Last updated on May 16th, 2022 at 07:26 pm
Ineffective Impulse Control Nursing Care Plans Diagnosis and Interventions
Ineffective Impulse Control NCLEX Review and Nursing Care Plans
Ineffective Impulse Control pertains to the tendency to react quickly and uncontrollably to both mental and external stimuli. It is also characterized by the inability to control one’s impulses, which may be damaging to oneself or others.
Intermittent explosive disorder (IED), kleptomania, oppositional defiant disorder (ODD), and conduct disorders fall under impulse control disorders.
Signs and Symptoms of Ineffective Impulse Control
Ineffective impulse control disorders may or may not appear until adulthood. In all age groups, the most prevalent symptoms are:
- Pyromania
- Kleptomania
- Explosive rage
- Injuring others (including animals)
- Anorexia
- Bulimia
- Irritability
- Trichotillomania
Adult symptoms:
- Sensation seeking
- Sexual promiscuity
- Pyromania
- Excessive gambling
- Compulsive hoarding and buying
Types of Impulse Control Disorders
- Oppositional defiant disorder (ODD). It’s a disorder primarily affecting children, commonly characterized by defiance or vindictiveness toward an individual or other authoritative figure. Examples of rebellious actions include disagreements with adults and refusals to comply with their requests or rules, such as “I refuse to do it” and “You can’t force me.” Additional manifestations include a persistent pattern of anger, impatience, and irritability. Anger feelings can manifest by losing one’s temper or becoming irritated by others. Additionally, persons who suffer from this disorder tend to purposely annoy and blame others for their shortcomings and wrongdoing.
- Intermittent explosive disorder (IED). This is characterized by the incapacity to control one’s actions, resulting in a tendency to engage in aggressive or destructive behavior completely out of proportion. It is more common in adults eighteen years of age and older. Emotional outbursts can be expressed verbally or physically, and they can be aimed at anyone or anything, including other people, animals, or even one’s property. During the initial stage, there is a buildup of tension and agitation, followed by an outburst of rage and violence. After addressing the issue, the individual feels relieved and at rest, and reality may begin to set in. Implications include feelings of guilt, anger, and embarrassment.
- Conduct disorder. People who suffer from this disorder are unable to carry out their daily activities normally. Other defining characteristics include:
- A low sense of self-worth
- Lack of empathy
- Low self-esteem
- A low threshold for irritation
- Lack of empathy
- Frequent outbursts of rage
It’s not uncommon for people with this disorder to engage in physical confrontations, juvenile delinquency, skip class, and bullying. They may even use illegal weapons to damage or steal from others. Moreover, there is a higher prevalence of substance abuse and addiction. As a result, people who suffer from this illness are prone to violent outbursts, resulting in property damage or physical harm to themselves and others.
- Pyromania. It is defined as a pattern of a recurrent, purposeful urge to set things aflame or start a fire. Before lighting a match, the individual is tense or aroused and demonstrates an unusual attraction or interest in fire. In addition, there is a sense of satisfaction or fulfillment that comes from setting something ablaze and seeing it burn to the ground.
- Kleptomania. Individuals suffering from this disorder have an irrational desire to steal essential and non-essential items, including those with no practical or financial worth. Additionally, individuals with kleptomania tend to satisfy a compulsion to attain a sense of relief or pleasure in the aftermath of the theft.
- Antisocial personality disorder. It is a mental illness characterized by a person’s disdain and lack of remorse for the rights and feelings of others, which can show as a pattern of long-term abuse and exploitation.
Causes of Ineffective Impulse Control
- Biological. Genetics may play a role in the development of ODD and conduct disorders. Those diagnosed with this disorder have a family history of other mental health conditions in many cases. Changes in the brain’s neurobiology can also cause ODD. A reduced gray matter may be detrimental since this region is connected to impulsivity, self-control, violence, and antisocial personality. Adolescents with less gray matter are less likely to experience guilt or remorse for their behavior. Moreover, individuals with IEDs may have abnormalities in their brain’s serotonin regulation.
- Psychosocial. Childhood traumas may serve as a catalyst for subsequent impulsive behavior. Conduct disorder is more likely to occur in situations where there is past substance abuse, poor parenting, and mental health issues.
- Psychological. Children with conduct disorders are known to exhibit immature problem-solving methods. To compensate for their poor self-esteem, some people with impulsive conduct problems engage in deceitful behaviors.
Related Factors to Ineffective Impulse Control
- Family history
- Brain Injury
- Genetics
- Comorbid disorders
- History of substance abuse
- Gender (males)
Diagnosis of Ineffective Impulse Control
A mental health professional or psychologist makes the diagnosis of ineffective impulse control. In order to get a complete picture of a patient’s mental state, it is necessary to speak with the patient and get input from family members and significant other(s). The following considerations are taken into account while making a diagnosis:
- Family history
- Co-existing conditions
- Verbal and physical aggression such as arguments, fights, tantrums, destruction of property, and physical assault
- Behavioral pattern analysis
- Intentional fire setting or pyromania
- Inability to resist theft or kleptomania
Treatment of Ineffective Impulse Control
- Psychotherapy. This treatment measure includes individual and group counseling. Providing the patient a safe and non punitive environment in which care is a fundamental feature constitutes a therapeutic milieu. Furthermore, allowing patients to engage in solitary activities can help them learn to take responsibility for their well-being. Therapy may also entail educating parents of teenagers or children with impulse control disorders on how to respond positively to their child’s behavior.
- Cognitive-behavioral therapy (CBT). This is a commonly utilized therapy that helps individuals overcome, reframe and alter negative thought patterns and behaviors. Since the treatment is focused on identifying the relation between thoughts and actions, CBT is beneficial in addressing ineffective impulse control.
- Dialectical behavior therapy. It is another type of cognitive-behavioral therapy that stresses the practice of mindfulness. This encourages the individual to concentrate on the present moment. DBT can be used to control substance abuse, self-mutilation, and self-harm behaviors such as suicidal thoughts.
- Medications. The physician may prescribe mood stabilizers and antidepressants to treat any underlying mental health or neurological issues.
- Contingency management. This is a behavioral therapy that aims to make behavioral changes by using a reward system. These are employed in both standard and clinical settings. Contingency management isn’t just for substance abuse treatment, but it is also practical for those with dual diagnoses or co-occurring disorders.
Prevention of Ineffective Impulse Control
- Self-Care Practices
- Meditation
- Cessation of alcohol and substance abuse
- Monitoring impulsive episodes
- Avoiding Triggers
- Programs focused on resolving issues associated with impulse control disorders (ICD)
Ineffective Impulse Control Nursing Diagnosis
Nursing Care Plan for Ineffective Impulse Control 1
Nursing Diagnosis: Ineffective Coping related to impulsive concentration on radical solutions, secondary to ineffective impulse control, as evidenced by destructive behavior, failure to live up to norms and expectations, use of coping mechanisms that may impair adaptive behavior, and verbalization of incapacity to seek assistance.
Desired Outcome: The patient will express willingness to learn new coping methods and show evidence of his/her ability to adapt to situations.
| Ineffective Impulse Control Nursing Interventions | Rationale |
| Assess the patient’s current level of coping. | Demonstrates the patient’s ability to tolerate and delay gratification in the face of unpleasant emotions like frustration and anger. Moreover, assessing their coping status helps recognize their inability to identify stimulation, agitation, and poor emotional responses. |
| Examine distinguishing features such as verbal and non-verbal responses. | Stress can sometimes cause a wide range of behavioral and physiological reactions. An assessment might reveal the extent of ineffective coping that has occurred. |
| Determine the patient’s stressors. | Internal and external factors can trigger ineffective impulse control. Reduced executive function resulting from stress also impairs memory recall, impulse control, mental flexibility, and coping abilities. |
| Define acceptable and unacceptable behavior. | Two things need to be done for the nurse to effectively limit unwanted behavior: establishing a clear set of rules and ensuring the ramifications are significant to the patients. Establishing a well-defined framework will help reduce violence and enhance patient compliance. Moreover, it is beneficial to establish and adhere to restrictions to boost the patient’s sense of security. |
| Enhance the patient’s sense of self-worth and dignity by adopting an attitude of tolerance and openness. Communicate empathically. | The ability to express one’s thoughts and feelings freely can help patients better understand why they act on their impulses. It can also help them see how their actions influence other people. Furthermore, recognizing and empathizing with the patient helps create a supportive environment that aids them in coping better with their situation. |
| Provide channels for self-esteem and personal accomplishment. | Self-esteem is enhanced in real-life situations when people have access to positive avenues for expressing themselves. One more reason to provide patients with effective coping strategies is to prevent them from making decisions or acting in ways they could later come to regret. |
| Encourage the use of relaxation techniques such as cognitive-behavioral therapy (CBT), music therapy, and guided imagery. | Relaxation techniques, stress relief, and guided imagery are patient-centered approaches that help patients cope, develop a stronger sense of control, and alleviate their anxieties. |
| Ensure that the patient avoids situational triggers. Encourage them to participate in good coping activities to alleviate the situation. | Helps with trigger management |
Nursing Care Plan for Ineffective Impulse Control 2
Nursing Diagnosis: Non-Compliance related to concerns about possible side effects of the treatment plan, secondary to ineffective impulse control, as evidenced by denial of the condition, missed appointments, and behavior that suggests a lack of adherence.
Desired Outcome: The patient will demonstrate a desire to undertake change by identifying impediments affecting treatment compliance.
| Ineffective Impulse Control Nursing Interventions | Rationale |
| Assess the patient’s knowledge about ineffective impulse control, indications, medical management, and treatment. | Provides nurses with the opportunity to discuss or clarify information as needed. Moreover, it helps to individualize the care plan according to the patient’s needs, thereby promoting compliance with treatment recommendations. |
| Identify available support systems. | Patients who receive positive feedback feel better about themselves and are more likely to continue counseling. |
| Evaluate the patient’s perspective and willingness to adhere to the treatment plan. | The perceived benefits, implications of the disease, effects, and outcomes of treatment influence patient compliance. Patients with defiant personalities often dispute with adults and are non-compliant with rules and orders. It is crucial to evaluate their willingness to comply with the program since they may not be able to comprehend the severity of their sickness or their ability to care for themselves. |
| Establish rapport between the patient and his or her family members. | It helps develop the patient-nurse relationship. Consequently, the patient has a greater sense of confidence and conviction in his/her ability to finish the treatment. |
| Eliminate any opportunities, temptations, and incentives which may cause non-compliance. | Recommendations for reduced activity levels, reduced wait times in clinics, medications with fewer side effects, and help with the patient’s time management help encourage compliance associated with poor impulse control. Additionally, proper self-management helps patients adhere to their treatment plans and increase their overall sense of well-being and safety. |
| Ensure that therapy guidelines are brief, basic, and clear to understand. | When therapy is brief and easy to grasp, patients are more likely to comply. |
| Establish a reward system for the patient based on their compliance with the treatment plan. | Getting praised, encouraged, or rewarded for cooperating and adhering to the care plan reinforces compliant behavior. |
| Provide a safe space for the patient to express negative emotions. Ask the patient if he/she is satisfied or dissatisfied with the recommended treatment plan. | This approach enables the patient’s perspective and vulnerability to be communicated more effectively. Additionally, it would aid in identifying concerns and issues with the treatment plan. |
| Refer the patient for psychotherapy or counseling. | Relieves stress and improves the quality of life. Anxiety and impulsive behaviors can be controlled with the help of this technique. |
Nursing Care Plan for Ineffective Impulse Control 3
Nursing Diagnosis: Risk for Injury related to hyperactivity, secondary to ineffective impulse control, as evidenced by agitation, inability to exert control over harmful motions, and risk behavior.
Desired Outcome: The patient will exhibit less agitation and motor activity.
| Ineffective Impulse Control Nursing Interventions | Rationale |
| Assist the patient in employing problem-solving skills by identifying the problem, exploring the alternatives, weighing the benefits and drawbacks of each option, selecting and implementing an approach, and assessing the outcomes. | Patients’ impulsive conduct is exacerbated when they are unable to discuss or address their difficulties successfully. Problem-solving is a highly effective form of impulse control since it facilitates the evaluation of available options before taking action. |
| Redirect the patient’s aggressive behavior. Employ verbal communication to avoid the need for physical restraint when behavior reaches a damaging threshold. | Patients are prone to turn aggressive without notice after a time of building stress. Instead of acting out their emotions, they can express them more effectively by using non-destructive techniques like communication. |
| Encourage solitary activities such as journaling and drawing. | Patients with ineffective impulse control or impulse control disorders (ICD) are more likely to be involved in accidents and mishaps resulting in physical injury. Establishing solitary activities give the patient a sense of direction and provides security. Also, these kinds of activities may help alleviate the patient’s feelings of isolation. |
| Reduce the amount of stimulation in the patient’s physical environment. Incorporate stress-relieving measures into the setting, such as lighting, soft music, absent noises, and low-temperature ventilation. | To avoid overstimulation, keep stimuli to a minimum and the surroundings as quiet as possible. |
| Maintain a consistent schedule for relaxation and breaks. | It eases negative thoughts and aggression. In addition, it’s critical to take regular rests to minimize fatigue, which hinders a patient’s capacity to recover. |
| Eliminate or confine objects that the patient could utilize to engage in self-destructive behavior or self-injury | Patients with ICD tend to experience intense feelings that can be overwhelming and controlling, often resulting in violent or aggressive acts. For instance, the patient may distrust other people and carry concealed weapons. Priority is given to ensuring the patient’s security and others around them. |
Nursing Care Plan for Ineffective Impulse Control 4
Impaired Social Interaction
Nursing Diagnosis: Impaired Social Interaction related to excessive restlessness and out-of-control motor activity, secondary to ineffective impulse control, as evidenced by the inability to form meaningful relationships, offensive language, lack of focus, and disruptive relationships with others.
Desired Outcome: The patient will engage in activities and verbal exchanges with others that are both goal-directed and mutually fulfilling.
| Ineffective Impulse Control Nursing Interventions | Rationale |
| Ensure that patients know what they may expect. In the first meetings, take the time to define expectations and prevent conflicts and power disputes. | Patients suffering from ineffective impulse control or ICD tend to have less control over their emotions, and maintaining balance and stabilization is always challenging. To ensure that severe and intense countertransference reactions are minimized or lessened, it is the nurses’ responsibility to take a neutral approach and validate the patient’s concerns. |
| Convey expectations, limitations, and obligations to patients in a polite and non-judgmental manner. Assert the rules and regulations of the institution and the penalties imposed if they are violated. | Patients with ICD tend to violate social rules. They are more inclined to react aggressively, violently, or with fits of anger. Imposing boundaries and employing good teaching strategies assist patients in developing impulse control and self-regulation. |
| Encourage non-stimulating social activities such as board games, arts groups, and the use of soft or slow music. | Non-stimulating activities help improve interpersonal skills, whereas stimulating exercises such as playing badminton or dancing may increase aggressiveness and physical exertion. |
| Create an environment that is free of stimulus | It may be beneficial to curate interventions that aim to reduce triggers, including providing an atmosphere absent of stimuli to minimize distractibility. By removing sources of distraction, the patient can better control his or her urges to react to the surrounding environment. |
Nursing Care Plan for Ineffective Impulse Control 5
Nursing Diagnosis: Chronic Low Self-Esteem related to afflicted or guilty expressions, secondary to ineffective impulse control, as evidenced by self-defeating statements, long-held shame/guilt, indecisiveness, and rejecting positive feedback
Desired Outcome: The patient will recognize cognitive distortions that negatively impact his/her self-image.
| Ineffective Impulse Control Nursing Interventions | Rationale |
| Establish rapport between the patient and his or her family members. | It helps develop the patient-nurse relationship. Consequently, the patient has a greater sense of confidence and conviction in his/her ability to finish the treatment. |
| Ask about the patient’s future goals. Set realistic and reachable short-term goals. Determine what the patient needs to improve on in order to reach their objectives. | Positive self-reflection and a sense of sentimentality are curbed when one concentrates on the present rather than the past. When short-term goals are met, it is possible to gain a sense of accomplishment, direction, and meaning in one’s life. Achieving one’s goals can boost one’s self-esteem and give one a sense of achievement. |
| Observe the patient’s behavior as he/she may resort to blaming, projection, indifference, demanding behavior, and anger to stave off feelings of low self-esteem. | Patients with ICD exhibit a wide range of behaviors that mask a poor self-image and self-esteem. Depression, low self-esteem, and social disengagement are symptoms of this group of conditions. |
| Employ visualization techniques that can assist the client in replacing negative self-images and thoughts with more positive ones. | People with poor self-esteem may be more likely to exhibit impulsive behaviors. Using visualization techniques helps the patient develop a more positive self-image by encouraging them to think and act more positively. Impulsive behavior can occur due to anxiety; however, this is an uncommon occurrence. Anxiety and stress, both of which are associated with uncontrolled impulsivity, can be lessened using guided imagery techniques. |
| Assist the patient in activities that require problem-solving skills. | Employing problem-solving abilities to develop realistic and attainable self-management goals can improve one’s self-concept. |
| Assist the client in reframing and refuting cognitive distortions. | Cognitive distortions and ICD are interrelated. Cognitive distortions are distorted ways of thinking that are not grounded in reality. These negative thought patterns can contribute to a decrease in motivation and a reduction in self-esteem. In addition, lack of focus, unpredictable behaviors, and inadequate impulse control are all possible manifestations. |
| Encourage participation in the decision-making process and promote the patient’s adaptive responses by providing constructive comments. | Perceptions of self are enhanced when one has control over one’s own life events. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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