Paitent refused

Personally I like the third one because it shows a verbalized lack of knowledge?

Another vote for the last one.

I'm trying to come up with a nursing dx for a patient with osteoarthritis who has refused physical therapy treatment. Reason: pt stated that she don't think it helps

Which would be a great nursing dx:

Ineffective management of therapeutic regimen r/t lack of understanding of the implications of not following the prescribed treatment plan.

or

Ineffective health maintenance r/t lack of understanding the benefits of physical therapy AEB non-copliance with the prescribed treatment.

or

Ineffective management of therapeutic regimen r/t lack of understanding of the implications of not following the prescribed treatment plan AEB non-compliance and patient states "I don't think it helps."

I am looking at the NANDA-I 2012-2014. There is no nursing diagnosis called "Ineffective management of therapeutic regimen", although there is "Ineffective family therapeutic regimen management."

The nursing diagnosis "Ineffective health maintenance" includes the following:

Definition: Inability to identify, manage, and/or seek out help to maintain health

Defining characteristics (as evidenced by) :

* Demonstrated lack of adaptive behaviors to environmental change

* Demonstrated lack of knowledge about basic health practices

* History of lack of health-seeking behavior

* Inability to take responsibility for meeting basic health practices

* Impairment of personal support systems

* lack of expressed interest in improving health behaviors

Related factors (causative):

* Cognitive impairment

* complicated grieving

* deficient communication skills

* diminished or lack of fine or gross motor skills

* inability to make appropriate judgments

* ineffective family coping

* ineffective individual coping

* insufficient resources (e.g., equipment, finances)

* perceptual impairment

* spiritual distress

* underachieved developmental tasks

I don't see anything there that says anything about lack of compliance being a defining characteristic (BTW, we don't us that word anymore-- we use "adherence," as it is the patient's choice whether to adhere to a medical or nursing plan of care, not to chose to comply with "orders.")

You might have assessed something about your patient that you didn't express here that would match the required elements listed above; if not, you can't use this as a nursing diagnosis. No matter how great it sounds to you, you must use what NANDA-I gives you for diagnostic criteria (AEB/defining characteristics) and causes (r/t). If you don't have your own copy, so you'll never be tempted to make this common rookie error again AND you'll have the definitive answers for your faculty, it's $29 at Amazon, free 2-day delivery to students, or $24 for your Kindle.

Does refusing physical therapy automatically mean that she's not maintaining her health in some other way? Perhaps this patient has tried PT in the past and truly found it to be not helpful.

Thank the Gods for GrnTea...I thought I had seriously missed something as I was reading the responses and then GrnTea saved me from having to do a search on NANDA approved Dx.

It must be written as NANDA writes, or is it wrote:banghead:... yours did sound good; it just didn't sound right.

Remember to have fun in school; it is possible.

has it been explained to the patient that the goal of PT is more stabilization than improvement?

Yeah I missed that it wasn't an actual NANDA too. My brain is still mushy from my EBP project class.

Ineffective management of therapeutic regimen r/t lack of understanding of the implications of not following the prescribed treatment plan AEB non-compliance and patient states "I don't think it helps."

Is more like;

Noncompliance r/t lack of knowledge AEB pt. refusing physical therapy and reports "I don't think it helps."

I am thinking is a possibility. As GrnTea pointed out Ineffective management of therapeutic regimen isn't a NANDA

As Ineffective self maintenance or risk of ineffective self maintenance are closely related to noncompliance, but as I understand it is more related to unhealthy behaviors like smoking or high fat diet. Where as noncompliance is going against medical advice. They can correct me if I am wrong.

I don't see anything there that says anything about lack of compliance being a defining characteristic (BTW, we don't us that word anymore-- we use "adherence," as it is the patient's choice whether to adhere to a medical or nursing plan of care, not to chose to comply with "orders.")

I don't see this in my nursing diagnosis book, is it something fairly new?