Psych Care Plan Help

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I'm in my second year of nursing school, and it seems like I still struggle with formulating care plans for my clinical instructors. Psych has especially thrown me for a loop, as I feel very out of my element and uncomfortable.

I'm trying to write a care plan for a adolescent patient with major depression. My nursing diagnosis is "ineffective coping r/t anxiety and altered body chemistry". I'm having trouble with my "as evidenced by" and so far have: grandiosity and somatization. It doesn't sound right, or cohesive. I haven't even started on my interactions yet. Blah.

Am I really far off base?

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Specializes in med/surg, telemetry, IV therapy, mgmt.

hi, cansgstudent!

well, one of the problems i am seeing right off is that you have another nursing diagnosis as the etiology of your ineffective coping nursing diagnosis. anxiety is a legitimate nursing diagnosis and if your patient is having symptoms of anxiety then you should, perhaps, consider using a nursing diagnosis of anxiety as well. in any case, i think you actually have two different nursing diagnoses here rather than one.

i'm looking at my copy of nursing diagnoses: definitions & classification 2005-2006 published by nanda international on page 45 at the nursing diagnosis of ineffective coping and this is what it lists as the etiologies (the r/ts, related factors, or causes) of this diagnosis:

  • gender differences in coping strategies
  • inadequate level of confidence in ability to cope
  • uncertainty
  • inadequate social support created by characteristics of relationships
  • inadequate level of perception of control
  • inadequate resources available
  • high degree of threat
  • situational or maturational crisis
  • disturbance in pattern of tension release
  • inadequate opportunity to prepare for stressor
  • inability to conserve adaptive energies
  • disturbance in pattern of appraisal of threat

do any of those sound like the cause of your patient's coping problem? if not, then you've chosen the wrong nursing diagnosis.

another problem i think you might be having is that you are using two very broad terms: grandiosity and somatization. when you are defining a patient's problems they need to be listed out in more specific wording. in other words, what behavior did you observe this patient perform that made you say he is acting in a grandiose way? now i've just looked up grandiosity in my copy of nursing diagnosis handbook: a guide to planning care, 7th edition, by betty j. ackley and gail b. ladwig and these authors suggest using the following nursing diagnosis for this particular problem (page 66):

  • defensive coping r/t inaccurate perception of self and abilities

here is what nanda has to say about the diagnosis of defensive coping (nursing diagnoses: definitions & classification 2005-2006 published by nanda international, page 46):

defining characteristics (symptoms):

  • grandiosity
  • rationalization of failures
  • hypersensitivity to slight/criticism
  • denial of obvious problem/weaknesses
  • projection of blame/responsibility
  • lack of follow-through or participation in treatment or therapy
  • superior attitude toward others
  • hostile laughter or ridicule of others
  • difficulty in perception of reality/reality testing
  • difficulty establishing/maintaining relationships

your symptoms of this (or "as evidenced by" items) would be the actual behavior you've observed to support this. i don't have a weblink to give you for this diagnosis as it is not on either the ackley/ladwig or gulanick/myers care plan constructor sites. however, if you have access to a copy of a nursing diagnosis book you should be able to find information on the goals and interventions for this diagnosis.

for somatization, the ackley/ladwig book suggest these possible nursing diagnoses (page 131)

  • anxiety r/t unresolved conflicts channeled into physical complaints or conditions [there's your patient's anxiety!]
  • chronic pain r/t unexpressed anger, multiple physical disorders, [or] depression
  • ineffective coping r/t lack of insight into underlying conflicts
  • ineffective denial r/t displaces psychological stress to physical symptoms

hope that helps you with this dilemma you've had. once you list your specific assessment data items out, those become the actual problems that you address with your nursing interventions.

you might want to check out these two threads on allnurses related to care plan writing and the nursing process:

learning how to pick and use nursing diagnoses is not as easy as it might seem. if you pick wrong, the whole care plan falls apart, pieces don't fit together like they should and the whole thing seems jumbled up and makes no sense whatsoever.

good luck!

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