Psychosocial nursing diagnosis is a critical aspect of holistic patient care, focusing on the interplay between a patient’s mental health, emotional state, social environment, and their overall well-being. Unlike medical diagnoses that primarily address physical ailments, psychosocial assessments delve into the emotional, mental, and social dimensions of health. These factors, including anxiety, depression, stress, and self-esteem issues, can significantly influence a patient’s physical condition and recovery. Recognizing and addressing these psychosocial elements is essential for effective nursing practice.
Psychosocial Nursing Diagnosis Explained
Mental health conditions 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 psychosocial nursing in healthcare.
Common Conditions Addressed by Psychosocial Nursing Diagnosis
Psychosocial nursing diagnoses are frequently applied to patients experiencing 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 negative perceptions about one’s physical appearance.
- Behavioral Problems: Difficulties in conduct and social interaction.
- Bipolar Disorder: A mental disorder causing unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks.
- Coping and Self-Esteem Issues: Difficulties managing stress and negative self-perception.
- Depression: Persistent feelings of sadness and loss of interest.
- Post-Traumatic Stress Disorder (PTSD): A condition that can develop after experiencing or witnessing a traumatic event.
- Suicidal Ideation and Attempts: Thoughts or actions related to ending one’s own life.
- Schizophrenia: A chronic brain disorder that affects a person’s ability to think, feel, and behave clearly.
- Substance Use Disorders: Problematic patterns of using substances like drugs or alcohol.
Psychosocial nursing helps nurses identify psychological stressors, coping mechanisms, and relationship dynamics that may be contributing to a patient’s overall health status, whether physical or psychological. This comprehensive approach allows for the development of patient-centered care plans that address emotional, social, and physical needs. By considering these interconnected factors, Psychosocial Diagnosis Nursing plays a vital role in enhancing patient care and improving health outcomes.
NANDA-I Psychosocial Nursing Diagnoses Examples
The North American Nursing Diagnosis Association International (NANDA-I) provides a standardized list of nursing diagnoses, including numerous psychosocial diagnoses. These examples are not exhaustive but represent common areas of focus in psychosocial nursing:
- 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: Examples and Applications
Psychosocial nursing diagnoses are the foundation for developing effective care plans tailored to meet patients’ unique needs. Evidence-based nursing care plans are crucial tools in addressing psychosocial challenges and improving patient outcomes. Let’s explore examples of care plans for common psychosocial diagnoses:
Ineffective Coping Care Plan
Ineffective coping is a nursing diagnosis used when individuals struggle to manage stressful situations, impacting their daily life and overall well-being. This can manifest in behaviors or reactions to life events. Treatment focuses on identifying the stress source and may involve counseling, therapy, lifestyle adjustments, and supportive care management. With appropriate support, individuals can learn to process emotions, manage stress, and develop coping strategies.
Related Diagnoses to Ineffective Coping
- Disabled Family Coping
- Compromised Family Coping
- Defensive Coping
- Ineffective Community Coping
- Readiness for Enhanced Coping (Individual)
- Readiness for Enhanced Family Coping
Signs and Symptoms of Ineffective Coping
- Verbalizing inability to cope or asking for help
- Reporting secondary symptoms like appetite loss, fatigue, or sleep disturbances
- Chronic worry
- Delayed decision-making
- Physical symptoms such as muscle tension, headaches, insomnia, fatigue
- Poor concentration
- Frequent illness
- Changes in social interaction
- Inappropriate defense mechanisms
Nursing Assessment for Ineffective Coping
- Assess behavioral and physiological responses to stress to gauge coping difficulty.
- Consider cultural values and beliefs in the patient’s perception of coping.
- Determine if ineffective coping stems from grief, self-concept issues, lack of support, problem-solving deficits, or life changes.
- Evaluate suicide risk and refer for mental health care if needed.
Nursing Interventions and Rationales for Ineffective Coping
- Empathic Communication: Encourage open communication with empathy to build a supportive environment.
- Honest Reassurance: Acknowledge the patient’s situation without giving false hope to foster trust and effective problem-solving. False reassurance can be detrimental.
- Engage in Activities: Promote mental and physical activities like reading, games, exercise, and socializing to improve mood and reduce anxiety.
- Situational Assessment: Help patients assess their accomplishments and situations realistically to build self-efficacy.
Expected Outcomes for Ineffective Coping
- Within 24-48 hours, the patient will identify behaviors disrupting daily life and coping.
- The patient will communicate 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 recognizing a temporary lack of self-confidence and self-worth, often triggered by traumatic events or difficult circumstances like abuse or poverty. It can lead to social withdrawal, indecisiveness, avoidance of commitments, and even depression or anxiety. Intervention involves therapy and nursing support to help individuals regain self-esteem and resilience.
Currently, there is no universally accepted test for low self-esteem, but the Rosenberg Self-Esteem Scale (RSE) is widely used since 1965 to assess this condition.
Related Nursing Diagnoses to Situational Low Self-Esteem
- Chronic Low Self-Esteem
- Disturbed Body Image
- Risk for Situational Low Self-Esteem
- Social Isolation
Signs and Symptoms of Situational Low Self-Esteem
- Self-critical and negative self-talk
- Self-deprecating humor and feelings of helplessness
- Focusing on negatives and dismissing achievements
- Comparing oneself unfavorably to others
- Self-blame or blaming others for failures
- Hypersensitivity to criticism
- Loss of interest in enjoyable activities
Nursing Assessment for Situational Low Self-Esteem
- Assess patient’s satisfaction with their performance.
- Evaluate for unresolved grief.
- Assess patient’s confidence in meeting expectations.
Nursing Interventions and Rationales for Situational Low Self-Esteem
- Supportive Environment: Create a safe space for expressing feelings and encourage healthy emotional expression.
- Normalize Change: Reassure patients that self-esteem fluctuations are normal during significant life changes and that recovery is part of adjustment.
- Dedicated Time: Spend quality time with the patient for calm, deliberate interaction.
- Ensure Privacy: Provide a private environment for open and honest discussions.
- Active Listening: Use active listening and open-ended questions to encourage verbalization of concerns and show respect for the patient’s strengths.
Expected Outcomes for Situational Low Self-Esteem
- The patient will identify causes of their low self-esteem.
- The patient will implement two self-esteem-building strategies.
- The patient will express increased confidence and self-worth.
Grieving Care Plan
Grief is a natural emotional response to loss. Nursing diagnoses related to grieving address the needs of individuals coping with loss in various ways. Nurses assess, diagnose, and create individualized care plans to support the grieving process through active listening, providing realistic expectations, suggesting coping strategies, and connecting patients with support resources. This approach ensures compassionate and thorough care during the healing journey.
Related Nursing Diagnoses to Grieving
- Anticipatory grieving
- Risk for complicated grieving
- Risk for anxiety
- Risk for knowledge deficit related to the grieving process
Signs and Symptoms of Grieving
- Verbal expressions of distress
- Denial of loss
- Changes in eating habits
- Sleep disturbances
- Disorganization
- Psychological distress
Nursing Assessment for Grieving
- Assess the patient and family’s grief stage.
- Determine if family members are grieving at different stages.
- Evaluate the patient’s decision-making capacity.
- Assess the need for referrals to social services, support groups, and legal consultants.
Nursing Interventions and Rationales for Grieving
- Expect Exaggerated Emotions: Understand that emotional responses may be heightened during grief, including anger or regression.
- Therapeutic Communication: Engage in therapeutic communication to allow patients and families to verbalize feelings and find meaning in their loss.
- Support and Sharing: Support patients and families in sharing fears, concerns, hopes, and plans to facilitate family growth during stressful times.
- Highlight Progress: Acknowledge and reinforce strengths and progress to provide a sense of advancement in the grieving process.
- Support for Caregivers: Coach family members on supporting the patient during hospitalization and managing altered routines.
- Resource Development: Provide spiritual and community resources for ongoing support during grief.
- Encourage Normal Life: Encourage patients to resume normal activities to promote a sense of continuity and healing.
Expected Outcomes for Grieving
- The patient will experience expected grief symptoms.
- The patient will adopt a grief coping strategy.
- The patient will express future plans, indicating movement forward in the grieving process.
Psychosocial Nursing Diagnosis Case Study: Risk for Suicide
Risk for Suicide Case 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 under involuntary psychiatric hold and 1:1 monitoring. The patient was found by his spouse with neck and wrist wounds and a broken mirror. His history includes 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 psychotic, euphoric, and grandiose with rapid speech, denying homicidal ideations but expressing belief in future suicide success. Vital signs are elevated BP and pulse, with normal temperature and SpO2.
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 understanding how to improve his suicide plan for future attempts.
Objective Data
- Vital signs: T 98.4°F, BP 175/102 mmHg, HR 127 bpm, RR 22 bpm, SpO2 95% on room air.
- Neck wounds requiring care.
- Psychotic behavior: rapid, grandiose, incoherent speech, euphoria.
- History of alcohol withdrawal seizure, risk of withdrawal.
- 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 about self-harm.
- Family will identify three warning signs of impending self-harm.
- Patient will verbalize understanding of and intent to use a 24-hour emergency hotline post-discharge.
- Patient will identify personal triggers for suicidal thoughts and feelings.
- Patient will verbalize three coping techniques for managing stress.
Nursing Interventions
- Maintain constant observation of the patient.
- Educate and implement a safety contract within 24-48 hours.
- Encourage patient to discuss reasons for self-harm.
- Educate family on four warning signs of self-harm risk.
- Educate patient on identifying triggers for suicidal ideation.
- Teach three coping skills for stress management.
- Refer to mental health professionals and provide crisis hotline and local emergency service resources.
Psychosocial Nursing Diagnosis NCLEX Questions
Psychosocial Integrity constitutes approximately 9% of NCLEX exam content. Here are sample questions to enhance understanding:
Question 1: A client with borderline personality disorder is engaging in self-harm. What is the priority nursing intervention?
Answer: The priority is to ensure the client’s safety and prevent further harm. This includes immediate intervention to stop self-harm, creating a safe environment, crisis management, assessing mental and emotional state, therapeutic communication, and care plan development with the healthcare team.
Question 2: A 60-year-old patient attempts to go to the cafeteria despite restrictions. When asked to return to their room, the patient becomes verbally abusive. What is the most appropriate nursing approach?
Answer: Firmly escort the patient back to their room and request additional assistance if needed to manage the situation safely and effectively.
This guide offers a comprehensive overview of psychosocial diagnosis nursing, emphasizing its importance in patient care through definitions, examples, care plans, and case studies. Understanding these principles is crucial for nurses aiming to provide holistic and effective care.
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/
