Psychosocial Nursing Diagnosis and Nursing Care Plan

PsychosocialNursing Care Plans Diagnosis and Interventions

Psychosocial NCLEX Review and Nursing Care Plans

Psychosocial nursing diagnosis and care involves culturally sensitive social, psychological, and spiritual care through the use of therapeutic communication. According to recent studies, provision of good psychosocial care may improve patient outcomes by reducing anxiety, stress, period of hospitalization, and healthcare costs.

It may also enhance the patient’s coping mechanisms and reduce pain levels, thereby improving their quality of life. The healthcare worker’s understanding and competence are prerequisites in providing an effective psychosocial care.

Nurses perform a vital role in patient support by establishing a dialogue with them and tackling the patient’s self-image and how their interpersonal interactions influence their decision-making. The patient’s ability to stand by their decisions throughout the treatment period and beyond is also assessed. In building rapport with patients, good communication and assessment skills are a must.

Psychosocial Theories

Psychosocial theories are important in the provision of excellent psychosocial care, as they explicate social relationships, the nature of self-understanding, and mental processes which encourage interactions between an individual and his/her social environment.

These also shed light on changes in ego development that include the formation of one’s identity, self-understanding, social relationships, and an individual’s worldview across all stages of development. At present, there are six psychosocial theories which include the following:

  • Psychoanalytic Theories

This is also known as the deterministic theory which states that all human behavior is causal and can be explained

  • Developmental Theories

This theory believes that a person must accomplish a certain task that is vital to his/her mental health and overall well-being in each stage of his/her life.

  • Interpersonal Theories

This theory supports the notion that an individual’s personality is not only composed of an individual’s characteristics but also the way a person interacts with other people.

  • Humanistic Theories

Humanism focuses on an individual’s potential to change as well as their positive qualities. This also represents a transition from the psychoanalytic view which sees a person as neurotic and impulse-driven with repressed psychic problems.

  • Behavioral Theories

Behaviorism is a branch of psychology which believes that all behaviors can be acquired through conditioning. It highlights behaviors that are observable and external ways in which a person can foster behavior change. 

  • Existential Theories

Existentialism supports the premise that being out-of-touch from one’s authentic self and the environment can result in behavior deviations.

Psychosocial Nursing Interventions

Aside from pharmacologic treatment, psychosocial interventions have been recognized as part of the management of severe mental illness. The foundation of these interventions is built from cognitive behavioral therapies and educational theories which support the notion that there is a complex interaction between biological, sociological, and environmental factors.

Additionally, they assume that ambient stress and specific life events may serve as triggers for an onset or relapse of mental health conditions in some individuals. The basis for the employment of psychosocial nursing interventions is the diagnostic assessment of an individual’s psychopathology. Psychosocial interventions include the following:

  • Psychosocial management of psychosis through cognitive behavioral therapy, self-monitoring methods, enhancement of coping mechanisms, and problem-solving training
  • Family’s assessment of patient needs
  • Engagement and outcome-based assessment
  • Management of medications through motivational interviewing techniques

Psychosocial Nursing Care Plans

Psychosocial Nursing Diagnosis Example 1

Disturbed Body Image

Nursing Diagnosis: Disturbed Body Image related to distorted perception of one’s physical self, secondary to permanent changes in structure and/or function of a body part or situational changes (e.g., aging, pregnancy) as evidenced by verbalization about alterations in structure or function of a body part and employment of appearance management behaviors.

Desired Outcome: The patient will be able to acknowledge, evaluate, and restructure irrational thoughts to more rational self-talk.

Psychosocial Nursing InterventionsRationale
1. Recognize and accept the patient’s expression of frustration, anger, grief, hostility, and dependence. Expression of withdrawal and denial must also be noted.Resolution can be achieved by first accepting that the expression of these feelings is valid and is a normal response to the situation. It must be recognized that the patient’s denial may be persistent as a defense mechanism. Avoid forcing the patient to deal with the situation if he/she is not ready to cope with personal problems.
2. The patient’s normal response to the actual or perceived alteration in body structure or function must be acknowledged.Feelings of grief over loss of a body part or function is normal. This may also involve denial whose period may vary across patients.
3. Avoid showing judgmental behavior while providing psychosocial care to the patient. Set boundaries on maladaptive behavior and encourage the patient to determine positive behaviors that can be beneficial for recovery. It is important to recognize that maladaptive behavior, in most cases, is targeted toward the situation and not the healthcare provider. 
4. Embody a realistic and positive attitude during health education and treatment period. Remember to set realistic goals with accompanying limitations.This helps in building rapport and trust between the nurse and the patient.
5. Provide positive reinforcement of progress and encourage methods that will help in achieving rehabilitation goals.Expressing encouraging words can enhance the development of positive coping mechanisms.

Psychosocial Nursing Diagnosis Example 2

Disturbed Thought Process

Nursing Diagnosis: Disturbed Thought Process related to psychological problems (e.g., perceived lack of control and sense of crippling self-worth) as evidenced by impaired decision-making and problem-solving skills, fictional verbalizations, ideas of reference, alteration in sleep patterns, distractibility, anxiety, fatigue, and depression.

Desired Outcome: The patient will be able to articulate understanding of causal factors related to the impairment and demonstrate improved decision-making and problem-solving skills.

Psychosocial Nursing Interventions Rationale
1. Recognize the patient’s impaired cognitive ability.This will allow the healthcare provider to set realistic expectations of the patient and aid in providing the appropriate treatment and support. 
2. Utilize active listening skill to the patient and challenge the patient’s irrational thoughts. Briefly explain reality to the patient and avoid making ambiguous remarks. It is important to acknowledge that responding logically is difficult when there is impaired cognition. Avoid challenging the patient as it may lead to frustration and mistrust.
3. Support with treatment of underlying conditions (e.g., brain injury, anorexia, elevated intracranial pressure, biochemical imbalances, sleep disorders)Treatment of existing medical or psychiatric problems can improve cognitive ability.
4. Avoid coercing communication or performance of activities.Withdrawal or rebellion may arise as the patient may feel threatened.
5. Identify and acknowledge the patient’s accomplishments (i.e., completed tasks, fulfilled responsibilities, or initiated interactions)This can lessen the anxiety of the patient and reduce the need for delusions as a source of self-esteem.
6. Practice methods of consensual validation and seek clarification when communicating with a patient exhibiting alteration in cognition. (e.g., “I don’t understand what you mean. Can you please explain?”)The perception of people towards the patient are often realized with the employment of those methods. The responsibility of misunderstanding must be accepted by the nurse.   
7. Engage the patient in verbalizing their true feelings. When feelings of anger are expressed, avoid being defensive. Verbalizing feelings in a safe environment allows the patient to revisit and settle unresolved issues in the past.

Psychosocial Nursing Diagnosis Example 3

Situational Low Self-Esteem

Nursing Diagnosis: Situational low self-esteem related to perception of being out of control, stigma associated with the condition, feelings of abandonment, social role changes, and inconsistent behavior as evidenced by fear of rejection, verbalization of altered lifestyle, expression of negative feelings about body, altered self-perception, and feelings of incompetence when it comes to dealing with situations or events.

Desired Outcomes:

  • The patient will be able to determine feelings and coping mechanisms to address the negative perception of the self.
  • The patient will be able to verbalize an improved sense of self-esteem associated with the diagnosis.
  • The patient will be able to demonstrate techniques that would regain his/her positive self-esteem and verbalize a realistic perception and acceptance of oneself as reflected by a change in role or lifestyle.
Psychosocial Nursing Interventions Rationale
1. The nurse must act as a role model for the patient in expressing feelings or concerns in a healthy manner. Use “I think” in conversations to reflect that you are assuming responsibility for your own thoughts and actions. In order for the patient to express their feelings, an example of the proper way of displaying feelings is taught to them. Self-awareness allows the nurse to manifest their real behavior.
2. Support the patient by protecting her sense of autonomy, positive self-esteem, sense of capability, reality, and problem-solving.Continuous positive feedback and support is vital for the patient to manage his/her behaviors to improve his/her self-esteem. Provision of a realistic evaluation of the patient’s development and reinforcement of the effective change manifested by the patient are beneficial.
3. Provide preventive direction to decrease the patient’s fear or anxiety in situations where there is disturbance of their self-esteem.This should be part of the treatment process, specifically in the adjustment phase of the treatment course. The change in self-esteem of the patient must be positioned within the context of the normal recuperative process.

Psychosocial Nursing Diagnosis Example 4

Ineffective Coping

Nursing Diagnosis: Ineffective Coping related to intense emotional state, lack of motivation to alter behaviors, failure to attempt to change behavior, expression of negative attitudes toward health behavior, neurologic factors, or trauma early in life (i.e., emotional, physical, sexual abuse) as evidenced by anger/ hostility, dependency, dishonesty, demonstration of denial of health status, extreme distrust to others, manipulation, poor judgement, and inability to positively alter behavior based on previous experiences.

Desired Outcomes:

  • The patient will be able to demonstrate an improved impulse control and utilize healthy coping mechanisms to control anxiety and frustration.
  • The patient will be able to acknowledge behaviors leading to hospitalization and remain safe during this period.
Psychosocial Nursing Interventions Rationale
1. Communicate with the patient with empathy.Acknowledgement and empathy foster a supportive environment that can lead to improved coping.
2. Express feelings of understanding and recognition of the patient’s situation. Avoid giving a false sense of reassurance. To bring about problem-solving and effective coping, an honest relationship must first be established. Giving a false sense of reassurance is disadvantageous to the patient and, in some cases, may only just provide relief to healthcare providers.
3. Encourage the patient to engage in mental and physical activities that are within the patient’s capacity. These may include reading, watching the television, doing arts and crafts, exercise, sports, games, and participating in social gatherings.Exercise, proper nutrition, muscular relaxation, and other activities which enhance body awareness can aid in the treatment of anxiety and depression.
4. Support the patient by providing an accurate situational assessment and evaluation of their own accomplishments.It will be beneficial for the patient to acknowledge that he/she is capable of effectively managing the situation. However, it is important to note that this must arise from a realistic perspective.

Psychosocial Nursing Diagnosis Example 5

Risk for Suicide

Nursing Diagnosis: Risk for Suicide related to childhood abuse, family history of suicide, alcohol and substance use/abuse, fits demographic, loss of a relevant relationship, history of previous suicide attempt, feelings of helplessness/hopelessness/ loneliness, involvement in disciplinary or legal problems, presence of physical illness/ chronic pain/ terminal illness, presence of psychiatric conditions (e.g., depression, bipolar disorder, schizophrenia), lack of support system as evidenced by verbalization of feelings of helplessness/hopelessness/ despair, having a clear and specific suicide plan, exhibiting suicide behavior (e.g., attempt, talk, attempt, plan, stating available means), or expression of covert or overt suicide cues.

Desired Outcome: The patient will be able to avoid attempting suicide and will be able to make a no-suicide contract with the nurse/ healthcare provider assigned for the next 24 hours and establish a renegotiation at that period.  The patient will remain safe inside the hospital or institution with the help of nursing interventions and support.

Psychosocial Nursing Interventions Rationale
1. Provide an environment where the patient can freely express his/her thoughts and feelings. This should be a safe space for the patient that is free of judgment.Talking about the patient’s suicidal ideations and attempts to harm themselves is important to lessen its intensity. The patient must also witness that the healthcare providers are open-minded to discuss these thoughts.
2. Assist the patient to improve his/her problem-solving skills in a constructive manner.With this intervention, the patient can identify interpersonal, emotional, and situational triggers as well as learn to evaluate a problem and employ problem-solving methods to address these before reacting.
3. Help the patient learn cognitive-behavioral self-management approaches to suicidal thoughts. This will aid the patient in identifying negative thoughts and in developing positive thinking. 
4. Encourage the patient to use self-expression methods to manage suicidal ideations or feelings.Keeping journals and reaching out to suicide hotlines can help the patient to better acknowledge and safely handle his/ her suicidal thoughts.

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

Nursing Stat Facts
Nursing Stat Facts

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

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

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

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