Nursing diagnosis – PARENTAL ROLE CONFLICT

PARENTAL  ROLE  CONFLICT

DEFINITION

Parent experience of role confusion and conflict in response to crisis

DEFINING CHARACTERISTICS

• Disruption in care-taking routines

• Expressed concern about changes in parental role and family func-

tioning, communication, and health

• Expressions of inadequacy to provide for child’s needs

• Expressed loss of control over decisions relating to child

• Expressed or demonstrated feelings of guilt, anger, fear, anxiety,

and frustration about the effect of the child’s illness on family

• Reluctance to participate in usual caregiving activities, even with

support

RELATED FACTORS

• Change in marital status

• Intimidations with invasive

• Home care of a child with

modalities

special needs

• Intimidation with restrictive

• Interruptions of family life due

modalities

to home care regimen

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Roles/relationships

• Communication

• Self-perception

• Coping

EXPECTED OUTCOMES

The parents will

• Communicate feelings about present situation.

• Participate in their child’s daily care.

• Express feelings of greater control and ability to contribute more

to the child’s well-being.

• Express knowledge of child’s developmental needs.

• Hold, touch, and convey warmth and affection to child.

• Use available support systems or agencies to assist with coping.

SUGGESTED NOC OUTCOMES

Caregiver Adaptation to Patient Institutionalization; Caregiver Care

Readiness; Coping: Family

INTERVENTIONS AND RATIONALES

Determine: Assess the child’s special needs; age and maturity of par-

ents; roles within the family; available support systems for parents;

parent–child relationship; and presence of conflict between family’s

lifestyle and child’s needs. Assessment information will be useful in

establishing appropriate interventions.

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Perform: Make changes in the environment with child-friendly

pictures, and so forth, to foster enhanced communication between

parents and child.

Provide family-centered care by involving the parents in the child’s

care. Parents are responsible for decisions about the child’s care.

Inform: Provide information on informed consent because parents

will be making decisions for child’s care.

Teach parents about normal growth and development and advocate

that they provide as much normalcy for the child with special needs as

possible. Treating them differently will retard progress in socialization.

Teach patient and caregiver the skills necessary to manage care

adequately. Teaching will encourage compliance and adjustment to

optimum wellness.

Teach parents how to find areas in ADLs in which it is possible to

maintain control in order to avoid feelings of powerless.

Teach parents to assist child with self-care activities in a way

that maximizes the child’s potential. This enables caregivers to

participate in child’s care while supporting child’s independence.

Attend: Encourage visit by friends to promote socialization.

Encourage parents to pay attention to needs of siblings at home,

and to discuss with siblings their feelings about having a sister or

brother with special needs. The goal is to have siblings be support-

ive but feel important in their own rites.

Provide respite care to promote emotional well-being of parents.

Encourage patents to spend time away from child to enhance their

marital relationship.

Manage: Act as a liaison between family and multidisciplinary health-

care team to provide support to the patients as they reach out for

help.

Refer parents to home care agencies and ensure that an appropri-

ate assessment is done to encourage long-term support.

Refer parents to a mental health specialist to enable support for the

family members as they continue coping with the child’s special needs.

Arrange for parents to meet with parents who are coping

positively with the same kinds of issues. Peer support will help par-

ents cope with their child’s issues.

SUGGESTED NIC INTERVENTIONS

Family Process Maintenance; Limit Setting; Mutual Goal-Setting;

Parenting Promotion; Role Enhancement

Reference

Secco, M. Loretta, et al. (2006). Factors affecting parenting stress among bio-

logically vulnerable toddlers. Issues in Comprehensive Pediatric Nursing,
29(3), 131–156.

Nursing diagnosis – DECISIONAL CONFLICT

DECISIONAL  CONFLICT

DEFINITION

Uncertainty about course of action to be taken when choice among

competing actions involves risk, loss, or challenge to values and beliefs

DEFINING CHARACTERISTICS

• Delayed decision making

• Focusing on self

• Lack of experience or interference with decision making

• Questioning personal values or beliefs while attempting to make a

decision

• Vacillation between alternative choices

• Verbal statements describing undesirable consequences of alterna-

tive actions being considered

• Verbal expression of distress and uncertainty

RELATED FACTORS

• Divergent sources of informa-

• Lack of relevant information

tion

• Moral obligations require

• Interference with decision

actions

making

• Moral obligations require no

• Lack of experience with deci-

action

sion making

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Roles and relationships

• Values and beliefs

EXPECTED OUTCOMES

The patient will

• State feelings about the current situation.

• Discuss benefits and drawbacks of treatment options.

• Make minor decisions related to daily activities.

• Accept assistance from family, friends, clergy, and other support

persons.

• Report feeling comfortable about ability to make an appropriate,

rational choice.

SUGGESTED NOC OUTCOMES

Decision Making; Information Processing; Participation in

Healthcare Decisions

INTERVENTIONS AND RATIONALES

Determine: Assess major challenges patient will face in making deci-

sions about care, as well as factors that influence patient’s present

decision-making skills. This information will be useful in establishing

appropriate interventions.

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Perform: Arrange patient’s environment to promote relaxation and

comfort while the patient is trying to gain control of decision making.

Assist with self-care activities while patient needs help to ensure

that ADLs are met.

Offer massage to reduce tension and assist patient to relax.
Help patient make decisions about daily activities to enhance her

feelings of control.

Help patient identify available options and possible consequences

to assist with rational, logical decision making.

Inform: Teach techniques for progressive muscle relaxation to

decrease physical and psychological signs of tension.

Attend: Encourage visits with family, friends, and clergy; provide pri-

vacy during visits to foster emotional support.

Encourage patient to express concerns about frustrations in mak-

ing decisions. Take the time to assist the patient to explore or sort

out aspects of decision making that cause him or her difficulty.

Manage: Offer written information, a reading list, or a referral to a

support group to ensure that patient will have reference material

when it is needed.

Refer to home health nurse for a follow-up visit in the home.
Refer to a nutritionist for information on good nutrition and fluid

management.

SUGGESTED NIC INTERVENTIONS

Active Listening; Assertiveness Training; Decision-Making Support;

Learning Facilitation; Mutual Goal-Setting

Reference

Popejoy, L. (2005). Health-related decision-making by older adults and their

families: How clinicians can help. Journal of Gerontological Nursing, 31(9),
12–18.