The Fundamentals of Caring

Conklin Family Assessment The Fundamentals of Caring

ISSSU Visual Report -YezieYoon - California State University San Marcos

N480 Family Nursing - Dr. Monica Sprague,APRN, FNP-BC, MSN, PHN, Ph.D - November 20, 2022

Meet Trevor Conklin

Trevor is an 18-year-old boy living with Duchenne Muscular Dystrophy. He is the only child of Elsa Conklin.Trevor’s father, Bob, abandoned the family when he was diagnosed with Duchenne Muscular Dystrophy at the age of 3.Trevor keeps a stack of letters that he believes Bob writes to him. He does not read them because he is angered by feelings of abandonment.Trevor is notorious for having caregivers who quit shortly after working with him due to his behavior. He is verbally abusive and condescending. He enjoys playing pranks related to his condition to scare his caregivers.Trevor is wheelchair bound and does not like to leave his home. He has a set routine and does not like to divert from his normal activities.After an argument with Ben about his quality of life, he decides to step out of his comfort zone and take a road trip to the world’s biggest pit.Trevor craves female attention, and, on the trip, he meets a girl who he develops a crush on. On the trip, he decides to confront his father and discovers that his father never wrote to him, but his mother had been writing to him. (Erikson’s Intimacy vs. Isolation)

Elsa Conklin

Elsa Conklin (unspecified age, led to believe she is in her 40’s) isTrevor’s mother who works as a bank manager. She is a single parent and head of the household raisingTrevor with the assistance of a caregiver. She goes to work in the morning and returns in the evening to take care ofTrevor. She is very protective ofTrevor becoming attached to a caregiver because she does not want him to feel abandoned when his caregivers quit. She has been raisingTrevor alone since he was 3-years old. (Erikson’s Generativity vs. Stagnation)

Ben Bob

Ben is a 39-year-old man who assumes the role ofTrevor’s full-time caregiver while Elsa goes to work. Ben is suffering with grief from the loss of his 3-year-old son, whom he lost two and a half years ago in a car accident. His wife wants to divorce him, but he avoids her because he is unable to accept the separation. Ben is sarcastic likeTrevor, and their personalities are compatible. He does not tolerateTrevor’s abusive behavior and confronts him to take accountability for his actions. (Erikson’s Intimacy vs. Isolation)

Bob (unspecified age, led to believe he is in his 40’s) isTrevor’s biological father who has been absent from his life. He abandoned the family whenTrevor was diagnosed with Duchenne Muscular Dystrophy at the age of 3-years-old. Elsa givesTrevor the impression that Bob still tries to stay in touch with him, so he would not feel abandoned. However, when Bob is confronted byTrevor on the road trip, Bob reveals that he never wrote and that he did not want anything to do with them. (Erikson’s Generativity vs. Stagnation)

Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness due to the alterations of a protein called dystrophin that helps keep muscle cells intact. DMD is one of four conditions known as dystrophinopathies. DMD symptom onset is in early childhood, usually between ages 2 and 3.The disease primarily affects boys, but in rare cases it can affect girls. Weakness related to DMD selectively affects the limb muscles close to the trunk before the ones far from it; the legs are affected before the arms. Growth velocity with DMD is typically slower than normal in the first years of life, leading to short stature. (Muscular Dystrophy Association, 2022)

Duvall’s Traditional Family Life Cycle Stage and Developmental Tasks

The Conklin family is in the families with adolescents stage. Family development tasks for this stage include allowing adolescents to establish their own identities but still be part of family, thinking about the future (education, jobs, working), and increasing roles of adolescents in family (cooking, repairs, power base). (Kaakinen et al., 2015)The Conklin family is not a traditional family and some of the developmental tasks associated with this stage is not appropriate.Trevor has a disability which does not allow him to work or assist around the home, instead, he is the one who requires care. Planning forTrevor should be within realistic time frames.Trevor is not very social and prefers not to leave his house. Ben encouragesTrevor to venture out and explore, rather than sitting at home and watching television all day.

Culture/Religion/Tradition

Ben is a Caucasian-American male with no religious affiliation. Elsa andTrevor are both Caucasian-British with no religious affiliation.They moved to Seattle, Washington from London 8 months prior to encountering each other.The Conklin family is a single parent household with a child with a chronic disability.

Communication

Communication amongst the Conklin family is verbal. Elsa, Trevor, and Ben all speak English.Trevor and Ben communicate in a sarcastic manner with each other, which they enjoy. Elsa understandsTrevor’s unique sense of humor and conversations are open between them. WhenTrevor and Ben venture out on their road trip, he stays in touch with Elsa every 3 hours to assure her that everything is okay.

Chronic Illness Framework

Illness types include the following aspects of chronic illness: onset of the illness, the course of the disease, the outcome of the illness, and the degree of incapacitation of the family member. (Kaakinen et al., 2015)

The onset ofTrevor’s DMD was gradual. He was diagnosed at the age of 3.The course of his illness is 15 years and his condition progressively worsened.Trevor is wheelchair bound and requires a CPAPmachine at night to sleep due to his condition. His eventual outcome will be total incapacitation and death due to loss of his voluntary muscle movements.

The aspect of time addresses how issues facing families and individuals vary depending on the timing in the course of illness (initial, mid, and terminal). Mid-time phase: Family tasks in this phase are to redefine normal, adjust to social stigma or altered relationships caused by the disability or illness, continue to maintain positive relationships with the healthcare team, and successfully grieve the loss caused by the disability or chronic condition. (Kaakinen et al., 2015)

The Conklin family is in the mid-time phase.Trevor has a normal routine and is medically stable.Trevor does not like to leave his house and has very limited social interactions. On the road trip,Trevor initially believes the girl he likes would never look at a “guy like him”. When his crush likes him, despite his disability, he is happy and relieved. Even after Ben quits being his caregiver,Trevor maintains a friendship with him. He accepts his chronic condition and frequently makes jokes and plays pranks on caregivers.

Family functioning includes the demands of managing the illness and the family strengths and vulnerabilities. (Kaakinen et al., 2015)

Trevor requires a caregiver with him at all times. His disability severely impacts his physical mobility and he requires meal preparations, assistance with activities of daily living, and monitoring for aspiration precautions or other potential hazards. Elsa has a 9-5 job at the bank and takes care ofTrevor when she finishes work. Strengths: strong bond between Trevor and Elsa, compatible personalities between Ben andTrevor, financially stable living situation, and set routines. Weaknesses: single parent household, limited physical mobility, feelings of abandonment leading to anger and mistrust, and limited socialization.

Interventions

Trevor has situational low self esteem related to parental abandonment and disability as evidenced by his father abandoning their family when he was 3 years old and his belief that a girl would not “like a girl like him”.

Intervention:Trevor will see a therapist to work through self-esteem problems. (GoodTherapy, 2022) Outcome:Trevor will have increased self esteem and resolve negative feelings towards himself.

Ben has ineffective coping related to situational crises as evidenced by the loss of his son and avoiding his wife for separation.

Intervention: Ben will attend a grief support group to cope with the loss of his son. (Alioto et al., 2020)

Outcome: Ben will receive support and learn effective coping mechanisms.

Elsa suffers from anxiety related to perceived threats toTrevor’s biological integrity as evidenced by her initial disapproval and concern regarding the road trip.

Intervention: Elsa will include mindful meditation as part of her daily routine. (Smith et al, 2022)

Outcome: Elsa will have decreased feelings of anxiety with improvement in mental clarity.

Alioto, G., Chadwell, M., Baran-Prall, J., Canelo, R., Carmona,A., Gotham, H., Kurtz, L., Rivera, K., Wenger, P., Wolf-Prusan, L. (2020). Grief, Loss, and Bereavement. https://www.jber.jb.mil/Portals/144/Services-Resources/Resiliency-Resources/PDF/Grief.pdf

GoodTherapy. (2022). Get Help forAbandonment Issues. https://www.goodtherapy.org/learn-about-therapy/issues/abandonment/get-help Kaakinen,J.R.,Coehlo,D.P.,Steele,R.,Tabacco,A.,&Hanson,S.M.H.(2015). Family Health Care Nursing: Theory, Practice, and Research.F.A.Davis Company.

Muscular DystrophyAssociation. (2022). Duchenne Muscular Dystrophy. https://www.mda.org/disease/duchenne-muscular-dystrophy#:~:text=Duchenne%20muscular%20dystrophy%20(DMD)%20is,four%20conditions%20 known%20as%20dystrophinopathies.

Smith, M., Segal, R., Segal, J. (2022).Therapy forAnxiety Disorders. https://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm

https://moviesalamark.com/2021/03/22/the-fundamentals-of-caring/ https://consequence.net/2016/06/sundance-film-review-the-fundamentals-of-caring/ https://www.imdb.com/title/tt2452386/ https://hollywoodlife.com/pics/the-fundamentals-of-caring-movie-photos/the-fundamentals-of-caregiving-9 https://www.dailydot.com/upstream/fundamentals-of-caring-review-netflix/ https://anempireofwords.wordpress.com/2016/10/18/the-fundamentals-of-caring-2016/ https://www.news-medical.net/news/20220701/Cancer-drug-helped-delay-progression-of-Duchenne-muscular-dystrophy-in-mice.asp x https://www.santhera.com/patients/our-research/duchenne-muscular-dystrophy