Compromised/Disabled Family Coping | Nursing Care Plan for Multiple Sclerosis

Nursing diagnosis: Compromised/Disabled Family Coping related to Situational crisis; temporary family disorganization and role changes, Highly ambivalent family relationship, Prolonged disease and disability progression that exhausts the supportive capacity of SO. Client providing little support in turn for SO, SO with chronically unexpressed feelings of guilt, anxiety, hostility, despair

Possibly evidenced by
Client expresses or confirms concern or complaint about SO response to client’s illness
SO withdraws or has limited personal communication with client or displays protective behavior disproportionate to client’s abilities or need for autonomy
SO preoccupied with own personal reactions
Intolerance, abandonment
Neglectful care of client
Distortion of reality regarding client’s illness

Desired Outcomes/Evaluation Criteria— Family Will
Family Coping
Identify or verbalize resources within themselves to deal with the situation.
Express more realistic understanding and expectations of client.
Interact appropriately with client and healthcare providers providing support and assistance as indicated.
Verbalize knowledge and understanding of disability, disease process, and community resources.

Nursing intervention with rationale
1. Note length and severity of illness. Determine client’s role in family and how illness has changed the family organization.
Rationale: Chronic or unresolved illness, accompanied by changes in role performance and responsibility, often exhausts supportive capacity and coping abilities of SO and family.

2.Determine SO’s understanding of disease process and expectations for the future.
Rationale: Inadequate information or misconception regarding disease process and unrealistic expectations affect ability to cope with current situation. Note: A particular area of misconception is the fatigue experienced by clients with MS. Family members may view client’s inability to perform activities as manipulative behavior rather than an actual physiological deficit.

3. Discuss with SO and family members their willingness to be involved in care. Identify other responsibilities and factors impacting participation.
Rationale: Individuals may not have desire or time to assume responsibility for care. If several family members are available, they may be able to share tasks.

4. Assess other factors that are affecting abilities of family members to provide needed support, such as own emotional problems and work concerns.
Rationale: Individual members’ preoccupation with own needs and concerns can interfere with providing needed care and support for stresses of long-term illness. Additionally, caregiver(s) may incur decrease or loss of income and risk losing own health insurance if they alter their work hours.

5. Discuss underlying reasons for client’s behaviors.
Rationale: Helps SO understand and accept and deal with behaviors that may be triggered by emotional or physical effects of MS.

6. Encourage client and SO to develop and strengthen problem-solving skills to deal with situation.
Rationale: Family may or may not have handled conflict well before illness. The stress of long-term debilitating condition can create additional problems, including unresolved anger.

7. Encourage free expression of feelings, including frustration, anger, hostility, and hopelessness.
Rationale: Individual members may be afraid to express “negative” feelings, believing it will discourage client. Free expression promotes awareness and can help with resolution of feelings and problems (especially when done in a caring manner).

8. Identify community resources, such as local MS organization, support groups, home care agencies, and respite programs.
Rationale: Community resources provide information, opportunities to share with others who are experiencing similar difficulties, and potential sources of assistance.

9. Refer to social worker, financial adviser, psychiatric clinical nurse specialist, and psychiatrist, as appropriate.
Rationale: Client, SO, and family may need more in-depth assistance from professional sources.