Family relations which fail to support the well-being of its members

• Difficulty solving problems
• Ineffective use of coping strategies
• Perceived vulnerability

• Depressive disorder
• Developmental disabilities
• Intimacy dysfunction
• Surgical procedures

• Family status, including alcoholic family member's ability to function in occupational and family roles, ability of other family members to function in their roles, family conflicts, financial status, and rituals during holidays and family celebrations
• Coping patterns, including type and number of changes family has recently experienced, usual response to stress, ability to adapt to change, and use of support systems
• Family health history, including medication use, mental illness, stress-related illnesses, history of alcohol or drug abuse, and evidence of emotional, physical, or sexual abuse of spouse or children
• Parental status, including age, marital status, number and ages of dependent children, and knowledge of normal child behavior
• Drinking pattern, including continuous or binge drinking, periods of abstinence and relapse, use of other substances, symptoms of withdrawal, and past drinking patterns and treatment
• Psychological status, including self-image and self-esteem, functional ability, independence level, and problem-solving and decision-making skills
• Spiritual status, including affiliation with a religious group and religious practices

• Family members will acknowledge that there's dysfunction within the family.
• Alcoholic family member will sign a contract stating that the person agrees to abstain from alcohol.
• Family members will sign contracts stating that they won't engage in abusive behavior.
• Family members will communicate their needs using “I” statements.
• Parents will take steps to reassert appropriate boundaries with children and resume parental responsibilities.
• Family members will discuss problems in an open, safe environment.
• Family members will acknowledge their strengths and their progress in resolving problems.
• Number and intensity of family crises will diminish.
• Family members will state their plans to continue to seek counseling and attend appropriate support group meetings.

Suggested NOC Outcomes

• Encourage family members to acknowledge that alcoholism is a problem within the family to break through family denial. Encourage individual family members to take responsibility for their problems. Problems can't be addressed until family members take responsibility for them.
• Inform alcoholic family member that he or she will have to address alcoholism before progress can be made in rebuilding family relations. Tell the person that abstinence with the help of a support group such as Alcoholics Anonymous is the only proven effective treatment for alcoholism to establish abstinence as the basis for treatment.
• Ask the alcoholic family member to sign a contract stating he or she will abstain from alcohol to help him or her take responsibility for own behavior.
• Help family members evaluate the consequences of abusive and violent behavior. Inform them that any suspected abuse will be reported. Ask family members to sign contracts stating they won't abuse each other to help ensure the safety of family members.
• Teach family members to communicate their needs assertively. Encourage family members to use “I” statements to express feelings, for example, “I'm mad because you didn't show up for the school play like you promised,” to help family members get in touch with and talk about their feelings.
• Discuss with parents their ideas and beliefs regarding parental authority. Ask if they feel they have abdicated authority. Work with parents to develop steps to reassert parental authority to reestablish appropriate boundaries and relieve children of the need to assume parental roles.
• Provide an opportunity for family members to discuss conflicts in an open, safe atmosphere to decrease anxiety and help family members develop confidence in their ability to resolve problems.
• Assist family members in identifying their strengths and their progress in addressing problems to build self-esteem.
• Encourage family members to continue to seek counseling to enhance interpersonal skills and strengthen the family unit.
• Encourage family members to participate in Al-Anon or Alateen to foster recovery.

Suggested NIC Interventions

• Family members acknowledge that there is dysfunction in the family.
• Alcoholic family member signs a contract stating that the person agrees to abstain from alcohol.
• Family members sign contracts stating that they won't engage in abusive behavior.
• Family members communicate their needs using “I” statements.
• Parents take steps to reassert appropriate boundaries with children and to resume parental responsibilities.
• Family members discuss problems in an open, safe environment.
• Family members acknowledge their strengths and the progress they have made in resolving problems.
• Number and intensity of family crises diminish.
• Family members state their plans to continue to seek counseling and attend appropriate support groups.

• Family's reactions to and experience with alcoholism
• Interventions to assist family and family's response to them
• Referrals to community agencies
• Evaluations for expected outcomes

• Kivelä, S., Leppäkoski, T., Helminen, M., & Paavilainen, E. (2018). A cross-sectional descriptive study of the family functioning, health and social support of hospital patients with family violence backgrounds. Scandinavian Journal of Caring Sciences, 32(3), 1083-1092.
• Sleczka, P., Braun, B., Grüne, B., Bühringer, G., & Kraus, L. (2018). Family functioning and gambling problems in young adulthood: The role of the concordance of values. Addiction Research & Theory, 26(6), 447-456.
• Tramonti, F., Bonfiglio, L., Bongioanni, P., Belviso, C., Fanciullacci, C., Rossi, B., … Carboncini, M. C. (2019). Caregiver burden and family functioning in different neurological diseases. Psychology, Health & Medicine, 24(1), 27-34.
• Zhang, Y. (2018). Family functioning in the context of an adult family member with illness: A concept analysis. Journal of Clinical Nursing, 27(15-16), 3205-3224.