Ineffective Relationship Nursing Diagnosis and Nursing Care Plan

Ineffective Relationship Nursing Care Plans Diagnosis and Interventions

Ineffective Relationship NCLEX Review and Nursing Care Plans

An ineffective relationship is characterized by a pattern of interaction, engagement, or partnership that is inadequate to satisfy the expectation and requirements of both partners.

For a relationship to be effective and functional, both members (the patient/ affected individual and their partner) must demonstrate mutual respect, understanding, well-balanced autonomy, and mutual collaboration.

  • Developmental crises
  • Situational crises
  • Lack of preparedness to adapt to stressors
  • Lack of support from partner
  • History of trauma (e.g., domestic violence)
  • Substance abuse
  • Unreasonable expectation

Stress and Its Role in Ineffective Relationship

Stress can negatively affect the patient’s health and strain relationships with others. They become mentally drained and less able to carry out their responsibilities, making it difficult to put forth the necessary effort for the relationship to thrive. Family conflict can also cause stress, which can lead to difficulty maintaining health and well-being.

When the patient suppresses their emotions and feelings, it can be difficult for their partners to comprehend what they are experiencing. Anger or frustrations that are not acknowledged by partners or family members can be damaging. In addition, it may result in debilitating behaviors, such as social withdrawal, decreased affection, and inattentiveness.

Stress is also transmittable. When a patient is under a lot of stress, their loved ones may also feel the impact. Couples tend to become trapped in this cycle or become too stressed to address the underlying issues constructively. Over time, the relationship turns self-indulgent as both parties become less involved in each other’s lives, resulting in alienation.

The influence of stress on relationships is as follows:

  • Reduced self-esteem. Patients who experience low self-esteem are more likely to experience insecurity and anxiety in their personal relationships. They also tend to avoid confrontation, which in turn impedes communication. This can turn into a continuous cycle since poor communication leads to interpersonal disputes, which in turn cause the affected individual to lose confidence and self-esteem.
  • Increased disagreement or relational discord. Compatibility on the basis of religion, ethnicity, or culture is not a necessity for maintaining relationships. In times of conflict or stress, however, both the patient and their respective partner (if they share the same belief) can draw on the same coping mechanisms. Cross-cultural concerns faced by partners include identity loss, disputes over fundamental beliefs, collisions in parenting tactics, and difficulties with unsupportive families. Couples who are aware of these scenarios can seek the necessary aid or counseling that enables them to venture outside of their cultural, social, or religious identities in order to view each other as individuals.
  • Decreased sexual satisfaction. Sex promotes a positive relationship in a number of ways, but the most important biological mechanism behind it is the release of oxytocin during intercourse. This peptide hormone has a function in social bonding by enhancing a sense of connection and emotional intimacy. However, since stress and anxiety are often a byproduct of a change in mental or physical health, behavioral changes, deconditioning, and activity intolerance are likely to occur (which are contributing factors to sexual dysfunction). 

Chronic Illness and Ineffective Relationship

Chronic disease is seen as a shared issue. Since it affects both partners equally, there should be mutual regard for the needs of each partner. Relationship dynamics can be drastically altered when one or both partners are suffering from a chronic disease, leading to any of the following outcomes:

  • Marital or relationship struggles (e.g., disagreements, infidelity, separation). If patients who are in constant pain or discomfort believe that they need more special attention and care than they are receiving, their partner or spouses will be more likely to feel emotionally strained. A mismatch in sentiments and attitudes can cause problems in relationships and spread to other areas of contention, such as financial and recreational decisions. It can also result in family dysfunction, increased conflict, and an increased likelihood of divorce.
  • Changed in role and relationship dynamics. In addition to being a lover, a spouse or partner frequently fills the function of caregiver. The strain of being a caregiver or witnessing a loved one’s distress may exacerbate pre-existing relationship issues. They also tend to experience a loss of self-identity and deterioration of their mental and emotional health.
  • Impaired sexual relationships. Psychiatric disorders and mental health problems might impede an individual’s capacity to engage in sexual activity and experience sexual fulfillment. Some couples may experience a significant emotional crisis when they have sexual relations with a partner suffering from a chronic illness.

Other relational effects of chronic illness on ineffective relationship are as follows:

  • Social isolation
  • Alcoholism
  • Depression
  • Anxiety
  • Emotions of anger and guilt

Coping With Ineffective Relationship

  • Distribution of roles and responsibilities. In order to accomplish this, it is necessary to determine what tasks the person with the condition can and cannot perform and how the partner can assist in fulfilling those duties. This allows the affected individual to discuss household duties and responsibilities with their partner openly.
  • Demonstration of understanding and compassion. Patients with chronic illnesses frequently complain about isolation. Symptoms and fatigue can reduce a person’s capacity for social interaction. This also applies to their partners, as they often assume the role of caregiver. The patient’s spouse or partner can be cared for in a considerate manner by assisting them in uncovering aspects of themselves that are unrelated to caregiving and connecting them with others.
  • Communication but within limits. Daily conversations and check-ins on the ill individual’s well-being or feelings can aid in improving intimacy and communication. Always ask about their well-being and their main sources of stress, or schedule a separate schedule for this. Set periods when the health-related chat is exempted. In order to improve communication, one must transcend the level of conventional conversation and avoid “yes” or “no” questions. Listening to what the partner is not explicitly stating is an additional step in the process.
  • Recognizing pain and suffering of both the patient and partner. Individuals with long-term chronic illnesses experience a great deal of grief, both for themselves and for the people who love and care for them. Couples may be unable to express their own grief due to clear expectations or understanding that each person is mourning separately. Communication is hampered because of this mutual need to keep each other protected. It is easier for a couple to open up to one another when they regard conflicts with mutual effort and understanding.
  • Collaborative problem-solving. When partners can process grief collaboratively, they can engage in proactive problem-solving.

Other interventions for ineffective relationships include:

  • Cognitive-behavioral therapy. One of the linked causes of sexual dysfunction in a relationship is anxiety and stress, and cognitive behavioral therapy (CBT) is frequently used to treat it. CBT programs offer a directive intervention that alters thinking and beliefs about how a person behaves towards sex.
  • Counseling. Talking about issues and beliefs would reduce anxiety related to sex and performance, as well as meeting other physical needs. In addition, counseling could help identify measures to enhance the quality of sexual life.
  • Pharmacotherapy. Medications can be utilized for the management of anxiety, stress, sexual dysfunction, underlying chronic illnesses, or mental/physical impairments.

Prevention of Ineffective Relationship

  • The nurse or healthcare provider should effectively communicate with the partner or affected individual.
  • The patient and partner should be encouraged to share expectations.
  • Advise them to focus on individual well-being and avoid stressors.
  • Validate thoughts regarding the underlying condition and aim toward obtaining medical treatment.
  • Encourage help-seeking behavior.

Ineffective Relationship Nursing Diagnosis

Ineffective Relationship Nursing Care Plan 1

Sexual Dysfunction

Nursing Diagnosis: Ineffective Relationship related to an underlying chronic condition that affects sexual performance, secondary to sexual dysfunction, as evidenced by diminished libido, failure to obtain sexual satisfaction, pain, and inability to sustain a full erection

Desired Outcome: The patient will express a sexually fulfilling relationship with their spouse or partner.

Ineffective Relationship Nursing InterventionsRationale
Assess the duration of sexual dysfunction and examine the psychological factors contributing to it.Stress and anxiety can cause concerns about sexual performance, resulting in self-consciousness and the inability to engage in sexual activity.
Assess the patient’s willingness to discuss sexual and relationship issues.When patients are asked sensitive, open-ended questions, it is easier for them to communicate their concerns.
Discuss potential problems with sexual performance related to anxiety, trauma, body image, pain, or joint function.During this discussion, patients are given the opportunity to express their concerns about their sexual performance, changes in their body perception, discomfort, and mobility, all of which may affect their desire for or capacity to engage in sexual or intimate relations.
Provide information about alternative methods to usual sexual practicesNon-pharmacologic procedures such as mutual masturbation, changes in positions, vibrators, and the identification of different sexual zones for each partner are possible alternatives to medications.
Establish a therapeutic relationship with the patient and adopt a neutral, nonjudgmental approach during interactions and patient encounters.Facilitates a trusting relationship. Often, male patients are reluctant to share their sexual concerns with a female nurse. A nurse’s calm, neutral, and professional approach will inspire patients to trust in their ability to work with them. This may also promote acceptance and alleviate anxiety.
Discuss the importance of rest before any intimate or sexual encounters.Conserves energy and facilitates a more meaningful experience for both the patient and his/her partner.
Discuss the relevance of sufficient rest and sleep.Adequate rest and recuperation (e.g., sleeping on time and enough) prior to sexual activity can improve mental health, reduce stress, and enhance impulse control. However, insufficient rest (such as fragmented sleep) can exacerbate conditions like depression and anxiety. And these conditions are typically linked to sexual dysfunction in women and men.
Provide information about the possible side effects of drug therapies.Certain medications can cause sexual dysfunction, and alterations in sexual function might have a negative impact on the patient’s relationship.

Ineffective Relationship Nursing Care Plan 2

Prolonged Bed rest

Nursing Diagnosis: Ineffective Relationship related to changes in sensorium, secondary to prolonged bed rest, as evidenced by lack of enthusiasm, lack of interest, changes in sexual behavior, helplessness, and muscular deconditioning

Desired Outcome: The patient will demonstrate satisfaction and an increased capacity to maintain interpersonal relationships and sexual activities.

Ineffective Relationship Nursing InterventionsRationale
Assess and validate the patient’s concerns regarding his or her physical or sexual functioning.Determines the cause of sexual dysfunction. These may be the response to an existing ailment, a loss of autonomy, or perceived limits. Prolonged bed rest might diminish libido or sexual hormones, and in women, it can induce menstrual abnormalities. It is also likely to cause an increase in frailty and a decrease in the patient’s capacity to maintain personal hygiene and grooming routine, which can have a detrimental effect on their self-image and confidence.
Determine the patient’s feelings and perceptions regarding the situation/immobilization. Involve the patient in the process of establishing goals and formulating a treatment plan.The patient’s perspective serves as a starting point for establishing the care plan. It reveals if the patient believes he or she has control over the problem or whether the patient believes he or she has no control over the situation and desires seclusion. Compliance increases when patients are actively involved in developing their treatment plans. This also enables the personalization of the treatment plan.
Offer activities that demand the involvement of a significant other (SO).These activities increase the time spent interacting and communicating with the significant other.
Assess potential issues with sexual function and take note of the following: the amount of contact, the significance of sex in the relationship, and typical positions used.Assists in determining the patient’s normal sexual function and any alterations that will be required according to the present situation.
Encourage the patient’s partner or significant other to participate in his or her care. Encourage physical interaction between the two. Allow the patient and his or her significant other to converse and connect in privacy.These activities increase the time spent interacting and communicating with the significant other.
Avoid downplaying the patient’s reported depressive feelings. Permit outbursts of emotion with a supportive and encouraging atmosphere.Achieving independence requires emotional support, which can be delivered by providing attainable goals and encouragement.

Ineffective Relationship Nursing Care Plan 3

Substance Abuse

Nursing Diagnosis: Ineffective Relationship related to physiologic changes due to drug use, secondary to substance abuse, as evidenced by anxiety, poor motor coordination, inattentiveness, impaired judgment, and anger.

Desired Outcomes:

  • The patient will openly and clearly express his or her feelings.
  • The patient will have an enhanced sense of self-worth, develop goals and engage in realistic planning for the necessary lifestyle adjustments to live in sobriety.
InterventionIneffective Relationship Nursing InterventionsRationale
Determine the patient’s understanding of the present situation and previous coping strategiesProvides information upon which the current plan of care can be based.
Explain the patient’s medical condition and the debilitating effects of drug or narcotic use.Sexual function may have been impaired by drug or substance (alcohol) use or by psychological variables such as stress or depression. Patients on stimulants may have been able to engage in a variety of sexual behaviors, which could lead to the patient losing a partner or having difficulty transitioning to life without the drug. With the right information, the patient and their partner can better comprehend their situation and determine the right plan of action for a positive outcome.
Encourage therapeutic writing, such as guided journaling.Health care providers can use anecdotal notes to improve treatment or develop new approaches based on the patient’s experiences. When used during rehabilitation, it’s a helpful way for patients to express their feelings such as anger, stress, or grief.
Explain the significance of enabling behavior and characteristic of addictive behavior for both user and nonuserPartners can initiate the process of change when they are aware of and knowledgeable about enabling behaviors such as shielding and subservience.
Explain the implications of addictive behaviors to both the patient and their SO. Communicate post-discharge expectations.Often patients and their SOs are unaware of the characteristics of addiction. If a patient uses prescription or legally acquired medications, he or she may assume that this is not abuse.
Encourage participation in self-help programs.The patient and their SO are placed in contact with the appropriate support networks ensuring that they can help the patient stay sober and resolve any concerns that may occur.

Ineffective Relationship Nursing Care Plan 4

Personality Disorder

Nursing Diagnosis: Ineffective Relationship related to inappropriate interaction and conduct, secondary to personality disorder (PD), as evidenced by avoidance of contact, dependency, manipulative and demeaning behavior, and ineffective communication.

Desired Outcome: The patient will recognize their personal behaviors that are causing relationship conflicts.

Ineffective Relationship Nursing InterventionsRationale
Identify the patient’s stressors and the onset of the problem. Discuss the events that occur in his or her life within that period.Identifying the patient’s stressors is the first step in correcting distortions of one’s view, resolving interpersonal conflict in all of their relationships, and reducing negative self-rumination and dwelling on the past. Moreover, this intervention will facilitate goal-setting.
Correct any misconceptions the patient may have regarding his/her self and care. Avoid criticism and be tolerant and accepting.This intervention establishes an atmosphere that encourages free expression. Since sexuality is a highly personal and sensitive topic, the patient is more inclined to disclose it if he or she does not worry about being scrutinized by the healthcare professional.
Facilitate discussion regarding the disease process.Discussing the impact of disease on one’s sexual and social functioning can lessen one’s fears and anxiety about it. Misconceptions can also be clarified through these discussions.
Establish a therapeutic relationship with the patient and encourage him/her to express concerns, especially with the way he/she perceives oneselfMaintaining a healthy intimate relationship demands open communication. Additionally, it assists the patient in recognizing that he or she is a respected individual, even when their behavior is inappropriate.
Ask about the factors that contribute to sexual dysfunction or sexual identity. Consider the cultural, socioeconomic, ethnic, racial, and religious aspects that may contribute to sexual-related disputes.These norms and beliefs can impact how the patient and their partners express and manage interpersonal conflicts.
Ensure the patient is aware of various means to achieve sexual satisfaction. Explain that sex counseling is an option if he or she and their partner want to learn more about sexual fulfillment.If the patient is taking psychiatric medication, the patient’s usual means of sexual expression may not work. Understanding the sexual experiences of people with PD might help practitioners devise therapeutic interventions for individuals who are experiencing sexual dysfunction or dissatisfaction.

Ineffective Relationship Nursing Care Plan 5

Major Depression

Nursing Diagnosis: Ineffective Relationship related to altered mental processes, secondary to major depression, as evidenced by expressed feelings of isolation, avoidance of contact, loss of interest, and negative ruminations.

Desired Outcome: The patient will demonstrate functional interaction with his/her partner and will recognize behaviors that contribute to poor interpersonal relationships.

Ineffective Relationship Nursing InterventionsRationale
Evaluate the patient’s level of self-esteem and look for signs of hopelessnessIndicates negative thought patterns and the inability to take action to resolve marital or relationship conflicts.
Encourage activities such as board games and sketching that require minimal concentration.Due to irregularities in the brain, depressed individuals are more likely to have a lapse in concentration, memory loss, and an inability to process information. Activities with no right and wrong decrease the patient’s prospects for self-deprecation
Engage the patient in gross motor activities with minimal concentration, such as walking. Monitor the patient’s vital signs and motor functioning.Psychomotor retardation and social disengagement are typical manifestations of depression. Understanding the psychologic symptoms of the patient allows for more successful therapeutic interventions. Moreover, participation in motor tasks will aid in releasing stress and may contribute to an improvement in mood.
During a depressive state, encourage one-on-one activity.Increases the likelihood of patient interactions and encounters while decreasing anxiety levels. When the nurse is aware of the patient’s level of anxiety, he/she is more able to provide appropriate treatments and make adjustments to the care plan.
Engage the patient in collaborative activities with his/her partner.Socializing helps to alleviate feelings of isolation. Moreover, this interaction distracts the patient from introspection.
Explain the correlation between motor performance and interpersonal relationships.Chores help strengthen fine motor function. Poor performance on tasks (due to physical or mental impairment) can compromise the time and priorities of others (partners).
Discuss how depression can be effectively treated.Medications are frequently recommended in the course of treatment. They may not alleviate the issues that may have resulted from depression, but they provide the required energy to deal with these problems. However, the side effects of these medications or extended treatment can induce sexual dysfunction. As the medication affects sexual activity, patients who attribute their sexual issues to drugs are less willing to conform to or finish the treatment.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon


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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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