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Family scenario 1- The Williams family

Create a Genogram to visually depict the Family’s Structure.

Assessment

Figure: Genogram of the Williams Family

The present genogram focuses on the Williams family, namey Hannah and Steven Williams. The two have been married for three years, after Hannah go divorced from her former husband, Barry. The two have a child named Billy. Barry at present is in a relationship with Jane, who has two children, the elder one Ronan and the younger one Emily, from the previous relationship whose name has not been mentioned. Steven’s father Henry passed away a year ago while his mother Mavis is alive. Hannah’s father Sam is presently married to his second wife Ariel, while his first mother Marion, Hannah’s mother is alive.

The first strength that the Williams family is having is support. Hannah has been receiving the required physical support from her mother at frequent intervals. Her mother has come forward to share the load. She has relocated to the area the Williams have been living recently and has expressed a desire to help Hannah with taking care of the new born. According to Hockenberry and Wilson (2014), support from an elderly family member is crucial for a family that is struggling to cope up with the pressures of parenthood. If there is a pillar of support, parents are better to fulfil the responsibilities assigned to them. Positive family support enhances the ability of a new parent to make healthier life choices. Support from the mother would probably be thee best form of support one can receive. The support at the times of crisis has been indicated to have a good impact on the individual.

The second strength that the Williams family is having is instances of shared activities. Steven expresses his wish to help her wife with cooking in the evening when is at home. This is the time frame when the couple gets to spend some time together while completing the household chores. As pointed out by Lowdermilk et al., (2014) sharing tasks with the spouse is a positive approach. While the couple shares a certain family responsibility and engages in an activity, the communication and bond between the two individuals are enhanced. There is an increased opportunity to understand the opposite person’s feelings and perceptions. Shared activities lead to harmony and peace in the family.

Issue 1- Social isolation

Description of the issue- The prime challenge that the Williams family is facing is social isolation. From the case study, it is found that Hannah and Steven have relocated to their present location recently and have not been successful in establishing social contacts with the community. Due to commitments of their professional life and relocation, they have not met new people, except for a group of mothers through Billy's school. Steven has recently joined the local golf club and wishes to take his family to the club so that they can meet new people. The only source of support for Hannah is her mother Marion as Steven’s mother stays away and does not visit them often. It is therefore evident that the family, and more precisely Hannah is suffering from social isolation. According to Kaakinen et al., (2014) social isolation is the state of lack of contact between a person and the society. Social isolation can have a deep impact on almost all aspects of the existence of the person, including parenting. It is feared that a new parent might develop feelings of loneliness due to social isolation, resulting in depression. This would ultimately have a negative impact on her parenting style. Once loneliness engulfs a new mother, as a result of becoming disconnected from the outer world, negative responses are expected to come in. Since there are no peer groups with whom the new mother can share her ideas and thoughts, the person is likely to suffer from low self-esteem and loss of energy. It is imperative that a new mother has enhanced self-confidence and esteem, and adequate energy to establish a stable relationship with the family members.

Family strengths


Nursing care plan- The nursing goal for Hannah, in relation to social isolation would be aligned with the present situation she is facing. The goal would be to use recognisable and repetitive strategies that are valid for increasing the morale of the individual and provide her with emotional support. The rationale for this nursing goal is that emotional support and guidance would provide Hannah with the human companionship she seeks. The establishment of a new relationship based on trust and exchange of feelings would cover up for the solitary existence she is living in. Engaging in regular conversations with an individual outside the family would increase possibilities of social engagement and maintain the uniqueness of relationships within the family (Denham et al., 2015).

Implementation of care plan- The nurse would play the role of a counsellor and supporting the individual to assist Hannah to cope up with her feelings os isolation. It is advised that the nurse visits her on a regular basis and spends a considerable amount of time with her at her home. Such regular periods of interaction would help in enhancing her self-esteem as the nurse would suggest ways to cope up with the pressures of parenting a new born. The client is to be assisted in expressing their concerns and the challenges they face on a daily basis. Discussing barriers to social interactions would be a beneficial approach. In addition, motivational devices can be used by the nurse to develop the discussion between the nurse and the client.  These can be in the form of videos, pictures or audio recordings. The nurse must engage in an effective commucniation with the client that is based on trust and mutual respect. The communication must be transparent and culturally sensitive (Ammerman et al., 2013).

The very important step of helping the client rebuild the family network would also prove to be beneficial in this respect. Since rebuilding and keeping family networks has a lot to offer, the nurse must help Hannah build up a strong relationship with her family members (Widarsson et al., 2014). The user can consider making contact with her husband for discussing strategies by which he can help in reducing the issues pertaining to social isolation. It is crucial that Steven supports Hannah for combating social isolation. He, therefore, needs to be motivated and encouraged by the nurse for the same.

Evaluation of care plan- Ideally, the preferred outcomes of the provided intervention would be to reduce social isolation and increase the integrity of the client. The outcomes of the intervention could be evaluated through two distinct processes; observations taken for the client and using a tool for the same. The nurse must consider taking regular observations regarding client’s change in behaviour and expressions of self-esteem. Whether the client exhibits increased energy and enthusiasm and points out an improved relationship with her husband, are the other aspects to be evaluated. A measurement instrument could be used for the same purpose if required. One such example of a tool is the Lubben Social Network Scale. This scale applies 10 items, placing individuals into four different quartiles each with a cut-off score for indication of social isolation (Denham et al., 2015).

Planning, Implementation and Evaluation

Issue 2- Transition to parenthood

Description of the issue- The second issue that coms up in light of the presented case study are difficulties in transition to parenthood as experienced by Steven. Steven is found to be concerned about the financial condition of the family. Moreover, he is unable to cope with the needs of parenthood and is not emotionally prepared to embrace fatherhood. This is evident from the fact that he wants his wife to manage and take care of the baby early in the mornings while he is away for his golf sessions. To add to the issue, he is only looking to family time if the baby does not cry too much. As highlighted by Bennett et al., (2017) transition to parenthood is considered as a vital adjustment period for the family members, especially the father. With the addition of a baby to the family, a drastic change in lifestyle is to be expected. This developmental period has serious implications for fathers. Research has been continually indicating that it is stressful for an individual to embrace fatherhood and cope up with the profound sudden changes. Since these changes are often problematic, chances are high that the father is not able to establish a strong relationship with the baby or the mother.

Nursing care plan- The nursing goal in relation to the issue above would be to promote better engagement of Steven in the care process of the newborn. He would be demonstrating increased intentions to help out Hannah with the care taking of the baby and handle tactfully instances of the baby crying or similar concerns. The rationale for this goal is that fathers play a crucial role in the upbringing of the child and his involvement is as necessary as that of the mother (Roy et al., 2014). Steven is in need of promoting his parental competencies and provide support to his wife in times of need. The necessity of the father figure is required in the first few months after child birth as the mother alone is not able to handle the challenges of parenting alone.

Implementation of care plan-  Parenthood is a relevant ensuring topic in the contemporary society and probably the most vital developmental transition in nursing. Promotion, facilitation and empowerment of the father are the key aim of nurses in this regard (Gross & Marcussen, 2017). According to Ateah (2013), the best proven strategy for enhancing the experiences of fathers and motivating them to take part in the child caring process is to conduct educational sessions. Such sessions are known to help new fathers cope up with the burdens faced while undergoing the transition. Educational sessions have the key focus on imparting information to the parents on different effective strategies using which the individual can better handle the challenges coming up. The authors emphasises that the education session content must have the focus on case study examples where parents combat challenges similar to the faced by the client. Steven can relate the information provided to him with his real life experiences to come up with logical solutions to problems.


Through the different adaptation strategies, Steven would be helped to make a healthy transition to the reality of becoming a father. The participation of the parent needs to be upheld throughout the entire education session. By doing so, there would be a reduction of the rejection that Steven might feel while taking care of the baby. Since Steven is a working father and has rotational job schedule, it would be advisable to conduct the sessions just after he gets back home on leave. However, the time and duration of the sessions are to be decided as per the convenience of Steven (Sethna et al., 2017).

Evaluation of care plan- The best possible method of evaluating the improvements shown by Steven is to receive feedback from Hannah. Hannah would be the person who would provide information on whether Steven shows changes in his behaviours in relation to parenting. For achieving this, Hannah needs to be educated with strategies to observe behaviours and note them over a considerable period of time. Since Stevens is known to remain at on-job sites for certain time frames, the same can be challenging. Hannah needs to be motivated to remain patient and enduring while engaging in any conversation with steven regarding his change of behaviour. Feedback needs to be taken on a regular basis whenever there is a chance of getting so. It is vital that the nurse answers any doubts or questions that Hannah has in relation to what to expect from Steven. Reinforcing the skills of  Steven to the advancement of his parental role would be a justified approach (Denham et al., 2015).

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. https://www.sciencedirect.com/science/article/pii/S0145213413000756

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. https://www.sciencedirect.com/science/article/pii/S0891524511002252

Bennett, C. T., Buchan, J. L., Letourneau, N., Shanker, S. G., Fenwick, A., Smith-Chant, B., & Gilmer, C. (2017). A realist synthesis of social connectivity interventions during transition to parenthood: The value of relationships. Applied Nursing Research, 34, 12-23. https://www.sciencedirect.com/science/article/pii/S0897189716303032

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

Gross, C. L., & Marcussen, K. (2017). Postpartum depression in mothers and fathers: The role of parenting efficacy expectations during the transition to parenthood. Sex Roles, 76(5-6), 290-305. https://link.springer.com/article/10.1007/s11199-016-0629-7

Hockenberry, M. J., & Wilson, D. (2014). Wong's Nursing Care of Infants and Children-E-Book. Elsevier Health Sciences.

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.

Lowdermilk, D. L., Perry, S. E., & Cashion, M. C. (2014). Maternity Nursing-Revised Reprint-E-Book. Elsevier Health Sciences.

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

Sethna, V. F., Perry, E., Domoney, J., Iles, J., Psychogiou, L., Rowbotham, N. E., ... & Ramchandani, P. G. (2017). Father-child interactions at 3-months and 2 years: contributions to children’s cognitive development at 2 years. Infant Mental Health Journal, 38(3), 378-390. https://centaur.reading.ac.uk/67959/

Widarsson, M., Engström, G., Berglund, A., Tydén, T., & Lundberg, P. (2014). Parental stress and dyadic consensus in early parenthood among mothers and fathers in Sweden. Scandinavian journal of caring sciences, 28(4), 689-699. https://onlinelibrary.wiley.com/doi/10.1111/scs.12096/full

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