Unsatisfactory handling of symptoms, treatment regimen, and lifestyle changes that is unsatisfactory for meeting specific health goals of the family unit

• Competing demands on family unit
• Competing lifestyle preferences within family unit
• Conflict between health behaviors and social norms
• Conflict between spiritual beliefs and treatment regimen
• Difficulty accessing community resources
• Difficulty dealing with role changes associated with condition
• Difficulty managing complex treatment regimen
• Difficulty navigating complex health care systems
• Difficulty performing aspects of treatment regimen
• Difficulty with decision-making
• Family conflict
• Inadequate commitment to a plan of action
• Inadequate health literacy of caregiver
• Inadequate knowledge of treatment regimen
• Inadequate number of cues to action
• Inadequate self-efficacy
• Inadequate social support
• Ineffective communication skills
• Ineffective coping skills
• Negative feelings toward treatment regimen
• Nonacceptance of condition
• Perceived barrier to treatment regimen
• Perceived social stigma associated with condition
• Substance misuse
• Unaware of seriousness of condition
• Unaware of susceptibility to sequelae
• Unrealistic perception of treatment benefit
• Unsupportive family relations

• Chronic disease
• Mental disorders
• Terminal illness

• Family status, including marital status, family composition, communication patterns, coping skills, drug or alcohol abuse, psychiatric history, and beliefs and attitudes about health and illness
• Health status, including chronic or terminal illness and severely disabling physical conditions
• Socioeconomic factors, including financial status, insurance, accessibility of health care, availability of health care providers, and transportation system
• Social status, including communication skills, size of social network, degree of trust in others, self-esteem, and ability to function in social and occupational roles
• Spiritual status, including religious or church affiliation and description of faith and religious practices

• Caregiving burden
• Decrease in attention to illness in one or more family members
• Depressive symptoms of caregiver
• Exacerbation of disease signs of one or more family members
• Exacerbation of disease symptoms of one or more family members
• Failure to take action to reduce risk factor in one or more family members
• Ineffective choices in daily living for meeting health goal of family unit
• One or more family members report dissatisfaction with quality of life.

• Family members will identify behaviors that lead to conflict.
• Family members will participate in family therapy sessions and openly express feelings about illness of family member.
• Family members will express desire to have help in resolving conflicts.
• Family members will describe coping mechanisms that help reduce conflicts.
• Family members will cooperate in finding ways to incorporate therapeutic regimen into their lifestyle.
• Family members will express desire to carry out therapeutic regimen.
• Family members will plan for future course of illness.

Suggested NOC Outcomes

• Spend time with family, get to know each family member individually, and establish a trusting relationship with each family member to help identify measures that will increase family cohesiveness.
• Encourage family members to attend and participate in family therapy sessions to strengthen family unit and promote resolution of conflict.
• Help family members describe feelings associated with the illness of a relative to bring family conflict into the open. Unresolved family conflicts may prevent family members from fully implementing therapeutic regimen.
• Elicit family members' personal beliefs about the illness and review relevant information to establish their support for improving management of therapeutic regimen.
• Educate family members about the pathophysiology of illness and explain relationship between the pathophysiology and the therapeutic regimen. If family members know reasons for specific behaviors, they may be more willing to adjust lifestyle.
• Work with family members to identify behaviors that have contributed to family conflict and help them identify alternative behaviors to promote resolution of the conflict.
• Encourage family members to address individual needs assertively to promote healthy interactions within family.
• Help family members clarify values associated with their lifestyle to enhance understanding of conflicts between lifestyle and demands of therapeutic regimen.
• Work with family members to develop a daily routine for managing the therapeutic regimen that fits with lifestyle. Collaboration with family members makes it possible to incorporate lifestyle factors, such as culture, family dynamics, and finances, into a plan for managing the illness.
• Assist family members in modifying factors (such as lack of supportive behaviors among family members) that interfere with treatment management to enhance level of care.
• Work with family in establishing goals for coping with conflicts to focus their energy on achievable objectives and to foster hope.
• Refer family members to appropriate agencies, if needed. This can ensure continued family support and help reduce conflicts.
• Help family members plan for a future course of the illness. Planning enhances family members' abilities to develop an appropriate strategy to manage the therapeutic regimen.

Suggested NIC Interventions

• Family members identify unresolved conflicts.
• Family members attend and participate in family therapy sessions.
• Family members express a desire to resolve conflicts.
• Family members describe coping mechanisms that can reduce conflicts.
• Family members successfully incorporate components of therapeutic regimen into daily activities.
• Family members carry out therapeutic regimen.
• Family members establish a plan for coping with future course of illness.

• Description of each family member's understanding of patient's illness
• Family members' expressions of feelings regarding patient's illness
• Compliance with participation in family therapy sessions
• Evaluations for expected outcomes

• Aarthun, A., Øymar, K. A., & Akerjordet, K. (2018). How health professionals facilitate parents' involvement in decision-making at the hospital: A parental perspective. Journal of Child Health Care, 22(1), 108-121. doi:10.1177/1367493517744279
• Koren, D., Laidsaar-Powell, R., Tilden, W., Latt, M., & Butow, P. (2018). Health care providers' perceptions of family caregivers' involvement in consultations within a geriatric hospital setting. Geriatric Nursing, 39(4), 419-427. doi:10.1016/j.gerinurse.2017.12.013
• Whiston, L., Barry, J. M., & Darker, C. D. (2017). Participation of patients and family members in healthcare services at the service and national levels: A lesson learned in Dublin, Ireland. Patient Education and Counseling, 100(3), 583-591. doi:10.1016/j.pec.2016.10.025