Help with goal for Hopelessness or Anxiety careplan.

  1. Hi, I had a pt the other day who had been waiting for discharge for 3 hours. Literally sitting in his chair clothes on, ready to go. The doc told him he would be going home within the hour. He got very upset, and told a nurse he was going to discharge himself, and she very rudely told him if he did, his insurance would not pay for his visit. He responded by saying something to the effect that the hospital had him then. He was having nothing done, just waiting for the discharge. Long story short, he made the doc mad, she was punishing him by keeping him there. He didn't have the finances to pay the bill s his insurance. I am doing a careplan on him for hopelessness r/t inablity to leave hospital aeb "my hands are tied, if I leave I can't pay the bill, but if I stay, there is no telling how long I'll be here. Today is my wifes birthday, and I can't even spend it with her". Any ideas for a goal? Or suggestions for a better nsg dx?
    Last edit by RNnTrainin' on Jun 14, '09
  2. 10 Comments

  3. by   elb252
    What horrible care that poor man received!! At least as a nursing student now (I'm assuming), you know that you won't make similar mistakes as a future nurse.

    I don't know about you, but my personal goal for this patient would be to provide overall patient a) satisfaction, or b) comfort/reassurance. You could do this by allowing the patient to express his feelings/emotions and actively listening, and you probably (as the nurse) would act upon this abuse and report this physician. Nurses are the patients' advocates, the ones who stand up for their integrity and for who they are...

    I'm a nursing student, by the way, so my patient care plan probably is far from perfect, but I hope I was able to help you out!
  4. by   Valerie Salva
    I would say the man is not hopeless- he hopes to spend time with his wife on her birthday, he has hope for the future- hopelessness as a nursing diagnosis is meant to describe situations in which which a person may have no desire to carry on with life, or is deeply clinically depressed- not this situation.
    To call this man "hopeless" in this situation would be like calling a bruise terminal.
  5. by   RNnTrainin'
    I agree with you, but our goals have to be measurable and time specific. I don't know how my instructors can measure these. Ex for a pt c pain of 6/10, my goal would be Pt will express pain of 5 or less / 10 by ______(date & time)

    He told me I was the only one who treated him like he was a person on that made me feel good, but sad at the same time. This is a caring profession, at least I thought!
  6. by   RNnTrainin'
    Valerie Salva

    Thanks for your post! I was in the field of hopelessness being "Well, I guess I can't do anything about it now, it's out of my hands". Thanks for the clarification.
  7. by   Valerie Salva
    rnntrainin' -

    maybe you could use individual coping- effective. this man is coping effectively with the situation aeb:
    1. he is rational, and did not go ama, or d/c himself. he is able to realize that even though it is a frustrating and inappropriate situation he is in, he knows he would do himself harm (finacially) if he were to just leave.
    2. he is able to verbally express his thoughts and to get his frustrations out by verbally venting.

    your interventions could be therapeutic communication via active listening, reflecting, restating, using body language which shows you are listening to him and validating his feelings ( make eye contact, nod frequently, do not cross your arms, tap your foot or look at your watch when he is talking).

    a measurable goal would be that he is able to maintain his composure until the time of d/c.

    you could also take this time to determine the pt's knowledge level and determine his educational needs. you could educate the pt on his medical condition, and what he needs to do to take care of himself. could you add "knowledge defecit"? this extra time presents a great pt teaching opportunity for you.
    Last edit by Valerie Salva on Jun 14, '09
  8. by   RNnTrainin'
    Great ideas!!! I can't do knowledge deficit now because we have to do a concept map c that, and our instructor has to be present to witness the teaching in process. I wasn't going to do my paperwork on this pt, but at 0600 he was believed to have renal issues, and I had prepared most of my data on him, and didn't have time to start over c one of my other 2 pts. So, now I am here....with nothing really to do 4 nsg dx on and 2 ncp's. Oh well.....I'll figure out something. All of his tests/labs are WNL, nothing out of the ordinary. I am going to use Impaired Nutrition: Less than body requirements r/t refusal to eat aeb pt states " I am not eating a thing until they let me out of this hospital". He didn't eat/drink anything from the time I got there 0530, until I left at 1800. He was on clear liquid, then NPO for colonoscopy p 0800. He did have diarrhea, but I don't know what to r/t, because he had no problems.
  9. by   Daytonite
    i think this is diagnosed incorrectly. hopelessness doesn't happen in a few minutes or 3 hours. it is something that happens over a long period of time. see the definition of hopelessness in a copy of taber's cyclopedic medical dictionary.
    • in 3 hours with this patient you assessed a problem of hopelessness based on this statement: "my hands are tied, if i leave i can't pay the bill, but if i stay, there is no telling how long i'll be here. today is my wifes birthday, and i can't even spend it with her".
      • your interpretation of that is: hopelessness
      • my interpretation of that statement is: a possible financial problem, worry about having to stay in the hospital longer (why?) and potential loneliness or concern for his wife.
      • the man was verbally abused by someone on the hospital staff and he was angry over it.
        • this is powerlessness r/t interpersonal interaction and helplessness aeb dependence on others, anger, frustration and dissatisfaction in not being able to participate in decision making and control over his discharge from the hospital.
    goals are based upon what you predict the results of your nursing interventions for the symptoms proving the nursing problem are going to be.

    why was this patient admitted to the hospital in the first place? what discharge needs were there? were they fulfilled? in the 3 hours that he was waiting for someone to pick him up, were they discussed? obviously, he is not able to accomplish all his adls without help because he does not drive. if he can't pay his insurance bill, how does he pay for food? how does he shop for food? who cooks his food? i really would like to know what kind of living situation he was going home to because it sounds like there may be some problems there that needed to be addressed. his anger may have just been a manifestation of some even bigger problems going on.
  10. by   Daytonite
    all care plans start with assessing the patient. all nursing diagnoses are based on symptoms that you find in the patient that are proof that the nursing diagnosis exists. see - help with care plans for direction on how to determine nursing diagnoses using the nursing process (which is what you should be doing if you are concept mapping).
  11. by   starxxx
    The patient has ideation of suicide, but has never attempted. she has stated how she feels hopeless, doesnt want to live and other s and s related to hopelessness. which diagnosis should i use
  12. by   jroo
    I just registered on here...can anyone tell me how do post a question? I am looking to find a goal for a Hopelessness r/t terminal illness aeb by statement of I just want to die, this is getting too hard"