Introduction
The movie selected for this case study is Little Miss Sunshine, which portrays a family with complicated relationships and dysfunctional communication. The Hoover family consists of a husband and wife, their two children, the husband’s father, and the wife’s brother. They live together, struggle to understand each other due to generation gaps and differences in values, and try to deal with financial and personal issues. The film portrays their family trip across the US to attend a beauty pageant called Little Miss Sunshine, where 7-year-old Olive, the daughter, will participate. During this trip, the characters and relationships between the family members unveil and transform. This paper aims to present a nursing assessment of the family by analyzing its members’ relationships and roles, the social determinants of health, and their resilience sources. In addition, it addresses the analysis of the psychosocial development stage of one family member according to Erickson’s psychosocial theory. Recommendations for health promotion for the individual and the family functioning are provided.
The Family
Relationships and Roles
The genogram for the Hoover family is presented in Appendix 1. The genogram demonstrates that the family portrayed in the film consists of six members. Edwin Hoover, whose wife is not mentioned in the movie, is an elderly man who lives with his son and his family, uses drugs, and has close relationships with his granddaughter. Edwin’s son, Richard Hoover, is a middle-aged self-employed success mentor who tries to build his career but fails to provide for his family. Richard is married to Sheryl, a middle-aged woman who is the main breadwinner for the family; she secretly smokes and tries to maintain a functioning environment in the family. Sheryl has a brother Frank who lives with them after an attempt to commit suicide due to an unhappy romantic relationship with his male student.
Richard and Sheryl have two children, namely 15-year-old Dwayne and 7-year-old Olive. Dwayne is an asocial, pessimistic, intellectual teenager who resists communicating and is committed to a vow of silence till he accomplishes his dream of becoming a pilot. Olive is a cheerful and sociable girl who struggles with self-doubt and searches for confidence when developing her self-image.
Social Determinants of Health
The film portrays the family’s life with explicit and implicit identification of some important social determinants of health. This term is defined as “conditions or circumstances in which people are born, grow, live, work, and age” that are “shaped by political, social, and economic forces” (Islam, 2019, p. 1). Moreover, the social determinants of health expend on the external and internal environment, incorporating many factors that might have short- or long-term implications for health (Sokol et al., 2019). In the case of the Hoover family from the analyzed movie, their social determinants of health include income, employment, and access to healthy food.
In particular, one factor that influences the health and well-being of the Hoovers is their socio-economic status. It has direct and indirect influences on their health outcomes and psychological well-being. Indeed, Sheryl repeatedly complains about the lack of money they save during the trip, demonstrating their scarce financial means (Dayton & Faris, 2006). Unstable employment is another particularity that predetermines health risks for the family. Indeed, Richard does not have a steady source of income, while Sheryl struggles to provide for the whole family. Moreover, the insufficient economic stability is intertwined with another determinant of health, which is access to healthy food. The diet of the Hoover family, as portrayed in Dayton and Faris’s (2006) film, is unhealthy since they consume ordered fried food and sweetened drinks. Such a diet containing high levels of fats and fast carbs might have negative long-term health implications for all the family members.
Resilience
The risks to family resilience are associated with dysfunctional relationships. In particular, the family members fail to establish functional communication and problem-solving strategies. They disagree on many points, which becomes the reason for their continuous arguments. They interrupt each other and use rude and disrespectful language that neglects other people’s feelings. For example, in a scene at a cafeteria, Richard interrupts Frank by saying, “shut up, Frank,” (00:26:50 – 00:26:54). After that, Sheryl expresses her disapproval of such language by calling her husband by his name but without explicitly discussing the issue, as she always does.
Moreover, the disagreement and the lack of unity in decision-making in Richard and Sheryl’s marriage disrupt the consistency of their family development and children’s upbringing. Indeed, Richard fails to establish an appropriate upbringing influence on his daughter by cultivating stereotypical beliefs about the human body and women’s appearance. In this regard, as well as in many other aspects, the views and opinions of Sheryl and Richard do not coincide, which complicates their family environment. The wife diminishes the husband’s competencies, which deteriorates their resilience. In particular, Sheryl says, “if you are doing it, how hard could it be,” implying that her husband is not capable of accomplishing challenging achievements (00:28:38-00:28:41). Furthermore, the family (except for Olive) is uncomfortable expressing their feelings, and do not demonstrate empathy, which is a risk factor for their resilience. However, the family has overcome Frank’s suicide attempt, coped with their financial struggles in the past, and dealt with Dwayne’s teenage rebellion, which strengthens their capacity to overcome challenges and build resilience.
The Individual
Psychosocial Stages of Development
The individual from the Hoover family selected for the psychosocial stages of development assessment is Olive. She is a 7-year-old schoolgirl, which complies with Erickson’s fourth stage of lifespan development entitled “Industry vs. Inferiority,” commonly observed between 5 and 12 years (Maree, 2021). At this stage, children search to solve the conflict between their industriousness or capability to master their competencies and inferiority or failure to complete difficult tasks. Indeed, at this stage, children “consciously attempt to acquire new competencies” and are particularly susceptible to praise or criticism” (Maree, 2021, p. 1111). Thus, the major life events at this stage include learning to cope with difficult problems and dealing with challenges independently.
Several examples from the film justify the application of this stage of development to Olive. Indeed, throughout the film, Olive seeks approval of her actions and appearance from significant others, namely her mother, father, and grandfather. For example, Olive devotes much time to the preparation for the pageant learning her dance moves and continuously rehearsing; importantly, during this process, she inquires for validation and encouragement from her family (Dayton & Faris, 2006). Another example might be the scene at a hotel Olive feels insecure about her appearance and doubts her ability to win the beauty pageant; she refers to her grandfather to validate her beauty (Dayton & Faris, 2006). The discouraging remarks of her father jeopardize Olive’s self-belief; he sets a high benchmark for not becoming a loser, which hinders Olive’s belief in her capability to accomplish her goals (Dayton & Faris, 2006). Development of industriousness with the virtue of competency denotes successful completion of this stage (Orenstein & Lewis, 2021). Thus, the girl tries to overcome the conflict between industry and inferiority.
Health and Wellbeing
When assessing the health and wellbeing of the selected individual, one should focus on physical and mental health separately. At this stage, children’s health depends on providing necessary conditions for their developing bodies and bodily systems, as well as emotional health and cognitive functions (Orenstein & Lewis, 2021). Indeed, in terms of Olive’s physical health, one of the main concerns is her diet. The family’s lack of whole foods, excessive calories, and insufficient home-cooking culture might put Olive’s long-term health outcomes at risk. The nursing implications of this health concern include diabetes, high cholesterol levels, and impaired physical development.
As for the psychological well-being of the character, her health is influenced by the family culture and environment comprised of the relationships and communication in the family. She witnessed self-destructing behaviors of her mother, who smokes, her grandfather, who uses drugs, and her uncle, who intended to commit suicide (Dayton & Faris, 2006). Such influences might have negative effects on the girl’s mental state, jeopardizing her consistent healthy personality development. In this regard, the nursing implications associated with Olive’s psychological concerns might include addiction, personality disorders, and impairments of cognitive functions.
Health Promotion
Olive’s health promotion interventions should include initiating healthy dieting, exercise, confidence-building psychological practices, and educational measures for abstinence from substances. In the context of the family relationships that affect the health and well-being of the individual, family interventions constitute a significant aspect of health promotion measures. Indeed, research shows that “the family must be engaged, educated, and invited to participate in altering their cognitive domain, which in turn creates behavioral domain change” (Mileski et al., 2022, p. 2). Thus, the health promotion plan would include the following components:
- Educational sessions for healthy eating habits development;
- Individual physical activity intervention;
- Family-centered conflict management intervention (Russell, 2020);
- Family-centered emotional regulation training (O’Connor et al., 2019).
These interventions will help integrate the family into the negative change in behaviors and attitudes for Olive. Moreover, combining physical and mental health-adjusting measures will provide the most beneficial health outcomes. The outcomes of the health promotion plan’s evaluation would be conducted using observation and a self-reported survey (O’Connor et al., 2019). With the help of observation, the nurse will identify possible improvements in the dieting and conflict-management practices of the family. Moreover, the self-reported survey will allow for collecting and interpreting the data indicating individuals’ perceived changes in their behavior and wellbeing as an outcome of the interventions.
Conclusion
In summation, the case study focused on the Hoover family from Little Miss Sunshine, which demonstrated a dysfunctional relationship, failure to establish open communication, and jeopardizes the healthy development of minors. The family’s low socioeconomic status, unhealthy dieting, unstable employment, and destructive emotional environment have a negative impact on their health outcomes. Despite multiple risks jeopardizing their resilience, they are capable of overcoming challenges due to successful accomplishments in the past. The assessment of Olive demonstrated that she is at the fourth stage of psychosocial development with the conflict between industry and inferiority to solve. The girl is exposed to adverse role models, unhealthy eating habits, and a dysfunctional emotional environment that threatens her physical and mental health. To minimize the risks, educational, correctional, and behavioral interventions with the individual and her family should be implemented.
References
Dayton, J., & Faris, V. (2006). Little Miss Sunshine [Film]. Fox Searchlight.
Islam, M. M. (2019). Social determinants of health and related inequalities: Confusion and implications. Frontiers in Public Health, 7(11), 1-4.
Maree, J. G. (2021). The psychosocial development theory of Erik Erikson: Critical overview. Early Child Development and Care, 191(7-8), 1107-1121.
Mileski, M., McClay, R., Heinemann, K., & Dray, G. (2022). Efficacy of the use of the Calgary family intervention model in bedside nursing education: A systematic review. Journal of Multidisciplinary Healthcare, 15, 1323-1347.
O’Connor, S., Brenner, M., & Coyne, I. (2019). Family‐centred care of children and young people in the acute hospital setting: a concept analysis. Journal of Clinical Nursing, 28(17-18), 3353-3367.
Orenstein, G. A., & Lewis, L. (2021). Erikson’s stages of psychosocial development. National Library of Medicine.
Russell, L. T. (2020). Capturing family complexity in family nursing research and practice. Journal of Family Nursing, 26(4), 287-293.
Sokol, R., Austin, A., Chandler, C., Byrum, E., Bousquette, J., Lancaster, C., Doss, G., Dotson, A., Urbaeva, V., Singichetti, B., Brevard, K., Towner Wright, S., Lanier, P., & Shanahan, M. (2019). Screening children for social determinants of health: A systematic review. Pediatrics, 144(4), 1-20.
Appendix 1
