Chapter 3 | Family Dynamics and Communicating With Children and Families 47
BOX 32 | Examples of Family Nursing Diagnoses Any North American Nursing Diagnosis Association (NANDA) diagnosis may be appropriate for describing an individual fam- ily member’s health status. A family diagnosis is intended to describe the health status of the family as a whole. Examples of family diagnoses include the following: ● Caregiver role strain (actual and risk for) ● Dysfunctional family processes: Alcoholism ● Family coping: Compromised ● Family coping: Disabled ● Impaired parenting (actual and risk for) ● Ineffective family therapeutic regimen management ● Readiness for enhanced family copying ● Readiness for enhanced parenting ● Risk for parent–infant–child attachment
● Social isolation ● Spiritual distress
FIGURE 311 A kinetic drawing illustrates the family unit.
is usually completed in an outpatient or home environment and consists of the following five items: ● A—Adaptation: the ability to use resources for problem-solving in a crisis ● P—Partnership: the ability to share responsibilities and nur- turing roles in a crisis ● G—Growth: the ability to achieve physical or emotional growth ● A—Affection: the ability to demonstrate love and attention to family members ● R—Resolve: the ability to devote time to other family mem- bers in the nurturing process Results are scored numerically from 0 to 20 and categorized as highly functional, moderately dysfunctional, or highly dys- functional. Higher scores indicate higher family satisfaction (Smilkstein, 1978; Takenaka & Bon, 2016). Nursing Outcomes Classification (NOC) designations specifically for families as units are included in the NOC domain “Family Health.”This category includes the following classes: family caregiver status, family member health status, and family well-being and parenting. Outcomes from other domains may also apply. Nursing Intervention Classification (NIC) designations for families as units are included in the NIC domain “Family.”This category includes the following classes: childbearing care, childrearing care, and life-span care.
Triangulation Triangulation occurs when two or more family members team up against a third family member. It can also occur when one family member will not speak to another family member but communicates through a third family member, placing the third family member in a triangular relationship. A dyad is the forma- tion of a two-person bond or subsystem within the family unit, such as a husband-and-wife dyad or a twin-to-twin dyad. Functional Family Assessment With this assessment, the nurse interviews family members and records observations such as: ● Who has the power or makes decisions in the family? ● What characterizes family interactions and roles? ● What communication methods are used, and are they successful? This type of assessment allows the nurse to develop cultural sensitivity in recognizing cultural factors that shape family per- ceptions and to develop cultural competence as a nursing assess- ment tool (see Chapter 4). Subroles of the nurse conducting this assessment include: ● Stranger ● Resource person ● Teacher ● Leader ● Surrogate ● Counselor (Child Welfare Group, n.d.) Family APGAR Five-Item Questionnaire The APGAR questionnaire is used to determine family members’ satisfaction with the functional status of the family (Box 3-2). It
COMMUNICATING WITH THE FAMILY
Pediatric nurses should use the following strategies for effective communication: ● Encourage parents to talk openly regarding their concerns. ● Use open-ended questions.
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