Angelite Nurses: Alteration in Family Processes

Alteration in Family Processes

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Illness of a family member:_____________________ (_) Loss/gain of family member due to:______________ ____________________________________________ (_) Change in family roles:_______________________ (_) Conflict:___________________________________ (_) Financial crisis:_____________________________ (_) Other:____________________________________ ____________________________________________ ____________________________________________

**As evidenced by:**
*[Check those that apply]*
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: meet physical needs of all its members meet emotional needs of all its members meet spiritual needs of all its members express or accept a wide range of feelings seek or accept help appropriately

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:________________
________________________
________________________
________________________

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Patient/Significant other signature

__________________________
RN signature

Angelite Nurses