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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Nursing Diagnosis: Interrupted Family Processes
Ineffective Individual Coping

NOC Outcomes (Nursing Outcomes Classification)

  • Family Coping
  • Family Functioning
  • Family Normalization

NIC Interventions (Nursing Interventions Classification)

  • Family Process Maintenance
  • Normalization Promotion

NANDA Definition: Change in family relationships and/or functioning

Altered family processes occur as a result of the inability of one or more members of the family to adjust or perform, resulting in family dysfunction and interruption or prevention of development of the family. Family development is closely related to the developmental changes experienced by adult members. Over time families must adjust to change within the family structure brought on by both expected and unexpected events, including illness or death of a member, and/or changes in social or economic strengths precipitated by divorce, retirement, and loss of employment. Health care providers must also be aware of the changing constellation of families: gay couples raising children, single parents with children, elderly grandparents responsible for grandchildren or foster children, and other situations.

    Defining Characteristics:
  • Inability to meet physical or spiritual needs of family members
  • Inability to function in larger society; no job, no community activity
  • Inability to meet emotional needs of family members (e.g., feelings of grief, anxiety, or conflict)
  • Inability to accept or receive needed help
  • Ineffective family decision-making process
  • Rigidity in roles, behavior, and beliefs
  • Inappropriate or poorly communicated family rules, rituals, or symbols
  • Poor communication
  • Failure to accomplish current or past developmental task
    Related Factors:
  • Illness of family member
  • Change in socioeconomic status
  • Births and deaths
  • Conflict between family members
  • Situational transition and/or crisis
  • Developmental transition and/or crisis
    Expected Outcomes
  • Family develops improved methods of communication.
  • Family identifies resources available for problem solving.
  • Family expresses understanding of mutual problems.

Ongoing Assessment

  • Assess for precipitating events (e.g., divorce, illness, life transition, crisis). Depending on the stressor, a variety of strategies may be required to facilitate coping.
  • Assess family members’ perceptions of problem. Resolution is possible only if each person’s perceptions are understood. Understanding another’s perceptions can lead to clarification and problem solving.
  • Evaluate strengths, coping skills, and current support systems. This facilitates the use of previously successful techniques.
  • Assess developmental level of family members. Middle-aged adults may be having difficulty handling the demands of adolescent children and elderly parents.
  • Consider cultural factors. In some cultures, the male head of the family must make all major decisions about health care. This can create serious conflict when the female is often more participative in health care and desires a different decision than her husband.

Therapeutic Interventions

  • Provide opportunities to express concerns, fears, expectations, or questions. This promotes communication and support.
  • Explore feelings: identify loneliness, anger, worry, and fear. The feelings of one family member influence others in the family system.
  • Phrase problems as "family" problems. This way they are dealt with by the family.
  • Encourage members to empathize with other family members. This increases understanding of other’s feelings and fosters mutual respect and support.
  • Assist family in setting realistic goals. This helps family gain control over the situation.
  • Assist family in breaking down problems into manageable parts. Assist with problem-solving process, with delineated responsibilities and follow-through.
  • Encourage family members to seek information and resources that increase coping skills. Practical information and positive role models can be very effective.
  • Refer family to social service or counseling. Long-term intervention or assistance may be required.

Education/Continuity of Care

  • Provide information regarding stressful situation, as appropriate (e.g., pattern of illness, time frames for recovery, and expectations).
  • Identify community resources that may be helpful in dealing with particular situations (e.g., telephone hotlines, self-help groups, educational opportunities, social service agencies, and counseling centers). Groups that come together for mutual support or information exchange can be beneficial in helping family reach goals.

Include Rationales?

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