Understanding Psychosocial Nursing Diagnosis for Holistic Care Plans

Psychosocial nursing diagnosis is a critical aspect of patient care, focusing on the intricate relationship between a patient’s mental health, social environment, and overall well-being. Unlike medical diagnoses that address physical ailments, psychosocial assessments delve into emotional and mental facets, such as anxiety, depression, or self-esteem issues, which can significantly impact physical health and recovery.

It’s estimated that mental illness and substance abuse disorders affect nearly 20% of adults in the United States(1), contributing substantially to morbidity and mortality rates. Recognizing and addressing these psychosocial factors is paramount in providing comprehensive and effective healthcare.

Table of Contents

• The Significance of Psychosocial Nursing Diagnoses
• Conditions Often Requiring Psychosocial Assessment
• NANDA-I Psychosocial Nursing Diagnoses List
• Developing Psychosocial Care Plans
  • Ineffective Coping: A Detailed Care Plan
    • Related Diagnoses
    • Evidenced By
    • Nursing Assessment
    • Nursing Interventions and Rationale
    • Expected Outcomes
  • Situational Low Self-Esteem: A Comprehensive Care Plan
    • Related Nursing Diagnoses
    • Evidenced By
    • Nursing Assessment
    • Nursing Interventions and Rationale
    • Expected Outcomes
  • Grieving: A Supportive Care Plan
    • Related Nursing Diagnoses
    • Evidenced By
    • Nursing Assessment
    • Nursing Interventions and Rationale
    • Expected Outcomes
• Psychosocial Nursing Diagnosis Case Study: Risk for Suicide
  • Scenario
  • Nursing Diagnosis
  • Subjective Data
  • Objective Data
  • Desired Outcomes
  • Nursing Interventions
• NCLEX Practice Questions on Psychosocial Integrity
• References

The Significance of Psychosocial Nursing Diagnoses

Psychosocial nursing diagnoses are essential tools for nurses to identify psychological and social elements—stressors, coping mechanisms, and relationship dynamics—that may be influencing a patient’s physical or mental state. By adopting a holistic approach, nurses can gain vital insights that contribute to a well-rounded plan of care. This plan addresses not only the patient’s physical symptoms but also their emotional and social needs, leading to more patient-centered and effective clinical strategies. Ultimately, a thorough psychosocial evaluation aims to guide healthcare providers in helping patients achieve optimal physical health and an improved quality of life.

Psychosocial Nursing Diagnosis Explained: Understanding the importance of mental and social factors in patient care plans. Learn about creating effective nursing diagnoses for psychosocial well-being.

Conditions Often Requiring Psychosocial Assessment

Psychosocial nursing diagnoses are frequently utilized for patients experiencing a range of conditions, including:

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

NANDA-I Psychosocial Nursing Diagnoses List

The North American Nursing Diagnosis Association International (NANDA-I) provides a standardized language for nursing diagnoses, including a comprehensive list of psychosocial diagnoses. Here are examples of psychosocial nursing diagnoses recognized by NANDA-I (this list is not exhaustive):

• Disturbed Personal Identity
• Hopelessness
• Chronic Low Self-Esteem; Situational Low Self-Esteem; Risk for Situational 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

Developing Psychosocial Care Plans

Psychosocial nursing diagnoses are fundamental in creating evidence-based care plans that are tailored to the patient’s unique needs. These plans outline specific nursing interventions and expected outcomes to address the identified psychosocial issues. Below are examples of care plans for common psychosocial nursing diagnoses. For further exploration of nursing care plan development, resources are available online.

Ineffective Coping Care Plan

Ineffective coping is a nursing diagnosis assigned when an individual struggles to manage stressful situations effectively. This inability to cope can disrupt daily functioning and negatively impact overall health and well-being. It can manifest in behaviors or reactions to life events. Treatment focuses on identifying the root cause of stress and may involve therapy, lifestyle adjustments, and supportive care. With appropriate support, individuals can improve emotional processing, stress management, and develop coping skills 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 As Evidenced By:

• Verbalizing inability to cope or asking for help
• Reporting secondary symptoms like appetite changes, fatigue, or sleep disturbances
• Persistent worry
• Procrastination or delayed decision-making
• Physical symptoms of stress: muscle tension, headaches, insomnia, fatigue
• Difficulty concentrating
• Increased susceptibility to illness
• Changes in social interactions
• Maladaptive defense mechanisms

Ineffective Coping Nursing Assessment

• Assess for behavioral and physiological responses to stress to gauge coping difficulty.
• Consider cultural influences on the patient’s perception of effective coping.
• Determine underlying causes: grief, self-concept issues, lack of support, problem-solving deficits, or life changes.
• Evaluate suicide risk and refer for mental health care if necessary.

Nursing Interventions and Rationale For Ineffective Coping

• Employ empathy-based communication: Empathy builds trust and a supportive environment, fostering better coping.
• Validate the patient’s situation without false reassurance: Honesty is crucial for problem-solving and effective coping. False hope can be detrimental to the patient’s progress.
• Encourage engagement in mental and physical activities: Reading, games, arts, exercise, and socializing can improve mood and reduce anxiety by promoting body awareness and well-being.
• Help the patient assess accomplishments and situational realities: Recognizing their ability to manage situations, realistically, can boost self-efficacy.

Expected Outcomes

• Within 24-48 hours, the patient will identify behaviors that hinder 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

Situational Low Self-Esteem is a nursing diagnosis that recognizes a temporary decrease in an individual’s self-worth and confidence, often triggered by a traumatic event or challenging circumstances like abuse or poverty. This condition can lead to social withdrawal, indecisiveness, avoidance of commitments, and potentially depression and anxiety. Seeking support from healthcare professionals can empower individuals to overcome these feelings and develop resilience. 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 Diagnosis

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

Situational Low Self-Esteem As Evidenced By:

• Self-critical and negative self-talk
• Self-deprecating humor and feelings of helplessness; poor self-care
• Dismissing personal achievements while focusing on failures
• Comparing oneself unfavorably to others
• Self-blame or blaming others for negative outcomes
• Increased sensitivity to criticism
• Loss of interest in previously enjoyed activities

Situational Low Self-Esteem Nursing Assessment

• Evaluate the patient’s satisfaction with their performance and abilities.
• 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 and Rationale for Situational Low Self-Esteem

• Foster a supportive environment for emotional expression: Encourage healthy expression of feelings and concerns. Model responsible communication using “I think” statements.
• Normalize the impact of change on self-esteem: Reassure the patient that self-esteem fluctuations are common during significant life changes and that recovery is part of the adjustment process.
• Dedicate time for calm and deliberate interaction: Ensure sufficient time for meaningful conversations.
• Ensure privacy: Create a confidential space for the patient to express vulnerable feelings without fear of being overheard.
• Practice active listening and use open-ended questions: Encourage the patient to verbalize concerns and thoughts without interruption. This approach shows respect for their strengths and acknowledges their difficulties.

Expected Outcomes

• The patient will identify factors contributing to their low self-esteem.
• The patient will implement at least two strategies to enhance self-esteem and reduce self-neglect.
• The patient will report increased confidence and self-worth.

Grieving Care Plan

Grief is a natural and often painful emotional response to loss. Nursing diagnoses in this area focus on supporting individuals through the grieving 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 support systems. A compassionate and attentive approach ensures the patient’s emotional healing is prioritized and their grief is addressed thoroughly.

Grieving Related Nursing Diagnosis(4)

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

Grieving As Evidenced By:

• Verbal expressions of distress and sorrow
• Denial of the loss
• Changes in eating habits
• Sleep disturbances
• Disorganization and difficulty concentrating
• Psychological distress

Grieving Nursing Assessment

• Assess the patient and family’s current stage of grief.
• Determine if the patient and loved ones are grieving at different paces or stages.
• Evaluate the patient’s decision-making capacity during this emotional time.
• Consider referrals to social services, support groups, and legal advisors as needed.

Nursing Interventions and Rationale for Grieving

• Anticipate heightened emotional responses: Expect exaggerated affective behaviors. In older adults, anxieties about death may surface. Unexpected loss can trigger anger. Regression is possible during grieving.
• Use therapeutic communication to facilitate verbalization of feelings: Sharing feelings with a healthcare provider can help patients find meaning in their loss.
• Support the patient and family in expressing fears, concerns, hopes, and plans: Open communication is essential; secrecy is unhelpful. Stressful times can foster family growth.
• Highlight strengths and progress: Reviewing progress provides encouragement and indicates the direction of healing.
• Coach family members in supporting the patient: Normal routines are disrupted during grief; address symptoms carefully to avoid complicating emotional recovery.
• Develop a plan for ongoing support and resources: Spiritual support can be beneficial for both the patient and family.
• Encourage resumption of normal life activities: Support the patient in regaining a sense of normalcy.
• Provide community resources: Connect the patient and family with community groups for shared experiences and support during their grief journey.

Expected Outcomes

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

Psychosocial Nursing Diagnosis Case Study: Risk for Suicide

Risk for Suicide Case Study Example

Scenario

A 35-year-old homeless man is brought to the emergency department by EMS after a suicide attempt following his brother’s suicide. He is placed on involuntary psychiatric hold with 1:1 monitoring. His spouse found him with neck and wrist wounds and a broken mirror. He has a history of schizophrenia, major depressive disorder, alcohol use disorder with withdrawal seizures, IV drug use, and a prior suicide attempt requiring blood transfusions for hypovolemic shock. Currently, he is experiencing a psychotic episode, expressing euphoria and grandiosity with rapid speech, but denies homicidal ideation. He refuses bloodwork and medication, believing his next attempt will succeed as he now knows what he did wrong. Vital signs: 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 and major depressive disorder, as evidenced by suicidal ideations and self-inflicted wounds.

Subjective Data

The patient states he understands how to improve his suicide plan for future attempts based on this failed one.

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 care, hypertension, tachycardia, tachypnea, psychotic behavior (rapid, grandiose, incoherent speech, euphoria). History of alcohol withdrawal seizures necessitates monitoring for withdrawal. Refusal of lab work and medication.

Desired Outcomes

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

Nursing Interventions

• Maintain constant observation throughout hospitalization.
• Educate the patient about the safety contract and assess comprehension and ability to agree within 24-48 hours.
• Encourage and actively listen to the patient’s reasons for self-harm.
• Educate the family on four warning signs of self-harm risk.
• Educate the patient on identifying thoughts, feelings, and behaviors leading to suicidal ideation.
• Teach the patient three coping techniques for stress management.
• Refer to mental health professionals, providing resources like crisis centers, hotlines, grief counseling, and local emergency services. Ensure patient understanding of resources.

Psychosocial NCLEX Questions

Approximately 9% of NCLEX questions relate to Psychosocial Integrity(5). Here are sample questions to test your understanding:

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

Answer: Ensure the client’s safety and prevent further harm. Intervene physically if necessary, provide a safe environment, manage the crisis, assess mental and emotional state, communicate therapeutically, and collaborate on an individualized care plan.

Question 2: 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 de-escalate the situation.

STAFF NOTE: Original Community Post

This article was developed in response to a community question seeking clarification on psychosocial nursing diagnoses. The original question and subsequent community responses have been included as they may provide additional helpful context.

Original Post Excerpt:

Could someone please explain Psychosocial Nursing Diagnosis? I’m unsure if I’m understanding it correctly. I thought “Anxiety” would be considered psychosocial, but my textbook places it under Coping/Stress Tolerance, not specifically “Psychosocial.”

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/