Nursing Diagnosis: Ineffective Therapeutic regimen management Application of NANDA, NOC, NIC

Nursing Diagnosis: Ineffective Therapeutic regimen management
Margaret Lunney

NANDA Definition: Pattern of regulating and integrating into daily living a program for treatment of illness and the sequelae of illness that is unsatisfactory for meeting specific health goals

Defining Characteristics: Choices of daily living ineffective for meeting the goals of a treatment or prevention program; verbalizes that did not take action to reduce risk factors for progression of illness and sequelae; verbalizes desire to manage the treatment of illness and prevention of sequelae; verbalizes difficulty with regulation of one or more prescribed regimens for prevention of complications and the treatment or illness or its effects; verbalizes that did not take action to include treatment regimens in daily routines

Related Factors: Perceived barriers; social support deficits; powerlessness; perceived susceptibility; perceived benefits; mistrust of regimen and/or health care personnel; knowledge deficit; family patterns of health care; family conflict; excessive demands made on individual or family; economic difficulties; decisional conflicts; complexity of therapeutic regimen; complexity of health care system; perceived seriousness; inadequate number and types of cues to action

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels
·         Decision Making
·         Knowledge: Disease Process
·         Knowledge: Treatment Regimen
·         Participation: Health Care Decisions
·         Symptom Severity
·         Treatment Behavior: Illness or Injury

Client Outcomes

·         Describes daily food and fluid intake that meets therapeutic goals
·         Describes activity/exercise patterns that meet therapeutic goals
·         Describes scheduling of medications to meet therapeutic goals
·         Verbalizes ability to manage therapeutic regimens
·         Collaborates with health providers to decide on a therapeutic regimen that is congruent with health goals and lifestyle

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels
·         Anticipatory Guidance
·         Health Education
·         Health Screening
·         Health System Guidance
·         Learning Facilitation
·         Learning Readiness Enhancement
·         Risk Identification
·         Self-Modification Assistance

Nursing Interventions and Rationales

·         NOTE: This diagnosis does not have the same meaning as the diagnosis Noncompliance. This diagnosis is made with the client. If the client does not agree with the diagnosis, it should not be made (Lunney, 1997; Bakker, Kastermans, Dassen, 1995).
·         See care plans for Effective Therapeutic regimen management and Ineffective family Therapeutic regimen management.
·         Establish a collaborative partnership with the client for purposes of meeting health-related goals. Partnerships with health care consumers are different than traditional roles in health care. Partnerships enable the consumer to take an active role in decision-making regarding the therapeutic regimen (Courtney et al, 1996; Lunney, 1997).
·         Discuss all strategies with the client in the context of the client's culture. Culture affects all decisions for meeting therapeutic goals (Degazon, 2000).
·         Review daily actions that are not therapeutic. Client and nurse/provider should agree on which actions are not therapeutic as a basis for interventions.
·         Identify the reasons for actions that are not therapeutic (e.g., inaccurate perceptions of risks, fatigue, pain) and discuss alternatives. There are many possible reasons for actions that do not meet therapeutic goals. Older women, for example, may not increase their activity levels because they have inaccurate perceptions of the related risks (Cousins, 2000). Fatigue and pain can have profound effects on ability to perform therapeutic actions (Thorne, Paterson, 2000). Perceptions may differ according to diseases (e.g., people with pulmonary diseases are more likely than others to blame themselves for their condition) (Thorne, Paterson, 2000). Substantial numbers of older adults are fatalistic about their diseases (Goodwin, Black, Satish, 1999).
·         Explain the rationales for specific therapeutic regimens to meet health-related goals. Knowledge of scientific rationales improves client's understanding of and increases responsibility for the therapeutic regimen.
·         Provide information about the therapeutic regimen in various formats (e.g., brochure, video, written instructions). People learn in various ways (e.g., visual, auditory). Therapeutic regimens that are prescribed by health providers are often harder to learn than providers realize. Adequate resources are needed to enhance learning (Lubkin, 1998).
·         Deliberate with the client on changes that are possible to meet therapeutic goals. Although decisions about actions to meet therapeutic goals are made by the client, the presence of the nurses and the collaborative nature of a nurse-client relationship can help the client with decision-making.
·         Encourage critical thinking to consider strategies for changes in behavior. Habits that are unhealthy (e.g., overeating, smoking) are difficult to change. The impetus for change must come from the client, but the nurse can prompt the client to consider alternative strategies.
·         Assess temporal orientation and relationship to management of therapeutic regimen. Temporal orientation differs among cultures. The client's orientation to the present or the future was shown to affect management of hypertension and may also affect other therapeutic regimens (Brown, Segal, 1996).
·         Develop a contract with the client to maintain motivation for changes in behavior. Developing a contract between nurse and client, or helping the client to develop a contract with self, provides a concrete means of keeping track of actions to meet health-related goals (Clemen-Stone, McGuire, Eigsti, 1998).
·         Review methods of contacting health provider(s) as needed for changes in therapeutic regimen. People with chronic illnesses need to know how to obtain interventions that are needed in the future (Lubkin, 1998).
·         Assess for the influence of cultural beliefs, norms, and values on the client's ability to modify health behavior. What the client considers normal and abnormal health behavior may be based on cultural perceptions (Leininger, 1996).
·         Discuss with the client those aspects of his or her health behavior/lifestyle that will remain unchanged by the therapeutic regimen. Aspects of the client's life that are meaningful and valuable to him or her should be understood and preserved without change (Leininger, 1996).
·         Negotiate with the client regarding the aspects of health behavior that will need to be modified. Give and take with the client will lead to culturally congruent care (Leininger, 1996).
·         Assess the role of fatalism on the client's ability to adopt the therapeutic regimen. Fatalistic perspectives, which involve the belief that you cannot control your own fate, influence health behaviors in some African-American and Latino populations (Phillips, Cohen, Moses, 1999; Harmon, Castro, Coe, 1996).
·         Validate the client's feelings regarding the impact of therapeutic regimen on current lifestyle. Validation lets the client know that the nurse has heard and understands what was said, and it promotes the nurse-client relationship (Stuart, Laraia, 2001; Giger, Davidhizer, 1995).

Client/Family Teaching

·         Teach client/family about all aspects of therapeutic regimens; provide as much knowledge as client/family will accept; adjust instruction to account for what family already knows; provide information in a culturally congruent manner.
·         Teach ways to adjust daily activities for inclusion of therapeutic regimens.
·         Teach safety in taking medications.
·         Teach client to act as self-advocate with health providers who prescribe therapeutic regimens.

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