Question

In preparation for her appointment with the Bono family, in the mother–baby clinic, Vicki reviews the chart notes the nurse midwife wrote about the family and the delivery of Hannah. Vicki sees that the Bono family is coming in for a well-baby checkup of newborn infant Hannah and a follow-up with Libby, the mother, after her cesarean section (C-section) delivery 7 days ago. The note from the receptionist indicates that Libby expressed some concerns with her effectiveness in breastfeeding Hannah. The appointment book notes that the whole Bono family is coming for this visit. Vicki notes that the Bonos are a nuclear family that consists of a married couple with two biological children. Figure 4-8 shows the Bono family genogram.

Knowing that this is a nuclear family coming in for a well-baby checkup, Vicki decides to use a Developmental Family Life Cycle theoretical approach to this family with a new member. (See Chapter 3 for details about this theoretical model.) Based on this approach, Vicki has many questions in her mind as she prepares for her appointment with the Bono family. The questions Vicki has about each family member and the whole family are presented in bulleted lists after a brief description of each family member.

Libby Bono is a 35-year-old mother recovering from a cesarean section delivery 7 days ago. She does not have any existing health problems. Libby’s roles in the family are primary childrearer, events planner, disciplinarian, and health expert. Libby is a hairdresser and is independently contracted with a hair salon. She has planned to take off 3 months for maternity leave.

Matt Bono, 36 years old, works for Frito Lay Company in sales and distribution. His primary roles in the family are decision maker, maintenance person, pioneer, and information provider. He reports feeling little attachment to his occupation and welcomes this new birth as a change in routine and opportunity to leave his place of employment. His current medical problems include type 2 diabetes and mild hypertension; both are well managed and controlled by oral diabetic and antihypertensive medications. Currently, he is following the Weight Watchers diet to reduce his weight and to control the symptomatology experienced from his health conditions.

Sabrina Bono is a healthy 2-year-old girl who is developmentally appropriate. Developmentally, Sabrina is in the autonomy versus shame and doubt developmental stage. Her parents report that she often attempts to try new things on her own, and they frequently praise her efforts to promote independence. She is not yet interested in potty training. Her immunizations are current. She normally goes to a cay-care center that is close to her mother’s place of employment during the workweek.

Hannah Bono, 7 days old, was delivered after 42 weeks’ gestation and was proved to be adequate for gestational age (AGA; 10th to 90th percentile), 53.75 cm and 3,966 g, with American Pediatric Gross Assessment Record (APGAR) scores of 8 at 1 minute and 9 at 5 minutes.

Family Story

During the appointment, Vicki confirmed that family life for the Bono family has changed. Hannah was found to be healthy and developmentally appropriate. Libby is healing well from the C-section but reported occasional discomfort when she “overdoes it.” Libby’s concerns about breastfeeding were easily relieved as Vicki validated her breastfeeding technique. An assessment for postpartum depression revealed that Libby is not demonstrating any signs of depression at this time. Throughout the examination of Hannah, the parents demonstrated overwhelming signs of bonding, such as talking with the infant and bragging about her beauty and temperament. During the appointment, Vicki noted that Sabrina was throwing toys and attempting to crawl onto her mother’s lap while Libby was nursing Hannah. Sabrina would say, “Take back” when she was upset. When Matt attempted to coddle or praise the baby, Sabrina became extremely angry with her father. They were not ignoring Sabrina but were not focused on her during the appointment. The parents’ nonverbal actions showed frustration with Sabrina’s behaviors. When asked, they reported that Sabrina has been very temperamental and inconsolable at day care. They reported that she had begun to show progress with toilet training before Hannah’s birth but had now lost all interest.

The purpose of this scenario is for you to learn about the needs of families adjusting to a new baby and how to best to meet their need; to identify priorities of care and supports and to plan interventions and follow-up actions.

1. How does family assessment differ from an individual assessment?

2. Why is it critical for the family and nurse to agree on what the health issue is for the family?

3. What assessment tool, model or instrument would you use on the Bono Family? Give your rationale for your answer.