Sarah Braverman, Amber Holt, and Drew Holt
Braverman/ Holt Family Assessment
Katherine Blaylock CSUSM School of Nursing N480 Family Nursing, Theory, & Practice ISSUU Visual Report Assignment
Amber Holt Amber is an 18 year old high school senior applying to colleges. She lives with her mother and brother in their grandparents house after they relocate to Berkeley. Her father is a drug addict and alcoholic whom her mother divorced when she was younger. She is close with her brother and mother but can act rebellious with her mother. She is in the identity vs role confusion stage of Erikson’s stages of psychosocial development. After moving in with her grandparents, she grows closer to them as well.
Generalized Anxiety Disorder When Amber gets rejected from UC Berkeley, she begins to develop generalized anxiety disorder. She begins to have persistent and excessive anxiety and worry that causes her to feel restless and on edge (Townsend & Morgan, 2018). The condition and symptoms impair her occupational and social functioning and she begins to avoid her family (Townsend & Morgan, 2018). She even becomes aggressive with her family without justifiable cause when they try to talk with her, which can be a symptom of anxiety (Fernandes et al., 2017). She quits her internship, starts taking illegal drugs, drinking alcohol, and driving under the influence to cope with her anxiety. She gets into a car with her intoxicated boyfriend driving and they even get into a car accident. She has minor injuries, including lacerations and a broken wrist, and has a panic attack when she wakes up in the hospital. She is still in denial about her anxiety and her ineffective coping until her grandfather speaks with her.
Meet the Family Sarah Braverman is a 41 year old woman and the second child of Zeek and Camille Braverman. She is a former bartender, former graphic designer, and wrote a play. She is a free spirit and still trying to figure her life out. She was married to Seth Holt, whom she divorced after he refused to go to rehabilitation for his drug abuse and alcoholism. She has two children, Amber and Seth, and moves in with her parents. She is in the generativity vs stagnation stage of Erikson’s psychosocial developmental theory.
Seth Holt is a 16 year old high school sophomore. He is close with his sister and gets close to his grandfather Zeek after they move in with. He is quiet, sensitive and wants to be close with his father despite his father not being a big part of his life after the divorce. He is in the identity vs role confusion stage of Erikson’s psychosocial development theory. Zeek and Camille Braverman are the parents of Sarah and grandparents to Amber and Seth. Zeek and Camilla allow them to move in with them so they can help out financially and be there for Seth and Amber. Zeek is retired and Camille is a painter. They are both in the ego integrity vs despair stage of Erikson’s developmental theory.
Developmental Stage & Family Dynamic/ Function/Roles The Braverman/Holt Family is at the families with adolescents stage (Kaakinen et al., 2015). The families with adolescent stage includes the following family developmental tasks: allow adolescents to establish their own identities yet still be part of the family, increase their roles of the family by helping around the house by cooking, repairing, etc., and thinking about their own future, education, jobs, and working (Kaakinen et al., 2015). Amber is applying to college, has a job, and is still experiencing conflict over independence and control while Drew is establishing his own identity outside his family, increasing in self-esteem, places a heavier emphasis on peer relationships, and is also establishing independence and control. Sarah has to allow both her children to establish their own identity separate from her own by letting them make their own decisions while also still setting boundaries for their safety and well-being.
Sarah has to deal with being a single parent after a divorce by adapting to her new family, maintaining financial responsibilities as provider, caring for her children, and moving back in with her parents. She was used to living on her own and taking full responsibility for the care of her children but after moving back in with her parents, she has to adjust to their offers of help and advice. Her father Zeek regularly offered advice and help with finances, which Sarah had to adjust to since she was used to doing everything on her own. Amber and Drew had to adjust to a new living environment while also being adolescents who are trying to form their own opinions and gain more independence. They all also have to adjust to living with their grandparents as they are used to living with their working mother so adjusting to grandparents who care and want to place constraints on them as well as their mother contradicts their newfound independence and control they are trying to develop. The Braverman/Holts are close since it has been just the three of them for an extended period of time so they are fairly reliant on one another and care for each other tremendously.
Family Traditions/ Religion
Communication Strengths/ Weaknesses Verbal: The family will
The Braverman Family has a tradition of regular family dinners where the entire extended family meets for dinner. The entire family meets at Zeek and Camille’s house where they gather outside under the stars at a large table and easily talk while they eat. These dinners can last for a couple hours. They catch up and interact as a whole family. The family as a whole is not religious but more spiritual. They don’t consider themselves “Christians” but they do believe in God. They don’t go to church, regularly pray, or are shown to be reading the bible. They instead emphasis the importance of loving one another with an emphasis on loving your family. For Sarah, Amber, and Drew, they all feel a strong connection and appreciation for music, They all play guitar, with Sarah enjoying writing music, and Drew and Amber like to sing as well.
communicate face to face on most occasions. They have good rapport and trust with one another. As an adolescent, Amber can be sarcastic and acerbic as she grows in independence. Sarah talks in a respectful manner to her parents but can also get frustrated with them as an adult living with her parents. Drew speaks with love and respect to most family members but can also be abrasive when trying to obtain independence.
Non-verbal: The family all gesture when they talk, make emotive facial expressions when angry, happy, and sad, and like to give hugs, especially Sarah when talking to Amber and Drew.
Strengths: The Braverman/Holt family is good at spending time together, have a strong commitment to the family, are supportive of one another, have strong resilience to rebound from stress and crisis, and are adaptive to change. They are exceedingly good at supporting one another whenever there is a crisis. Therefore, they will be able to offer lots of support to Amber to help through this time. Weaknesses: The Braverman/Holt family can have trouble communicating at times, especially Amber. Amber is at a period in her life where she wants independence and control and this can cause miscommunication with her family. She can be sarcastic, acerbic, and abrasive and will run away when overwhelmed. She would initially rather avoid conflict than find resolutions. Therefore, getting her to admit there is a problem and than communicating about it could be difficult.
The Braverman/Holt Family & Family Systems Theory The Family Systems Theory allows nurses to assess families as a whole and/or as individuals within a family unit who form an interdependent, dynamic system (Kaakinen et al., 2015). It provides a framework to think about family as a unit with emphasis on the whole family rather than an individual (Kaakinen et al., 2015). Families are dynamic and change in response to stresses and strains from internal and external environments and families learn to adapt to these changes (Kaakinen et al., 2015). The goals in family systems theory are to help maintain or restore the stability of the the family and help each family member achieve the highest level of functioning they can (Kaakinen et al., 2015). This theory is made up of 4 concepts. Concept 1: All parts of the system are Concept 3: All systems have Concept 2: The whole is more than the sum interconnected and when one family some form of boundaries or of its parts and the whole family is affected experiences a health event, all members are borders between the system by the unexpected event (Kaakinen et al., affected because they are connected and its environment, in which 2015). Since this family is tight knit and close, (Kaakinen et al., 2015). When Amber starts families uses barriers to control when Amber begins to have disruptive to develop GAD, she uses ineffective coping the impact of stressors on the behavior and lets her anxiety interrupt her methods and begins to avoid her family. She family (Kaakinen et al., 2015). functioning, it greatly affects her mother and disrupts family communication, embarrasses The Braverman/Holt Family brother. Both Sarah and Drew are affected her Aunt by quitting the job she got her, have an open boundary to the by her out of character behavior and scares her mother and brother since her extended Braverman family, avoidance because they are used to her father has a history of drug especially to Zeek and Camille, performing a certain role in their family and abuse/alcoholism, and worries her entire and a flexible boundary to other without her, they feel lost. extended family. resources. The extended family talks to Amber about seeking Concept 4: Systems can be further organized into subsystems and take into account all the help and they use outside different relationships in a family such as mother to child, brother to sister, grandparent to resources to get her someone grandchild, etc. (Kaakinen et al., 2015). The Braverman/Holt Family is able to rely on their to talk to if she wants. extended family for support, encouragement, and love. Sarah and Drew are able to also get support from the extended family when Amber is in the hospital by being present and offering comfort and reassurance.
Interventions & Outcomes 1.
2.
3.
Use verbal and nonverbal therapeutic communication approaches such as empathy, active listening, and confrontation to encourage the client and family to express emotions, verbalize concerns and set goals. Rationale: Researchers found empathy, active listening, and use of silence were among the therapeutic communication approaches that were required to implement presence and improve client outcomes (Ackley et al., 2020). Encourage the client to describe previous stressors and coping mechanisms used and offer alternative coping strategies as needed. Let the parent/family be involved in the decision making regarding a new coping strategy. Rationale: Offering several choices can increase the sense of ownership an individual experiences when choosing the next step (Ebberwein et al., 2020). Evaluation of coping strategies can promote well-being and minimize poor mental health outcomes (Ackley et al., 2020). Parents and family are familiar with the patient and can help identify strategies to help relieve anxiety (Hockenberry et al., 2017). Provide or recommend mental and physical activities within the client’s ability such as reading, music, crafts, social gatherings, exercise, etc. Rationale: Research has shown physical activity improved state anxiety and feelings of energy with small improvements were found for worry, worry engagement, and feelings of fatigue among young men and women (Herring et al. 2019).
Outcomes: Patient will identify and begin using effective and adaptive coping strategies within 1 week. Patient will remain free of destructive behaviors toward self and others for at least 1 month. Patient will report increase in psychological comfort within 1 month.
References Ackley, B. J., Ladwig, G. B., Flynn Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnosis handbook (12 ed.). Elsevier. Ebberwein, C. A., Hopper, M. T., Raghuveer, V., & Macaluso, M. M. (2020). When worry is excessive: Easing the burden of GAD. Journal of Family Practice, 69(7), 357-361. Fernandes, M. A., Torres de Meneses, R., Guimarães Franco, S. L., Soares E Silva, J., Araújo Feitosa, C. D. (2017). Anxiety disorders: Experiences of users of a specialized mental health outpatient service. Journal of Nursing EFPE, 11(10), 3836-3844. https://doi.org/10.5205/reuol.12834-30982-1-SM.1110201718 Herring, M. P., Monroe, D. C., Gordon, B. R., Hallgren, M., Campbell, M. J. (2019). Acute exercise effects among young adults with analogue generalized anxiety disorder. Medicine & Science in Sports & Exercise, 51(5), 962-969. https://doi.org/10.1249/MSS.0000000000001860 Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2017). Essentials of Pediatric Nursing (10th ed.). Elsevier, Inc. Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Harmon Hanson, S. M. (2015). Family health care nursing: Theory, practice and research. (5th ed.). F.A. Davis. Townsend, M. C., & Morgan, K. I (2018). Psychiatric Mental Health Nursing: Concepts in Evidence Based Practice (9th ed.). F.A. Davis.
Images Image 1: https://tv-fanatic-res.cloudinary.com/iu/s--1rLaDdz1--/t_episode_lf/cs_srgb,f_auto,fl_strip_profile.lossy,q_auto:420/v1371143113/parenthood-family.png Image 2: https://i.pinimg.com/736x/5d/4a/6e/5d4a6ebd0788d9f25e5fc9df9953102c--parenthood-tv-show-movies-free.jpg Image 3: https://static.wikia.nocookie.net/parenthood/images/c/cd/Amber-holt-photo.jpg/revision/latest/top-crop/width/360/height/450?cb=20100926154520 Image 4: https://www.simplypsychology.org/generalized-anxiety.jpg?ezimgfmt=ng%3Awebp%2Fngcb30%2Frs%3Adevice%2Frscb30-2 Image 5: https://static.wikia.nocookie.net/parenthood/images/6/66/Sarah-braverman-picture.png/revision/latest/scale-to-width/360?cb=20150913192800 Image 6: https://static.wikia.nocookie.net/parenthood/images/2/2a/Drew-Holt-pic.jpg/revision/latest?cb=20150914170149 Image 7: https://i.pinimg.com/originals/85/fb/f4/85fbf4ea017d673997e26fdc03df6145.jpg Image 8: https://cdn3.vectorstock.com/i/1000x1000/12/32/stages-family-development-and-life-cycle-flat-vector-31351232.jpg Image 9: http://media2.s-nbcnews.com/i/streams/2014/April/140417/1D274905647993-today-parenthood-140417.jpg Image 10: https://imgix.bustle.com/rehost/2016/9/13/3f1c3e0c-3751-4a67-9c34-856d40a6def5.jpg?w=800&fit=crop&crop=faces&auto=format%2Ccompress Image 11: http://3.bp.blogspot.com/-KYWLR0LMtrs/Ta8CctyFOpI/AAAAAAAADhE/A7TWhdNV2hI/s1600/sarah+amber+drew.jpg Image 12: https://miro.medium.com/max/1000/1*mkN1-dRRph6HBTUvKlMzEw.jpeg Image 13: https://www.wonderwall.com/wp-content/uploads/sites/2/2018/05/1028682-parenthoodtvs6e2_02.jpg?w=700 Image 14: http://blogs.longwood.edu/sparrockls/files/2018/10/FC20_Physical-Activity-and-Stress-Reactivity_620x350.png