Nursing Diagnosis - Psychosocial

[Lemetria Whitehurst]

The psychosocial nursing diagnosis focuses on how a patient's mental health and social environment might affect their overall wellness. Instead of strictly physical issues, like other medical diagnoses, this type of evaluation looks at emotional and mental attributes—such as anxiety, depression, or low self-esteem—that can manifest into serious physical conditions. 

An estimated 20% of Americans⁽¹⁾ are affected by mental illness and substance abuse disorders, which lead to significant morbidity and mortality.

Table of Contents

• List of Psychosocial Nursing Diagnosis
• Psychosocial Care Plans
• Psychosocial Nursing Diagnosis Case Study Examples
• Psychosocial NCLEX Questions

Psychosocial nursing diagnoses are often used for patients with conditions such as:

• Anxiety
• Anorexia, bulimia, and other eating disorders
• Body-image illnesses
• Behavioral Issues
• Bipolar disorder
• Coping and Self Esteem Issues
• Depression
• Post-Traumatic Stress Disorder (PTSD)
• Risk of, or attempted, Suicide
• Schizophrenia
• Substance abuse

It helps nurses to recognize psychological factors such as stressors, coping and relationships that may be contributing to the physical or psychological state of the patient. By taking a holistic approach to the patient, psychosocial nursing diagnoses can provide essential background information and insight which help create a detailed plan of care that accounts for the patient's emotional and social—as well as physical—needs.

Psychosocial diagnoses are invaluable in creating patient-centered clinical plans, which can lead to better care outcomes. Ideally, the resulting evaluation gives insight into how best to help patients attain optimal physical health and improved quality of life.

NANDA-I List of Psychosocial Nursing Diagnosis

Examples of psychosocial nursing diagnoses are (not exhaustive):

• Disturbed Personal Identity
• Hopelessness
• Chronic Low Self-Esteem; Situational and Risk for Low Self-Esteem
• Social Isolation
• Caregiver role strain; Risk for caregiver Role Strain
• Impaired Parenting; Risk for Impaired Parenting; Readiness for Enhanced Parenting
• Interrupted Family Processes; Readiness for Enhanced Family Processes
• Risk for Impaired Parent/Infant/Child Attachment
• Dysfunctional Family Processes: Alcoholism
• Effective Breastfeeding; Ineffective Breastfeeding; Interrupted Breastfeeding
• Ineffective Role Performance
• Parental Role Conflict
• Impaired Social Interaction
• Fear
• Anxiety
• Death Anxiety
• Chronic Sorrow
• Ineffective Denial
• Grieving; Complicated Grieving; Risk for Complicated Grieving
• Ineffective Coping
• Disabled Family Coping; Compromised Family Coping; Readiness for Enhanced Family Coping
• Defensive Coping
• Ineffective Community Coping; Readiness for Enhanced Community Coping
• Readiness for Enhanced Coping (Individual)
• Stress Overload
• Risk-prone Health Behavior

Psychosocial Care Plans

The following are potential evidence-based nursing care plans that could be used in conjunction with a psychosocial nursing diagnosis.

Ineffective Coping Care Plan

Nursing diagnosis of ineffective coping is a label given to those individuals who find it difficult to deal with stressful situations effectively. The inability to cope with different stressors interferes with daily life and an individual's overall health and well-being. 

This diagnosis can be seen through a person's behavior or as appearing in an individual's reaction to various life events. Treating this diagnosis depends on the source of distress and often includes long-term counseling or therapy, lifestyle changes, and supportive care management. 

With proper support, individuals can process their emotions better, manage stress, and acquire new tools for effectively dealing with future challenges.

Ineffective Coping Related Diagnoses

• Disabled Family Coping
• Compromised Family Coping
• Defensive Coping
• Ineffective Community Coping
• Readiness for Enhanced Coping (Individual)
• Readiness for Enhanced Family Coping

Ineffective Coping As Evidenced By:

• Verbalization of inability to or ask for help
• A complaint of secondary symptoms associated with lack of coping (lack of appetite, fatigue, sleep disturbances)
• Chronic worry
• Delayed decision making
• Muscular tension, frequent headaches, insomnia, fatigue 
• Poor concentration 
• High illness rate
• Alteration in social interaction
• Inappropriate use of defense mechanism

Ineffective Coping Nursing Assessment

• Assess for the presence of defining behavioral or physiological responses to stress which may provide clues to the level of coping difficulty.    
• Assess for the impact of cultural values, norms, and beliefs when assessing the patient's perception of successful coping.
• Assess whether ineffective coping is caused by grief, self-concept, lack of support, insufficient problem-solving skills, or recent changes in life circumstances.
• Assess whether a person is at risk of suicide. If mental health care is needed, refer the patient immediately.    

Nursing Interventions and Rationale For Ineffective Coping

• Encourage the patient using empathy-based communication. Empathy and acknowledgment foster a supportive environment that can help people cope better.
• Ensure that a patient knows you understand and recognize his or her situation. Don't give false hope. Establishing an honest relationship is essential for problem-solving and effective coping. Providing false reassurance to patients is detrimental to them and may occasionally only provide relief to healthcare professionals.
• Actively engage the patient in mental and physical activities. Among them are reading, watching TV, games, doing arts and crafts, exercising, playing sports, and socializing. Activities that promote body awareness, such as exercise, good nutrition, and relaxation, can help to alleviate depression and anxiety.
• Assist the patient in assessing their own accomplishments and providing accurate situational assessments. The patient will benefit from acknowledging that they are capable of managing the situation effectively. However, it is important to note that this must be viewed realistically.

Expected Outcomes

• Patient will pinpoint behaviors that disrupt their daily lives and make it harder for them to cope within 24-48 hours
• Patient will communicate effective coping strategies and resources to avoid ineffective coping 
• Patient will demonstrate the ability to cope with stressors and ask for support when necessary

Situational Low Self-Esteem Care Plan

The nursing diagnosis of Situational Low Self-Esteem is a formal recognition of an individual's lack of confidence in their abilities and value to the world. It happens when someone experiences feelings of inadequacy or helplessness in their current situation, usually caused by a traumatic event or difficult circumstances such as abuse or poverty. 

This issue can greatly impact someone's life, as they may withdraw from social interaction, struggle with decision-making, avoid making long-term commitments, and possibly even experience depression and anxiety. 

Fortunately, by speaking to a trained nurse or therapist who understands this diagnosis and its associated problems, sufferers can fight back against sensations of low self-esteem and learn how to thrive in difficult situations.

Currently, no test or technique is widely accepted to detect low self-esteem. Nevertheless, the Rosenberg Self-Esteem Scale (RSE) has been in use extensively to assess low self-esteem since it was developed in 1965⁽³⁾.

Situational Low Self-Esteem Related Nursing Diagnosis

• Chronic Low Self-Esteem
• Disturbed Body Image
• Risk for Situational Low Self-Esteem
• Situational Low Self-Esteem
• Social Isolation

Situational Low Self-Esteem As Evidenced By:

• Being judgmental of oneself and making negative comments
• Humor rooted in self-loathing and a feeling of powerlessness; lack of self-care
• Neglecting one's achievements while only focusing on the negatives
• Making comparisons with others
• Self-blame or blaming others when things go wrong
• Being highly irritated by criticisms or disapproval
• Having lost interest in previously enjoyed activities

Situational Low Self-Esteem Nursing Assessment

• Assess how comfortable and satisfied the patient is with their own performance.
• Assess whether unfinished grief is present.
• Assess patient confidence in their ability to perform and meet expectations.        

Nursing Interventions and Rationale for Situational Low Self-Esteem

• Create a support system, or environment in which feelings can be expressed. Assist the patient or significant others in expressing emotions or concerns in a healthy way. Use "I think" language in conversation to take responsibility for your thoughts and actions.
• Be aware of the "normal" impact of change on self-esteem. Reassure the patient that such modifications often occur in a variety of emotional or behavioral responses. Disturbances in self-esteem are natural responses to important changes. Reconstitution of the patient's self-esteem occurs as part of the patient's adjustment to change.
• Allow yourself time to spend with the patient. Ensure that you give yourself enough time to have a calm and deliberate interaction.
• Ensure privacy. In order to have a private discussion, the patient must be in an environment where they are free to express feelings without having them overheard.
• Engage in active listening and ask open-ended questions. The patient can verbalize their concerns, interests, worries, and thoughts without interruption using these communication methods. In addition to acknowledging problems and concerns, this technique conveys respect for a patient's abilities and strengths.

Expected Outcomes

• Patient will describe causes of low self-esteem 
• Patient will implement two strategies to build self-esteem and reduce self-care deficit
• Patient will acknowledge feeling more confident with more self worth

Grieving Care Plan

Grief is a normal, albeit oftentimes painful, emotion expressed by individuals as they cope with loss. As such, nursing diagnoses are keen on addressing the needs of mourning individuals in a variety of ways. 

Nurses can assess, diagnose and create an individualized plan of care that supports their patient's grieving process through active listening, providing information about realistic expectations, suggesting problem-solving strategies or connecting patients to additional sources of support. 

Through an attentive approach, nurses can safely assure their patient's healing journey remains at the forefront of care and that their grief is addressed thoroughly and compassionately.

Grieving Related Nursing Diagnosis⁽⁴⁾

• Anticipatory grieving
• Risk for complicated grieving
• Risk for anxiety
• Risk for knowledge deficit related to the grieving process

Grieving As Evidenced By:

• Verbal expression of distress
• Denial of loss
• Altered eating habits 
• Impaired sleep pattern
• Disorganization
• Psychological distress

Grieving Nursing Assessment

• Assess the phase of grief experienced by the patient and their family.
• Assess whether the patient and their loved ones are grieving at different stages.
• Assess the patient's decision-making ability.
• Assess whether referrals should be made to social services, support groups, and legal consultants.

Nursing Interventions and Rationale for Grieving

• Expect an increase or exaggeration of affective behavior. All affective behavior may seem exaggerated during this time. In older adults, the thought of dying or uncertainty may preoccupy their minds. Loss that does not occur as expected may result in anger and resentment. During this time, regression may occur.
• Engage in therapeutic communication with patients and their family members and allow them to verbalize their feelings. When patients share their feelings with a healthcare provider, they may be able to find meaning in their loss experience.
• Be supportive of patients and their significant others as they share fears, concerns, hopes, and plans. It won't help to keep secrets during this time. A stressful time can be a time for family growth and development.
• Highlight strengths and progress made so far. The process of reviewing the patient's progress is very useful and gives the nurse a sense of how things are progressing.
• Provide coaching to significant others as they support the patient during their hospital stay. During times of stress, normal activities are altered. Symptoms such as these should be treated carefully so as not to complicate emotional recovery.
• Develop a process for providing additional support and resources. Spiritual support resources may be beneficial for both the patient and family.
• Provide encouragement to the patient so he or she can continue living a normal life. Give patients and families the feeling that they are able to accomplish this by supporting them.
• Provide community resources to the patient and family. There are many ways to provide support during the grieving process. Community groups provide the family with similar experiences to help them get through such a painful event and continue to live their lives.

Expected Outcomes 

• Patient will go through expected grieving symptoms 
• Patient will adopt one grief coping strategy
• Patient will express his or her future plans

Psychosocial Nursing Diagnosis Case Study Examples

Risk for Suicide Case Study Example

Scenario

A 35-year-old homeless male presents to the emergency department via EMS for a suicide attempt after the suicide of his brother. The patient is on an involuntarily psychiatric hold and has a 1:1 sitter.

The patient's spouse found the patient with bloody wounds to his neck and wrists and a broken mirror nearby. The patient has a history of schizophrenia, major depressive disorder, alcohol abuse disorder with a history of complicated withdrawal secondary to withdrawal seizure, intravenous drug user, and one previous suicide attempt in the past by exsanguination requiring 2 liters of packed red blood cells secondary to hypovolemic shock.

Currently, the patient is having a psychotic episode but denies homicidal ideations. The patient is expressing euphoria and being grandiose with rapid speech. In addition to refusing to give blood for lab work, the patient also refuses to take medications. As a result of this failed attempt, he believes that he will succeed the next time as he knows what he did wrong as he was unsuccessful the first time. Vital signs: T 98.4, BP 175/102, P 127, R 22, SpO2 95% on room air.

Nursing Diagnosis 

Risk for Self Harm related to feelings of loneliness, grief, homelessness, hopelessness, or hopelessness secondary to the psychiatric disorder schizophrenia as evidenced by suicidal ideations and self-inflicted wounds.

Subjective Data

The patient states that he understands how to change his suicide plan the next time based on this failed suicide attempt. 

Objective Data

Vital signs: T 98.4, BP 175/102, P 127, R 22, SpO2 95% on room air.

The patient has multiple neck wounds requiring wound care, hypertension, tachycardia, and tachypnea. The patient is also showing psychotic behavior, as evidenced by fast, at times, grandiose, incoherent speech and euphoria. Based on the patient's history of a seizure related to alcohol withdrawal, it is necessary to observe the patient for signs of alcohol withdrawal. Also, the patient is refusing to submit for lab testing and refusing medications.

Desired Outcomes

• The patient will contract to safety within 24-48 hours of hospitalization. During hospitalization, the patient will refrain from self-harm and express his feelings about why he wants to harm himself. 
• The patient's family will verbalize three strategies for recognizing impending self-harm by their loved one.
• Once discharged, the patient will be instructed to contact the 24-hour emergency hotline if he feels like self-harming. The patient will verbalize understanding. 
• The patient will assist in identifying thoughts, feelings, behavior, or external triggers that lead to him wanting to commit suicide.
• The patient will verbalize three techniques for developing coping skills to help him handle stressful situations.

Nursing Interventions

• Ensure the patient is not left alone at any time during his hospitalization.
• Educate the patient on what the contract of safety means and evaluate the patient's understanding and ability to contract for safety within 24-48 hours of admission.
• Encourage and listen to the patient about why he wants to harm himself.
• Educate the family on four ways to recognize impending self-harm by the patient.
• Educate the patient on the importance of identifying thoughts, feelings, and behavior leading to suicidal ideations.
• Educate the patient on three techniques for developing coping skills during stressful times.
• Refer the patient to appropriate mental health professionals as needed. Provide resources such as crisis centers and hotlines for grief counseling services, suicide prevention programs, and other local emergency services. The patient will verbalize understanding.

Psychosocial NCLEX Questions

Approximately 9 percent of the questions on the NCLEX relate to Psychosocial Integrity⁽⁵⁾. The following questions are hypothetical questions created to help you better understand the material.

Question: A client with borderline personality disorder is exhibiting self-harming behavior. What is the nurse's priority intervention in this situation?

Answer: The nurse's priority intervention in this situation is to ensure the client's safety and prevent further harm. This may include physically intervening to stop the self-harming behavior, providing a safe and supportive environment, and engaging in crisis management. The nurse should also assess the client's mental and emotional state, provide therapeutic communication, and collaborate with the healthcare team to develop an individualized care plan for the client. 

Question: A 60-year-old male patient leaves their room and begins walking to the cafeteria. You recall that his privileges do not include visiting the cafeteria, and kindly ask the man to return to their room and you can place a food order. The patient becomes verbally abusive. What is the most appropriate approach?

Answer: Firmly escort the patient back to his room and request additional assistance if needed.

STAFF NOTE: Original Community Post 

This article was created in response to a community post. The comments and responses have been left intact as they may be helpful. Here's the original post:

Quote

Could someone please tell me what a Psychosocial Nursing Diagnosis is? I'm not sure if I'm headed in the right direction... I was thinking "Anxiety" would fall under that topic... But in the book I have, there's nothing that specifically says Psychosocial and Anxiety falls under Coping/Stress Tolerance.

References

1. Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders; Board on Health Sciences Policy; Institute of Medicine; England MJ, Butler AS, Gonzalez ML, editors. Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards. Washington (DC): National Academies Press (US); 2015 Sep 18. 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK321284/

 

2.  Mughal S, Azhar Y, Mahon MM, et al. Grief Reaction. [Updated 2022 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507832/

 

3.  Kourakou A, Tigani X, Bacopoulou F, Vlachakis D, Papakonstantinou E, Simidala S, Ktena E, Katsaouni S, Chrousos G, Darviri C. The Rosenberg Self-Esteem Scale: Translation and Validation in the Greek Language in Adolescents. Adv Exp Med Biol. 2021;1339:97-103. doi: 10.1007/978-3-030-78787-5_13. PMID: 35023095.

 

4. Oates JR, Maani-Fogelman PA. Nursing Grief and Loss. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518989/

 

5. https://www.kaptest.com/study/NCLEX/whats-tested-on-the-NCLEX-psychosocial-integrity/

[carrothead73]

Hi!

I have an assignment on psychosocial responses to illnesses and as a part of it I have to formulate a nursing diagnosis based on the following case study.

A 22 year girl with a hx of idiopathic epilepsy first diagnosed at age 12. She was prescribed dilantin and weaned off it at age 19. She has been seizure free until now when she has been admitted to ED with a tonic clonic seizure. She had one seizure at home in front of her fiance and another in the ED. She is due to be married in 2 weeks and has been stressed leading up to the wedding. She and her fiance want to start a family soon so she has stopped the pill. The key point... she has not told her partner of her hx of epilepsy!

I keep coming back to the diagnosis of Ineffective coping but it's not sitting quite right with me. Coping, to me, seems to be a here and now issue and I think that after three years she probably doesn't see it as an issue any more. My feeling is something along the lines of she hasn't had a seizure in years so what's the point in raising an issue that need not be addressed. I think it is more of a denial thing - an effort to retain the idea of normalcy but how does that fit into a nursing diagnosis?

I hope that makes sense.

Thanks in advance fior your help.

[Daytonite, BSN, RN]

Ineffective coping is what I would diagnose. What you must understand about diagnoses is that the nursing diagnosis itself is a label. It is a shorthand expression of the true problem which is fully described in the definition. the definition of ineffective coping can be found in any publication that contains the Nanda taxonomy.

The definition of ineffective coping is inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources (page 254, nanda international nursing diagnoses: definitions and classifications 2009-2011).

That a bride-to-be has not disclosed her history of epilepsy demonstrates a failed operation of problem solving skills. The entire upcoming wedding is a stressor, but no other symptoms of stress are given in the scenario. The time element, if anything, is insignificant as far as I can see except that it added to her stress and may have had something to do with bringing on her seizure.

I would diagnose ineffective coping r/t impaired problem solving skills aeb failure to disclose medical history of epilepsy to fiancé prior to the wedding.

What makes psychosocial diagnoses a little more difficult to word is that the nanda taxonomy only offers guidelines and we have to supply the actual wording. For the physiological diagnoses the related factors and defining characteristics are pathophysiology, signs and symptoms we readily recognize. It's different and much more vague with these psychosocial diagnoses because they are based upon behaviors the patient exhibits and they are dependent on the patient assessment.

[Smurfie]

LOL, I think you might be in my class at uni. Actually, given your username I think I have an idea who you might be too. (Did I see you in Woolies last week?!) I just googled for epilepsy nursing diagnosis ideas and found this!! I too have been struggling and am considering a diagnosis of Ineffective Coping. Not only has the nursing diagnosis guru Daytonite suggested it, but it's also the only one listed in our Brown & Edwards for psychosocially related epilepsy nursing diagnoses (page 1640 if you're interested), and it's really the only one I can find. Sucks that we'll all probably use the same one, but if it's the right one, who cares huh? I did consider using the Anxiety one, related to threat to role function (she won't be able to drive etc) but there's no evidence for her being anxious and I can't find a 'Risk for Anxiety' one. Good luck finishing it!!

[Smurfie]

Also...

Can we use future assumptions for Ineffective Coping in our AEB bit by the way? ie. she's proven her coping mechanisms are inadequate by not disclosing her medical disorder to her fiance, but we can also assume (not necessarily a wise move, I understand) that her coping techniques will also be stretched in weeks/months to come given the changes in her life that come with a re-diagnosis (which is what it essentially is for her) of epilepsy?

[Smurfie]

One more question for Daytonite - you've used 'inadequate problem solving' as your related factor in your example, but it is given as a 'defining charcateristic' rather than a 'related factor' in my nursing diagnosis textbook. Can it still be used?

[Daytonite, BSN, RN]

smurfie said:

One more question for daytonite - You've used 'inadequate problem solving' as your related factor in your example, but it is given as a 'defining characteristic' rather than a 'related factor' in my nursing diagnosis textbook. can it still be used?

Yes. Look carefully at how I worded the related factor ... impaired problem solving skills. It was the patients poor skill that led to impaired problem solving. I couldn't find another way to reword impaired problem solving. But, it is her skill that failed her.

It was the only way I could find to get a link between the problem and the proof. In my psych handbook impaired problem solving skills is listed as a related factor for ineffective coping in the section on crisis intervention. That is where I got that. she made a poor choice (problem solution) to keep her medical diagnosis a secret from her future husband and that fit as evidence for ineffective coping.

You were also asking "Can we use future assumptions for ineffective coping in our aeb bit by the way?" I would never assume a patient is going to do anything when it comes to behavior until they have done it. Human behavior is not like physiology.

[marie_22]

I have to do a psychosocial nursing diagnosis for my pre-op patient. The patient is an alcoholic and smoker. I was thinking of doing:

Ineffective coping related to inability to manage stressors without alcohol and smoking, inability to cope with death of parents as evidenced by destructive behaviour towards self, abuse of alcohol and smoking, taking prozac to help cope with life.

But where the patient is only in my care from 3am-8am before there surgery is this even realistic to do

Thanks.

[Daytonite, BSN, RN]

Is this is pre-op patient who is going to be undergoing general anesthesia (be put to sleep)? Think about this. What would you fear most if you were going to be put to sleep? I'll answer for you--that you will never wake up or that you are afraid of what is going to happen. Forget about the smoking and drinking. They are insignificant in relation to these threats to the person's immediate self. The nursing diagnosis for this crisis is Anxiety R/T fear of the unknown AEB [signs of symptoms of the anxiety].

[jaywife]

Hi everyone,

May I please have an additional question?

Does anyone know what does " the psychosocial impact of the disease label and the trajectory of chronic illness (epilepsy)" mean?

In my opinion, "disease label" is the way how people treat the patients with epilepsy

And I really don't understand the "trajectory"

Can anyone help me? thx!!

Do u think we should write this (psychosocial impacts)on common chronic illness or just epilepsy?

Thx for everyone!

[jaywife]

Ineffective coping could be the answer. it's confirmed by my tutor.

hugs

[jaywife]

Smurfie said:

LOL, I think you might be in my class at uni Actually, given your username I think I have an idea who you might be too (Did I see you in Woolies last week?!) I just googled for epilepsy nursing diagnosis ideas and found this!! I too have been struggling and am considering a diagnosis of Ineffective Coping. Not only has the nursing diagnosis guru Daytonite suggested it, but it's also the only one listed in our Brown & Edwards for psychosocially related epilepsy nursing diagnoses (page 1640 if you're interested), and it's really the only one I can find. Sucks that we'll all probably use the same one, but if it's the right one, who cares huh? I did consider using the Anxiety one, related to threat to role function (she won't be able to drive etc) but there's no evidence for her being anxious and I can't find a 'Risk for Anxiety' one. Good luck finishing it!!

Lewis's book gives a pathophysiologic diagnose, but the question is about psychology

[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