Nursing diagnosis: impaired Parenting related to Issues of control in family, Situational or maturational crises, History of inadequate coping methods
Possibly evidenced by
Dissonance among family members
Family developmental tasks not being met
Focus on “identified client” (IP)
Family needs not being met
Family member(s) acting as enablers for IP
Ill-defined family rules, function, and roles
Desired Outcomes/Evaluation Criteria—Family Will
Demonstrate individual involvement in problem-solving process directed at encouraging client toward independence.
Express feelings freely and appropriately.
Demonstrate more autonomous coping behaviors with individual family boundaries more clearly defined.
Recognize and resolve conflict appropriately with the individuals involved.
Nursing intervention with rationale:
1. Identify patterns of interaction. Encourage each family member to speak for self. Prevent two members discussing a third without that member’s participation.
Rationale: Helpful information for planning interventions. The enmeshed, overinvolved family members often speak for each other and need to learn to be responsible for their own words and actions.
2. Discourage members from asking for approval from each other. Be alert to verbal or nonverbal checking with others for approval. Acknowledge competent actions of client.
Rationale: Each individual needs to develop own internal sense of selfesteem. Individual often is living up to others’ (family’s) expectations rather than making own choices. Acknowledgment provides recognition of self in positive ways.
3. Listen with regard when client speaks.
Rationale: Sets an example and provides a sense of competence and selfworth in that client has been heard and attended to.
4. Encourage individuals not to answer to everything.
Rationale: Reinforces individualization and return to privacy.
5. Communicate message of separation—that it is acceptable for family members to be different from each other.
Rationale: Communicate message of separation—that it is acceptable for family members to be different from each other.
6. Encourage and allow expression of feelings, such as crying or anger by individuals.
Rationale: Often these families have not allowed free expression of feelings and need help and permission to learn and accept this.
7. Prevent intrusion in dyads by other members of the family.
Rationale: Inappropriate interventions in family subsystems prevent individuals from working out problems successfully.
8. Reinforce importance of parents as a couple who have rights of their own.
Rationale: The focus on the child with anorexia is very intense and often is the only area around which the couple interacts. The couple needs to explore their own relationship and restore the balance within relationship to help prevent its disintegration.
9. Prevent client from intervening in conflicts between parents. Assist parents in identifying and solving their marital differences.
Rationale: Triangulation occurs in which a parent-child coalition exists. Sometimes the child is openly pressed to ally self with one parent against the other. The symptom (anorexia) is the regulator in the family system, and the parents deny their own conflicts.
10. Be aware and confront sabotage behavior on the part of family members.
Rationale: Feelings of blame, shame, and helplessness may lead to unconscious behavior designed to maintain the status quo.