Nursing diagnosis – READINESS FOR ENHANCED KNOWLEDGE

READINESS  FOR  ENHANCED  KNOWLEDGE

DEFINITION

The presence or acquisition of cognitive information related to a

specific topic that is sufficient for meeting health-related goals and

can be strengthened

DEFINING CHARACTERISTICS

• Expresses an interest in

• Behaves congruent with

learning

expressed knowledge

• Explains knowledge of

• Describes previous experience

topic

related to other topics

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Risk management

• Knowledge

• Values and beliefs

EXPECTED OUTCOMES

The patient will

• Identify new sources for enhancing knowledge in the topic of

interest.

• Make use of all relevant resources to enhance knowledge.

• Ask questions where new information needs clarification.

• Begin practicing new behaviors gleaned from enhanced knowledge.

SUGGESTED NOC OUTCOMES

Knowledge: Health Promotion

INTERVENTIONS AND RATIONALES

Determine:  Assess current health status; problems, restrictions, limita-

tions; personal habits, such as the use of tobacco, drugs, alcohol con-

sumption, level of knowledge about disease process; communication

skills (verbal and written), degree of motivation to maintain health;

familiarity with technology as a source of learning. Assessment infor-

mation will help identify appropriate interventions.

Perform:  Plan a health maintenance program for the patient and

family members addressing current problems. Developing a plan

with the family will increase the probability of compliance by giving

them information to review each day. Provide the family and patient

with a written copy. A written copy can be posted in the patient’s

home where it is always available for review.

Inform:  Provide books and videos that will help the patient’s quest

for enhanced knowledge. Supplying some materials directly may be

a motivation for the patient to search further.

Direct patient and family to use other sources such as libraries,

the Internet, or professional organizations. An independent search

results in the patient developing confidence in his or her ability to

go much deeper into the area of interest.

217

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

cerns related to the knowledge and skills that patient needs. This

promotes greater ease in managing challenging situations.

Demonstrate willingness to repeat instruction and demonstrations

of skills needed by the patient. Repetition will reinforce learning and

give the patient added confidence in his or her ability to comply.

Be available to answer questions and correct misconceptions for

the patient/family to enhance the effectiveness of learning.

Introduce the patient and/or family to individuals who may have

had experience with the health problems in question if that is advis-

able. In many cases, having the opportunity to talk to another per-

son that has coped well with the same problem will provide support

and encouragement to the patient.

Manage:  Refer to social worker/case manager early in the patient’s

hospitalization. This person will begin identifying the types of sup-

port and resources the family and patient will need to prepare for

follow on care.

Refer to social and community resources, such a stroke support

group, and Alzheimer’s family support group, American Cancer

Society. The patient can contact these sources for additional

information as needed.

SUGGESTED NIC INTERVENTIONS

Discharge Planning; Individual; Learning Enhancement; Learning

Facilitation; Referral; Teaching

Reference

Eldh, A. C., et al. (2006, September). Conditions for patient participation and

non-participation in health care. Nursing Ethics, 13(5), 503–514.

Nursing diagnosis – READINESS FOR ENHANCED ORGANIZED INFANT BEHAVIOR

READINESS  FOR  ENHANCED  ORGANIZED

INFANT  BEHAVIOR

DEFINITION

A pattern of modulation of the physiologic and behavioral systems

of functioning (such as autonomic, motor, state-organizational, self-

regulatory, and attentional–interactional systems) in an infant that is

satisfactory but that can be improved

DEFINING CHARACTERISTICS

• Use of some self-regulatory behaviors

• Definite sleep–wake states

• Responsiveness to visual and auditory stimuli

• Stable physiologic measures

RELATED FACTORS

• Pain

• Immaturity

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Elimination

• Role/relationships

• Neurocognition

• Sensation/perception

• Nutrition

• Sleep/rest

• Physical regulation

EXPECTED OUTCOMES

The parents will

• Express understanding of their role in infant’s behavioral develop-

ment.

• Express confidence in their ability to interpret infant’s behavioral

cues.

• Identify means to promote infant’s behavioral development.

• Express positive feelings about their ability to care for infant.

• Identify resources for help with infant.

The infant will

• Maintain physiologic stability.

• Maintain an organized motor system.

• Respond to information in an adaptive way.

SUGGESTED NOC OUTCOMES

Knowledge: Child Development: 1, 2, 4, 6, and 12 Months; Infant

Care; Neurological Status; Sleep

INTERVENTIONS AND RATIONALES

Determine: Monitor infant’s responses to ensure effectiveness of

preventive measures.

Perform: Demonstrate appropriate ways of interacting with the

infant, such as moderate stimulation, gentle rocking, and quiet

vocalizations, to help the parents identify the most effective methods

of interacting with their child.

199

Inform: Explain to parents that infant maturation is a developmental

process. Further explain that infants exhibit three behavioral states:

sleeping, crying, and being awake and alert. Also explain that

infants provide behavioral cues that indicate their needs. Education

will help parents understand the importance of nurturing the infant

and prepare them to respond to the infant’s behavioral cues.

Explain to parents that their actions can help promote infant

development. Make it clear, however, that infant maturation isn’t

completely within their control. Explanation may decrease feelings

of anxiety and incompetence and help prevent unrealistic

expectations.

Help parents interpret behavioral cues from their infant to foster

healthy parent–child interaction. For example, help them recognize

when the infant is awake and alert, and point out to them that this

is a good time to provide stimulation.

Help parents identify ways they can promote the infant’s develop-

ment, such as providing stimulation by shaking a rattle in front of

the infant, talking to the infant in a gentle voice, and looking at the

infant when feeding him. This encourages practices that promote the

infant’s development. Sensory experiences promote cognitive devel-

opment.

Attend: Explore with parents ways to cope with stress caused by the

infant’s behavior to increase their coping skills.

Praise parents for their attempts to enhance their interaction with

the infant to provide positive reinforcement.

Manage: Provide parents with information on sources of support

and special infant services to encourage them to continue to foster

their infant’s development.

SUGGESTED NIC INTERVENTIONS

Attachment Promotion; Developmental Care; Environmental

Management: Attachment Process; Family Integrity Promotion:

Childbearing Family; Infant Care; Sleep Enhancement

Reference

Byers, J. F., et al. (2006, January–February). A quasi-experimental trial on

individualized, developmentally supportive family-centered care. Journal of
Obstetric, Gynecologic, and Neonatal Nursing, 35(1), 105–115.

Nursing diagnosis – READINESS FOR ENHANCED IMMUNIZATION STATUS

READINESS  FOR  ENHANCED

IMMUNIZATION  STATUS

DEFINITION

A pattern of conforming to local, national, and/or international stan-

dards of immunization to prevent infectious disease(s) that is sufficient

to protect a person, family, or community and can be strengthened

DEFINING CHARACTERISTICS

Expresses desire to enhance

• Behavior to prevent infectious disease.

• Identification of possible problems associated with immunizations.

• Identification of providers of immunizations.

• Immunization status.

• Knowledge of immunization standards.

• Record keeping of immunizations.

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Healthcare system

• Self-perception

EXPECTED OUTCOMES

The patient will

• Express knowledge of health-seeking behaviors necessary to partic-

ipate in immunization.

• Demonstrate adherence behavior to standard recommended immu-

nization protocols.

• Develop an ongoing plan for maintaining records of

immunizations.

SUGGESTED NOC OUTCOMES

Community Health Status: Immunity; Community Risk Control:

Communicable Disease; Immunization Behavior; Knowledge:

Infection

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s prior participation in immunization pro-

gram. Determine patient’s perception of the need for the prevention

of infectious diseases and responsibility for controlling the spread

of communicable disease. Assess patient’s attitude toward health-

seeking behavior that leads to immunization and knowledge of

infection control through immunization for communicable disease.

Assessment factors help in determining appropriate interventions.

Perform: Administer vaccines, as ordered, to ensure expected result

will occur. Implement a mechanism or device for record keeping

of immunizations to prevent gaps and overlaps in patient immuniza-

tions.

Inform: Help patient understand possible risks associated with immu-

nizations to assist patients identify reportable risks and

complications resulting from immunizations.

181

Attend: Encourage patients to have immunizations as close to due

dates as possible to ensure that protection from disease will be con-

sistent and continuous.

Listen attentively to what patient has to say about fear of vaccines.

Fear is often the factor that keeps people from being vaccinated.

Manage: Request for a case manager to make a home visit to help

prepare the family for the patient’s return to a safe environment.

Refer patient to community resources that may offer assistance to

the patient when needed.

Offer written information that can be referred to when needed.
Refer to home health nurse for a follow-up visit in the home.

SUGGESTED NIC INTERVENTIONS

Communicable Disease Management; Immunization/Vaccination

Management; Infection Control

Reference

Wiggs-Stayner, K. S., et al. (2006, August). The impact of mass school immu-

nization on school attendance. Journal of School Nursing, 22(4), 9–22.

Nursing diagnosis – READINESS FOR ENHANCED HOPE

READINESS  FOR  ENHANCED  HOPE

DEFINITION

A pattern of expectations and desires that is sufficient for mobilizing

energy on one’s own behalf and can be strengthened

DEFINING CHARACTERISTICS

Expresses desire to enhance:

• Ability to set personal goals

• Belief in possibilities

• Congruency of expectations with desires

• Hope

• Interconnectedness with others

• Problem solving to meet goals

• Sense of meaning to life

• Spirituality

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Roles/responsibilities

• Coping

• Self-perception

• Emotional status

EXPECTED OUTCOMES

The patient will

• Express desire for positive health outcomes.

• Share personal goals to increase autonomy and personal

satisfaction.

• Increase quality of life.

• Plan to promote maximal physical, mental, social, and psychologi-

cal abilities.

• Share strategies to live a meaningful life.

• Express awareness of the need for developing and maintaining a

positive attitude of hope.

• Seek spiritual support as needed.

SUGGESTED NOC OUTCOMES

Hope; Personal Well-Being; Quality of Life; Will to Live

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s perception of ability to set personal goals.

Assess expression of desire to build on possibilities for the future,

and ability to align desires and expectations. Assess ability of patient

to maintain and enhance relationships with others. Assess patient’s

and family’s spiritual needs, including religious beliefs and affiliation.

Information from assessment will assist in determining appropriate

interventions.

Perform: Schedule time to meet with family and patient to listen to

ways in which they plan to enhance their coping skills in the present

situation.

171
Facilitate opportunities for spiritual nourishment and growth to

address patient’s holistic needs for maximal therapeutic environment.

Inform: Teach self-healing techniques to both the patient and family,

such as meditation, guided imagery, yoga, and prayer, to promote

relaxation.

Teach patient how to incorporate the use of self-healing techniques

in carrying out usual daily activities. Practicing will increase the

chance that the patient will himself use these techniques.

Teach caregivers to assist patient with self-care activities in a way

that maximizes patient’s comfort. Comfort will reduce anxiety and

help patient cooperate with his or her treatment.

Demonstrate procedures and encourage participation in patient’s

care.

Provide patient with concise information about patient’s condition.

Be aware of what the family members have already been told.

Attend: Reinforce family’s efforts to care for the patient. Let them

know they are doing well to ease adaptation to new caregiver roles.

Encourage family to support patient’s independence.

Encourage patient’s cooperation as you continue with healing

techniques, such as therapeutic touch. Cooperation will enhance the

effect of the therapy.

Provide emotional support to family and be available to answer

questions. Being available to answer questions and listen builds trust

of the family.

Manage: Refer family to community resources and support groups to

assist in managing patient’s illness and providing emotional and

financial assistance to caregivers.

Refer to a member of the clergy or a spiritual counselor, accord-

ing to the patient’s preference, to show respect for the patient’s

beliefs and provide spiritual care.

SUGGESTED NIC INTERVENTIONS

Hope Facilitation; Self-Esteem Enhancement; Spiritual Growth Facili-

tation

Reference

Davidson, P. M., et al. (2007, January–February). Maintaining hope in transi-

tion: A theoretical framework to guide interventions for people with heart
failure. Journal of Cardiovascular Nursing, 22(1), 58–64.

Nursing diagnosis – READINESS FOR ENHANCED FLUID BALANCE

READINESS  FOR  ENHANCED

FLUID  BALANCE

DEFINITION

A pattern of equilibrium between fluid volume and chemical compo-

sition of body fluids that is sufficient for meeting physical needs and

can be strengthened

DEFINING CHARACTERISTICS

• Verbalization of willingness to enhance fluid balance

• Stable weight

• Moist mucous membranes

• Food and fluid intake adequate for daily needs

• Straw-colored urine with specific gravity within normal limits

• Good tissue turgor

• No excessive thirst

• Urine output appropriate for intake

• No evidence of edema or dehydration

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Activity/exercise

• Fluid and electrolytes

• Cardiac function

• Neurocognition

• Elimination

• Respiratory function

EXPECTED OUTCOMES

The patient will

• Have stable vital signs within normal ranges; electrocardiograph

shows no abnormality in rhythm.

• Have normal skin temperature, moistness, turgor, and color.

• Have moist and noncracked mucous membranes.

• Have stable weight.

• Have adequate fluid volume intake and thirst satiety.

• Produce adequate urine volume (approximately equal to fluid

intake) of light to straw-colored urine.

• Maintain a urine specific gravity between 1.015 and 1.025.

• Have normal values for plasma and serum for electrolytes, osmo-

larity, glucose, blood urea nitrogen, hematocrit (HCT), and hemo-
globin (Hb).

• Be alert and respond to demands of living; react appropriately to

reflex needs (i.e., thirst); have normal muscle reflexes, strength,
and tone.

• Express understanding of factors that contribute to normal fluid

and electrolyte balance.

• Adhere to prescribed therapies to manage such coexisting disease

processes.

SUGGESTED NOC OUTCOMES

Fluid Balance; Hydration; Nutritional Status: Food & Fluid Intake;

Tissue Integrity: Skin & Mucous Membranes; Vital Signs

139

INTERVENTIONS AND RATIONALES

Determine: Assess usual fluid intake and desire to improve fluid sta-

tus to establish a baseline.

Inform: Teach patient to read and interpret labels on beverage and

food containers. For example, humans require 0.5 g (500 mg) of

sodium per day; typical intake is 5–6 g daily. Reducing the amount

of sodium reduces the amount of fluid volume in the vascular

system.

Encourage adequate water intake (1,200–2,000 ml) during

exercise or high environmental temperatures; unmeasured fluid losses

through diaphoresis and lung evaporation can be significant.

Teach signs and symptoms of dehydration (dry mouth and

mucous membranes), light-headedness (blood pressure and vital sign

changes), scant urine output (glycosuria and polyuria), and over-

hydration (cough, increased weight gain, dependent edema, and

jugular vein distention). Teaching prevents severe complications.

Attend: Encourage patient to select healthy beverages such as water

and limit beverages such as soda or sports drinks that have high

sugar content (which increase the osmolar content of the body, caus-

ing greater thirst and increased load on the renal system and diuresis)

and caffeine (which causes diuresis and may cause an increased fluid

loss), alcoholic beverages during hot weather because these can

cause fluid and electrolyte disturbances through excess diuresis.

SUGGESTED NIC INTERVENTIONS

Electrolyte Management; Fluid/Electrolyte Management; Fluid Man-

agement; Fluid Monitoring

Reference

Mentes, J. (2006, June). Oral hydration in older adults: Greater awareness is

needed in preventing, recognizing, and treating dehydration. American Journal
of Nursing, 106(6), 40–49.

Nursing diagnosis – READINESS FOR ENHANCED FAMILY PROCESSES

READINESS  FOR  ENHANCED

FAMILY  PROCESSES

DEFINITION

A pattern of family functioning that is sufficient to support the well-

being of family members and can be strengthened

DEFINING CHARACTERISTICS

• Activities support the growth of family members

• Activities support the safety of family members

• Balance exists between autonomy and cohesiveness

• Boundaries of family members are maintained

• Energy level of family supports ADLs

• Family adapts to change

• Relationships are generally positive

• Respect for family members is positive

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Roles/relationship

• Coping

• Communication

• Values/beliefs

EXPECTED OUTCOMES

Family members will

• Identify family goals and structured directions.

• Express enjoyment and satisfaction with their roles in the family.

• Express a willingness to enhance roles in family dynamics.

• Participate regularly in traditional family activities.

• Maintain open and positive communication.

• Maintain a safe home environment.

• Seek regular health screenings and immunizations.

• Identify and acknowledge family risk factors.

• Make plans to deal with life changes and events.

SUGGESTED NOC OUTCOMES

Family Coping; Family Functioning; Family Health Status; Family

Integrity; Family Normalization; Family Social Climate

INTERVENTIONS AND RATIONALES

Determine: Assess family composition, roles within the family,

communication patterns, family developmental stages, developmen-

tal tasks, health patterns, coping mechanisms, socioeconomics,

educational levels, ethnicity, and cultural and religious beliefs.

Assessment information helps identify appropriate interventions.

Perform: Establish an environment in which family members can

openly share their issues and concerns in comfort to reduce anxiety

and develop their ability to resolve problems.

Inform: Explain importance of setting goals as a method of estab-

lishing boundaries that will be respected by all family members.

Family functioning with structural direction will enhance the poten-

tial to meet physical, social, and psychological needs.

133
Show family how to develop a Genogram to identify genetic risk

factors. Information from the Genogram will highlight things that

can modify a family’s health patterns, lead to early identification of

genetically related diseases, and may delay onset of disease.

Teach value of daily exercise, well-balanced diet, and use of

proven holistic strategies to improve health.

Provide family with information on recommended health screen-

ings and immunization schedules. It is essential to keep immuniza-

tions given according to schedule to prevent loss of immunity.

Attend: Encourage family members to identify individual and family

goals and a structured direction toward sound health habits for the

entire family. Developing a structured plan will assist in having

everyone work together toward goals set by the family for

themselves.

Involve family in planning and decision making. Having the abil-

ity to participate encourages greater compliance with the plan.

Encourage family to spend time together enjoying traditional

activities that everyone likes doing to promote a healthy lifestyle and

encourage strong family unity.

Manage: Refer, where requested, for follow-up for a family member

who needs exercise, weight management, diet assistance, health

screenings, and so forth. Providing referrals will help to provide

continuity of care for the patient.

SUGGESTED NIC INTERVENTIONS

Family Support; Family Integrity Promotion; Family Maintenance

Reference

Yanaka, L., et al. (2007, January–February). Barriers to screening for domestic

violence in the emergency departments. Journal of Continuing Education in
Nursing, 38(1), 37–45.

Nursing diagnosis – READINESS FOR ENHANCED DECISION MAKING

READINESS  FOR  ENHANCED

DECISION  MAKING

DEFINITION

A pattern of choosing courses of action that is sufficient for meeting

short- and long-term health-related goals and can be strengthened

DEFINING CHARACTERISTICS

• Expresses desire to enhance decision making

• Expresses desire to enhance congruency of decisions with personal

values and goals

• Expresses desire to enhance congruency between decisions and

sociocultural goals and values

• Expresses desire to enhance risk–benefit analysis of decisions

• Expresses desire to enhance the understanding of choices

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Coping

• Knowledge

• Communication

• Values and beliefs

EXPECTED OUTCOMES

The patient will

• Express the desire to make effective decisions.

• Verbalize decision-making goals and concerns.

• Discuss measures used to evaluate decisions.

• Make decisions that promote maximal physical, mental, social,

and psychological well-being.

• Involve family, friends, and clergy in healthcare decision making

when appropriate.

SUGGESTED NOC OUTCOMES

Decision Making; Participation in Healthcare Decisions; Self-Care:

IADLs

INTERVENTIONS AND RATIONALES

Determine: Assess usual coping strategies employed by the patient

when making decisions; determine how the patient goes about mak-

ing difficult decisions; have the patient describe several challenging

decisions he or she made in the past year. Assessment information

will help identify appropriate interventions.

Evaluate support systems available to the patient when it is neces-

sary to make decisions. Patients often need support of families or

other support systems when they are faced with major decisions.

Perform: Provide assistance with ADLs as required. As the patient

receives assistance, it is important to allow him or her to be as inde-

pendent as possible.

Make changes in the environment to reduce unnecessary stimula-

tion and promote a sense of calm.

Inform: Teach patient simple decision-making techniques and role-

play the same. Return demonstration from the patient will give

101

him or her confidence that he or she can choose wisely among

options.

Educate family about the importance of allowing the patient to

think and act for himself or herself in order to give the patient a

sense of control over the present situation.

Attend: Provide emotional support and encouragement to help

improve patient’s confidence in his or her ability to make logical

decisions.

Provide patient with all necessary support during hospitalization

to prepare him and his family to continue the process of having the

patient make decisions about his own care.

Involve patient in planning and decision making. Having the abil-

ity to participate will encourage greater compliance with the treat-

ment plan.

Manage: If patient continues to have difficulty, refer to case

manager/social worker/mental health professional for continued

follow-up.

Provide appropriate assistance to the family members when they

are trying to provide; it might be helpful in working with the

patient.

SUGGESTED NIC INTERVENTIONS

Decision-Making Support; Health System Guidance; Self-Responsibility

Facilitation

Reference

Moser, A., et al. (2007, February). Patient autonomy in nurse-led shared care:

A review of theoretical and empirical literature. Journal of Advanced Nurs-
ing, 57(4), 357–365.

Nursing diagnosis – READINESS FOR ENHANCED FAMILY COPING

READINESS  FOR  ENHANCED

FAMILY  COPING

DEFINITION

Effective management of adaptive tasks by family member involved

with the client’s health challenge, who now exhibits desire and

readiness for enhanced health and growth in regard to self and in

relation to the client

DEFINING CHARACTERISTICS

• Individual expresses interest in making contact with others who

have experienced a similar situation.

• Family member attempts to describe growth impact of crisis.

• Family member moves in direction of enriching lifestyle.

• Family member moves in direction of health promotion.

• Individual chooses experiences that optimize wellness.

RELATED FACTORS

• Adaptive tasks effectively addressed to enable goals of self-

actualization to surface

• Needs sufficiently gratified to enable goals of self-actualization

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Emotional status

• Coping

• Roles/responsibilities

EXPECTED OUTCOMES

Family members will

• Discuss the impact of patient’s illness and feelings about it with

healthcare professional.

• Participate in treatment plan.

• Establish a visiting routine beneficial to the patient.

• Demonstrate the care needed to maintain patient’s health status.

• Identify and use available support systems.

SUGGESTED NOC OUTCOMES

Caregiver–Patient Relationship; Caregiver Well-Being; Family

Coping; Family Normalization; Health-Promoting Behavior

INTERVENTIONS AND RATIONALES

Determine: Assess normal pattern of communication among family

members; understanding and knowledge of family members about

patient’s condition; family’s past response to crises; patient’s percep-

tion of health problem. Assess patient and family’s spiritual needs,

including religious beliefs and affiliation. Assessment of these factors

will assist in selecting appropriate interventions.

Perform: Schedule time to meet with family and patient in order to

listen to ways in which they plan to enhance their coping skills in

the present situation.

Provide comfort measures such as bathing, massage, regulation of

environmental temperature, and mouth care, according to the

97

patient’s needs and preferences. Comfort can promote ability to

cooperate with the plan.

Establish a visiting schedule that will not tax patient’s or family’s

resources. Use patient’s daily routine to aid in planning (e.g., no vis-

iting during treatments or during periods of uninterrupted rest).

Establishing a routine will allow the patient have consistency and a

measure of control.

Inform: Teach self-healing techniques to patient and family such as

meditation, guided imagery, yoga, and prayer. These strategies pro-

mote anxiety reduction.

Teach patient how to incorporate the use of self-healing

techniques in carrying out usual daily activities in order to encour-

age ongoing use of the strategies.

Demonstrate procedures and encourage participation in patient’s

care in a way that maximizes patient’s comfort. Both patient and

family need to work together to implement the plan with patient’s

comfort in mind.

Provide patient with concise information about condition. Be

aware of what family members already know. Honesty is important

when conveying information.

Attend: Reinforce family’s efforts to care for patient. Let family

know they are doing well to ease adaptation to new caregiver roles.

Ensure privacy for patient and family visits to foster open

communication.

Encourage family to support patient’s independence. Encourage

patient’s cooperation as you continue with healing techniques, such

as therapeutic touch. There is a need to allow for as much independ-

ence on the part of the patient as possible. At times the family will

try to promote dependency to the detriment of the patient.

Provide emotional support to family by being available to answer

questions. Availability will communicate to the family that you are

concerned for them and the patient.

Manage: Refer family to community resources and support groups

available to assist in managing patient’s illness and providing emo-

tional and financial assistance to caregivers.

Refer to a member of the clergy or a spiritual counselor, accord-

ing to the patient’s preference, to show respect for the patient’s

beliefs and provide spiritual care.

SUGGESTED NIC INTERVENTIONS

Coping Enhancement; Family Process Management

Reference

Nelson, J. E., et al. (2005, March). When critical illness becomes chronic: Infor-

mational needs of patient and family. Journal of Critical Care, 20(1), 79–89.

Nursing diagnosis – READINESS FOR ENHANCED COMMUNITY COPING

READINESS  FOR  ENHANCED

COMMUNITY  COPING

DEFINITION

Pattern of community activities for adaptation and problem solving

that is satisfactory for meeting the demands or needs of the commu-

nity but can be improved for management of current and future

problems/stressors

DEFINING CHARACTERISTICS

• Active planning to handle predicted stressors

• Active problem solving when faced with stressors

• Agreement that community carries responsibility for stress manage-

ment

• Positive communication among community members and between

community members and larger organizations

RELATED FACTORS

One or more characteristics that indicate effective coping:

• Acknowledges power

• Defines stressors as manageable

• Aware of possible environmen-

• Seeks knowledge of new

tal changes

strategies

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Populations

• Coping

• Risk management

EXPECTED OUTCOMES

Community members will

• Express understanding of problems associated with failure to

immunize population and will recognize the needs to reduce the
number of adults and children who are not immunized.

• Initiate a plan to increase the number of immunizations in popula-

tion and provide adequate protection from communicable diseases.

• Work to reduce spread of communicable diseases and increase the

number of immunizations.

• Evaluate established plans for ensuring that all children become

immunized, and will make changes to plans as needed.

SUGGESTED NOC OUTCOMES

Community Competence; Community Health Status: Immunity;

Community Risk Control: Communicable Disease

INTERVENTIONS AND RATIONALES

Determine: Assess community member’s level of understanding of the

importance of immunization. If level of compliance is low, survey

community needs to determine why. Determine ease of access in the

community for members to comply with immunization

requirements/needs. Identify new members of the community, such

as immigrants or refugees. This assessment will assist in identifying

appropriate intervention.

95

Perform: Collect statistical data from community health sources,

such as the health department and schools to continue to identify

children who have not been immunized. Recruit local agencies with

an adequate number of professionals able to deliver the immuniza-

tion services.

Contact parents personally or by handwritten note about children

who have not been immunized. Make it clear to the parents that

your purpose is to protect the children.

Inform: Provide extensive educational opportunities in the

community about communicable diseases and the importance of

immunization. Educate persons in the community in their first lan-

guage to ensure adequate understanding.

Attend: Encourage community members to implement a program to

disseminate information about problems associated with inadequate

immunization to educate residents and promote the community’s

established immunization program.

Encourage health departments, clinics, and practitioners’ offices to

provide information on the recommended childhood immunization

schedule to the public to foster understanding about the importance

of educating the public.

Conduct a follow-up survey on immunization rates to measure the

effectiveness of educational initiatives.

Manage: Supply a list of referrals for the parents of children who

are not immunized. Include information on low-cost health

insurance, city health centers, and well-baby clinics to encourage

compliance. Helping the parents by giving referrals will empower

them to meet their child’s health care needs.

SUGGESTED NIC INTERVENTIONS

Communicable Disease Management; Community Health Develop-

ment; Health Education; Health Policy Monitoring; Immunization/

Vaccination Management

Reference

Pender, N. J., Murdaugh, C., et al. (2006). Health promotion in nursing prac-

tice (5th ed.). Upper Saddle River, NJ: Prentice Hall.

Nursing diagnosis – READINESS FOR ENHANCED COPING

READINESS  FOR  ENHANCED  COPING

DEFINITION

A pattern of cognitive and behavioral efforts to manage demands

that is sufficient for well-being and can be strengthened

DEFINING CHARACTERISTICS

• Defines stressors as manageable

• Seeks knowledge of new strategies

• Seeks social support

• Uses a broad range of problem-oriented and emotion-oriented

strategies

• Uses spiritual resources

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Roles/relationships

• Communication

• Self-perception

• Coping

EXPECTED OUTCOMES

The patient will

• Identify major issues that require ongoing enhancement of coping

strategies.

• Express feelings associated with coping strategies.

• Demonstrate readiness to develop enhanced strategies.

• Identify support persons and activities that will assist in goal

attainment.

SUGGESTED NOC OUTCOMES

Coping; Quality of Life

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s usual coping mechanisms, roles and

responsibilities, social support, spiritual resources, and use of alcohol

and tobacco in order to decide on a focus for interventions.

Perform: Establish a trusting relationship with patient by spending

time with the patient each shift, which will encourage the patient to

be more honest and open.

Begin discussions at patient’s level of comfort. If patient wants to

express anger or other emotion, listen carefully. Until the patient has

had an opportunity to talk, you will not be able to move him to a

place where the issue can be discussed logically.

Inform: Provide information on informed consent because parents

will be making decisions for the child’s care.

Teach additional skills that enhance coping strategies. Help the

patient develop a program by using relaxation strategies (i.e., medi-

tation, guided imagery, yoga, exercise); these strategies will help to

reduce anxiety and allow the patient to concentrate.

Teach problem-solving skills. Have patient role-play to

demonstrate how to set up options and choose from among them.

93

Attend: Encourage patient to continue adhering to his plan for

enhanced coping strategies. Compliance with the plan will produce

results for the patient. It will also help patient measure success.

Encourage patient to continue involvement in a wide range of

activities. More activities will involve more choices.

Encourage patient to look for volunteer opportunities in the com-

munity as a way of keeping the patient involved with others.

Offer to meet with patient regularly, if desired, to help patient

continue developing enhanced coping skills.

Manage: Refer patients to support groups and offer ideas about edu-

cational opportunities in the community.

SUGGESTED NIC INTERVENTIONS

Active Listening; Coping Enhancement

Reference

Fiks, A. G., et al. (2006, December). Identifying factors predicting immuniza-

tions delay for children followed in an urban primary care network using
an electronic health record. Pediatrics, 118(6), 1680–1686.

Nursing diagnosis – READINESS FOR ENHANCED COMMUNICATION

READINESS  FOR  ENHANCED

COMMUNICATION

DEFINITION

A pattern of exchanging information and ideas with others that is suf-

ficient for meeting one’s needs and life’s goals, and can be strengthened

DEFINING CHARACTERISTICS

• Expresses willingness to enhance communication ability

• Can speak or write language clearly

• Forms words, phrases, and language with articulation

• Uses and interprets nonverbal cues appropriately

• Expresses satisfaction with ability to share information and ideas

with others

• Expresses needs in an assertive way

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Communication

• Roles and relationships

• Coping

• Values and beliefs

EXPECTED OUTCOMES

The patient will

• Maintain pulse within predetermined limit.

• Maintain blood pressure within predetermined limits.

• Have no arrhythmias.

• Exhibit skin that is warm and dry.

• Have no pedal edema.

• Maintain acceptable cardiac output.

• Verbalize understanding of reportable signs and symptoms.

• Understand diet, medication regiment, and prescribed activity level.

SUGGESTED NOC OUTCOMES

Cardiac Pump Effectiveness; Circulation Status; Tissue Perfusion:

Peripheral; Vital Signs

INTERVENTIONS AND RATIONALES

Determine: Monitor patient at least every 4 hr for irregularities in

heart rate, rhythm, dyspnea, fatigue, crackles in lungs, jugular venous

distension, or chest pain. Any or all of these may indicate impending

cardiac failure or other complications. Report changes immediately.

Perform: Provide an environment that diminishes space between the

patient and the nurse to eliminate barriers to communication such

as noise and lack of privacy.

Incorporate questions that are open-ended and start with such

words as “what,” “how,” and “could,” rather than “why.” Open-

minded, nonthreatening questioning encourages patient to discuss

issues of concern and improve communication skills.

Schedule frequent interdisciplinary treatment team meetings

regarding communication skill development with patient. Team

meetings with the patient can ensure continuity of care.

Inform: Educate patient and family members about the aging

process. Educating the patient and family will help them anticipate

processes that will naturally occur again.

Teach theory of assertive behavior and role-play assertive commu-

nication approaches. Assertive training can decrease passive or

aggressive communication patterns.

Include role-playing as a teaching strategy to model methods of

enhanced verbal and nonverbal communication skills. Role-playing in

a nonthreatening safe environment can enhance communication skills.

Attend: Encourage patient verbally and nonverbally to explore

strategies to enhance self-advocacy communication skills with health

care providers. Self-advocacy communication can guide a patient

toward autonomy, confidence, and independence.

Provide support through active listening, appropriate periods of

silence, reflection on feelings, and paraphrasing and summarizing

comments. Active listening techniques encourage patient

participation in communication.

Provide patient with clear explanations for everything that will

happen to him. Ask for feedback to ensure that the patient under-

stands. Anxiety may impair patient’s cognitive abilities.

Manage: Identify appropriate social agencies and support groups for

the patient and provide referrals to ensure ongoing opportunities for

the patient to increase social interaction.

SUGGESTED NIC INTERVENTIONS

Active Listening; Anticipatory Guidance; Assertiveness Training;

Behavior Modification; Social Skills; Relationship-Building Enhance-

ment; Simple Guided Imagery; Support Group

Reference

Whyte, R. E., et al. (2006, September). Nurses’ opportunistic interventions

with patients in relation to smoking. Journal of Advanced Nursing, 55(5),
568–577.

Nursing diagnosis – READINESS FOR ENHANCED COMFORT

READINESS  FOR  ENHANCED  COMFORT

DEFINITION

A pattern of ease, relief, and transcendence in physical, psychospiritual

environmental, and/or social dimensions that can be strengthened

DEFINING CHARACTERISTICS

• Expresses desire to enhance comfort

• Expresses desire to enhance feelings of contentment

• Expresses desire to enhance relaxation

• Expresses desire to enhance resolution of complaints

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Communication

• Coping

EXPECTED OUTCOMES

The patient will

• Express positive perception of nursing assistance to perform activi-

ties that promote comfort.

• Experience physical and psychological ease.

• Develop plans to optimize level of comfort.

• Report an increase in relaxation.

SUGGESTED NOC OUTCOMES

Coping Enhancement; Client Satisfaction; Comfort Level; Emotional

support; Environmental Management

INTERVENTIONS AND RATIONALES

Determine: Assess patient’s satisfaction with the amount of assistance

the nurse is presently offering to determine whether the patient per-

ceives self as performing physical, psychosocial, and spiritual activi-

ties as a level that is comfortable for self-changes in status.

Determine what enhancements to care can be made to provide the

patient a greater degree of comfort.

Ask for feedback from the patient at least once a day to evaluate

progress.

Perform: Adjust environmental factors, where possible, to enhance

the patient’s feeling of a safe and comfortable environment.

Assist patient with bathing, feeding, and toileting to ensure that

his or her needs are met.

Turn and reposition patient every 2 hr to promote comfort.

Inform: Teach patient when he or she is ready about his or her dis-

ease. Present only what patient is able and willing to absorb to pre-

vent him or her from becoming overwhelmed.

Avoid insisting that the patient accept information. Readiness is

an important factor in adult education. Provide both patient and

family with written information such as pamphlets and so forth.

57
Teach the patient and family techniques for relaxation such as

guided imagery to promote comfort and reduce anxiety.

Attend: Provide emotional support and encouragement to help

improve ability of patient to cope with the diagnosis.

Involve patient in planning and decision making. Having the abil-

ity to participate will encourage greater compliance with the plan

and enhance comfort.

Encourage patient to communicate with others, asking questions

and clarifying concerns based on readiness. This will enhance the

patient’s learning ability.

Manage: Maintain frequent communication with physicians and

other staff to determine what the patient is being told about his or

her condition.

Collaboration will foster consistency in what the patient is being

told.

Refer patient to a mental health professional/grief counselor if

denial interferes with ability of patient to function within limits.

SUGGESTED NIC INTERVENTIONS

Anxiety Reduction; Calming Techniques; Counseling; Health Educa-

tion; Reality Orientation; 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.

Nursing diagnosis – READINESS FOR ENHANCED CHILDBEARING PROCESS

READINESS  FOR  ENHANCED CHILDBEARING  PROCESS

DEFINITION

A pattern of preparing for, maintaining and strengthening a healthy

pregnancy and childbirth process and care of newborn

DEFINING CHARACTERISTICS

During pregnancy

• Reports appropriate prenatal lifestyle, physical preparations; man-

aging unpleasant symptoms in pregnancy

• Demonstrates respect for unborn baby

• Reports a realistic birth plan

• Prepares necessary newborn care items

• Seeks necessary knowledge (e.g., of labor & delivery, newborn

care)

• Reports availability of support systems

• Has regular prenatal health visits

During labor & delivery

• Reports lifestyle that is appropriate for the stage of labor

• Responds appropriately to the onset of labor

• Is proactive in labor & delivery

• Uses relaxation techniques appropriate for the stage of labor

• Demonstrates attachment behavior to the newborn baby

• Utilizes support systems appropriately

After birth

• Demonstrates appropriate baby-feeding techniques; basic baby care

techniques

• Provides safe environment for the baby

• Reports appropriate lifestyle

• Utilizes support system appropriately

RELATED FACTORS

• Prenatal health status

• Obstetrical/medical history (including perinatal risks/complications)

• Cultural beliefs/expectations

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Behavior

• Knowledge

• Roles/relationships

EXPECTED OUTCOMES

The patient/childbearing family will

• Demonstrate a willingness to maintain/modify his or her lifestyle

for optimal prenatal health.

• Convey confidence and knowledge of pregnancy, the labor &

delivery process, and newborn care.

• Express appropriate self-control and readily cooperate with recom-

mendations of the healthcare team during labor & delivery.

• Exhibit parent–newborn attachment after delivery.

• Meet the newborn’s physical, social, and nutritional needs.

SUGGESTED NOC OUTCOMES

Prenatal Health Behavior; Knowledge: Pregnancy; Knowledge: Labor

& Delivery; Knowledge: Newborn Care; Parent Infant Attachment.

INTERVENTIONS AND RATIONALES

Determine: Assess baseline knowledge of prenatal self-care, labor &

delivery process, and newborn care to identify and resolve

knowledge deficits.

Perform: Provide written literature on prenatal wellness, labor &

delivery expectations, and newborn care. Providing written materials

allows adequate time to synthesize and understand new information.

Inform: Teach self-care for common prenatal discomforts to promote

patient autonomy.

Teach childbearing family labor & delivery process and newborn

care. Understanding   expectations improves confidence and reduces

anxiety.

Attend: Assist childbearing family with development of a birth plan.

This allows childbearing family to participate in managing the birth

experience and promotes communication with the healthcare team.

Encourage and support childbearing family throughout the course

of the pregnancy to improve self-confidence and promote patient

compliance with health recommendations.

Manage: Refer to certified childbirth educator for classes on prenatal

care, labor & delivery (to include Cesarean birth), breast-feeding,

and newborn care. Advanced knowledge of the childbearing process

promotes empowerment and positive maternal outcomes.

SUGGESTED NIC INTERVENTIONS

Anticipatory Guidance; Childbirth Preparation; Emotional Support;

Parent Education: Infant, Prenatal Care.

Reference

Ward, S. L., & Hisley, S. M. (2009). Maternal–child nursing care: Optimizing

outcomes for mothers, children, and families. Philadelphia: F.A. Davis Com-
pany.