00063 Dysfunctional Family Processes

Domain 7: role/relationships
Class 2: family relationships
Diagnostic Code: 00063
Nanda label: dysfunctional family processes
Diagnostic focus: family processes
Approved 1994 • Revised 2008, 2017 • Evidence level 2.1

NANDA Nursing Diagnosis Definition

The Nanda nursing diagnosis « dysfunctional family processes »  is defined as: family operation that is not able to support its members.

Definite characteristics

Behavioral factors

  • Altered academic performance
  • Conflict avoidance
  • Contradictory communication pattern
  • Controller communication pattern
  • Criticism of others
  • Decrease in physical contact
  • Denies the problems
  • Difficulty to accept a wide range of feelings
  • Difficulty to accept help
  • Difficulty for adaptation to change
  • Inability to treat constructively with traumatic experiences
  • Difficulty expressing a wide range of feelings
  • Difficulty in having fun
  • Difficulty to meet the emotional needs of the members
  • Difficulty to meet the security needs of members
  • Inability to meet the spiritual needs of the members
  • Difficulty to receive help properly
  • Difficulty in maintaining intimate personal relationships
  • Difficulty in the transitions of the life cycle
  • Allow patterns of inadequate use of substances
  • Increasing conflicts
  • Severo self -play
  • Imadurity
  • Inadequate communication skills
  • Inappropriate knowledge about the inappropriate use of substances
  • Inappropriate expression of anger
  • Loss of independence
  • Lying
  • Imported duel
  • Handling
  • Nicotine addiction
  • Orientation favors the relaxation of tension instead of achieving the objectives
  • Paradoxical communication pattern
  • Promise breach pattern
  • Power struggles
  • Psychomotor agitation
  • Rationalization
  • Reject accept your own responsibility
  • rejects obtaining help
  • seeks affirmation
  • Look for approval
  • Autoculpabilization
  • Social isolation
  • Special occasions focused on inappropriate use of substances
  • Stress related physical condition
  • Inappropriate use of substances
  • Unconsable behavior
  • Verbal abuse of children
  • Verbal abuse of parents
  • Verbal abuse of the couple


  • Anxiety
  • Confuse love and compassion
  • Confusion
  • Depressive symptoms
  • dissatisfaction
  • Emotionally controlled by others
  • Express anger
  • Express distress
  • Express shame
  • Express fear
  • Express feeling of abandonment
  • Express feelings of failure
  • Express not feel loved
  • Express frustration
  • Express insecurity
  • Express prolonged resentment
  • Express loneliness
  • Express dishonor
  • Express tension
  • Desperateness
  • Hostility
  • Loss
  • Loss of identity
  • Low self -esteem
  • Distrust of others
  • Malhumor
  • Impotence
  • Rejection
  • Informs to feel different from others
  • Informs to feel emotionally isolated
  • Report feel guilty
  • Informs to feel misunderstood
  • Repressed emotions
  • Assume responsibility for the inappropriate use of substances from another family member
  • Unfeltness
  • Insutility

Role and Relationships

  • Alteration of family relationships
  • Alteration in the role of role
  • Chronic family problems
  • Closed communication systems
  • Conflict between the couple
  • Deterioration of family relationships
  • Decreased the ability of family members to relate to each other, to achieve joint growth and maturation objectives
  • Interruption of family rituals
  • Interruption of family roles
  • Family denial
  • Family disorganization
  • Inadequate family cohesion
  • Inappropriate family respect for the autonomy of its members
  • Inappropriate family respect for the individuality of its members
  • Skills for inadequate interpersonal relationships
  • Inconsistent parenting
  • ineffective communication with the couple
  • Unattainment of obligations towards a family member
  • Rejection pattern
  • Perception of inadequate parental support
  • Triangular family relationships

Related factors

  • Addictive personality
  • Inadequate problem solving skills
  • Ineffective coping strategies
  • Vulnerability perception

Risk population

  • Families at an economic disadvantage
  • Families with family history of resistance to the therapeutic regime
  • Families with members with a history of inappropriate use of substances
  • Families with members with genetic predisposition to inappropriate use of substances

Associated problems

  • Depression
  • Disabilities of development
  • Dysfunction of intimacy
  • Surgical procedures

Suggestions of use

(a) Since its review, this diagnosis is no longer limited to its use with alcohol abuse. It was extended to include the abuse of any substance, as well as other factors (for example, inability to face traumatic experiences, inadequate expression of anger). It is also now a broader diagnosis than that of compromised family coping or that of disabling family coping, (b) the compromised or incapacitating family coping labels are more useful to describe a family that fails, specifically, when facing the disease of one of its members, (c) the interruption of family processes describes a family with a normal functioning history, but that is experiencing a change in relationships or its operation (for example, changes in intimacy, changes in the alliances of can). Apparently, it describes a healthier state than the other two diagnoses.

Suggested alternative diagnostics

  • Committed family coping
  • Incapacitating family coping
  • Family processes, interruption of the
  • Self -directed violence, risk of
  • Violence aimed at others, risk of

NOC Results

  • Family coping: family actions to manage stressful factors that test family resources
  • Family social atmosphere: support environment characterized by the objectives and relations between family members
  • Consequences of substance addiction: severity of changes in health and social functioning due to substance addiction
  • Family operation: Family system capacity to meet the needs of its members during development transitions
  • Family integrity: behaviors of family members who together demonstrate cohesion, strength and emotional ties
  • Family resilience: Positive adaptation and functioning of the family system after an important crisis or problem

Evaluation objectives and criteria

  • • Dysfunctional family coping is resolved, which is demonstrated by satisfactory levels of coping, operation, integrity, resilience, family social atmosphere and consequences of substance addiction.
  • • The family member or members who abuse substances (for example, alcohol) demonstrate consequences of substance addiction, as manifested by the following indicators (specify
    • 1 to 5: serious, substantial, moderate, light or none):
      • Sustained decrease in physical activity
      • Chronic deterioration of motor function
      • Chronic fatigue
      • Chronic deterioration of cognitive function
      • Difficulty conserving a job
      • Arrest during the last year
      • Absenteeism of work or school

Other examples

The patient and family will be able to:

  • • Recognize that alcoholism is a family disease
  • • Recognize the severity of threats to the welfare of the family
  • • Identify destructive behaviors
  • • Start modifying dysfunctional patterns (for example, codependence)

NIC Interventions

  • Support in decision making: information and support to a patient who is making a decision regarding their health
  • Facilitate personal responsibility: impulse to a patient to assume greater responsibility for their own behavior
  • Promotion of family integrity: promotion of cohesion and family unit
  • Promotion of family integrity: parenting: facilitation of the growth of individuals or families that add a child to the family unit
  • Maintenance of family processes: Reduction of the effects of the destabilization of family processes
  • Improvement of coping: Help the patient to adapt to stressful factors, changes or perceived threats, which interfere with the satisfaction of the demands and the roles of life
  • Improvement of the role: Help a patient, the closest people and/or the family, to improve relationships by clarifying and complementing specific role behaviors
  • Resilience promotion: Help people, families and communities, to develop, use and strengthen protective factors that must be used to face environmental and social stressful factors
  • Family therapy: Help family members to lead the family to a more productive way of living
  • Treatment of substance consumption: patient care and care and family members suffering from physical and psychosocial problems, related to alcohol or drug use

Nursing Activities


  • • Record the history of drug and alcohol consumption
  • • Determine which substances are consumed
  • • Identify the nature of spiritual support for the family
  • • Directly question about alcohol consumption (for example, how often do you consume six or more drinks per day? In the last year, how many times have you driven after drinking three or more drinks?)
  • • (NIC) Treatment of substance consumption:
    • Identify with the patient the factors (for example, genetic, psychological tension and stress) that contribute to chemical dependence
    • Evaluate regular intervals if the patient continues to consume substances, using urine tests or breath analysis, as required
    • Determine if there are codependence relationships in the family

Patient and family education

  • • Inform family members about alcoholism or help them find other sources of information
  • • (NIC) Treatment of substance consumption: instruct the patient and family about drugs used to treat the consumption of specific substances

Collaboration activities

  • • (NIC) Treatment of substance consumption: Identify support groups in the community that offer long -term treatment for substance abuse
  • • Channel to pharmacological therapies to avoid relapses


  • • Recognize and accept that perhaps the solution of alcoholism is not the objective of care
  • • Emphasis to relatives who must allow the person to take responsibility for their consumption habits and their behaviors
  • • Explore with the family the methods you use to control the alcoholic’s behavior (for example, hide alcohol).
  • • Help the family establish realistic objectives to change family interaction patterns
  • • Help family members concentrate on modifying their answers to drinking behavior, instead of trying to control it | J [
  • • suggest that the patient proves acupuncture and other alternative therapies
  • • Facilitate communication between family members
  • • Provide positive feedback for adaptive coping mechanisms used by the patient and the family
  • • (NIC) Treatment of substance consumption:
    • Establish a therapeutic relationship with the patient (and with the family)
    • Help the patient and the family identify the use of denial to avoid confrontation of the problem
    • Facilitate the support of the closest people
    • Encourage the patient to take control of their own behavior
    • Help family members recognize that chemical dependence is a family disease
    • Dialogue with the patient about the effect of relating to other consumers during work and recreation time
    • Dialogue on the effects of substance consumption on family relationships, friends and co -workers
    • Encourage the patient to make a detailed record of their substance consumption to evaluate progress
    • Help the patient learn alternative methods to face stress or emotional tension

At home

  • • Because alcoholism is a family problem, care can be provided at home. All above interventions can be applied at home.

Babies and Children

  • • Evaluate whether the child demands inappropriate roles
  • • Determine if there are behavioral and social problems caused by family dynamics
  • • Evaluate the consumption of drinks in children of alcoholic parents
  • • Recommend cognitive-behavioral intervention programs of alcohol

Older people

  • • Include the evaluation of alcohol abuse and other substances when evaluating older people