• Assess client’s ability to perform ADLs independently with the Katz Index of Independence in Activities of Daily Living. The Katz Index is the most appropriate instrument for assessing client’s ADL abilities (Shelkey & Wallace, 1998).
• Assess self-efficacy (The Self-Efficacy for Functional Activities scale); assess outcome expectations (Outcome Expectations for Functional Activities scale). Based on assessment, promote motivation and self-efficacy for ADL functioning by role modeling via videotape or partnering; verbal encouragement; individualize care using humor, kindness, joy, and excitement with achievements; social supports; and decrease unpleasant sensations with the ADL function. EBN: Assessment and interventions for self-efficacy strengthen client efficacy expectations and improve functional performance (Resnick, 2002).
• Assess for grieving resulting from loss of function. Grief resulting from loss of function can inhibit relearning of self-care.
• Develop client muscle strength building plan through exercise to build the client’s physiological capacity and prevent decline in ADLs. EB: Older adults who live in assisted living may have declines in their ADLs that access to a physical activity program can reverse. Maintaining independence in ADLs is vital to a sense of dignity and autonomy (Taylor et al, 2003).
• Include exercise and walking program in plan of care. EB: Exercise for flexibility, strengthening, and a walking program in the hospital promotes ADLs, prevents injury, increases quality of life, and may delay admission to a long-term care facility (Hart et al, 2002; Penninx, 2001).
• Provide same type of bathrobe and bathing articles, such as scented dusting powder and bath oil, that the client used previously. Use of sensory channels to stimulate memory may help foster understanding of bathing and self-care.
• Emphasize how client experiences the bathing setting with secondary focus on ways environment can support caregiver. Recognizing and supporting cognitive, emotional, psychological, spiritual, and physical needs of individuals should be reflected in spaces where the most personal care—such as bathing—is provided, which demonstrates the quality of a care setting (Calkins, 2005).
• Design bathing environment for comfort: Visual. Reduce clutter and use partitions to hide equipment storage. Consider what bather looks at as he/she enters room and bathes. Reduce institutional signs and blend into background. Laminate and put artwork or decorative objects in bather’s view, or cue cards to bathing process (wall, ceiling, shower). Stand or sit in bather’s position to experience what he/she see. Decrease glare from tiles, white walls, and artificial lights. Use contrasting colors and soft but adequate lighting on a dimming switch for adjustment. Bathing rooms are sterile, institutional, and frightening spaces filled with unfamiliar equipment—tubs with sides that open up and look like they might swallow you or gurneys with arms that look like construction cranes. Overhead lights can be bright and shine into the bather’s eyes. Glare can cause visual discomfort, especially in clients with visual changes or cataracts (Calkins, 2005).
• Arrange bathing environment to promote sensory comfort: Auditory. Reduce noise of voices and water. Do not allow traffic into bathing room. Add fabric to absorb sound (three to four times the width of the opening for sound absorbing folds). Play soft music. Noise discomfort can result from high-echo tiled walls, loud voices, and running water. Traffic can compromise privacy. Absorb negative sounds, and add positive sounds through music. (Calkins, 2005).
• Design bathing environment for comfort: Tactile. Use heat lamps or radiant heat panels to keep room warm. Use warmed towels. Use powder-coated grab bars in decorative colors with non-slip grip. Provide soft rug to stand on. Ensure flooring is not slippery (a high coefficient of friction, ideally above 80, is desired and obtained through flooring coatings). If caregiver is warm, to point of sweating, room temperature is about right for older person being bathed. Warm towels and soft rugs make bathing a much more luxuriant experience. Appealing stable grab bars are needed for balance. Preventing slippery floor from water is essential (Calkins, 2005).
• Teach caregivers to use behaviors that validate client’s feelings, reassure, segment tasks, and explain the care process while bathing Alzheimer’s clients. EBN: Caregivers should work to make bathing more therapeutic for individuals with Alzheimer’s disease (Somboontanont et al, 2004).
• Advise caregivers to initiate shower spray or touch during bathing carefully with verbal prompts beforehand. EBN: Assaults are particularly likely to occur when caregivers spray water on a resident without letting the individual know in advance or when they touch resident’s feet, axilla, or perineum possibly due to the startle reflex (Somboontanont et al, 2004).
• Train caregivers bathing those with Alzheimer’s disease to avoid behaviors that can trigger assault: confrontational communication, invalidation of resident’s feelings, failure to prepare a resident for a task, speaking disrespectfully to the client, and a hurried pace of the bath. EBN: Assaults by nursing home residents with Alzheimer’s disease during bathing arc frequently triggered by caregiver actions that frighten, hurt, or upset the resident (Somboontanont et al, 2004).
• When bathing a cognitively impaired client, have all bathing items ready for the client’s needs before bathing begins. Injury often occurs when cognitively impaired client is left alone while forgotten items are obtained.
• Teach caregiver to use massage for frail elderly clients during bathing. Massage is desired by clients to reduce pain or agitation (Perimutter & Camberg, 2004).
• Bathe elderly clients before bedtime to improve sleep. An evening bath helps elderly clients sleep better (Kanda et al, 1999).
• Limit bathing to once or twice a week; provide a partial bath at other times. Frequent bathing promotes skin dryness. Reducing frequency of bathing decreases aggressive behavior in cognitively impaired clients.
• Allow the client or caregiver adequate time to complete the bathing activity. Significant aging increases the time required to complete a task; therefore elderly individuals with a self-care deficit require more time to complete a task.
• Use a nondetergent, no-rinse cleanser for bed bathing rather than soap and water. EBN: Nondetergent, no-rinse cleanser bathing reduces skin tears and saves money for skin tear treatment costs, reduces bathing time, and eliminates soap residue on the skin (Burch & Coggins, 2003).
• Avoid soap or use only mild soap on genital and axillary areas; rinse well. Soap can alter skin pH and thus skin defenses, and it may increase skin dryness that results from decreased oil and perspiration production in the elderly.
• Use tepid water. Hot water promotes skin dryness.
• Test water temperature before use with thermometer. With assistive bathing, temperature changes are not felt by the person controlling them (Fathers, 2004).
• Recommend use of water temperature–sensing shower valve to prevent scalding. Older or disabled people have slower reflexes to respond to hot water, yet may be left unattended although they are unable to regulate water temperature; water at 130° F takes 20 seconds to produce a first-degree burn; at 135–140° F, 5–6 seconds causes third-degree burns (Fathers, 2004).
• Use a gentle touch when bathing; avoid vigorous scrubbing motions. Aging skin is thinner, more fragile, and less able to withstand mechanical friction than younger skin.
• Add hydrating bath oils to tub bath water 15 minutes after the client immerses in water. Client’s skin is coated with oil rather than being hydrated if bath oil is placed in water before the client’s skin is moistened with water.

• If in a typical bathing setting for the client, assess the client’s ability to bathe self via direct observation using physical performance tests for ADLs. Observation of bathing performed in an atypical bathing setting may result in false data for which use of a physical performance test compensates to provide more accurate ability data.
• Ask the client for input on bathing habits and cultural bathing preferences. EB: Creating opportunities for guiding personal care honors long-standing routines, increases control, and makes bath time more pleasant for caregiver (Perimutter & Camberg, 2004).
• Develop a bathing care plan based on the client’s own history of bathing practices that addresses skin needs, self-care needs, client response to bathing, and equipment needs. Bathing is a healing rite and should be a comforting experience that concentrates on the client’s needs, rather than being a routinely scheduled task (Rasin & Barrick, 2004).
• Individualize bathing by identifying function of bath (e.g., odor, urine removal), frequency required to achieve function, and best bathing form (e.g., towel bathing, tub, shower) to meet client preferences, preserve client dignity, make bathing a soothing experience, and reduce client aggression. EB: Individualized bathing produces a more positive bathing experience and preserves client dignity. Client aggression is increased with shower (especially) and tub bathing. Towel bathing increases privacy and eliminates need to move the client to central bathing area; therefore it is a more soothing experience than either showering or tub bathing (Perimutter & Camberg, 2004).
• Request referrals for occupational and physical therapy. Collaboration and correlation of activities with interdisciplinary team members increases the client’s mastery of self-care tasks.
• Plan activities to prevent fatigue during bathing; seat the client with feet supported. Energy conservation increases activity tolerance and promotes self-care.
• Provide pain relief measures: ice packs, heat, and analgesics 45 minutes before bathing if needed. Pain relief promotes participation in self-care, and preserves dignity.
• Consider environmental and human factors that may limit bathing ability, such as bending to get into tub, reaching required for bathing items, grasping force needed for faucets, and lifting of self. Adapt environment by placing items within easy reach, lowering faucets, and using a hand held shower. Environmental factors affect task performance. Function can be improved based on engineering principles that adapt environmental factors to the meet the client’s capabilities.
• Teach use of adaptive bathing equipment (e.g., long-handled brushes, soap-on-a-rope, washcloth mitt, wall bars, tub bench, shower chair, commode chair without pan in shower) and follow up in the home. EB: Adaptive devices extend the client’s reach, increase speed and safety, and decrease exertion and reduce caregiver burden (Chen et al, 2000). Follow-up teaching in the home increases device use and safety of bathing (Chiu & Man, 2004).
• Identification of the client’s likelihood of using devices such as the long-handled brush allows for alternate device planning (Rogers et al, 2002).
• Ensure bathing assistance preserves client dignity through conveyance of honor and recognition of the deservedness of respect and esteem of all persons regardless of their dependency and infirmity. EB: Needing assistance with bathing, being hospitalized, and having pain, were among the most significant issues fracturing a sense of the terminally ill client’s dignity (defined as being worthy of honor, respect, or esteem), which resulted in a higher desire for death and loss of will to live; thus dignity-conserving care should be part of palliative care for all clients near death (Chochinov et al, 2002).
• Provide privacy: have only one caregiver providing bathing assistance, encourage a traffic-free bathing area, and postprivacy signs. The client perceives less privacy if more than one caregiver participates or if bathing takes place in a central bathing area in a high-traffic location that allows staff to enter freely during care (Calkins, 2005).
• Keep the client warmly covered. Clients, especially elderly clients who are prone to hypothermia, may experience evaporative cooling during and after bathing, which produces an unpleasant cold sensation.
• Enhance communication during bathing. Allow the client to participate as able in bathing. Smile and provide praise for accomplishments in a relaxed manner. EB: Improved communication decreases aggression during bathing and individualizes care (Perimutter & Camberg, 2004).
• Inspect skin condition during bathing. Observation of skin allows detection of skin problems. Towel bathing facilitates inspection of skin.
• Use or encourage caregiver to use an unhurried, caring touch. The basic human need of touch offers reassurance and comfort.
• If the client is bathing alone, place assistance call light within reach. A readily available signaling device promotes safety and provides reassurance for the client.
• Bathe cognitively impaired clients before bedtime. Bathing a cognitively impaired client in the evening helps improve symptoms of dementia (Deguchi et al, 1999).
• Nurture personal attributes such as humor, positive attitude, faith, and hope. Control stress for clients with multiple sclerosis. EBN: For those with multiple sclerosis, personal attributes intervene between emotional distress and ADL functioning by decreasing a stress appraisal response (Gulick, 2001). EBN: Continue rehabilitation efforts with poststroke client’s long-term to achieve optimal functioning. Client improvement may continue 6 months or longer poststroke (Cavanagh et al, 2002).

Activities

• open the airway, using the chin lift or jaw thrust technique, as appropriate
• position patient to maximize ventilation potential
• identify patient requiring actual/potential airway insertion
• insert oral or nasopharyngeal airway, as appropriate
• perform chest physical therapy, as appropriate
• remove secretion by encouraging coughing or suctioning
• encourage slow, deep breathing, turning and coughing
• instruct how to cough effectively
• assist with incentive spirometer, as appropriate
• auscultate breath sounds, noting areas of decreased or absent ventilation and presence of adventitius sounds
• perform endotracheal or nasotracheal suctioning, as appropriate
• administer bronchodilators, as apropriate
• teach patient how to use prescribe inhalers, as appropriate
• administer aerosol tretments, as appropriate
• administer ultrasonic nebulizer treatments, as appropriate
• administer humidified air or oxygen, as appropriate
• regulate fluid intake to optimized fluid balance
• position to alleviate dyspneu
• monitor respiratory and oxygenation status, as appropriate

defining Characteristics:
- Dispneu, Decreased breath sounds
- Orthopneu
- Cyanosis
- Abnormal breath sounds (rales, wheezing)
- Difficulty speaking
- Cough, not efektif or no
- Eyes widened
- Production of sputum
- Fidget
- Changes in the frequency and rhythm of the breath

Related factors:
- Environment: smoking, inhaling cigarette smoke, passive smoking-POK, infections
- Physiological: neuromuscular dysfunction, bronchial wall hyperplasia, airway allergy, asthma.
- Obstruction of the airway: airway spasm, secretion detained, the number of mucus, the presence of artificial airway, bronchial secretions, the presence of exudate in the alveoli, the presence of foreign bodies in the airway.

• Provide truthful information and support for the family and significant people regarding the client’s specific illness or condition. EBN: The results of this study indicate that attention needs to be given to methods of providing information and support to couples coping with prostate cancer. Both patients and partners need to be included in discussions about the effect of the illness and treatments so that both can feel more prepared to manage them (Harden et al, 2002).
• Refer women with recurrent breast cancer and their family caregivers to a FOCUS Program (family involvement, optimistic attitude, coping effectiveness, uncertainty reduction, and symptom management), a family-based program of care. EBN: Patients with recurrent breast cancer and their family members reported high satisfaction with the FOCUS Program. This study indicates that a need exists for family-based programs of care that enable both patients and their family members to manage the multiple demands associated with recurrent breast cancer (Northouse et al, 2002).
• Promote individual and family relaxation and stress-reduction strategies. The immune system weakens in response to stress; relaxation elicits the opposite, healthful response (Bulechek & McCloskey, 1992).
• Provide a parent support and education group to provide opportunities for parents to access support, learn new parenting skills, and, ultimately, optimize their relationships with their children in families of children in residential care. EB: Working with the families of children in residential care is critical to the success of the placement. In this study a parent support and education group was designed and implemented. The responses of both parents and staff to this program were favorable. It served as a springboard to enhance family involvement in other program areas (Modlin, 2003).

• The interventions described previously may be adapted for home care use.
• Assess the reason behind the breakdown of family coping. Knowledge of the reasons behind compromised coping will assist in identification of appropriate interventions. Are family members physically able to aid client? Is there a lack of resources? Do past relationship issues interfere with motivation? Are family members feeling stressed dealing with client’s care needs? Refer to the care plan for Caregiver role strain.
• During the time of compromised coping, increase visits to ensure the safety of the client, support of the family, and assistance with coping strategies. Provide reassurance regarding expectations for prognosis as appropriate. Increased time for expressions of support, active listening, and empathy can nurture the client and family and move them toward more effective coping. EBN: A study identified the need for support of the spouses of heart transplantation clients (Bohachick et al, 2001).
• Assess the needs of the caregiver in the home. Intervene to meet needs as appropriate to total case management and explore all available resources that may be used to provide adequate home care (e.g., parish nursing as an effective adjunct, home health aide services to relieve caregiver’s fatigue). Encourage caregivers not to neglect their own physical, mental, and spiritual health and give more specific information about the client’s needs and ways to meet them. Meeting the needs of caregivers supports their ability to meet the needs of the client. Assess the client and caregiver separately and in interaction. Do not assume that the client and his or her spouse experience similar patterns of distress or psychological adjustment. EBN: In one study, the highest level of distress in heart transplantation clients related to effects on their ability to work, while spouses felt higher levels of psychological distress (Bohachick et al, 2001).
• Refer the family to medical social services for evaluation and supportive counseling. Dedicating time for nurturing the caregivers and reassuring the client allows them to express feelings and feel hope.
• Serve as an advocate, mentor, and role model for caregiving. Write down or contract for the care needed by the client. Therapeutic use of self by the nurse and concrete task definition and assignment reinforce positive coping strategies and allow caregivers to feel less guilty when tasks are delegated to multiple caregivers.
• When a terminal illness is the precipitating factor for ineffective coping, offer hospice services and support groups as possible resources. Nonjudgmental support from helpers with no agenda allows verbalization of feelings. The hospice paradigm addresses the physical, emotional, and spiritual needs of the dying and their loved ones.
• With a cancer client, encourage family discussion of stressors (including the meaning of the illness, fear of recurrence, the client’s employment status) and resources (family social support). EBN: Stressors and resources have been shown to play an important role in determining family quality of life among cancer survivors (Mellon & Northouse, 2001).
• Encourage the client and family to discuss changes in daily functioning and routines created by the client’s illness. Validate discomfort resulting from changes. Individuals who live together for a long period tend to become entrained to each others’ patterns: meals are expected at certain times, a spouse becomes accustomed to the client’s sleep habits. Changes in these patterns may result in a vague discomfort that may be relieved when its source is known.
• Support positive individual and family coping efforts. Positive feedback reinforces desired behaviors and supports the family unit.
• If compromised family coping interferes with the ability to support the client’s treatment plan, refer for psychiatric home health care services for family counseling and implementation of a therapeutic regimen. EBN: Psychiatric home care nurses can address issues relating to family members’ ability to adjust to changes in the client’s health status. Behavioral interventions in the home can help the family to participate more effectively in the treatment plan (Patusky, Rodning, & Martinez-Kratz, 1996).

• Acknowledge racial/ethnic differences at the onset of care. EBN: Acknowledgment of race/ethnicity issues will enhance communication, establish rapport, and promote treatment outcomes (D’Avanzo et al, 2001; Ludwick & Silva, 2000; Vontress & Epp, 1997).
• Approach families of color with respect, warmth, and professional courtesy. EB: Instances of disrespect and lack of caring have special significance for families of color (D’Avanzo et al, 2001; Vontress & Epp, 1997). Latina mothers of developmentally disabled adults reported their relationship with the educational and service delivery systems to be characterized by poor communication, low effort in providing services, negative attitudes of professionals toward the client-children, and negative treatment of parents by professionals (Shapiro et al, 2004).
• Assess for the influence of cultural beliefs, norms, and values on the family’s perceptions of coping. EBN: What the family considers normal and abnormal coping behavior may be based on cultural perceptions (Leininger & McFarland, 2002; Cochran, 1998; Doswell & Erlen, 1998).
• Give a rationale when assessing families with regard to sensitive issues. EBN: African Americans and other people of color may expect Caucasian caregivers to hold negative and preconceived ideas about them. Giving a rationale for questions asked will help reduce this perception (D’Avanzo et al, 2001; Vontress & Epp, 1997). Topics such as smoking in the household, financial difficulties, and emotional support available to the parent were more likely to be asked of parents of African-American and Hispanic children than of parents of Caucasian children (Kogan et al, 2004).
• Use a family-centered approach when working with Latino, Asian, African-American, and Native-American clients. EBN: Latinos may perceive the family as a source of support, solver of problems, and source of pride. Asian Americans may regard the family as the primary decision maker and influence on individual family members (D’Avanzo et al, 2001; Guarnaccia, 1998). Elders may play a key role in decision making for some Asian populations (Davis, 2000). Native-American families have extended structures and exert powerful influences over functioning (Seiderman et al, 1996). Use of a family-based intervention among American-Indian families resulted in higher levels of child prosocial behavior and lowered drug use (Boyd-Ball, 2003). Among Mexican Americans with type 2 diabetes, higher levels of perceived family support and greater self-efficacy were associated with higher reported levels of diet and exercise self-care (Wen, Shepherd, & Parchman 2004).
• Facilitate modeling and role playing for family regarding healthy ways to communicate and interact. EBN: It is helpful for families and the client to practice communication skills in a safe environment before trying them in a real-life situation (Rivera-Andino & Lopez, 2000).
• Validate the family’s feelings regarding the impact of the client’s illness on the family’s lifestyle. EBN: Validation lets family members know that the nurse has heard and understood what was said, and it promotes the relationship between nurse and family members (Heineken, 1998).
• Work to provide caregivers who understand the importance of cultural beliefs and values the family may hold. EBN: There are differences in some cultures regarding health beliefs, practices, and values (Camphinha-Bacote & Narayan, 2000).

• Assess the adolescent’s perception of support from family and friends during crisis. EBN: Some teens find parents and friends burdensome during a time of grief, whereas others find their support critical for coping with crises. Recognition of individual perception can assist families in negotiating times of crisis (Rask, Kaunonen, & Paunonen-Ilmonen, 2002).
• Provide educational interventions and psychosocial interventions such as coping skills training in treatment for families and their adolescents who have type 1 diabetes. EB: Education interventions increase diabetes knowledge but are not consistently helpful in improving metabolic outcomes. Psychosocial interventions such as coping skills training and behavioral family systems therapy have demonstrated improvements in metabolic control, self-efficacy, diabetes stress, quality of life, and parent-adolescent conflict. Family interventions are emerging as a positive way to improve interpersonal relations and assist the adolescent in transitioning from family-management toward self-management of their diabetes (Urban, Berry, & Grey, 2004).
• Encourage the use of family rituals such as connection, spiritual, love, recreation, celebration, and evolving especially in single parent families. EBN: Data from this study indicated that these rituals were found to be used by single-parent families as a way to facilitate family cohesion and instill family values (Moriarty & Wagner, 2004).
• Encourage laughing, playing, singing, talking, and praying with seriously injured children. EBN: This interpretive study examined the experiences of 16 pediatric burn intensive care unit nurses for the purpose of uncovering and articulating practices that help critically burned children to heal holistically. These everyday practices were identified as maintaining or reestablishing harmony of the children’s mind, body, and spirit (Zengerle-Levy, 2004).
• Link trained volunteers with “vulnerable” first-time parents. Provide social support and information related to age appropriate expectations of infants. EBN: This descriptive comparative design demonstrated participant’s satisfaction with the program and improvement in family functioning. The program could be appropriate for all parents (Kelleher & Johnson, 2004).

• Caregiver Support
• Coping Enhancement
• Family Involvement Promotion
• Family Mobilization
• Family Support
• Mutual Goal Setting
• Normalization Promotion
• Sibling Support

Example NIC Activities—Family Support

Appraise family’s emotional reaction to client’s condition; promote trusting relationship with family

Nursing Interventions and Rationales

• Assess the strengths and deficiencies of the family system. EBN: Assessments allow for anticipatory care and guidance to help members acquire and maintain supports and coping strategies (Thomas, 2000). EB: Chronic illness in children affects the psychological health of the parents. Active coping strategies are associated with fewer distress indices and thus if inculcated may improve the ability to bear the burden of the illness without becoming themselves affected by psychiatric illnesses (Rao, 2004).
• Assess how family members interact with each other; observe verbal and nonverbal communication and individual and group responses to stress. EBN: Understanding how families cope with stress is important. Family cohesion, presence of a partner, emotional support, and a mother’s satisfaction with her family all contributed to her better mental health in a research study focusing on mothers of low-birth-weight infants (Weiss & Chen, 2002).
• Establish rapport with families by providing accurate communication EBN: This qualitative exploratory study of families in psychiatric settings indicated that family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals (Rose, Mallinson, & Walton-Moss, 2004).
• Consider the use of family theory as a framework to help guide interventions (e.g., family stress theory, role theory, social exchange theory). EBN: This study demonstrated that use of a family assessment tool is an effective way of appraising families and addressing suffering. Formative evaluations demonstrated improvements in team members’ perceptions of their knowledge, family centeredness, and ability to assess and intervene with families (Hogan & Logan, 2004.)
• Help family members recognize the need for help and teach them how to ask for it. EBN: Recognizing the need for help and knowing how to ask for it enables family members to maintain control (Szabo & Strang, 1999).
• Encourage expression of positive thoughts and emotions. EB: Positive emotions initiate upward spirals toward enhanced emotional well-being (Fredrickson & Joiner, 2002). EBN: This study shows that clients believe that coping is important to their well-being (Edgar, 2004).
• Encourage family members to verbalize feelings. Spend time with them, sit down and make eye contact, and offer coffee and other nourishment. EBN: The expression of feelings helps family caregivers to regain and maintain control (Szabo & Strang, 1999). Acceptance of nourishment indicates a beginning acceptance of the situation.
• Provide opportunities for families to discuss spirituality. EB: This research provided by survivors of haematological malignancies gives insight into factors impacting their need to talk about spiritual issues (McGrath & Clarke, 2003).
• Mothers may require additional support in their role of caring for chronically ill children. EBN: Mothers exhibit greater efforts than fathers in coping patterns, including strategies to acquire social support outside the family, increase self-worth, and decrease psychological tensions (Brazil & Krueger, 2002).
• Provide privacy during family visits. If possible, maintain flexible visiting hours to accommodate more frequent family visits. If possible, arrange staff assignments so the same staff members have contact with the family. Familiarize other staff members with the situation in the absence of the usual staff member. Providing privacy, maintaining flexible hours, and arranging consistent staff assignments will reduce stress, enhance communication, and facilitate the building of trust.
• Determine whether the family is suffering from additional stressors (e.g., child care issues, financial problems). EBN: One study found that in mothers of low-birth-weight infants, the presence of other life stressors and the family’s use of internally focused coping strategies contributed to worse mental health outcomes for the mother (Weiss & Chen, 2002).
• Refer the family with ill family members to appropriate resources for assistance as indicated (e.g., counseling, psychotherapy, financial or spiritual support). EBN: The findings of this study demonstrate the importance of supporting family functioning in the families of people with heart disease is an important challenge for family nursing. The most important predictors of family health were family structural factors. It was found that the better the family structure and relationships, the better the family health (stedt-Kurki et al, 2003).