N480 Switched at Birth Family Assessment Visual Report

IntroductionThe Kennish-Vasquez family was formed when the Kennish and Vasquez families came together after discovering their daughters were switched at birth. After a blood test in a high school biology class, Bay Kennish learned that it was impossible for her parents to be biologically related. A DNA test confirmed this. Regina Vasquez was found to be Bay’s biological mother and Daphne Vasquez was Kathryn and John’s biological daughter. When meeting for the first time, the Kennish family discovered that Daphne has sensorineural hearing loss due to bacterial meningitis. Daphne had this infection when she was 3 years old.

Developmental Stage

According to the Duvall, a developmental and family life cycle theory, The Kennish-Vasquez family is in the families with adolescents stage. In this stage the parents allow their children to develop their own identities while still being a part of the family (Kaakinen, et al., 2015). This applies as all the parents encourage Bay and Daphne to learn and grow into their own identities by learning about their biological parents and participate in activities with their peers. However they also remain a part of the family by participating in family activities. In this stage adolescents will also think about their future which includes education and working (Kaakinen et al., 2015). This is seen as Daphne goes to college to study pre med and Bay pursues her dreams of becoming an artist and moving across the country.

Meet the Kennish-Vasquez Family

Daphne Paloma Vasquez

Age: 15

Daphne is in the erikson stage of Identity Vs. Role confusion. This is seen as Daphne is continuing to develop a sense of identity. Daphne is deaf and develops group identify with other deaf individuals. Daphne struggles with how people treat her and according to Darling-Fisher (2018) Coping and psychosocial skills are lower in learning disabled students. This is seen as Daphne often experiences frustration with being deaf.

Bay Madeline Kennish Age: 15

Bay is in the erikson stage of Identity Vs. Role confusion. This is seen as Bay is gaining a sense of personal identity by learning about who she is and where she comes from. Specifically Bay learns she has a lot of similarities to her biological mother. She also tries to find out who her father is and eventually does.

Regina Vasquez Age: 38

Regina Vasquez is the legal mother of Daphne, but the biological mother of Bay. Regina is in the erikson stage of Intimacy Vs Isolation. This is seen as she constantly has new romantic partners. Due to the fact Regina is not married and is low-income she shifts the family dynamic greatly. Regina and Mr. and Mrs. Kennish struggle on coming to agreements with parenting styles as Regina’s viewpoints differ from the Kennishes.

John Kennish: Age 41

John kennish is the legal father of Bay, but the biological father of Daphne. John is in the erikson stage of generativity vs. stagnation. This is seen he makes an effort to bond and nurture his biological and legal children.

Kathryn Kennish: Age 40

Kathryn Kennish is the legal mother of Bay, but the biological mother of Daphne. Kathryn is in the erikson stage of generativity vs. stagnation. This is seen as Kathryn is preoccupied with parenting her legal and biological children. Kathryn and Regina struggle on sharing parenting roles for Bay and Daphne. They each have different ideas of control and discipline.

Toby Kennish: Age 17

Toby is the Kennish’s biological son. He is in the erikson stage of identity vs role confusion. This is seen as Toby struggles with his identity as he makes poor decisions. For example he loses a huge amount of money by gambling and stealing exams. However, he then finds his identity with his passion for music.

Daphne’s Condition

Sensorineural hearing loss is the most common neurological complication of bacterial meningitis. Bacterial meningitis is inflammation of the meninges. Bacterial meningitis is caused by Streptococcus pneumoniae,Haemophilusinfluenzaetypeb,or Neisseria meningitidis. Those more at risk include children due to their immature immune systems, those who are malnourished,those who are not vaccinated, and those who are living in poverty. This occurs as inflammation releases by-products that disrupt the blood labyrinth barrier. This is cytotoxic to the cochlea. Blood vessels to the inner ear are also occluded, this causes hypoxia and ischemia of the cochlea ( Jatto et al., 2020). Daphne had bacterial meningitis when she was 3 years old, an age at a higher risk. Since she was switched at birth she also lived in a poorer area.

Cultural/Religious Traditions

The Kennish family is an upper class caucasian family, while the Vasquez family is a lower class latina family. Therefore when the two families combine their are cultural differences that cause conflict when it comes to raising the families’ shared daughters. One culture, Switched at Birth highlights is death culture. Deaf culture is formed by the traits and abilities of deaf people ( Korte et al., 2017) This means using visual skills more and having a language barrier/communication gap with the hearing community. They also use sign language as their preferred language of communication, which is seen with Daphne (Korte et al., 2017).

Strengths

Communication

Challenges of the Kennish-Vasquez family include those with communication. The family learns to speak slowly and be patient with Daphne. With time they also learn ASL. Fortunately Daphne has the opportunity to go to an all deaf high school. However when she started to take classes outside of the deaf high school ( at Buckner Hall and when she left for college) she struggled to keep up with her peers. She is required to have an interpreter but as the world does not accommodate her disability she has to work twice as hard.

ChallengesStrengths of the Kennish- Vasquez family include practicing therapeutic communication. Due to the fact Daphne is deaf, the KennishVasquez family has to use more eye contact,expressive body language, and therapeutic touch to communicate. This enhances there non verbal communication skills after the initial challenges.

Communication with Daphne due to her sensorineural hearing loss differs from those who have the ability to hear.

Verbal: Daphne uses ASL and relies heavily on reading lips. When Daphne took classes with hearing students, she was required to have an interpreter.

Non Verbal: Due to the fact that Daphne cannot hear, a lot of the communication is nonverbal. This includes body language, facial expressions and gestures (including ones that are not part of ASL).

Biological Systems Theory

Microsystem

The microsystem includes settings in which people inhabit. This is where families experience every day, and it includes who they live with and activities they do together (Kaakinen et al.,2015). In the KennishVasquez family, the microsystem consists of the family members, the household, the high schools ( Carlton High School for the death and Buckner Hall) as well as their peers ( this includes friends, classmates, and romantic partners)

Mesosystem

The Mesosystem consists of relationships between major microsystems (Kaakinen et al.,2015). One example in the mesosystem includes the relationships between Carlton High School for the deaf and the parents. One example of this is positive relationship between the basketball coach and Mr. Kennish.

Exosystem

The exosystem involves external environments that affect families or individuals (Kaakinen et al.,2015). One example of this is the hospital staff that switched Bay and Daphne at birth. Although, Bay and Daphne have no memory of the hospital it affected their lives dramatically.

Macrosystem

The Macrosystem describes cultural attitudes or belief systems that influence the family (Kaakinen et al.,2015). This includes socioeconomic status in which the culture differed between low-income neighborhoods from where the Vasquez family is from and high-income areas from which the Kennish family is from.

Chronosystem

The Chronosystem refers to changes that occur over time that have an effect on the other systems (Kaakinen et al.,2015). An example of this is the timing of when the Kennish-Vasquez family discovered that their daughters were switched at birth. This timing being that this occurred when their daughters were adolescents.

Nursing Process

Outcome 1: The family will use effective communication techniques (Ackley, 2021)

Intervention: The family will speak slowly and be patient so that the child can read lips.

Rationale: Those that are deaf or hard of hearing rely on visual senses therefore they use lip reading and focus on facial features as a way to communicate (Agrawal & Peiris, 2021)

Outcome 2: The family will use alternative methods of communication effectively (Ackley, 2021)

Intervention: The family will use ASL to communicate rather than speaking oral language.

Rationale: Sign language is accessible to all deaf children and helps develop a wide vocabulary in reading. The whole families communication has been shown to improve with sign language (Humphries et al., 2019)

Outcome 3: The family will demonstrate congruency of of verbal and nonverbal behavior

Intervention: The family will not raise their voice or over- enunciate, grab their daughter’s attention before speaking and use gestures as appropriate.

Rationale: raising one’s voice and over enunciating distorts the voice and lips, making it difficult to understand for someone with hearing loss. Grabbing her attention and using appropriate gestures will increase awareness and and improve communication ( Ackley, 2021).

Nursing Diagnosis: Impaired verbal communication related to physiological condition as evidenced by difficulty forming words and inability to hear.

Text References

Ackley,B.J.,Ladwig,G.B.,Makic,M.B.F.,Martinez-Kratz,M.,&Zanotti,M.(2021). Nursing diagnosis handbook: An evidence-based guide to planning care (12thed.).Elsevier

Agrawal,C.,&Peiris,R.L.(2021).Iseewhatyou’resaying:AliteratureReviewofEyeTracking Researchincommunicationofdeaforhardofhearingusers. The 23rd International ACM SIGACCESS Conference on Computers and Accessibility. https://doi.org/10.1145/3441852.3471209

Darling-Fisher,C.S.(2018).Applicationofthemodifiederiksonpsychosocialstage inventory:25YearsinReview. Western Journal of Nursing Research, 41(3), 431–458.https://doi.org/10.1177/0193945918770457

Humphries,T.,Kushalnagar,P.,Mathur,G.,Napoli,D.J.,Rathmann,C.,&Smith,S.(2019).Supportfor parentsofdeafchildren:Commonquestionsandinformed,evidence-basedanswers. International Journal of Pediatric Otorhinolaryngology, 118,134–142. https://doi.org/10.1016/j.ijporl.2018.12.036

Jatto,M.E.,Adeyemo,A.A.,Ogunkeyede,S.A.,Lagunju,I.A.,&Nwaorgu,O.G.(2020).Pediatric hearingthresholdspost-bacterialmeningitis. Frontiers in Surgery, 7. https://doi.org/10.3389/fsurg.2020.00036

Kaakinen,J.,Duff-Gedaky,V.,Hanson,S.&Coelho,D.(2015)FamilyHealthCareNursing:Theory, practiceandresearch(5thed.).F.A> Davis:Philadelphia.IBSN-13:9780803639218

Korte,J.,Potter,L.E.,&Nielsen,S.(2017).Theimpactsofdeafcultureondesigningwithdeafchildren. Proceedings of the 29th Australian Conference on

https://doi.org/10.1145/3152771.3152786

Image references

American sign language.SwitchedatBirthWiki.(n.d.).RetrievedOctober28,2022,from https://switchedatbirth.fandom.com/wiki/American_Sign_Language

Funkymbtifiction.(2016,February17). Switched at birth: Bay kennish [ISFP].Tumblr.RetrievedOctober 28,2022,from https://funkymbtifiction.tumblr.com/post/139507132509/switched-at-birth-bay-kennish-isfp IMDb.com.(2011,June6). Switched at birth.IMDb.RetrievedOctober28,2022,from https://www.imdb.com/title/tt1758772/ John Kennish.TVmaze.(n.d.).RetrievedOctober28,2022,from https://www.tvmaze.com/characters/69767/switched-at-birth-john-kennish

Littlehandswear.(2014,July29). Switched at birth.LittleHandsWear.RetrievedOctober28,2022,from https://littlehandswear.wordpress.com/tag/switched-at-birth/ Moore,K.(2016,December14). Switched at birth season 4 arrives on Netflix from November 25th. What'sonNetflix.RetrievedOctober28,2022,from https://www.whats-on-netflix.com/news/switched-at-birth-season-4-arrives-on-netflix-nov-25 / Stanhope,K.(2013,January21). Switched at birth scoop on Daphne's "profound" struggle and the all-asl episode.TVGuide.com.RetrievedOctober28,2022,from https://www.tvguide.com/news/switched-birth-all-asl-episode-1059332/

The Kennish's.SwitchedatBirth.(2014,March28).RetrievedOctober28,2022,from https://rachaeljones12.wordpress.com/characters/the-kennishs/

Interaction

Watch switched at birth TV show - streaming online.Freeform.(n.d.).RetrievedOctober28,2022,from https://www.freeform.com/shows/switched-at-birth/