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The Messner Family

Meet the Messners: Kate is a 15 year old girl that attends high school in Boring, Oregan as a sophomore in the early 1990’s. Kate is relatively quiet and soft spoken, but gets along with her peers easily and has a supportive group of friends. She is a part of AV club and enjoys spending her time working with cameras and filming videos. She sees her father very often, as he is the principal of her school. She has family dinners with her father every night, communicates with him on a regular basis, and has an overall close relationship with him. Her mother committed suicide 5 years ago due to depression and she has coped very well with it. She is even able to talk to her friends about it. When she thinks about it, she gets sad but, she is able to move on from the traumatic event and continue her daily activities. She and her father have each other to depend on for support, however they tend to avoid talking about the suicide event due to her father not avoiding it to avoid becoming too emotional. She tries to be more of an emotional support for her father because he has a harder time accepting what has happened. Kate often feels upset seeing her father sad and depressed. She feels as though she sometimes cannot talk to him about that event because of his reactions.

Ken is a 40 year old man who is the principal of a high school in Boring, Oregan in the early 1990’s. Ken seems to get along with his colleagues, but often avoids making conversations with them. He seems to be respected by both students and staff. Ken often sees his daughter around school and talks with her on a regular basis. He tries to be supportive of Kate in anything she does. Ken is widowed due to his wife’s suicide from depression 5 years ago. Ken never accepted how his wife died, and told others it was related to a medical illness, rather than saying suicide. He and his daughter became closer after that and try to be supportive of each other. However, Ken struggles much more than Kate in coping with it, and has developed depression over the years. He tries his best to be strong for her, but at times he is not emotionally present and often avoid talking about it because he becomes very emotional. While he does have his daughter for emotional support, he often says he feels alone and breaks down in tears when he is by himself. He has said many times that he feels sad and lonely and that he may never feel complete again. Ken has not sought out professional help.

Developmental Stage

Depression Depression, either major depressive disorder or clinical depression, is a serious mood disorder . This disorder causes symptoms like persistent sadness, emptiness, hopelessness, and irritability. It may affect how you feel, think, and handle daily activities, such as sleeping, eating, or working, and even make you feel as though life is not worth living (“Depression (major depressive disorder),” 2018). Depression may also create a loss of interest or pleasure in many things such as sex, hobbies, or even daily activities. It is not just regular sadness and cannot simply be “snapped out of.” To be diagnosed with depression, the symptoms must be present for at least two weeks (“Depression,” 2018).

Duvall’s eight stages of family development is based on the oldest child and describes expected developmental changes in families that are raising children (Kaakinen, Coehlo, Steele, Tabacco, &Hanson 2015). According to Duvall’s theory, this family is in the 5th stage, families with teenagers, the oldest child being anywhere from ages 13 to 15. The oldest child, Kate, is 15, so this stage applies to the Messner family.

Culture/Religion The Messners are a Caucasian family, not affiliated with any religion. Ken has a college degree and Kate has plans to attend college in New York for film. They spend every holiday together. They also have family dinners together every night. They drive to school and back home together on school days and enjoy listening to their shared favorite soundtracks during the rides. On the weekends, they go out for ice cream after dinner at their favorite ice cream parlor “Pop’s. ”

Strengths and Weaknesses ● ● ● ● ●

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Strengths: They are financially stable and have easy access to different resources, such as grocery stores/food, medical care, and quality education They live in a safe, friendly community They talk to each other regularly and see each other often, at school and at home. They can usually rely on each other for support They have a car for transportation to be able to make it from place to place such as to school, work, the grocery store, and medical appointments Kate copes well with the suicide of her mother and is able to be there for her father, who sometimes needs more support than her Weaknesses: Ken does not know how to cope very well with the suicide of his wife from 5 years ago, sometimes breaking down at random times and not fully expressing his emotions to his daughter, avoiding the topic Ken is sometimes not emotionally present and is withdrawn and sometimes avoids conversation with others They do not have a good understanding of Ken’s condition of depression When they are frustrated at each other, they sometimes do not talk for a bit and go into their separate rooms Ken has not seeked professional medical help At times, the emotional support is not equal between Ken and Kate Lack of spirituality

Communication The Messners have family dinner together every night and talk about their day and any new events going on in their lives. They usually communicate well and take turns listening and speaking and they respond meaningfully to each other. They share their feelings and emotions with each other, except for when Ken avoids talking about the suicide of his wife. Kate is even comfortable enough to talk with Ken about boys and relationships in her life. At times Ken is not emotionally present or avoids conversation because of his condition and emotions, and Kate tries her best to help by initiating conversation, but is sometimes shut down. They seldom have arguments, but when they do Kate will raise her voice at Ken, and Ken at Kate. They avoid each other at first and go into their separate rooms and may not be as communicative as usual for a day or 2. They are able to overcome arguments by talking about the problem respectfully and they do not hold grudges or stay upset for very long. They look each other in the eyes when speaking and they use therapeutic touch, such as touching the arm and hand or embracing each other.

Family Systems Theory The family systems theory is based around the idea that any change to one member of the family, affects all members of the family (Kaakinen, Coehlo, Steele, Tabacco, &Hanson 2015). It illustrates a family as individuals who form an interactive and interdependent system. Therefore, when one family member experiences a health event, all members are affected because they are connected, and each family member is affected differently (Kaakinen et. al, 2015). This theory allows nurses to assess and understand families as a whole and/or individuals within the family unit (Kaakinen et. al, 2015). The nurse who will be caring for the Messners must assess the impact of Kate’s mother’s suicide on the entire family. The nurse must also assess the impact of Ken’s depression on the entire family. Furthermore, the nurse must assess the effects that the suicide and Ken’s depression has on family functioning. The nurse should facilitate and encourage communication between Ken and Kate, and analyze the type of support each of them provides. Kate may feel that she is not enough emotional support for her father or that she is is not doing a good enough job at it, and that may be too much strain on her. Ken may feel that he is not strong enough for his daughter, or that he is too emotional and feels hopeless, which is why he sometimes may be withdrawn or avoid certain conversations. Therefore the nurse must help them facilitate open and honest conversation and define their roles and how they are able to best support each other. He is also struggling to effectively cope with what happened, so the nurse must provide resources to help him individually with that, such as counseling, therapy, and/or medications, and include Kate by encouraging family and group counseling. The goal of the nurse is to help maintain or restore the stability of the family and to help family members achieve the highest level of functioning that they can (Kaakinen et. al, 2015).

The 4 concepts of the family systems theory: 1. All parts of the system are interconnected (Kaakinen et. al, 2015). a. After Kate’s mother’s death, it had an effect on the whole family. Ken became depressed but, they became closer and had found some support in one another 2. The whole is more than the sum of its parts (Kaakinen et. al, 2015). a. They have both experienced stress and sadness over the suicide but, have coped differently. Ken has developed depression which is putting more stress on the family; each of them is individually affected, but so is the family as a whole from both the suicide and Ken’s condition. 3. All systems have form of boundaries or borders between the system and the environment (Kaakinen et. al, 2015). a. The Messners have a flexible boundary. They would not want to have their situation known by just anyone and everyone, but would be open to family therapy or counseling. 4. Systems can be further organized into subsystems (Kaakinen et. al, 2015). a. Within the Messner family there really are no subsystems. There no other children, parent, or grandparents. It is just Kate and Ken.

Problem: Ken has a hard time fully communicating his emotions and feelings to Kate about her mother’s suicide. Ken is still grieving and sometimes avoids conversations about it and can become emotionally removed. Interventions: Encourage each family member to discuss how Kate’s mother’s death has affected them individually by creating an open and safe environment. Outcome: The Messner family will have open and honest conversation about their true thoughts and feelings regarding the suicide. They will effectively communicate their thoughts, concerns, and emotions on how the death has affected them individually, without avoiding significant details in order to strengthen their relationship and reach acceptance. Rationale: It is significant for all members of the family to feel support in discussing difficult emotions because an individual’s specific understanding of the concepts of loss and death play a fundamental role in the subjective experience of loss (Distelberg, Williams-Reade, Tapanes, Montgomery, & Pandit, 2014). Prolonged grief can lead to and increase risk of emotional and behavioral conditions, including major depression, increased anxiety, and post-traumatic stress disorder (Distelberg et. al, 2014). Understanding through non judgemental listening and observing for cues of the underlying grief, is important in in building strong relationships within the family.

Interventions and Outcomes #1

Problem: Ken struggles with coping with the loss of his wife. It has been 5 years since the event and he is still grieving. He sometimes breaks down in tears when he is alone and avoids talking about it. Ken has become depressed and his behavior has affected Kate because she feels as though she cannot adequately help him. Interventions: Encourage each family member to identify their coping mechanisms in response to stress, both individually and as a family, and educate them on effective coping mechanisms such as journaling or participating in an open discussion. Outcome: The Messner family will be able to recognize their current negative or ineffective coping mechanisms, and identify at least 2 new positive and effective coping mechanisms in which they will be able to apply to their family system in response to the stress of dealing with the traumatic event of the suicide and Ken’s depression. Rationale: It is significant to focus on understanding and addressing patterns of coping and stress with conditions such as depression or when dealing with loss, which are both situations that can place stress on the family (Distelberg, Williams-Reade, Tapanes, Montgomery, & Pandit, 2014). Often times individuals and families develop maladaptive stress and coping patterns that prevent the family from successfully functioning and may cause further stress within the family system, worsening the condition (Distelberg et. al, 2014).

Interventions and Outcomes #2

Problem: Ken has has not seeked medical help for his depression, and in turn has dealt with it by himself because he wants to be strong for his family. This has resulted in him avoiding important conversations with his daughter and sometimes not being emotionally present. Interventions: Encourage the family to attend support groups and family counseling for bereavement and depression and provide resources that are easily accessible to them. Outcome: The Messner family will be able to openly discuss the death of Kate’s mother. They will be able to better support each other and understand how to best deal with the loss and Ken’s depression, which will improve their coping, communication, and relationship. Rationale: The availability of other support systems are key influences on the ability to cope with loss (Palmer, Saviet, & Tourish, 2016). Families who are open to meeting with a trained or experienced counselor may benefit from the opportunity to process thoughts and feelings about a loss with guidance on how to manage their emotions, especially related to the grieving process (Palmer, Saviet, & Tourish, 2016). Group counseling or support sessions offer an opportunity to demonstrate that others also struggling with issues like loss and grief, and the the group dynamic builds connections where support from others can be garnered (Palmer, Saviet, & Tourish, 2016).

Interventions and Outcomes #3

References Distelberg, B., Williams-Reade, J., Tapanes, D., Montgomery, S., & Pandit, M. (2014). Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction ( MEND). Family Process, 53(2), 194-213. doi:10.1111/famp.12066 Depression. (2018, February). In National Institute of Mental Health. Retrieved from Depression (major depressive disorder). (2018, February 3). In Mayo Clinic. Retrieved from Kaakinen, R. J., Coehlo, P. D., Steele, R., Tabacco, A., & Hanson, M. H. S. (2015). Family health care nursing: theory, practice, and research (5th ed.). F.A. Davis: Philadelphia. Palmer, M., Saviet, M., & Tourish, J. (2016). Understanding and Supporting Grieving Adolescents and Young Adults. Pediatric Nursing, 42(6), 275-281.

Images References [Untitled image of Messner family] Retrieved from [Untitled image of Kate Messner] Retrieved from [Untitled image of Ken Messner in costume] Retrieved from [Untitled image of Kate Messner playing piano] Retrieved from [Untitled image of Ken Messner on the telephone] Retrieved from [Untitled image of Ken Messner] Retrieved from

Images Reference [Untitled image of Messner family sitting on a bed] Retrieved from [Untitled image of Ken Messner] Retrieved from [Untitled image of Kate Messner] Retrieved from

The Messner Family  
The Messner Family