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Part 1 - Nursing Care of the Family: Assessment


• Create a genogram to visually depict the family’s structure (template and exemplar provided)
• Summarise the structure of the family to demonstrate your understanding of the family assessment findings
• Identify and briefly describe two (2) strengths of the family you are assessing using the Australian Family Strengths Nursing Assessment Guide (AFSNAG).

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

• 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.
• For each issue/challenge identified in the family assessment (allow approximately
a) Describe the issue
o Use appropriate evidence from scholarly literature to describe the issue and discuss what is known about the issue/challenge.

b) Plan nursing care
o 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
o 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
o Describe how you would evaluate the effectiveness of the intervention to address whether it met the planned goal of care.

Sheila's Background and Current Situation

                                               

Sheila is a 24 year old stay at home mom who is married to Scott, a 38 year old accountant. Before they met, Scott was married two times before, first to Lydia with no children, the second to Shelly and they had three boys aged ten, eight and six years. Sheila and Scott have two children, Olivia who is two years old and Leo, a newborn of four weeks. Both Sheila’s parents, Mary and Keith, live two hours away from Sheila and come to visit during the weekends but preferably when Scott is not around because they have a strained relationship with him.

Scott lost his father two years ago to bowel cancer and his mother, Brydey, lives two hours away in assisted living. Sheila met Scott’s parents once during their wedding two years ago. She has never been employed since she finished schooling in TAFE and now wants to work part-time as a teacher. This will be difficult because she will have to go to school. Her other option is to look for a part-time bookkeeping job but she will do this once Leo is older. Scott has a busy schedule and often comes home late with his work. He puts pressure on Sheila to keep the house clean and have dinner ready before he gets. Sheila finds this difficult on top of having a new born child and a toddler who is still in nappies, doesn’t eat well and doesn’t get enough sleep. She is feeling tired because she hasn’t slept in four weeks and feels isolated because they have one car and the nearest bus stop is one kilometre. This also makes it hard to take Olivia to daycare and the child has become withdrawn with tantrums.

The two strengths identified for the Brown family based on AFSNAG are support and resilience (Barnes & Rowe, 2008, p.14). In support, Sheila does not receive much help from her husband Scott because expects Sheila to cook and clean for him without offering help. Sheila has support from her parents Mary and Keith who visit during the weekends. They want to come more often to help Sheila with the kids and housework but because of their strained relationship with Scott, it has become difficult. Because of the lack of support from her husband, any observer looking at the Brown family would conclude that Sheila is alone.

Except for her parents, Sheila has no one to look out for her because Scott is constantly busy with his job and does not help with the kids or housework. In resilience (Barnes & Rowe, 2008, p.14), Sheila still has hopes of working part-time as a teacher but she wants to be a bookkeeper first once Leo is older. This keeps her hopeful even though Scott wants her to stay at home. In terms of crisis, the family has not dealt with a crisis ever since Scott and Sheila have been married. She is currently having problems with Olivia because she doesn’t sleep and eat well. Sheils has also not slept for the last four weeks since Leo was born. She is dealing with these problems on her own because Scott has not made efforts to offer assistance.

Strengths of the Brown Family Based on AFSNAG

Sheila is a stay at home mom with two children and they live 40 kilometers away from the town. They have only one car and the nearest bus stop is one kilometer away. Because of this, it becomes difficult for her to go anywhere with her children. Her husband Scott has a busy work life and the only people that come to see her are Mary and Keith, her parents. One issue that is affecting Sheila is social isolation which refers to how an individual feels they don’t belong, lacks engagement with others (family or friends) and lacks any meaningful or fulfilling relationships (Alspach, 2013).

Social isolation differs from loneliness which is a feeling of not belonging and lacking any meaningful relationships. Researchers in the field of psychiatry agree that loneliness is the embodiment of social isolation while others see it as a distressing feeling that results from comparing one’s actual relationships to desired relationships (Steptoe, Shankar, Demakakos & Wardie, 2013). Human beings are social animals and social relationships are seen as a vital component of life. Having a strong and positive relationship is good for the health while negative relationships can be harmful (Ge, Yap, Ong & Heng, 2017).

A nursing goal that can be used for Sheila is to increase her social interaction and communication with other people (Swearingen, 2016). She can do this by interacting with neighbors, community coordinators or local pastor who can then connect her with other people. Because they live 40 kilometers from town, it can be assumed they live in a remote or rural area. There are studies done in Australia which have shown that people living in rural and remote communities have stronger social relationships than those in urban or cosmopolitan areas (Beer et al., 2016).

People living in remote communities have stronger social interactions especially if they share similarities or have things in common (Beer et al., 2016). Connecting with her neighbors gives Sheila an opportunity to learn about the community and get into a social club which will give her a chance to interact with others. It will also benefit Olivia because she will meet and play with children her age. Social engagement with the neighbors will also provide carpool opportunities for Sheila especially when she enrolls Olivia into daycare.

One nursing intervention that can address the patient goal is to help Sheila identify available support networks in her community and look for ways to increase contact with these networks (Swearingen, 2016, p.81). This could be done by identifying a potential support person such as a neighbor, church minister, or an events coordinator. The rationale for this is that engaging in social activities will reduce her feelings of isolation and it will lead to an improved sense of wellbeing. In the event she can’t access any of these people, then a trained volunteer can be engaged by her family nurse with the sole objective of decreasing her social isolation. This is referred to as befriending (Balaam, 2014).

It is an intervention that is used in nursing and social care to provide support for individuals who are isolated. It involves two or more people, engaged in a relationship that is meant to be supportive to one person, primarily the individual who is suffering from social isolation (Balaam, 2014). An example of befriending is the Befriending Network of Scotland whose purpose is to have trained volunteers befriend people suffering from mental conditions by taking them to parks, the store or to the library. The network encourages these people to take part in community activities and develop relationships with locals living in the area (Perese, 2012, p.226).

Effects of Social Isolation on Sheila and Her Family

The family nurse in Sheila’s case should refer her to a social worker who can then assess her relationships and connect her with a trained volunteer. An online resource Sheila and her family can also use to get engaged in their community is Rural Aid Australia. It is an organization that offers holistic support programs to people living in remote or rural parts of Australia (Rural Aid, 2018).

To assess whether the intervention has worked, the family nurse can get in touch with the trained volunteer by phone or email to follow-up on Sheila’s progress. The success of the intervention will be gauged by whether she has formed relationships outside her family circle especially with her neighbors and whether she is actively participating in community activities. The nurse can also get information from Sheila during her next visit on whether she has connected with people in her community.

The second problem is Olivia’s poor eating habits. In the scenario, Olivia who is two years old does not eat very well, sleeps poorly, has tantrums and has become withdrawn. The developmental milestones for children who are two years old include having tantrums and showing defiant behavior because they are becoming more independent and aware of themselves. Temper tantrums in children can be caused by being ill, exhaustion, hunger and frustration, seeking attention from parents or caregivers and avoiding activities like picking toys from the floor (Daniels, Mandleco & Luthy, 2012).

During the early years of their life, children tend to have erratic eating habits although these vary for every child. After their infancy, toddlers face a period of rapid growth spurts which are characterized by decreased appetite and sporadic periods of eating (Linnard-Palmer, 2019). They also develop a sense of autonomy at this stage and become selective in the type of food they want to eat. For some children, refusing to eat might be a form of attention seeking behavior and an indicator of a difficult parent-child relationship. For others, their decision to eat might be influenced by copying their parents or role models food preferences (Leung, Marchand & Sauve, 2012).

A nursing care goal that can be used for Olivia is that she will be able to eat three square meals in a day by the end of two weeks. Sheila needs to keep a journal that documents Olivia’s eating patterns over the course of the two weeks. The reasons for this nursing goal is that children Olivia’s age tend to have poor appetites and eating habits because of slowing growth rates after the infancy period, an increasing sense of independence, preferring to select their own meals, psychological changes that might affect their dietary intakes and an increasing preference to self-feed (Walton, Kuczynski, Haycraft, Breen & Haines, 2017).

According to the American Academy of Pediatrics (Healthy Children, 2017), two year-old children should be eating three healthy meals in a day and one or two snacks. Because they are cognitively developed, toddlers can become active participants during meal times without prodding. Having three meals that are balanced is also important preventing nutritional deficiencies such as iron deficiency which many healthcare providers have now started screening toddlers for (Linnard-Palmer, 2019, p.91).

Importance of Social Engagement and Community Connections

The family nurse should provide patient teaching on the nutritional needs of children at her developmental stage as an intervention. This will involve looking at Olivia’s current eating habits and the nutritional patterns of the family. Assessing the family’s dietary and nutritional patterns is important because they affect the child’s development of eating habits (Ralph & Taylor, 2014, p.751) Once her eating patterns have been identified, the nurse can discuss the importance having three square meals in a day that are balanced and also how Sheila can limit Olivia’s snacks before breakfast, lunch and dinnertime.

The teaching lesson will also cover the portions or servings that Sheila should give her daughter in a day and what nutritious snacks she can give that are as similar to meals. Some examples of these include carrot or celery sticks, cheese, crackers and boiled eggs. Sheila can also help Olivia create a food chart that monitors what she eats and how well she is eating by ticking-off meals that she has finished (Ralph & Taylor, 2014). An online resource that the nurse can recommend to Sheila is the Eat for Health website created by the Australian Government’s Department of Health.

This website offers important information about the dietary guidelines for Australia in the form of electronic brochures that show specific dietary guidelines for infants, children and adults (EatforHealth.Gov, 2018). The dietary guideline for children shows the types of food children Olivia’s age should be fed, the portions to be served, foods to limit and how parents can encourage healthy eating especially during mealtimes (EatforHealth.Gov, 2018). Sheila can also be referred to a nutritionist that specializes with toddlers.

To evaluate whether the teaching session was effective, the nurse will schedule a follow-up appointment with Sheila in three weeks and she will be required to come with the journal and chart so that the nurse can check Olivia’s consumption. Checking the journal will provide useful information on the types of foods Olivia eats and those she doesn’t eat as well as the servings she takes per meal. This information is useful in coming up with a dietary plan. It will help the nurse calculate the nutritional intake Olivia has been receiving for the prior weeks before the visit and readjust the dietary plan if there are any deficiencies noted.

References:

Alspach, J.G. (2013). Loneliness and social isolation: risk factors long overdue for surveillance. Critical Care Nurse Journal, 33, 8-13. Retrieved from https://ccn.aacnjournals.org/content/33/6/8.full

Barnes, M., & Rowe, J. (2008). Child, youth and family health: strengthening communities. New South Wales, Australia: Elsevier Australia.

Balaam, M. (2014). A concept analysis of befriending. Journal of Advanced Nursing, 71, 24-34. Retrieved from https://clok.uclan.ac.uk/11220/1/11220_balaam.pdf

Beer, A., Faulkner, D., Law, J., Lewin, G., Tinker, A., Buys, L., Bentley, R., Watt, A., McKechnie, S., & Chessman, S. (2016). Regional variation in social isolation amongst older Australians. Journal of Regional Studies, Regional Science, 3, 170-184. Retrieved from https://www.tandfonline.com/doi/full/10.1080/21681376.2016.1144481

Daniels, E., Mandleco, B., & Luthy, K.E. (2012). Assessment, management, and prevention of childhood temper tantrums. Journal of the American Academy of Nurse Practitioners, 24, 569-573. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1745-7599.2012.00755.x

EatforHealth.Gov (2018). Healthy eating for children: teach your child healthy habits for a healthy life. Retrieved from https://www.eatforhealth.gov.au/sites/default/files/content/The%20Guidelines/n55f_children_brochure.pdf

EatforHealth.Gov (2018). The guidelines. Retrieved from https://www.eatforhealth.gov.au/guidelines

Ge, L., Yap, C.W., Ong, R., & Heng, B.H. (2017). Social isolation, loneliness and their relationships with depressive symptoms: a population-based study. PLoS ONE, 12, 1-13. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0182145

Healthy Children (2017). Feeding and nutrition tips: your 2-year-old. Retrieved from https://www.healthychildren.org/English/ages-stages/toddler/nutrition/Pages/Feeding-and-Nutrition-Your-Two-Year-Old.aspx

Leung, A.K.C., Marchand, V., & Sauve, R.S. (2012). The ‘picky eater’: the toddler or preschooler who does not eat. Pediatric Child Health, 17, 455-457. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3474391/

Linnard-Palmer, L. (2019). Pediatric nursing care: a concept-based approach. Burlington, US: Jones and Bartlett Learning

Perese, E.F. (2012). Psychiatric advanced practice nursing: a biopsychsocial foundation for practice. Philadelphia, US: F.A. Davis Company

Ralph, S.S., & Taylor, C.M. (2014). Sparks and Taylors nursing diagnosis reference manual. St. Louis, US: Wolters Kluwer Health, Lippincott Williams and Wilkins

Rural Aid (2018). Programs initiatives. Retrieved from https://www.ruralaid.org.au/programs/

Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. PNAS, 110, 5797-5801. https://doi.org/10.1073/pnas.1219686110.

Swearingen, P.L. (2016). All-in-one nursing care planning resource: medical-surgical, pediatric, maternity and psychiatric-mental health. St. Louis, US: Elsevier

Walton, K., Kuczynski, L., Haycraft, E., Breen, A., & Haines, J. (2017). Time to re-think picky eating?: a relational approach to understanding picky eating. International Journal of Behavioural Nutrition and Physical Activity, 14. https://doi.org/10.1186/s12966-017-0520-0

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