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Impaired Parenting
Inability of the primary caregiver to create, maintain, or regain
an environment that promotes the optimum growth and development
of the child
Defining Characteristics
The home environment must be assessed for safety before discharge:
location of bathroom, access to water, cooking facilities,
and environmental barriers (stairs, narrow doorways).
Inappropriate and/or nonnurturing parenting behaviors
Lack of behavior indicating parental attachment
Inconsistent behavior management
Inconsistent care
Frequent verbalization of dissatisfaction or disappointment with
Verbalization of frustration with role
Verbalization of perceived or actual inadequacy
Diminished or inappropriate visual, tactile, or auditory stimulation
of infant
Evidence of abuse or neglect of child
Growth and development challenges in infant/child
Related Factors
Individuals or families who may be at risk for developing or
parenting difficulties
Financial resources
Addicted to drugs
Terminally ill
Acutely disabled
Psychiatric disorder
Accident victim

Of unwanted pregnancy
With undesired characteristics
Terminally ill
With hyperactive characteristics
Mentally handicapped
Of undesired gender
Physically handicapped
Situational (Personal, Environmental)
Related to interruption of bonding process secondary to:
Illness (child, parent)
Relocation/change in cultural environment
Related to separation from nuclear family
Related to lack of knowledge
Related to inconsistent caregivers or techniques
Related to relationship problems (specify):
Marital discord
Live-in partner
Related to little external support and/or socially isolated family
Related to lack of available role model
Related to ineffective adaptation to stressors associated with:
Economic problems
New baby
Substance abuse
Elder care
Adolescent Parent
Related to the conflict of meeting own needs over child’s
Related to history of ineffective relationships with own parents
Related to parental history of abusive relationship with parents
Related to unrealistic expectations of child by parent
Related to unrealistic expectations of self by parent
Related to unrealistic expectations of parent by child
Related to unmet psycho-social needs of child by parent

Author's Notes
The family environment should provide the basic needs for a child’s
physical growth and development: stimulation of the child’s emotional,
social, and cognitive potential; consistent, stable reinforcement to learn
impulse control; reality testing; freedom to share emotions; and moral
stability (Pfeffer, 1981). This environment nurtures a child to develop, as
Pfeffer (1981) states, “the ability to disengage from the family constellation
as part of a process of lifelong individualization.” It is the role of
parents to provide such an environment. Most parenting difficulties stem
from lack of knowledge or inability to manage stressors constructively.
The ability to parent effectively is at high risk when the child or parent
has a condition that increases stress on the family unit (e.g., illness,
problems). “The phenomenon of parenting is relevant to many
disciplines, including nursing” (Gage, Everett, & Bullock, 2006).
Impaired Parenting describes a parent experiencing difficulty creating
or continuing a nurturing environment for a child. Parental Role Conflict
describes a parent or parents whose previously effective functioning
is challenged by external factors. In certain situations, such as illness,
divorce, or remarriage, role confusion and conflict are expected. If
parents do not receive assistance in adapting their role to external
Parental Role Conflict can lead to Impaired Parenting.

The parent/primary caregiver demonstrates two effective skills
to increase parenting effectiveness, as evidenced by the following
• Will acknowledge an issue with parenting skills.
• Identify resources available for assistance with improvement of
parenting skills that are culturally considerate.

Encourage Parents to Express Frustrations Regarding Role
Responsibilities, Parenting, or Both
• Convey empathy.
• Reserve judgment.
• Convey/offer educational information based on assessment.
• Help foster realistic expectations.
• Encourage discussion of feelings regarding unmet expectations.
• Discuss individualized, achievable, and culturally considerate
strategies (e.g., discussing with partner, child; setting personal
Educate Parents About Normal Growth and Development and Age-
Related Expected Behaviors (Refer to Delayed Growth and Development)
Explore With Parents the Child’s Problem Behavior
• Frequency, duration, context (when, where, triggers)
• Consequences (parental attention, discipline, inconsistencies in
• Behavior desired by parents
Discuss Positive Parenting Techniques
• Convey to child that he or she is loved.
• Catch child being good; use good eye contact.
• Set aside “special time” when parent guarantees time with
child without interruptions.
• Ignore minor transgressions by having no physical contact, eye
contact, or discussion of the behavior.
• Practice active listening. Describe what child is saying, reflect
back the child’s feelings, and do not judge.
• Parents need to identify the difference between discipline and
punishment, with parents focusing their communications with
children on discipline (Deloian & Berry, 2009).
• Use “I” statements when disapproving of behavior. Focus on
the act, not the child, as undesirable.
• Positive reinforcement is an effective and recommended
discipline technique for all ages (Banks, 2002). Redirecting is
effective for infant to school age, whereas verbal instruction/
explanation is most effective for school-age and adolescents
(Banks, 2002).
• Different child temperaments may challenge parenting behaviors,
as evidenced when an infant is demanding and a parent
lacks resilience or when the child’s behavior is normal and the
parents’ expectations are unrealistic.
Explain the Discipline Technique of “Time Out,” Which Is a
Method to Stop Misconduct, Convey Disapproval, and Provide
Both Parent and Child Time to Regroup (Christophersen, 1992;
Herman-Staab, 1994)
• Time out is most effective for the toddler and school-age child
and provides a time for both parent and child to “cool off”
(Banks, 2002; Hockenberry, 2011).
• Outline the procedure.
• Place child in or bring the child to a chair in a quiet place with
few distractions (not the child’s room or an isolated place).
• Instruct child to stay in the chair. Set timer for 1 minute of
quiet time for each year of age.
• Start the timer when the child is quiet.
• If the child misbehaves, cries, or gets off the chair, reset the
• When the timer goes off, tell the child it is okay to get up.
• Explain to the child.
• This is not a game.
• Practice it once when the child is behaving.
• Explain rules and then ask the child questions to ensure
understanding (if older than 3 years).
• Remember:
• Do not warn child before sending for time out.
• If time out is appropriate, use it; do not threaten.
• If child laughs during time out, ignore it.
• Be sure no television is on or can be seen.
• Do not look at or talk to or about child during time out.
• Do not act angry; remain calm.
• Keep yourself busy; let the child see you and what he or she
is missing.
• Do not give up or give in.
If Additional Sources of Conflict Arise, Refer to the Specific
Nursing Diagnosis (e.g., Caregiver Role Strain, Fatigue)
Take Opportunities to Model Effective Parenting Skills; If Relevant,
Share Some Frustrations You Have Experienced With Your Child to
Help Normalize the Frustrations
Acknowledge Cultural Impacts
Clarify the Strengths of the Parents or Family
Role-Play Asking for Help or Disciplining a Child
Provide General Parenting Guidelines
Practice open, honest dialogues. Never threaten with vague
(e.g., “If you are bad, I won’t take you to the movies”).
• Do not lecture. Tell the child he or she was wrong and let it
go. Spend time talking about pleasant experiences.
• Compliment children on their achievements. Make each child
feel important and special. Especially tell a child when he or
she has been good; try not to focus on negative behavior.
• Provide appropriate physical affection to children.
• Set limits and be consistent. Expect cooperation.
• Encourage the child to participate in activities. Let the child
help you as much as possible. “Nurses can encourage parents
in their roles beyond childbearing, help them to solve problems,
perform parenting tasks, and understand what is developmentally
appropriate” (Gage, Everett, & Bullock, 2006).
• Discipline the child by restricting activity. Sit a younger child
in a chair for 3 to 5 minutes. If the child gets up, reprimand
once and put him or her back. Continue until the child sits for
the prescribed time. For an older child, restrict bicycle riding
or going to the movies (pick an activity that is important to
him or her).
• Make sure the discipline corresponds to the unacceptable
• Allow children opportunities to make mistakes and to express
anger verbally.
• Stay in control. Try not to discipline when you are irritated.
• When long explanations are needed, give them after the
• Remember to examine what you are doing when you are not
disciplining your child (e.g., enjoying each other, loving each
• Never reprimand a child in front of another person (child or
adult). Take the child aside and talk.
• Never decide you cannot control a child’s destructive behavior.
Examine your present response. Are you threatening? Do you
follow through with the punishment or do you give in? Has
the child learned you do not mean what you say?
• Be a good model (the child learns from you whether you
intend it or not). Never lie to a child even when you think it
is better; the child must learn that you will not lie, no matter
• Give each child a responsibility suited to his or her age, such
as picking up toys, making beds, or drying dishes. Expect the
child to complete the task.
• Share your feelings with children (happiness, sadness, anger).
Respect and be considerate of the child’s feelings and of his or
her right to be human.
Initiate Health Teaching and Referrals, as Indicated
• Community resources such as counseling, social services,
parenting classes, support groups, self-help, church.
• Support cultural considerations of parenting skills as age

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