Not sure how to do Psychosocial ND?

  1. Hey guys, I have a question. Next week we start clinicals on a respiratory floor and we have to come with 2 physical nursing dx. While we are there we have to do a psychosocial nursing dx after spending time with the pt. Our clinical instructor last semester never made us do one of these, we only did the physical symptoms. I'm unsure how to set one up or exactly what they are! Any links or tips?!
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    About beth66335

    Joined: May '07; Posts: 900; Likes: 298
    Student, wife, and Mom of 3, and that is plenty!; from US


  3. by   Daytonite
    You might want to get together with your nursing instructor during office hours and ask if they have a list that classifies the nursing diagnoses into a psychosocial category. The thing is that some nurses classify the nursing diagnoses differently than others do. What I will do is list for you how NANDA classifies the nursing diagnoses. As you read them, I think you'll get the idea of why many of them are psychosocial. Print this listing out, but I would still show it to, and discuss it with, one or more of your instructors to be sure you and they are both on the same page with it.

    NANDA defines psychosocial as diagnoses [that] promote optimal mental and emotional health and social functioning.

    Here are some other definitions with regard to these diagnoses listed below (page 259, NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008):
    "The subject of the diagnosis is defined as the person(s) for whom a nursing diagnosis is determined. . .
    • Individual: A single human being distinct from others, a person.
    • Family: Two or more people having continuous or sustained relationships, perceiving reciprocal obligations, sensing common meaning, and sharing certain obligations toward others; related by blood and/or choice
    • Group: A number of people with shared characteristics
    • Community: A group of people living in the same locale under the same governance. Examples include neighborhoods and cities.

    When the subject of the diagnosis is not explicitly stated, it becomes the individual by default."

    • Class: Behavior
      • Ineffective Health Maintenance
      • Health-seeking Behaviors
      • Noncompliance
      • Effective Therapeutic Regimen Management
      • Ineffective Therapeutic Regimen Management
      • Ineffective Community Therapeutic Regimen Management
      • Ineffective Family Therapeutic Regimen Management
      • Readiness for Enhanced Therapeutic Regimen Management

    • Class: Communication
      • Impaired Verbal Communication
      • Readiness for Enhanced Communication

    • Class: Coping
      • Risk-prone Health Behavior
      • Decisional Conflict
      • Ineffective Coping
      • Ineffective Community Coping
      • Readiness for Enhanced Community Coping
      • Defensive Coping
      • Compromised Family Coping
      • Disabled Family Coping
      • Readiness for Enhanced Family Coping
      • Ineffective Denial
      • Grieving
      • Complicated Grieving
      • Risk for Complicated Grieving
      • Post-Trauma Syndrome
      • Risk for Post-Trauma Syndrome
      • Rape-Trauma Syndrome
      • Rape-Trauma Syndrome: Compound Reaction
      • Rape-Trauma Syndrome: Silent Reaction
      • Relocation Stress Syndrome
      • Risk for Relocation Stress Syndrome
      • Self-Mutilation
      • Risk for Self-Mutilation
      • Risk for Suicide
      • Risk for Self-Directed Violence
      • Readiness for Enhanced Coping
      • Stress Overload
      • Readiness for Enhanced Decision Making

    • Class: Emotional
      • Anxiety
      • Death Anxiety
      • Fear
      • Hopelessness
      • Chronic Sorrow
      • Readiness for Enhanced Hope

    • Class: Knowledge
      • Deficient Knowledge (specify)
      • Readiness for Enhanced Knowledge (specify)

    • Class: Roles/Relationships
      • Risk for Impaired Parent/Child Attachment
      • Caregiver Role Strain
      • Risk for Caregiver Role Strain
      • Parental Role Conflict
      • Dysfunctional Family Processes: Alcoholism
      • Interrupted Family Processes
      • Impaired Parenting
      • Risk for Impaired Parenting
      • Ineffective Role Performance
      • Impaired Social Interaction
      • Social Isolation
      • Risk for Other-Directed Violence
      • Readiness for Enhanced Family Processes
      • Readiness for Enhanced Parenting

    • Class: Self-Perception
      • Disturbed Body Image
      • Disturbed Personal Identity
      • Risk for Loneliness
      • Powerlessness
      • Risk for Powerlessness
      • Chronic Low Self-Esteem
      • Situational Low Self-Esteem
      • Risk for Situational Low Self-Esteem
      • Readiness for Enhanced Self-Concept
      • Readiness for Enhanced Power
      • Risk for Compromised Human Dignity

    The above listing is from pages 289 - 293 of NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008.

    As always, to use any of these diagnoses (many of which I'm sure you are now seeing for the first time) you really need a nursing diagnosis reference that contains all the current NANDA diagnoses to refer to in order to make sure that you are matching patients signs and symptoms (defining characteristics) with the correct diagnosis. A good many of the above diagnoses will not appear in care plan books that only address common medical/surgical conditions.
    Last edit by Joe V on Mar 22, '18
  4. by   beth66335
    Thanks! I knew you would have a nice organized and very informative way to explain this as always! I have both a Med/Surg Care Plan book and a Sparks and Taylor's Nursing Diagnoses reference manual, so those should cover it ....thanks again!
  5. by   Daytonite
    You are welcome. Happy care planning!
  6. by   kawmed
    Hi I am wondering if someone can help me with nanda and evidence by statement
    The patient is in acute/chronic renal failure and I was going to use Deficient knowledge lack of information

    but what would my evidence by statemnet be?

    if someone can help I would appereciate it
  7. by   nurseprnRN
    well, how do you know that the patient has a knowledge deficit? you don't decide on a diagnosis and then go looking for support for it.

    how would you like it if you had never seen a physician or had any labs drawn, and when s/he walked into the exam room to see you for the first time, s/he announced. "you have leukemia. now, let's examine you and get some labs." examination and evidence first, then diagnosis.

    take out your nanda book (you do have it, right? if not, get it now. the 2012-2014 edition is out now and that's the one you want). thumb through it and get some ideas about what might be going on with your patient, and then see if s/he has any of the defining characteristics, the evidence that that diagnosis is correct.

    many nursing students think there is a big list somewhere where column a is the medical diagnosis and column b is the nursing diagnosis. this is wrong-headed for several reasons. one is that nursing diagnoses are made by nurses using the nursing process (which i know you don't have a good handle on yet but we're trying to help), not dependent on a medical diagnostic process. nursing diagnosis is in no way subservient to or inferior to medical diagnosis.

    yes, experienced nurses will use a patient's medical diagnosis to give them ideas about what to expect and assess for, but that's part of the nursing assessment, not a consequence of a medical assessment.

    for example, if i admit a 55-year-old with diabetes and heart disease, i recall what i know about dm pathophysiology. i'm pretty sure i will probably see a constellation of nursing diagnoses related to these effects, and i will certainly assess for them-- ineffective tissue perfusion, activity intolerance, knowledge deficit, fear, altered role processes, and ineffective health management for starters. i might find readiness to improve health status, or ineffective coping, or risk for falls, too. these are all things you often see in diabetics who come in with complications. they are all things that nursing treats independently of medicine, regardless of whether a medical plan of care includes measures to ameliorate the physiological cause of some of them. but i can't put them in any individual's plan for nursing care until *i* assess for the symptoms that indicate them, the defining characteristics of each.

    does that help? what other questions do you have on nursing diagnosis?