Nursing diagnosis – READINESS FOR ENHANCED FAMILY PROCESSES

READINESS  FOR  ENHANCED

FAMILY  PROCESSES

DEFINITION

A pattern of family functioning that is sufficient to support the well-

being of family members and can be strengthened

DEFINING CHARACTERISTICS

• Activities support the growth of family members

• Activities support the safety of family members

• Balance exists between autonomy and cohesiveness

• Boundaries of family members are maintained

• Energy level of family supports ADLs

• Family adapts to change

• Relationships are generally positive

• Respect for family members is positive

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Roles/relationship

• Coping

• Communication

• Values/beliefs

EXPECTED OUTCOMES

Family members will

• Identify family goals and structured directions.

• Express enjoyment and satisfaction with their roles in the family.

• Express a willingness to enhance roles in family dynamics.

• Participate regularly in traditional family activities.

• Maintain open and positive communication.

• Maintain a safe home environment.

• Seek regular health screenings and immunizations.

• Identify and acknowledge family risk factors.

• Make plans to deal with life changes and events.

SUGGESTED NOC OUTCOMES

Family Coping; Family Functioning; Family Health Status; Family

Integrity; Family Normalization; Family Social Climate

INTERVENTIONS AND RATIONALES

Determine: Assess family composition, roles within the family,

communication patterns, family developmental stages, developmen-

tal tasks, health patterns, coping mechanisms, socioeconomics,

educational levels, ethnicity, and cultural and religious beliefs.

Assessment information helps identify appropriate interventions.

Perform: Establish an environment in which family members can

openly share their issues and concerns in comfort to reduce anxiety

and develop their ability to resolve problems.

Inform: Explain importance of setting goals as a method of estab-

lishing boundaries that will be respected by all family members.

Family functioning with structural direction will enhance the poten-

tial to meet physical, social, and psychological needs.

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Show family how to develop a Genogram to identify genetic risk

factors. Information from the Genogram will highlight things that

can modify a family’s health patterns, lead to early identification of

genetically related diseases, and may delay onset of disease.

Teach value of daily exercise, well-balanced diet, and use of

proven holistic strategies to improve health.

Provide family with information on recommended health screen-

ings and immunization schedules. It is essential to keep immuniza-

tions given according to schedule to prevent loss of immunity.

Attend: Encourage family members to identify individual and family

goals and a structured direction toward sound health habits for the

entire family. Developing a structured plan will assist in having

everyone work together toward goals set by the family for

themselves.

Involve family in planning and decision making. Having the abil-

ity to participate encourages greater compliance with the plan.

Encourage family to spend time together enjoying traditional

activities that everyone likes doing to promote a healthy lifestyle and

encourage strong family unity.

Manage: Refer, where requested, for follow-up for a family member

who needs exercise, weight management, diet assistance, health

screenings, and so forth. Providing referrals will help to provide

continuity of care for the patient.

SUGGESTED NIC INTERVENTIONS

Family Support; Family Integrity Promotion; Family Maintenance

Reference

Yanaka, L., et al. (2007, January–February). Barriers to screening for domestic

violence in the emergency departments. Journal of Continuing Education in
Nursing, 38(1), 37–45.

Nursing diagnosis – INTERRUPTED FAMILY PROCESSES

INTERRUPTED  FAMILY  PROCESSES

DEFINITION

Change in family relationship or functioning

DEFINING CHARACTERISTICS

Changes in:

• Assigned tasks

• Availability for affective responses and/or emotional support

• Communication patterns

• Effectiveness in completing assigned tasks

• Expressions of conflict within family and/or community resources

• Expressions of isolation from community resources

• Intimacy

• Participation in problem solving and/or decision making

• Stress-reduction behaviors

RELATED FACTORS

• Developmental crises

• Modification in family finances

• Developmental transition

• Modification in family social

• Family role shift

status

• Interaction with community

• Situational transition

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Emotional

• Coping

• Roles/relationship

EXPECTED OUTCOMES

Family members will

• Not experience physical, verbal, emotional, or sexual abuse.

• Communicate clearly, honestly, consistently, and directly.

• Establish clearly defined roles and equitable responsibilities.

• Express understanding of rules and expectations.

• Report the methods of problem solving and resolving conflicts

have improved.

• Report a decrease in the number and intensity of family crises.

• Seek ongoing treatment.

SUGGESTED NOC OUTCOMES

Family Coping; Family Functioning; Family Normalization; Social

Interaction Skills; Substance Addiction Consequences

INTERVENTION AND RATIONALES

Determine: Assess family’s developmental stage, roles, rules, socioeco-

nomic status, health history, history of substance abuse; history of sex-

ual abuse of spouse or children, problem-solving and decision-making

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skills, and patterns of communication. Assessment information will

provide development of appropriate interventions.

Perform: Meet with family members to establish levels of authority

and responsibility in the family. Understanding the family dynamics

provides information about the kinds of support the family needs to

work with the patient’s issues.

Create an environment in which family members can express

themselves openly and honestly to build trust and self-esteem.

Establish rules for communication during meetings with the family

to assist family members to take responsibility for their own behavior.

Inform: Teach family members basic communication skills to enable

them to discuss issues in a positive way. Have them role-play with

one another numerous times to demonstrate what has been learned.

Involve the family in exercises to reduce stress and deal with

anger.

Attend: Hold adults accountable for their alcohol or substance abuse

and have them sign a “Use contract” to decrease denial, increase

trust, and promote positive change.

Involve patient in planning and decision making. Having the abil-

ity to participate will encourage greater compliance with the plan.

Assist family to set limits on abusive behaviors and have them

sign “Abuse contracts” to foster feelings of safety and trust.

Manage: Refer to case manager/social worker to ensure that a home

assessment is done.

Refer to support groups that deal with substance abuse, domestic

violence, or sexual abuse depending on the needs of the patient

and/or family to enhance interpersonal skills and strengthen the fam-

ily unit.

Provide all appropriate phone numbers so that the family

members can initiate whatever follow-up is needed.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Family Integrity Promotion; Family Process

Maintenance; Family Support; Normalization Promotion; Substance

Use Prevention; Substance Use Treatment

Reference

Yonaka, L., et al. (2007, January–February). Barriers to screening for domestic

violence in the emergency department. Journal of Continuing Education for
Nursing, 38(1), 37–45.

Nursing diagnosis – DYSFUNCTIONAL FAMILY PROCESSES ALCOHOLISM

DYSFUNCTIONAL  FAMILY  PROCESSES:

ALCOHOLISM

DEFINITION

Psychosocial, spiritual, and physiological functions of the family unit

are chronically disorganized, which leads to conflict, denial of prob-

lems, resistance to change, ineffective problem solving, and a series

of self-perpetuating crises

DEFINING CHARACTERISTICS

• Alcohol abuse; agitation; blaming; broken promises

• Deficient knowledge about alcoholism

• Denial of problems; difficulty with intimate relationships

• Enabling to maintain alcoholic drinking pattern

• Rationalization; moodiness; rejection; tension

• Triangulating family relationships

• Marital problems; ineffective spousal communication

RELATED FACTORS

• Abuse of alcohol

• Family history of alcoholism

• Addictive personality

• Family history of resistance to

• Biochemical influences

treatment

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Communication

• Emotional

• Knowledge

• Coping

• Self-perception

• Values and beliefs

EXPECTED OUTCOMES

Family members will

• Acknowledge there is a problem with alcoholism within the family.

• Sign contracts stating they will not engage in abusive behavior.

• Communicate their needs, using “I” statements.

• Discuss problems in an open, safe environment.

• Acknowledge their strengths and progress in resolving problems.

• State plans to continue to seek counseling and attend appropriate

support group meetings.

SUGGESTED NOC OUTCOMES

Family Coping; Family Functioning; Family Normalization; Role

Performance; Substance Abuse Consequences

INTERVENTIONS AND RATIONALES

Determine: Assess drinking pattern; use of other substances; patterns

of withdrawal; ability of alcoholic member to function in

occupational and familial roles; ability of family members to func-

tion in their roles; family health history; affiliation with a religious

group and religious practices. Assessment factors will assist in identi-

fying appropriate interventions.

Perform: Create an environment in which family members feel free

to express themselves honestly about the present situation to

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decrease their anxiety and help family members develop confidence

in their ability to resolve problems.

Inform alcoholic family member that he will have to acknowledge

his alcoholism before progress can be made in rebuilding family

relations to establish abstinence as a basis for treatment.

Inform: Teach family members to communicate their needs

assertively. Have them practice using “I” statements to express feel-

ings to help them get in touch with their feelings.

Inform patient and family about the symptoms and effects of addic-

tive behaviors on both the patient and the family to help them under-

stand the role they play in both the disease and the recovery process.

Do interactive planning and role-playing with the patient and

family to help them gain the skills needed to effect necessary

changes in communication patterns in the family. Role-playing helps

create a realistic view of the behaviors that reinforce behaviors in

themselves and the patient.

Attend: Encourage family members to acknowledge that alcoholism is

a problem within the family in order to break through family denial.

Ask alcoholic family member to sign a contract stating he will

abstain from alcohol to help him take responsibility for his own

behavior.

Help family members evaluate the consequences of abusive and vio-

lent behavior. Inform them that any suspected abuse will be reported.

Ask family members to sign contracts so they will not continue to

abuse one another to make them take responsibility for their behavior.

Being able to identify strengths provides the confidence the family

needs to continue working toward a positive outcome for both

patient and family.

Assist family members to identify their strengths and talk about

progress they have made in resolving problems associated with alco-

holism or living with a family member who has alcoholism.

Provide additional emotional support to the head of the family

about altered role and additional responsibility to build self-esteem.

Manage: Refer family for continued family therapy so they can con-

tinue the process of restructuring their lives.

Refer patient and family to AA, Alanon, or other appropriate sup-

port group to establish the importance of abstinence.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Family Process Maintenance; Family Support;

Substance Use Prevention; Substance Use Prevention

Reference

Fowler, T. L. (2006, July). Alcohol dependence and depression: Advanced

nursing interventions. Journal of the American Academy of Nurse
Practitioners, 18(7), 303–308.

Nursing diagnosis – READINESS FOR ENHANCED FAMILY COPING

READINESS  FOR  ENHANCED

FAMILY  COPING

DEFINITION

Effective management of adaptive tasks by family member involved

with the client’s health challenge, who now exhibits desire and

readiness for enhanced health and growth in regard to self and in

relation to the client

DEFINING CHARACTERISTICS

• Individual expresses interest in making contact with others who

have experienced a similar situation.

• Family member attempts to describe growth impact of crisis.

• Family member moves in direction of enriching lifestyle.

• Family member moves in direction of health promotion.

• Individual chooses experiences that optimize wellness.

RELATED FACTORS

• Adaptive tasks effectively addressed to enable goals of self-

actualization to surface

• Needs sufficiently gratified to enable goals of self-actualization

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Emotional status

• Coping

• Roles/responsibilities

EXPECTED OUTCOMES

Family members will

• Discuss the impact of patient’s illness and feelings about it with

healthcare professional.

• Participate in treatment plan.

• Establish a visiting routine beneficial to the patient.

• Demonstrate the care needed to maintain patient’s health status.

• Identify and use available support systems.

SUGGESTED NOC OUTCOMES

Caregiver–Patient Relationship; Caregiver Well-Being; Family

Coping; Family Normalization; Health-Promoting Behavior

INTERVENTIONS AND RATIONALES

Determine: Assess normal pattern of communication among family

members; understanding and knowledge of family members about

patient’s condition; family’s past response to crises; patient’s percep-

tion of health problem. Assess patient and family’s spiritual needs,

including religious beliefs and affiliation. Assessment of these factors

will assist in selecting appropriate interventions.

Perform: Schedule time to meet with family and patient in order to

listen to ways in which they plan to enhance their coping skills in

the present situation.

Provide comfort measures such as bathing, massage, regulation of

environmental temperature, and mouth care, according to the

97

patient’s needs and preferences. Comfort can promote ability to

cooperate with the plan.

Establish a visiting schedule that will not tax patient’s or family’s

resources. Use patient’s daily routine to aid in planning (e.g., no vis-

iting during treatments or during periods of uninterrupted rest).

Establishing a routine will allow the patient have consistency and a

measure of control.

Inform: Teach self-healing techniques to patient and family such as

meditation, guided imagery, yoga, and prayer. These strategies pro-

mote anxiety reduction.

Teach patient how to incorporate the use of self-healing

techniques in carrying out usual daily activities in order to encour-

age ongoing use of the strategies.

Demonstrate procedures and encourage participation in patient’s

care in a way that maximizes patient’s comfort. Both patient and

family need to work together to implement the plan with patient’s

comfort in mind.

Provide patient with concise information about condition. Be

aware of what family members already know. Honesty is important

when conveying information.

Attend: Reinforce family’s efforts to care for patient. Let family

know they are doing well to ease adaptation to new caregiver roles.

Ensure privacy for patient and family visits to foster open

communication.

Encourage family to support patient’s independence. Encourage

patient’s cooperation as you continue with healing techniques, such

as therapeutic touch. There is a need to allow for as much independ-

ence on the part of the patient as possible. At times the family will

try to promote dependency to the detriment of the patient.

Provide emotional support to family by being available to answer

questions. Availability will communicate to the family that you are

concerned for them and the patient.

Manage: Refer family to community resources and support groups

available to assist in managing patient’s illness and providing emo-

tional and financial assistance to caregivers.

Refer to a member of the clergy or a spiritual counselor, accord-

ing to the patient’s preference, to show respect for the patient’s

beliefs and provide spiritual care.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Family Process Management

Reference

Nelson, J. E., et al. (2005, March). When critical illness becomes chronic: Infor-

mational needs of patient and family. Journal of Critical Care, 20(1), 79–89.

Nursing diagnosis – DISABLED FAMILY COPING

DISABLED  FAMILY  COPING

DEFINITION

Behavior of significant person (family members or other primary per-

son) that disables his or her capabilities and the patient’s capabilities

to effectively address tasks essential to either person’s adaptation to

the health challenge

DEFINING CHARACTERISTICS

• Intolerance

• Distortion of reality regarding

• Agitation, depression, aggres-

patient

sion, hostility

• Impaired restructuring of a

• Taking on illness of patient

meaningful life

• Rejection

RELATED FACTORS

• Arbitrary handling of family’s

• Significant person with chroni-

resistance to treatment

cally unexpressed feelings (e.g.,

• Dissonant coping styles among

guilt, anxiety, hostility,

significant people

despair)

• Basic breast-feeding knowledge

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Knowledge

• Coping

• Values and beliefs

EXPECTED OUTCOMES

To the extent possible, family members will participate in aspects of

patient’s care without evidence of increased conflict.

The patient will

• Express confidence in his or ability to make decisions despite pres-

sure from family members.

• Contact appropriate sources of support outside the family.

• Take steps to ensure that care needs are met despite family’s short-

comings.

• Express greater understanding of emotional limitations of family

members.

SUGGESTED NOC OUTCOMES

Caregiver Emotional Health; Caregiver–Patient Relationship; Care-

giving Endurance Potential; Family Coping

INTERVENTIONS AND RATIONALES

Determine: Assess effects of patient’s disease on ability of family to

cope to identify strengths and weaknesses in patient’s patterns of

coping.

Describe role relationships in the family. Evaluate changes that

occur in family relationships during the course of the patient’s hos-

pitalization. This information will be helpful in making a plan.

87
Have patient identify support systems outside the family to encour-

age responsibility for knowing what support systems are helpful.

Perform: Engage family in assisting with physical aspects of patient

care. Family members should have an opportunity to overcome dys-

functional behavior.

Develop short- and long-term goals with both patient and family.
Problems associated with coping may will require long-term plan-

ning to resolve.

Inform: Teach patient strategies to discuss, to confront in a positive

way that will help cope with the present situation. Role-play coping

strategies with the patient to reinforce new adaptive behaviors.

Educate family members about resources in the community that

can assist them with the patient after hospitalization.

Teach patient decision-making skills and assist him or her to prac-

tice with simple decisions. Beginning with simple decisions will

begin helping the patient lay out options before deciding.

Attend: Maintain objectivity when dealing with family conflicts. Do

not become embroiled in the dynamics of a dysfunctional family in

order to maintain objectivity and effectiveness.

Focus on being a patient advocate. Reaffirm patient’s right to

make decisions without interference from family members. Encour-

age patient to seek help family cannot provide by participating in

support group.

Help patient select a support group that best meets personal

needs. Participation in a support group may improve the patient’s

ability to cope as well as provide meaningful relationships.

Listen attentively to patient’s expression of pain over unresolved

conflicts with family members. The patient may have to grieve over

the fact that he or she does not have an “ideal” family, capable of

meeting his emotional needs. Therapeutic listening helps patient to

understand himself and his family better and to understand how

conflicts from the past affect his behavior.

Manage: Refer patient to a home health agency, homemaker service,

meals-on-wheels, or other appropriate community services for assis-

tance and follow-up. Use of various community services may help

make up the family’s shortcomings in coping.

SUGGESTED NIC INTERVENTIONS

Anger Control Assistance; Caregiver Support; Family Involvement

Promotion; Family Mobilization; Family Support

Reference

Andershed, B. (2006, September). Relatives in end-of-life care, Part 1: A sys-

tematic review of the literature the last five years, January, 1999–February,
2004. Journal of Clinical Nursing, 15(9), 1158–1169.

Nursing diagnosis – COMPROMISED FAMILY COPING

COMPROMISED  FAMILY  COPING

DEFINITION

Usually supportive primary person (family member or close friend)

provides insufficient, ineffective, or compromised support, comfort,

assistance, or encouragement that may be needed by the patient to

manage or master adaptive tasks related to health challenge

DEFINING CHARACTERISTICS

• Attempts to assist the patient with unsatisfactory results

• Displays of protective behavior disproportionate to the patient’s

abilities or need for autonomy (family member)

• Expresses concern about the family’s response to health problem

• Reports preoccupation with personal reaction to the patient’s

health

RELATED FACTORS

• Exhaustion of supportive

• Lack of reciprocal support

capacity of significant people

• Temporary preoccupation by a

• Incorrect information by a pri-

significant person

mary person

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Coping

• Communication

• Emotional status

EXPECTED OUTCOMES

The family members will

• Assume responsibility for roles and activities formerly held by the

patient.

• Express feelings about assuming responsibility of care for an older

family member.

The patient and family members will

• Identify and make use of appropriate community services.

• Express satisfaction with improved ability to cope with current crisis.

SUGGESTED NOC OUTCOMES

Caregiver Emotional Health; Caregiver–Patient Relationship; Care-

giver Stressors; Family Coping; Family Normalization

INTERVENTIONS AND RATIONALES

Determine: Identify the primary caregiver in family and assess roles

of other family members. Determine usual coping mechanisms

employed by this patient and family. Describe patterns of communi-

cation used in problem solving. Identify what support systems exist

for the family and patient outside the family. Identify strengths and

weakness in the family’s communication patterns. Assessment data

will assist with establishment of interventions.

Perform: Direct development of short- and long-term goals by the

patient and family members. Initially, the family members will need

83

help from the caregiver until they understand more about the

process of planning.

Identify appropriate community services for the family to assist

with coping.

Inform: Educate patient and family members about the process of

aging to assist patient and family to understand how changes in the

patient have affected the family.

Teach family members ways of maximizing the use of coping

strategies that seem to have worked for them in the past. Teach new

coping strategies and have family members role model them. Prac-

tice will help the family practice the behaviors in real situations.

Attend: Avoid becoming involved in a power struggle between

patient and family members. The patient may no longer be able to

fill ordinary roles and the sudden shift in roles may lead to a power

struggle.

Encourage family members to express feelings about caring for an

older family member. Be nonjudgmental when listening to the

family; discuss the issues associated with caring for an older person.

If the nurse is judgmental, the family members may not be comfort-

able discussing their problem.

Provide emotional support for primary caregiver. Some families

may hesitate to accept outside help. Other families may be unwilling

to make even small sacrifices to care for an older family member. If

family members have not been supportive or caring for the elder

member before, they are unlikely to change.

Manage: Refer to community agencies (e.g., adult day care, respite

care, and geriatric outreach services) that can assist the family in

caring for the elder. Communicate to the hospice nurse where the

patient is at present in coping with the terminal illness.

Refer to case manager or social service to assist with ongoing

coordination of the patient’s needs after hospitalization.

Refer to a member of the clergy or a spiritual counselor when

deemed appropriate. Patients will often be more inclined to talk to a

spiritual counselor.

SUGGESTED NIC INTERVENTIONS

Caregiver Support; Coping Enhancement; Family Involvement

Promotion; Respite Care

Reference

Garity, J. (2006). Caring for a family member with Alzheimer’s disease: Cop-

ing with caregiver burden post-nursing home placement. Journal of Geron-
tological Nursing, 32(6), 39–48.