Nursing Care Plan Deficient Diversional Activity

Nursing Care Plan deficient Diversional Activity, Definition: Decreased stimulation from (or interest or engagement in) recreational or leisure activities Note: Internal/external factors may or may not be beyond the individual’s control.

Related Factors

• Environmental lack of diversional activity [e.g., long-term hospitalization; frequent, lengthy treatments; home-bound


• Physical limitations; bedridden; fatigue; pain Situational, developmental problem; lack of resources Psychological condition, such as depression

Defining Characteristics

Subjective

• Patient’s statements regarding boredom (e.g., wish there were something to do, to read)


• Usual hobbies cannot be undertaken in hospital [home or other care setting]


• Changes in abilities/physical limitations

Objective

• Flat affect; disinterest, inattentiveness Restlessness; crying


• Lethargy; withdrawal


• Hostility


• Overeating or lack of interest in eating; weight loss or gain

Desired Outcomes/Evaluation Criteria Client Will:

• Recognize own psychological response (e.g., hopelessness and helplessness, anger, depression) and initiate appropriate coping actions.


• Engage in satisfying activities within personal limitations.

Actions/Interventions

1. Assess client’s physical, cognitive, emotional, and environmental status. Rationale: Validates reality of environmental deprivation when it exists, or considers potential for loss of desired diversional activities in order to plan for prevention or early interventions.


2. Note impact of disability or illness on lifestyle (e.g., young child with leukemia, elderly person with fractured hip, individual with severe depression). Rationale: Provides comparative baseline for assessments and interventions.


3. Note age and developmental level, gender, cultural factors, and the importance of a given activity in client’s life. Rationale: in order to support client participation in something that promotes self-esteem and personal fulfillment.


4. Determine client’s actual ability to participate and interest in available activities, noting attention span, physical limitations and tolerance, level of interest or desire, and safety needs. Rationale: Presence of acute illness, depression, problems of mobility, protective isolation, or sensory deprivation may interfere with desired activity.


5. Institute and continue appropriate actions to deal with concomitant conditions such as anxiety, depression, grief, dementia, physical injury, isolation and immobility, malnutrition, acute or chronic pain. Rationale: These interfere with the individual’s ability to engage in meaningful diversional activities.


6. Acknowledge reality of situation and feelings of the client. Rationale: to establish therapeutic relationship and support hopeful emotions.


7. Review history of lifelong activities and hobbies client has enjoyed. Discuss reasons client is not doing these activities now and determine whether client can and would like to resume these activites.


8. Encourage mix of desired activities and stimuli (e.g., music, news, educational presentations TV/tapes, movies, computer or Internet access, books and other reading materials, visitors, games, arts and crafts, sensory enrichment [e.g., massage, aromatherapy], grooming and beauty care, cooking, social outings, gardening, discussion groups, as appropriate). Rationale: Activities need to be personally meaningful and not physically or emotionally overwhelming for client to derive the most benefit.


9. Participate in decisions about timing and spacing of lengthy treatments. Rationale: to promote relaxation and reduce sense of boredom.


10. Encourage client to assist in scheduling required and optional activity choices (e.g., if client’s favorite TV show occurs at bathtime, reschedule bath for a later time), Rationale: enhancing client’s sense of control.


11. Refrain from making changes in schedule without discussing with client. Rationale: It is important for staff to be responsible in making and following through on commitments to client.


12. Provide change of scenery (indoors and outdoors where possible) Rationale: to provide positive sensory stimulation, reduce sense of boredom, improve sense of normalcy and control.


13. Identify requirements for mobility (wheelchair, walker, van, volunteers, etc.).


14. Provide for periodic changes in the personal environment when the client is confined. Use the individual’s input in creating the changes (e.g., seasonal bulletin boards, color changes, rearranging furniture, pictures).


15. Suggest activities, such as bird feeders or baths for birdwatching, a garden in a window box or terrarium, or a fish bowl or aquarium. Rationale: to stimulate observation as well as involvement and participation in activity, such as identification of birds, choice of seeds, and so forth.


16. Accept hostile expressions while limiting aggressive acting out behavior. Rationale: Permission to express feelings of anger, hopelessness allows for beginning resolution. However, destructive behavior is counterproductive to self-esteem and problem solving.


17. Involve recreational, occupational, play, music, and/or movement therapist as appropriate. Rationale: to help identify enjoyable activities for client; to procure assistive devices and/or modify activities for individual situation.


18. Explore options for useful activities using the person’s strengths and abilities.


19. Make appropriate referrals to available support groups, hobby clubs, service organizations.


20. Refer to NDs Powerlessness; Social Isolation.

Documentation Focus

Assessment/Reassessment

• Specific assessment findings, including blocks to desired activities.


• Individual choices for activities.

Planning

• Plan of care, specific interventions, and who is involved in planning.

Implementation/Evaluation

• Client’s responses to interventions, teaching, and actions performed.


• Attainment or progress toward desired outcome(s).


• Modifications to plan of care.

Discharge Planning

• Long-term needs and who is responsible for actions to be taken.


• Referrals and community resources.

References: Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2011).Nurse’s pocket guide, diagnoses, prioritized interventions, and rationales. (12 ed.). F A Davis Co.

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