages-Familie-Grape.jpg Albert Grape- http://i.dailymail.co.uk/i/pix/2016/02/06/21/00C8DD841000044C-3435309-image-m-24_1454794124969.jpg Bonnie Grape- http://images2.fanpop.com/images/photos/5000000/What-s-Eating-Gilbert-Grape-whats-eating-gilbertgrape-5048493-852-480.jpg Gilbert Grapehttps://www.bing.com/images/search?view=detailV2&ccid=0tu9BJkk&id=84E76A2B2CACB8A785D24783107CE7C93E09CA79 &q=what%27s+eating+gilbert+grape+family+&simid=608023295790616125&selectedIndex=56&ajaxhist=0 Family around TV- http://images2.fanpop.com/images/photos/5000000/What-s-Eating-Gilbert-Grape-whats-eating-gilbertgrape-5051381-852-480.jpg Arnie Grape- http://cdn.womensunitedonline.com/gallery/leo_dicaprio_whats_eating_gilbert_grape.jpg Ellen Grape- http://37.media.tumblr.com/tumblr_me1xjjAO4x1rzd6w3o1_1280.png Family in car- http://i2.cdn.turner.com/cnnnext/dam/assets/160111140815-whats-eating-gilbert-grape-restricted-super169.jpg