Altered family process is a nursing diagnosis that describes a change in family relationships and/or functioning.
This diagnosis is used when a family is experiencing difficulties in coping with situational or developmental crises, leading to ineffective family functioning. Understanding and addressing altered family processes is crucial for promoting family health and well-being.
Causes (Related to)
Altered family process can result from various factors that disrupt family dynamics and relationships. Common causes include:
- Major life transitions (e.g., birth, death, divorce, relocation)
- Chronic illness or disability of a family member
- Substance abuse or addiction within the family
- Financial stress or job loss
- Cultural conflicts or acculturation issues
- Domestic violence or abuse
- Mental health disorders affecting family members
- Ineffective communication patterns
- Unresolved family conflicts
- Deployment or separation of family members (e.g., military service)
Signs and Symptoms (As evidenced by)
Altered family process can manifest in various ways, affecting family dynamics, communication, and overall functioning. The following are common signs and symptoms:
Subjective: (Family members report)
- Feelings of disconnection or isolation within the family
- Increased family conflicts or arguments
- Difficulty making decisions as a family
- Lack of support from family members
- Feelings of guilt, blame, or resentment
- Expressed dissatisfaction with family roles or responsibilities
Objective: (Nurse assesses)
- Ineffective or hostile communication patterns
- Inability to meet the emotional needs of family members
- Neglect of family responsibilities
- Inconsistent parenting practices
- Triangulation or scapegoating within family relationships
- Inappropriate family boundaries
- Difficulty adapting to changes or crises
- Decreased family participation in social or community activities
- Observable tension or conflict during family interactions
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for altered family process:
- Family members will demonstrate improved communication skills within [specific timeframe].
- Family will report increased satisfaction with family relationships by [date].
- Family will demonstrate effective problem-solving strategies during conflicts.
- Family members will express increased emotional support for one another.
- Family will establish and maintain appropriate boundaries within [specific timeframe].
- Family will engage in regular, positive family activities by [date].
- Family will utilize community resources and support systems as needed.
- Family will demonstrate adaptive coping mechanisms when facing stressors or changes.
Nursing Assessment
The nursing assessment for altered family process involves gathering comprehensive data about family dynamics, relationships, and functioning. The following steps guide the assessment process:
- Conduct a family interview
Engage all available family members in a discussion about their perceptions of family functioning, roles, and relationships. Use open-ended questions to encourage open communication. - Observe family interactions
Pay attention to communication patterns, non-verbal cues, and dynamics between family members during the assessment. - Assess family structure and roles
Identify family members, their roles, and how these roles may have changed due to recent events or stressors. - Evaluate communication patterns
Assess how family members communicate with each other, noting any ineffective or harmful patterns. - Identify family strengths and resources
Determine the family’s coping mechanisms, support systems, and positive attributes that can be leveraged in the care plan. - Assess cultural and spiritual factors
Consider how cultural beliefs and practices influence family dynamics and decision-making processes. - Evaluate the impact of external stressors
Identify any significant life events, financial concerns, or other external factors affecting family functioning. - Assess for signs of abuse or neglect
Be alert for any indicators of physical, emotional, or verbal abuse within the family system. - Use family assessment tools
Employ standardized assessment tools such as genograms, ecomaps, or family functioning scales to gather comprehensive data. - Review medical and social history
Examine the family’s health history and any social factors that may contribute to altered family processes.
Nursing Interventions
Nursing interventions for altered family process focus on improving family communication, enhancing coping skills, and promoting healthy family functioning. The following interventions can be tailored to meet the specific needs of each family:
- Facilitate open communication
Encourage family members to express their thoughts and feelings openly and respectfully. Teach active listening skills and provide a safe environment for family discussions. - Promote problem-solving skills
Guide the family through a structured problem-solving process, helping them identify issues, generate solutions, and make decisions collaboratively. - Encourage family meetings
Suggest regular family meetings to discuss concerns, make plans, and strengthen family bonds. Provide guidance on how to structure these meetings effectively. - Teach conflict resolution techniques
Educate family members on constructive ways to handle disagreements and resolve conflicts without resorting to harmful behaviors. - Support role adaptation
Help family members adjust to new roles or responsibilities, particularly in the face of significant life changes or stressors. - Promote family rituals and traditions
Encourage the maintenance or development of positive family rituals and traditions that foster a sense of belonging and continuity. - Refer to family therapy
When appropriate, suggest family therapy or counseling to address deep-seated issues or complex family dynamics. - Provide education on family life cycle
Offer information about normal family developmental stages and transitions to help families understand and navigate changes. - Encourage use of support systems
Help the family identify and utilize community resources, support groups, or extended family support as needed. - Promote stress management techniques
Teach relaxation techniques, mindfulness, or other stress reduction strategies that can be practiced individually and as a family. - Address specific health concerns
Provide education and support for managing any chronic illnesses or health issues affecting family dynamics. - Evaluate and reinforce progress
Regularly assess the family’s progress, celebrate successes, and adjust interventions as needed to support ongoing improvement in family functioning.
Nursing Care Plans
The following nursing care plans address various aspects of altered family process. Each plan includes a nursing diagnosis statement, related factors/causes, nursing interventions with rationales, and desired outcomes.
Care Plan #1: Ineffective Family Coping
Nursing Diagnosis Statement:
Ineffective Family Coping related to inadequate coping mechanisms and lack of support systems as evidenced by expressed feelings of overwhelm and increased family conflicts.
Related factors/causes:
- Recent job loss of primary breadwinner
- Limited social support network
- History of poor problem-solving skills
Nursing Interventions and Rationales:
- Assess the family’s current coping mechanisms and support systems.
Rationale: Identifies strengths and areas for improvement in the family’s coping strategies. - Teach and practice stress management techniques with the family.
Rationale: Equips family members with tools to manage stress more effectively. - Assist the family in identifying and accessing community resources (e.g., job placement services, support groups).
Rationale: Expands the family’s support network and provides practical assistance. - Encourage regular family meetings to discuss concerns and brainstorm solutions.
Rationale: Promotes open communication and collaborative problem-solving. - Provide education on healthy coping mechanisms and the importance of self-care.
Rationale: Empowers family members to take an active role in managing stress and maintaining well-being.
Desired Outcomes:
- Family will demonstrate the use of at least two new coping strategies within two weeks.
- Family members will report decreased feelings of overwhelm within one month.
- Family will actively engage with at least one community resource or support group within three weeks.
Care Plan #2: Interrupted Family Processes
Nursing Diagnosis Statement:
Interrupted Family Processes related to chronic illness of a family member as evidenced by changes in family roles and expressed difficulty in adapting to new caregiving responsibilities.
Related factors/causes:
- Recent diagnosis of a chronic illness in a parent
- Increased caregiving demands on other family members
- Lack of knowledge about the illness and its management
Nursing Interventions and Rationales:
- Provide comprehensive education about chronic illness and its management.
Rationale: Increases family members’ understanding and ability to provide appropriate care. - Assist the family in reorganizing roles and responsibilities to accommodate new caregiving needs.
Rationale: Helps maintain family functioning while addressing the needs of the ill family member. - Teach effective communication techniques to express needs and concerns.
Rationale: Improves family members’ ability to support each other and address challenges. - Refer the family to appropriate support groups or counseling services.
Rationale: Provide additional emotional support and coping strategies specific to their situation. - Encourage maintenance of family rituals and routines when possible.
Rationale: Promotes a sense of normalcy and continuity despite changes in family dynamics.
Desired Outcomes:
- Family members will demonstrate an understanding of the chronic illness and its management within two weeks.
- Family will report successful adaptation to new roles and responsibilities within one month.
- Family will maintain at least two regular family routines or rituals within three weeks.
Care Plan #3: Dysfunctional Family Processes
Nursing Diagnosis Statement:
Dysfunctional Family Processes related to a history of substance abuse as evidenced by poor communication patterns and frequent conflicts.
Related factors/causes:
- Long-standing substance abuse issues in a family member
- Lack of trust and emotional safety within the family
- Inconsistent parenting practices
Nursing Interventions and Rationales:
- Assess the family’s readiness for change and motivation to address substance abuse issues.
Rationale: Determines the most appropriate interventions and level of support needed. - Provide education on the impact of substance abuse on family dynamics.
Rationale: Increases awareness and understanding of how substance abuse affects the entire family system. - Teach and practice healthy communication skills, including “I” statements and active listening.
Rationale: Improves family members’ ability to express feelings and needs constructively. - Refer the family to specialized substance abuse treatment and family therapy.
Rationale: Addresses the root cause of family dysfunction and provides professional support for recovery. - Help the family establish clear boundaries and consistent rules.
Rationale: Promotes a sense of structure and safety within the family system.
Desired Outcomes:
- Family will engage in substance abuse treatment and family therapy within two weeks.
- Family members will demonstrate the use of healthy communication skills in 75% of observed interactions within one month.
- Family will report a decrease in conflicts related to substance abuse issues within six weeks.
Care Plan #4: Impaired Parenting
Nursing Diagnosis Statement:
Impaired Parenting related to lack of knowledge about child development and effective parenting strategies as evidenced by inconsistent discipline and expressed feelings of frustration with child behavior.
Related factors/causes:
- Limited exposure to positive parenting models
- Unrealistic expectations of child behavior
- Stress from work-life balance challenges
Nursing Interventions and Rationales:
- Assess parents’ knowledge of child development and current parenting practices.
Rationale: Identifies areas for education and skill-building. - Provide education on age-appropriate expectations and positive discipline techniques.
Rationale: Equips parents with realistic expectations and effective tools for managing child behavior. - Teach and practice stress management techniques for parents.
Rationale: Helps parents manage their own emotions and respond more effectively to child behavior. - Encourage participation in parenting classes or support groups.
Rationale: Provides ongoing education and peer support for improving parenting skills. - Assist in developing a consistent daily routine for the family.
Rationale: Promotes structure and predictability, which can reduce behavior issues and parental stress.
Desired Outcomes:
- Parents will demonstrate understanding of age-appropriate expectations within two weeks.
- Parents will implement at least two new positive discipline techniques within three weeks.
- Family will establish and maintain a consistent daily routine within one month.
Care Plan #5: Compromised Family Coping
Nursing Diagnosis Statement:
Compromised Family Coping related to recent relocation and cultural adjustment as evidenced by social isolation and expressed feelings of disconnection from community.
Related factors/causes:
- Recent move to a new country
- Language barriers
- Unfamiliarity with local customs and resources
Nursing Interventions and Rationales:
- Assess the family’s cultural background, values, and adjustment challenges.
Rationale: Provides insight into the family’s specific needs and potential barriers to adaptation. - Connect the family with cultural liaison services or immigrant support organizations.
Rationale: Facilitates cultural integration and provides access to culturally appropriate resources. - Encourage participation in language classes or conversation groups.
Rationale: Improves communication skills and increases opportunities for social connection. - Assist in identifying and accessing community resources (e.g., schools, healthcare, social services).
Rationale: Helps the family navigate their new environment and meet basic needs. - Promote maintenance of cultural traditions while exploring new cultural experiences.
Rationale: Supports cultural identity while fostering adaptation to the new environment.
Desired Outcomes:
- Family will engage with at least one community resource or support organization within two weeks.
- Family members will report an increased connection to their new community within two months.
- The family will demonstrate the ability to navigate basic community services independently within three months.
References
- Bridges, W. (2019). Transitions: Making sense of life’s changes. Da Capo Lifelong Books.
- Coyne, J. C., & Fiske, V. (1992). Couples coping with chronic and catastrophic illness. In T. J. Akamatsu, M. A. P. Stephens, S. E. Hobfoll, & J. H. Crowther (Eds.), Family health psychology (pp. 129-149). Hemisphere Publishing Corp.
- Friedman, M. M., Bowden, V. R., & Jones, E. G. (2003). Family nursing: Research, theory, and practice (5th ed.). Prentice Hall.
- Herdman, T. H., & Kamitsuru, S. (Eds.). (2018). NANDA International nursing diagnoses: Definitions and classification 2018-2020. Thieme.
- Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. H. (2014). Family health care nursing: Theory, practice, and research (5th ed.). F.A. Davis Company.
