6 Psychosocial support for the patient’s family and significant other
Nursing diagnosis:
Fear
related to patient’s life-threatening condition and knowledge deficit
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess family’s fears and their understanding of patient’s clinical situation. | Some fears may be realistic; others may not be and need clarification. |
| Evaluate verbal and nonverbal responses. | Some family members may not readily verbalize their fears but may give nonverbal cues such as withdrawing emotionally (evidenced by body position, facial expression, attitude of disinterest), refusing to be present during discussion, or disrupting discussion. |
| Acknowledge family’s fear. | Simple acknowledgment and giving more information can go a long way toward decreasing fear. For example, “I understand these tubes must frighten you, but they are necessary to help nourish your son.” |
| Assess family’s history of coping behavior. | How a family has coped with fear in the past often is a reliable predictor of how they will cope in the current situation. For example, “How does your family react to difficult situations?” Awareness of maladaptive responses may assist nurse in fostering more productive methods of coping. |
| Provide opportunities for family members to express fears and concerns. | Verbalizing feelings in a nonthreatening environment can help them deal with unresolved/unrecognized issues that may be contributing to the current stressor. Anger, denial, withdrawal, and demanding behavior may be adaptive coping responses during the initial period of crisis. |
| Provide information at frequent intervals about patient’s status, treatments, and equipment used. | This information increases family’s knowledge of patient’s health status, helping alleviate fear of the unknown. |
| Encourage family to use positive coping behaviors by identifying fears, developing goals, identifying supportive resources, facilitating realistic perceptions, and promoting problem solving. | When under stress, family may not recall sources of support without being reminded. For example, “Who usually helps your family during stressful times?” |
| Recognize anxiety, and encourage family members to describe their feelings. | Before family members can learn coping strategies, they must first clarify their feelings. For example, “You seem very uncomfortable tonight. Can you describe your feelings?” |
| Be alert to maladaptive responses to fear. Provide referrals to psychiatric clinical nurse specialist or other staff member as appropriate. | Violence, withdrawal, severe depression, hostility, and unrealistic expectations for staff or of patient’s recovery are maladaptive responses to fear, and they require expert guidance. |
| Offer realistic hope, even if it is hope for patient’s peaceful death. | Even though family members may have feelings of hopelessness, it sometimes helps to hear realistic expressions of hope. |
| Explore family’s desire for spiritual or other counseling. | People often derive hope and experience a decrease in fear and dread from spiritual counseling. |
| Assess your own feelings about patient’s life-threatening illness. | Without personal awareness of one’s beliefs, a health care provider’s attitude and fears may be reflected inadvertently to the family. |
| For other interventions, see Interrupted Family Processes and Disabled Family Coping listed later in this care plan. |
Nursing diagnosis:
Interrupted family processes
related to situational crisis (patient’s illness)
| ASSESSMENT/INTERVENTIONS | RATIONALES |
|---|---|
| Assess family’s character: social, environmental, ethnic, and cultural factors; relationships; and role patterns. | Having this detailed information will assist nurse in developing an individualized care plan. |
| Identify family’s developmental stage. | The family may be dealing with other situational or maturational crises, such as managing an elderly parent or a teenager with a learning disability. |
| Assess previous adaptive behaviors. | How the family has dealt with problems in the past may be a reliable predictor of how they will adapt to current issues. For example, “How does your family react in stressful situations?” |
| Discuss observed conflicts and communications. | Awareness of this information will assist with development of an individualized plan of care, including referral for specialized care if appropriate. For example, “I noticed that your brother would not visit your mother today. Has there been a problem we should be aware of? Knowing about it may help us better care for your mother.” |
| Acknowledge family’s involvement in patient care and promote strengths. Encourage family to participate in patient care conferences. Promote frequent, regular patient visits by family members. | This reinforces positive ways of dealing with the crisis and promotes a sense of involvement and control for the family. For example, “You were able to encourage your wife to turn and cough. That is very important to her recovery.” |
| Provide family with information and guidance related to patient. Discuss the stresses of hospitalization, and encourage family to discuss feelings of anger, guilt, hostility, depression, fear, or sorrow. Refer to clergy, clinical nurse specialist, or social services as appropriate. | Encouraging expressions of emotion assists family members in beginning the process of grieving. For example, “You seem to be upset since being told that your husband is not leaving the hospital today.” Acknowledging their feelings promotes acceptance and facilitates therapeutic communication. |
| Evaluate patient and family responses to one another. Encourage family to reorganize roles and establish priorities as appropriate. | These actions will help facilitate family’s adaptation to the situation regarding patient and prevent unnecessary conflict. Assisting family members to redefine their roles may reduce confusion and provide direction. For example, “I know your husband is concerned about his insurance policy and seems to expect you to investigate it. I’ll ask the financial counselor to talk with you.” |
| Encourage family to schedule periods of rest and activity outside the hospital and to seek support when necessary. | Persons undergoing stress sometimes require guidance of others to promote their own self-care. For example, “Your neighbor volunteered to stay in the waiting room this afternoon. Would you like to rest at home? I’ll call you if anything changes.” |
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