Child and Family Nursing Practice: Case Study of the Zhang Family

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Case Study
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This document presents a comprehensive nursing care plan for the Zhang family, addressing various challenges they face, including Lucy's aggressive behavior, the emotional burden on Ling, and financial constraints. The care plan is developed according to a social model of health, considering social, political, and cultural factors. It includes interventions such as in-home nursing care, referrals to IHC services, palliative care for Wei, and family therapy. The evaluation section emphasizes frequent assessments and follow-ups to monitor the plan's effectiveness. Furthermore, the assignment explores the social needs of the family and relevant health policies, such as financial hardship assistance and Medicare coverage, and provides recommendations for policy advocacy. The document also includes references to support the nursing care plan.
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Running head: CHILD AND FAMILY NURSING PRACTICE
CHILD AND FAMILY NURSING PRACTICE
Name of the Student:
Name of the University:
Author note:
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1CHILD AND FAMILY NURSING PRACTICE
Part 1: Nursing Care Plan
Challenges
One of the major challenges is the aggressive behavior demonstrated by Lucy. It has been
evidenced by Logan-Greene and Jones (2015), that aggressive behavior across children in the
family results in adverse physiological as well as psychological consequences upon every family
member. Lucy’s recent aggressive behaviors and tantrums have not only become an issue of
annoyance for Jin, but has also affected Lucy’s lifestyle, both during the day as well as at night.
According to Tucker, Rodriguez and Baker (2017), neglectful behavior by parents is a
strong determinant of aggression in children. Both Daiyu and Jin now have little time to care for
Lucy which has in turn, led to the present challenge. Emotional stress and trauma in children, as
researched by Camilo, Garrido and Calheiros (2016), are also associated with aggressive
behavior across children. The Zhang household is currently preoccupied with a stressful situation
of bowel cancer in Wei, for which, Lucy’s parents have diverted their attention from their
children.
Individual family members are also found to encounter a number of challenges: Ling
feeling burdened due to her responsibilities of being the sole caregiver for Wei, the financial
burden encountered by Jin due to lack of Medicaid and Daiyu feeling upset as a result of familial
expectations and being away from her parents.
Plan
As postulated by the Australian Primary Health Care Nurses Association (APNA, 2019),
one of the major responsibilities of community nurses include a comprehensive identification of
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the multifaceted hurdles encountered by families which hinder their health and wellbeing. Thus,
the community nurse must develop a nursing care plan in accordance to a social model of health.
As per the social model of health, an individual’s current state of health and disease are a result
of multiple factors across social, political, cultural and environmental levels (Sallis, Owen &
Fisher, 2015).
As researched by Ban and Oh (2016), a lack of adequate parental care or neglect from
parents are the key contributors to aggressive behavior in children. Thus, a key community
nursing goal must include the management of aggression in Lucy by taking responsibilities of
her care needs. The next factor which must be targeted by the community nurse \ are social and
cultural issues within the Zhang family, primarily the burden of conception faced by Daiyu by
her parents and the burden encountered by Ling as the sole caregiver of Wei. Lastly, the
community nursing care plan must also address the political factor of lack of Medicare and
financial burdens encountered by Daiyu and Jin. Indeed, it has been evidenced that an
individual’s health and wellbeing, in addition to disease, are affected by the prevalence or lack of
familial support and availability of adequate healthcare services (Adler, Glymour & Fielding,
2016). Hence, it is for this reason that the community nurse must adhere to a social model of
health and according formulate a holistic care plan addressing the social, political and cultural
challenges troubling the Zhang family (Garg, Toy, Tripodis, Silverstein & Freeman, 2015).
Implement
Children during the first few years of their life, have an intrinsic need to share an
affectionate bond with their parents, especially their mother, and are dependent on them to
support their emotional as well as physiological development. A lack of fulfillment of
attachments induce aggressive behaviors in children as well as delay their achievement of
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3CHILD AND FAMILY NURSING PRACTICE
developmental milestones (Meins, Bureau & Fernyhough, 2018). This is extensively observed in
Lucy’s regression to an inability to fulfill her toilet training needs without assistance. Further,
children like Lucy, lack the vocabulary to communicate their concerns and hence, revert to
aggressive behaviors as an attempt to express their need to be attended to and feel loved by their
parents (McElwain, Holland, Engle, Wong & Emery, 2015). As directed by the Department of
Health (2019), a key of role of community nurses is to provide ‘in-home’ nursing care and
assistance for families unable to visit healthcare organizations. In this case, considering the busy
schedules encountered by Daiyu and Jin as well as their traveling expenses the community nurse
can address this care plan objective by attending to Lucy’s toileting needs. Additionally, patient
advocacy, imparting patient education and referral recommendations also fall under the scope of
practice of a community nurse (APNA, 2019). Thus the community nurse can also recommend a
referral of In Home Care (IHC). IHC services aim to deliver childcare and education in the
homes of families and hence, can be of special benefit to the Zhang family where both Jin and
Daiyu are working (Australian Home Childcare Association, 2019). Additionally, the community
nurse and IHC service provider must work collaboratively with the Zhang family using family
centered approaches and communicate and provide assistance on strategies with which Jin and
Daiyu can revert a significant section of their time to their children (Lor, Crooks & Tluczek,
2016).
Ling is feeling emotionally stressed and burdened due to her responsibilities of being the
sole caregiver of Wei in his deteriorating condition of bowel cancer. Lack of support and
communication often result in consequences like compassion fatigue, burnout, stress and feelings
of disregard and apathy towards personal as well as familial responsibilities – which are
observed prevalently in Ling (Lynch, Shuster & Lobo, 2018). Provision of assistance for
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4CHILD AND FAMILY NURSING PRACTICE
caregivers as well as in-home palliative care for patients with chronic, life limiting conditions are
key responsibilities comprising under the scope of practice of community health nurses. Thus,
the community nurse can attend to Wei’s needs in collaboration with Ling at home, through the
provision of in-home rehabilitation, palliative and bedside services (Dening & Hibberd, 2016).
The community nurse must address these needs using a culturally competent approach,
considering that Ling and Wei do not know English. This can be done by the community health
organization providing an interpreter or a community health nurse who is fluent with the cultural
and linguistic needs of the Zhang family. Such culturally appropriate practices will not only
relieve the burden on family caregivers but will also instill positive perceptions where the
patients and the family will feel dignified and respected (Shen, 2015).
Evaluate
In order to monitor the strengths and weaknesses in the given community nursing care
plan as well any form of progress and deterioration within the Zhang family, the community
nurse must conduct frequent evaluations (Knapp, Cambridge, Thomason, Beecham, Allen &
Darton, 2018). This can be done with the help of timely follow ups comprising of the
community nurse, family therapist and the interpreter engaging in a weekly discussion with the
Zhang family regarding their thoughts, opinions and concerns regarding the care plan provided to
them. The care plan can then be improvised accordingly based on the insights given the family.
Further, the community nurse can also provide referrals to the family on any specialist cancer
care or palliative care services which may then be able to evaluate the status of bowel cancer in
Wei (Davy, Bleasel, Liu, Tchan, Ponniah & Brown, 2015). Lastly, the community nurse must
repeat a family strengths assessment on the family and compare with previous results in order to
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review the presence of previous or any new challenges, as well as the existing levels of strengths
and protective factors within the family (Hamilton & Carr, 2016).
Part 2: Social Needs and Health Policy
Community health nurses are especially entrusted with the role of addressing the social
and cultural barriers encountered by a family (APNA, 2019). As part of the care plan, the
community nurse must also address the cultural and social pressures faced by Daiyu and Jin to
have a child from her parents. Thus, the community nurse can provide a referral to the family for
a clinical family therapist, registered with the Australian Association of Family Therapy (AAFT,
2019), who then can collaboratively communicate with an interpreter to Jin, Daiyu and Daiyu’s
family on the importance of frequent communication and the need to empathize with the current
issues of chronic illness which are making it difficult to have a grandchild. The therapist can also
assist Daiyu in receiving assistance on optimum maternal and childcare services considering her
past experiences with miscarriages (AAFT, 2019).
According to the social model of health, the health and wellbeing of an individual are
largely impacted by political factors such as the prevalence of relevant policies as well as
availability and affordability of existing healthcare services (Haslam, McMahon, Cruwys,
Haslam, C Jetten & Steffens, 2018). In this case, social as well as cultural pressure of the need to
provide care by family caregivers as well the Zhang family’s inability to acquire a Medicare has
not only resulted in a difficulty for Jin and Daiyu to financially support the family, but has also
resulted in associated challenges such as Lucy’s aggression and Lin’s compassion fatigue. Thus
to address the same, the relevant financial and care policy which the community health nurse can
refer to the Zhang family is the ‘Financial Hardship Assistance’ (Bond, Chalmers, Jorm,
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Kitchener & Reavley, 2015). Since the cultural values of the Zhang family may not align to
residential respite care services provided by aged care health organizations, the family can avail
home care packages of the same for Wei’s care which can further be covered by the government
as a part of the Financial Hardship Assistance plan (My Aged Care, 2019). Further, as a part of
responsibilities for patient advocacy, the community nurse can refer a private health insurer to
the Zhang family or advocate in support of the family’s need acquire relevant Medicare
coverage with the assistance of relevant policy advocacy groups like Cancer Council Australia
(2019).
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References
AAFT. (2019). What is Family Therapy?. Retrieved 18 September 2019, from
https://www.aaft.asn.au/.
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health-nursing
Australian Home Childcare Association. (2019). In Home Care | Australian Home Childcare
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http://australianhomechildcare.com.au/in-home-care/.
Ban, J., & Oh, I. (2016). Mediating effects of teacher and peer relationships between parental
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Camilo, C., Garrido, M. V., & Calheiros, M. M. (2016). Implicit measures of child abuse and
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Meins, E., Bureau, J. F., & Fernyhough, C. (2018). Mother–child attachment from infancy to the
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