Nursing Care Plan Risk Prone Health Behavior

Nursing Care Plan Risk Prone Health Behavior, stigmatized disease, incomplete or ongoing grieving, assault to self-esteem, altered locus of control, denial, negative attitudes toward health behavior and/or lifestyle changes, inadequate support systems, complex medication regimen and side effects—fatigue and depression

Definition: Impaired ability to modify lifestyle/behaviors in a manner that improves health status

Related Factors

• Inadequate comprehension; low self-efficacy


• Multiple stressors


• Smoking; excessive alcohol


• Inadequate social support; low socioeconomic status


• Negative attitude toward healthcare

Defining Characteristics
Subjective
Minimizes health status change
Failure to achieve optimal sense of control
Objective
Failure to take action that prevents health problems
Demonstrates nonacceptance of health status change

Desired Outcomes/Evaluation Criteria Client Will:

• Demonstrate increasing interest/participation in self-care.


• Develop ability to assume responsibility for personal needs when possible.


• Identify stress situations leading to difficulties in adapting to change in health status and specific actions for dealing with them.


• Initiate lifestyle changes that will permit adaptation to current life situations.


• Identify and use appropriate support systems.

Actions/Interventions

1-Perform a physical and/or psychosocial assessment

Rationale: to determine the extent of the limitation(s) of the current condition.
2- Listen to the client’s perception of inability or reluctance to adapt to situations that are currently occurring.
3- Survey (with the client) past and present significant support systems (e.g., family, church, groups, and organizations)

Rationale: to identify helpful resources.
4- Explore the expressions of emotions signifying impaired adjustment by client/SO(s) (e.g., overwhelming anxiety, fear, anger, worry, passive and/or active denial).

5- Note child’s interaction with parent/caregiver

Rationale: Development of coping behaviors is limited at this age, and primary caregivers provide support for the child and serve as role models.
6- Determine whether child displays problems with school performance, withdraws from family or peers, or demonstrates aggressive behavior toward others/self.
7- Listen to client’s perception of the factors leading to the present dilemma, noting onset, duration, presence or absence of physical complaints, and social withdrawal.
8- Review previous life situations and role changes with client

Rationale: to determine effects of prior experiences and coping skills used.
9- Note substance use/abuse (e.g., smoking, alcohol, prescription medications, street drugs)

Rationale: that may be used as a coping mechanism, exacerbate health problem, or impair client’s comprehension of situation.
10- Determine lack of/inability to use available resources.
11- Review available documentation and resources to determine actual life experiences (e.g., medical records, statements by SO[s], consultants’ notes).

Rationale: In situations of great stress, physical and/or emotional, the client may not accurately assess occurrences leading to the present situation.
12- Organize a team conference (including client and ancillary services)

Rationale: to focus on contributing factors affecting adjustment and plan for management of the situation.
13- Acknowledge client’s efforts to adjust: “Have done your best.”

Rationale: Lessens feelings of blame, guilt, or defensive response.
14- Share information with adolescent’s peers with permission as indicated when illness/injury affects body image

Rationale: Peers are primary support for this age group.
15- Explain disease process, causative factors, and prognosis, as appropriate, and promote questioning

Rationale: to enhance understanding.
16- Provide an open environment encouraging communication

Rationale: so that expression of feelings concerning impaired function can be dealt with realistically and openly.

17- Use therapeutic communication skills (Active-listening, acknowledgment, silence, I-statements).
18- Discuss/evaluate resources that have been useful to the client in adapting to changes in other life situations (e.g., vocational rehabilitation, employment experiences, psychosocial support services).
19- Develop a plan of action with client to meet immediate needs (e.g., physical safety and hygiene, emotional support of professionals and SO[s]) and assist in implementation of the plan.

Rationale: Provides a starting point to deal with current situation for moving ahead with plan and for evaluation of progress.
20- Explore previously used coping skills and application to current situation. Refine or develop new strategies, as appropriate.
21- Identify and problem-solve with the client frustration in daily health-related care.

Rationale: Focusing on smaller factors of concern gives individual the ability to perceive impaired function from a less-threatening perspective, one-step-at-a-time concept.
22- Involve SO(s) in long-range planning for emotional, psychological, physical, and social needs.
23- Identify strengths the client perceives in current life situation. Keep focus on the present,

Rationale: as unknowns of the future may be too overwhelming.
24- Refer to other resources in the long-range plan of care (e.g., occupational therapy, vocational rehabilitation, smoking cessation program, Alcoholics Anonymous) as indicated.
25- Assist client/SO(s) to see appropriate alternatives and potential changes in locus of control.
26- Assist SO(s) to learn methods for managing present needs. (Refer to NDs specific to client’s deficits.)
27- Pace and time learning sessions

Rationale: to meet client’s needs. Provide feedback during and after learning experiences (e.g., selfcatheterization, range-of-motion exercises, wound care, therapeutic communication)

Rationale: to enhance retention, skill, and confidence.
Documentation Focus
Assessment/Reassessment

• Reasons for, and degree of, impaired adaptation.


• Client’s/SO’s perception of the situation.


• Effect of behavior on health status/condition.

Planning

• Plan for adjustments and interventions for achieving the plan and who is involved.


• Teaching plan.

Implementation/Evaluation

• Client responses to the interventions, teaching, and actions performed.


• Attainment or progress toward desired outcome(s).


• Modifications to plan of care.

Discharge Planning

• Resources that are available for the client and SO(s) and referrals that are made.

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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