You are a community health nurse who has been visiting the Zhang family (refer to your Genogram from Assessment 1). Wei’s stoma has broken down and he requires daily intravenous antibiotics via a peripherally inserted central catheter (PICC). You are also providing stoma education for Wei and the family. You use the phone interpreter to speak to the Grandparents during a family meeting with Wei, Ling, Jin and Daiyu to undertake a family assessment.
Your family assessment is as follows:
Parents:
• Jin Zhang is a thirty-seven (37) year old man. He has been married to Daiyu Zhang, a thirty-one (31) year old woman, for ten (10) years. It is the first marriage for both of them.
• Jin and Daiyu were both born in China and immigrated to Australia 4 years ago.
• They have two daughters:
o Lucy (3 years old) and Olivia (6-month-old).
• Daiyu is a G5P2; she has had 3 miscarriages at 8 weeks, 17 weeks and 14 weeks gestation.
• Jin works long hours as an accountant in a large firm, and he is working towards a promotion. He leaves early and gets home late, often after the children have been bathed and put to bed.
• Daiyu is a full-time dental nurse and works Monday – Friday, but has to do a Saturday shift 0900-1500 every second weekend. She has just returned to full time work after 6 months maternity leave.
• They rent a 2 story, 3-bedroom town house in Sunnybank Hills with a small backyard.
• They do not have a car and neither of them drive. The house is located about 1 kilometre from the nearest bus stop, and the shopping centre is 2 kilometres away.
Extended Family
• Jin is an only child and his parents immigrated to Australia at the same time as Jin and Daiyu. They live with Jin and Daiyu. Jin’s father, Wei, is aged 74, and his mother, Ling is aged 67. Jin financially supports both his parents. They have no other family in Australia.
• Wei and Ling speak Mandarin and do not speak, read or write English. .
• Daiyu’s parents are still in China. They visited Australia when Lucy was born, but they have not been able to afford to come back since. Ling has 2 brothers, who still live in China.
Current situation:
• Ling is the primary carer for Lucy and Olivia whilst Jin and Daiyu are at work.
• Wei has recently been diagnosed with stage four (4) bowel cancer and had a bowel resection and colostomy six weeks ago. Because he was not eligible for Medicare, there was a big gap payment that Jin had to pay, so Daiyu was forced to return to full time work earlier than planned.
• Ling is also caring for Wei. His stoma has broken down and he is struggling to cope with his wound and the diagnosis of stage 4 bowel cancer. He does not help much with the children or housework and spends most of his time in bed or in the garden.
• Ling also does all the cooking and housework.
• Olivia is still being breast fed at night and Daiyu wakes 2-3 times a night to feed her. Olivia has formula and expressed breast milk during the day and has just commenced solid food. Diayu has not had much sleep since returning to work.
• Daiyu is also worried about Lucy. Since Daiyu returned to work, Lucy has started sucking her thumb and has regressed in her toilet training. She now needs nappies both day and night. Lucy has also started to throw tantrums at night and in the morning when Jin and Diayu are leaving for work or coming home. Her tantrums are annoying Jin; Wei and Ling do not know how to cope with this.
• Ling is becoming withdrawn and is constantly snapping at the children and Daiyu.
• Daiyu is missing her parents very much as she is feeling isolated from her family. Daiyu skypes her parents regularly but often becomes upset as her parents ask her constantly when they will have a grandson. She has told Jin she would like another baby, but Jin has said no.
Part 1 of assessment:
Nursing Care of the Family using the following aspects of the nursing process: Problem/Challenge identification, Planning, Implementation and Evaluation.
Many families, even those with healthy strengths, can face issues and challenges that affect family functioning and health. Even one family member’s challenges can impact the health of other family members. You, as the community health nurse have already assessed these strengths and challenges in the above case study
For Part 1, with reference to evidenced based literature and current policy guidelines, you need to write 1000 words under the following headings: (A suggested breakdown of the word count for each requirement is given below). Do NOT use a table format.
1a. Problem/Issue Identification: Recognition of challenges/issues faced by the family
Identify one (1) problem/issue/challenge to family functioning that the Zhang family or a member of the family faces.
• The challenge may have been identified by the nurse, family or both. It must be a family health, social or developmental family challenge. It should not be a medical issue/challenge eg PICC line, daily intravenous Antibiotics, Bowel cancer
Briefly discuss how the identified problem/issue/challenge may impact family function. 125 words
1b. Planning: Development of a nursing goal for the family
Identify a nursing goal for the family
• The goal may be short or long term, it should be based on the issue previously identified
• The goal must be family focused, realistic and have clear measurable criteria
The rationale behind why the goal was chosen, and why it is a priority for the family, is discussed, and supported by literature 125 words
1c. Implementation of Nursing Care Interventions
Following your goal development, develop two (2) nursing care interventions. Discuss how these two interventions would be implemented and how the nurse would enable/support the family to achieve the goal you identified in 1b.
Support your discussion with reference to the literature. 500 words
1d. Evaluation of Nursing Care Interventions
Describe how the nurse would evaluate the effectiveness of these two nursing care interventions in supporting family functioning. 250 words
Part 2
2a. Analyse the impact that current social and health policy has on children and families
As the community nurse you return to see the Zhang family. Daiyu tells you that Lucy is going to Kindergarten next year, but she is very worried because the kindergarten has told her that Lucy must be up to date with her vaccinations before she attends. Daiyu has not vaccinated Lucy or Olivia because she is worried about the impact that the vaccinations may have on her children.
For Part 2 you need to write 500 words in which you analyse evidence-based literature and current policy to formulate a nursing response to Daiyu’s concern.