Nursing Care Of The Family

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Nursing Care Of The Family

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1.Create a genogram to visually depict the family’s structure. Summarise the structure of the family to demonstrate your understanding of the family assessment findings.

2.Identify two (2) issues/challenges for the family or a member of the family you have selected. These issues may be identified by the nurse, family or both. These can be health, social, or developmental family issues/challenges e.g., breastfeeding, social isolation, transition to parenting; they should NOT be ‘medical’ issues e.g., diabetes, high blood pressure.

Answer:
1.Family assessment

The Wilson family, as provided in the family genome above is a nuclear family, where two partners, Hannah (27) and Sharon (30) got married in the year 2017. Prior to this marriage, Sharon was married to Michael (30), with whom she has a daughter Matilda (3) and Michael has the full custody of their daughter. Hannah’s parents, Jim (65) and Maggie (56) were not happy with Sharon and Hannah’s marriage and hence, they stopped all their contacts with their daughter. Whereas, it is not clear that Sharon’s parents, Carl (59) and Catherine (60) support this marriage, but they fly down from New Zealand to Australia every year to visit their daughter and granddaughter. Hannah and Sharon are going to have their first children and they mutually decided that Hannah will carry their twin children for the first time. Professionally, Sharon is an engineer for a Brisbane based engineering company and due to her work projects, she needs to travel two to three times per month. On the other hand, Hannah is a primary school teacher and hence, they have decided about Hannah carrying their babies for the first time.
As per the Australian Family Strengths Assessment Guide (ASFNAG), it is the duty of the nursing professionals to ask a series of question to the families so that the strengths and weaknesses of a family can be identified (Foster, O’brien & Korhonen, 2012). The family members responded to the question asked by healthcare professionals and depending on which later, the nursing care goals are implemented and evaluated. These strengths afterward are used in increasing the family’s ability to overcome difficult situations. In the case of the Wilson family, the identified strengths were belief and understanding (Bird et al., 2012).

Using ASFNAG, the first strength which was identified was the belief of the family members. Though it is not clear that Sharon’s father and mother supported their marriage or not, But they had belief on their daughter’s decision that she will take care of herself and hence, fly down from New Zealand to Australia to visit their daughter and granddaughter Matilda. Further, Michael also had belief in Carl and Catherine, the parents of Sharon and hence despite having the complete custody of his daughter Matilda, he allowed them to visit her without any specific clause.
The understanding was designated to be a strength for this family. It can be seen that each of the families involved had an unconditional understanding between them. With reference to the separation of Michael and Sharon, it can be said that they separated with the clear understanding that after their divorce, the complete custody of Matilda will be with Michael (Foster, O’brien & Korhonen, 2012). On the other hand, while involving in a same-sex marriage, Hannah and Sharon both informed their families and tried to involve them in the ceremony, however, Hannah’s family did not want to be a part of it, and Sharon’s parent did not show agreement or disagreement to this relationship (Bird et al., 2012). Further, the understanding was also witnessed in the situation where Hannah took the responsibility to deliver their first baby through IVF as Sharon had critical work responsibilities and stress.
2.Nursing care of the family: Planning, Implementing and Evaluating
Majority of the families go through personal and professional difficulties and challenges while fulfilling their family functioning. With the onset of parenthood, several changes in lifestyle, roles, responsibilities, and relationships are witnessed which has the ability to strengthen or weaken the bonding between the family members. It has been seen that after the birth of a baby, the complete family actions are dominated by the child itself, as the parents had to wake up all the nights, sacrifice their sleep and comfort to protect, feed and care for the newborns. Stress and anxiety of parenthood had affected Sharon and Hannah as well. The first stress came as the premature delivery of Gus and Harvey as they were born 2 weeks early to their estimated birth date. These six-week premature baby boys spent two weeks’ time in a special care nursery and after they brought back home, they had to breastfed by Hannah, who had several complications related to breastfeeding.

Therefore, the primary goal for Hannah was to be able to breastfeed their children without being affected by her nipple related infection or her episiotomy related three stitches. This goal was relevant in the case of Hannah as she witnessed an infection around her nipple which makes her breastfeeding sessions painful and she is unable to control the situation (World Health Organization, 2018). The importance of breastfeeding can be understood from the fact that in the early stages of life, mother’s milk provides the baby with all important nutrients, immunological strength and vital minerals that help them to develop faster (Briggs, Freeman & Yaffe, 2012). The Australian National Breastfeeding strategy also focuses on the importance of breastfeeding to children in their first six months as it helps in the improvement of well-being and nutritional condition of the infant as well as the mother and provides healthcare-related protection, guidelines, promotion and monitoring of breastfeeding. Further Nyqvist et al. (2013) also mentions that mothers, who breastfed their babies are more likely to recover faster from the delivery related ailments than the women who do not breastfeed. Therefore, the intervention that will be implemented on Hannah will be allocating healthcare professionals, who can make Sharon and Hannah adapt to the situations of parenthood and make Hannah able to breastfeed her children without any stress (Debes et al., 2013). In this situation, the UNICEF and WHO driven breastfeeding initiative, Baby Friendly Hospital Initiative (BFHI) should be discussed as the ten steps of this initiative makes mothers compatible to breastfeeding by fostering complete protection and promotion of breastfeeding related knowledge (World Health Organization, 2016). In the case of Hannah, due to the premature birth of her children, it will take a long time to make them able to breastfeed properly and this is the reason she is feeling or experiencing the nipple trauma and therefore requires a counselling and educational session with the healthcare professional to understand the factors she is and will be facing in her parenthood. Hannah could be advised to visit a midwife so that she can understand the tools of effective breastfeeding (Eidelman et al., 2012)7. Further, she can visit a lactation specialist if she is unable to understand the strategies and also seek knowledge about the effectiveness of breastfeeding so that she does not opt for any supplementation for her children to comfort herself from the pain of breastfeeding (Pritham, 2013).
Further, she also suffered from episiotomy and due to this, she had three stitches, which is being infected after she and Sharon came to the home. This can be a crucial situation as Hannah and Sharon has given birth to a twin and managing twins, and their care will require their maximum time, leading Hannah to neglect her health condition, this can be witnessed in Hannah’s case as she has become teary and is being upset with small things (Debes et al., 2013). Therefore, the intervention for Hannah’s physiological condition will be appointing a healthcare professional so that she can provide proper care to her episiotomy related condition. Further, she will be provided with hot baths, changes dressings, and pads and she will be asked to keep the area of stitches clean and dry so that further infection can be prevented (Briggs, Freeman & Yaffe, 2012).
It is also noted that due the presence of Matilda, it has become difficult for Sharon and Hannah to manage both the newborn as Matilda is excited to have two newborn brothers and she is not listening to any instructions of her mother Sharon (Pritham, 2012). This situation can affect Hannah and the children physically and mentally as there is a possibility of fall due to the toys which Matilda has spread all her toys on the floor and is running throughout the house. Therefore, the intervention will be appointing one caretaker for Matilda and the two newborns so that all the children’s safety can be assured (Kozinszky & Dudas, 2015). Further, it will also help Sharon and Hannah to get some time for their own health and relationship as Sharon will be out for 10 days for her rotational professional shift. Therefore with the help of a Midwife, they will be able to take care of themselves. Further, as per the BFHI, the midwife should know the strategies and ethical considerations of maternal caring so that she can provide holistic care to the newborn and the mother (Matthey, Fisher & Rowe, 2013).

The next goal will be targeting her psychological and mental health as mentioned by Giubilini and Minerva (2012), after giving birth to a child, a mother goes through several physiological and psychological changes that have the capability to make her prone to different mental and physical health conditions. Postnatal depression is one of the things which could be one of the things which can affect developing the mother and infant bonding. It was witnessed in the case of Hannah’s mother Maggie (56) who also suffered from postnatal depression due to which, Hannah had to spend a maximum time of childhood at her maternal grandparent’s place. Besides its effectiveness in harming the mother-infant bonding, it should also be noted that it is very difficult to detect depression condition as a maximum of the mothers are unable to accept to the fact that they are suffering from depression (Glynn, Davis & Sandman, 2013). Due to which the mother and newborn both suffer from social and emotional cognition. Therefore, the second goal for Hannah will be helping her to lead a positive and confident lifestyle. This is important as being positive will help her to judge any negative situation with her cognitive strength and she will be able to neglect those consequences while taking care of her child. Further another intervention will be asking her to consult a counselor for her depression condition (DiPietro, 2012). It has been seen that using therapies like ‘talking and sharing’ help mothers to overcome postnatal depression syndrome effectively and they can take care of themselves and their children. Evaluation will be done by asking Hannah about her experience with the counselor or the healthcare professional appointed to take care of her episiotomy related infection so that gaps in the care process could be removed (Parsons et al., 2012). Further, to overcome this depressive condition, Hannah will be asked to join a mothers group. This will be very informative for her maternal life as she will be able to know different strategies and effective steps by discussing her problem within the group. This intervention is a rationale as it will help her from being affected with social isolation and will engage her in activities. As she is on maternity leave, it will be a difficult transition for her from an active lifestyle to a sedentary lifestyle. Hence, joining a mothers group will help her by keeping her busy and she will not be able to think negative thoughts as it would harm her mental health (Glynn, Davis & Sandman, 2013).

Parenting is a difficult phase, as during it parents had to suffer from different transitions. Therefore it is important for both the parents to understand all the aspect of parenting so that while caring for their children, they are aware of all the positive and negative aspects. In this case, discussion about Wilson family has been carried out, in which the Sharon and Hannah are the parents caring for their twin infants. As Hannah gave birth to twins, she is suffering from episiotomy, cuts, nipple irritation and another physiological factor which is affecting her mental condition as well (Faisal-Cury & Menezes, 2012). In this assignment two challenges were identified which was her breastfeeding issue and the other was her postnatal depression condition. Further, in the later sections, description, nursing care plan, implementation of that care plan and evaluation was carried out for other the challenges so that a holistic knowledge of parenting can be provided to Hannah and Sharon.

References
Bird, V. J., Le Boutillier, C., Leamy, M., Larsen, J., Oades, L. G., Williams, J., & Slade, M. (2012). Assessing the strengths of mental health consumers: A systematic review. Psychological assessment, 24(4), 1024. DOI: https://dx.doi.org/10.1037/a0028983
Briggs, G. G., Freeman, R. K., & Yaffe, S. J. (2012). Drugs in pregnancy and lactation: a reference guide to fetal and neonatal risk. Lippincott Williams & Wilkins. https://books.google.co.in/books?hl=en&lr=&id=ScPvM03B3lUC&oi=fnd&pg=PA181&dq=Briggs,+G.+G.,+Freeman,+R.+K.,+%26+Yaffe,+S.+J.+(2012).+Drugs+in+pregnancy+and+lactation:+a+reference+guide+to+fetal+and+neonatal+risk.+Lippincott+Williams+%26+Wilkins.&ots=tJR2qEeYto&sig=U2V5jdNxPqdoK1GPyLZt05URQqQ#v=onepage&q&f=false
Debes, A. K., Kohli, A., Walker, N., Edmond, K., & Mullany, L. C. (2013). Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review. BMC public health, 13(3), S19. DOI: https://doi.org/10.1186/1471-2458-13-S3-S19
DiPietro, J. A. (2012). Maternal stress in pregnancy: considerations for fetal development. Journal of Adolescent Health, 51(2), S3-S8. DOI: https://doi.org/10.1016/j.jadohealth.2012.04.008
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827-e841.
Faisal-Cury, A., & Menezes, P. R. (2012). Antenatal depression strongly predicts postnatal depression in primary health care. Revista Brasileira de Psiquiatria, 34(4), 446-450. DOI: https://dx.doi.org/10.1016/j.rbp.2012.01.003

Foster, K., O’brien, L., & Korhonen, T. (2012). Developing resilient children and families when parents have mental illness: A family?focused approach. International Journal of Mental Health Nursing, 21(1), 3-11. DOI: https://doi.org/10.1111/j.1447-0349.2011.00754.x
Giubilini, A., & Minerva, F. (2012). After-birth abortion: why should the baby live?. Journal of medical ethics, medethics-2011. DOI: 10.1136/medethics-2011-100411
Glynn, L. M., Davis, E. P., & Sandman, C. A. (2013). New insights into the role of perinatal HPA-axis dysregulation in postpartum depression. Neuropeptides, 47(6), 363-370. DOI: https://doi.org/10.1016/j.npep.2013.10.007
Kozinszky, Z., & Dudas, R. B. (2015). Validation studies of the Edinburgh Postnatal Depression Scale for the antenatal period. Journal of affective disorders, 176, 95-105.DOI: https://doi.org/10.1016/j.jad.2015.01.044
Matthey, S., Fisher, J., & Rowe, H. (2013). Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations. Journal of Affective Disorders, 146(2), 224-230. DOI: https://doi.org/10.1002/da.20415
Nyqvist, K. H., Häggkvist, A. P., Hansen, M. N., Kylberg, E., Frandsen, A. L., Maastrup, R., … & Haiek, L. N. (2013). Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations. Journal of Human Lactation, 29(3), 300-309. DOI: https://doi.org/10.1177/0890334413489775
Parsons, C. E., Young, K. S., Rochat, T. J., Kringelbach, M., & Stein, A. (2012). Postnatal depression and its effects on child development: a review of evidence from low-and middle-income countries. British medical bulletin, 101(1).
Pritham, U. A. (2013). Breastfeeding promotion for management of neonatal abstinence syndrome. Journal of Obstetric, Gynecologic & Neonatal Nursing, 42(5), 517-526. DOI: https://doi.org/10.1111/1552-6909.12242
Trevathan, W. R. (2017). Human birth: An evolutionary perspective. Routledge.
World Health Organization. (2016). Breastfeeding in the context of Zika virus: interim guidance.
World Health Organization. (2018). Baby-friendly Hospital Initiative. Retrieved from: https://www.who.int/nutrition/topics/bfhi/en/ [Accessed on 26th August]

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