Child and Family Nursing Report: Social and Parenting Issues Analysis

This report presents a child and family nursing analysis of the Williams family, focusing on two primary issues: social isolation and the transition to parenthood. The report begins with a genogram outlining the family structure and history, highlighting strengths such as shared activities and mutual support. The first nursing issue addressed is Hannah's social isolation, exacerbated by a recent move and Steven's work commitments. The report discusses the negative impacts of social isolation and proposes a nursing care plan to build Hannah's social network. The second issue focuses on the transition to parenthood, examining the challenges faced by Hannah and Steven, including Steven's lack of experience and the need for support. A nursing care plan is suggested to increase Steven's participation and provide parent education. The report emphasizes the importance of interventions to improve the family's well-being and strengthen their relationships. The report provides detailed nursing care plans to address the issues and improve the family's well-being.

Running head: CHILD AND FAMILY NURSING
Child and Family Nursing
Name of student:
Name of university:
Author note:

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Table of Contents
Part 1....................................................................................................................................2
Genogram of the Williams Family......................................................................................2
Summary..............................................................................................................................3
Strengths of family..............................................................................................................3
Part 2....................................................................................................................................4
First nursing issue................................................................................................................4
Second nursing issue............................................................................................................6
References..........................................................................................................................10

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Part 1
Genogram of the Williams Family

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Summary
The genogram depicts the family structure and history of Hannah and Steven Williams.
Hannah has been married to Steven for three years. Unlike Steven, Hannah was married before
to Barry. She is divorced and has a 5-year-old son, named Billy. Barry and Jane are in the
relationship and live together. Jane has two children from her previous relationship, Ronan and
daughter Emily. Steven lost his father to coronary heart disease a year ago. His mother Mavis
lives alone. Hannah’s father is currently living with his second wife, Ariel. Her mother Marion is
living alone.
Strengths of family
The two strengths of William’s family includes the following as per the “Australian
Family Strengths Nursing Assessment guide” (AFSNA) (Children’s Health Queensland Hospital
and Health Service., 2017)-
Shared activities- Steven and Hannah spend time together as a family. Steven plans to
take the family to the golf club for launch. He plans to help Hannah in cooking in the evenings
when he is home.
Support- Hannah and Steven both share the load of the house and are there for each
other. Hannah is running her clothes boutique business successfully. To save money also plans to
paint and make new curtains for the baby’s bedroom. When Hannah declined to resume any
sexual activity after caesarean section delivery, Steven supported her considering her weakness.

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Part 2
First nursing issue
Social isolation is one of the major issue faced by Hannah as the family have recently
moved to the suburb on the southern Gold Coast, three bedroom home. Due to work
commitment, she has not made many friends there except the small group of mothers met Billy’s
prep-school. Since Steven visits two weeks from work, he too does not have a big channel of
friends in Gold Cast who may support Hannah in his absence. They are mainly socially isolated
as Steven, and his mother does not see often, and he has lost his father to coronary heart disease.
Thus, the family has less family and friends support.
According to Ammerman et al. (2013), social isolation is the challenge because it leads to
loneliness and depression. It has broad social and economic implications. Socially isolated
people enjoy poor health outcomes and are in greater need of the health care services. Hannah is
already experiencing physical weakness caesarian delivery, and social isolation may exacerbate
this condition. Just like Marion, Hannah may too undergo postnatal depression if social isolation
is continued. It has been observed in the most case of social isolation, sexual abuse, child and
spousal abuse are highly likely to occur. Social isolation eats away at the community level in
addition to the exacerbation of the mental health issues. Social isolation in broad aspect is
associated with the increasing rate of suicide, increased inequality, rising drug and alcohol
addiction, political polarisation and alienation (De Jong Gierveld et al., 2016). It is the reason
behind the walled communities. Eventually, people with the social isolation not only keep their
potential social problems, rather tend to isolate themselves from the community. The same may
happen with Hannah and Steven eventually.

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In the case of this family, social isolation may influence their parenting style. In the case
of Steven and Hannah, the chance of family dysfunction is high considering Hannah's past
relationship issues. Both the husband and wife lack of support from their parents as well as a
community. Hannah's mother is looking forward to spending time together with children, but
father lives in the Philippines. Steven has experienced the harsh discipline of his father, and he
too may engage in violence if socially isolated. Lack of family and peer support prevents a
person from being happy, self-confident and self-esteem. In addition, Hannah is burdened with
financial challenges with the new home, mortgage, recruitment of business manger and newborn
baby (Hildingsson & Thomas, 2014). Consequently, it may hamper her physical and mental
well-being.
Nursing care plan: The solution to this issue is to help Hannah build the strong social
network in Gold Coast. It is necessary for her to feel more connected, know the neighbours and
others in the community. The first nursing goal is to enhance confidence and morale in Hannah.
The second nursing goal is to build the strong relationship with her family and make new friends.
The rationale for this goal is to help Hannah increase the social network (Ammerman et al.,
2013).
Implementing nursing care: As a nurse, it is important to engage in counselling with
Hannah to help her manage the conflicting thoughts. To increase the client's confidence and
morale, emotional support must be provided. Therefore, the nurse must spend a certain amount
of time with Hannah at home. Engaging in conversation with the nurse will help Hannah to
develop new insights on consequences of social isolation and strategies to cope up with it.
Educating Hannah through motivational audios, videos, and audio recordings can be beneficial in
uplifting her self-esteem. According to Barlow et al. (2015), home visiting interventions and

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social support have been effective in enhancing the depressed mood of mothers and attitude
towards children and family. This response was found successful in increasing attachment
security and psychomotor development.
The nurse can help Hannah build the strong family network by allowing Marion to visit
the place. Being with her mother, Hannah will feel secured and enthusiastic. Further, Hannah can
spend more time at prep school and neighbours while her mother takes care of her new born
baby. Consequently, it will combat social isolation (Hildingsson & Thomas, 2014).
Evaluating nursing care: The expected outcomes of the intervention are increased
interaction of Hannah with the society and improved emotional security. The achievement of the
outcomes can be evaluated by observing the changes in the client’s behaviour, attitude,
confidence, esteem and perception. If the client is ready for household challenges and regularly
interacts with her friends at prep school or neighbours, takes their help and invites neighbours to
house, it is indicative of increasing social connection. The same can be evaluated with the
Lubben Social Network Scale (Denham et al., 2015). The scale consists of ten items and four
different categories. In each category the cutoff scorethat indicates the level of social isolation.
Second nursing issue
Transition to parenting is the other main issue of William’s family. In any family,
pregnancy and transition to parenthood is the stage of major adjustment. A drastic change in the
lifestyle is expected for both Hannah and Steven. In this stage, Hannah and Seven are in need of
support mechanism, antenatal education, information on child and mother care, breastfeeding
challenges and relationship changes (Osman et al., 2016). The transition has been recognised as
the challenge because Steven stays away from the house. In a case of any personal and

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professional issue, he may turn to his colleagues. However, the same is not the case with
Hannah.
According to Roy et al. (2014) after pregnancy, mothers need greater support on the
elements of baby care. Since she has given birth before, she may have some knowledge but
handling two young children in the absence of Steven is quite challenging for her. She cannot
independently handle her daily chores if her baby wakes her up early in the morning or late at
nights. She needs support while cooking and other activities of daily living. Female support is
greatly demanded by the mothers after delivery of a baby. However, Hannah lacks this support
as neither of the husband or wife's parents visits them regularly.
Further, Hannah and Steven’s relationship may be at stake. Unlike Hannah, he is the first
time father to a newborn baby. He may lack awareness of new responsibilities. It is evident when
Steven says that he would like his wife to take care of crying baby when he is out for golf
sessions. Further, he is willing to spend time in weekends with his family only if the baby does
not cry too much. Lack of sexual intimacy between the husband and wife due to her
complications during delivery may be added disadvantage to the relationship. Hannah may fail to
provide emotional support to her husband when he is back home after four-week rotation. In this
situation, it is difficult for Hannah to maintain a strong relationship with both her children and
husband (Roy et al., 2014).
Nursing care plan: The nursing goal here is to increase the participation of Steven in
bonding with family and children. When he is at home, he should take better care of the baby
when crying or while changing the diaper. He should participate in household chores like
cooking and cleaning when Hannah is busy handling the two small children. The next nursing

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goal is to provide parents education to support a transition to parenting. The rationale for the
goal is the significance of the father's role in the upbringing of the child. Further, it is essential
to increase the parental competencies of the father, so that he can better handle the
responsibilities when at home (Kaakinen et al., 2014).
Implementing nursing care: Firstly, the nurse may provide parent education
intervention. It is to educate the client about the role that, he can play in the first six months of
the baby. The educational intervention to parents has been found successful in empowering the
fathers to take responsibilities of the newborn in the house. These short learning sessions will
help Steven overcome the barriers to bonding with the child and develop the coping strategies to
avoid stress. During the session, the nurse can emphasis on various case study as an example to
teach them about parenting style. Learning about other real life situation through case studies can
help the parents to devise logistic solutions to baby care problems (Ateah, 2013). Consequently,
Steven and Hannah would be able to make a healthy transition to the parenthood. Secondly, the
nurse can engage both Hannah and Steven in marriage counselling by referring them to the
professional. Sorting out the marital problems (individual contribution to finance and household
work, sexual relationship issues) is essential to fulfilling the roles and responsibilities of parents
(Stillwell, 2016).
Evaluating nursing care: The nurse can take regular feedback from Hannah about
Steven’s transition to parent. Hannah must be aware of the verbal and non-verbal cues indicating
the change in her husband's behaviour. Further, the nurse must interview with father to identify
the merits and demerits in the responsibilities he has been recently up taking. After two months
the nurse can provide Steven with “ fathering self-efficacy scale" to help him identify where he
wants to be. The scale consists of 28 items to figure out if the father is engaged in financial

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responsibility, and positive engagement. Base on the score, further therapeutic family
interventions can be developed for the couple (Sevigny et al., 2016).

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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.
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.
Barlow, A., Mullany, B., Neault, N., Goklish, N., Billy, T., Hastings, R., ... & Carter, A. (2015).
Paraprofessional-delivered home-visiting intervention for American Indian teen mothers
and children: 3-year outcomes from a randomized controlled trial. American Journal of
Psychiatry, 172(2), 154-162.
Children’s Health Queensland Hospital and Health Service. (2017). Child and Youth Health
Practice Manual. www.childrens.health.qld.gov.au. Retrieved 19 August 2017, from
https://www.childrens.health.qld.gov.au/wp-content/uploads/PDF/qcycn/cy-prac-manual-
pt1.pdf
De Jong Gierveld, J., Van Tilburg, T., & Dykstra, P. (2016). Loneliness and social isolation.
Denham, S., Eggenberger, S., Young, P., & Krumwiede, N. (2015). Family-Focused
Nursing Care. FA Davis.
Hildingsson, I., & Thomas, J. (2014). Parental stress in mothers and fathers one year after
birth. Journal of reproductive and infant psychology, 32(1), 41-56.

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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.
Osman, F., Klingberg-Allvin, M., Flacking, R., & Schön, U. K. (2016). Parenthood in
transition–Somali-born parents’ experiences of and needs for parenting support
programmes. BMC international health and human rights, 16(1), 7.
Roy, R. N., Schumm, W. R., & Britt, S. L. (2014). Transition to parenthood. Springer
New York.
Sevigny, P. R., Loutzenhiser, L., & McAuslan, P. (2016). Development and validation of the
Fathering Self-Efficacy Scale. Psychology of Men & Masculinity, 17(1), 92.
Sevigny, P. R., Loutzenhiser, L., & McAuslan, P. (2016). Development and validation of
the Fathering Self-Efficacy Scale. Psychology of Men & Masculinity, 17(1), 92.
Stillwell, D. (2016). Helping Couples Fulfill the “Highest of Life’s Goals”: Mate
Selection, Marriage Counselling, and Genetic Counseling in United
States. Journal of genetic counseling, 25(1), 157-165.