Understanding The William Family According To The Genogram Provided

Family Structure according to the provided Genogram

Question:

Discuss About The William Family According Genogram Provided?

The structure of the William family according to the genogram provided above is explained here. Hannah Williams and Steven Williams are married to each other for 3 years since 2014. Before Steven, Hannah was married to Barry but their relationship ended followed by divorce. Billy 5 years old is the only son of Hannah and Barry and shares their joint custody. Recently, Hannah gave birth to a premature girl child conceived with Steven. Barry is in relationship with Jane and lives with Emily and Ronan, children of Jane from her previous relationship. Hannah’s mother Marion lives with her and Hannah’s father Sam lives with his new wife Ariel in Philippines. Steven’s father, Henry died on last year, 2016. Henry was married to Mavis on 1978.

According to The Australian Family Strengths Nursing Assessment Guide (AFSNAG), the two strengths that were found in the William family were sharing activities in order to support each other and acceptance of the situation (Gbur, 2013). These guides help the families to identify and develop their subsequent strengths to bring out positive changes in family functioning. These strengths were observed by the nurses by watching their behaviour or by asking questions to them. One of the strength in the William family was sharing the activities. This strength was evident from the behaviour of Steven as Hannah recently gave birth to a premature baby and she required some time to recover from the caesarean delivery. Therefore in order to provide a healthy orientation he planned to take his family to the local golf club for lunch because that would help them to meet new people as due to commitments in work place and moving to a new place they hardly met new friends. But he was bit concerned about the financial management in the coming six months as due to Hannah’s pregnancy they hired a paid manager to look after her boutique business and thus he wanted Hannah to get back to her work as soon as possible. When Steven was asked about handling the crying baby in the morning, he replied that he got golf rounds in the morning and Hannah was accustomed to sort this problem as she experienced it earlier when her son Billy was a baby. Although he planned to help her in cooking after getting back home. The second strength was the acceptance of not resuming back into their sexual relationship. He anticipated the decision of not involving into any sexual relationship at that very moment as Hannah underwent a caesarean delivery recently. He believed that they will resume back to their sexual relationship within two week and things will be normalised. He even added up to the fact that as her wife was on leave from work, she would be able to take proper rest and relaxed. This would help them to get back to their normal sexual relationship.

Family Strengths according to AFSNAG

The two challenges or issues faced by the William family were breastfeeding and transition to parenthood. The first issue is breastfeeding faced by both the baby and the mother. Several challenges are faced by the mother while breastfeeding (Rollins et al., 2016). The most common is latching the baby properly and improper latching leads to sore nipples in mother and insufficient milk to the baby (Holmes, 2013). Pinching pain in the nipple area if persists after four days implies improper latching of the baby. Another issue is the formation of tender lump in the breast area which suggests that the duct that connects the glands producing milk to the nipple is clogged. The concerned issue in case of Hannah in this study was taking extra help to breastfeed her baby as she underwent a caesarean delivery and needed time to recover her heal. It takes longer time for the milk to secrete in caesarean cases with problem in latching due to improper position of the other (Dahl, 2015). Postoperative pain is common in this cases which challenges the mothers from enjoying the first few days of motherhood.

One of the issues faced in breastfeeding is the improper latching of the baby that can lead to soreness of the nipple and insufficient intake of the milk by the baby (Kent et al., 2015). Providing proper nursing management can solve the problem. The nurse in charge should recommend the mother to position her body properly in a relaxed state as this helps better flow of milk. A proper nursing station should be provided with a comforting chair having sufficient pillows to support and a peaceful environment. Secondly, the position of the baby should be maintained by holding the baby under the arm and closer to breast by supporting the baby’s neck with hand. In case of mother lying sideways, the baby should face towards the breast keeping the mouth at the nipple level. Then cupping the breast with fingers along with palm below and on top with thumb should be done. It should be ascertained that the baby sucks the milk from the areola inspite of the nipple. In order to avoid painful feeding from the breast, baby’s gum should grab a radius of one inch surrounding the nipple at the time of latching. Compressing the areola region of the breast successfully provides sufficient milk to the baby as the sinuses for milk are situated below the areola of the breasts (Simpson, 2017).

Challenges of Breastfeeding

One of the interventions related to successful breastfeeding in nursing health care is by supporting the mothers to breastfeed their babies (Renfrew et al., 2012). The initiation of the breastfeeding starts with proper skin contact between the mother and the baby. The encouragement of having unhurried contact of the mothers’ skin to their babies immediately after birth is one of the possible strategies. During this procedure, the physiological along with the emotional benefits about the skin contact should be made aware to the mothers. Making direct contact ok skin makes both the mother and the newborn baby calm by keeping the baby warm. The breathing rate and the heart rate are stabilised with facilitating increased hormonal release that initiates a new bond in the mother with the baby. The first breastfeeding starts immediately after the baby is born by initiating skin contact (Moore et al., 2012). With this procedure, both the mother and the newborn baby get alert towards each other. In some cases the baby develops an attachment with the breast with any assistance. During the first breastfeeding time, the care giver supports the mother in proper positioning of the body and helping in proper attachment. Successful breastfeeding can be obtained in three steps. With proper assistance and support breastfeeding occurs naturally and works fine with 99% mothers with their babies (Guyer, J Millward & Berger, 2012). However, when the mother grows surrounding the bottle feeding, certain things about the breastfeeding should be known.  Breastfeeding should be started early to starts early milk production so that if the baby is born immature, the mother will have to express breast milk (Meier et al., 2013). Secondly, the mothers should know that breastfeeding should not cause pinching sensation in their nipple or cause pain producing sore nipple. Lastly breastfeeding should be done whenever required in order to comfort the baby and assuring sufficient supply of milk (Bealafeld, 2015). Breastfeeding is always surrounded with strong emotions both in the mother and the baby. Thus it is essential to encourage the mothers and the caregivers to understand how the baby can feel while breastfeeding. Both breast feeding and bottle feeding are accomplished by eye contact thereby increasing the emotional bond and intimate sensation between the mother and the infant (Brookes, Harvey & Mullany, 2016).

Another major challenge in family planning is the transition to parenthood. Mental satisfaction sometimes declines following the birth of a chid due to stresses in looking after the infant (Lutz et al., 2012). Apart from enjoying the parenthood, certain challenges impact the development of the child. Births occurring immediately after marriage play negative impact on the couple relationship leading to separation followed by divorce (Gottman, 2014).  According to some research studies it has been found that women become more unsatisfied during the transition of motherhood in comparison to men (Mortensen et al., 2012). Women are found to be more vulnerable towards the challenges of parenthood as the workload increases with giving primary care to the baby along with other household works. Socioeconomic status also affects the women who left their jobs to experience motherhood struggle more in the transition period (Goldenberg & Goldenberg, 2012).  A little is known about the impact on parenting due to disturbed sleep. The factor challenge that the couples face is the marital satisfaction such as thoughts about how their partner feels, affection, conflict in prenatal stage and withdrawal. Factors related to child such as child with temperament and always crying challenges the wellbeing in parenthood transition especially in fathers.

Interventions related to successful breastfeeding

One of the nursing goal to prevent the challenges in transition to parenthood is the supporting the parents for forming a parental bond with the new born (Cockcroft, 2012). The process through which the parents develop love and acceptance towards the child is called attachment. The bonding should be accomplished immediately by forming close contact with the baby in the few first hours of the birth both from mothers and fathers side (Dermott, 2014).  Attachment is established by maintain a close proximity with the infant by whom the parents become acquainted with the baby and starts accepting the baby as the new member of the family. This process develops through positive feedbacks such as through socially, verbally with non verbal responses (Schaffer, 2013). The attachment is perceived by mutuality through the behaviour of the infant eliciting the behaviours of the parents. When the infant expresses signals such as through crying, cooing and sometimes smiling, these initiates the parents close to them. Following this behavioural signals other signals such as grasping with postural adjustments also maintains the attachment. Care givers are more attracted towards the infants who are alert and responsive but if the infant becomes irritable, the care givers repel themselves from the attachment process.

Among many interventions in transition to parenthood, implementing the role of the parents after the birth of the newborn is one of them. The transition to parenthood is considered as a period of disequilibrium and sometimes a period of satisfaction in the mothers and their partners (Wolkoff, 2014). Some parents, specially the men think their spouse to be their only support and this transition brings a feeling of deprivation when their spouses are unable to provide that support. Emotions like feeling helpless, inadequate and anger when dealing with a crying infant makes many parents not ready to accept the transition. Fathers can undergo interventions in order to improve their relationship with their infants (Alio et al., 2013). Nurses can make arrangements to teach them about the infant care and provide necessary guidance regarding the acceptance of the transition to parenthood. Separate sessions of prenatal along with parenting classes and the groups that provide parenting support for the fathers can give them a chance to discuss about their concerns by meeting some of their demands. Making home visits by the nursing staffs includes assessment time to help adjust the need of the fathers. This intervention can successfully fulfil the gap between the fathers and the infant as they gets less time to spend with their new born baby to meet other demands. The effectiveness of this intervention is to build up a strong communication between the two and thereby granting delights by the response of the infants. It builds a sense of feeling proud and matured with increased self esteem (Liang, 2017). From the following study, it can be said that implementing this strategy towards Steven who recently became father can bring a positive inclination in his parenthood. When the nurse asked him how he would manage if woken up in the morning by the baby, he replied that as he got his golf session his wife would better handle the situation as she had experienced early parenthood. He even confirmed to spend with his family in the weekends if the baby does not cry. Interventions with thorough knowledge about parenthood would effectively build a positive response in Steven towards his infant.

Transition to parenthood

References:

Alio, A. P., Lewis, C. A., Scarborough, K., Harris, K., & Fiscella, K. (2013). A community perspective on the role of fathers during pregnancy: a qualitative study. BMC pregnancy and childbirth, 13(1), 60.

Bealafeld, L. (2015). Initiating skin-to-skin in the operating room: program planning, implementation, and evaluation (Doctoral dissertation, University of Pittsburgh).

Brookes, G., Harvey, K., & Mullany, L. (2016). 'Off to the best start'? A multimodal critique of breast and formula feeding health promotional discourse. Gender & Language, 10(3).

Cockcroft, S. (2012). How can family centred care be improved to meet the needs of parents with a premature baby in neonatal intensive care?. Journal of Neonatal Nursing, 18(3), 105-110.

Dahl, L. (2015). Clinician’s Guide to Breastfeeding.

Dermott, E. (2014). Intimate fatherhood: A sociological analysis. Routledge.

Gbur, M. (2013). Effects of Blackboard on the work-life balance of students and lecturers (Bachelor's thesis, University of Twente).

Goldenberg, H., & Goldenberg, I. (2012). Family therapy: An overview. Cengage Learning.

Gottman, J. M. (2014). What predicts divorce?: The relationship between marital processes and marital outcomes. Psychology Press.

Guyer, J., J Millward, L., & Berger, I. (2012). Mothers' breastfeeding experiences and implications for professionals. British journal of midwifery, 20(10).

Holmes, A. V. (2013). Establishing successful breastfeeding in the newborn period. Pediatric Clinics, 60(1), 147-168.

Kent, J. C., Ashton, E., Hardwick, C. M., Rowan, M. K., Chia, E. S., Fairclough, K. A., ... & Geddes, D. T. (2015). Nipple pain in breastfeeding mothers: incidence, causes and treatments. International journal of environmental research and public health, 12(10), 12247-12263.

Liang, H. (2017). Inside Out Parenting: How to Build Strong Children from a Core of Self-Esteem. Pan Macmillan.

Lutz, K. F., Burnson, C., Hane, A., Samuelson, A., Maleck, S., & Poehlmann, J. (2012). Parenting Stress, Social Support, and Mother?Child Interactions in Families of Multiple and Singleton Preterm Toddlers. Family relations, 61(4), 642-656.

Meier, P. P., Patel, A. L., Bigger, H. R., Rossman, B., & Engstrom, J. L. (2013). Supporting breastfeeding in the neonatal intensive care unit. Pediatric Clinics, 60(1), 209-226.

Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 5(5).

Mortensen, Ø., Torsheim, T., Melkevik, O., & Thuen, F. (2012). Adding a baby to the equation. Married and cohabiting women's relationship satisfaction in the transition to parenthood. Family process, 51(1), 122-139.

Renfrew, M. J., McCormick, F. M., Wade, A., Quinn, B., & Dowswell, T. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev, 5(5).

Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., ... & Group, T. L. B. S. (2016). Why invest, and what it will take to improve breastfeeding practices?. The Lancet, 387(10017), 491-504.

Schaffer, R. (2013). Early social development. Becoming a Person, 1(5).

Simpson, A. C. (2017). Boost Your Breast Milk: An All-in-one Guide for Nursing Mothers to Build a Healthy Milk Supply. Workman Publishing.

Wolkoff, S. R. (2014). Paternal Empathy: A Moderating Effect on Maternal Mood and Marital Satisfaction in the Transition to New Parenthood. Adelphi University, School of Social Work.