NURSING DIAGNOSIS: Altered family processes

related to change in family roles and structure associated with a family member's verbal, motor, and sensory impairments; altered thought processes; and need for lengthy rehabilitation.

Desired Outcome
The family members§ will demonstrate beginning adjustment to changes in functioning of family member and family roles and structure as evidenced by:
  1. meeting client's needs
  2. verbalization of ways to adapt to required role and lifestyle changes
  3. active participation in decision making and client's rehabilitation
  4. positive interactions with one another.

§The term "family members" is being used here to include client's significant others.

Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of altered family processes (e.g. inability to meet client's needs, statements of not being able to accept client's diagnosis of CVA and its effects or make necessary role and lifestyle changes, inability to make decisions, inability or refusal to participate in client's rehabilitation, negative family interactions).
  2. Identify components of the family and their patterns of communication and role expectations.
  3. Implement measures to facilitate family members' adjustment to client's diagnosis, changes in client's functioning within the family system, and altered family roles and structure:
    1. encourage verbalization of feelings about the CVA and its effects on family structure; actively listen to each family member and maintain a nonjudgmental attitude about feelings shared
    2. reinforce physician's explanation about the CVA and planned treatment and rehabilitation
    3. assist family members to gain a realistic perspective of client's situation, conveying as much hope as appropriate
    4. provide privacy so that family members and client can share their feelings with one another; stress the importance of and facilitate the use of good communication techniques
    5. assist family members to progress through their own grieving process; explain that they may encounter times when they need to focus on meeting their own rather than the client's needs
    6. emphasize the need for family members to obtain adequate rest and nutrition and to identify and utilize stress management techniques so that they are better able to emotionally and physically deal with the changes and losses experienced and the physical care of the client
    7. encourage and assist family members to identify coping strategies for dealing with the client's impairments and their effects on the family
    8. assist family members to identify realistic goals and ways of reaching these goals
    9. include family members in decision making about client and his/her care; convey appreciation for their input and continued support of client
    10. encourage and allow family members to participate in client's care and rehabilitation as appropriate
    11. assist family members to identify resources that could assist them in coping with their feelings and meeting their immediate and long-term needs (e.g. counseling and social services; pastoral care; adult day care or respite program; service, church, and stroke support groups); initiate a referral if indicated.
  4. Consult appropriate health care provider (e.g. psychiatric nurse clinician, physician) if family members continue to demonstrate difficulty adapting to changes in client's functioning, roles, and family structure.