NCP Parenting Growth Promoting Relationship

DSM-IV

V61.20 Parent-child relational problem

Many parents are concerned about how to raise responsible children who have high self-esteem, demonstrate self-control, and display skills of cooperation and consideration of others. Most people believe that we somehow know how to “parent” instinctively. Usually, this attitude results in parenting the same way we were parented. However, it is clear that the traditional authoritarian or permissive methods of parenting create inner conflict for most parents, and praise, punishment, and rewards do not have the desired effects of positive relationships with children. Conflicts in the parent/child relationship can lead to dysfunctional/abusive relationship patterns. In addition, when children are experiencing mental health crises requiring therapeutic intervention, learning different ways of parenting becomes essential to developing positive relationships between parent and child. It is generally accepted that primary prevention activities (e.g., parenting classes, support for new parents) produce more functional families and are cost-effective for society over the long run.

ETIOLOGICAL THEORIES

Psychodynamics

Effective parenting is a learned skill and is not a set of instinctive behaviors. Parental roles are derived from many factors (e.g., the family of origin, family myths and scripts, parental skills, knowledge and level of differentiation, socioeconomic and cultural factors, and the marital relationship). Family interactional patterns develop in a predictable pattern over time. The family rules that develop out of these patterns can be functional or dysfunctional. Functional rules are workable and constructive, promoting the needs of all family members. Dysfunctional rules are contradictory, self-defeating, and destructive.

Biological

There is a genetic plan for the growth and development of the physical body. In the same way, there is a biological plan for intelligence that is genetically encoded within the individual and drives the child from within. At the same time, parents provide an anxiety-conditioned view of the world that conflicts with the child’s nature. Many of the problems of parenting are caused by people ignoring this plan of nature. When parental expectations of child behavior are inconsistent with the reality of a developmental stage (i.e., bladder/bowel training) conflicts arise that may result in dysfunctional parenting.

Family Dynamics

A family is seen as a natural social system, with its own set of rules, definition of roles, power structure, and methods of communicating, negotiating, and problem-solving that provides a means of dealing with the process of daily living. These family patterns are largely unconscious and set the emotional tone. These systems are multigenerational, with underlying family dynamics affecting all members in some way. These patterns may be functional or dysfunctional.

PARENT ASSESSMENT DATA BASE

Activity/Rest

Difficulty sleeping

Exhaustion

Ego Integrity

Broad range of feelings (e.g., calm to hysterical) may be noted

May display increasing tension and disorganization (e.g., anger, frustration, crying, depression); may repeat the same question over and over

Defense mechanisms (e.g., denial, rationalization, defensiveness, intellectualization, projection)

Multiple stress factors, changes in relationships

Feelings of helplessness, hopelessness, powerlessness

Food/Fluid

Difficulty eating, loss of appetite

Hygiene

General appearance of family members (neat or disheveled; clean or odious) may be indicators of coping ability, state of denial, presence of crisis

Neurosensory

Behavior: Upset, anxious, rapid speech or quiet and withdrawn; appropriate or inappropriate

Social Interactions

Family Genogram: Determine patterns between family members and generations and identify potential positive and negative dynamics

Family structure: May be traditional 2-parent, or single-parent (mother or father as head), blended (stepfamily), or other nontraditional structure

Lack of/limited support (presence of/geographic distance and degree of involvement of extended family)

Some family member(s) may not seem to be experiencing symptoms of stress or may possibly have changed their usual patterns of interacting

Varied socioeconomic/cultural factors (e.g., financial status, inclusion of extended family, family myths and beliefs, sense of community)

Multiple losses/crises (e.g., death, divorce, other separations, frequent relocation)

History of period of family disorganization often present

Child-rearing practices may be ineffective; dysfunctional/ineffective communication patterns present

History of child abuse/sexual abuse

NURSING PRIORITIES

1. Promote positive feelings about parenting abilities.

2. Involve parents in problem-solving solutions for current situation.

3. Provide assistance to enable family to develop skills to deal with present situation.

4. Facilitate learning of new parenting skills.

DISCHARGE GOALS

1. Parenting role, expectations, and responsibilities understood.

2. Aware of own strengths, individual needs, and methods/resources to meet them.

3. Demonstrates appropriate attachment/parenting behaviors.

4. Involved in activities directed at family growth.

5. Plan in place to meet needs after discharge.