Understanding Behavioral Nursing Diagnosis: A Comprehensive Guide

Behavioral Nursing Diagnosis Psychosocial Factors

Behavioral Nursing Diagnosis is a critical aspect of holistic patient care, focusing on the interplay between a patient’s mental health, social environment, and their overall well-being. Unlike medical diagnoses that primarily address physical ailments, behavioral nursing diagnoses delve into the emotional and psychological factors that significantly influence a patient’s health status. These factors can range from conditions like anxiety and depression to issues such as low self-esteem and behavioral disorders, all of which can manifest as or exacerbate physical health problems.

It is estimated that mental health and substance abuse disorders affect a substantial portion of the population, with approximately 20% of adults in the United States experiencing these conditions annually.(1) This prevalence underscores the importance of behavioral nursing diagnoses in addressing significant sources of morbidity and mortality within healthcare.

The Role of Behavioral Nursing Diagnosis

Behavioral nursing diagnoses are particularly relevant for patients experiencing a wide array of conditions, including but not limited to:

Anxiety Disorders
Eating Disorders (Anorexia Nervosa, Bulimia Nervosa, etc.)
Body Image Issues
Behavioral Problems
Bipolar Disorder
Coping and Self-Esteem Deficits
Depression
Post-Traumatic Stress Disorder (PTSD)
Suicidal Ideation or Attempts
Schizophrenia Spectrum Disorders
Substance Use Disorders

These diagnoses enable nurses to identify crucial psychological elements such as stressors, coping mechanisms, and interpersonal relationships that may be contributing to a patient’s current physical or psychological state. By adopting a comprehensive, patient-centered approach, behavioral nursing diagnoses provide essential context and understanding. This deeper insight is instrumental in formulating a detailed and effective care plan that addresses the patient’s emotional, social, and physical needs in an integrated manner.

Ultimately, the application of behavioral diagnoses is invaluable in crafting personalized clinical strategies. These tailored plans are designed to optimize patient care, leading to improved health outcomes and a better overall quality of life. The goal is to gain actionable insights into the most effective ways to support patients in achieving optimal physical health while enhancing their psychological and emotional well-being.

NANDA-I Behavioral Nursing Diagnoses Examples

The North American Nursing Diagnosis Association International (NANDA-I) provides a standardized language for nursing diagnoses. Here are examples of behavioral nursing diagnoses within the NANDA-I framework (this list is not exhaustive):

Disturbed Personal Identity
Hopelessness
Chronic Low Self-Esteem; Situational Low Self-Esteem 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

Behavioral Nursing Care Plans: Examples and Applications

Behavioral nursing diagnoses are the foundation for developing evidence-based nursing care plans. These plans guide nursing interventions and aim to achieve specific patient outcomes. Let’s explore some examples of care plans associated with common behavioral nursing diagnoses.

Ineffective Coping Care Plan

Ineffective coping is a nursing diagnosis assigned when an individual struggles to manage stressful situations effectively. This inability to cope with stressors negatively impacts daily functioning and overall health. This diagnosis is evident through observable behaviors and reactions to life events. Treatment strategies vary based on the source of stress, often involving long-term therapy, lifestyle adjustments, and comprehensive support.

With appropriate intervention and support, individuals can improve their emotional processing, stress management, and develop effective coping mechanisms for future challenges.

Ineffective Coping: Related Diagnoses

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

Ineffective Coping: Evidenced By

Verbalizing inability to cope or seeking help
Complaints of secondary symptoms related to poor coping (e.g., fatigue, sleep issues, appetite changes)
Chronic worry
Difficulty making decisions
Physical symptoms such as muscle tension, headaches, insomnia, fatigue
Poor concentration
Frequent illnesses
Changes in social interactions
Maladaptive use of defense mechanisms

Ineffective Coping: Nursing Assessment

Assess for behavioral and physiological responses to stress to determine the degree of coping difficulty.
Consider cultural values and beliefs as they influence the patient’s perception of effective coping.
Identify underlying causes of ineffective coping, such as grief, self-concept issues, lack of support, inadequate problem-solving skills, or recent life changes.
Evaluate for suicide risk and refer for immediate mental health care if needed.

Ineffective Coping: Nursing Interventions and Rationale

Employ empathy-based communication: Empathy and validation create a supportive environment that encourages better coping.
Acknowledge and validate the patient’s situation without providing false hope: Honesty is crucial for building trust and facilitating effective problem-solving. False reassurance can be detrimental to the patient’s progress.
Promote engagement in mental and physical activities: Encourage activities like reading, games, arts and crafts, exercise, and social interaction. These activities can improve mood, reduce anxiety, and foster body awareness through exercise, nutrition, and relaxation techniques.
Assist the patient in recognizing accomplishments and making realistic assessments of situations: Help patients acknowledge their abilities to manage situations effectively, while maintaining a realistic perspective.

Ineffective Coping: Expected Outcomes

Within 24-48 hours, the patient will identify behaviors that disrupt daily life and hinder effective coping.
The patient will articulate effective coping strategies and resources to mitigate ineffective coping patterns.
The patient will demonstrate improved coping skills in response to stressors and seek support when necessary.

Situational Low Self-Esteem Care Plan

Situational low self-esteem is diagnosed when an individual experiences a temporary decline in self-confidence and self-worth, often triggered by specific events or circumstances. These situations can include traumatic experiences, abuse, or significant life challenges. This condition can significantly impair an individual’s life, leading to social withdrawal, indecisiveness, avoidance of commitments, and potentially depression and anxiety.

However, with professional support from nurses or therapists, individuals can address these feelings of inadequacy and learn to build resilience and thrive even in difficult circumstances. While there isn’t a universally accepted diagnostic test, the Rosenberg Self-Esteem Scale (RSE) is widely used to assess self-esteem levels.(3)

Situational Low Self-Esteem: Related Nursing Diagnoses

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

Situational Low Self-Esteem: Evidenced By

Self-critical and negative self-talk
Self-deprecating humor and feelings of helplessness; neglect of self-care
Downplaying achievements while focusing on failures
Constant comparisons to others
Self-blame or blaming others for negative outcomes
Hypersensitivity to criticism or disapproval
Loss of interest in previously enjoyed activities

Situational Low Self-Esteem: Nursing Assessment

Evaluate the patient’s level of comfort and satisfaction with their performance and capabilities.
Assess for unresolved grief, which can contribute to low self-esteem.
Determine the patient’s confidence in their ability to meet expectations and perform tasks.

Situational Low Self-Esteem: Nursing Interventions and Rationale

Establish a supportive environment for expressing feelings: Encourage the patient and family to express emotions healthily. Model “I think” statements to promote personal responsibility in communication.
Normalize the impact of change on self-esteem: Reassure the patient that fluctuations in self-esteem are common during significant life changes. These shifts are natural responses, and recovery involves adjusting to change and rebuilding self-esteem.
Dedicate time to spend with the patient: Ensure sufficient time for calm and deliberate interaction to build rapport and trust.
Ensure privacy: Create a confidential environment where the patient feels safe to express feelings without fear of being overheard.
Practice active listening and use open-ended questions: Facilitate the patient’s verbalization of concerns and thoughts without interruption. This technique demonstrates respect for the patient’s abilities and strengths while acknowledging their challenges.

Situational Low Self-Esteem: Expected Outcomes

The patient will identify the causes contributing to their low self-esteem.
The patient will implement at least two strategies to enhance self-esteem and reduce self-care deficits.
The patient will report feeling more confident and possessing a greater sense of self-worth.

Grieving Care Plan

Grief is a natural emotional response to loss. Nursing diagnoses related to grief focus on supporting individuals through the mourning process. Nurses play a crucial role in assessing, diagnosing, and developing individualized care plans to support grieving patients. This involves active listening, providing realistic expectations, suggesting coping strategies, and connecting patients with additional support systems.

Through a compassionate and attentive approach, nurses ensure that the patient’s healing journey is prioritized and their grief is addressed thoroughly and with empathy.

Grieving: Related Nursing Diagnoses (4)

Anticipatory Grieving
Risk for Complicated Grieving
Risk for Anxiety
Risk for Knowledge Deficit related to the grieving process

Grieving: Evidenced By

Verbal expressions of distress
Denial of the loss
Changes in eating habits
Disturbed sleep patterns
Disorganization
Psychological distress

Grieving: Nursing Assessment

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

Grieving: Nursing Interventions and Rationale

Anticipate heightened emotional reactivity: Recognize that affective behaviors may be amplified during grief. Older adults may experience increased preoccupation with mortality. Unexpected loss can lead to anger and resentment. Regression may occur as a coping mechanism.
Engage in therapeutic communication: Facilitate verbalization of feelings with patients and families. Sharing feelings with healthcare providers can help patients find meaning in their loss experience.
Provide support while patients and families express fears, hopes, and plans: Encourage open communication and avoid secrecy, as stressful times can also foster family growth and development.
Highlight strengths and progress: Regularly review the patient’s progress to provide encouragement and track recovery.
Coach family members in supporting the patient: Educate family on how to provide effective support during hospitalization. Understand that normal routines may be disrupted, and address symptoms carefully to avoid complicating emotional recovery.
Develop a plan for additional support and resources: Offer spiritual support resources as beneficial for both patients and families.
Encourage resumption of normal life activities: Support patients and families in feeling capable of moving forward and living as normally as possible.
Connect patients and families with community resources: Provide access to community groups that offer shared experiences and support to navigate grief and continue with life.

Grieving: Expected Outcomes

The patient will experience expected symptoms of grieving in a healthy manner.
The patient will adopt at least one effective grief coping strategy.
The patient will express future plans and demonstrate movement forward in their life.

Behavioral Nursing Diagnosis Case Study Example: Risk for Suicide

Scenario

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

The patient’s spouse found him 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 requiring blood transfusions for hypovolemic shock.

Currently, he is experiencing a psychotic episode, though denies homicidal ideation. He exhibits euphoria, grandiosity, and rapid speech. He refuses both bloodwork and medication. He expresses a belief that 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 now understands how to ensure a successful suicide attempt next time.

Objective Data

Vital signs: T 98.4°F, BP 175/102 mmHg, HR 127 bpm, RR 22 bpm, SpO2 95% on room air.
Multiple neck wounds requiring wound care.
Hypertension, tachycardia, and tachypnea.
Psychotic behavior: rapid, grandiose, incoherent speech and euphoria.
History of alcohol withdrawal seizures necessitating monitoring for withdrawal symptoms.
Refusal of lab tests and medications.

Desired Outcomes

The patient will agree to a safety contract within 24-48 hours of admission, refraining from self-harm and expressing feelings about suicidal ideation.
The patient’s family will identify three warning signs of impending self-harm.
Upon discharge, the patient will verbalize understanding of and commitment to contacting a 24-hour emergency hotline if feeling suicidal.
The patient will participate in identifying personal triggers (thoughts, feelings, behaviors, external factors) for suicidal urges.
The patient will verbalize three coping techniques for managing stressful situations.

Nursing Interventions

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

Behavioral Nursing NCLEX Practice Questions

Approximately 9% of NCLEX questions relate to Psychosocial Integrity.(5) The following are sample questions to enhance understanding of this area.

Question: A client with borderline personality disorder is engaging in self-harming behavior. What is the priority nursing intervention?

Answer: The priority is to ensure the client’s safety and prevent further harm. This involves immediate intervention to stop the self-harm, creating a safe and supportive environment, and initiating crisis management. Further actions include assessing the client’s mental and emotional state, providing therapeutic communication, and collaborating with the healthcare team to develop a personalized care plan.

Question: A 60-year-old male patient attempts to go to the cafeteria despite restrictions. When kindly redirected, he becomes verbally abusive. What is the most appropriate nursing approach?

Answer: Firmly escort the patient back to his room and request additional assistance if needed to ensure safety and manage the situation effectively.

STAFF NOTE: Original Community Post

This article was developed based on a community inquiry, and the original comments are retained as they may offer additional helpful context.

Quote

Could someone please explain Psychosocial Nursing Diagnosis? I’m wondering if “Anxiety” fits this category… My textbook places Anxiety under Coping/Stress Tolerance, not specifically Psychosocial.

References

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