Psychosocial Nursing Diagnosis & Care Plan

Definition:

A NANDA Psychosocial Nursing Diagnosis refers to the identification of a client’s psychosocial needs or problems that can be addressed through nursing interventions. It focuses on the psychological, emotional, and social aspects of an individual’s well-being.

Defining Characteristics:

These are observable signs and symptoms that indicate the presence of a psychosocial problem. Defining characteristics may include changes in mood, altered self-esteem, social withdrawal, difficulty coping with stress, impaired communication, or dysfunctional relationships.

Subjective:

Subjective data refers to the client’s personal experiences, thoughts, feelings, and perceptions. This may include the client’s self-report of anxiety, sadness, loneliness, or relationship difficulties.

Objective:

Objective data refers to observable and measurable signs that can be assessed by the nurse. This may include changes in behavior, social interactions, non-verbal cues, or physiological responses such as increased heart rate or elevated blood pressure.

Related Factors:

These are factors or conditions that contribute to the development or exacerbation of the psychosocial problem. They may include stressors, trauma, inadequate coping mechanisms, lack of social support, or a history of mental health disorders.

Risk Population:

The risk population refers to individuals who are more susceptible to developing the specific psychosocial problem. For example, individuals with a history of substance abuse may be at a higher risk for developing a problem related to self-esteem or impaired social functioning.

Associated Problems:

These are additional issues or complications that may arise as a result of the primary psychosocial problem. For instance, a person with low self-esteem may also experience difficulties in forming healthy relationships or maintaining employment.

Suggestions for Use:

When using a NANDA Psychosocial Nursing Diagnosis, it is important to gather comprehensive subjective and objective data, collaborate with the client to identify goals and desired outcomes, and implement appropriate nursing interventions to address the identified problem.

Suggested Alternative NANDA Diagnoses

Other examples of psychosocial nursing diagnosis include

1. Ineffective Coping
2. Anxiety
3. Impaired Social Interaction
4. Risk for Loneliness
5. Risk for Impaired Self-Esteem

Usage Tips:

When formulating a NANDA Psychosocial Nursing Diagnosis, it is essential to consider the client’s cultural background, individual strengths and limitations, and their unique psychosocial context. Collaboration with the client and their support system is crucial for the development of effective care plans.

NOC Outcomes:

NOC (Nursing Outcomes Classification) outcomes are measurable criteria used to evaluate the client’s progress in achieving their desired psychosocial well-being.

Examples of NOC outcomes for a psychosocial nursing diagnosis may include improved self-esteem, enhanced coping skills, increased social support, or improved interpersonal relationships.

NOC Results:

NOC results refer to the client’s actual achievement of the desired outcomes. These results are assessed and documented by the nurse through ongoing evaluation and reassessment of the client’s psychosocial status.

NIC Interventions:

NIC (Nursing Interventions Classification) interventions are evidence-based actions that nurses can implement to address the client’s psychosocial problems.

Examples of NIC interventions for psychosocial nursing diagnoses may include therapeutic communication, counseling, stress management techniques, facilitation of social support, health education, and promoting self-care activities.

a) Therapeutic Communication: Engaging in active listening, providing emotional support, and utilizing therapeutic techniques such as reflection, empathy, and clarification to promote effective communication and understanding between the nurse and the client.

b) Counseling: Providing guidance, support, and assistance in exploring and addressing the client’s psychosocial concerns, facilitating problem-solving, and promoting adaptive coping strategies.

c) Stress Management Techniques: Assisting the client in identifying stressors, teaching relaxation techniques such as deep breathing, mindfulness, or guided imagery, and promoting stress reduction activities such as exercise or hobbies.

d) Facilitation of Social Support: Assisting the client in identifying and accessing appropriate social support networks, including family, friends, support groups, or community resources, to enhance their social interactions and sense of belonging.

e) Health Education: Providing information and education to the client and their support system about psychosocial issues, mental health promotion, coping strategies, self-care practices, and available resources.

f) Promoting Self-Care Activities: Encouraging the client to engage in self-care practices such as maintaining a healthy lifestyle, engaging in enjoyable activities, practicing relaxation techniques, or seeking help when needed, to enhance their overall well-being.

Psychosocial Nursing Care Plans

Nursing Care Plan for Psychosocial – Chronic Low Self-Esteem:

Nursing Diagnosis: Chronic Low Self-Esteem

Related Factors/Causes:

1. History of childhood abuse and neglect
2. Repeated failures or setbacks in personal or professional life
3. Negative self-perception due to body image issues
4. Lack of positive reinforcement or support system
5. Cultural or societal factors that devalue individual worth

Desired Outcomes:

1. Client will verbalize increased self-worth and positive self-perception.
2. Client will identify personal strengths and achievements.
3. Client will demonstrate increased self-confidence and assertiveness in social interactions.
4. Client will engage in self-care activities that promote a positive self-image.
5. Client will establish a supportive network of individuals who provide positive feedback and reinforcement.

Nursing Interventions for Low Self Esteem:

1. Establish Therapeutic Relationship:
   • Build a trusting and empathetic relationship with the client.
   • Use therapeutic communication techniques to encourage expression of feelings and thoughts.
   • Provide a non-judgmental and supportive environment.
2. Assess Self-Esteem Factors:
   • Explore the client’s perception of self, body image, and self-worth.
   • Identify past experiences or current situations contributing to low self-esteem.
   • Discuss societal or cultural influences affecting self-perception.
3. Enhance Self-Awareness and Positive Self-Talk:
   • Encourage the client to identify and challenge negative self-beliefs.
   • Teach positive affirmations and self-talk techniques.
   • Provide resources for self-help materials or support groups focused on building self-esteem.
4. Encourage Self-Reflection and Identifying Strengths:
   • Assist the client in recognizing personal strengths, talents, and achievements.
   • Guide the client in setting realistic and achievable goals.
   • Encourage journaling or self-reflection exercises to promote self-awareness and self-discovery.
5. Promote Body Positivity and Self-Care:
   • Provide education on body acceptance and challenging societal beauty standards.
   • Collaborate with the client to develop a self-care plan that includes activities promoting physical and emotional well-being.
   • Encourage the client to engage in regular exercise, practice good hygiene, and dress in a way that makes them feel confident.
6. Facilitate Support Network:
   • Assist the client in identifying individuals who provide positive support and reinforcement.
   • Encourage the client to seek out relationships and connections with supportive friends, family, or support groups.
   • Provide information on local community resources that promote self-esteem and personal growth.

Evaluation:

• Regularly assess the client’s self-perception and self-esteem levels.
• Use self-report and observation to determine progress towards desired outcomes.
• Collaborate with the client to review achievements, identify areas of ongoing concern, and modify the care plan as necessary.

Nursing Care Plan for Psychosocial – Impaired Social Interaction:

Nursing Diagnosis: Impaired Social Interaction

Related Factors/Causes:

1. Social anxiety or phobia
2. Cognitive impairments affecting communication and social skills
3. Language barriers or limited proficiency in the dominant language
4. Physical disabilities or limitations hindering social participation
5. Lack of social support or isolation due to living arrangements or cultural factors

Desired Outcomes:

1. Client will demonstrate improved social skills and initiate interactions with others.
2. Client will express increased comfort and reduced anxiety in social situations.
3. Client will actively engage in group activities and conversations.
4. Client will establish and maintain meaningful relationships with others.
5. Client will verbalize satisfaction and increased sense of belonging in social settings.

Nursing Interventions for Impaired Social Interaction:

1. Assess Social Interaction Skills:
   • Observe the client’s current social skills and abilities.
   • Identify any specific challenges or areas of difficulty.
   • Evaluate communication patterns, body language, and non-verbal cues.
2. Create a Supportive Environment:
   • Foster a welcoming and inclusive atmosphere for social interactions.
   • Encourage group activities that promote participation and engagement.
   • Provide opportunities for the client to interact with others in a safe and non-judgmental space.
3. Teach and Role Model Social Skills:
   • Provide education on effective communication techniques, active listening, and maintaining eye contact.
   • Demonstrate appropriate social skills through role-playing or modeling.
   • Encourage the client to practice new skills in a supportive setting.
4. Reduce Social Anxiety:
   • Use relaxation techniques, deep breathing exercises, or mindfulness activities to help manage anxiety.
   • Gradually expose the client to social situations, starting with less intimidating environments and gradually increasing complexity.
   • Provide emotional support and reassurance during social interactions.
5. Facilitate Socialization Opportunities:
   • Organize group activities or outings that promote social interaction.
   • Encourage participation in community events, clubs, or support groups.
   • Collaborate with the client to identify areas of interest and connect them with relevant social opportunities.
6. Encourage Self-Expression:
   • Help the client identify personal interests and hobbies.
   • Encourage creative outlets such as art, music, or writing for self-expression.
   • Provide opportunities for the client to share their thoughts and opinions within group settings.

Evaluation:

• Regularly assess the client’s comfort level and engagement in social interactions.
• Use self-report, observation, and feedback from others to determine progress towards desired outcomes.
• Collaborate with the client to review achievements, identify areas of ongoing concern, and modify the care plan as necessary.

Psychosocial questions for nursing students:

Question 1: A nurse is caring for a client diagnosed with major depressive disorder. Which intervention would be most appropriate for promoting client engagement?

A. Encouraging solitary activities to allow for introspection.

B. Facilitating group therapy sessions for peer support.

C. Providing frequent periods of uninterrupted rest.

D. Limiting social interactions to prevent overstimulation.

Answer: B. Facilitating group therapy sessions for peer support.

Rationale: Group therapy sessions provide an opportunity for clients with major depressive disorder to connect with others who may share similar experiences. Peer support can help reduce feelings of isolation and provide a supportive environment for clients to express themselves and learn coping strategies.

Question 2: A client with generalized anxiety disorder is experiencing excessive worry and restlessness. Which nursing intervention would be most effective in assisting the client to manage anxiety?

A. Encouraging the client to avoid stressful situations.

B. Teaching relaxation techniques, such as deep breathing exercises.

C. Providing frequent reassurance to alleviate worries.

D. Administering an anxiolytic medication as prescribed.

Answer: B. Teaching relaxation techniques, such as deep breathing exercises.

Rationale: Teaching relaxation techniques, such as deep breathing exercises, can help the client manage anxiety by activating the body’s relaxation response. These techniques promote a sense of calm and can be used as a coping mechanism during times of heightened anxiety.

Question 3: A client diagnosed with schizophrenia is experiencing auditory hallucinations. Which intervention should the nurse prioritize?

A. Engaging in reality orientation techniques.

B. Administering antipsychotic medication as prescribed.

C. Encouraging the client to engage in social activities.

D. Assisting the client in exploring the meaning of the hallucinations.

Answer: B. Administering antipsychotic medication as prescribed.

Rationale: Administering antipsychotic medication is a priority intervention for managing symptoms of schizophrenia, including auditory hallucinations. Antipsychotic medications help to reduce the intensity and frequency of hallucinations, promoting improved mental health and overall well-being.

Question 4: A client diagnosed with borderline personality disorder displays impulsive behaviors and has difficulty regulating emotions. Which intervention is appropriate for managing the client’s impulsive behavior?

A. Establishing strict rules and consequences.

B. Encouraging the client to engage in distracting activities.

C. Teaching the client mindfulness techniques.

D. Administering sedative medications as needed.

Answer: C. Teaching the client mindfulness techniques.

Rationale: Teaching the client mindfulness techniques can help improve emotional regulation and reduce impulsive behaviors. Mindfulness promotes self-awareness and the ability to observe and accept emotions without immediately reacting to them, allowing for more thoughtful and controlled responses.

Question 5: A client with post-traumatic stress disorder (PTSD) experiences intrusive memories and nightmares related to a traumatic event. Which intervention would be most helpful in managing these symptoms?

A. Encouraging the client to avoid any reminders of the traumatic event.

B. Assisting the client in developing a trauma narrative.

C. Administering anxiolytic medications to alleviate anxiety.

D. Teaching relaxation techniques, such as progressive muscle relaxation.

Answer: B. Assisting the client in developing a trauma narrative.

Rationale: Assisting the client in developing a trauma narrative can help process and integrate the traumatic memories, reducing the frequency and intensity of intrusive memories and nightmares. This intervention is commonly used in trauma-focused therapies and can contribute to the client’s healing and recovery process.

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. 

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.

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. 

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. 

Best Nursing Books and Resources

These are the nursing books and resources that we recommend.

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The Nursing Diagnosis Handbook E-Book: An Evidence-Based Guide to Planning Care

This is an excellent reference for nurses and nursing students. While it is a great resource for writing nursing care plans and nursing diagnoses, it also helps guide the nurse to match the nursing diagnosis to the patient assessment and diagnosis.

This handbook has been updated with NANDA-I approved Nursing Diagnoses that incorporates NOC and NIC taxonomies and evidenced based nursing interventions and much more.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023

All introductory chapters in this updated version of a ground-breaking text have been completely rewritten to give nurses the knowledge they require to appreciate assessment, its relationship to diagnosis and clinical reasoning, and the goal and use of taxonomic organization at the bedside.

Nursing Care Plans: Nursing Diagnosis and Intervention

It contains more than 200 care plans that adhere to the newest evidence-based recommendations.

Additionally, it distinguishes between nursing and collaborative approaches and highlights QSEN competencies.

Disclaimer:

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This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.