Introduction
Child and family health issues are of primary concern to the Australian government and society. However, many Australian citizens live in an unhealthy family environment that negatively affects people’s well-being. According to the Australian Institute of Health and Welfare (AIHW 2017), 949,000 or 14% of all families are single-parent families. Some of the family members become victims of family, domestic, or sexual violence, which forces them to leave the household and live in the streets. In 2016, there were 105,237 homeless people, among which 17,845 were children (Homelessness in Australia 2016).
People living in the streets, supported accommodation, boarding houses, and severely crowded dwellings often abuse alcohol or illicit drugs to cope with their problems. According to the Australian Department of Health (n.d.), approximately 3.1 million Australians reported using an illegal drug in 2016. In short, there are significant social problems in the country that can negatively affect children’s health.
The well-being of children living in at-risk families is a front matter for child and family health nurses. These nurses offer free support and information to families with children under six concerning breastfeeding, sleep and settling, child safety, immunization, and parenting in general. The present paper offers an overview of the rationale for the plan of care for a family with multiple social risk factors.
Background and Purpose
The family under assessment consists of two people: Cassie, a 22-year mother, and Jordan, a 5-months old son. Cassie is a recovering drug and alcohol addict who has been living in the streets for seven years due to domestic violence. She has a history of working in the sex industry and being an inpatient in rehabilitation facilities several times. Jordan is a smiling and busy baby who does not sleep much and often requires his mother’s attention.
The family is currently living in public housing in an inner-city suburb and receives Centrelink benefits. Cassie is currently single with no ongoing relationships. The purpose of the present paper is to provide a holistic assessment of Jordan’s health and elaborate a comprehensive care plan for the family that considers all the risk factors and prioritizes self-care strategies.
Family Assessment
Vulnerabilities
Four major vulnerabilities can be identified in the family environment. First, the family does not have permanent residency, which may negatively affect the well-being of the child and his mother. According to Shinn et al. (2015), homelessness is associated with poor mental health, educational problems, and behavioural issues in children. Second, parental substance abuse may become a traumatic experience for Jordan since it may be associated with long-lasting consequences at the neuro-behavioural level (Parolin et al., 2016).
Additionally, children with early exposure to drug and alcohol misuse have a higher chance of becoming an addict in adolescence and early adulthood (Parolin et al., 2016). Third, the family single-parent, which may also have a negative effect on the child. Stephen and Udisi (2016) state that children living with only one parent are more likely to live in poverty, drop out of school, and become teen parents. Fourth, Cassie has been a victim of domestic abuse, which may lead to abusive behaviour toward her child (Nemeroff 2016, p. 894). In short, the child and family health nurse is to help the family to cope with the issues mentioned above.
Strengths
Despite the abundance of vulnerabilities, there are some strengths that can be used to improve the current situation. First, Cassie has managed to discontinue the majority of dangerous behaviours to become a good mother. This fact leads to the understanding that she values her new role and her son’s health. Second, the family has limited emotional support from the extended family. The mother of the family mentioned that she sees her brother and father, and they are on good terms. Third, Cassie receives financial, medical, and psychological health, which may help to deal with the problem. In short, even though the strengths are scarce, they can be utilised to address the issues.
Obtaining Information
When assessing the health and well-being of a child, it is vital to consider six spheres. According to the Department of Communities Tasmania (2018), the domains of child well-being includes being loved and safe, having material basics, learning, being healthy, participating, and having a positive sense of culture and identity. Therefore, a child and family nurse need to obtain pertinent information about all these aspects, considering the developmental stage of the child.
The information obtained from Cassie is enough to make preliminary conclusions. The family needs assistance with receiving access to material basics and learning activities. The mother needs help to encourage participation and a positive sense of identity. Additional information is required in order to evaluate physical and emotional health and safety.
Transitioning to Parenting
A child and family nurse is to be aware of the additional issues Cassie may face due to the transition to parenting. According to Gilmer et al. (2016), the period after having the first baby is associated with an increased amount of stress for various reasons. The adverse psychological outcomes of the period in parents may be negatively associated with the child’s attachment. Therefore, the mother is being provided with adequate parent education to help her cope with emerging hardships. Parental education “will reduce parental stress, improve knowledge and awareness of healthy parenting behaviours and activities, and promote healthy parent-child relationships” (Gilmer et al., 2016, p. 119). If parents are emotionally detached from their children due to stress, it may be associated with adverse developmental outcomes in children.
Risk of Harm
The assessment shows that the child is at permanent risk of harm. First, Jordan’s mother is coping with multiple stress sources, including recovery from substance abuse, lack of material basics, transition to parenthood, and absence of emotional support from her partner. According to AIHW (2018), increased stress may lead to family violence. Second, since Cassie cannot support her and her son’s living, the child is at risk of being abandoned. Third, Jordan lives in an unhealthy environment and can become a victim of crime and abuse from non-family members in the public housing facility. However, additional information is needed to assess the risks of harm and evaluate if the nurse should suspect the risk of significant harm (ROSH) in this case.
Advocating for the Child
Child and family nurses are to adhere to legal and professional responsibilities. Even though qualified healthcare employees are to assist vulnerable parents in accessing appropriate support services, the primary role of nurses is to promote the health, safety, welfare and well-being of children (NSW Health 2018). Health providers need to act in accordance with the Children and Young Persons (Care and Protection) Act 1998, Child Protection (Working with Children) Act 2012, and Ombudsman Act 1974 (NSW Health 2018). These legislatures oblige the nurses to collaborate with partners, promote information exchange that supports the provision of safety, report all cases of ROSH to born and unborn children, respond to the needs of children, and assist in court proceedings (NSW Health 2018).
As for the professional responsibilities, child and family nurses are to recognize and respond to the possible risk factors, help others and seek assistance to identify those risks and participate in training to improve risk detection skills. In other words, healthcare providers are to advocate for the child’s health and well-being even if it may mean separation from parents.
Care Plan
Risk Factors
The care plan is to be based on the risk factors associated with child and family health and well-being. Well-identified risk factors help to set care priorities and elaborate an adequate plan of care. First, the family of Cassie and Jordan are at risk of losing access to material basics since their only source of income is Centrelink benefit, and the mother uses the money to buy Methadone. Second, the child may be at risk of harm from his mother and other people due to multiple environmental reasons discussed above. Third, the family faces numerous participation concerns since it is isolated from society, and it has poor relationships with some members of the extended family. Therefore, according to the Department of Communities Tasmania (2018), the family can be identified as in need of a secondary response, which is targeted multi-agency support over a medium to the long-term timeframe.
Care Priorities
The risk factors mentioned above are to be used as directions to set family care priorities. However, before identifying the care priorities, it is vital to acknowledge the guidelines for the care plan. According to Grant, Mitchell and Cuthbertson (2017), a child and family health nurse is to develop a care plan based on empirical knowledge and expertise. To acquire the knowledge, the healthcare professional should work in partnership and collaboration with families to gain trust and support (Grant, Mitchell & Cuthbertson 2017, p.13). Therefore, the primary concern of the nurse is to acquire a holistic picture of the family situation.
In particular, the nurse needs to assess the child’s and his mother’s physical and mental health and evaluate their relationships. Close cooperation with the family may cause close emotional attachment, which may interfere with performing legal and professional duties. Therefore, the top priority is to gain a complete unbiased understanding of the family’s state of health.
Based on the present body of evidence, the proposed directions for the care plan are as follows. First, Cassie should be specialists that can help her continue receiving current benefits to acquire adequate accommodation. Second, the mother needs to apply for assistance to address the problem of drug abuse to decrease the risk of harm and improving the financial situation. Third, the parent is to receive appropriate parental education to reduce stress from transitioning to parenting. Fourth, the nurse should promote immunization to shield Jordon from dangerous diseases he can be exposed to in public housing.
Fifth, the family should be referred to a family psychologist to encourage socialization. The care plan is coherent with the framework proposed by Grant, Mitchell and Cuthbertson (2017) since it is based on the risk factors, empirical evidence, and expertise.
Community Resources
It is beneficial to utilise the assistance of community resources to ensure positive outcomes of care. According to NSW Health (2018), the family may be referred to as Child Wellbeing Units, Family Referral Services, Brighter Futures Program, and hospital and community health-based social workers. The final selection of recommended community resources should be based upon the holistic assessment of the family. Based on the present body of evidence, the family should be advised to utilise the services of social workers and the Brighter Futures Program to cope with the current risk factors.
Self-Care Strategies
The nursing profession is associated with an increased level of stress and burnout, especially when working with at-risk families. According to Berger et al. (2015), nurses working with children are exposed to compassion fatigue, which may negatively affect the quality of provided care. Therefore, it is vital that nurses are acquainted with adequate self-care strategies to avert adverse effects. The efficient strategies for self-caring are relaxation, social support, cognitive techniques, exercise, and music (Berger et al., 2015). Additionally, a nurse may participate in a multimodal resilience training program to acquire relevant coping skills. Nurses are to choose the most pertinent technique supported by empirical evidence and personal experience to avoid the adverse effects of the profession.
Conclusion
At-risk families are a major concern for the healthcare system in Australia. The most common vulnerabilities of such families are substance misuse, single parenting, homelessness, unemployment, domestic violence, and poor relationships with extended family. Child and family nurses are to assess the possible risk factors and use identified family strengths to develop an appropriate plan of care. This plan should be based on empirical evidence and expertise.
While developing a plan, nurses are to their legal and professional responsibilities and regard child safety as the top priority. Healthcare providers are advised to utilise all the available community resources to ensure the best possible outcomes. At the same time, nurses are to be aware of self-care strategies to avoid an increased level of stress and burnout.
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