Psychosocial diagnoses refer to the psychological, emotional, social, and spiritual aspects of nursing care. Interruptions in relationships, grieving, coping, and parenting can complicate physical illnesses, as well as vice versa. Psychosocial nursing diagnoses are just as important for the nurse to recognize as other diagnoses as alterations in these areas can potentially lengthen illnesses and worsen outcomes.
Nursing Process
A large component of holistic nursing care is evaluating the psychosocial needs of patients and intervening appropriately. Therapeutic communication is an important skill for nurses to master to build a rapport with patients and provide necessary interventions to improve their quality of life.
Nursing Care Plans
Once the nurse identifies psychosocial nursing diagnoses, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find psychosocial nursing care plan examples.
Chronic Low Self-Esteem
Patients may have long-standing negative beliefs or feelings about themselves.
Additional/related nursing diagnoses:
- Situational low self-esteem
- Risk for situational low self-esteem
- Readiness for enhanced self-concept
- Disturbed body image
- Hopelessness/Powerlessness
Related to:
- Chronic physical conditions or mental illness
- Functional impairments
- Loss (health status, independence, cognition)
- Lack of support system, abandonment
- Lack of success with life choices
- Inability to maintain relationships
As evidenced by:
- Verbalizes negative self-talk
- Rejects positive feedback
- Exaggerates negative self-worth (“I’m a failure” “No one cares about me”)
- Nonassertive, passive, indecisive
- Hesitant to try new things
Expected Outcomes:
- Patient will verbalize reasons for low self-esteem
- Patient will incorporate two techniques to improve self-esteem
- Patient will verbalize feeling a sense of increased self-worth
Assessment:
1. Determine specific causes for low self-esteem.
Though the patient’s lack of self-esteem is chronic, assess current and past factors affecting their self-concept such as past abuse or neglect from family, bullying from peers, etc. along with the compounding effect of current physical illnesses or social isolation. Take into account the client’s age and developmental level.
2. Assess contents of negative beliefs.
Have the patient describe how they view themselves as well as how they think others view them. The nurse may be able to redirect misconceptions.
3. Identify family or social support.
Assess for any family, friends, or other support systems such as co-workers that may be a contributing source of low self-esteem or a positive influence.
Interventions:
1. Develop a therapeutic relationship.
Maintain open communication, actively listen, and do not downplay or dismiss the patient’s statements or perceptions.
2. Discuss and confront misconceptions.
An outside perspective may aid the patient in recognizing their self-limiting beliefs. The nurse can confront the patient’s negative self-talk, their distortions in thinking, and help the patient realize they are focusing on the negative and worst-case scenarios instead of allowing the opportunity for change.
3. Model positive behavior and assist with goal setting.
The nurse can prevent the patient from ruminating on negative concepts by engaging in positive conversations, offering the patient simple decisions, and helping them set and achieve goals. This can increase the patient’s sense of self-esteem in their abilities.
4. Refer to resources and counseling.
Chronic low self-esteem may require the help of a mental health professional. Other resources depending on the causes of low self-esteem may include employment assistance or life coaching.
Caregiver Role Strain
Caregivers may feel burdened with their role due to their personal physical or mental difficulties, or those of the person they are providing care to.
Additional/related nursing diagnoses:
- Risk for caregiver role strain
- Impaired parenting
- Readiness for enhanced parenting
- Ineffective role performance
- Interrupted family processes
Related to:
- Chronic illness of caregiver
- Increasing care needs
- Unpredictable illness course
- Inexperience with caregiving
- Complex activities (tube feeding administration, tracheostomy care, etc.)
- Psychological or cognitive disabilities
- Lack of respite support
- Multiple role commitments
- Family relationship dysfunction
- Inadequate equipment or transportation
- Insufficient finances
- Knowledge deficit regarding access to resources
As evidenced by:
- Caregiver verbalizes inadequacy or apprehension in providing care
- Caregiver or care receiver suffering a decline in health status
- Unable to meet responsibilities of other roles (workplace, parenting)
- Lack of personal or leisure time
- Preoccupation with care routine and tasks
Expected Outcome:
- Caregiver will identify and utilize resources available to support the caregiver
- Caregiver will institute two boundaries to manage caregiving with other responsibilities
- Caregiver will report an improved sense of caregiving abilities
Assessment:
1. Assess caregiver’s self-care.
Obtain an accurate understanding of the caregiver’s responsibilities and assess whether or not the caregiver takes time for themselves and their needs.
2. Note barriers to adequate caregiving.
Assess for financial barriers, lack of equipment, need for professional in-home care, or the presence of additional family support. These barriers can be overcome with appropriate referrals and community resources.
3. Assess for knowledge deficits or unsafe situations.
Ensure the caregiver and person receiving care are safe in their environment. Assess the caregiver’s knowledge and confidence in the skills they are providing. Situations that are unsafe such as the caregiver’s inability to provide medication administration, hygiene, or proper nutrition may require the transfer of the care receiver to a facility setting.
Interventions:
1. Encourage the caregiver to express difficulties.
Caregivers often feel isolated in their duties or may feel that expressing their burden is inappropriate or will result in their family member being placed in a facility. Offer a non-judgmental opportunity for the caregiver to openly express any doubts, fears, and concerns to provide accurate interventions.
2. Educate on signs of burnout and coping strategies.
Exhaustion, stress, poor sleep, weight loss, and isolation from friends are signs of burnout. Teach stress management strategies such as asking for help, taking time away from the home, and taking care of one’s self through proper diet and exercise. Remind the caregiver that their ability to give care is only as good as the care they give themselves.
3. Discuss scheduling, coordination, and boundary setting.
Help the caregiver create a schedule/routine for caregiving along with other responsibilities including leisure time. Caregivers must implement boundaries and not allow a caregiving role to consume their lives.
4. Provide community resources.
Nurses can request referrals for services such as respite programs, home health care, or hospice. The nurse can also research and offer community resources such as support groups, church-provided volunteer services, and financial programs.
Grieving
Grieving is a normal response to loss that affects a person emotionally, socially, spiritually, and physically.
Additional/related nursing diagnoses:
- Complicated grieving
- Readiness for enhanced hope
- Chronic sorrow
- Ineffective coping
- Spiritual distress
Related to:
- Anticipatory loss (loved one, independence, possessions)
- Death of a loved one
As evidenced by:
- Verbalization of pain, anger, despair
- Changes in sleep patterns and dreams
- Lack of appetite or overeating
- Crying
- Withdrawn behavior
- Processing loss and experiencing growth
Expected Outcomes:
- Patient will experience expected feelings of grief
- Patient will institute one coping strategy to manage grief
- Patient will verbalize a plan for the future
Assessment:
1. Identify the spiritual impact on grief.
Assess the patient’s religiosity and how this affects their grief. A strong sense of faith is often helpful in navigating grief and loss.
2. Observe for nonverbal displays of grief.
Outward despair or crying is not how everyone displays grief. Body language such as a lack of eye contact, disinterest in activities, or short “yes” or “no” responses may be seen.
3. Monitor for complicated grieving.
A patient who is not moving through the expected stages of grief, who cannot seem to accept their loss, or experience continued distress that affects daily life will require further counseling/therapy.
Interventions:
1. Educate on the grieving process and answer questions.
The nurse can educate the patient on the 5 stages of grief and that they will work through these at their own pace, and not necessarily in order. If anticipating a loss, answer questions honestly and do not provide false reassurances such as “everything will be ok.”
2. Encourage expressions of grief.
Encourage the patient to journal or verbalize feelings of loss. Remind them their feelings are normal and remembering their loved one is therapeutic in moving on.
3. Promote family and religious support.
The support of friends, family, and chaplains (if religious) is beneficial in working through grief and preventing delayed or complicated grieving.
4. Offer bereavement services and support groups.
Loss of a loved one, whether sudden or expected may necessitate additional support. If hospice care was provided, bereavement is offered to family members for 13 months following the loss. Support groups for losses such as children, pets, and suicide can help with coping with these specific situations.
References
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
