Nursing diagnosis – INEFFECTIVE HEALTH MAINTENANCE

INEFFECTIVE  HEALTH  MAINTENANCE

DEFINITION

Inability to identify, manage, and/or seek out help to maintain health

DEFINING CHARACTERISTICS

· Demonstrated lack of adaptive behaviors (internal or external

environmental changes)

· Demonstrated lack of knowledge regarding basic health practices

· History of lack of health-seeking behaviors

· Reported or observed impairment of personal support systems

· Reported or observed inability to take responsibility for meeting

basic health practices in any or all functional pattern areas.

· Reported or observed lack of equipment or financial and other

resources

RELATED FACTORS

· Cognitive impairment

· Diminished gross motor skills

· Complicated grieving

· Inability to make appropriate

· Deficient communication skills

judgments

· Diminished fine motor skills

· Ineffective family coping

ASSESSMENT FOCUS                           (Refer  to  comprehensive  assessment  parameters.)

· Communication

· Knowledge

· Coping

· Risk management

· Healthcare system

· Values and beliefs

EXPECTED OUTCOMES

The patient will

· Maintain current health status.

· Sustain no harm or injury.

· Verbalize feelings and concerns.

· Explain health maintenance program.

· Identify available health resources.

SUGGESTED NOC OUTCOMES

Coping; Decision Making; Health Beliefs: Perceived Resources;

Health-Promoting Behavior; Social Support; Spiritual Health

INTERVENTIONS AND RATIONALES

Determine: Assess current health status; personal habits such as use

of tobacco, drugs, and alcohol; level of knowledge about disease

process; level of family and community assistance; coping

mechanisms and communication skills (verbal and written); and

degree of motivation to maintain health. Assessment factors will

assist the nurse in establishing interventions for this diagnosis.

Perform: Provide assistance with self-care, as needed. Encourage

increasing levels of independence. The patient should be as

independent in ADLs as possible.

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Administer medications as prescribed to ensure continuation of

therapy.

Adapt environment to that which is best suited to the particular

patient. Reorient the patient as needed. In the disoriented patient,

reorientation should take place frequently to keep the person as

close to knowing person, place, and time as possible.

Provide a consistent caretaker whenever possible to promote sta-

bility for the patient.

Plan a health maintenance program for patient and family members

addressing current disabilities. Provide patient and family with a writ-

ten copy. Giving instructions in writing will reinforce the various

aspects of the program and increase the possibility of compliance.

Inform: Fully describe all aspects of the patient’s care to the family

to elicit cooperation from them in continuing a plan.

Instruct family members how to carry out health maintenance

practices. Demonstrate skills such as bathing, feeding, and reality

orientation; then, have family members return demonstration under

supervision. Involving family members allows them the opportunity

to perform skills and solve problems with support and supervision.

Provide specific instructions on how to maintain a safe

environment for the patient to avoid falls and other types of

accidental injuries.

Teach relaxation techniques (e.g., guided imagery, progressive mus-

cle relaxation, and meditation) that can be done by the patient and

the family to enhance coping ability and restore psychological and

physical equilibrium by decreasing autonomic response to anxiety.

Attend: Encourage patient and family to verbalize feelings and con-

cerns related to health maintenance. This promotes better

understanding and greater ease in managing challenging situations.

Demonstrate willingness to repeat instruction and demonstrate

skills needed to care for the patients until they feel comfortable.

Manage: Refer to social and community resources, such a stroke sup-

port group, and Alzheimer’s family support group. This helps the family

gain support and receive factual information. It provides opportunity to

express feeling in a group where others are experiencing similar issues.

Making referrals is appropriate to mental health professional to

assist with prevention of burnout for the family.

SUGGESTED NIC INTERVENTIONS

Anticipatory Guidance; Coping Enhancement; Counseling; Discharge

Planning; Health Education; Health System Guidance; Physician

Support; Referral; Support System Enhancement

Reference

Cole, C. S., et al. (2006, April). Assessment and discharge planning for the

older hospitalized adults with delirium. Medsurg Nursing, 15(2), 71–76.

Nursing diagnosis – risk prone health behavior

Risk prone health behavior
DEFINITION
Impaired ability to modify lifestyle/behaviors in a manner consistent
with a change in health status
DEFINING CHARACTERISTICS
• Demonstration of nonacceptance of health status to achieve optimal
sense of control
• Failure to take action to prevent future health problems
• Denial of health status change
• RISK-PRONE HEALTH BEHAVIOR
RELATED FACTORS
• Inadequate comprehension
• Inadequate social support
• Low self-efficacy
• Multiple stressors
• Negative attitude toward healthcare
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Behavior
• Communication
• Coping
EXPECTED OUTCOMES
The patient will
• Identify inability to cope and will adjust adequately.
• Express understanding of the illness or disease.
• Participate in healthcare regimen including planning activities.
• Demonstrate ability to manage health problems.
• Help perform self-care activities.
• Show ability to accept and adapt to a new health status and integrate
learning.
• Demonstrate new coping abilities.
SUGGESTED NOC OUTCOMES
Acceptance: Health Status; Adaptation to Physical Disability; Coping;
Health Seeking Behavior; Participation in Healthcare Decisions;
Psychosocial Adjustment: Life Change; Social Support; Treatment
Behavior: Illness
INTERVENTIONS AND RATIONALES
Determine: Assess patient’s present understanding of health status
and treatment to form the basis for any further planning. Assess
feelings about present health status. Do this in a safe, nonthreatening
environment to allow the patient to gain insight into and rationally
define fears, goals, and potential problems. Monitor patient
involvement in care-related activities.
Perform: Make changes in the environment that will encourage
healthy behavior.
• Knowledge
• Self-perception
Inform: Teach patient and caregiver the skills necessary to manage
care adequately. Teaching will encourage compliance and adjustment
to optimum wellness.
Teach patient how to find areas in which it is possible to maintain
control to avoid feelings of powerlessness and allow the patient to
feel like a member of the team’s effort to assist him or her.
Teach caregivers to assist patient with self-care activities in a way
that maximizes patient’s potential. This enables caregivers to participate
in patient’s care and encourages them to support patient’s independence.
Attend: Provide emotional support and encouragement by listening
to the patient’s feelings. This will reassure the patient that you care.
Allow patient to grieve. Grieving is a normal and essential aspect
of any kind of negative change in health status. After working
through denial and isolation, anger, bargaining, and depression, the
patient will progress toward acceptance.
Provide reassurance that the patient’s feelings, under the circumstances,
are normal. By realizing that it is acceptable to grieve, the
patient will be willing to look for positive ways of coping.
Involve patient in planning and decision making. Having the ability
to participate will encourage greater compliance with the plan
for activity.
Discuss health problems with family members to encourage participation
in the patient’s care.
Manage: Refer to a mental health specialist if patient develops severe
depression or other psychiatric problem. Although trauma or illness
commonly causes some depression or other psychiatric disorders,
consultation with a mental health professional may help minimize it.
Arrange for an individual who has the same problem to meet
with the patient. This exposes the patient to suitable role models
and may encourage a supportive relationship to evolve.
SUGGESTED NIC INTERVENTIONS
Anxiety Reduction; Behavior Modification; Coping; Enhancement;
Counseling; Decision-Making Support; Mutual Goal-Setting; Role
Enhancement; Support System Enhancement
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.