Assessing a Support System

Nursing Procedure 13.4

Assessing a Support System

Determines extent of emotional support, physical assistance, and assistance with care that can be provided to the client by others
Identifies the baseline for assistance that may be needed for the client to receive care in the home

Comprehensive assessment form (agency-specific)
Client history
Completed physical assessment
Client problem list or plan of care
Doctor's orders for care
Pen

Assessment should focus on the following:

Client's relationship with family, friends, and others in the community
Client's wishes regarding information given to others
Client's financial status, ability to hire assistance or insurance coverage for assistant
Availability, willingness, and ability of others to assist with client care

Nursing diagnoses may include the following:

Ineffective therapeutic regimen management related to excessive family demands
Bathing/hygiene self-care deficit related to pain and environmental barriers

Outcome Identification and Planning

Desired Outcomes

Sample desired outcomes include the following:

Client demonstrates effective therapeutic regimen management with assistance from support person before discharge from agency care.
Client maintains routine self-care hygiene with assistance from support persons, including home health care personnel as needed.

Special Considerations in Planning and Implementation

General

When assessing the client's support systems, provide the client with privacy to enable him or her to answer questions honestly. In some instances, the nurse will be unable to assess the client's support systems accurately until the client has developed trust in the nurse. Note any indications of abuse or neglect during an assessment of support systems. Elderly, pediatric, physically challenged, and emotionally challenged clients are particularly prone to abuse. Be knowledgeable in recognizing the signs of abuse and in determining what actions to take.

End-of-Life Care

Assess the caregiver's emotional ability to support the dying client. Be prepared to offer emotional support to the caregiver. Be familiar with hospice and other facilities in the community that can offer additional support services.

Transcultural

Cultures vary widely in their response to illness and supporting a person who is ill. In some cultures, offering assistance is considered insulting; in other cultures, everyone is involved with the client and is expected to know all details of care and the disease process. In some cultures certain diseases are considered shameful, and the client may be reluctant to risk any possibility of disclosure to another person. Be knowledgeable of the cultural factors that influence the client so that you can assess the support system in a nonjudgmental manner. Make every effort to provide resources that may support the client both emotionally and physically within the belief system of the client's culture.

Delegation

The nurse should perform the support system assessment but should receive input from all levels of personnel who visit the client. Include reports on support systems in information obtained from nursing care personnel.

[Outline]

Desired Outcomes
Special Considerations in Planning and Implementation

Action		Rationale
1	During all visits, observe the interaction between the client and others in the home.	Provides insight into the client’s relationships with others
2	Initially, and on an ongoing basis, ask client who is to be notified in an emergency and with whom information concerning client may be discussed.	Protects confidentiality and control of personal and medical information
3	Explain to client that you need to know who is available to assist with care, run errands, and so forth.	Enhances client cooperation
4	If client lives with others, ask who can help with care, be responsible for decisions, provide emotional support, and so forth. Maintain a nonjudgmental attitude. Avoid asking about personal relationships, family matters, and so forth unless these have a direct impact on the client’s care.	Elicits information without violating client’s right to privacy
5	Assess for indications of abuse, such as client appears fearful, appears to be restricted to one room in home, has bruising or injuries that cannot be explained, family members will not allow client to be alone with the nurse, or family members appear very hostile to the nurse’s presence. Report suspicions of abuse to the appropriate authority; check agency policy and procedure.	Enhances client safety
6	If client lives alone, inquire about friends, neighbors, or family members who could provide assistance. Note this information on the assessment form.	Determines the existence of extended support
7	Once support people have been identified, ask client what information may be shared with them.	Protects client confidentiality
8	Ask support people what help they can provide, such as helping with care, errands, transportation, meals, and emotional support. Approach support individuals in a nonjudgmental manner to elicit honest responses.	Determines the availability and willingness of support persons
9	If no support system is identified, refer client to a social worker for assistance with use of community resources. Provide client with information on transportation services, grocery delivery, housekeeping services, and so forth. Assist client in using services, including use of computer and Internet services. Advise client of local groups that may provide help. Consider using home health aides to assist with care, if appropriate.	Provides needed support services to client
10	Review the results of the support system assessment only with other agency personnel involved in client’s care.	Protects confidentiality while providing continuity of care

Were desired outcomes achieved? Examples of evaluation include:

Desired outcome met: Client demonstrates maintenance of therapeutic regimen with emotional and physical support from family members.
Desired outcome met: Client maintains self-care and personal hygiene with support of significant others and supplemental care by home health aides.

The following should be noted on the client's record:

Whom to notify in case of emergency
Who has access to client information
Availability, willingness, and ability of support people
Name, address, phone number, and relationship of each support person to the client
Any referrals made for supplemental or paid support

section name header

Purpose ⬇

Equipment ⬆ ⬇

Assessment ⬆ ⬇

Nursing Diagnoses ⬆ ⬇

Outcome Id ⬆ ⬇

Implementation ⬆ ⬇

Evaluation ⬆ ⬇

Documentation ⬆