Nursing diagnosis – IMPAIRED ENVIRONMENTAL INTERPRETATION SYNDROME
IMPAIRED ENVIRONMENTAL
INTERPRETATION SYNDROME
DEFINITION
Consistent lack of orientation to person, place, time, or
circumstances over more than 3 to 6 months necessitating a
protective environment
DEFINING CHARACTERISTICS
• Chronic confusion
• Consistent state of disorientation to environment
• Inability to reason, concentrate, or follow simple instructions
• Loss of occupation or social function resulting from memory decline
• Slow response to questions
RELATED FACTORS
• Dementia
• Depression
• Huntington’s disease
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Behavior
• Knowledge
• Communication
• Sensory perception
EXPECTED OUTCOMES
The patient will
• Acknowledge and respond to efforts by others to establish
communication.
• Identify physical changes without making disparaging comments.
• Remain oriented to the environment to the fullest possible extent.
• Remain free from injuries.
The caregiver will
• Describe measures for helping the patient cope with disorientation.
• Demonstrate reorientation techniques.
• Describe ways to make sure that the home is safe for the patient.
• Identify and contact appropriate support services for the patient.
SUGGESTED NOC OUTCOMES
Cognitive Orientation; Concentration; Fall-Prevention Behavior;
Memory; Safe Home Environment
INTERVENTIONS AND RATIONALES
Determine: Assess cultural status, functional ability and coordination,
interaction with others in social settings, and presence of vision or
hearing deficits. Assessment of these factors will help in identifying
appropriate interventions.
Perform: Orient patient to reality, as needed: call patient by name;
tell patient your name; provide day, date, year, and place; place a
photograph or patient’s name on the door; keep all items in the
same place. Consistency and continuity will reduce confusion and
decrease frustration.
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Place patient in a room near the nurse’s station to provide imme-
diate assistance from staff, if needed.
Clear patient’s room of any hazardous materials, and accompany
patient who wanders to prevent injury.
Work with patient and caregivers to establish goals for coping
with disorientation. Practice with coping skills can prevent fear.
When speaking to the patient, face him and maintain eye contact
to foster trust and communication.
Promote independence while performing ADL measures patient is
unable to perform to reduce feelings of dependence.
Inform: Provide written information to caregivers on reorientation
techniques. Demonstrate reorientation techniques to caregiver to
prepare caregiver to cope with the patient when he or she returns
home.
Teach caregivers to assist patient with self-care activities in a way
that maximizes patient’s potential to encourage patient’s independence.
Attend: Be attentive to the patient when you are with him. Be aware
that patient may be sensitive to your unspoken feelings about him in
order to inspire confidence in the caregiver.
Help patient and caregivers cope with feelings associated with the
disease. Understanding promotes affective coping.
Have patient perform ADLs. Begin slowly and increase daily, as
tolerated to assist patient to regain independence and enhance self-
esteem. Provide reassurance and praise for completing simple tasks.
Focus on patient’s strengths.
Involve caregiver and patient in planning and decision making as
a cooperative effort supports patient’s needs.
Encourage patient to engage in social activities with people of
all age groups once a week to help relieve the patient’s sense of
isolation.
Manage: Refer patient to case manager/social worker to ensure
that patient receives longer term assistance to ensure continued
care.
Refer caregiver to a support group. Caregivers need continuous
support from others to cope with the need to provide constant
supervision to the patient.
SUGGESTED NIC INTERVENTIONS
Anxiety Reduction; Behavior Management; Dementia Management;
Emotional Support; Mood Management; Reality Orientation
Reference
Patton, D. (2006). Reality orientation: Its use and effectiveness within older
person health care. Journal of Clinical Nursing, 15(11), 440–449.