The Role of the Nurse in Meeting their Clients Need in the Term of Family - Case Study Example

344168 - CHILD AND FAMILY NURSING Introduction: Nursing is a field that is known for the selflessness, with nobility in the cause of serving for the betterment of wellness of manhood. From time immemorial, nursing field has been known to care for families.. With the families becoming more nuclear, the care became more hospital oriented, with the family focus slowing losing its color. Now as a circle, with the return of community based home care, the term family nursing has again surfaced back. In this assignment, with the given case study, we would explore the role of nurse as a health provider in meeting their client’s need in the term of family.(International nursing day report,2002) Genogram: A genogram may describe as a tool, helpful in family counseling, a pictorial depiction of family relationship and medical history. It is very useful in identifying the repetitive pattern of behavior and understanding hereditary tendencies. Eunpu proposes the use of the genogram, a multigenerational family tree that plots biological relationships and graphically records information about social relationships and psychosocial issues in the family, to provide genetic counselors with a tool to help families adjust to a genetic diagnosis and enhance decision making. (Mary etal.,1999) Genogram of the family taken up in the case study: Family situations observed in the case study: The family given for case study, when observed, was found to be, a nuclear family with a new born, of James and Naomi Brown with two young children, Steven, 3 years old and Felicity, four weeks old. Felicity was born in hospital through normal delivery and the couples have moved to a new small mining town as James found a good paying job in the mine. They have left behind their friends and absolutely knew no one in the town Naomi, whose parents and sibling were living closely before the move was very close to them. But James, (whose mother passed away due to breast cancer), father, step mom with their two children stayed overseas. Since then the move, Steven who had stopped bedwetting six months ago has started bedwetting, and Felicity started more demanding. Naomi at this misses her family and thinks that her milk might not be adequate. She also feels that Steven might resent her relationship with newborn as breast feeding takes up lots of her time. Studying thoroughly, it could be seen that the main problems to be addressed are, Naomi, missing her family that was so close to her, their lack of friends in new town. James since had only a distant relationship with his parents seems to be unaffected by the change and insensitive to Naomi’s feeling. The bed wetting of Steven has to be sorted out and Naomi’s fear of inadequate milk for baby has also to be taken care of. Naomi’s fear of Steven’s resentment over her with the arrival of newborn has also to be sorted out. Assessment of the family using Calgary Family Assessment Model: Many approaches can be used to collect information on families for assessment Purposes and one such model that is widely adopted is the Calgary Family Assessment Model (CFAM). It is a comprehensive three-pronged structural, develop-mental and functional family assessment framework The CFAM blend nursing and family therapy concepts and are grounded in systems theory, cybernetics, communications theory, change theory and the biology of cognition. Assessment questions here are focused on collecting information on the family’s structural, developmental and functional status. An emphasis is placed on identifying strengths and resources of families.. The CFAM provides a means to decide on interventions consistent with the family assessment. Fundamental to this tool is the recognition that each family is unique and has specific strengths. Interventions are directed towards strengthening, promoting and/or sustaining effective family functioning in the cognitive, affective and behavioral domains. The goal is to assist family members to discover new solutions to help diminish and ease Emotional, physical and spiritual suffering The family when analyzed using the CFAM tools in structural, developmental and functional dimension, a clear picture of intervention was obtained. In the structural dimension, when the internal feature of the family is concerned, it could be seen as nuclear family, with two young children with a working male, with women taking care of the family. On discussing the external dimension it could be seen that Naomi has close relationship with her family, but James is distant and they don’t have any friends in the new place. With context parameter doesn’t apply here, the development dimension explains the stage of family cycle. The family in the case study belongs to stage 3 ,of CFAM , a family consisting of two young children. They typically go through the cycle of adjusting the marital space with children, joining in childrearing, financial and house hold task and realigning relationship with the family and extended family. The functional assessment involves emotional communication, verbal communication, non-verbal, circular, problem solving, roles, influence and power, believes and alliances and coalition. This family as per CFAM model has to be intervened using the functional aspect , on the basis of the genogram. .(Write and Leahley , 1994) Significant events to be taken care of in the family: Thus critically the challenge the family faces is to effectively adjust to the new environment and to the new addition in the family. With James engrossed in new work and who is not much attached to his parental relationship, is unable to understand the feeling of Naomi, who is used to very close family ties. With the burden of taking care of two young kids, she faces depression. To add to the point they don’t have any friends in the area, still adding to her emotional agony. The first kid Stevens has started bedwetting again can be taken as a case of sibling rivalry; feeling sidelined with the baby’s arrival, his emotional feeling has to be taken care of. Again Naomi feeling that milk might not be adequate for four weeks old is also again is mainly an emotional feeling that can be solved. The resentment of elder kid over his mother with the birth of new child, that again is emotional trauma. Nursing intervention: Once the comprehensive family assessment is over the stages set for the effective intervention by nurses is indicated interventions are targeted to promote, improve and sustain functioning in all the three domains of family functioning – in CFIM in three stages as cognitive, affective and behavioral. But it is true that profound and sustaining changes occurs within family belief (cognition), which mediates behavioral change. Therefore the intervention is aimed that eliminating physical/emotional symptoms and suffering. There are myriad of interventions that health professional can choose or it may be tailor made to suite individual families. The tool that we plan to use in our family is interventive questions that we plan to explain with the example of questions that might be asked by the nurse practitioners. In this family lets us use the tool of interventive questioning as a mode on nursing intervention followed by providing necessary information’s and suggestions paving way for better understanding in the family. Interventive questions One of the simplest and most powerful interventions for families experiencing health problems is use of interventive questions. It is found to effect change in all the three domains of the family. The health practioner should have a sound knowledge of when, where, how and with what purpose to post the question, that is the underline factor for the success. In practice there are 2 types of questions usually used. The linear and circular questioning .The effect of linear question is thus constraining where as circular question is generative. The linear questions in the end are intended to correct behavior where as circular questions facilitates behavior change. In general questionings tend to provide new information and answers for family. The circular question, which is widely used in the interview, is the concept of framing new questions and the basis of information provided by the family members and cycle continuous. (Friedman, 1998) Addressing the issues through nursing intervention: When it comes to displacement of location, nurses are the one among the front line health providers, who are in a better position to deal with the immediate and long term health needs of displaced family, which literally would mean both mental and physical wellness. In this case a NP could start with resolving the first issue of feeling lonely in a new place. First she has to undertake round of circular questioning with Naomi and James as what is her feeling, what does she feels that she misses, what does she expects from James, what change she expects. On other hand the same type of circular question can be asked to James, thus bringing out his feelings and emotion towards the issue. As the next step NP can arrange a joint session where feelings of Naomi and James can be made to known to each other. This would effectively resolve the severity of issue. As the next step NP can provide certain tips, information and suggestions. Here where the issue of reallocation is concern, she could ask them to arrange for an introduction party with neighbors, could suggest that for initial stage any of Naomi’s relatives to come and stay with her which would be an enormous confident booster for her. On the other hand James might be encouraged to share house chores and in child rearing. This would help the depression of Naomi to be brought down and the tension of James to be reduced. This is the base, working on which other issues could be resolved.(Hertz etal,2005) Thus here the role of family is very important and significant .Based on family life theory (Cowan, 1991), if a couple does not successfully adapt to each stage of conjugal life, unresolved emotional issues will be brought into the next stage of conjugal life, potentially increasing the already existing strain often associated with each stage of parenthood. The accumulation of conjugal strain could eventually result in emotional withdrawal and set into motion an irreversible process leading to dissatisfaction and unhappiness with the relationship When addressing the issue of bedwetting of Stevens, again is an emotional issue where, attention has to be given to Stevens and Naomi and the feelings between them. Here more than NP doing the questioning she can encourage Naomi to talk with Stevens regarding his emotional traumas and doubts. But the major intervention here would be providing the basic information regarding bedwetting to Naomi. As she is new to the place the NP can neither provide information nor arrange for her to meet a peadeatrist or a psychiatric counselor. The information provided by NP should explain the cause for resumed bedwetting. With all the changes that a new baby brings in the house it is very common to expect a 3 years old kid-undergoing trauma and struggles adjust to the changes. At instance few kids who are very eager for brothers and sisters also at time starts kicking and screaming literally. New additions of siblings are expressed by the kids in many way in their distressed and confusion, as they feel that they are not the center of attention. There are many reports where three year old well potty trained kids starts wetting pants months after, a 2 year old suddenly wants to drink from bottle, forgetting how to talk, begging mummy to take back baby to hospital these are all science that a child needs more one on one time with his mother. If the child feels jealous and resentful, he might express it either by throwing tantrums or by betting bed waking up and crying in consolably, etc. They need little extra patient and love. The presence of sibling rivalry has been emphasize as a love of children for their parents and their filling of not to share that. But slowly as the baby understands sibling’s love is invariably found to cover the unconscious, envy jealousy, malice delight and frustrated love. The resuming of bedwetting is one such expression of the kid’s emotional status. (Cecily etal, 1995) The mother might be asked to talk about any angry or resentful feelings that the child may feel with the baby. She can try to spend more quality of time with elder kid and has to reemphasize that the new born will at any cost affect the love and affection she has for the elder kid. Also the kid can be involved in helping mother in dealing with the kid which would as fetching diapers, staying close with the siblings, etc that would make the kid feel very much in the family. Other family members here especially husband has to help the mother to take breaks when necessary. It is important that every child is unique and the determining the child’s age, temperament and other developmental factors when determining the best approach. The parents have to use such situation where they can teach each other to live with others in the family. Apart from new arrival the change of place might also give an insecure feeling which would dissipate over time.(Schimidt,1999) (Kernberg &Richard ,1988) On extreme conditions, behavioral techniques, cognitive therapy and pharmacotherapy can be suggested, where she may ask to meet paediatrist. The same approach when put into effect would help to reduce the resentment of the kid towards his mother. If the child is cooperative NP can also pay the role of mediator. When addressing the feeling of mother that milk might not be adequate for the kid, more than questioning, again here providing the information and clearing the doubts would be more effective approach. After interviewing the mother of her routine, how she feeds, her health status, checking her diets and understanding her emotional feelings, again here the NP can provide the information or can arrange a meeting of mother with a doctor. The American academy of peadiatrists and other professional groups, advocates breast feeding is best for baby for 6 moths. In the beginning it has to be understood that for first 2 to 3 weeks the baby has to be fed every 2 to 3 hrs and the mother also would feel full accordingly. But after 3 weeks the processes more of supply on demand, where the milk supply would be seen only when the baby is hungry, as they grow old the frequency of nursing reduces. This might be the stage the mother might experience. The science that baby is having adequate milk would be, it eats at least once in 3 hrs , it gains weight an a ounce a day by 1 week to the age of 3 months, wets 8 to 7 diapers can hear the baby swallowing, breast is soft after nursing and can see milk in the baby’s mouth. Other science if the baby is not satisfied with the milk would be, moving the heads from side to side opening their mouths sticking out their tongues placing hands and fist in mouth, nuzzling against mother’s milk breast, and reduction in weight and constant crying and fussing. Nursing is more an emotional feelings and her mothers are peaceful and have nutritious food they can feed their baby better, which again demands the cooperation of the family. Again if the condition persists, meeting with a doctor can be arranged. ( Cameron& Hofvander, 1976) (Helsing & King,1986) Conclusion: Thus for the nurses who care for families, it becomes essential for them to understand the importance of family relationship in ill and wellness, and are expected to use certain basic principles that would guide their intervention. Thus the family care nursing portrays big picture, where the nurse’s plays role as health educator, family advocate, etc. this case study explains the role that a nurse practitioner could play in effectively resolving the issues. Reference list: 1. INTERNATIONAL NURSES DAY 2002, NURSES ALWAYS THERE FOR YOU: CARING FOR FAMILIES, Information and Action Tool Kit Copyright © 2002 by ICN - International Council of Nurses,3, place Jean-Marteau, CH-1201 Geneva (Switzerland). 2. Mary Daly, Jennifer Farmer, Christine Harrop-Stein, Susan Montgomery, Mark Itzen, Josephine Wagner Costalas, Andre Rogatko, Suzanne Miller, Andrew Balshem and Doris Gillespie, Exploring Family Relationships in Cancer Risk Counseling Using the Genogram1. Cancer Epidemiology Biomarkers & Prevention Vol. 8, 393-398, April 1999 © 1999 American Association for Cancer Research . 3. Wright LM and Leahey, M (1994),Nurses and Families: A Guide to Family Assessmentand Intervention. F.A. Davis: Philadelphia. 4. Friedman, M.M. (1998). Family nursing.(4th Ed.). Stamford, Connecticut: Appleton & Lange 5. Hertz JE, Rossetti J, Koren ME, Robertson JF. Management of relocation in cognitively intact older adults. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2005 May. 63 p 6. Cowan, C.;Cowan, P.;Heming, G.; Miller, N1991, Becoming a family: Marriage, parenting, and child development. 1991. In P. A. Cowan and M. Hetherington (Eds.), Family transitions (pp. 79–109). Hillsdale, NJ: Lawrence Erlbaum. 7. Cecily Legg, Ivan Sherick and William Wadland,1995, managing sibiling rivalary, Houston Family Magazine http://www.houstonfamilymagazine.com/parents-ask.html 8. Schmitt, BD. Bed-Wetting (Enuresis). In: Instructions for Pediatric Patients. Saunders, Philadelphia 1999. p.209. 9. Kernberg, P.F., Richards, A.K. (1988). Siblings of Preadolescents: Their Role in Development. Psychoanal. Inq., 8:51-65. 10. Cameron, M., and Y. Hofvander, Manual on Feeding Infants and Young Children (PAG, UN 2nd ed., New York, 1976). 11. Helsing, E., and F. King, Lactation in Practice- How to Help Mothers to Breast-Feed. Manual for health workers (to be published 1981, Oxford University Press, London). Read More