Psychosocial nursing diagnosis is a critical aspect of holistic patient care, focusing on the intricate relationship between a patient’s mental health, social environment, and overall well-being. Unlike medical diagnoses that pinpoint physical ailments, psychosocial assessments delve into the emotional and mental landscape of individuals. These evaluations explore attributes such as anxiety, depression, and self-esteem, which, when compromised, can significantly impact physical health and quality of life.
Psychosocial nursing diagnosis explained: focusing on mental and emotional health factors like anxiety, depression, and self-esteem and their impact on physical wellness.
Mental health challenges are widespread, with approximately 20% of adults in the United States experiencing mental illness or substance use disorders annually. These conditions contribute significantly to morbidity and mortality, underscoring the importance of addressing psychosocial factors in healthcare.
Understanding Psychosocial Nursing Diagnoses
Psychosocial nursing diagnoses are particularly relevant for patients facing a range 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: Concerns and distortions about one’s physical appearance.
- Behavioral Issues: Challenges in conduct and emotional regulation.
- Bipolar Disorder: A condition marked by extreme mood swings.
- Coping and Self-Esteem Issues: Difficulties managing stress and maintaining a positive self-regard.
- Depression: Persistent feelings of sadness and loss of interest.
- Post-Traumatic Stress Disorder (PTSD): A condition developing after a traumatic event, leading to flashbacks and anxiety.
- Suicidal Ideation and Attempts: Thoughts of or actions toward 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 alcohol or drugs.
Psychosocial diagnoses empower nurses to identify psychological elements—stressors, coping mechanisms, and relationship dynamics—that influence a patient’s overall state. This holistic perspective is crucial for crafting comprehensive care plans. By considering the patient’s emotional, social, and physical needs, nurses can develop interventions that are truly patient-centered. These tailored plans aim to optimize physical health outcomes and enhance the patient’s overall quality of life.
NANDA-I Psychosocial Nursing Diagnoses: A Comprehensive List
The North American Nursing Diagnosis Association International (NANDA-I) provides a standardized language for nursing diagnoses. Here are examples of psychosocial nursing diagnoses recognized by NANDA-I. This list is not exhaustive but represents common diagnoses:
- Disturbed Personal Identity
- Hopelessness
- Chronic Low Self-Esteem
- Situational Low Self-Esteem
- 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 Care Plans: Evidence-Based Approaches
Psychosocial nursing diagnoses are the foundation for developing evidence-based care plans. These plans guide nursing interventions and aim to improve patient outcomes. Let’s explore examples of care plans for common psychosocial diagnoses:
Ineffective Coping Care Plan
Definition: Ineffective coping is a nursing diagnosis assigned when an individual struggles to manage stressors effectively. This inability to cope disrupts daily life and negatively impacts overall health and well-being.
Characteristics: This diagnosis manifests in behaviors and reactions to life events. Individuals might exhibit avoidance, express feelings of being overwhelmed, or demonstrate risky behaviors. Addressing ineffective coping requires understanding the stress source and often involves a combination of therapy, lifestyle adjustments, and supportive care.
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 asking for help
- Reporting secondary symptoms like appetite changes, fatigue, or sleep disturbances
- Chronic worry
- Difficulty making decisions
- Physical symptoms such as muscle tension, headaches, insomnia, and fatigue
- Poor concentration
- Increased susceptibility to illness
- Changes in social interactions
- Inappropriate defense mechanisms
Nursing Assessment:
- Identify Stress Responses: Assess behavioral and physiological responses to stress to gauge coping difficulty.
- Consider Cultural Factors: Evaluate the influence of cultural values on the patient’s perception of effective coping.
- Determine Underlying Causes: Investigate if ineffective coping stems from grief, self-concept issues, lack of support, problem-solving deficits, or life changes.
- Suicide Risk Assessment: Assess for suicide risk and immediately refer for mental health care if needed.
Nursing Interventions and Rationale:
- Empathic Communication: Use empathy-based communication to create a supportive environment that encourages better coping. Empathy builds trust and facilitates open communication.
- Validate Patient’s Situation: Acknowledge and validate the patient’s situation without offering false hope. Honesty is crucial for building a therapeutic relationship. False reassurance can be detrimental to patient trust and coping.
- Promote Engaging Activities: Encourage participation in mental and physical activities like reading, games, arts, exercise, and socializing. These activities enhance body awareness, reduce anxiety and depression, and promote well-being.
- Assist with Realistic Self-Assessment: Help the patient assess their accomplishments and provide accurate situational assessments. Recognizing personal capabilities realistically is essential for fostering effective coping.
Expected Outcomes:
- Within 24-48 hours, the patient will identify behaviors that hinder effective coping.
- The patient will articulate effective coping strategies and available resources.
- The patient will demonstrate improved coping with stressors and seek support when necessary.
Situational Low Self-Esteem Care Plan
Definition: Situational low self-esteem is a nursing diagnosis describing a temporary state of negative self-perception arising from specific life circumstances. It involves a lack of confidence in one’s abilities and self-worth, often triggered by traumatic events or difficult situations like abuse or poverty.
Impact: Low self-esteem can significantly affect a person’s life, leading to social withdrawal, indecisiveness, avoidance of commitments, and increased risk of depression and anxiety.
Assessment Tools: While no universally accepted test exists, the Rosenberg Self-Esteem Scale (RSE) is a widely used tool for assessing self-esteem levels.
Related Nursing Diagnoses:
- Chronic Low Self-Esteem
- Disturbed Body Image
- Risk for Situational Low Self-Esteem
- Situational Low Self-Esteem
- Social Isolation
As Evidenced By:
- Self-critical and negative self-talk
- Self-deprecating humor and feelings of powerlessness
- Neglecting positive achievements while focusing on negatives
- Comparing oneself unfavorably to others
- Self-blame or blaming others for failures
- Heightened sensitivity to criticism or disapproval
- Loss of interest in previously enjoyed activities
Nursing Assessment:
- Performance Satisfaction: Evaluate the patient’s satisfaction with their performance and abilities.
- Unresolved Grief: Assess for the presence of unfinished grief that may contribute to low self-esteem.
- Confidence Levels: Determine the patient’s confidence in meeting expectations and performing tasks.
Nursing Interventions and Rationale:
- Create a Supportive Environment: Foster an environment where the patient feels safe to express emotions. Encourage healthy expression of feelings by the patient and significant others. Using “I think” statements promotes personal responsibility in communication.
- Normalize Change-Related Self-Esteem Fluctuations: Reassure the patient that changes often impact self-esteem, leading to varied emotional and behavioral responses. Self-esteem disturbances are normal reactions to significant life changes, and adjustment processes naturally involve self-esteem reconstitution.
- Dedicated Time: Allocate sufficient time for calm and deliberate interactions with the patient.
- Ensure Privacy: Provide a private setting for discussions, enabling the patient to express feelings without fear of being overheard.
- Active Listening and Open-Ended Questions: Employ active listening and open-ended questions to encourage verbalization of concerns, interests, and worries. This demonstrates respect for the patient’s strengths and acknowledges their problems.
Expected Outcomes:
- The patient will identify factors contributing to low self-esteem.
- The patient will implement two 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 diagnoses related to grieving address the needs of individuals experiencing this process. Nurses play a vital role in supporting patients through grief by providing compassionate care and guidance.
Nursing Role: Nurses assess, diagnose, and create individualized care plans to support the grieving process. This involves active listening, providing realistic expectations, 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 loss
- Altered eating habits
- Sleep disturbances
- Disorganization
- Psychological distress
Nursing Assessment:
- Grief Phase: Assess the patient’s and family’s current stage of grief.
- Stage Mismatches: Identify if the patient and loved ones are grieving at different paces or stages.
- Decision-Making Capacity: Evaluate the patient’s ability to make decisions.
- Resource Referrals: Determine the need for referrals to social services, support groups, and legal consultants.
Nursing Interventions and Rationale:
- Expect Exaggerated Affective Behavior: Understand that emotional responses may be heightened during grief. Older adults may be preoccupied with thoughts of death and uncertainty. Unexpected loss can lead to anger and regression.
- Therapeutic Communication: Use therapeutic communication to allow patients and families to verbalize feelings. Sharing feelings with a healthcare provider can help find meaning in loss.
- Support and Validation: Support patients and significant others as they express fears, concerns, hopes, and plans. Open communication strengthens family bonds during stressful times.
- Highlight Strengths and Progress: Emphasize the patient’s strengths and progress to provide a sense of accomplishment and forward movement.
- Coach Significant Others: Provide guidance to family members on how to support the patient during hospitalization. Grief can disrupt normal activities, and addressing these symptoms supports emotional recovery.
- Resource Development: Establish a process for providing ongoing support and resources, including spiritual support, which can be beneficial for both patient and family.
- Encourage Normal Life Activities: Encourage the patient to resume normal life activities to foster a sense of continuity and healing.
- Community Resources: Provide information about community support groups that offer shared experiences and assistance in navigating grief and rebuilding life.
Expected Outcomes:
- The patient will experience expected grief symptoms within a healthy range.
- The patient will adopt a grief coping strategy to manage emotional distress.
- The patient will express future plans, indicating a move towards acceptance and adaptation.
Psychosocial Nursing Diagnosis Case Study Example: 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 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, intravenous drug use, and a prior suicide attempt requiring blood transfusions. Currently, he is psychotic but denies homicidal ideation, expressing euphoria and grandiosity with rapid speech. He refuses blood work and medication, stating he now knows how to succeed in a future attempt. Vital signs: T 98.4°F, BP 175/102 mmHg, P 127 bpm, R 22 breaths/min, 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: Elevated BP and pulse, rapid breathing.
- Neck wounds requiring care.
- Psychotic behavior: Rapid, grandiose, incoherent speech, euphoria.
- History of alcohol withdrawal seizures necessitates monitoring for withdrawal symptoms.
- Refusal of lab work and medications.
Desired Outcomes:
- Patient will agree to a safety contract within 24-48 hours and refrain from self-harm during hospitalization, expressing feelings related to suicidal ideation.
- Family will identify three strategies to recognize impending self-harm.
- Patient will understand and agree to contact a 24-hour emergency hotline post-discharge if feeling suicidal.
- Patient will participate in identifying triggers for suicidal thoughts.
- Patient will verbalize three coping techniques for managing stressful situations.
Nursing Interventions:
- Continuous 1:1 monitoring to ensure patient safety.
- Educate the patient about safety contracts and assess understanding and willingness to agree.
- Encourage and actively listen to the patient’s reasons for self-harm.
- Educate the family on recognizing signs of impending self-harm.
- Educate the patient on identifying triggers for suicidal thoughts and feelings.
- Teach the patient three coping techniques for stress management.
- Refer to mental health professionals and provide resources like crisis centers and suicide prevention hotlines.
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 is exhibiting self-harming behavior. What is the nurse’s priority intervention?
Answer: The priority is to ensure the client’s safety and prevent further harm. Interventions include physically stopping self-harm, providing a safe and supportive environment, crisis management, assessing mental state, therapeutic communication, and care plan development with the healthcare team.
Question 2: A 60-year-old male patient attempts to go to the cafeteria against hospital privileges and becomes verbally abusive when redirected. 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 escalating behavior.
This guide provides a comprehensive overview of psychosocial nursing diagnosis, highlighting its importance in patient care, NANDA-I diagnoses, care planning, and practical application through case studies and NCLEX-style questions. Understanding and applying these principles is essential for nurses to provide holistic and effective care that addresses the mental and social well-being of their patients.
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/
