Conscious or unconscious attempt to disavow the knowledge or
meaning of an event to reduce anxiety/fear, but leading to the detri-
ment of health
• Delay in seeking or refusal of medical attention to detriment of
• Displacement of fear about condition’s impact
• Displacement of sources of symptoms to other organs
• Failure to perceive personal relevance or danger of symptoms
• Inability to admit impact of disease on life pattern
• Inappropriate affect
• Minimization of symptoms
• Refusal to admit fear of death or invalidism
• Lack of control of the situation
• Fear of death
• Overwhelming stress
• Fear of loss of autonomy
• Threat of unpleasant reality
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Values and beliefs
The patient will
• Describe knowledge and perception of present health problem.
• Describe life pattern and report any changes.
• Express knowledge of stages of grieving.
• Demonstrate behavior associated with the grief process.
• Indicate, either verbally or through behavior, an increased aware-
ness of reality.
SUGGESTED NOC OUTCOMES
Acceptance: Health Status; Anxiety Level; Coping; Fear Self-Control;
Health Beliefs: Perceived Threat; Symptom Control
INTERVENTIONS AND RATIONALES
Determine: Assess patient’s understanding and perception of present
health state, including awareness of diagnosis, and perception of rel-
evance on life pattern and description of symptoms.
Evaluate coping status and mental status, including mood, affect,
memory, and judgment. Assessment of these factors will help iden-
tify appropriate interventions.
Perform: Schedule a speciﬁc amount of uninterrupted non-care-
related time each day with the patient to allow patient to express
feelings and concerns.
Assist patient with ADLs as needed to conserve energy and avoid
overexertion. Assist with grooming (e.g., shaving for men, hair and
makeup for women). Offer massage to enhance comfort and
Encourage active exercise (e.g., provide a trapeze or other assistive
device if needed). Exercise will promote positive attitude.
Inform: Discuss stages of anticipatory grieving to increase
understanding of what is happening and increase patient’s ability to
Teach patient about diagnosis and treatment as he or she demon-
strates readiness to learn. Provide brochures and simple written
materials to help with the learning process.
Attend: Provide emotional support and encouragement to help
improve patient’s self-concept and motivate the patient to be more
involved in planning care.
Involve patient in planning and decision making. Having the abil-
ity to participate will encourage greater compliance with the plan
Have patient perform self-care activities. Begin slowly and increase
daily, as tolerated. Performing self-care activities will assist patient
to regain independence and enhance self-esteem.
Schedule treatments apart from visiting to allow for periods of
Maintain frequent discussions with physicians and staff to be cer-
tain what patient has been told by other care providers.
Manage: Refer to case manager/social worker for follow up care.
Refer to clergy person for spiritual care if patient expresses interest.
SUGGESTED NIC INTERVENTIONS
Anxiety Reduction, Behavior Modiﬁcation; Calming; Counseling;
Decision-Making Support; Truth Telling
Telford, K., et al. (2006, August). Acceptance and denial: Implications for
people adapting to chronic illness: Literature review. Journal of Advanced
Nursing, 55(4), 457–464.