4 End-of-Life Care (Hospice Care) Nursing Care Plans

Compromised Family Coping

Nursing Diagnosis

• Compromised Family Coping
• Risk for Caregiver Role Strain

May be related to

• Inadequate or incorrect information or understanding by a primary person; unrealistic expectations
• Temporary preoccupation by a significant person who is trying to manage emotional conflicts and personal suffering and is unable to perceive or to act effectively with regard to a patient’s needs; do not have enough resources to provide the care needed
• Temporary family disorganization and role changes; feel that caregiving interferes with other important roles in their lives
• The patient provides little support in turn for the primary person
• Prolonged disease/disability progression that exhausts the supportive capacity of significant persons
• A significant person with chronically unexpressed feelings of guilt, anxiety, hostility, despair
• Highly ambivalent family relationships; feel stress or nervousness in their relationship with the care receiver

Possibly evidenced by

• Patient expressing/confirming a concern or complaint about SO’s response to the patient’s health problem, despair about family reactions/lack of involvement; history of the poor relationship between caregiver and care receiver
• Neglectful relationships with other family members
• Inability to complete caregiving tasks; altered caregiver health status
• SO describing preoccupation about personal reactions; displaying intolerance, abandonment, rejection; caregiver not developmentally ready for caregiver role
• SO attempting assistive/supportive behaviors with less than satisfactory results; withdrawing or entering into limited or temporary personal communication with the patient; displaying protective behavior disproportionate (too little or too much) to the patient’s abilities or need for autonomy
• Apprehension about the future regarding the care receiver’s health and the caregiver’s ability to provide care

Desired Outcomes

• The client will identify resources within themselves to deal with the situation.
• The client will visit regularly and participate positively in the care of the patient, within the limits of their abilities.
• The client will express a more realistic understanding and expectations of the patient.
• The client will provide an opportunity for the patient to deal with the situation in own way.

Nursing Assessment and Rationales

1. Assess the level of anxiety present in the family and/or SO.
Anxiety level needs to be dealt with before problem-solving can begin. Individuals may be so preoccupied with the client’s own reactions to situations that they are unable to respond to another’s needs.

2. Determine the level of impairment of perceptual, cognitive, and/or physical abilities. Evaluate illness and current behaviors that are interfering with the care of the patient.
Information about family problems will be helpful in determining options and developing an appropriate plan of care.

3. Note the patient’s emotional and behavioral responses resulting from increasing weakness and dependency
Approaching death is most stressful when patient and/or family coping responses are strained, resulting in increased frustration, guilt, and anguish.

4. Determine current knowledge and/or perception of the situation.
Provides information on which to begin planning care and make informed decisions.

5. Assess the current actions of SO and how they are received by the patient.
Lack of information or unrealistic perceptions can interfere with the caregiver’s and/or care receiver’s response to the illness situation.

Nursing Interventions and Rationales

1. Establish rapport and acknowledge the difficulty of the situation for the family.
May assist SO to accept what is happening and be willing to share problems with staff.

2. Discuss underlying reasons for patient behaviors with family.
When family members know why the patient is behaving differently, it may help them understand and accept or deal with unusual behaviors.

3. Assist family and patient to understand “who owns the problem” and who is responsible for resolution. Avoid placing blame or guilt.
When these boundaries are defined, each individual can begin to take care of own self and stop taking care of others in inappropriate ways.

4. Involve SO in information giving, problem-solving, and care of patients as feasible. Instruct in medication administration techniques, and needed treatments, and ascertain adeptness with the required equipment.
Significant others (SO) may be trying to be helpful, but actions are not perceived as being helpful by the patient. In addition, may be withdrawn or can be too protective.

5. Include all family members as appropriate in discussions. Provide and/or reinforce information about terminal illness and/or death and future family needs.
Information can reduce feelings of helplessness and uselessness. Helping a patient or family find comfort is often more important than adhering to strict routines. However, family caregivers need to feel confident with specific care activities and equipment.