Nursing diagnosis – risk for parent-child attachment

Risk for Impaired Parent-Child Attachment
Disruption of the interactive process between parent/significant other
and child/infant that fosters the development of a protective and
nurturing reciprocal relationship
• Anxiety over parental roles
• Illness in infant that doesn’t
allow initiation of interaction
with parents
• Inability of parents to meet
their personal needs
• Lack of privacy, physical barriers,
separation, substance abuse
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Communication
• Coping
• Emotional status
The parents will
• Initiate positive interaction with child.
• Hold child and talk to him or her.
• Express confidence in their ability to respond to child’s needs.
• Respond appropriately to child.
• Express positive feelings about child.
• Express confidence in their ability to care for child.
• Recognize when they need assistance.
The child will
• Respond positively to parents.
• Show interest in parents’ faces.
• Become calm when soothed by parents.
Parenting Performance; Role Performance
Determine: Assess composition of family and ages of members;
ability of family to meet physical and emotional needs of its members;
knowledge of growth and development patterns; energy levels
of parents; recent life changes; child’s neurological and sensory
status, including vision and hearing; sleep patterns of parents and
child. This information will assist in establishing appropriate interventions.
Perform: Reduce environmental stressors (including people) where it
is possible to observe whether the parents’ responses to the child are
Provide parents and child with periods of privacy to promote
• Role/relationships
• Sleep and rest
• Values and beliefs
Provide physical care to child when appropriate. This may be to
demonstrate to the family the appropriate way to perform ADLs.
Inform: Teach parents to observe and understand behavioral cues
from the child. For example, the child may become fussy when he
or she is ready for a nap or may pull his or her ear if he or she has
an earache. Explain the range of options for responding to these
cues positively. It is important that the parents have a variety of
options made available to them.
Teach parents to give physical care when the needs exist to
increase their self-confidence and self-competence.
Teach relaxation techniques (guided imagery, progressive muscle
relaxation, and meditation) that can be done by the parents to
restore psychological and physical equilibrium by decreasing
autonomic response to anxiety.
Attend: Provide emotional support and encouragement to help
improve parents’ self-concept and self-confidence in parental roles.
Initiate discussions with parents on life changes precipitated by
the birth of the child. Parents are often confused and blame themselves
because the stress of birth causes frustration and anger.
Encourage parents to talk about the kinds of activities that
promote feelings of comfort. Assist parents to create a plan to
engage in at least one of these activities each day. This provides parents
with a sense of control over their own lives.
Make sure parents have clear explanations for everything that is
expected of them. Ask for feedback to ensure parents understand.
Anxiety may impair their cognitive abilities.
Manage: Provide the name of professionals and/or agencies where
parents can receive assistance to continue developing attachment
skills and/or ongoing support. Refer to case manager/social worker
to assess the home environment to enable the parents to make modifications
that will be needed.
Abuse Protection Support: Child; Child Coping Enhancement; Developmental
Enhancement; Parenting
Delaney, K. R. (2006, November). Learning to observe relationships and coping.
Journal of Child and Adolescent Psychiatric Nursing, 19(4), 194–202.

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