Diagnosa 1.

Toileting self care deficit Domain: 4 Class 5: Self Care Definition: impaired ability to perform or complete toileting activities for self - Defining Characteristics: 1. Inability to carry out proper toilet hygiene - Related Factors: 1. Decreased motivation

NOC Suggested Outcome: 1. Self Care: Toileting,definiti on: ability to toilet indenpendently with or without assistive device Indikator: 1 = severely compromised 2 = substantially compromised 3 = moderately compromised 4 = mildly compromised 5 = not compromised Indikator; Wipes self after bowel movement Wipes self after urinating Positions self on toilet or commode Gets up from toilet or commode Sugessted Outcome: 1. Caregiver emotional health,definition: emotional well being of family care provider while caring for family member Indikator: 1 = severely compromised 2 = substantially compromised 3 = moderately compromised 4 = mildly

NIC Suggested Intervention: - Self care assistance: toileting,definition: assisting another with elimination 1. Assist patient to toilet/commode 2. Facilitate toilet hygiene after completion of elimination - Teaching: individual,definition: planning, implementation, and evaluation of a teaching program designed to address a patients needs 1. Determine the patients learning needs 2. Instruct the patient, when appropriate 3. Include the family/significant others, as appropriate

2. Caregiver Role Strain Domain: 7 Class 1: Caregiving roles Definition: Difficulty in performing family caregiver role - Defining Characteristics: Caregiving activities 1. Difficulty completing required task 2. Difficulty performing

Suggested Intervention: - Caregiver support,definition: provision of the necessary information, advocacy, and support to facilitate primary patient care by someone other than a health care professional 1. Accept expressions of negative emotion 2. Determine caregivers acceptance of role 3. Encourage caregiver to assume responbility, as appropriate 4. Explore with caregiver how she/he is coping

require task Caregiving health status emotional 1. Increased emotional lability 2. Lack of time to meet personal needs 3. Impaired individual coping 4. Disturbed sleep Sosioecono mic 1. Changes in leisure activities Caregiver-care receiver relationship 1. Uncertainty regarding relationship with care receiver Family processes 1. Family conflict Related factors Care receiver health status 1. Dependency 2. Increasing care needs Caregiver health status 1. Inability to fulfill others expectations Resources 1. Emotional strength 2. Insufficient finances 3. Insufficient time 4. Lack of support

compromised 5 = not compromised Indikator: Anger 2. Caregiver-patient relationship,defin ition: positive interactions and connections between the caregiver and care recipient Indikator: 1 = Never positive 2 = rarely positive 3 = sometimes positive 4 = often positive 5 = consistently positive Indikator: Effective communication Caring Mutual acceptance Sense of responbility 3. Caregiver performance: Direct,definition: provision by family care provider of appropriate personal and healthcare for a family member Indikator: 1 = not adequate 2 = slighty adequate 3 = moderately adequate

5. Teach caregiver stress management techniques 6. Provide support for decisions made by caregiver 7. Acknowledge dependency of patient on caregiver,as appropriate - Role enhancement,definition: assisting a patient,significant other, and/or family to improve relationships by clarifying and supplementing specific role behaviors 1. Assist patient to identify behaviors needed for new or changed roles 2. Assist patient to identify specific role changes required due to illness or disability 3. Encourage patient to identify a realistic description of change in role 4. Facilitate discussion of role adaptation of family to compensate for ill members role changes Additional Intervention: - Counseling,definition: use of an interactive helping process focusing on the needs, problems, or feelings of the patient and significant others to enhanceor support coping, problem solving and interpersonal relationships 1. Demonstrate emphaty, warmth, genuineness 2. Encourage expression of feelings 3. Use technique of reflection 4. Clarification to facilitate expression of concerns - Family involvemenet Promotion

4 = substantially adequate 5 = totally adequate Indikator: Establishes role flexibility Manages family problem Shares responbility for family task Obtains family assistance 4. Family support during treatment Indikator: Members maintain communication with ill member Member express desire to support ill member Additional Outcome: 1. Family coping, definition: family actions to manage stressors that tax family resources Indikator: 1 = never demonstrated 2 = rarely demonstrated 3 = sometimes demonstrated 4 = often demonstrated 5 = consistently demonstrated Indikator: Assistance with care recipients activities of

1. Estabilsh a personal relationship with the patient and family members who will be involved in care 2. Determine physical, emotional, and educational resources of primary caregiver 3. Monitor family structure and roles 4. Identify family members perceptions of the situation, precipitating events, patients feelings, and patients behavior 5. Identify other situational stressors for family members Family support,definition: promotion of family values, interests and goal 1. Appraise familys emotional reaction to patients condition 2. Facilitate communication of concerns/feelings between patient and family or between family members Role enhancement,definition: assisting a patient, significant other, and/or family to improve relationships by clarifying and supplementing specific role behavior 1. Assist patient to identify behaviors needed for new or changed roles 2. Assist patient to identify specific role changes required due to illness or disability 3. Encourage patient to identify specific role changes required due to illness or disability

daily living needs Provision of emotional support to care recipient

4. Encourage patient to identify a realistic description of change in role 5. Facilitate discussion of role adaptation of family to compensate for ill members role changes