Alteration in Family Processes
Alteration in Family Processes
(_)Actual (_) Potential
| (_)
Illness of a family member:_____________________ (_) Loss/gain of family member due to:______________ ____________________________________________ (_) Change in family roles:_______________________ (_) Conflict:___________________________________ (_) Financial crisis:_____________________________ (_) Other:____________________________________ ____________________________________________ ____________________________________________ |
| Major:
(Must be present) |
(_) Family system cannot or does not adapt constructively to crisis or family system cannot or does not communicate openly and effectively between family members. |
| Minor:
(May be present) |
(_)
Family system cannot or does not:
|
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
family member or patient will: (_) Frequently verbalize feelings to professional nurse and each other. (_) Maintain functional system of mutual support for each member. (_) Seek appropriate external resources when needed. (_) Other: |
(_)
Assess causative and contributing factors. (_) Meet with patient/family to identify:
(_) Encourage verbalization of guilt, anger, hostility, etc. and subsequent recognition of these feelings to:
(_)Direct family to hospital/community agencies:
(_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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