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 – risk for caregiver role restrain

RISK  FOR  CAREGIVER  ROLE  STRAIN

DEFINITION

Caregiver is vulnerable for felt difficulty in performing the family

caregiver role

RISK FACTORS

• Not developmentally ready for

• Situational factors, such as

caregiver role (e.g., young
adult who must unexpectedly
care for a middle-age parent)

close relationship between
caregiver and care recipient;
discharge of family member

• Evidence of drug or alcohol

with significant home care

addiction in caregiver or care
recipient, health impairment
of caregiver, severity or unpre-
dictable course of illness, or
instability of care recipient’s
health

needs; inadequate environment
or facilities for providing care;
isolation, inexperience, or
overwork of caregiver; lack of
recreation for caregiver; pres-
ence of abuse or violence;

• Evidence of codependency;

simultaneous occurrence of

deviant, bizarre behavior of care
recipient; dysfunctional family
coping patterns that existed
before the caregiving situation

other events that cause stress
for family (significant personal
loss, natural disaster, economic
hardship, or major life events)

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Neurocognition

• Coping

• Role/relationships

• Knowledge

EXPECTED OUTCOMES

The caregiver will

• Identify current stressors.

• Identify appropriate coping strategies and will state plans to incor-

porate strategies into daily routine.

• State intention to contact formal and informal sources of support.

• State intention to incorporate recreational activities into daily rou-

tine.

• Report satisfaction with ability to cope with stress caused by care-

giving responsibilities.

SUGGESTED NOC OUTCOMES

Caregiver Emotional Health; Caregiver Home Care Readiness; Care-

giver Lifestyle Disruption; Caregiver–Patient Relationship; Caregiver

Physical Health; Caregiver Stressors; Caregiving Endurance Potential;

Rest

INTERVENTIONS AND RATIONALES

Determine: Help caregiver identify current stressors. Ask whether

stress is likely to increase or decrease in the future to evaluate the

risk of caregiver role strain.

Attend: Encourage caregiver to discuss coping skills used to

overcome similar stressful situations in the past to bolster caregiver’s

confidence in ability to manage current situation and explore ways

to apply coping strategies before caregiver becomes overwhelmed.

Help caregiver identify formal and informal sources of support,

such as home health agencies, municipal or county social services,

hospital social workers, physicians, clinics and day-care centers, fam-

ily members, friends, church groups, and community volunteers, to

plan for an occasional or regularly scheduled respite.

Encourage caregiver to discuss hobbies or diversional activities.

Incorporating enjoyable activities into the daily or weekly schedule

will discipline caregiver to take needed breaks from caregiving

responsibilities and thereby diminish stress.

Encourage caregiver to participate in a support group. Provide infor-

mation on organizations such as Alzheimer’s Association and Children

of Aging Parents to foster mutual support and provide an outlet for

expressing feelings before frustration becomes overwhelming.

If caregiver seems overly anxious or distraught, gently point out

facts about care recipient’s mental and physical condition. Many

times a caregiver’s perspective is clouded by a long history of emo-

tional involvement. Your input may help caregiver view the situation

more objectively. Suggest ways for caregiver to use time efficiently.

Better time management may help caregiver reduce stress.

Manage: If you believe that excessive emotional involvement is hin-

dering caregiver’s ability to function, consider recommending Code-

pendents Anonymous to provide support.

SUGGESTED NIC INTERVENTIONS

Caregiver Support; Home Maintenance Assistance; Referral; Respite

Care; Role Enhancement; Support Group

Reference

Perren, S., et al. (2006, September). Caregivers’ adaptation to change: The

impact of increasing impairment of persons suffering from dementia on
their caregivers’ subjective well-being. Aging and Mental Health, 10(5),
539–548.

Nursing diagnosis – caregiver role restrain

Caregiver Role Restrain

DEFINITION

Difficulty in performing a family caregiver role

DEFINING CHARACTERISTICS

• Difficulty performing/completing required tasks

• Preoccupation with care routine

• Apprehension about care receiver’s health and caregivers’ ability to

provide care

• Fate of the care receiver if the caregiver becomes ill or dies, or the

possible institutionalization of care receiver

• Caregiver–care receiver relationship: grief or uncertainty regarding

changed relationship with care receiver

• Difficulty with watching care receiver experience the illness

RELATED FACTORS

• Care receiver health status

• Caregiving activities

• Caregiver health status

• Family processes

• Caregiver–care receiver

• Resources

relationship

• Socioeconomic

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior    •  Neurocognition

• Coping    •  Role/relationships

• Emotional    •  Support systems

• Home environment

EXPECTED OUTCOMES

The caregiver will

• Describe current stressors.

• Identify stressors that can and can’t be controlled.

• Identify formal and informal sources of support.

• Show evidence of using support systems.

• Report increased ability to cope with stress.

SUGGESTED NOC OUTCOMES

Caregiver Emotional Health; Caregiver Lifestyle Disruption;

Caregiver Stressors; Caregiver Well-Being; Caregiving Endurance

Potential

INTERVENTIONS AND RATIONALES

Determine: Help caregivers identify current stressors to evaluate the

causes of role strain.

Perform: Provide care, as indicated, to give caregivers respite.

Inform: Suggest ways for caregivers to use time more efficiently. For

example, caregiver may save time by filling out insurance forms

while visiting and chatting with care recipient. Better time manage-

ment may help caregiver reduce stress.

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Attend: Using a nonjudgmental approach, help caregiver evaluate

which stressors are controllable and which aren’t to begin to

develop strategies to reduce stress.

Encourage caregiver to discuss coping skills used to overcome sim-

ilar stressful situations in the past to build confidence for managing

the current situation.

Encourage caregiver to participate in a support group. Provide

information on organizations such as Alzheimer’s Association, Chil-

dren of Aging Parents, or the referral service of the community-

acquired immunodeficiency syndrome task force to foster mutual

support and provide an opportunity for caregiver to discuss personal

feelings with empathetic listeners.

Help caregiver identify informal sources of support, such as family

members, friends, church groups, and community volunteers, to pro-

vide resources for obtaining an occasional or regularly scheduled

respite.

Help caregiver identify available formal support services, such as

home health agencies, municipal or county social services, hospital

social workers, physicians, clinics, and day-care centers, to enhance

coping by providing a reliable structure for support.

If caregiver seems overly anxious or distraught, gently point out

facts about care recipient’s mental and physical condition. Many

times, especially when care recipient is a family member, caregiver’s

perspective is clouded by a long history of emotional involvement.

Your input may help caregiver view the situation more objectively.

Manage: If you believe that excessive emotional involvement is hin-

dering caregiver’s ability to function, consider recommending Code-

pendents Anonymous, a support group for people whose preoccupa-

tion with a relationship leads to chronic suffering and diminished

effectiveness, to provide support.

SUGGESTED NIC INTERVENTIONS

Active Listening; Caregiver Support; Coping Enhancement; Counsel-

ing; Role Enhancement; Support Group

Reference

Schumacher, K., et al. (2006, August). Family caregivers: Caring for older

adults, working with their families. American Journal of Nursing, 106(8),
40–49.