Family Nursing with Childbearing Families

THEORY-GUIDED, EVIDENCE BASED CHILDBEARING NURSING

Family Systems Theory

Family Developmental and Life Cycle Theory

The nine tasks for childbearing families and nursing interventions are explained in
the following subsections

TASK ONE: ARRANGING SPACE (TERRITORY) FOR A CHILD

Arranging space (territory) involves families making space preparations
for their infants. Families accommodate newborns by moving to a new
residence during pregnancy or the rst year after birth, or by modifying
their living quarters and furnishings.
Family Nursing Interventions Inquire about the living space, material,
and physical preparation all families have made for the baby. Inquire
about the families thoughts, values, beliefs, and possible fears about
making preparations for the anticipated arrival of the baby. Assist
families to explore and manage their fear about survival of the baby
and then mobilize resources to help them cope so that family
development can continue. Assist adolescents to nd ways to
communicate with their families and make plans for the future of the
infant and the adolescent parents. Refer families who are homeless
or live in inadequate or unsafe housing to appropriate resources for
obtaining safer housing.

TASK TWO: FINANCING CHILDBEARING AND CHILDREARING

Childbearing results in additional expenses and lower family
income. Most employed women will miss some employment and
forego possible career advancement during childbearing. Men are
more likely to take on additional paid work, leaving them less time
for family matters, which may be a source of more anxiety and
stress for the family.
Family Nursing Interventions Assist families to nd needed
resources, such as nutrition programs and prenatal clinics, that t
with the nancial resources of the family. Provide families with
information and resources that will help them choose safe and
appropriate child care. Identify associated barriers to prenatal
care, such as lack of transportation and child care, hours of service
that conict with family employment, and difculty obtaining or
using health care benets.

TASK THREE: ASSUMING MUTUAL RESPONSIBILITY FOR CHILD CARE

AND NURTURING The care and nurturing of infants bring sleep
disruptions, demands on time and energy, additional household
tasks, and personal discomfort for caretakers.
Family Nursing Interventions Educate parents about the realities
of parenting, such as interrupted sleep and a change in how time
is spent. Teach a family to alternate who responds to the babys
needs, including feeding, changing, and comforting. Assist
parents to develop new skills in care giving and ways of interacting
with their babies. Observe for signs of attachment by listening
to what parents say about their babies and observing parent
behaviors (see Box 12-2, which outlines parental behaviors that
facilitate attachment). Refer families who do not demonstrate
nurturing behaviors to other professionals who can provide more
intensive intervention.

TASK FOUR: FACILITATING ROLE LEARNING OF FAMILY MEMBERS

Learning roles is particularly important for childbearing families. For
many couples, taking on the role of parents is a dramatic shift in their
lives. Difculty with adaptation to parenthood may be related to the
stress of learning new roles. Role learning involves expectations
about the role, developing the ability to assume the role, and taking
on the role.
Family Nursing Interventions Assist and encourage pregnant
couples to explore their attitudes and expectations about the role of
their partners. Encourage contact with others who are in the
process of taking on the parenting role, especially if the parents are
isolated, adolescent, or culturally diverse and living apart from
traditional networks. Encourage expectant women to bring their
partners into the experience by sharing their physical sensations and
emotions of being pregnant. Provide opportunities for fathers and
other partners to become skilled infant caregivers.

TASK FIVE: ADJUSTING TO CHANGED COMMUNICATION PATTERNS

Communication patterns change in order for the family to
accommodate newborn and young children. As parents and infants
learn to interpret and respond to each others communication
cues, they develop effective, reciprocal communication patterns.
Family Nursing Interventions Educate parents about different
infant temperaments so they are able to interpret their babys
unique style of communication. Encourage parents to talk to and
engage in eye contact with the baby. Incorporate couple
communication into care and education of expectant parents.
Promote effective couple communication by encouraging the
partners to listen to each other actively, using I phrases instead
of blaming the other. Encourage couples to set aside a regular
time to talk and enjoy each other as loving partners.

TASK SIX: PLANNING FOR SUBSEQUENT CHILDREN. After the birth,

some parents will have denite, mutually agreed-on plans for
additional children, whereas others will have decided against
future children or will be ambivalent about family plans. Families
who have denite plans primarily need information about family
planning options so that they can carry out their plans.
Family Nursing Interventions Consider a familys cultural and
religious background, and identify the power structure and locus of
decision making in the family when discussing reproductive
matters. Provide current, evidenced-based information about
family planning options.
Refer to a nurse genetic specialist for assessment and
counseling when appropriate

TASK SEVEN: REALIGNING INTER GENERATIONAL PATTERNS. The

rst baby adds a new generation in the family lineage that carries
the family into the future. Expectant parents change from being
children of their parents to becoming parents themselves.
Childbearing may signify the onset of being an adult for adolescent
parents and some cultural groups.
Family Nursing Interventions Assist new parents to seek support
from friends, family members, organized parent groups, and work
colleagues as a way to cope with the demands of parenting.
Work with families to develop strategies that maintain their couple
activities, adult interests, and friendships. Facilitate partner
discussions about perceptions of extended family involvement in
care of the new child.

TASK EIGHT: MAINTAINING FAMILY MEMBERS MOTIVATION AND MORALE After

the initial excitement surrounding the arrival of a new baby, families must
learn to adjust to and cope with the new demands that caring for the baby
will have on their time, energy, sexual relationship, and personal resources.
Many new moms experience postpartum fatigue, which is a feeling of
exhaustion and decreased ability to engage in physical and mental work.
Family Nursing Interventions Inform family members about ways to
promote comfort, rest, and sleep, which will make it easier for them to cope
with fatigue. Promote parental rest while a baby needs nighttime feedings
by encouraging parents to alternate who responds to the baby. Teach
parents ways to cope with a crying infant, which will boost family morale,
increase condence, and allow family members to get additional sleep.
Provide information on ways parents can reduce isolation and loneliness by
seeking support from friends, family members, organized parent groups, and
work colleagues. Encourage parents to articulate their needs and to nd
help in ways that support their selfesteem as new parents. Counsel
couples about changes in sexuality after birth and help them develop
mutually satisfying sexual expression. Help families to develop strategies
that maintain their couple activities, adult interests, and friendships.

TASK NINE: ESTABLISHING FAMILY RITUALS AND ROUTINES Rituals

develop as children come into a family, and these rituals become a
source of comfort, as well as part of the uniqueness and identity of
a family.
Family Nursing Interventions Determine the special cultural
meaning each ritual has for the family and respect those
meanings. Encourage families to carry out their usual routines
and established rituals related to their babies and other children.
Facilitate couple discussion of bedtime and bathing routines, a
babys special possessions such as a treasured blanket,
nicknames, language for body functions, and welcoming rituals
such as announcements, baptisms, circumcision, or other
celebrations.

FAMILY TRANSITIONS
Transition, a major concept of Family Developmental Theory, is
similar to change theory. Inherent in transition from one
developmental stage to the next is a period of upheaval as the
family moves from one state to another.
The notion of family transition gives foundation to nursing
interventions that promote parenting because opening of self
involves the real experiences of being with and caring for the
child.
Nurses who understand the stressors that families experience as
they transition from one state to another can use this theoretical
concept to realize that a mother may be frustrated over not
being able to cope in her old ways

CHILDBEARING FAMILY STRESSORS

Infertility
Adoption
Perinatal Loss
Pregnancy after pernatal loss

THREATS TO HEALTH DURING CHILDBEARING

Acute and Chronic Illness During Childbearing

Effect of Threats to Health on Childbearing Families
For example, three sources of stress that alter family
processes when the mother or infant experiences a chronic
health threat are: (1) assuming household tasks, (2)
managing changes in income and resources, and (3) facing
uncertainty and separation.

FAMILY NURSING OF POSTPARTUM FAMILIES

Feeding Management
Attachment
Siblings
Postpartum management

SUMMARY
Childbearing family nursing focuses on family relationships and the health
of all members of the childbearing family even during times of extreme
threats to maternal health. Several different theories are available to
nurses encountering families during childbearing, which can help guide
their assessment of, plan of care, and interventions for the family. Nurses
are also in a position to have a powerful inuence on the ways in which
family centered care is practiced and on the development of family
friendly policies at both the federal and practice setting level. In addition
nurses can contribute to the knowledge base of childbearing families
through design and implementation of research aimed at understanding
their unique experiences. While giving direct physical care, teaching
patients, or performing other traditional modes of maternity nursing,
family nurses focus on family relationships and health of all members of
the childbearing family. Several theories are helpful to guide nurses
understanding of childbearing families and to structure nursing care,
particularly Family Systems Theory and Family Developmental Theory.
Even in extreme threats to health, family nurses do not ignore the whole
of the family. Nurses have a powerful inuence on family practice,
policy, and research for childbearing families.