Nursing diagnosis: interrupted Family Processes related to situational transition and crisis, uncertainty about outcomes, expectations
Possibly evidenced by
Difficulty adapting to change or dealing with traumatic experience constructively
Family not meeting needs of its members
Difficulty accepting or receiving help appropriately
Inability to express or to accept feelings of members
Desired Outcomes/Evaluation Criteria—Client Will
Begin to express feelings freely and appropriately.
Identify internal and external resources to deal with the situation.
Direct energies in a purposeful manner to plan for resolution of crisis.
Encourage and allow injured member to progress toward independence.
Nursing intervention with rationale:
1. Note components of family unit, availability, and involvement of support systems.
Rationale: Defines family resources and identifies areas of need.
2. Encourage expression of concerns about seriousness of condition, possibility of death, or incapacitation.
Rationale: Verbalization of fears gets concerns out in the open and can decrease anxiety and enhance coping with reality.
3. Listen for expressions of helplessness and hopelessness.
Rationale: Joy of survival of victim is often quickly replaced by grief and anger at “loss” of the preinjury person and the necessity of dealing with new person that family does not know and may not even like. Prolongation of these feelings may result in depression.
4. Encourage expression and acknowledgment of feelings. Do not deny or reassure client/SO that everything will be all right.
Rationale: Because it is not possible to predict the outcome, it is more helpful to assist the person to deal with feelings about what is happening instead of giving false reassurance.
5. Support family grieving for “loss” of member. Acknowledge normality of wide range of feelings and ongoing nature of process.
Rationale: Although grief may never be fully resolved and family may vacillate among various stages, understanding that this is typical may help members accept and cope with the situation.
6. Stress importance of continuous open dialogue between family members.
Rationale: Provides opportunity to get feelings out in the open. Recognition and awareness promotes resolution of guilt and anger.
7. Help family recognize needs of all members.
Rationale: Attention may be so focused on injured member that other members feel isolated or abandoned, which can compromise family growth and unity.
8. Evaluate and discuss family goals and expectations.
Rationale: Family may believe that if client is going to live, rehabilitation will bring about a cure. Despite accurate information, expectations may be unrealistic. Also, client’s early recovery may be rapid, then plateau, resulting in disappointment and frustration.
9. Reinforce previous explanations about extent of injury, treatment plan, and prognosis. Provide accurate information at current level of understanding and ability to accept.
Rationale: Client and SO are unable to absorb or recall all information, and blocking can occur because of emotional trauma. As time goes by, reinforcement of information can help reduce misconceptions, fear about the unknown, and future expectations.
10. Identify individual roles and anticipated and perceived changes.
Rationale: Responsibilities and roles may have to be partially or completely assumed by others, which can further complicate family coping.