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Strengths of Family

The genogram depicts the family structure and history of Hannah and Steven Williams. Hannah has been married to Steven for three years. Unlike Steven, Hannah was married before to Barry. She is divorced and has a 5-year-old son, named Billy. Barry and Jane are in the relationship and live together. Jane has two children from her previous relationship, Ronan and daughter Emily. Steven lost his father to coronary heart disease a year ago. His mother Mavis lives alone. Hannah’s father is currently living with his second wife, Ariel. Her mother Marion is living alone.

The two strengths of William’s family includes the following as per the “Australian Family Strengths Nursing Assessment guide” (AFSNA) (Children’s Health Queensland Hospital and Health Service., 2017)-

Shared activities- Steven and Hannah spend time together as a family. Steven plans to take the family to the golf club for launch. He plans to help Hannah in cooking in the evenings when he is home.

Support- Hannah and Steven both share the load of the house and are there for each other. Hannah is running her clothes boutique business successfully. To save money also plans to paint and make new curtains for the baby’s bedroom. When Hannah declined to resume any sexual activity after caesarean section delivery, Steven supported her considering her weakness.  

Social isolation is one of the major issue faced by Hannah as the family have recently moved to the suburb on the southern Gold Coast, three bedroom home. Due to work commitment, she has not made many friends there except the small group of mothers met Billy’s prep-school. Since Steven visits two weeks from work, he too does not have a big channel of friends in Gold Cast who may support Hannah in his absence. They are mainly socially isolated as Steven, and his mother does not see often, and he has lost his father to coronary heart disease. Thus, the family has less family and friends support.

According to Ammerman et al. (2013), social isolation is the challenge because it leads to loneliness and depression. It has broad social and economic implications. Socially isolated people enjoy poor health outcomes and are in greater need of the health care services. Hannah is already experiencing physical weakness caesarian delivery, and social isolation may exacerbate this condition.  Just like Marion, Hannah may too undergo postnatal depression if social isolation is continued.  It has been observed in the most case of social isolation, sexual abuse, child and spousal abuse are highly likely to occur. Social isolation eats away at the community level in addition to the exacerbation of the mental health issues. Social isolation in broad aspect is associated with the increasing rate of suicide, increased inequality, rising drug and alcohol addiction, political polarisation and alienation (De Jong Gierveld et al., 2016). It is the reason behind the walled communities. Eventually, people with the social isolation not only keep their potential social problems, rather tend to isolate themselves from the community. The same may happen with Hannah and Steven eventually.

First Nursing Issue

In the case of this family, social isolation may influence their parenting style. In the case of Steven and Hannah, the chance of family dysfunction is high considering Hannah's past relationship issues. Both the husband and wife lack of support from their parents as well as a community. Hannah's mother is looking forward to spending time together with children, but father lives in the Philippines. Steven has experienced the harsh discipline of his father, and he too may engage in violence if socially isolated. Lack of family and peer support prevents a person from being happy, self-confident and self-esteem. In addition, Hannah is burdened with financial challenges with the new home, mortgage, recruitment of business manger and newborn baby (Hildingsson & Thomas, 2014). Consequently, it may hamper her physical and mental well-being.

Nursing care plan: The solution to this issue is to help Hannah build the strong social network in Gold Coast. It is necessary for her to feel more connected, know the neighbours and others in the community. The first nursing goal is to enhance confidence and morale in Hannah. The second nursing goal is to build the strong relationship with her family and make new friends. The rationale for this goal is to help Hannah increase the social network (Ammerman et al., 2013).

Implementing nursing care: As a nurse, it is important to engage in counselling with Hannah to help her manage the conflicting thoughts. To increase the client's confidence and morale, emotional support must be provided. Therefore, the nurse must spend a certain amount of time with Hannah at home. Engaging in conversation with the nurse will help Hannah to develop new insights on consequences of social isolation and strategies to cope up with it. Educating Hannah through motivational audios, videos, and audio recordings can be beneficial in uplifting her self-esteem. According to Barlow et al. (2015), home visiting interventions and social support have been effective in enhancing the depressed mood of mothers and attitude towards children and family. This response was found successful in increasing attachment security and psychomotor development.

The nurse can help Hannah build the strong family network by allowing Marion to visit the place. Being with her mother, Hannah will feel secured and enthusiastic. Further, Hannah can spend more time at prep school and neighbours while her mother takes care of her new born baby. Consequently, it will combat social isolation (Hildingsson & Thomas, 2014). 

Implementing nursing care

Evaluating nursing care: The expected outcomes of the intervention are increased interaction of Hannah with the society and improved emotional security. The achievement of the outcomes can be evaluated by observing the changes in the client’s behaviour, attitude, confidence, esteem and perception. If the client is ready for household challenges and regularly interacts with her friends at prep school or neighbours, takes their help and invites neighbours to house, it is indicative of increasing social connection. The same can be evaluated with the Lubben Social Network Scale (Denham et al., 2015).  The scale consists of ten items and four different categories. In each category the cutoff scorethat indicates the level of social isolation.

Transition to parenting is the other main issue of William’s family. In any family, pregnancy and transition to parenthood is the stage of major adjustment. A drastic change in the lifestyle is expected for both Hannah and Steven.  In this stage, Hannah and Seven are in need of support mechanism, antenatal education, information on child and mother care, breastfeeding challenges and relationship changes (Osman et al., 2016). The transition has been recognised as the challenge because Steven stays away from the house. In a case of any personal and professional issue, he may turn to his colleagues. However, the same is not the case with Hannah.

According to Roy et al. (2014) after pregnancy, mothers need greater support on the elements of baby care. Since she has given birth before, she may have some knowledge but handling two young children in the absence of Steven is quite challenging for her. She cannot independently handle her daily chores if her baby wakes her up early in the morning or late at nights. She needs support while cooking and other activities of daily living. Female support is greatly demanded by the mothers after delivery of a baby. However, Hannah lacks this support as neither of the husband or wife's parents visits them regularly.  

 Further, Hannah and Steven’s relationship may be at stake. Unlike Hannah, he is the first time father to a newborn baby. He may lack awareness of new responsibilities. It is evident when Steven says that he would like his wife to take care of crying baby when he is out for golf sessions.  Further, he is willing to spend time in weekends with his family only if the baby does not cry too much. Lack of sexual intimacy between the husband and wife due to her complications during delivery may be added disadvantage to the relationship. Hannah may fail to provide emotional support to her husband when he is back home after four-week rotation. In this situation, it is difficult for Hannah to maintain a strong relationship with both her children and husband (Roy et al., 2014). 

Evaluating nursing care

Nursing care plan: The nursing goal here is to increase the participation of Steven in bonding with family and children. When he is at home, he should take better care of the baby when crying or while changing the diaper. He should participate in household chores like cooking and cleaning when Hannah is busy handling the two small children. The next nursing goal is to provide parents education to support a transition to parenting.  The rationale for the goal is the significance of the father's role in the upbringing of the child.  Further, it is essential to increase the parental competencies of the father, so that he can better handle the responsibilities when at home (Kaakinen et al., 2014).

Implementing nursing care: Firstly, the nurse may provide parent education intervention. It is to educate the client about the role that, he can play in the first six months of the baby. The educational intervention to parents has been found successful in empowering the fathers to take responsibilities of the newborn in the house. These short learning sessions will help Steven overcome the barriers to bonding with the child and develop the coping strategies to avoid stress. During the session, the nurse can emphasis on various case study as an example to teach them about parenting style. Learning about other real life situation through case studies can help the parents to devise logistic solutions to baby care problems (Ateah, 2013). Consequently, Steven and Hannah would be able to make a healthy transition to the parenthood. Secondly, the nurse can engage both Hannah and Steven in marriage counselling by referring them to the professional. Sorting out the marital problems (individual contribution to finance and household work, sexual relationship issues) is essential to fulfilling the roles and responsibilities of parents (Stillwell, 2016).

Evaluating nursing care: The nurse can take regular feedback from Hannah about Steven’s transition to parent. Hannah must be aware of the verbal and non-verbal cues indicating the change in her husband's behaviour.  Further, the nurse must interview with father to identify the merits and demerits in the responsibilities he has been recently up taking. After two months the nurse can provide Steven with “ fathering self-efficacy scale" to help him identify where he wants to be. The scale consists of 28 items to figure out if the father is engaged in financial responsibility, and positive engagement. Base on the score, further therapeutic family interventions can be developed for the couple (Sevigny et al., 2016).  

References

Ammerman, R. T., Putnam, F. W., Altaye, M., Teeters, A. R., Stevens, J., & Van Ginkel, J. B. (2013). Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning. Child abuse & neglect, 37(8), 544-554.

Ateah, C. A. (2013). Prenatal parent education for first-time expectant parents:“Making it through labor is just the beginning…”. Journal of Pediatric Health Care, 27(2), 91-97.

Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., ... & Carter, A. (2015). Paraprofessional-delivered home-visiting intervention for American Indian teen mothers and children: 3-year outcomes from a randomized controlled trial. American Journal of Psychiatry, 172(2), 154-162.

Children’s Health Queensland Hospital and Health Service. (2017). Child and Youth Health Practice Manual. www.childrens.health.qld.gov.au. Retrieved 19 August 2017, from https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/qcycn/cy-prac-manual-pt1.pdf

De Jong Gierveld, J., Van Tilburg, T., & Dykstra, P. (2016). Loneliness and social isolation.

Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family-Focused Nursing Care. FA Davis.

Hildingsson, I., & Thomas, J. (2014). Parental stress in mothers and fathers one year after birth. Journal of reproductive and infant psychology, 32(1), 41-56.

Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. H. (2014). Family health care nursing: Theory, practice, and research. FA Davis.

Osman, F., Klingberg-Allvin, M., Flacking, R., & Schön, U. K. (2016). Parenthood in transition–Somali-born parents’ experiences of and needs for parenting support programmes. BMC international health and human rights, 16(1), 7.

Roy, R. N., Schumm, W. R., & Britt, S. L. (2014). Transition to parenthood. Springer New York.

Sevigny, P. R., Loutzenhiser, L., & McAuslan, P. (2016). Development and validation of the Fathering Self-Efficacy Scale. Psychology of Men & Masculinity, 17(1), 92.

Sevigny, P. R., Loutzenhiser, L., & McAuslan, P. (2016). Development and validation of the Fathering Self-Efficacy Scale. Psychology of Men & Masculinity, 17(1), 92.

Stillwell, D. (2016). Helping Couples Fulfill the “Highest of Life’s Goals”: Mate Selection, Marriage Counselling, and Genetic Counseling in United States. Journal of genetic counseling, 25(1), 157-165. 

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