Nursing Essay: Family Care Assessment, Planning, Implementation, And Evaluation.

• Create a genogram to visually depict the family's structure. 

• Below the genogram, summarise the structure of the family to demonstrate your understanding of the family assessment findings.

• Use the Australian Family Strengths Nursing Assessment Guide (AFSNAG) to identify and briefly describe two (2) strengths of the family you are assessing. 

• Select 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.

• For each issue/challenge identified in the family assessment

a) Describe the issue

Use appropriate evidence from scholarly literature to describe the issue and discuss what is known about the issue/challenge. 

b) Plan nursing care 

Provide a relevant nursing goal and justify the goal (explain why it is relevant to the issue) using appropriate evidence or policies. 

c) Implement nursing, care 

Outline one nursing intervention that supports the family to achieve the goal. Each nursing intervention should be supplemented by the recommendation of an existing online resource for the family and an appropriate referral. 

d) Evaluate nursing care 

Describe how you would evaluate the effectiveness of the intervention to address whether it met the planned goal of care. 

Part I - Nursing Care of the Family: Creating a Genogram and Identifying Family Strengths

Challenge/issue in the family-

Describe the issue:

The main challenge or issue facing Sheila is the transition to parenting and handling tantrums of her children. She has an older daughter Jessie of 2 years old and new born son Grant of 4 years old. For  Sheila, handling Jessie has been difficult as she is not yet toilet-trained, does not sleeps much and eats very less too. Her tantrums are also too hard for Sheila to handle as she has to attend to her new born baby, Grant too. Getting from her husband while caring for husband also makes her worried and exhausted. Hence, the issues related to challenges in transition to parenting are a common thing for most parents. The evidence by Hutteman et al., (2014) reveals that parenting often involves a hectic schedule for parents, which makes it challenging for them. Because of the need to constantly address their child’s need, they often find less time for themselves. Secondly, adjusting to the new role of parenting becomes difficult because there is a dramatic change in lifestyle after the birth of bath. Imbalanced life and inability to understand certain behavior patterns of children make parents feel exhausted and emotionally drained (Roeters, Mandemakers, & Voorpostel, 2016).

In relation to the challenges faced by Sheila after acquiring the new parenting roles and handling the tantrums of their children, the main nursing goals is to:

• Support Sheila in identifying the needs of her children and handling their tantrums
• Providing parenting knowledge  and practices to Sheila so that she can manage both personal and situation adversities during parenthood
• Implement specific problem-solving interventions to manage  behavioral problems in Jessie
• Support Sheila to achieve parenthood goals as well as find time for her own personal interest

The above mentioned goals is relevant to the problem of challenges in parenting. Specific nursing intervention related to supporting Sheila during parenthood would help her handle pressures as well as address social isolation in her. The above is in relevance of the policies too which emphasizes on supporting parents of children below 8 years. These kinds of interventions mainly focus on supporting parents of young children by providing knowledge about children development and successful parenting practices. On the whole, the nursing interventions would help to strengthen the parenting capacity of parents like Sheila.

To achieve the above goal and help Sheila address all her worries related to parenting, the main nursing intervention is providing education on successful parenting practices and recognizing child development patterns and needs at different age. Major challenges for parents arise when they do not understand the reason why their child is crying so much or why they are not eating properly. Hence, the nurse supports parents to understand the behavior patterns of children and address them accordingly. Early care education mostly facilitates parents to understand the health, learning and development of their children. To meet the diverse needs of family, the nurse may teach her several coping mechanism to handle issues in parenting. Directing parents to home and community service for children with specialized care also encourages successful parenting practice (Breitenstein, Gross, & Christophersen, 2014). The nursing goal of supporting parents with young children is also recommended by pediatric nursing services, as it is part of the family centered care philosophy (Harrison, 2010). Such nursing intervention promotes emotional and psychological development of family as a whole too.

Part 2 - Nursing Care of the Family: Planning, Implementing, and Evaluating Nursing Care

The nurse can also teach Sheila how to toilet train Jessie by the following steps-

• Teaching Sheila to identify whether her child is toilet ready or not
• The child can be taught about giving signs when she need to go to the toilet
• The parents can also detect toileting needs in her child with the movement and behavior pattern
• Secondly, education related to teaching children how to use toilet should also be given
• Effective toileting training will make the child develop a routine and prevent soiling clothes.

The above mentioned nursing care of supporting Sheila through education and knowledge on successful parenting practice can be evaluated by seeing whether Sheila has affected acquired all the knowledge in her daily life. If she is recognizing the signs and symptoms related to toileting needs or reasons for crying, then it can be said that the planned goal of care has been made. This will eventually help to address social isolation of Sheila too and she feels confident that she can manage her child’s need very well now. This will help to maintain emotional as well as physical health of Jessie as well as overall family too

Describe the issue:

Another issue found in Jenson family is that her 4 weeks old son, Grant is not developing properly and many abnormalities have been found in him due to pre-term birth. Secondly, little support from her husband, Scott has particularly made things difficult for Sheila. This issue is relevant to co-parenting challenges during parenthood and poor physical development in pre-term birth children. Riina & McHale, (2014) has showed that different dimensions of coparenting affect the development of children and management of their risky behavior. Hence, support from Scott would have helped Sheila to easily care for her child. Soares et al., (2016) also that proper  care of children with preterm birth is important because they are at greater risk of developing short and long-term health complications. Hence, unless action is taken at the right time, the parents are mostly likely to be exposed to physical, emotional and financial challenges.

One of the major family issues of Jenson family is the complications seen in their pre-term baby, Grant. Although Grant is breast fed, however he cries all the time and does not sleeps much. He was also on neonatal intensive care unit on CPAP for 24 hours and special care nursery for two weeks. Hence, to prevent health related complications in Grant, the goal of nursing care are to

• To monitor development and health of Grant regularly
• Monitoring and responding to abnormal weight, length and head circumference measurement of grant
• Teaching and providing education to Sheila about care for her children with pre-term birth
• Teaching coping and management skills to Scott to engage in successful co-parenting activities (Lunsky et al., 2015)

The above mentioned goals are relevant to the inappropriate development and growth issues in preterm birth children as evidence have shown that such children growth with of many diseases throughout their lives. The earlier is the pre-term birth, the earlier is the risk of medical complications in later life. Apart from chronic health issues, it may also lead to learning and motor disabilities for children (Ranke, Krägeloh?Mann, & Vollmer, 2015). Hence, tracking the growth and progress of Grant will be important for her growth and development.

Challenge/issue in the Family: Transition to Parenting and Handling Tantrums

The key nursing care relevant to the family issue is management of care and well-being of Grant. The nursing intervention for care of pre-term birth baby can be done by routine assessment and evaluation of growth and development in Grant. As part of assessment regarding Grant’s progress, it has been found that his weight, length and head circumference is tracking along 10^th percentile line. This indicates that overall growth and development of Grant is not normal like other child and the measurement indicates that out of 100 children, only 10 children will have such head, weight and length measurements. In response to such measurement, the nurse needs to evaluate the reasons for such measurements and any possibilities of abnormal growth development. Evidence has shown that there is rise in focus on growth, metabolic status and neurocognitive development of pre-term birth children so that atypical development can be detected early and nurses can take preventive measures at the right time to improve outcomes (Ranke, Krägeloh?Mann, & Vollmer, 2015).

Secondly, in response to nursing intervention for addressing the special needs of pre-term birth child, the main nursing action is to provide adequate knowledge to parents about abnormalities and teaching them coping skills to handle such child. Supportive  nursing care is critical to the adequate management preterm infant (Benzies et al., 2013). Firstly, education for parents is needed in the area of nutritional supplementations required for such baby and engaging in neuro-developmental care for such infants. As Sheila is unaware about immunization needs of her baby, the nurse needs to guide regarding the same and direct her to adequate health care services to fulfill the immunizations needs too. Such children may also develop thermoregulation stability, so the nurse needs to provide appropriate environment and clothing to the child too (Lester et al., 2014).

In relation to the nursing intervention for management of care for pre-term birth baby, the success of the outcome is dependent on good physical and neuro-cognitive outcome of patients. When Sheila is aware about the care needs and complications in such pre-term birth baby, she can take the actions at the right time. This will help the child to get adequate treatment and nursing care and facilitate optimal health and well-being too.

References

Benzies, K. M., Magill-Evans, J. E., Hayden, K. A., & Ballantyne, M. (2013). Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC pregnancy and childbirth, 13(1), S10.

Breitenstein, S. M., Gross, D., & Christophersen, R. (2014). Digital delivery methods of parenting training interventions: a systematic review. Worldviews on Evidence?Based Nursing, 11(3), 168-176.

Harrison, T. M. (2010). Family-centered pediatric nursing care: state of the science. Journal of pediatric nursing, 25(5), 335-343.

Hutteman, R., Bleidorn, W., Keresteš, G., Brkovi?, I., Butkovi?, A., & Denissen, J. J. (2014). Reciprocal associations between parenting challenges and parents' personality development in young and middle adulthood. European Journal of Personality, 28(2), 168-179.

Lester, B. M., Hawes, K., Abar, B., Sullivan, M., Miller, R., Bigsby, R., ... & Padbury, J. F. (2014). Single-family room care and neurobehavioral and medical outcomes in preterm infants. Pediatrics, 134(4), 754-760.

Lunsky, Y., Robinson, S., Reid, M., & Palucka, A. (2015). Development of a mindfulness-based coping with stress group for parents of adolescents and adults with developmental disabilities. Mindfulness, 6(6), 1335-1344.

Ranke, M. B., Krägeloh?Mann, I., & Vollmer, B. (2015). Growth, head growth, and neurocognitive outcome in children born very preterm: methodological aspects and selected results. Developmental Medicine & Child Neurology, 57(1), 23-28.

Ranke, M. B., Krägeloh?Mann, I., & Vollmer, B. (2015). Growth, head growth, and neurocognitive outcome in children born very preterm: methodological aspects and selected results. Developmental Medicine & Child Neurology, 57(1), 23-28.

Riina, E. M., & McHale, S. M. (2014). Bidirectional influences between dimensions of coparenting and adolescent adjustment. Journal of youth and adolescence, 43(2), 257-269.

Roeters, A., Mandemakers, J. J., & Voorpostel, M. (2016). Parenthood and well-being: The moderating role of leisure and paid work. European Journal of Population, 32(3), 381-401.

Soares, R. L. D. S. F., Christoffel, M. M., Rodrigues, E. D. C., Machado, M. E. D., & Cunha, A. L. D. (2016). The meanings of caring for pre-term children in the vision of male parents. Texto & Contexto-Enfermagem, 25(4).