Nursing diagnosis – DECISIONAL CONFLICT

DECISIONAL  CONFLICT

DEFINITION

Uncertainty about course of action to be taken when choice among

competing actions involves risk, loss, or challenge to values and beliefs

DEFINING CHARACTERISTICS

• Delayed decision making

• Focusing on self

• Lack of experience or interference with decision making

• Questioning personal values or beliefs while attempting to make a

decision

• Vacillation between alternative choices

• Verbal statements describing undesirable consequences of alterna-

tive actions being considered

• Verbal expression of distress and uncertainty

RELATED FACTORS

• Divergent sources of informa-

• Lack of relevant information

tion

• Moral obligations require

• Interference with decision

actions

making

• Moral obligations require no

• Lack of experience with deci-

action

sion making

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Roles and relationships

• Values and beliefs

EXPECTED OUTCOMES

The patient will

• State feelings about the current situation.

• Discuss benefits and drawbacks of treatment options.

• Make minor decisions related to daily activities.

• Accept assistance from family, friends, clergy, and other support

persons.

• Report feeling comfortable about ability to make an appropriate,

rational choice.

SUGGESTED NOC OUTCOMES

Decision Making; Information Processing; Participation in

Healthcare Decisions

INTERVENTIONS AND RATIONALES

Determine: Assess major challenges patient will face in making deci-

sions about care, as well as factors that influence patient’s present

decision-making skills. This information will be useful in establishing

appropriate interventions.

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Perform: Arrange patient’s environment to promote relaxation and

comfort while the patient is trying to gain control of decision making.

Assist with self-care activities while patient needs help to ensure

that ADLs are met.

Offer massage to reduce tension and assist patient to relax.
Help patient make decisions about daily activities to enhance her

feelings of control.

Help patient identify available options and possible consequences

to assist with rational, logical decision making.

Inform: Teach techniques for progressive muscle relaxation to

decrease physical and psychological signs of tension.

Attend: Encourage visits with family, friends, and clergy; provide pri-

vacy during visits to foster emotional support.

Encourage patient to express concerns about frustrations in mak-

ing decisions. Take the time to assist the patient to explore or sort

out aspects of decision making that cause him or her difficulty.

Manage: Offer written information, a reading list, or a referral to a

support group to ensure that patient will have reference material

when it is needed.

Refer to home health nurse for a follow-up visit in the home.
Refer to a nutritionist for information on good nutrition and fluid

management.

SUGGESTED NIC INTERVENTIONS

Active Listening; Assertiveness Training; Decision-Making Support;

Learning Facilitation; Mutual Goal-Setting

Reference

Popejoy, L. (2005). Health-related decision-making by older adults and their

families: How clinicians can help. Journal of Gerontological Nursing, 31(9),
12–18.

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