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.