Nursing Dx

Taxonomy II: Role Relationships—Class 1 Role Performance (00064)
[Diagnostic Division: Social Interaction]
Submitted 1988
Definition: Parent experience of role confusion and conflict in response to crisis

Related Factors
Separation from child because of chronic illness [/disability]
Intimidation with invasive or restrictive modalities (e.g., isolation, intubation); specialized care centers, policies
Home care of a child with special needs (e.g., apnea monitoring, postural drainage, hyperalimentation)
Change in marital status
Interruptions of family life because of home-care regimen (treatments, caregivers, lack of respite)

Defining Characteristics
SUBJECTIVE
Parent(s) express(es) concerns/feeling of inadequacy to provide for child’s physical and emotional needs during hospitalization or in the home
Parent(s) express(es) concerns about changes in parental role, family functioning, family communication, family health
Express(es) concern about perceived loss of control over decisions relating to child
Verbaliz(es) feelings of guilt, anger, fear, anxiety and/or frustrations about effect of child’s illness on family process
OBJECTIVE
Demonstrates disruption in caretaking routines
Reluctant to participate in usual caretaking activities even with encouragement and support
Demonstrates feelings of guilt, anger, fear, anxiety, and/or frustrations about the effect of child’s illness on family process

Desired Outcomes/Evaluation
Criteria—Parent(s) Will:
• Verbalize understanding of situation and expected parent’s/ child’s role.
• Express feelings about child’s illness/situation and effect on family life.

• Demonstrate appropriate behaviors in regard to parenting role.
• Assume caretaking activities as appropriate.
• Handle family disruptions effectively.

Actions/Interventions
NURSING PRIORITY NO. 1. To assess causative/contributory factors:
• Assess individual situation and parent’s perception of/ concern about what is happening and expectations of self as caregiver.
• Note parental status including age and maturity, stability of relationship, other responsibilities. (Increasing numbers of elderly individuals are providing full-time care for young grandchildren whose parents are unavailable or unable to provide care.)
• Ascertain parent’s understanding of child’s developmental stage and expectations for the future to identify misconceptions/ strengths.
• Note coping skills currently being used by each individual as well as how problems have been dealt with in the past. Provides basis for comparison and reference for client’s coping abilities.
• Determine use of substances (e.g., alcohol, other drugs, including prescription medications).May interfere with individual’s ability to cope/problem-solve.
• Assess availability/use of resources, including extended family, support groups, and financial.
• Perform testing such as Parent-Child Relationship Inventory (PCRI) for further evaluation as indicated.

NURSING PRIORITY NO. 2. To assist parents to deal with current crisis:
• Encourage free verbal expression of feelings (including negative feelings of anger and hostility), setting limits on inappropriate behavior.
• Acknowledge difficulty of situation and normalcy of feeling overwhelmed and helpless. Encourage contact with parents who experienced similar situation with child and had positive outcome.
• Provide information, including technical information when appropriate, to meet individual needs/correct misconceptions.
• Promote parental involvement in decision making and care as much as possible/desired. Enhances sense of control.

• Encourage interaction/facilitate communication between parent(s) and children.
• Promote use of assertiveness, relaxation skills to help individuals to deal with situation/crisis.
• Assist parent to learn proper administration of medications/ treatments as indicated.
• Provide for/encourage use of respite care, parent time off to enhance emotional well-being.

NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Provide anticipatory guidance to encourage making plans for future needs.
• Encourage setting realistic and mutually agreed-on goals.
• Provide/identify learning opportunities specific to needs (e.g., parenting classes, equipment use/troubleshooting).
• Refer to community resources as appropriate (e.g., visiting nurse, respite care, social services, psychiatric care/family therapy, well-baby clinics, special needs support services).
• Refer to ND impaired Parenting, for additional interventions.

Documentation Focus
ASSESSMENT/REASSESSMENT
• Findings, including specifics of individual situation/parental concerns, perceptions, expectations.
PLANNING
• Plan of care and who is involved in the planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Parent’s responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs and who is responsible for each action to be taken.
• Specific referrals made.