Nursing diagnosis – INEFFECTIVE DENIAL

INEFFECTIVE  DENIAL

DEFINITION

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

DEFINING CHARACTERISTICS

• Delay in seeking or refusal of medical attention to detriment of

health

• 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

RELATED FACTORS

• Anxiety

• 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.)

• Behavior

• Coping

• Communication

• Values and beliefs

EXPECTED OUTCOMES

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.

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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

promote relaxation.

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

cope.

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

for treatment.

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

rest.

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

Reference

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.

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