risk for impaired parent/infant/ child Attachment
Taxonomy II: Role Relationships—Class 2 Family Relationships (00058)
[Diagnostic Division: Social Interaction] Submitted 1994
[Diagnostic Division: Social Interaction] Submitted 1994
Definition: Disruption of the interactive process between parent/SO and infant that fosters the development of a protective and nurturing reciprocal relationship
Risk Factors
Inability of parents to meet personal needs
Anxiety associated with the parent role
Substance abuse
Premature infant; ill infant/child who is unable to effectively initiate parental contact due to altered behavioral organization
Separation; physical barriers
Lack of privacy
[Parents who themselves experienced altered attachment]
[Uncertainty of paternity; conception as a result of rape/sexual abuse]
[Difficult pregnancy and/or birth (actual or perceived)]
Inability of parents to meet personal needs
Anxiety associated with the parent role
Substance abuse
Premature infant; ill infant/child who is unable to effectively initiate parental contact due to altered behavioral organization
Separation; physical barriers
Lack of privacy
[Parents who themselves experienced altered attachment]
[Uncertainty of paternity; conception as a result of rape/sexual abuse]
[Difficult pregnancy and/or birth (actual or perceived)]
NOTE: A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
Desired Outcomes/Evaluation
Criteria—Parent Will:
• Identify and prioritize family strengths and needs.
• Exhibit nurturant and protective behaviors toward child.
• Identify and use resources to meet needs of family members.
• Demonstrate techniques to enhance behavioral organization of the infant/child.
• Engage in mutually satisfying interactions with child.
Criteria—Parent Will:
• Identify and prioritize family strengths and needs.
• Exhibit nurturant and protective behaviors toward child.
• Identify and use resources to meet needs of family members.
• Demonstrate techniques to enhance behavioral organization of the infant/child.
• Engage in mutually satisfying interactions with child.
Actions/Interventions
NURSING PRIORITY NO.1. To identify causative/contributing factors:
• Interview parents, noting their perception of situation, individual concerns.
• Assess parent/child interactions.
• Ascertain availability/use of resources to include extended family, support groups, and financial.
• Evaluate parents’ ability to provide protective environment, participate in reciprocal relationship.
NURSING PRIORITY NO.1. To identify causative/contributing factors:
• Interview parents, noting their perception of situation, individual concerns.
• Assess parent/child interactions.
• Ascertain availability/use of resources to include extended family, support groups, and financial.
• Evaluate parents’ ability to provide protective environment, participate in reciprocal relationship.
NURSING PRIORITY NO.2. To enhance behavioral organization of infant/child:
• Identify infant’s strengths and vulnerabilities. Each child is born with his or her own temperament that affects interactions with caregivers.
• Educate parents regarding child growth and development, addressing parental perceptions. Helps clarify realistic expectations.
• Identify infant’s strengths and vulnerabilities. Each child is born with his or her own temperament that affects interactions with caregivers.
• Educate parents regarding child growth and development, addressing parental perceptions. Helps clarify realistic expectations.
• Assist parents in modifying the environment to provide appropriate stimulation.
• Model caregiving techniques that best support behavioral organization.
• Respond consistently with nurturance to infant/child.
• Model caregiving techniques that best support behavioral organization.
• Respond consistently with nurturance to infant/child.
NURSING PRIORITY NO.3. To enhance best functioning of parents:
• Develop therapeutic nurse-client relationship. Provide a consistently warm, nurturant, and nonjudgmental environment.
• Assist parents in identifying and prioritizing family strengths and needs. Promotes positive attitude by looking at what they already do well and using those skills to address needs.
• Support and guide parents in process of assessing resources.
• Involve parents in activities with the infant/child that they can accomplish successfully. Enhances self-concept.
• Recognize and provide positive feedback for nurturant and protective parenting behaviors. Reinforces continuation of desired behaviors.
• Minimize number of professionals on team with whom parents must have contact to foster trust in relationships.
• Develop therapeutic nurse-client relationship. Provide a consistently warm, nurturant, and nonjudgmental environment.
• Assist parents in identifying and prioritizing family strengths and needs. Promotes positive attitude by looking at what they already do well and using those skills to address needs.
• Support and guide parents in process of assessing resources.
• Involve parents in activities with the infant/child that they can accomplish successfully. Enhances self-concept.
• Recognize and provide positive feedback for nurturant and protective parenting behaviors. Reinforces continuation of desired behaviors.
• Minimize number of professionals on team with whom parents must have contact to foster trust in relationships.
NURSING PRIORITY NO.4. To support parent/child attachment during separation:
• Provide parents with telephone contact as appropriate.
• Establish a routine time for daily phone calls/initiate calls as indicated. Provides sense of consistency and control; allows for planning of other activities.
• Invite parents to use Ronald McDonald House or provide them with a listing of a variety of local accommodations, restaurants when child is hospitalized out of town.
• Arrange for parents to receive photos, progress reports from the child.
• Suggest parents provide a photo and/or audiotape of themselves for the child.
• Consider use of contract with parents to clearly communicate expectations of both family and staff.
• Suggest parents keep a journal of infant/child progress.
• Provide “homelike” environment for situations requiring supervision of visits.
• Provide parents with telephone contact as appropriate.
• Establish a routine time for daily phone calls/initiate calls as indicated. Provides sense of consistency and control; allows for planning of other activities.
• Invite parents to use Ronald McDonald House or provide them with a listing of a variety of local accommodations, restaurants when child is hospitalized out of town.
• Arrange for parents to receive photos, progress reports from the child.
• Suggest parents provide a photo and/or audiotape of themselves for the child.
• Consider use of contract with parents to clearly communicate expectations of both family and staff.
• Suggest parents keep a journal of infant/child progress.
• Provide “homelike” environment for situations requiring supervision of visits.
NURSING PRIORITY NO.5. To promote wellness (Teaching/ Discharge Considerations):
• Refer to addiction counseling/treatment, individual counseling, or family therapies as indicated.
• Identify services for transportation, financial resources, housing, and so forth.
• Develop support systems appropriate to situation (e.g., extended family, friends, social worker).
• Refer to addiction counseling/treatment, individual counseling, or family therapies as indicated.
• Identify services for transportation, financial resources, housing, and so forth.
• Develop support systems appropriate to situation (e.g., extended family, friends, social worker).
• Explore community resources (e.g., church affiliations, volunteer groups, day/respite care).
Documentation Focus
ASSESSMENT/REASSESSMENT
• Identified behaviors of both parents and child.
• Specific risk factors, individual perceptions/concerns.
• Interactions between parent and child.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Parents’/child’s responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcomes.
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs and who is responsible.
• Plan for home visits to support parents and to ensure infant/ child safety and well-being.
• Specific referrals made.
ASSESSMENT/REASSESSMENT
• Identified behaviors of both parents and child.
• Specific risk factors, individual perceptions/concerns.
• Interactions between parent and child.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Parents’/child’s responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcomes.
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs and who is responsible.
• Plan for home visits to support parents and to ensure infant/ child safety and well-being.
• Specific referrals made.
Tags: nursing diagnoses, risk
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