I have a care plan question

anon456, BSN, RN · Jan 28, 2014

Is your careplan for the patient or for the husband? :-) While he may be reporting sleep disturbance, etc. the evidence is how it will affect her care and outcome.

Lev, MSN, RN, NP · Jan 28, 2014

Sounds like a good nursing diagnosis for the husband.

Esme12, ASN, BSN, RN · Jan 28, 2014

thread moved for best response...I will be back to help

nette1022 · Jan 28, 2014

I chose him because of the age, anxiety, not sleeping and not taking care of himself. I forgot to include anxiety in my related to. So am I writing it right? Care plans are sorta kinda fun in a weird nursing way..lol..I am really trying to get good at this so thanks everyone in advance for helpin

nurseprnRN, BSN, RN · Jan 29, 2014

.Caregiver role strain related to caregiving activities as evidenced by caregiver reporting sleep disturbance and self care deficit.

This is a perfectly acceptable possible nursing diagnosis to address what is part of your patient's problems. It's often ignored, but by definition the patient is always the one in the bed and his family/home caregivers. It needs only a little tweaking.

Looking in the NANDA-I 2012-2104 I see:

The definition of caregiver role strain is: Difficulty in performing the family/significant other caregiver role

Defining characteristics for caregiver role strain cover more than a page.

They include subheadings for caregiving activities, for example, difficulty completing required tasks or performing required tasks, and several others.

They include caregiver health status, listing findings for physical, emotional, and socioeconomic conditions. There may be more of these that you can cite, too. One is "disturbed sleep pattern" which you describe. Also included is "lack of time to meet personal needs." This may count for self-care deficit, however, that is a nursing diagnosis in itself with specific defining characteristics, so I think you're better off saying "lack of time to meet personal needs," if that's what's going on.

They include caregiver - care receiver relationship, such as: reporting difficulty watching care receiver go through the illness, uncertainty regarding change relationships, and grief.

They include family processes: reporting concerns about family members and family conflict.

Related to or causative factors, include subheadings for:

Care receiver health status, caregiver health status, caregiver - care receiver relationship, caregiving activities, family processes, resources, and socioeconomic factors. Each of these has somewhere between 2 and 8 defined activities or assessment findings. Therefore, you can say "related to caregiving activities," but you have to specify which ones.

Your choices under caregiving activities are: 24 hour care responsibilities, amount of activities, complexity of activities, discharge of family members to home with significant care needs, ongoing changes in activities, unpredictability of care situation, and years of caregiving.

Therefore, you have made a perfectly acceptable nursing diagnosis based on your assessment, with the modifications as described. Don't let anybody tell you that you can't include this as part of your patient's care plan, because it will have significant impact on her health if her home caregiver cannot continue. We look at the whole situation with any given patient.

I am so pleased to see a student look beyond the easy and common nursing diagnoses of ineffective breathing pattern, pain, impaired gas exchange, activity intolerance, and so forth. Your having assessed for this is a tribute to your education.

:flwrhrts:

nette1022 · Jan 29, 2014

Thank you so much...I am trying to look at the big picture it is difficult being a caregiver. With his age it must be increasingly demanding. I was thinking that many people of his age deny their inability to care for their loved one because they don't want them to be taken away. They will deny needing any help at the expense of himself. He could end up ill and be unable to be there for his wife. Also is safety, anger, depression, frustration an issue...is this a safe situation for both of them, where is their support system if they have one. Is he grieving depressed? Is she? Thank you...My classmates think I am a little strange because they wonder how I get all of this from this scenario. Being elderly I wonder how they are managing financially, who shops for them, who prepares their meals.. There are many care plans that can be done from this scenario but this is the one I chose for now...Thank-you for you compliments and help. I just want to be good at this and train my brain to start putting this into place in a systematic, logical, correct way. Thanks...

nurseprnRN, BSN, RN · Jan 29, 2014

Somebody within the last year did a study on predictors of failure after discharge, if memory serves. They had nurse ask four questions of everyone admitted before they were discharged. They were,

"Who lives with you?"

"Who cooks?"

"How many steps to get into your house?"

"How will you get to your follow-up appointments?"

You can imagine how some answers would scream "POTENTIAL DISCHARGE FAIL!!" -- and they are such innocuous-sounding questions.