Nursing Dx

Actions/Interventions
NURSING PRIORITY NO. 1. To assess factors affecting current situation:
• Note presence of high-risk situations (e.g., elderly client with total self-care dependence or 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.
• Identify relationship and proximity of caregiver to care receiver (e.g., spouse/lover, parent/child, friend).
• Note therapeutic regimen and physical/mental condition 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 strengths/weaknesses of caregiver and care receiver.
• Verify safety of caregiver/receiver.
• Discuss caregiver’s and care receiver’s view of and concerns about situation.
• Determine available supports and resources currently used.
• Note any co-dependency needs of caregiver.

NURSING PRIORITY NO. 2. To enhance caregiver’s ability to deal with current situation:
• Discuss strategies to coordinate care and other responsibilities (e.g., employment, care of children/dependents, housekeeping activities).
• Facilitate family conference as appropriate to share information and develop plan for involvement in care activities.
• Refer to classes and/or specialists (e.g., first aid/CPR classes, enterostomal/physical therapist) for special training as indicated.
• Identify additional resources to include financial, legal, respite care.
• Identify equipment needs/resources, adaptive aids to enhance the independence and safety of the care receiver.
• Identify contact person/case manager as needed to coordinate care, provide support, and assist with problem-solving.
• Provide information and/or demonstrate techniques for dealing with acting out/violent or disoriented behavior.
• Assist caregiver to recognize co-dependent behaviors (i.e., doing things for others that others are able to do for themselves) and how these behaviors affect the situation.

NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Stress importance of self-nurturing (e.g., pursuing selfdevelopment interests, personal needs, hobbies, and social activities) to improve/maintain quality of life for caregiver.
• Discuss/demonstrate stress-management techniques.
• Encourage involvement in specific support group(s).
• Provide bibliotherapy of appropriate references and encourage discussion of information.
• Assist caregiver to plan for changes that may become necessary for the care receiver (e.g., home care providers, eventual placement in long-term care facility).
• Refer to classes/therapists as indicated.
• Identify available 12-step program when indicated to provide tools to deal with codependent behaviors that impair level of function.
• Refer to counseling or psychotherapy as needed.

Documentation Focus
ASSESSMENT/REASSESSMENT
• Identified risk factors and caregiver perceptions of situation.
• Reactions of care receiver/family.
PLANNING
• Treatment plan and individual responsibility for specific activities.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Caregiver/receiver response 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 actions to be taken.
• Specific referrals provided for assistance/evaluation.

Taxonomy II: Role Relationships—Class 1 Caregiving Roles (00062)
[Diagnostic Division: Social Interaction]
Submitted 1992
Definition: Caregiver is vulnerable for experiencing difficulty in performing the family caregiver role

Risk Factors
Illness severity of the care receiver; psychological or cognitive problems in care receiver; addiction or co-dependency
Discharge of family member with significant home-care needs; premature birth/congenital defect
Unpredictable illness course or instability in the care receiver’s health
Duration of caregiving required; inexperience with caregiving; complexity/amount of caregiving tasks; caregiver’s competing role commitments
Caregiver health impairment
Caregiver is female/spouse
Caregiver not developmentally ready for caregiver role (e.g., a young adult needing to provide care for middle-aged parent); developmental delay or retardation of the care receiver or caregiver
Presence of situational stressors that normally affect families (e.g., significant loss, disaster or crisis, economic vulnerability, major life events [such as birth, hospitalization, leaving home, returning home, marriage, divorce, change in employment, retirement, death])
Inadequate physical environment for providing care (e.g., housing, transportation, community services, equipment)
Family/caregiver isolation
Lack of respite and recreation for caregiver
Marginal family adaptation or dysfunction prior to the caregiving situation
Marginal caregiver’s coping patterns
History of poor relationship between caregiver and care receiver
Care receiver exhibits deviant, bizarre behavior
Presence of abuse or violence
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—Client Will:
• Identify individual risk factors and appropriate interventions.
• Demonstrate/initiate behaviors or lifestyle changes to prevent development of impaired function.
• Use available resources appropriately.
• Report satisfaction with current situation.