Three Generations, One Kitchen Table: A Calgary Family Assessment of a Household Caring for a Grandmother With Early Alzheimer Disease
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RN to BSN Program, Aspen University
N493: Community Health II
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Month Day, Year
Three Generations, One Kitchen Table: A Calgary Family Assessment of a Household Caring for a Grandmother With Early Alzheimer Disease
Illness is lived by families, not only by individuals. When a parent develops dementia, the diagnosis belongs to one person but the work, the worry, and the changes in roles belong to everyone in the household. Family nursing treats the family itself as the unit of care. This paper applies the Calgary Family Assessment Model to a composite three-generation family caring for a grandmother with early Alzheimer disease, summarizes the family's strengths and concerns, and proposes nursing interventions using the companion Calgary Family Intervention Model. All names and details are invented; the family is a composite created for teaching.
The Calgary Family Assessment Model
The Calgary Family Assessment Model, developed by Lorraine Wright and Maureen Leahey, organizes a family assessment into three major categories: structural, developmental, and functional (Shajani & Snell, 2019). Structural assessment examines who is in the family, how members are related, and the family's external connections and context. Developmental assessment considers the family's life cycle stage, its tasks, and the attachments among members. Functional assessment looks at how the family carries out daily activities, called instrumental functioning, and how members communicate, solve problems, express emotion, and influence one another, called expressive functioning. The authors describe the model as a flexible map rather than a checklist; the nurse chooses which parts to explore based on the family's situation, and the model has been applied in many clinical settings and countries (Leahey & Wright, 2016).
Structural Assessment
The R. family lives in a three-bedroom house in a suburban neighborhood. The household includes Mrs. R., 46, a school bus driver; her husband, Mr. R., 48, who works night shifts at a distribution warehouse; their children, a 15-year-old daughter and a 12-year-old son; and Mrs. R.'s mother, Mrs. L., 74, a retired seamstress who moved in eight months ago after a diagnosis of early Alzheimer disease. Mrs. L. was widowed four years ago. Mrs. R. has a brother who lives three hours away and calls weekly.
A genogram of three generations shows the close tie between Mrs. R. and her mother and a more distant relationship with her brother, who Mrs. R. says "means well but isn't here." The ecomap shows strong connections to the family's church and to Mrs. R.'s employer, which has allowed some schedule flexibility, and weak or absent connections to health and community services: Mrs. L. sees a primary care provider twice a year, and the family has not contacted any dementia support organization. The family speaks English at home, and Mrs. L. also speaks Spanish, her first language, which she uses more often when tired.
Developmental Assessment
The R. family is at two life cycle stages at once. As parents of adolescents, Mr. and Mrs. R. are negotiating their children's growing independence. As adult children of an aging parent, they are taking on care for the older generation. This double responsibility, often called the sandwich generation, strains time and energy. The developmental tasks of the adolescent stage, such as allowing more autonomy and preparing for launching, compete with the tasks of caring for a parent with a progressive illness. The daughter, 15, has begun staying with her grandmother after school so that Mrs. R. can finish her afternoon route, a new role that brings her closer to her grandmother but reduces time with friends and for homework.
Functional Assessment
Instrumental functioning is adequate but fragile. Mrs. R. manages her mother's medications, appointments, and meals and coordinates the family calendar. Mr. R. sleeps during the day and is available in the evenings. Mrs. L. can still dress and bathe herself but has begun leaving the stove on and has twice become confused about the day of the week. Everyday care is working, but it depends almost entirely on Mrs. R.
Expressive functioning shows both strengths and strain. The family communicates warmly and jokes easily at dinner, and the children speak of their grandmother with affection. Mrs. R., however, reported feeling "tired all the time" and admitted that she has not told her husband how much she is struggling, because he is already working nights. Problem solving tends to fall to her alone. Mrs. L. is aware of her memory changes and expressed worry about being a burden. Roles have shifted quickly, and no one has openly discussed how the family will manage as the disease progresses.
Strengths and Concerns
The family's strengths are substantial: close relationships across three generations, warm communication, a shared faith community, a flexible employer, and children who want to help. Its main concerns are caregiver strain in Mrs. R., safety risks in the home as Mrs. L.'s memory declines, limited knowledge of the course of Alzheimer disease and available support, the daughter's growing caregiving load, and the absence of a family conversation about the future. In Wright and Leahey's approach, naming strengths explicitly is not a courtesy but an intervention, because families under stress often lose sight of what they are doing well (Shajani & Snell, 2019).
Nursing Interventions Using the Calgary Family Intervention Model
The Calgary Family Intervention Model targets three domains of family functioning: cognitive, affective, and behavioral (Shajani & Snell, 2019). A review of Family Systems Nursing intervention studies found family responses in all three domains, including improved understanding and coping, better emotional well-being, and improved interactions within and outside the family, although most studies were qualitative or used pre-post designs (Östlund & Persson, 2014).
In the cognitive domain, the nurse offers information about the expected course of Alzheimer disease and home safety, such as stove shutoff devices and a simple daily calendar for Mrs. L., and connects the family to a local dementia support organization. In the affective domain, the nurse commends the family's strengths, validates Mrs. R.'s exhaustion, and invites her to share her feelings with her husband during a family meeting the nurse facilitates. The nurse also acknowledges Mrs. L.'s fear of being a burden and asks what she wants her family to know.
In the behavioral domain, the nurse helps the family redistribute tasks: Mr. R. takes over Saturday appointments, the brother agrees to handle insurance paperwork remotely and visit monthly, and the daughter's afternoons with her grandmother are reduced to two days a week, with an adult day program covering the others. The nurse screens Mrs. R. for caregiver strain and suggests she discuss her fatigue with her own provider. A follow-up home visit in one month will review what changed, and the family will be encouraged to begin planning for future care decisions while Mrs. L. can still take part.
Conclusion
The R. family is doing many things right, and its difficulties come less from any failure than from the speed with which its roles changed. The Calgary Family Assessment Model revealed a family with strong bonds, overlapping developmental demands, and a caregiving system resting almost entirely on one person. Interventions across the cognitive, affective, and behavioral domains aim to share that load, prepare the family for what lies ahead, and preserve the relationships that are its greatest strength. For the community health nurse, the lesson is that the most important patient in a dementia diagnosis may be the family.
References
Leahey, M., & Wright, L. M. (2016). Application of the Calgary Family Assessment and Intervention Models: Reflections on the reciprocity between the personal and the professional. Journal of Family Nursing, 22(4), 450-459. https://doi.org/10.1177/1074840716667972
Östlund, U., & Persson, C. (2014). Examining family responses to Family Systems Nursing interventions: An integrative review. Journal of Family Nursing, 20(3), 259-286. https://doi.org/10.1177/1074840714542962
Shajani, Z., & Snell, D. (2019). Wright & Leahey's nurses and families: A guide to family assessment and intervention (7th ed.). F. A. Davis.
How this N 493 Module 3 example is structured
Family assessment is part of the clinical focus of N493, and in many sections a module asks for a written family assessment using an established model, with strengths, concerns and nursing interventions. Aspen does not publish module deliverables, so follow your classroom's prompt and model. This example explains the Calgary model briefly, assesses the family under each of its three categories, summarizes strengths and concerns, and organizes interventions by the three domains of the intervention model, with a follow-up visit to close the loop.
N493 Module 3 questions, answered
What does N493 Module 3 usually ask for?
Family assessment is a core part of N493's clinical focus, and a module in the early part of the course commonly asks for a written family assessment using a model such as Calgary or Friedman, with strengths, concerns and interventions. Aspen does not publish module deliverables, so your classroom's instructions and rubric set the exact requirements.
What are the three categories of the Calgary Family Assessment Model?
Structural (who is in the family, relationships, external connections and context), developmental (life cycle stage, tasks and attachments) and functional (instrumental daily activities and expressive communication, problem solving and roles). The sample assesses a family under each.
Do I need to include a genogram and ecomap?
Many rubrics expect them. In a paper you can describe them in prose, as the sample does, or attach the diagrams as an appendix. Either way, use them to draw conclusions, such as the weak connection to community services in the sample.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.