Question

Develop a plan of care for a family including at least two (2) priority nursing diagnoses for each of the following needs: psychological, sociocultural, spiritual, and physiological needs. The family has a history of domestic violence, child sexual abuse, depression, ptsd,

Answer 1

Plan of care for a Family :

1. Psychological needs: As the family has a history of Domestic violence, depression, PTSD and child sexual abuse etc, the health care worker/ nurse has to assess the situation and psychological needs of the client and family.  

Assessment:

* Assess the anxiety level and coping skills of family members.

* Assess the level of self esteem in partners

* Assess for any fear of abuse exist in child .

* Assess parent's understanding about the growth and developmental task of children and their emotional needs.

* Assess the parents - child bondage or parental attachment behaviours.

Nursing Diagnosis

i) Ineffective individual coping related to being a victim of violence.

ii) Low self esteem/ Self esteem disturbance related to feeling guilty and responsible for being a victim of Domestic violence/ childhood abuse.

2. Physiological needs

Assessment:

* Assess the signs and symptoms of malnutrition in family members, especially child/ children.

* Assess the use of alcohol / drugs and assess for any signs of Mental health issues

* Assess for the signs of physical injuries or signs of physical abuse in children or the woman partner.  

Nursing Diagnosis

i) Imbalanced nutrition less than bidy requirements related to the parental neglect on nutritional status as evidenced by malnutrition and loss of subcutaneous fat.

ii) Risk for trauma related to environment and care givers possibly evidenced by history of abuse / evidence of physical abuse of child.

3. Sociocultural needs

i) Social isolation related to shame and humility about being a victim of Domestic violence

ii) Powerlessness related to fear of disapproval from others possibly evidenced by dependence on others that may result in anger or irritability

4. Spiritual needs

i) Risk for compromised human dignity related to sexual abuse / domestic violence as evidenced by low self esteem. evidenced

ii) Fear related to phobic stimulus  / anxiety provoking stimulus as evidenced by the acknowledgement and discussion of fears.

Nursing Interventions for Family / client with Domestic violence, child sexual abuse, PTSD and depression:

* Inform the parents that Child protection services have been contacted, and they may come for inspection to evaluate the child's health and safety.

* Reasuure client of his safety and security

* Record all observations including the physical signs of child abuse/ abuse , physical condition, verbal or behavioral response of the victim

* Offer or refer for the Counselling or Social services and provide the helpline numbers, to contact agencies that work against Domestic violence to support the woman.

* Assist the patient to develop a safety plan as there is a chance to recur the incident

* Suggest the client / family to meet a therapist to open up the exact cause of violence.  

* Encourage the client / parents to ventilate the feelings, personal needs and fears

* Offer the contact numbers of Community support agencies for parents / spouses for the well planned child care or to get the protection .   

* Praise the parents for participating in planning the child care.

* Instruct the parents to provide a safe environment for the child