Understanding Psychosocial Nursing Diagnosis: A Comprehensive Guide for Holistic Patient Care

Psychosocial Nursing Diagnosis is a crucial aspect of healthcare, focusing on the intricate connection between a patient’s mental health, social environment, and their overall well-being. Unlike medical diagnoses that pinpoint physical ailments, psychosocial assessments delve into the emotional and mental facets of a patient’s life. These evaluations consider factors such as anxiety, depression, and self-esteem, recognizing that these emotional states can significantly impact physical health and quality of life.

It’s estimated that a substantial portion of the population, around 20% of adults in the United States, grapple with mental health conditions and substance use disorders. These issues contribute significantly to both morbidity and mortality, highlighting the critical role of psychosocial considerations in healthcare.

Table of Contents

• What is Psychosocial Nursing Diagnosis?
• Conditions Commonly Addressed by Psychosocial Nursing Diagnoses
• The Importance of Psychosocial Diagnosis in Holistic Care
• NANDA-I Psychosocial Nursing Diagnoses Examples
• Psychosocial Nursing Care Plans: Examples and Applications
  • Ineffective Coping Care Plan
  • Situational Low Self-Esteem Care Plan
  • Grieving Care Plan
• Psychosocial Nursing Diagnosis Case Study: Risk for Suicide
• NCLEX Style Questions on Psychosocial Integrity
• References

What is Psychosocial Nursing Diagnosis?

Psychosocial nursing diagnoses empower nurses to look beyond the physical symptoms and understand the psychological and social elements influencing a patient’s health. It’s about recognizing the significant role of stressors, coping mechanisms, and interpersonal relationships in shaping a patient’s physical and mental state. By adopting a holistic approach, psychosocial assessments provide valuable context and deeper insights, which are essential for crafting comprehensive care plans. These plans address not only the physical needs but also the emotional and social needs of the individual, leading to more patient-centered care.

The ultimate goal of psychosocial diagnoses is to create patient-centered clinical strategies that lead to improved care outcomes. A well-conducted evaluation offers critical insight into how healthcare professionals can best support patients in achieving optimal physical health and an enhanced quality of life.

Nursing Diagnosis – Psychosocial

Conditions Commonly Addressed by Psychosocial Nursing Diagnoses

Psychosocial nursing diagnoses are frequently applied to patients dealing with a wide array of conditions, including:

• Anxiety Disorders: Characterized by excessive worry and fear.
• Eating Disorders: Such as anorexia nervosa and bulimia nervosa, involving disturbed eating patterns and body image.
• Body Image Issues: Conditions where individuals have a distorted perception of their physical appearance.
• Behavioral Problems: Difficulties in conduct and behavior, especially in children and adolescents.
• Bipolar Disorder: A mental illness marked by extreme shifts in mood.
• Coping and Self-Esteem Issues: Challenges in managing stress and maintaining a positive self-image.
• Depression: Persistent feelings of sadness and loss of interest.
• Post-Traumatic Stress Disorder (PTSD): A condition that develops after experiencing a traumatic event.
• Suicidal Ideation and Attempts: Thoughts of or actions towards ending one’s own life.
• Schizophrenia: A chronic brain disorder affecting a person’s ability to think, feel, and behave clearly.
• Substance Use Disorders: Problematic patterns of using substances like drugs or alcohol.

The Importance of Psychosocial Diagnosis in Holistic Care

Integrating psychosocial diagnoses into nursing practice is vital for providing holistic patient care. It moves beyond treating just the symptoms and addresses the root causes of health issues, which often lie in a patient’s emotional and social circumstances. This approach ensures that care plans are comprehensive and tailored to the individual, considering all aspects of their life that contribute to their health status. By acknowledging and addressing these psychosocial factors, healthcare providers can significantly improve patient outcomes, enhance patient satisfaction, and promote long-term well-being.

NANDA-I Psychosocial Nursing Diagnoses Examples

The North American Nursing Diagnosis Association International (NANDA-I) provides a standardized language for nursing diagnoses. Here are some examples of psychosocial nursing diagnoses recognized by NANDA-I, illustrating the breadth of emotional and social factors considered in patient care (this list is not exhaustive):

• Disturbed Personal Identity
• Hopelessness
• Chronic Low Self-Esteem; Situational and Risk for Low Self-Esteem
• Social Isolation
• Caregiver Role Strain; Risk for Caregiver Role Strain
• Impaired Parenting; Risk for Impaired Parenting; Readiness for Enhanced Parenting
• Interrupted Family Processes; Readiness for Enhanced Family Processes
• Risk for Impaired Parent/Infant/Child Attachment
• Dysfunctional Family Processes: Alcoholism
• Effective Breastfeeding; Ineffective Breastfeeding; Interrupted Breastfeeding
• Ineffective Role Performance
• Parental Role Conflict
• Impaired Social Interaction
• Fear
• Anxiety
• Death Anxiety
• Chronic Sorrow
• Ineffective Denial
• Grieving; Complicated Grieving; Risk for Complicated Grieving
• Ineffective Coping
• Disabled Family Coping; Compromised Family Coping; Readiness for Enhanced Family Coping
• Defensive Coping
• Ineffective Community Coping; Readiness for Enhanced Community Coping
• Readiness for Enhanced Coping (Individual)
• Stress Overload
• Risk-prone Health Behavior

Psychosocial Nursing Care Plans: Examples and Applications

Psychosocial nursing diagnoses are not just labels; they are the foundation for developing evidence-based care plans designed to address specific patient needs. Here are examples of care plans for common psychosocial nursing diagnoses:

Ineffective Coping Care Plan

Definition: Ineffective coping is characterized by an individual’s struggle to effectively manage stressors and challenges, impacting their daily life and overall health.

Understanding Ineffective Coping: This diagnosis applies to individuals who demonstrate difficulty in dealing with stressful situations. This can manifest in behaviors or reactions to life events that hinder their ability to function optimally. Addressing ineffective coping often involves a multifaceted approach, including counseling, therapy, lifestyle adjustments, and supportive care management.

Related Diagnoses:

• Disabled Family Coping
• Compromised Family Coping
• Defensive Coping
• Ineffective Community Coping
• Readiness for Enhanced Coping (Individual)
• Readiness for Enhanced Family Coping

As Evidenced By:

• Verbalizing inability to cope or seeking help.
• Reporting secondary symptoms like appetite changes, fatigue, or sleep problems.
• Persistent worry.
• Procrastination or delayed decision-making.
• Physical symptoms such as muscle tension, headaches, insomnia, and fatigue.
• Difficulty concentrating.
• Increased susceptibility to illness.
• Changes in social interactions.
• Maladaptive use of defense mechanisms.

Nursing Assessment:

• Evaluate behavioral and physiological responses to stress to determine the extent of coping difficulties.
• Consider cultural influences on the patient’s perception of effective coping.
• Identify underlying causes of ineffective coping, such as grief, self-concept issues, lack of support, problem-solving deficits, or recent life changes.
• Assess for suicide risk and ensure immediate referral for mental health care if needed.

Nursing Interventions & Rationale:

• Empathic Communication: Use empathy-based communication to build a supportive environment conducive to better coping.
• Honest and Realistic Support: Acknowledge the patient’s situation without giving false hope to establish trust and facilitate problem-solving.
• Promote Engagement in Activities: Encourage mental and physical activities like reading, games, exercise, and socialization to alleviate depression and anxiety.
• Situational Assessment Support: Help the patient assess their accomplishments and provide realistic evaluations of their situation to foster self-efficacy.

Expected Outcomes:

• Within 24-48 hours, the patient will identify behaviors that interfere with effective coping.
• The patient will articulate effective coping strategies and resources.
• The patient will demonstrate improved coping with stressors and seek support when needed.

Situational Low Self-Esteem Care Plan

Definition: Situational Low Self-Esteem is a nursing diagnosis recognizing a temporary lack of confidence and self-worth triggered by specific life circumstances.

Understanding Situational Low Self-Esteem: This condition arises when individuals experience feelings of inadequacy or helplessness due to challenging situations like trauma, abuse, or poverty. It can lead to social withdrawal, indecisiveness, avoidance of commitments, and potentially depression and anxiety. Intervention from healthcare professionals can empower individuals to overcome these feelings and develop resilience.

Related Nursing Diagnoses:

• Chronic Low Self-Esteem
• Disturbed Body Image
• Risk for Situational Low Self-Esteem
• Social Isolation

As Evidenced By:

• Self-critical and negative self-talk.
• Self-deprecating humor and feelings of powerlessness.
• Downplaying achievements while focusing on negatives.
• Comparing oneself negatively to others.
• Self-blame or blaming others for failures.
• Heightened sensitivity to criticism.
• Loss of interest in previously enjoyed activities.

Nursing Assessment:

• Evaluate the patient’s satisfaction with their performance and capabilities.
• Assess for unresolved grief that may be contributing to low self-esteem.
• Determine the patient’s confidence in meeting expectations and performing tasks.

Nursing Interventions & Rationale:

• Supportive Environment: Create a safe space for patients to express feelings and concerns openly, fostering emotional processing. Encourage “I think” statements to promote self-responsibility in communication.
• Normalize Reactions to Change: Reassure patients that fluctuations in self-esteem are normal during significant life changes, aiding in their adjustment process.
• Dedicated Time and Privacy: Allocate sufficient time for calm, private interactions to facilitate open communication and trust.
• Active Listening and Open-Ended Questions: Employ active listening and open-ended questions to encourage verbalization of concerns, interests, and worries, demonstrating respect and valuing the patient’s perspective.

Expected Outcomes:

• The patient will identify factors contributing to their situational low self-esteem.
• The patient will implement strategies to enhance self-esteem and reduce self-care deficits.
• The patient will express increased confidence and self-worth.

Grieving Care Plan

Definition: Grief is a natural emotional response to loss. Nursing care plans for grieving aim to support individuals through this process with compassion and understanding.

Understanding Grief: Nurses play a crucial role in supporting individuals experiencing grief. This involves assessing the grieving process, diagnosing related needs, and developing personalized care plans. Key nursing actions include active listening, providing realistic expectations about grief, suggesting coping strategies, and connecting patients with support resources.

Related Nursing Diagnoses:

• Anticipatory grieving
• Risk for complicated grieving
• Risk for anxiety
• Risk for knowledge deficit related to the grieving process

As Evidenced By:

• Verbal expressions of distress.
• Denial of the loss.
• Changes in eating habits.
• Sleep disturbances.
• Disorganization.
• Psychological distress.

Nursing Assessment:

• Determine the patient and family’s current stage of grief.
• Assess for differences in grief stages between the patient and family members.
• Evaluate the patient’s decision-making capacity during grief.
• Identify the need for referrals to social services, support groups, and legal advisors.

Nursing Interventions & Rationale:

• Expect Exaggerated Emotions: Recognize that emotional responses may be intensified during grief. Older adults might exhibit heightened anxiety about death. Unexpected loss can lead to anger. Regression may occur.
• Therapeutic Communication: Engage in therapeutic communication to allow patients and families to verbalize feelings, facilitating meaning-making from their loss.
• Support and Validation: Support patients and families in expressing fears, concerns, hopes, and plans, fostering open communication and family growth during stressful times.
• Highlight Progress: Emphasize strengths and progress to provide encouragement and track the patient’s journey through grief.
• Support for Caregivers: Coach family members in supporting the patient during hospitalization, addressing altered routines and symptoms to prevent complications in emotional recovery.
• Resource Provision: Offer spiritual support and community resources to provide comprehensive assistance during grieving.
• Encourage Normal Life Activities: Encourage the patient to resume normal life activities, fostering a sense of normalcy and hope.
• Community Resources: Connect patients and families with community support groups to share experiences and facilitate coping.

Expected Outcomes:

• The patient will experience expected grief symptoms in a healthy manner.
• The patient will adopt effective grief coping strategies.
• The patient will articulate future plans, demonstrating movement forward in their life.

Psychosocial Nursing Diagnosis Case Study: Risk for Suicide

Scenario:

A 35-year-old homeless man is brought to the emergency department by EMS after a suicide attempt following his brother’s death. He is placed on involuntary psychiatric hold with 1:1 observation.

The patient was found by his spouse with self-inflicted neck and wrist wounds and a broken mirror nearby. His medical history includes schizophrenia, major depressive disorder, alcohol use disorder with past complicated withdrawal seizures, intravenous drug use, and a prior suicide attempt by exsanguination.

Currently, he is experiencing a psychotic episode but denies homicidal thoughts. He exhibits euphoria, grandiosity, and rapid speech. He refuses blood work and medication, believing his next suicide attempt will be successful because he now knows what he did wrong. Vital signs are: T 98.4°F, BP 175/102 mmHg, HR 127 bpm, RR 22 bpm, SpO2 95% on room air.

Nursing Diagnosis:

Risk for Self Harm related to feelings of loneliness, grief, homelessness, and hopelessness secondary to schizophrenia, as evidenced by suicidal ideations and self-inflicted wounds.

Subjective Data:

The patient states he understands how to improve his suicide plan for the next attempt.

Objective Data:

Vital signs: T 98.4°F, BP 175/102 mmHg, HR 127 bpm, RR 22 bpm, SpO2 95% on room air.
Physical findings: Neck and wrist wounds requiring care, hypertension, tachycardia, tachypnea.
Behavioral observations: Psychotic behavior, rapid and grandiose speech, euphoria. History of alcohol withdrawal seizures necessitates monitoring for withdrawal symptoms. Refusal of lab work and medications.

Desired Outcomes:

• The patient will agree to a safety contract within 24-48 hours, refrain from self-harm during hospitalization, and express feelings about self-harm.
• The patient’s family will identify three warning signs of impending self-harm.
• The patient will understand and agree to contact a 24-hour emergency hotline post-discharge if feeling suicidal.
• The patient will participate in identifying triggers for suicidal thoughts and feelings.
• The patient will learn and verbalize three coping techniques for managing stressful situations.

Nursing Interventions:

• Maintain constant observation; ensure the patient is never alone.
• Explain the safety contract and assess the patient’s understanding and willingness to agree within 24-48 hours.
• Encourage the patient to discuss reasons for self-harm and actively listen.
• Educate the family on recognizing four warning signs of self-harm.
• Educate the patient on identifying triggers for suicidal ideations.
• Teach the patient three coping skills for stress management.
• Refer to mental health professionals and provide resources like crisis centers, grief counseling, suicide prevention programs, and local emergency services. Ensure patient understanding of these resources.

Psychosocial NCLEX Questions

Psychosocial Integrity constitutes approximately 9% of NCLEX exam content. Here are sample questions to test your understanding:

Question 1: A client with borderline personality disorder engages in self-harm. What is the nurse’s priority intervention?

Answer: The priority is client safety and preventing further harm. Interventions include physically stopping self-harm, providing a safe environment, crisis management, assessing mental and emotional state, therapeutic communication, and collaborating on an individualized care plan.

Question 2: A 60-year-old patient attempts to go to the cafeteria against medical orders and becomes verbally abusive when redirected. What is the most appropriate nursing approach?

Answer: Firmly escort the patient back to their room and request additional assistance if necessary to ensure safety and de-escalation.

References

1. Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders; Board on Health Sciences Policy; Institute of Medicine; England MJ, Butler AS, Gonzalez ML, editors. Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards. Washington (DC): National Academies Press (US); 2015 Sep 18. 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321284/

2. Mughal S, Azhar Y, Mahon MM, et al. Grief Reaction. [Updated 2022 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507832/

3. Kourakou A, Tigani X, Bacopoulou F, Vlachakis D, Papakonstantinou E, Simidala S, Ktena E, Katsaouni S, Chrousos G, Darviri C. The Rosenberg Self-Esteem Scale: Translation and Validation in the Greek Language in Adolescents. Adv Exp Med Biol. 2021;1339:97-103. doi: 10.1007/978-3-030-78787-5_13. PMID: 35023095.

4. Oates JR, Maani-Fogelman PA. Nursing Grief and Loss. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518989/

5. https://www.kaptest.com/study/NCLEX/whats-tested-on-the-NCLEX-psychosocial-integrity/