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Difficulty: HardSupport Systems

The nurse is developing a discharge plan for a 7-year-old client with newly diagnosed end-stage renal disease who will require home peritoneal dialysis. The client's parents are divorced, share joint legal and medical custody, and have a known history of severe interpersonal conflict. Which of the following nursing actions are appropriate to establish an effective support system for this client and family? Select all that apply.

  1. Coordinate separate but identical dialysis training sessions for each parent.Answer
  2. Request a social work consult to help establish a structured communication plan between the parents.Answer
  3. Provide both parents with information about local and virtual support groups for families of children with chronic kidney disease.Answer
  4. D
    Advise the parents to let the 7-year-old child decide which parent's home will serve as the primary residence during treatment.
  5. E
    Designate one parent as the sole point of contact for the healthcare team to minimize opportunities for parental conflict.
  6. F
    Delegate the initial evaluation of the parents' emotional readiness and coping mechanisms to the unlicensed assistive personnel (UAP).

Answer

The correct actions are to coordinate separate identical dialysis training sessions for each parent, request a social work consult to establish a structured communication plan, and provide information about chronic kidney disease support groups to both parents.
Establishing an effective support system in a high-conflict, joint-custody family requires the nurse to facilitate the involvement of both parents without forcing them into hostile interactions. Coordinating separate training sessions ensures both parents learn vital medical skills in a stress-free environment. Consulting a social worker provides the family with professional mediation to handle medical communication objectively. Providing external support group information to both parents helps build a broader community support network, reducing individual caregiver strain.

Step-by-Step Solution

1
Analyze the client's psychosocial context and healthcare needs.
The client is a 7-year-old requiring complex home care (peritoneal dialysis). The primary caregivers (parents) share joint medical custody but have high interpersonal conflict.
Understanding the family dynamics and legal boundaries is required to identify appropriate support system interventions.
2
Evaluate interventions that foster a strong support system while safely navigating the family conflict.
Providing separate training, involving a social worker for communication strategies, and offering community support group information directly address the need for competent, supported caregivers across both households.
These actions empower both caregivers, respect legal custody arrangements, and mitigate the negative impact of parental conflict on the child's care.
3
Identify and eliminate inappropriate or non-therapeutic interventions.
Exclude options that violate developmental expectations (asking the 7-year-old to choose a residence), breach legal/ethical boundaries (isolating one parent from the healthcare team), or violate delegation rules (assigning initial psychosocial assessments to a UAP).
Nursing actions must adhere to developmental science, legal standards of custody, and scope of practice.

Key Concept

Navigating complex family dynamics to optimize the client's support system while maintaining legal, developmental, and professional boundaries.
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