The Current State of Nursing Education
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compromised family Coping - Outcome, Intervention, Documentation
compromised family Coping - Outcome, Intervention, Documentation
Desired Outcomes/Evaluation
Criteria—Family Will:
• Identify/verbalize resources within themselves to deal with the situation.
• Interact appropriately with the client, providing support and assistance as indicated.
• Provide opportunity for client to deal with situation in own way.
• Verbalize knowledge and understanding of illness/disability/ disease.
Criteria—Family Will:
• Identify/verbalize resources within themselves to deal with the situation.
• Interact appropriately with the client, providing support and assistance as indicated.
• Provide opportunity for client to deal with situation in own way.
• Verbalize knowledge and understanding of illness/disability/ disease.
• Express feelings honestly.
• Identify need for outside support and seek such.
• Identify need for outside support and seek such.
Actions/Interventions
NURSING PRIORITY NO. 1. To assess causative/contributing factors:
• Identify underlying situation(s) that may contribute to the inability of family to provide needed assistance to the client. Circumstances may have preceded the illness and now have a significant effect (e.g., client had a heart attack during sexual activity, mate is afraid any activity may cause repeat).
• Note cultural factors related to family relationships that may be involved in problems of caring for member who is ill.
• Note the length of illness, such as cancer, multiple sclerosis, and/or other long-term situations that may exist.
• Assess information available to and understood by the family/SO(s).
• Discuss family perceptions of situation. Expectations of client and family members may/may not be realistic.
• Identify role of the client in family and how illness has changed the family organization.
• Note other factors besides the client’s illness that are affecting abilities of family members to provide needed support.
NURSING PRIORITY NO. 1. To assess causative/contributing factors:
• Identify underlying situation(s) that may contribute to the inability of family to provide needed assistance to the client. Circumstances may have preceded the illness and now have a significant effect (e.g., client had a heart attack during sexual activity, mate is afraid any activity may cause repeat).
• Note cultural factors related to family relationships that may be involved in problems of caring for member who is ill.
• Note the length of illness, such as cancer, multiple sclerosis, and/or other long-term situations that may exist.
• Assess information available to and understood by the family/SO(s).
• Discuss family perceptions of situation. Expectations of client and family members may/may not be realistic.
• Identify role of the client in family and how illness has changed the family organization.
• Note other factors besides the client’s illness that are affecting abilities of family members to provide needed support.
NURSING PRIORITY NO. 2. To assist family to reactivate/develop skills to deal with current situation:
• Listen to client’s/SO’s comments, remarks, and expression of concern(s). Note nonverbal behaviors and/or responses and congruency.
• Encourage family members to verbalize feelings openly/ clearly.
• Discuss underlying reasons for behaviors with family to help them understand and accept/deal with client behaviors.
• Assist the family and client to understand “who owns the problem” and who is responsible for resolution. Avoid placing blame or guilt.
• Encourage client and family to develop problem-solving skills to deal with the situation.
• Listen to client’s/SO’s comments, remarks, and expression of concern(s). Note nonverbal behaviors and/or responses and congruency.
• Encourage family members to verbalize feelings openly/ clearly.
• Discuss underlying reasons for behaviors with family to help them understand and accept/deal with client behaviors.
• Assist the family and client to understand “who owns the problem” and who is responsible for resolution. Avoid placing blame or guilt.
• Encourage client and family to develop problem-solving skills to deal with the situation.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Provide information for family/SO(s) about specific illness/ condition.
• Involve client and family in planning care as often as possible. Enhances commitment to plan.
• Promote assistance of family in providing client care as appropriate. Identifies ways of demonstrating support while maintaining client’s independence (e.g., providing favorite foods, engaging in diversional activities).
• Refer to appropriate resources for assistance as indicated (e.g., counseling, psychotherapy, financial, spiritual).
• Refer to NDs Fear; Anxiety/death Anxiety; ineffective Coping; readiness for enhanced family Coping; disabled family Coping; anticipatory Grieving, as appropriate.
• Provide information for family/SO(s) about specific illness/ condition.
• Involve client and family in planning care as often as possible. Enhances commitment to plan.
• Promote assistance of family in providing client care as appropriate. Identifies ways of demonstrating support while maintaining client’s independence (e.g., providing favorite foods, engaging in diversional activities).
• Refer to appropriate resources for assistance as indicated (e.g., counseling, psychotherapy, financial, spiritual).
• Refer to NDs Fear; Anxiety/death Anxiety; ineffective Coping; readiness for enhanced family Coping; disabled family Coping; anticipatory Grieving, as appropriate.
Documentation Focus
ASSESSMENT/REASSESSMENT
• Assessment findings, including current/past coping behaviors, emotional response to situation/stressors, support systems available.
PLANNING
• Plan of care, who is involved in planning and areas of responsibility.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses of family members/client to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-range plan and who is responsible for actions.
• Specific referrals made.
ASSESSMENT/REASSESSMENT
• Assessment findings, including current/past coping behaviors, emotional response to situation/stressors, support systems available.
PLANNING
• Plan of care, who is involved in planning and areas of responsibility.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses of family members/client to interventions/teaching and actions performed.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-range plan and who is responsible for actions.
• Specific referrals made.
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compromised family Coping - Definition, Related Factors, Characteristics
Taxonomy II: Coping/Stress Tolerance—Class 2 Coping Responses (00074)
[Diagnostic Division: Social Interaction]
Submitted 1980; Revised 1996
[Diagnostic Division: Social Interaction]
Submitted 1980; Revised 1996
Definition: Usually supportive primary person (family member or close friend [SO]) provides insufficient, ineffective, or compromised support, comfort, assistance, or encouragement that may be needed by the client to manage or master adaptive tasks related to his/her health challenge
Related Factors
Inadequate or incorrect information or understanding by a primary person
Inadequate or incorrect information or understanding by a primary person
Temporary preoccupation by a significant person who is trying to manage emotional conflicts and personal suffering and is unable to perceive or act effectively in regard to client’s needs
Temporary family disorganization and role changes
Other situational or developmental crises or situations the significant person may be facing
Little support provided by client, in turn, for primary person
Prolonged disease or disability progression that exhausts the supportive capacity of SO(s)
[Unrealistic expectations of client/SO(s) or each other]
[Lack of mutual decision-making skills]
[Diverse coalitions of family members]
Temporary family disorganization and role changes
Other situational or developmental crises or situations the significant person may be facing
Little support provided by client, in turn, for primary person
Prolonged disease or disability progression that exhausts the supportive capacity of SO(s)
[Unrealistic expectations of client/SO(s) or each other]
[Lack of mutual decision-making skills]
[Diverse coalitions of family members]
Defining Characteristics
SUBJECTIVE
Client expresses or confirms a concern or complaint about SO’s response to his or her health problem
SO describes preoccupation with personal reaction (e.g., fear, anticipatory grief, guilt, anxiety) to client’s illness/disability or other situational or developmental crises
SO describes or confirms an inadequate understanding or knowledge base that interferes with effective assistive or supportive behaviors
OBJECTIVE
SO attempts assistive or supportive behaviors with less-thansatisfactory results
SO withdraws or enters into limited or temporary personal communication with the client at the time of need
SO displays protective behavior disproportionate (too little or too much) to the client’s abilities or need for autonomy
[SO displays sudden outbursts of emotions/shows emotional lability or interferes with necessary nursing/medical interventions]
SUBJECTIVE
Client expresses or confirms a concern or complaint about SO’s response to his or her health problem
SO describes preoccupation with personal reaction (e.g., fear, anticipatory grief, guilt, anxiety) to client’s illness/disability or other situational or developmental crises
SO describes or confirms an inadequate understanding or knowledge base that interferes with effective assistive or supportive behaviors
OBJECTIVE
SO attempts assistive or supportive behaviors with less-thansatisfactory results
SO withdraws or enters into limited or temporary personal communication with the client at the time of need
SO displays protective behavior disproportionate (too little or too much) to the client’s abilities or need for autonomy
[SO displays sudden outbursts of emotions/shows emotional lability or interferes with necessary nursing/medical interventions]
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risk for Constipation
Taxonomy II: Elimination—Class 2 Gastrointestinal System (00015)[Diagnostic Division: Elimination]
Nursing Diagnosis Extension and Classification (NDEC)
Submission 1998
Definition: At risk for a decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool
Risk Factors
FUNCTIONAL
Irregular defecation habits; inadequate toileting (e.g., timeliness, positioning for defecation, privacy)
Insufficient physical activity; abdominal muscle weakness
Recent environmental changes
Habitual denial/ignoring of urge to defecate
PSYCHOLOGICAL
Emotional stress; depression; mental confusion
PHYSIOLOGICAL
Change in usual foods and eating patterns; insufficient fiber/ fluid intake, dehydration; poor eating habits
Inadequate dentition or oral hygiene
Decreased motility of gastrointestinal tract
PHARMACOLOGICAL
Phenothiazides; nonsteroidal anti-inflammatory agents; sedatives; aluminum-containing antacids; laxative overuse; iron salts; anticholinergics; antidepressants; anticonvulsants; antilipemic agents; calcium channel blockers; calcium carbonate; diuretics; sympathomimetics; opiates; bismuth salts
MECHANICAL
Hemorrhoids; pregnancy; obesity
Rectal abscess or ulcer; anal stricture; anal fissures; prolapse; rectocele
Prostate enlargement; postsurgical obstruction
Neurological impairment; megacolon (Hirschsprung’s disease); tumors
Electrolyte imbalance
NOTE: A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
FUNCTIONAL
Irregular defecation habits; inadequate toileting (e.g., timeliness, positioning for defecation, privacy)
Insufficient physical activity; abdominal muscle weakness
Recent environmental changes
Habitual denial/ignoring of urge to defecate
PSYCHOLOGICAL
Emotional stress; depression; mental confusion
PHYSIOLOGICAL
Change in usual foods and eating patterns; insufficient fiber/ fluid intake, dehydration; poor eating habits
Inadequate dentition or oral hygiene
Decreased motility of gastrointestinal tract
PHARMACOLOGICAL
Phenothiazides; nonsteroidal anti-inflammatory agents; sedatives; aluminum-containing antacids; laxative overuse; iron salts; anticholinergics; antidepressants; anticonvulsants; antilipemic agents; calcium channel blockers; calcium carbonate; diuretics; sympathomimetics; opiates; bismuth salts
MECHANICAL
Hemorrhoids; pregnancy; obesity
Rectal abscess or ulcer; anal stricture; anal fissures; prolapse; rectocele
Prostate enlargement; postsurgical obstruction
Neurological impairment; megacolon (Hirschsprung’s disease); tumors
Electrolyte imbalance
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:
• Maintain usual pattern of bowel functioning.
• Verbalize understanding of risk factors and appropriate interventions/ solutions related to individual situation.
Criteria—Client Will:
• Maintain usual pattern of bowel functioning.
• Verbalize understanding of risk factors and appropriate interventions/ solutions related to individual situation.
• Demonstrate behaviors or lifestyle changes to prevent developing problem.
Actions/Interventions
NURSING PRIORITY NO. 1. To identify individual risk factors/ needs:
• Auscultate abdomen for presence, location, and characteristics of bowel sounds reflecting bowel activity.
• Discuss usual elimination pattern and use of laxatives.
• Ascertain client’s beliefs and practices about bowel elimination, such as “must have a bowel movement every day or I need an enema.”
• Determine current situation and possible impact on bowel function (e.g., surgery, use of medications affecting intestinal function, advanced age, weakness, depression, and other risk factors as listed previously).
• Evaluate current dietary and fluid intake and implications for effect on bowel function.
• Review medications (new and chronic use) for impact on/ effects of changes in bowel function.
NURSING PRIORITY NO. 1. To identify individual risk factors/ needs:
• Auscultate abdomen for presence, location, and characteristics of bowel sounds reflecting bowel activity.
• Discuss usual elimination pattern and use of laxatives.
• Ascertain client’s beliefs and practices about bowel elimination, such as “must have a bowel movement every day or I need an enema.”
• Determine current situation and possible impact on bowel function (e.g., surgery, use of medications affecting intestinal function, advanced age, weakness, depression, and other risk factors as listed previously).
• Evaluate current dietary and fluid intake and implications for effect on bowel function.
• Review medications (new and chronic use) for impact on/ effects of changes in bowel function.
NURSING PRIORITY NO. 2. To facilitate normal bowel function:
• Instruct in/encourage balanced fiber and bulk in diet to improve consistency of stool and facilitate passage through the colon.
• Promote adequate fluid intake, including water and high-fiber fruit juices; suggest drinking warm, stimulating fluids (e.g., decaffeinated coffee, hot water, tea) to promote moist/soft stool.
• Encourage activity/exercise within limits of individual ability to stimulate contractions of the intestines.
• Provide privacy and routinely scheduled time for defecation (bathroom or commode preferable to bedpan).
• Administer routine stool softeners, mild stimulants, or bulkforming agents prn and/or routinely when appropriate (e.g., client taking pain medications, especially opiates, or who is inactive, immobile, or unconscious).
• Ascertain frequency, color, consistency, amount of stools. Provides a baseline for comparison, promotes recognition of changes.
• Instruct in/encourage balanced fiber and bulk in diet to improve consistency of stool and facilitate passage through the colon.
• Promote adequate fluid intake, including water and high-fiber fruit juices; suggest drinking warm, stimulating fluids (e.g., decaffeinated coffee, hot water, tea) to promote moist/soft stool.
• Encourage activity/exercise within limits of individual ability to stimulate contractions of the intestines.
• Provide privacy and routinely scheduled time for defecation (bathroom or commode preferable to bedpan).
• Administer routine stool softeners, mild stimulants, or bulkforming agents prn and/or routinely when appropriate (e.g., client taking pain medications, especially opiates, or who is inactive, immobile, or unconscious).
• Ascertain frequency, color, consistency, amount of stools. Provides a baseline for comparison, promotes recognition of changes.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Discuss physiology and acceptable variations in elimination. May help reduce concerns/anxiety about situation.
• Review individual risk factors/potential problems and specific interventions.
• Discuss physiology and acceptable variations in elimination. May help reduce concerns/anxiety about situation.
• Review individual risk factors/potential problems and specific interventions.
• Review appropriate use of medications.
• Encourage client to maintain elimination diary if appropriate to help monitor bowel pattern.
• Refer to NDs Constipation; perceived Constipation.
• Encourage client to maintain elimination diary if appropriate to help monitor bowel pattern.
• Refer to NDs Constipation; perceived Constipation.
Documentation Focus
ASSESSMENT/REASSESSMENT
• Current bowel pattern, characteristics of stool, medications.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcomes.
• Modifications to plan of care.
DISCHARGE PLANNING
• Individual long-term needs, noting who is responsible for actions to be taken.
• Specific referrals made.
ASSESSMENT/REASSESSMENT
• Current bowel pattern, characteristics of stool, medications.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses to interventions/teaching and actions performed.
• Attainment/progress toward desired outcomes.
• Modifications to plan of care.
DISCHARGE PLANNING
• Individual long-term needs, noting who is responsible for actions to be taken.
• Specific referrals made.
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Improving the Physician–Nurse Dynamic
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