Powerlessness is a nursing diagnosis defined as a state in which the individual perceives a lack of personal control over certain situations or events and a sense that his/her actions will have no significant influence on an outcome.
This affects the individual’s outlook, lifestyles, and goals. Patients who experience powerlessness may feel like there is a loss of control over their situation and may exhibit violent behavior, apathy, passivity, or anger.
Situations where a patient may perceive powerlessness include being diagnosed with a chronic illness such as terminal cancer and congestive heart failure.
Patients who have lost abilities for the performance of activities of daily living due to an amputation or a stroke may also feel powerlessness.
In the nursing profession, powerlessness that is undiagnosed in patients can be a life-threatening situation; therefore, correct and immediate nursing diagnosis coupled with appropriate nursing interventions is essential.
Factors Related to Powerlessness
- Dysfunctional Environment
- Complex treatment regimen
- Insufficient Interpersonal Interactions
Defining Characteristics of Powerlessness
- Feelings of alienation
- Depression
- Dependency
- Frustration on inability to perform previous activities
- Doubt about role performance
- Insufficient sense of control
- Inadequate participation in care
- Shame
Nursing Care for Patients with Powerlessness
- Determine the behavior, person, thing, place, or situation that is causing the feeling of powerlessness
- Determine what about the problem is causing the feeling of powerlessness
- Determine what irrational beliefs prevent the admission of powerlessness over the problem
- Substitute irrational beliefs with more healthy beliefs like “I am capable of solving problems that come my way as long as I am willing to admit my incapacity to solve them by my own and seek help to deal with them.”
- Once there is affirmation in admitting powerlessness over the problem, seek the help of others for their support and assistance.
- Once gaining the help of others, carefully and diligently take steps to address the modifiable elements which one has the power and ability to change.
- Understand that progress will be sluggish and arbitrary at first. Time must be given for change to take place.
- Monitor the progress in solving the problem and handle relapses into old behaviors properly.
Powerlessness Nursing Diagnosis
Nursing Care Plan Powerlessness 1
Anxiety Disorder
Nursing Diagnosis: Powerlessness related to expression of an actual or perceived threatening situation secondary to anxiety disorder as evidenced by extraneous movement, fidgeting, hypervigilance, insomnia, poor eye contact, and restlessness secondary to anxiety
Desired Outcome: The patient will be able to identify, verbalize, and demonstrate techniques to control anxiety and demonstrate return of basic problem-solving skills
| Powerlessness Nursing Interventions | Rationale |
| Assess the patient’s level of anxiety and physical reactions to anxiety like tachycardia, tachypnea, and nonverbal expressions of anxiety. Symptoms evaluated include the mood, fear, insomnia, tension, worry, depressed mood, concentration, somatic complaints, cardiovascular, gastrointestinal, respiratory, autonomic, genitourinary, and behavioral symptoms. Use the Hamilton Anxiety Scale, which evaluates 14 symptoms. | Assessment of the anxiety levels and the patient’s physical reactions to anxiety should be done first to determine the interventions that should be performed on the patient. Generalized anxiety disorder is the most common anxiety with a 12-month prevalence. |
| Rule out alcohol, sedative, and smoking withdrawal as the cause of anxiety. | Those who withdraw from alcohol, sedatives, or smoking demonstrate higher levels of anxiety and nervousness. |
| Use empathy for the encouragement of the patient to interpret symptoms of anxiety as normal. | The nurses’ interaction with the patient influences the patient’s quality of life. Provision of psychological and social support can reduce the symptoms and problems that are associated with anxiety. Patients exhibit more trust and respond with more success to nurses who provide empathetic and compassionate responses and suggestions. |
| If irrational fears or thoughts are present, offer the patient accurate information and encourage the patient to talk about the significance of the events that are contributing to the anxiety. | Providing the patients with accurate information about their condition, prognosis, and outcomes significantly reduced their anxiety levels and increased patient empowerment. |
| Encourage the patient to use positive self-talk. | Reduction in negative self-talk and increasing positive self-talk is beneficial for all types of anxiety. Self-talk strengthens both actual behavior performance and potential behavioral intentions. |
| Intervene and remove sources of anxiety whenever possible. | Removal or the reduction of sources of stress and anxiety among patients has been shown to decrease comorbid conditions and hypertension. |
Nursing Care Plan Powerlessness 2
Nursing Diagnosis: Powerlessness related to insufficient information secondary to diabetes diagnosis
Desired Outcome: The patient will be able to explain the disease state, appreciate the need for medications, and comprehend treatments. The patient will also be able to incorporate health regimen into lifestyle and demonstrate how to perform health-related procedures satisfactorily
| Powerlessness Nursing Interventions | Rationale |
| Consider the literacy of the patient with regards to health and his/her readiness to learn. | Health literacy can vary depending on the situation and complexities of a chronic condition. Readiness to learn can also affect interventions done to improve the patient’s knowledge. |
| Focus on the tone of spoken and written communication when teaching patients who have literacy needs. | Provide an overview of tools for effective communication for teaching including providing feedback, actively seeking questions, using a teach-back method, and providing age-appropriate patient education materials that are written in simple language. |
| Things to be in consideration are the context, timing, and order of how the information is presented. | Presenting the most important information first and grouping information presented in short sessions are effective. |
| Use patient-centered approaches that interact and engage with patients. | Using teaching methods adapted to the patient’s learning style and priority concerns are effective for patient outcomes. |
| Reinforcement of learning through frequent repetition and follow-up sessions. | Frequent and regular education sessions will improve medication and self-care management outcomes for people who have chronic conditions. |
| Use of a variety of technological and multimedia methods of relaying information as appropriate. | Use of multimedia education as an adjunct with current education programs are shown to be effective. |
| Encourage patients and caregivers to maintain and/or expand social networks for support as self-care learning resources when appropriate. | Patients with long-term chronic health conditions who have sustained or expanded community networks are more likely to sustain self-care management, maintain treatment regimens and behavioral change, and access voluntary caregiving over formal caregiving. |
Nursing Care Plan Powerlessness 3
Prenatal Substance Abuse
Nursing Diagnosis: Powerlessness related to uncertainty of fetal health secondary to prenatal substance abuse as evidenced by frequent inquiries on the status of the fetus and history of substance abuse
Desired Outcome: For the mother to have regular prenatal care and obtain knowledge level needed for appropriate care of herself during pregnancy to develop a realistic birth plan, taking into account any high-risk pregnancy issues
| Powerlessness Nursing Interventions | Rationale |
| Encourage regular prenatal care and prenatal visits. | Women who attend less than 4 prenatal visits or who started prenatal care late are at risk for poorer outcomes. |
| Observe for signs of alcohol use and counsel the mother to stop drinking during pregnancy. Give the proper referral for treatment if necessary. | Alcohol is teratogenic, and prenatal exposure may result in facial abnormalities, impairment, central nervous system and/or intellectual impairment, and disorders in the behavior. |
| Ask the mother about any instance of substance abuse. Refer her to alcoholism treatment programs as needed. Refer the mother to a treatment program like a methadone clinic to aid in stabilizing the maternal-fetal duo. | Treating addiction as a chronic disease instead of a moral weakness is more supportive to mothers who abuse alcohol. |
| Monitor for psychosocial issues that includes lack of social support, depression, loneliness, maternal powerlessness, lack of confidence, socioeconomic problems, and domestic violence. | Psychosocial concerns can be identified if psychosocial factors are assessed. |
| Provision of antenatal education to increase the knowledge of the mother to make informed choices with regards to pregnancy, labor, and delivery and the promotion of a healthy lifestyle. | The nurse should act as a client advocate and help the mother feel empowered that the decisions she make with regards to maternity care and parenthood are made with up-to-date evidence-based information and fit into their lifestyle. |
| Encourage the expectant parents to prepare a realistic birth plan to prepare for the emotional and physical aspects of the birth process and to plan ahead for how to handle various situations. | Mothers will have an increase in the degree of satisfaction during the birth of their baby if an individualized birth plan is made and the medical team and the parents are able to adhere to it. |
| Encourage good nutritional intake during pregnancy for the facilitation of proper growth and development of the fetus. | A healthy diet is very important for optimal birth outcome. |
Nursing Care Plan Powerlessness 4
Advanced Cancer
Powerlessness related to situational crisis of advanced metastatic cancer as evidenced by verbalization of feeling hopeless, disorganized thought process, crying, and refusal to continue cancer treatment
Desired Outcome: The patient will be able to feel empowered about his/her cancer care and express desire to retain or improve quality of life.
| Powerlessness Nursing Interventions | Rationale |
| Explore the patient’s feeling of hopelessness in relation to cancer treatment and the different aspects of his/her life such as activities of daily living and social support from family and friends. Use open-ended questions. | To establish rapport with the patient, open-ended questions must be utilized when assessing powerlessness/ hopelessness. These can help explore the thoughts and feelings of the patient regarding the situational crisis. |
| Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with him/her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her. | A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if he/she sees the nurse as calm and appears to be in control. |
| Do not leave the patient alone. Re-assure that the healthcare team are here to help him/her. Inform the caregiver or significant other to ensure that there is always someone to be with the patient when at home. | To ensure the patient’s safety against self-harm. Leaving the patient alone during heightened levels of anxiety is dangerous. |
| Discuss with the patient and significant other/s the available treatments for advanced metastatic cancer. Answer all questions in detail and in a calm manner. Refer to cancer specialist nursing team for any concerns regarding treatment. Provide leaflets and other sources of information containing treatment options. | Providing detailed information and answering all questions will make the patient feel more in control of his/her treatment options. |
| Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation. | To promote relaxation and reduce stress levels. |
| Refer the patient to cancer support groups. Ensure that he/she gives consent for this referral prior to doing so. | The patient is more likely to feel empowered in the presence of other cancer patients who have gone through or are currently in the midst of cancer treatment. |
Nursing Care Plan Powerlessness 5
Nursing diagnosis: Powerlessness related to the nature of the disease and uncertain prognosis secondary to multiple sclerosis diagnosis as evidenced by verbalization of fear of poor quality of life in the future
Desired Outcome: The patient will be able to identify problems associated with powerlessness and express appropriate feelings of guild, fear, anger, or sadness. The patient should also be able to seek help in dealing with problems associated with grief and plan for the future one day at a time
| Powerlessness Nursing Interventions | Rationale |
| Assess for potential for suicide and refer the patient for appropriate treatment if a potential for suicide is identified. | Powerlessness/ Hopelessness is identified as an important risk factor for suicide and thus it is important to be identified by nurses. |
| Assess for potential for depression and refer the patient for appropriate treatment if a potential for depression is identified. | Powerlessness/ Hopelessness is a potential predictor for depression and suicidal symptoms. |
| Assess for hopelessness using the modified Beck Hopelessness Scale. | The modified Beck Hopelessness Scale is a reliable and valid tool for the measurement of hopelessness. |
| Engagement of the patient in a therapeutic relationship that can enhance social connectedness and networks for social support. | Relationship-based interventions improve a patient’s sense of social connectedness that will lead to a decrease in hopelessness. |
| Assess family caregivers for symptoms of hopelessness. | Caregivers of patients who are diagnosed with chronic illnesses are at risk for experiencing hopelessness. |
| Determine the appropriate approaches based on the underlying problem which is diagnosis of multiple sclerosis and its contribution to feelings of hopelessness | Understanding the source of hopelessness will indicate the approaches that are most beneficial to the patient. |
| Facilitate possible sources of the patient’s resilience. | Higher levels of resilience are associated with lower levels of hopelessness. |
| Assist the patient to expect positive outcomes and determine ways to achieve the positive outcomes | These actions facilitate the development of hope as a strength. |
| Assist the patient in examining alternatives and setting long and short-term goals that are important to him/her. | When nurses work with patients and their families, they should help in replacing avoidant coping strategies with alternate strategies. Setting goals is a future oriented action that promotes the development of optimism and hope. |
| Assist patients in the development of realistic goals for their recovery. | Realistic goals reflect realistic sense of hope versus false hope. |
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. (2020). 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
