Nursing Dx

Desired Outcomes/Evaluation
Criteria—Client Will:
• Identify resources within self to deal with situation.
• Provide opportunity for care receiver to deal with situation in own way.
• Express more realistic understanding and expectations of the care receiver.
• Demonstrate behavior/lifestyle changes to cope with and/or resolve problematic factors.
• Report improved general well-being, ability to deal with situation.

Actions/Interventions
NURSING PRIORITY NO. 1. To assess degree of impaired function:
• Inquire about/observe physical condition of care receiver and surroundings as appropriate.
• Assess caregiver’s current state of functioning (e.g., hours of sleep, nutritional intake, personal appearance, demeanor).
• Determine use of prescription/over-the-counter (OTC) drugs, alcohol to deal with situation.
• Identify safety issues concerning caregiver and receiver.
• Assess current actions of caregiver and how they are received by care receiver (e.g., caregiver may be trying to be helpful but is not perceived as helpful; may be too protective or may have unrealistic expectations of care receiver). May lead to misunderstanding and conflict.
• Note choice/frequency of social involvement and recreational activities.
• Determine use/effectiveness of resources and support systems.

NURSING PRIORITY NO. 2. To identify the causative/contributing factors relating to the impairment:
• Note presence of high-risk situations (e.g., elderly client with total self-care dependence, or family with several small children with one child requiring extensive assistance due to physical condition/developmental delays). May necessitate role reversal resulting in added stress or place excessive demands on parenting skills.
• Determine current knowledge of the situation, noting misconceptions, lack of information.May interfere with caregiver/ care receiver response to illness/condition.
• Identify relationship of caregiver to care receiver (e.g., spouse/lover, parent/child, sibling, friend).
• Ascertain proximity of caregiver to care receiver.
• Note physical/mental condition, complexity of therapeutic regimen of care receiver.
• Determine caregiver’s level of responsibility, involvement in and anticipated length of care.
• Ascertain developmental level/abilities and additional responsibilities of caregiver.
• Use assessment tool, such as Burden Interview, when appropriate, to further determine caregiver’s abilities.
• Identify individual cultural factors and impact on caregiver. Helps clarify expectations of caregiver/receiver, family, and community.
• Note co-dependency needs/enabling behaviors of caregiver.
• Determine availability/use of support systems and resources.
• Identify presence/degree of conflict between caregiver/care receiver/family.

• Determine preillness/current behaviors that may be interfering with the care/recovery of the care receiver.

NURSING PRIORITY NO. 3. To assist caregiver in identifying feelings and in beginning to deal with problems:
• Establish a therapeutic relationship, conveying empathy and unconditional positive regard.
• Acknowledge difficulty of the situation for the caregiver/ family.
• Discuss caregiver’s view of and concerns about situation.
• Encourage caregiver to acknowledge and express feelings. Discuss normalcy of the reactions without using false reassurance.
• Discuss caregiver’s/family members’ life goals, perceptions and expectations of self to clarify unrealistic thinking and identify potential areas of flexibility or compromise.
• Discuss impact of and ability to handle role changes necessitated by situation.

NURSING PRIORITY NO. 4. To enhance caregiver’s ability to deal with current situation:
• Identify strengths of caregiver and care receiver.
• Discuss strategies to coordinate caregiving tasks and other responsibilities (e.g., employment, care of children/dependents, housekeeping activities).
• Facilitate family conference to share information and develop plan for involvement in care activities as appropriate.
• Identify classes and/or needed specialists (e.g., first aid/CPR classes, enterostomal/physical therapist).
• Determine need for/sources of additional resources (e.g., financial, legal, respite care).
• Provide information and/or demonstrate techniques for dealing with acting out/violent or disoriented behavior. Enhances safety of caregiver and receiver.
• Identify equipment needs/resources, adaptive aids to enhance the independence and safety of the care receiver.
• Provide contact person/case manager to coordinate care, provide support, assist with problem-solving.

NURSING PRIORITY NO. 5. To promote wellness (Teaching/ Discharge Considerations):
• Assist caregiver to plan for changes that may be necessary (e.g., home care providers, eventual placement in long-term care facility).
• Discuss/demonstrate stress management techniques and importance of self-nurturing (e.g., pursuing self-development interests, personal needs, hobbies, and social activities).
• Encourage involvement in support group.
• Refer to classes/other therapies as indicated.

• Identify available 12-step program when indicated to provide tools to deal with enabling/co-dependent behaviors that impair level of function.
• Refer to counseling or psychotherapy as needed.
• Provide bibliotherapy of appropriate references for self-paced learning and encourage discussion of information.

Documentation Focus
ASSESSMENT/REASSESSMENT
• Assessment findings, functional level/degree of impairment, caregiver’s understanding/perception of situation.
• Identified risk factors.
PLANNING
• Plan of care and individual responsibility for specific activities.
• Needed resources, including type and source of assistive devices/durable equipment.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Caregiver/receiver response to interventions/teaching and actions performed.
• Identification of inner resources, behavior/lifestyle changes to be made.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Plan for continuation/follow-through of needed changes.
• Referrals for assistance/evaluation.