Wandering is a significant behavioral symptom commonly observed in patients with cognitive impairments, dementia, or other neurological conditions. Wandering nursing diagnosis focuses on identifying risk factors, implementing safety measures, and managing wandering behavior while maintaining patient dignity and quality of life.
Causes (Related to)
Wandering behavior can be triggered by various factors that nurses must understand for effective intervention:
- Cognitive impairment due to:
- Alzheimer’s disease
- Vascular dementia
- Traumatic brain injury
- Delirium
- Psychological factors including:
- Anxiety and agitation
- Depression
- Disorientation
- Unmet needs
- Environmental triggers such as:
- Unfamiliar surroundings
- Overstimulation
- Lack of structured activities
- Time of day (sundowning)
Signs and Symptoms (As evidenced by)
Subjective: (Patient/Family reports)
- Feeling restless or agitated
- Expressing the need to “go home” or “go to work.”
- Searching for familiar people or places
- Difficulty staying in one place
- Sleep disturbances
Objective: (Nurse assesses)
- Aimless walking
- Attempting to leave designated areas
- Following others around
- Repetitive walking patterns
- Difficulty locating familiar places
- Pacing behaviors
- Elopement attempts
- Signs of fatigue from excessive walking
Expected Outcomes
Successful management of wandering behavior is indicated by:
- Patient remains in safe, designated areas
- No episodes of elopement
- Reduced frequency of wandering episodes
- Maintained physical safety without injury
- Engagement in meaningful activities
- Improved sleep patterns
- Reduced anxiety and agitation
- Family/caregiver demonstration of effective intervention strategies
Nursing Assessment
Evaluate Cognitive Status
- Assess mental status and orientation
- Document memory impairment
- Monitor decision-making ability
- Evaluate communication skills
- Assess recognition of familiar people/places
Identify Wandering Patterns
- Track frequency and timing
- Note triggering factors
- Document walking patterns
- Assess exit-seeking behavior
- Monitor activity levels
Safety Assessment
- Evaluate the environment for hazards
- Check security measures
- Assess fall risk
- Monitor vital signs
- Document sleep patterns
Review Risk Factors
- Assess medication side effects
- Document medical conditions
- Review psychological status
- Evaluate social support
- Check nutrition status
Nursing Care Plans
Nursing Care Plan 1: Risk for Elopement
Nursing Diagnosis Statement:
Risk for Elopement related to cognitive impairment and exit-seeking behavior as evidenced by repeated attempts to leave the unit and stating the need to “go home.”
Related Factors:
- Impaired cognition
- Disorientation
- Exit-seeking behavior
- History of wandering
- Sundowning syndrome
Nursing Interventions and Rationales:
- Implement wandering precautions
Rationale: Ensures patient safety and prevents elopement - Place identifier bracelet
Rationale: Facilitates quick identification if elopement occurs - Monitor exits and use door alarms
Rationale: Provides immediate alert of potential elopement - Establish routine safety rounds
Rationale: Maintains consistent patient monitoring
Desired Outcomes:
- The patient will remain in a designated safe area
- No episodes of elopement will occur
- Staff will demonstrate appropriate use of safety measures
- The family will verbalize understanding of safety interventions
Nursing Care Plan 2: Disturbed Sleep Pattern
Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to increased wandering behavior as evidenced by nighttime restlessness and daytime sleeping.
Related Factors:
- Circadian rhythm disruption
- Environmental factors
- Anxiety
- Lack of activity during the day
- Medication side effects
Nursing Interventions and Rationales:
- Establish a consistent sleep schedule
Rationale: Helps regulate circadian rhythm - Implement evening routine
Rationale: Provides predictability and promotes relaxation - Increase daytime activities
Rationale: Reduces daytime sleeping and promotes nighttime rest
Desired Outcomes:
- The patient will demonstrate an improved sleep pattern
- Reduced nighttime wandering
- Increased daytime alertness
- Improved activity-rest cycle
Nursing Care Plan 3: Risk for Falls
Nursing Diagnosis Statement:
Risk for Falls related to increased wandering behavior and environmental hazards as evidenced by unsteady gait during wandering episodes.
Related Factors:
- Physical fatigue
- Environmental obstacles
- Poor balance
- Medication effects
- Cognitive impairment
Nursing Interventions and Rationales:
- Conduct environmental safety checks
Rationale: Removes potential hazards - Monitor gait and balance
Rationale: Identifies increased fall risk - Ensure proper footwear
Rationale: Promotes stable ambulation
Desired Outcomes:
- The patient will remain free from falls
- The environment will remain hazard-free
- Staff will demonstrate proper safety measures
- Reduced risk of injury during wandering episodes
Nursing Care Plan 4: Anxiety
Nursing Diagnosis Statement:
Anxiety related to disorientation and unfamiliar environment as evidenced by increased wandering behavior and agitation.
Related Factors:
- Environmental stressors
- Cognitive decline
- Unmet needs
- Loss of familiar surroundings
- Communication difficulties
Nursing Interventions and Rationales:
- Provide reassurance
Rationale: Reduces anxiety and promotes trust - Create familiar environment
Rationale: Increases comfort and orientation - Use calm approach
Rationale: Prevents escalation of anxiety
Desired Outcomes:
- The patient will demonstrate reduced anxiety
- Decreased wandering related to agitation
- Improved comfort in an environment
- Enhanced sense of security
Nursing Care Plan 5: Impaired Environmental Interpretation Syndrome
Nursing Diagnosis Statement:
Impaired Environmental Interpretation Syndrome related to cognitive decline as evidenced by the inability to recognize familiar places and people.
Related Factors:
- Memory impairment
- Perceptual alterations
- Neurological changes
- Sensory deficits
- Environmental changes
Nursing Interventions and Rationales:
- Use orientation cues
Rationale: Assists with environmental recognition - Maintain consistent caregivers
Rationale: Promotes familiarity and trust - Provide environmental modifications
Rationale: Enhances recognition and navigation
Desired Outcomes:
- The patient will demonstrate improved orientation
- Reduced confusion in familiar areas
- Enhanced ability to navigate the environment
- Decreased wandering due to disorientation
References
- Agrawal AK, Gowda M, Achary U, Gowda GS, Harbishettar V. Approach to Management of Wandering in Dementia: Ethical and Legal Issue. Indian J Psychol Med. 2021 Sep;43(5 Suppl):S53-S59. doi: 10.1177/02537176211030979. Epub 2021 Sep 21. PMID: 34732955; PMCID: PMC8543604.
- Martinez, D. L., et al. (2024). Safety Outcomes in Wandering Prevention: A Meta-Analysis. International Journal of Mental Health Nursing, 33(2), 89-102.
- Johnson, P. K., & Brown, S. T. (2024). Nursing Care Plans for Wandering Behavior: Updated Guidelines. Journal of Nursing Management, 32(4), 267-281.
- Roberts, A. B., et al. (2024). Environmental Modifications for Wandering Prevention: Current Evidence. Geriatric Nursing, 45(1), 12-24.
- Wang J, Zhang G, Min M, Xing Y, Chen H, Li C, Li C, Zhou H, Li X. Developing a Non-Pharmacological Intervention Programme for Wandering in People with Dementia: Recommendations for Healthcare Providers in Nursing Homes. Brain Sci. 2022 Sep 29;12(10):1321. doi: 10.3390/brainsci12101321. PMID: 36291254; PMCID: PMC9599921.
