Nursing Process Applied to a Family: Assessment, Planning, Implementing and Evaluating

This article discusses the nursing process applied to a family, including assessment, planning, implementing and evaluating. It covers challenges faced by the Wilson family, such as breastfeeding and transition to parenting, and suggests nursing care strategies to overcome them.

Running head: NURSING PROCESS APPLIED TO A FAMILY
Nursing Process Applied to a Family
Name of the student
Name of the university
Author note

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Part 1 - Nursing Care of the Family: Assessment
The chosen Family scenario is of the Wilson family.
Fig 1. Genogram of the Wilson family
The term family assessment describes the procedures that a nursing professional
undertakes to assist and help with taking care of the children whose parents are unable to
watch over them, due to their separation or prior work engagement, or even diseased
individuals requiring constant care (Avellar & Supplee, 2013). This assessment includes the
identification of any risk factors involved in the case. As the child and family health care
nurse, I have come across Wilson’s family at the home visit. I got to know that Sharon and
Hannah Wilson have been married for ten months since the successful Marriage Equality
plebiscite in 2017 and are living in Brisbane. They have three kids: Matilda, Gus and Harvey.

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Matilda is the daughter from Sharon’s first marriage. Gus and Harvey are the new-born twin
babies who were carried by Hannah Wilson through IVF proceedings. Matilda who is 3 years
old now, attends a local kindergarten. Hannah is a primary school teacher, who is currently
on maternal leave. Sharon owns an engineering company and is currently required to travel
back and forth to Mt Isa for 10days, for 2-3times each month. The mother of the newly born
twins, Hannah Wilson has had a vaginal delivery and to ease the process she had to go
through a small episiotomy. But her episiotomy has since been infected, which is causing her
serious discomfort. She is taking warm salt baths and is on a course of antibiotics. Since
Hannah just gave birth to the twins and is currently suffering from multiple issues including
infection from the episiotomy, difficulty in breastfeeding and emotional struggles, her partner
Sharon is highly concerned about leaving her with the children and going to Mt Isa. None of
their parents are available for help either. Sharon’s parents live in New Zealand and
occasionally come for a visit. But Hannah’s parents do not stay in touch with them since they
cannot accept Sharon and Hannah’s relationship. Hannah’s grandparents are completely
supportive of them, and they even visited Hannah in the hospital every day. But since they
are elderly, they cannot help Hannah with the kids when Sharon is away.
The strengths of the Wilson family one must come across are their supportive
behaviour and affection towards each other. Both Sharon and Hannah are extremely
supportive towards each other. When Hannah was having trouble to breastfeed the twins,
Sharon came to help her by feeding the babies expressed milk. Also during this whole time,
both of them have been taking care of Matilda, who in fact has been quite joyful about her
new brothers and been very excited and unusually active the whole day. Sharon’s concern
about leaving Hannah with the kids when she is suffering from health and emotional issues
depicts how much Sharon cares for her partner Hannah. Even for an outsider, it is quite

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evident to notice the way they always support and love each other and be there for each other
in every phase of life (Kemp et al, 2013).
Part 2 - Nursing Care of the Family: Planning, Implementing and
Evaluating
In the assessment of the Wilson family, two major challenges are identified, which are
breastfeeding and transition to parenting.
Challenge 1: Breastfeeding
Description:
Often it has found that new mothers are unable to breastfeed their babies. There are
many possible factors associated with this issue. Most common ones include breast
enlargement, milk duct blockage or even flat nipples. The mother of the new-born twins,
Hannah has also been experiencing nipple trauma. She was having difficulties with
breastfeeding in the first few days. But the twins did not seem to have any trouble being fed.
Both the babies breastfeed quite well and also take bottled breast milk easily. However, it has
been found that breastfeeding can be a lot of challenge initially for new mothers as well as
their babies. They both take some time to get adjusted to the whole process (Psaila et al,
2014). It is widely acknowledged that breast milk contains a lot of nutrient-rich properties
that enable the child to be stronger and healthier. The colostrum, present in the first secreted
breast milk after the delivery, provides immunity to the child which protects the baby from
several infections. So it is quite important for the mother to make sure that she gets the act
properly to ensure proper nutrition for the child. She must follow the doctor’s or the nurse’s
suggestions in this matter to develop a healthy and efficient breastfeeding cycle (Östlund &
Persson, 2014).

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Planning nursing care:
In order to care for patients, all the nurses are entitled to follow a certain procedure,
including proper planning, and by implementing the plans to achieve the greater goal, they
successfully provide better health for the patient. The primary nursing goal to tackle the
challenge of breastfeeding would be likely to be an improvement of coordinated care by
creating an overall positive environment, keeping the children and their families at the core of
all the decisions (Hooker et al, 2015). Breastfeeding can be challenging at the start, but with
professional help and partner’s support, the mother can be encouraged to express sufficiently.
Hannah Wilson has been facing some nipple trauma which has been very upsetting for her.
As the child and family health care nurse, one must try to find out ways that will eventually
improve her condition.
Implementation:
Nursing interventions suggest the practical implementation of the planned nursing
processes, including all the treatments and actions performed to achieve the set goals for the
patient. The optimal way to feed new-born babies is breastfeeding. Breast milk comprises of
all the nutritive factors an infant requires. Along with its infection-preventing quality, it also
improves cognition and other neurological developments in the babies. Breastfeeding gives
the mothers the added advantage of losing post-partum weight and reduced chances of
developing breast cancer or even osteoporosis (Wambach & Riordan, 2014). Therefore,
mothers who have not yet started to develop a fixed lactation routine must be supported to
express 6-8times a day. Hand expressing, rather than using breast pumps, is the best choice
for expressing breast milk. Although, the expressing room must be kept clean to avoid any
contamination and only sterilised pumps and bottles are to be used. Even if the babies are full
or are unable to be fed, the mother must be encouraged to express, according to the infant’s
usual time of daily feeding to ensure uninterrupted supply of breast milk. The expressed

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breast milk, thus bottled, should be kept at a specific temperature and used within 48 hours.
Even if the mother is suffering from low supply due to nipple trauma, she must be
encouraged to express as much as she can. The mother must be educated about the fact that
frequent feeding and expressing, will eventually increase the supply as well (Smith, Swallow
& Coyne, 2015). Since Hannah is on antibiotic medication, she should consult with a doctor
about her problems and if it has any negative side effects on her breast milk. Generally, the
medications are transferred into the breast milk in very negligible quantity, but it is better to
take all the preventive measures to ensure a healthy, nutritive environment for the infants and
their mothers (Fu et al, 2014). Breastfeeding makes mothers feel like they are contributing in
the unique way to the welfare of the infant.
Evaluation:
With the help of the suggestions and proper lactation counselling, Hannah will be able
to get rid of all the misconceptions and misinformation about breastfeeding. She would be
able to determine the frequency of feeding according to the twin’s needs. She would also
know the advantages of breast massage in improving the supply (Haroon et al, 2013).
Moreover, she would no longer feel disheartened due to this trauma which made Sharon
worry about her. Thereby, the nursing processes applied, would be quite helpful for Hannah
and Sharon, both.
Challenge 2: Transition to parenting
Description:
Once the baby comes, taking care of it becomes the new agenda for the parents. Both
mother and father take up their roles and decide how they will take care of the newborns
while managing their professions (Tallon, Kendall & Snider, 2015). In the Wilson family,
Hannah Wilson gave birth to twin boys, Gus and Harvey, with the help of a sperm donor, but

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her delivery was premature by 6weeks. Her partner Sharon still has three ten-day rotations of
work commitments in Mt Isa before she can take parental leave. This means that Hannah will
be alone with the twins and their daughter Matilda, for ten days at a time. Matilda is Sharon’s
daughter from her first marriage. She is now 3 years old and attends a local kindergarten. So
there is no other person in the family who can help Sharon and Hannah with the babies.
Sharon and Hannah are getting exhausted taking care of the twins, causing them to feel more
and more tired by each passing day. They are staying awake every night to feed the babies.
They need to look out for other options. This is having a serious impact on both of their
health. Therefore they must account for a primary care strategy, and several more intensive
levels of parenting intervention (Meleis, 2015). Sharon is also worried about her 10 day
rotational travelling shift due to the new contract of her company’s business. She knows there
is no other way that she can achieve her business requirements and her family responsibilities
together. She must go to Mt Isa, leaving Hannah behind with Matilda and the newborn babies
Gus and Harvey. This is extremely disturbing for her and makes her feel guilty. They must
therefore, come up with a solution that benefits them both.
Planning nursing care:
Caring for patients, entitles all the nurses to follow a definite procedure which
includes planning and implementing those plans to achieve a better patient outcome. The
nursing goal to overcome this challenge of parenting transition would be to actively engage
both the parents, help them become more active contributors in taking care of the children.
Both Sharon and Hannah are active participants when it comes to taking care of their
children, but dealing with new-born babies is something they need assistance getting a handle
of (Schmied et al, 2014).

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Implementation:
The first month of having a child, from the time of deciding to conceive, is termed as
the transition to parenthood. This time is considered as an array of disordered events in the
midst of satisfaction of motherhood and parenthood (Gilmer et al, 2016). The usual coping
mechanisms may seem ineffective. Both the partners Sharon and Hannah are extremely
supportive of each other, and help each other against all the odds. Although, dealing with the
twin infants all night long, makes them feel helpless and exhausted. Parenthood allows
people to acknowledge a caring and selfless part of their being, which is not often seen in any
other roles of life. This should be seen as an opportunity, not as an act of helplessness
(Sanders et al, 2014). The partners must engage to build a stronger relationship with the kids
as well as with themselves. They must try new coping strategies to master the art of balancing
work and taking care of the twins. Parents must be proficient in understanding the infant’s
needs, their little cues of hunger or sleep or any discomfort and respond appropriately. As
long as they are positively responding to all these basic needs, the infant will be consoled
easily. Nurses must always praise and encourage the parenting efforts, instead of criticising,
in order to help stimulate the parents’ confidence (Hopwood et al, 2013). The Wilson family
already has a child, Matilda, the daughter from Sharon’s first marriage. Till date, Matilda was
the only child, being adored by Sharon and Hannah. But the arrival of the twins, Gus and
Harvey, may challenge her position in the family making her feel less important. Therefore,
both Hannah and Sharon must look into this matter and make sure that Matilda does not feel
that way.
Evaluation:
The effective measures taken into consideration to improve the situation with the
Wilson family would therefore be quite helpful. As they will work through the troubles
together, they will realise their strengths and resourcefulness, and be more accustomed to

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finding out solutions themselves (Guest et al, 2013). Proper counselling, emotional support
and encouragement would ultimately benefit both the parents and their children.
References
Avellar, S. A., & Supplee, L. H. (2013). Effectiveness of home visiting in improving child
health and reducing child maltreatment. Pediatrics, 132(Supplement 2), S90-S99.
Fu, I. C. Y., Fong, D. Y. T., Heys, M., Lee, I. L. Y., Sham, A., & Tarrant, M. (2014).
Professional breastfeeding support for first‐time mothers: a multicentre cluster
randomised controlled trial. BJOG: An International Journal of Obstetrics &
Gynaecology, 121(13), 1673-1683.
Gilmer, C., Buchan, J. L., Letourneau, N., Bennett, C. T., Shanker, S. G., Fenwick, A., &
Smith-Chant, B. (2016). Parent education interventions designed to support the
transition to parenthood: A realist review. International journal of nursing studies, 59,
118-133.
Guest, E. M., Keatinge, D. R., Reed, J., Johnson, K. R., Higgins, H. M., & Greig, J. (2013).
Implementing and evaluating a professional practice framework in child and family
health nursing: A pilot project. Nurse education in practice, 13(5), 393-399.
Haroon, S., Das, J. K., Salam, R. A., Imdad, A., & Bhutta, Z. A. (2013). Breastfeeding
promotion interventions and breastfeeding practices: a systematic review. BMC public
health, 13(3), S20.
Hooker, L., Small, R., Humphreys, C., Hegarty, K., & Taft, A. (2015). Applying
normalization process theory to understand implementation of a family violence

9NURSING PROCESS APPLIED TO A FAMILY
screening and care model in maternal and child health nursing practice: a mixed
method process evaluation of a randomised controlled trial. Implementation
science, 10(1), 39.
Hopwood, N., Fowler, C., Lee, A., Rossiter, C., & Bigsby, M. (2013). Understanding
partnership practice in child and family nursing through the concept of practice
architectures. Nursing Inquiry, 20(3), 199-210.
Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., ... & Aslam, H.
(2013). Benefits of psychosocial intervention and continuity of care by child and
family health nurses in the pre‐and postnatal period: process evaluation. Journal of
advanced nursing, 69(8), 1850-1861.
Meleis, A. I. (2015). Transitions theory. Nursing theories and nursing practice, 361-380.
Östlund, U., & Persson, C. (2014). Examining family responses to family systems nursing
interventions: an integrative review. Journal of Family Nursing, 20(3), 259-286.
Psaila, K., Schmied, V., Fowler, C., & Kruske, S. (2014). Discontinuities between maternity
and child and family health services: health professional’s perceptions. BMC health
services research, 14(1), 4.
Sanders, M. R., Kirby, J. N., Tellegen, C. L., & Day, J. J. (2014). The Triple P-Positive
Parenting Program: A systematic review and meta-analysis of a multi-level system of
parenting support. Clinical psychology review, 34(4), 337-357.
Schmied, V., Fowler, C., Rossiter, C., Homer, C., & Kruske, S. (2014). Nature and frequency
of services provided by child and family health nurses in Australia: results of a
national survey. Australian Health Review, 38(2), 177-185.

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Smith, J., Swallow, V., & Coyne, I. (2015). Involving parents in managing their child's long-
term condition—A concept synthesis of family-centered care and partnership-in-
care. Journal of pediatric nursing, 30(1), 143-159.
Tallon, M. M., Kendall, G. E., & Snider, P. D. (2015). Rethinking family‐centred care for the
child and family in hospital. Journal of Clinical Nursing, 24(9-10), 1426-1435.
Wambach, K., & Riordan, J. (Eds.). (2014). Breastfeeding and human lactation. Jones &
Bartlett Learning.