Assignment 4: Family Assessment: 50% of the Final Grade:
This clinical assignment focuses on the family system and all the subsystems that affect the family, how the family unit copes, and how the nurse can help the family maintain a state of equilibrium. In your text is an outline of the Calgary Model and how it helps in the interviewing and assessment of the family.
Using this model as a guideline choose a family you know to help you complete this assignment; these should not be your own family. Be sure the family is well in that they are not dealing with a newly diagnosed chronic or acute illness. Families with long-standing chronic illnesses, such as controlled hypertension or diabetes, are acceptable. Do not choose a family with acute problems including acute psychiatric illnesses.
Contact the family and explain the project you need to complete and if they are willing to participate. Set up a meeting time to speak with family members who would be most helpful with this project. Have questions prepared concerning all of the subsystems that affect families including ethnic backgrounds, working status of family members, education, etc. You may need to meet with the family more than once. Using the family assessment summary in your text, complete a family assessment.
This assessment must include content on all of the subsystems discussed in class this semester as well as a genogram, a list of family diagnoses including strengths and problems (stressors) related to each diagnoses. Students will need to summarize their project by explaining how the family members and the family unit cope with any problems that may arise; are they able to maintain a state of equilibrium or are they having difficulty maintaining a functional system? What could be done to improve or help with coping of the identified problems? Could some of the coping mechanisms of one family help another family if similar problems exist?
Beyond the textbook, students should search for additional resources to help explain the subsystems of the families; for example, their response to illness may be based on cultural background or religious beliefs. Find resources to support this and explain fully.
This project should have a minimum of 10 resources in addition to the course textbook.
This project should be written in narrative format with appropriate headings to identify each required section. A Safe Assign folder will be available for its submission.
Additional helpful informations.
Application of the Calgary
Family Assessment and
Reflections on the Reciprocity
Between the Personal and the
Maureen Leahey, RN, PhD1,
and Lorraine M. Wright, RN, PhD2
Much has been written about the global implementation of the Calgary Family
Assessment and Intervention Models (CFAM/CFIM) and the application of
these practice models in various clinical settings. The purpose of this article
is to provide a brief update on the background of CFAM/CFIM, and the
current applications of the models as evidenced in the English-language
literature. Little has been written about the use of CFAM/CFIM in a personal
context, however. As originators of the models, we offer our own narratives
and reflections about the reciprocity between the personal and professional
applications of our models and the ways that our personal experiences
have extended our understanding about the utility of the models for clinical
practice with families.
Calgary Family Assessment Model (CFAM), Calgary Family Intervention
Model (CFIM), clinical models, personal application
1Consultant, Private Practice
2University of Calgary, Alberta, Canada
Maureen Leahey, Consultant, Private Practice, P.O. Box 303, Pugwash, Nova Scotia, Canada
667972JFNXXX10.1177/1074840716667972Journal of Family NursingLeahey and Wright
Leahey and Wright 451
When we considered what to present about the Calgary Family Assessment
and Interventions Models (CFAM/CFIM) at the 12th International Family
Nursing Conference (IFNC12) in Odense, Denmark, in August 2015, we
thought about discussing how changes in nurse/family relationships, demographics,
technology, cultural diversity, genomics, and postmodernism have
influenced these two practice models that we developed. However, we
decided such a presentation would not be “news of a difference” or add any
new dimension or expansion about our models. The majority of nursing professors,
researchers, and/or practitioners attending the IFNC12 are likely well
aware of the impact of these issues on their practice and application of the
models. Instead, we chose to focus on where we situate ourselves in relation
to the models we developed and offer a more personal view.
Therefore, the purpose of this article is to provide a brief update on the
background of CFAM/CFIM and current applications of the models as evidenced
in the literature. In addition, we will address the reciprocity between
our personal and professional application of our family assessment and intervention
CFAM/CFIM: Review of the Literature
To our surprise and gratification, much has been written and presented about
CFAM/CFIM since they first appeared in our family nursing textbook, Nurses
& Families: A Guide to Family Assessment & Intervention (Wright & Leahey,
1984, 1994). The assessment model, specifically CFAM, was included in the
first edition in 1984 while the intervention model, CFIM, was not introduced
until the second edition in 1994. The models have evolved and changed over
the six editions of our textbook and have reflected the shifts in family structure,
development, and functioning over the last 30 years. With the increase
of family nursing worldwide, there has been a corresponding increase in the
global use of CFAM/CFIM. To the best of our knowledge, the models have
been translated into eight languages and adopted in educational curricula and
intervention research in over 26 countries. The International Council of
Nurses published a significant document titled “The Family Nurse” and recognized
CFAM as one of the four leading family assessment models in the
world (Schober & Affara, 2001). CFAM and CFIM continue to be adopted in
undergraduate and graduate nursing curricula and by practicing nurses
In the family nursing literature, particularly the Journal of Family Nursing,
there have been numerous publications discussing CFAM and CFIM. In
2015, a bibliography was developed to identify any and all known Englishlanguage
books, articles, and media productions which reference CFAM/
452 Journal of Family Nursing 22(4)
CFIM (www.familynursingresources.com/bibliography.htm). Of course,
there may also be references to CFAM/CFIM that we are not familiar within
non-English journals. Currently, there are six books, 54 conceptual articles,
56 data-based research reports, two book reviews, two research instruments,
eight media productions (DVDs), and 21 articles on pedagogy in family nursing
that identify and apply CFAM/CFIM (see https://www.familynursingresources.com/bibliography.htm).
In considering how widespread the models have become, several questions
arise. First, what is the essence of these models? What differentiates
CFAM and CFIM from other practice models for family assessment and
intervention within nursing? Our answer is that CFAM and CFIM have
emerged from our own actual clinical practice and the observation and supervision
of colleagues and nursing students. We refer to this as the clinical
scholarship of practice (Bell, 2003). The models have also benefitted from
knowledge exchange, the circularity of evidence-based practice and practicebased
evidence. To us, clinical practice has always been an intense experience
where we engage with families, learn about their illness beliefs and
illness suffering, and what they find most helpful that enables and promotes
family healing (practice-based evidence). Also, we have conducted practicebased
research examining live and videotaped family interviews to learn
what it is that nurses actually do that softens illness suffering. We also offer
families ideas and interventions gleaned from others’ research with families
(evidence-based practice) and note whether these are useful in particular situations.
We find the circular process between evidence-based practice and
practice-based evidence intriguing and enhancing.
Why is it important that our clinical models have evolved from actual
practice with families? It is significant because these models link theory to
practice in an easy to understand manner. Over the years, colleagues and
learners have offered us feedback that the models are straightforward, comprehensible,
and easy to apply. The new International Family Nursing
Association (IFNA; 2015) Position Statement on Generalist Family Nursing
Practice lists many skills that are useful and helpful aspirations for learners.
However, lists of skills and competencies often fly out the window when a
nurse is in an actual clinical situation with a live family. When nurses possess
a thorough grounding in conceptual practice models, they can then practice
these competencies and skills more easily to assist families. They can progress
from lip service to actual practice. As Benner (2001) argues, practice is a
way of knowing; it is situated knowledge use.
A third question arising from a perusal of the existing CFAM/CFIM literature
pertains to popularity. What is the most popular aspect of CFAM and
CFIM that is applied in practice settings? It has been the 15-Minute Family
Leahey and Wright 453 Interview (Wright & Leahey, 1999, 2013) that integrates and distills the most important aspects of both clinical models.
ical settings (Bell, 2012). It fits
nurses’ practice in a variety of contexts. The majority of nursing students and
even some practicing nurses comment that they have never seen a family
interview. Therefore, they often feel anxious about meeting with a family and
sometimes will mask their apprehensions by commenting that they do not
have enough time to involve families in their nursing practice. But once practicing
nurses embrace the belief that “illness is a family affair,” realize they
can make a profound difference to softening suffering in just 15 min or less,
and have observed actual family interviews, they challenge their constraining
belief of not having enough time. One of the most fascinating outcomes of
nurses involving families in their practice is that they report increased job
satisfaction (Sigurdadottir, Svavarsdottir, & Juliusdottir, 2015).
Opportunities to observe actual demonstration family interviews either
live or on DVDs enable learners to increase their confidence and competence
about conducting actual family meetings. Our DVD titled “How to Conduct
a 15-Minute Family Interview” (Wright & Leahey, 2000) has been the most
sought after of our eight educational programs applying CFAM/CFIM
(Wright & Leahey, 2000, 2001, 2002, 2003, 2006, 2010a, 2010b, 2010c).
Another very interesting observation is that of all the ideas utilized in CFAM,
the two assessment tools, genogram and ecomap, have been the most frequently
integrated into actual everyday clinical practice. The most utilized
family nursing interventions from CFIM have been the offering of commendations
and the asking of particular kinds of therapeutic questions.
Reflections on the Reciprocity Between the
Personal and the Professional
CFAM: Family Life Cycle Stage
Both of us are now experiencing the Senior Family Life Cycle Stage. The
tasks for families in later life are typically described as dealing with one’s
own and couple functioning in the face of physiological decline, exploring
new familial and social role opportunities, making room for the wisdom and
experience of seniors, and dealing with loss and change. Prior to entering this
family life cycle stage ourselves, we had concentrated on the loss aspect versus
the opportunity aspect of this stage. Perhaps this is because neither of us
have grandchildren and because our clinical work focused on people presenting
with health problems. Now, we are focusing more on the positive aspects
of this stage of life, that is, new familial and social role opportunities.
454 Journal of Family Nursing 22(4)
In describing our lives at this stage, we tend to use the word “preferment”
instead of retirement. The term “preferment” was coined by David Epston and
adopted by Lorraine Wright to focus on the choice aspect of retirement. A
satisfying and fulfilling “preferment” is doing what you prefer, when you prefer,
with the people that you most prefer to be with. Our experience is congruent
with the research that identifies preferment/retirement as a process and
involves transitioning to a new identity often encompassing new roles, interests,
and even social networks. It is not like jumping off a diving board; it
takes time and can be self-empowering, self-reinventing, and self-reflective.
Application of CFAM/CFIM: Clinical Situation Influencing
Lorraine offers a reflection on how a clinical situation influenced her personal
life for the better.
LMW. I was working with an elderly couple in my clinical practice; they had
re-married in their late 70s following the deaths of their spouses. They related
that their children were not supportive of them marrying and did not want the
mother/wife to have to care for the new husband as he was already experiencing
health issues. But the couple said that they were not worried about their
health problems, money issues, or how many more years they might live.
Instead they were focusing on how wonderful it was to once again have companionship,
share daily trivia, and enjoy mutual activities with a new spouse.
Plus they had an interesting belief that their lives had been extended because
their paths had crossed in life. This couple were an excellent example of how
social support invites well-being. The usual focus on loss at this family life
cycle stage was replaced with focusing on their time together and not necessarily
reminiscing or longing for what was.
When I met this couple, my own father had recently re-married at 80 years
of age, and I admit that I was still adjusting to his re-marriage. My father had
been very lonely for 3 years following the passing of my mother. So I was
pleased that his days of loneliness were over but I still found it difficult to
witness my father with a woman who was not my mother. But listening to this
clinical couple helped me to refocus on the benefits of later life re-marriages
rather than simply focusing on what I call my own somewhat naïve and
immature understanding of later life marriages. I too came to adopt the facilitating
belief that this union would extend my father’s life and indeed it did for
another 12 years before his passing in January 2014, despite him having
chronic health problems. This couple helped me immensely in my personal
life as I challenged some of my own constraining beliefs, an area discussed in
Leahey and Wright 455
CFAM. By using interventions from CFIM such as adopting more facilitating
beliefs about my father’s new marriage and observing the benefits of later life
marriages, I more maturely adjusted, supported, and commended his new
Application of CFAM/CFIM: Personal Situation Influencing
Maureen offers a reflection of how a personal situation increased her compassion
in her clinical practice.
ML. My husband and I have been married for 45 years. In 2011, we had a
significant life event! We chose to retire and move from Calgary in Western
Canada to Pugwash, Nova Scotia, in Eastern Canada. This involved moving
about 3,000 miles from a city where we had lived for 40 years and that had a
population of more than 1 million to a village, my husband’s village of his
childhood, of about 830 souls. This includes Pugwash Junction, Pugwash
River, Pugwash Point, South Pugwash, West Pugwash, and Downtown
proper! I resigned from the hospital health service where I had worked managing
38 people and teaching and supervising interdisciplinary students and
various health professionals. I stopped my private practice in marriage and
I wanted a new life. We had designed a modern minimalist home by the
ocean, and I was ready for change. Change we got! We entered into our new
community, reconnected with family members, made new acquaintances,
began volunteering, started traveling, and enjoyed new experiences. But
then, little by little, after spending so much time together, our relationship
started to become challenging for me. My husband had not changed. Perhaps
when I was employed, I either had not noticed or dwelt upon things that were
now concerning me.
After several “marital conversations” about how things were between us,
I finally decided to go back to basics. I looked at CFAM and CFIM, did a
family assessment (through my own biased lens!), and devised an intervention
plan. Naturally, as a good wife, I initially looked more at my husband’s
failings than my own! I listed his negative behaviors I did not like. Then, I
started listing all the positive things about him. I thought about us from
CFAM’s structural, developmental, and functioning perspective and tried to
Figuring out an intervention plan proved to be a bit more challenging. In
considering CFIM, I noticed that I had been using and reusing the same old
456 Journal of Family Nursing 22(4)
strategies to try to make things better. Time for a change! I tried several new
strategies such as humor, ignoring the negative, praising the positive, acknowledging
his point of view before stating my own point of view, and so forth.
Now I am not a very patient person, so I started to look at that trait within
myself. I tried to get myself to slow down, do one thing at a time. For example,
instead of watching the news on television and looking at my iPad, I tried to
just do one thing or the other. I found I tended to walk fast in the house, intent
on getting things done so I slowed my pace. I found these interventions helped.
I interrupted less often. I focused more on what people were actually saying.
These personal changes had a tremendous positive effect on our relationship.
I began to talk more slowly to my husband, to whisper when I wanted
to get him to look up from his iPhone. I practiced a softened start-up to a
conversation instead of launching into something. CFAM and CFIM helped
me and us to become more compassionate. The models actually worked!
Things improved significantly. Influenced by my personal experiences, my
clinical work changed for the better. I became more patient, listened more
intently to clients, entertained more ideas for interventions, and expanded my
capacity for compassion.
Reflections on Expanding and Extending CFAM/
Having reflected on our own reciprocal professional and personal experiences
utilizing CFAM/CFIM over many years, we have wondered how our
experiences have extended our understanding about the relationships between
families, health, illness, and health care workers to transform practice with
families. We have addressed these clinical dilemmas by increasing our competent,
curious, and compassionate care of families. Also, we seek more regular
and ritualized feedback about whether our work is helping to soften illness
suffering and promote family healing. Some changes in our own practice
evolution have included a greater appreciation of the patients/family/client
reflections on what has been useful for their particular situation. Reflective
practice has been extremely useful for us, and we believe it is helpful for
clients as well.
In our own clinical practice, we try to obtain an early idea of what the client/family
desires from our meetings, their possible constraining illness
beliefs, and their preferred future in managing their health concerns. We have
moved away from tasks, homework, and similar nurse-initiated interventions.
We tend to focus more on discovering and building on the patient/family’s
ideas and resources for how to manage and/or soften their illness
Leahey and Wright 457
suffering. This shifts the conversation from information gathering toward cocreated
conversations. We believe that nurse-family relationships are actualized
in therapeutic conversations. We continue to include genograms,
ecomaps, and therapeutic questions not only as useful assessment tools and
interventions but also as conversation expanders, such as encouragement,
elaboration, description, impact, and so forth.
Although the intervention of commendations within CFIM was always an
important intervention, current brain science has helped us realize even more
the significance of focusing on the positive with regard to family functioning
and family strengths to enable sustained change in brain functioning when
experiencing a serious illness (Wright, 2015 a). Our goal is to help the client/
patient/family build a description of their preferred future that will soften suffering.
Paradoxically, assisting clients/families to express their preferred
future often means family members moving to accept “what is” in the present
moment, even with an experience of serious illness, rather than focusing on
the past or future (Wright, 2015b). Another useful expansion of our practice is
the awareness that struggling with the experience of an illness, that is, struggling
with “what is,” tends to invite more suffering. Consequently, we are also
less focused on explanation and technique. We engage with the client equably
(but not equally) as joint partners in a relationship to enable healing.
In exploring where we situate ourselves now in relation to CFAM and
CFIM after the models have been used for over 30 years, we have found it
helpful to ask ourselves additional questions. How have I changed my practice
using CFAM and CFIM over the last 10, 20 years? How have I changed
myself? Over the last 5 years? 1 year? How have I increased my clinical
imagination? How have I increased opportunities for compassionate
We are pleased to be part of this ongoing exploration.
This article is an adaptation of a podium presentation offered at the 12th International
Family Nursing Conference, Odense, Denmark, August 2015.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article
The authors received no financial support for the research, authorship, and/or publication
of this article.