Readiness for enhance comfort - HELP!!

[gikg]

Hi all,

I have to write a wellness nursing care plan for a client that the only problem he has is tinnitus (ringing in the ear). He also has 40% of hearing loss on his right ear. I have to write one actual problem, one risk-for, and one wellness diagnosis.

For my actual I am doing:

Disturbed sensory perception: auditory r/t decrease in sensory receptor 2nd to otosclerosis.

Risk-for:

Risk for injury r/t hearing loss 2nd to otosclerosis.

Wellness Dx:

Readiness for enhance comfort level r/t (this is my problem - do I put r/t ringing in the ear?)

Thanks!

[Esme12, ASN, BSN, RN]

You're kind of boxed in a corner. How about knowledge deficit...does your hubby need to exercise? eat heart healthy?

[gikg]

I don't think I am understanding this "readiness" diagnosis. I never written one before. I though that we always come with with diagnosis related to a problem that a patient has or a potential for a problem. But when I read the definition of the readiness diagnosis I get confused. For example, I was thinking that my hubby does not sleep much. One has to do with the fact that he has to wake up at 4:30 to go to work and with tinnitus the noise make it hard for him to fall asleep. So then I thought of doing "readiness for enhanced sleep". But the definition is:

"A pattern of natural, periodic suspension of consciousness that provides adequate rest, sustains a desired lifestyle, and can be strengthened"

The characteristics are:

"express wiliness to enhance sleep"

"express a feeling of being rested after sleep"

So can I use that for this case? That the client is not getting enough sleep but sure wants it?

A pattern of natural, periodic suspension of consciousness that providesadequate rest, sustains a desired lifestyle, and can be strengthenedA pattern of natural, periodic suspension of consciousness that providesadequate rest, sustains a desired lifestyle, and can be strengthened

[Esme12, ASN, BSN, RN]

yes....it seems to fit

[gikg]

Oh really? That is awesome to hear. So I guess I can finish this assignment. Thanks.

[gikg]

Another question. Does the wellness diagnosis have "related to"? I've been finding websites that says it doesn't. If I do readiness for enhance sleep, what my r/t would be?

[gikg]

Or should I do readiness for self health management?

[Esme12, ASN, BSN, RN]

A wellness nursing diagnoses focuses on the patient's progress or potential progress towards healthier behaviors...... rather than on a problem. They were created to change a situation in which only negative issues were addressed........leaving out diagnoses for patients in a healthy setting. A wellness diagnosis indicates a readiness to advance from the current level of health to a higher level. There are two prerequisites for a wellness diagnosis---a desire to advance and an ability to do so.

1) Emotional Readiness: The first requirement for a wellness diagnosis is a desire to attain a higher level of well-being. The patient must express emotional readiness to engage in interventions that will help him reach that next level.

2) Status and Function: The second prerequisite for a wellness diagnosis is the presence of status or function required to perform tasks related to the diagnosis.

3) Assessment: Assessing a patient's readiness to respond to a wellness diagnosis involves patient interviews and interaction.

4) Writing the Diagnosis: While most nursing diagnoses require at least two parts, the diagnosis and the "related to" factors, wellness diagnoses are written a little different. They are started with the word "readiness" followed by the action or health-seeking behavior that will be enhanced.

.......... Examples : "Readiness for enhanced management of therapeutic regimen" describes a patient who is willing and able to participate in her own treatment by following recommendations and helping set new goals for herself. A patient who has expressed a desire to come to terms with his illness and requests help with this is displaying "readiness for enhanced coping." "Readiness for enhanced religiosity" can be applied to a patient who previously stated she no longer believed in her religion but later states that she wants to get back in touch with her spiritual side.

Wellness Diagnoses

http://www2.bakersfieldcollege.edu/cgard/NURS%20B28/STUDY%20GUIDE%201.1%20NCP%20REVISED.pdf

[gikg]

Wow thank you. So you are saying that for the wellness diagnosis I don't use a "related to" part? This is what I had.

Readiness for enhanced sleep r/t altered sleeping pattern

Rationale: Readiness for enhanced sleep is “a pattern of natural, periodic suspension of consciousness that provides adequate rest, sustains a desired lifestyle, and can be strengthened” (Doenges, Moorhouse, & Murr, 2014, p. 625). This client states the desire to enhance his sleep pattern since he sleeps an average of 5-6 hours per day and sometimes feels unrested.

[Esme12, ASN, BSN, RN]

Wow thank you. So you are saying that for the wellness diagnosis I don't use a "related to" part? This is what I had.

Readiness for enhanced sleep r/t altered sleeping pattern

Rationale: Readiness for enhanced sleep is “a pattern of natural, periodic suspension of consciousness that provides adequate rest, sustains a desired lifestyle, and can be strengthened” (Doenges, Moorhouse, & Murr, 2014, p. 625). This client states the desire to enhance his sleep pattern since he sleeps an average of 5-6 hours per day and sometimes feels unrested.

right. When you add AEB it makes it a diagnosis. At least the way I understand and teach it.

[nurseprnRN, BSN, RN]

Wow thank you. So you are saying that for the wellness diagnosis I don't use a "related to" part? This is what I had.

Readiness for enhanced sleep r/t altered sleeping pattern

Rationale: Readiness for enhanced sleep is “a pattern of natural, periodic suspension of consciousness that provides adequate rest, sustains a desired lifestyle, and can be strengthened” (Doenges, Moorhouse, & Murr, 2014, p. 625). This client states the desire to enhance his sleep pattern since he sleeps an average of 5-6 hours per day and sometimes feels unrested.

You use what the NANDA-I says are the defining characteristics and related/causative factors for all nursing diagnoses; you don't (and cannot) make them up because they sound good to you. Have you read this book yet?

There are NO "related factors" for the nursing diagnosis of "readiness for enhanced sleep." So no, you cannot write them in there. It's on page 220. The defining characteristics are:

* Amount of sleep is congruent with developmental needs

*Expresses willingness to enhance sleep

*Follows sleep routines that promotes sleep habits

*Occasional use of pharmaceutical agents to induce sleep

*Reports being rested after sleep

I don't see any of this in your description of this patient. Therefore I question whether this would be an appropriate nursing diagnosis for him. He just does not meet the defining characteristics to make this diagnosis.

The nursing diagnosis, "disturbed sleep pattern" is defined as "time-limited interruptions of sleep amount and quality due to external factors."

Unfortunately, the defining characteristics may not meet your husband situation, because they include: change in normal sleep pattern, decreased ability to function, dissatisfaction with sleep, reports being awakened, reports no difficulty falling sleep, and reports not feeling well rested. However, if at least one of these does match him, then you may have the defining characteristics for this diagnosis.

However, the related (this means causative, and nothing else) include, as the definition of the diagnosis mentions, external factors. Not one relates to tinnitus. Not even in a stretch. Noise does occur in the list, but it's not an external factor in his case. Therefore, even if there is a defining characteristic, with no acceptable cause, you cannot make this diagnosis either.