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California State University, San Marcos

NURS 480

MEET THE FAMILY Jamie Elizabeth Sullivan

Jamie Elizabeth Sullivan is the daughter of the town’s Baptist minister with whom she has a very close relationship with. She is seventeen and one of the brightest students but she is an outcast. Jamie’s peers describe her as unattractive and distasteful. Jamie is often made fun of because of the only sweater she owns and the bible she carries everywhere. Although she is repeatedly tormented, she does not let her peers bring down her spirit and faith. Jamie does not care what others think of her nor does she judge others for their nonChristian behaviors. She believes there is good in everyone even if their behavior conflicts with that belief. Jamie spends a lot of her time giving back to the community by tutoring younger kids and raising money for school projects. Jamie is in the identity vs. role confusion stage of Erickson’s Developmental Stages. She is very independent and knows exactly who she is and how she wants to live her life. Although Jamie may seem like a normal high schooler, she has a secret of her own. Jamie was diagnosed with leukemia, a common cancer in children, and her body has stopped responding to treatment. She has accepted her fate and tries to live her life as best as she can and to its fullest. With the help of her new boyfriend (and future husband), Landon Carter, she is able to fulfill a list of things she wants to achieve in life.

Landon Rollins Carter

Landon Rollins Carter is a seventeen year old boy who lives with his mother. He has a close relationship with his mother but not with his father. Landon’s father is desperately trying to repair their damaging relationship. Landon is the stereotypical popular and rebellious teenager; he hangs out with the popular crowd at school, puts the least amount of effort as possible into everything, avoids helping others, and tends to often break the rules. Landon is in the identity vs. role confusion stage of Erickson’s Developmental Stages. He has limited selfawareness and is confused about who he really is. Landon does not have any future goals, except for getting out of Beaufort, North Carolina. After some poor decisions, Landon’s punishments lead him to frequently be in the presence of Jamie Sullivan. Their relationship grows into tenderness love and she turns his life towards a new direction.

Reverend Hegbert Sullivan Reverend Sullivan is Jamie Sullivan’s father and the town’s Baptist minister. He is first and foremost a father. Reverend Sullivan and Jamie share a very close bond that others may envy. He may seem overprotective, but he carries a deep love for his daughter. Reverend Sullivan is a man who has experienced great loss (the death of his wife) but manages to keep his faith and show love to his daughter and the people of the community. Like any father, Reverend Sullivan hesitates to allow Jamie to date Landon. But in the end, he sees the love they have for one another and supports their desire to marry.

Family Dynamics

The Sullivan family is not a traditional American family. It starts out as a singleparent family, which consist of a widowed parent and a biological child. The family grows as the daughter and her new boyfriend fall in love and later become husband and wife. In accordance with Duvall’s Developmental Theory, normal family dynamics change over time as the individuals grow and experience new life events. The Sullivan family is currently in the stage of families with adolescents (Kaakinen et al., 2015). When Jamie was diagnosed with leukemia, the family dynamics changed. The Sullivan family went though normative or “on time” changes to non-normative or “off time” changes (Kaakinen et al., 2015). The development of leukemia is out of the normal family life cycle sequence, which does not follow Duvall’s Developmental Theory (Kaakinen et al., 2015). With Jamie’s development of leukemia, more stress is added to the family. Reverend Sullivan has already loss his wife to an unexpected death. The thought of losing Jamie, terrifies Reverend Sullivan but he continues to show Jamie all the love and support he has for her. Even with life modifications and death in the nearby future, Reverend Sullivan and Jamie try to live life as normally as possible. Despite her limited time, Jamie is still able to go through some of the family life cycle stages. Jamie is able to establish her own identity and knows how she wants to live out the rest of her life. She continues to have a very close relationship with her father. Jamie skips a couple of the family life cycle stages because the advancement of leukemia hinders her from thinking about the future (advanced education, jobs, and work). When Jamie’s relationship with Landon quickly grows into a loving one, the Sullivan family experiences another “off time” event. Jamie and Landon’s relationship does not add stress to the family dynamic; it helps the family grow and become even closer than before. Jamie is shown more support and love than she had have ever hoped for. In the end, Jamie and Landon skip to the married couple stage.


Leukemia is the most common cancer to develop in young children (Järvelä et al., 2016). There are four types of leukemia that exist: acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia, and chronic lymphoblastic leukemia (NCI, 2017). In children, the most common type of leukemia is ALL, which is defined by an overproduction of immature lymphocytes (a type of white blood cell) in the bone marrow (NCI, 2017). Since the white blood cells are immature, the human body is not efficiently being protected, which causes the patient to become more susceptible to illnesses (NCI, 2017). Leukemia mainly affects white blood cells but can also affect red blood cells and platelets (NCI, 2017). According to Järvelä et al. (2016), “Established risk factors include Down syndrome, high doses of ionizing radiation, male gender and high birth weight (over 4,000 grams)” (p. 433). Some signs and symptoms of ALL include fever, bone or joint pain, painless lumps, petechiae, easy bruising or bleeding, loss of appetite, fatigue, and pain below the ribs (NCI, 2017). ALL is diagnosed by examining the patient’s blood and bone marrow samples. (NCI, 2017). Once diagnosed, treatment should began because ALL worsens rather quickly (NCI, 2017). The treatments used to treat ALL are chemotherapy, radiation therapy, chemotherapy with stem cell transplant, and targeted therapy (NCI, 2017). All of these treatments are used with the intention of killing the cancer cells to stop the spread of cancer (NCI, 2017).


Religion plays a huge part in Jamie’s life. Jamie’s father is a minister which influenced the start of Jamie’s beliefs. However, Jamie continues to hold her beliefs and faith throughout her life. She has total faith in God and uses her faith to rationalize things. Jamie believes that God has a bigger plan for her and that God sent Landon to help her through the difficult times and to be her angel.


Reverend Sullivan and Landon show Jamie endless amounts of love and support, which brings them all closer together. They are with her every step of the way, especially when her illness takes a turn for the worse. The unique unconditional love that Jamie and Landon share in particular strengthens both of them individually and as a couple. Jamie shows a lot of strength and courage by living every day to its fullest and not letting her illness break down her faith and will to live.


The main challenge is accepting the fact that Jamie only has a limited amount of time left to live. Reverend Sullivan already lost his wife so the thought of losing his daughter is unbearable. Reverend Sullivan’s faith in God helps guide him through the process of accepting Jamie’s fate. Landon has the most difficult time accepting Jamie’s fate because they have only started their relationship and journey towards happiness. Landon spending every day with Jamie to maximize their time together but he hopes more can be done to save Jamie.


Verbal Communication: During the worse time of Jamie’s illness, Jamie, Landon, and Reverend Sullivan demonstrate excellent verbal communication skills. They frequently express their concerns and love for each other. The three individuals let each other know that they are there for one another and want to help each other through the difficult times. Nonverbal Communication: There is a lot of nonverbal communication that happens between Jamie, Landon, and Reverend Sullivan. Reverend Sullivan communicates feelings of sadness, acceptance, and happiness through facial expressions. Landon and Jamie express their love through eye gazing, holding hands, hugging, and kissing. Landon also expresses and communicates his love for Jamie through his actions such as building her a telescope and fulfilling her wish list.

Chronic Illness Framework

The Chronic Illness Framework is an approach that allows healthcare providers to comprehend how a chronic illness affects the family and to assess the family’s functionality while dealing with the chronic illness (Kaakinen et al., 2015). This framework helps explain how a chronic illness affects not only the individual patient but the whole family as well (Kaakinen et al., 2015). The Chronic Illness Framework can be used to evaluate the Sullivan family. Even though Jamie has been diagnosed with leukemia, she tries her hardest to live life as normally as she can. The thought of losing his daughter is unbearable but Reverend Sullivan uses his strong faith and the strength of God to get him through the difficult times. Landon cannot bear the thought of losing his love but he turns all of his anger into tenderness love and does not fail to show Jamie that he is right by her side through the happiest and saddest times. As a family, they all try to forgive and accept Jamie’s fate, which empowers them and brings them closer as a family. They never fail to show their love and support for one and another.


Illness Types (Kaakinen et al., 2015). Leukemia develops over time so the onset of Jamie’s condition was gradual. Jamie’s condition is considered a progressive chronic illness because Jamie’s body has stopped responding to treatment, which leads the cancer to progressively spread and get worse. Due to the fact that there are no further solutions to terminate the cancer cells, Jamie’s leukemia bestows a fatal outcome on Jamie and shortens her life span. Jamie’s leukemia causes her to become weak and incapacitated to perform normal daily activities. This puts a lot of stress on Reverend Sullivan and Landon because they have to deal with accepting Jamie’s fatal prognosis and the progressive changes of her symptoms, as well as adapting to her new daily needs. Time Phases of the Illness (Kaakinen et al., 2015). Jamie’s condition is within the terminal time phase; her condition has taken a turn for the worse. There are no treatments that will help manage the leukemia so Jamie has to settle for comfort care measures. She is provided with home health care, which allows her to stay within the comfort of her home and surrounded by the ones she loves. Family Functioning (Kaakinen et al., 2015). As Jamie’s leukemia takes a turn for the worse, Reverend Sullivan and Landon have to adjust to Jamie’s new needs. Jamie’s needs are more demanding than before, which is why home health care was provided by Landon’s father. This take a lot of financial stress off of Reverend Sullivan. Reverend Sullivan has to put aside his mild disliking for Landon in order to fully focus on Jamie. As a family, they deal with the illness by living life as normally as possible. Jamie and Landon’s marriage is a testimony to them living life to its fullest.

Interventions and Outcomes

Problem #1

Problem: One of the main problems within the family is accepting Jamie’s fate and acceptance of death. Intervention: Assess the strengths and weaknesses of the Sullivan family and how the Sullivan family members interact with each other (Adams et al., 2014). Encourage Landon and Reverend Sullivan to spend time with Jamie and listen to her point of view and feelings (Adams et al., 2014). Encourage the family to verbalize their deepest feelings to each other (Adams et al., 2014). Outcome: With time, Landon and Reverend Sullivan will understand Jamie’s point of view and feelings. Even though it might be hard, Landon and Reverend Sullivan will come to accept Jamie’s acceptance of death and fate. Rationale: Comprehensive assessments provide healthcare providers with information regarding how the family copes with stress and how to help the family find coping strategies to deal with stress and chronic illnesses (Adams et al., 2014). Building rapport with the patient and family allows the healthcare provider to address the family’s concerns without speculation (Adams et al., 2014). Verbal communication may positively impact emotions, thoughts, and behaviors (Adams et al., 2014).

Problem #2

Problem: Landon has a lack of knowledge and understanding of Leukemia and its process. He begs his father to find a way to cure Jamie even though Jamie’s condition is within the terminal time stage. Intervention: Educate the family about leukemia (Shafik & Allah, 2015). Be honest and give support when providing the family with the information (Shafik & Allah, 2015). Outcome: Landon will have a better understanding of leukemia and its process. He will understand the term “terminal stage” and recognize how other possible treatments will most likely not cure Jamie. Rationale: Education and support have demonstrated to be effective in reducing family member’s strain, burden, and depression and anxiety levels (Shafik & Allah, 2015). More knowledge of the disease is gained through education programs (Shafik & Allah, 2015). With the proper education and guidance, family members will be more equipped to provide the essential care to their loved one (Shafik & Allah, 2015).

Interventions and Outcomes

Problem #3

Problem: Jamie has a really hard time telling people about her condition; she rather keep her illness a secret. Jamie does not go to any support groups; she only confides in Landon and Reverend Sullivan. Intervention: Support Jamie’s coping style but offer alternative coping methods (Han, Liu, & Xiao, 2017). Provide Jamie with information on the available community support groups (Adams et al., 2014). Outcome: Jamie will cope more effectively by being open about her illness and learning to accept support from the community. Jamie will consider attending support groups. Rationale: Communication provides the patient with a way of staying connected, having a voice, and decreasing the struggles for normalcy (Han, Liu, & Xiao, 2017). High social support is predicted to lead to adaptive coping in cancer patients (Geyer, Koch-Giesselmann, & Noeres, 2015). Families and friends are need in order to effectively cope and psychologically adjust to chronic illnesses (Han, Liu, & Xiao, 2017).

References Adams, J. A., Anderson, R. A., Docherty, S. L., Tulsky, J. A., Steinhauser, K. E., & Bailey Jr., D. E. (2014).

Nursing strategies to support family members of ICU patients at high risk of dying. Heart & Lung: The Journal of Acute and Critical Care, 43(5), 406-415. Geyer, S., Koch-Giesselmann, H., & Noeres, D. (2015). Coping with breast cancer and relapse: Stability of coping and long-term outcomes in an observational study over 10 years. Social Science & Medicine, 135, 92-98. Han, J., Liu, J., & Xiao, Q. (2017). Coping strategies of children treated for leukemia in China. European Journal of Oncology Nursing, 30, 43-47. Jarvela, L., Raitanen, J., Erme, S., Lohi, O., Auvinen, A., & Jarvela, L. (2016). Residential mobility and the risk of childhood leukemia. Cancer Causes & Control, 27(3), 433-443. Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. H. (2015). Family health care nursing: Theory, practice and research (5th ed.). F.A. Davis: Philadelphia. National cancer institute (NCI). (2017). Childhood acute lymphoblastic leukemia treatment – patient version. In National cancer institute. Retrieved February 17, 2018, from https://www.Cancer.Gov/types/leukemia/patient/child-all-treatment-pdq#section/_1

Shafik, S.A., & Allah, E. S. A. (2015). Improving the quality of nursing care for patients with leukemia in day care units through nursing education. American Journal of Nursing Science, 4(3), 63-72.

Photo Credit [Untitled illustration of marriage] Retrieved March 9, 2018 from

[Untitled illustration of Jamie Sullivan] Retrieved March 9, 2018 from [Untitled illustration of Landon Carter] Retrieved March 9, 2018 from [Untitled illustration of Reverend Sullivan] Retrieved March 9, 2018 from [Untitled illustration of Jamie in the hospital] Retrieved March 9, 2018 from [Untitled illustration of leukemia versus normal blood] Retrieved March 9, 2018 from [Untitled illustration of the church] Retrieved March 9, 2018 from [Untitled illustration of Jamie, Landon, and telescope] Retrieved March 9, 2018 from [Untitled illustration of Jamie and Landon in the hospital] Retrieved March 9, 2018 from [Untitled illustration of Jamie and Landon hugging] Retrieved March 10, 2018 from

NURS 480 - The Sullivan Family  
NURS 480 - The Sullivan Family