disabled family Coping
Taxonomy II: Coping/Stress Tolerance—Class 2 Coping Responses (00073)
[Diagnostic Division: Social Interaction]
Submitted 1980; Revised 1996
Definition: Behavior of SO (family member or other primary person) that disables his/her capacities and the client’s capacity to effectively address tasks essential to either person’s adaptation to the health challenge.
[Diagnostic Division: Social Interaction]
Submitted 1980; Revised 1996
Definition: Behavior of SO (family member or other primary person) that disables his/her capacities and the client’s capacity to effectively address tasks essential to either person’s adaptation to the health challenge.
Related Factors
Significant person with chronically unexpressed feelings of guilt, anxiety, hostility, despair, and so forth
Significant person with chronically unexpressed feelings of guilt, anxiety, hostility, despair, and so forth
Dissonant discrepancy of coping styles for dealing with adaptive tasks by the significant person and client or among significant people
Highly ambivalent family relationships
Arbitrary handling of a family’s resistance to treatment that tends to solidify defensiveness as it fails to deal adequately with underlying anxiety
[High-risk family situations, such as single or adolescent parent, abusive relationship, substance abuse, acute/chronic disabilities, member with terminal illness]
Defining Characteristics
SUBJECTIVE
[Expresses despair regarding family reactions/lack of involvement]
OBJECTIVE
Intolerance, rejection, abandonment, desertion
Psychosomaticism
Agitation, depression, aggression, hostility
Taking on illness signs of client
Neglectful relationships with other family members
Carrying on usual routines disregarding client’s needs
Neglectful care of the client in regard to basic human needs and/ or illness treatment
Distortion of reality regarding the client’s health problem, including extreme denial about its existence or severity
Decisions and actions by family that are detrimental to economic or social well-being
Impaired restructuring of a meaningful life for self, impaired individualization, prolonged overconcern for client
Client’s development of helpless, inactive dependence
SUBJECTIVE
[Expresses despair regarding family reactions/lack of involvement]
OBJECTIVE
Intolerance, rejection, abandonment, desertion
Psychosomaticism
Agitation, depression, aggression, hostility
Taking on illness signs of client
Neglectful relationships with other family members
Carrying on usual routines disregarding client’s needs
Neglectful care of the client in regard to basic human needs and/ or illness treatment
Distortion of reality regarding the client’s health problem, including extreme denial about its existence or severity
Decisions and actions by family that are detrimental to economic or social well-being
Impaired restructuring of a meaningful life for self, impaired individualization, prolonged overconcern for client
Client’s development of helpless, inactive dependence
Desired Outcomes/Evaluation
Criteria—Family Will:
• Verbalize more realistic understanding and expectations of the client.
• Visit/contact client regularly.
• Participate positively in care of client, within limits of family’s abilities and client’s needs.
• Express feelings and expectations openly and honestly as appropriate.
Criteria—Family Will:
• Verbalize more realistic understanding and expectations of the client.
• Visit/contact client regularly.
• Participate positively in care of client, within limits of family’s abilities and client’s needs.
• Express feelings and expectations openly and honestly as appropriate.
Actions/Interventions
NURSING PRIORITY NO. 1. To assess causative/contributing factors:
• Ascertain preillness behaviors/interactions of the family. Provides comparative baseline.
• Identify current behaviors of the family members (e.g., withdrawal—not visiting, brief visits, and/or ignoring client when visiting; anger and hostility toward client and others; ways of touching between family members, expressions of guilt).
NURSING PRIORITY NO. 1. To assess causative/contributing factors:
• Ascertain preillness behaviors/interactions of the family. Provides comparative baseline.
• Identify current behaviors of the family members (e.g., withdrawal—not visiting, brief visits, and/or ignoring client when visiting; anger and hostility toward client and others; ways of touching between family members, expressions of guilt).
• Discuss family perceptions of situation. Expectations of client and family members may/may not be realistic.
• Note cultural factors related to family relationships that may be involved in problems of caring for member who is ill.
• Note other factors that may be stressful for the family (e.g., financial difficulties or lack of community support, as when illness occurs when out of town). Provides opportunity for appropriate referrals.
• Determine readiness of family members to be involved with care of the client.
• Note cultural factors related to family relationships that may be involved in problems of caring for member who is ill.
• Note other factors that may be stressful for the family (e.g., financial difficulties or lack of community support, as when illness occurs when out of town). Provides opportunity for appropriate referrals.
• Determine readiness of family members to be involved with care of the client.
NURSING PRIORITY NO. 2. To provide assistance to enable family to deal with the current situation:
• Establish rapport with family members who are available. Promotes therapeutic relationship and support for problemsolving solutions.
• Acknowledge difficulty of the situation for the family. Reduces blaming/guilt feelings.
• Active-listen concerns; note both overconcern/lack of concern, which may interfere with ability to resolve situation.
• Allow free expression of feelings, including frustration, anger, hostility, and hopelessness. Place limits on actingout/ inappropriate behaviors to minimize risk of violent behavior.
• Give accurate information to SO(s) from the beginning.
• Act as liaison between family and healthcare providers to provide explanations and clarification of treatment plan.
• Provide brief, simple explanations about use and alarms when equipment (such as a ventilator) is involved. Identify appropriate professional(s) for continued support/problemsolving.
• Provide time for private interaction between client/family.
• Include SO(s) in the plan of care; provide instruction to assist them to learn necessary skills to help client.
• Accompany family when they visit to be available for questions, concerns, and support.
• Assist SO(s) to initiate therapeutic communication with client.
• Refer client to protective services as necessitated by risk of physical harm. Removing client from home enhances individual safety and may reduce stress on family to allow opportunity for therapeutic intervention.
• Establish rapport with family members who are available. Promotes therapeutic relationship and support for problemsolving solutions.
• Acknowledge difficulty of the situation for the family. Reduces blaming/guilt feelings.
• Active-listen concerns; note both overconcern/lack of concern, which may interfere with ability to resolve situation.
• Allow free expression of feelings, including frustration, anger, hostility, and hopelessness. Place limits on actingout/ inappropriate behaviors to minimize risk of violent behavior.
• Give accurate information to SO(s) from the beginning.
• Act as liaison between family and healthcare providers to provide explanations and clarification of treatment plan.
• Provide brief, simple explanations about use and alarms when equipment (such as a ventilator) is involved. Identify appropriate professional(s) for continued support/problemsolving.
• Provide time for private interaction between client/family.
• Include SO(s) in the plan of care; provide instruction to assist them to learn necessary skills to help client.
• Accompany family when they visit to be available for questions, concerns, and support.
• Assist SO(s) to initiate therapeutic communication with client.
• Refer client to protective services as necessitated by risk of physical harm. Removing client from home enhances individual safety and may reduce stress on family to allow opportunity for therapeutic intervention.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Assist family to identify coping skills being used and how these skills are/are not helping them deal with situation.
• Assist family to identify coping skills being used and how these skills are/are not helping them deal with situation.
• Answer family’s questions patiently and honestly. Reinforce information provided by other providers.
• Reframe negative expressions into positive whenever possible. (A positive frame contributes to supportive interactions and can lead to better outcomes.)
• Respect family needs for withdrawal and intervene judiciously. Situation may be overwhelming and time away can be beneficial to continued participation.
• Encourage family to deal with the situation in small increments rather than the whole picture at one time.
• Assist the family to identify familiar things that would be helpful to the client (e.g., a family picture on the wall), especially when hospitalized for long period of time, to reinforce/ maintain orientation.
• Refer family to appropriate resources as needed (e.g., family therapy, financial counseling, spiritual advisor).
• Refer to ND anticipatory Grieving, as appropriate.
• Reframe negative expressions into positive whenever possible. (A positive frame contributes to supportive interactions and can lead to better outcomes.)
• Respect family needs for withdrawal and intervene judiciously. Situation may be overwhelming and time away can be beneficial to continued participation.
• Encourage family to deal with the situation in small increments rather than the whole picture at one time.
• Assist the family to identify familiar things that would be helpful to the client (e.g., a family picture on the wall), especially when hospitalized for long period of time, to reinforce/ maintain orientation.
• Refer family to appropriate resources as needed (e.g., family therapy, financial counseling, spiritual advisor).
• Refer to ND anticipatory Grieving, as appropriate.
Documentation Focus
ASSESSMENT/REASSESSMENT
• Assessment findings, current/past behaviors, including family members who are directly involved and support systems available.
• Emotional response(s) to situation/stressors.
PLANNING
• Plan of care/interventions and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses of individuals to interventions/teaching and
actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Ongoing needs/resources/other follow-up recommendations and who is responsible for actions.
• Specific referrals made.
ASSESSMENT/REASSESSMENT
• Assessment findings, current/past behaviors, including family members who are directly involved and support systems available.
• Emotional response(s) to situation/stressors.
PLANNING
• Plan of care/interventions and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses of individuals to interventions/teaching and
actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Ongoing needs/resources/other follow-up recommendations and who is responsible for actions.
• Specific referrals made.
Tags: Coping/Stress Tolerance
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3 Respones to "disabled family Coping"
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