Introduction to Nursing Diagnosis: Deterioration of Independent Decision Making
Deterioration of independent decision making is a nursing diagnosis identified by the North American Nursing Diagnosis Association (NANDA), which is defined as the lessening of an individual's capacity to make sound decisions based on personal beliefs or values. The diagnosis is further linked to the individual's or family's unique physical, psychological, cultural, social, or spiritual needs. It is important for nurses to recognize the signs that can suggest a deteriorating level of independent decision making in order to intervene and provide comprehensive care to the patient.
Nursing Diagnosis Definition
The nursing diagnosis definition of Deterioration of Independent Decision Making is “The decrease in an individual's capacity to make sound decisions based on personal beliefs and values”.
Defining Characteristics
Subjective
- Verbal expression of feeling overwhelmed when faced with decisions
- Inability to make decisions without seeking approval from others
- Lack of self-confidence when making decisions
- Difficulty staying organized and following through with plans and tasks
Objective
- Impaired social developmental milestones
- Lack of interest in daily activities
- Evidence of detachment from relationships or social activities
- Decreased knowledge of making decisions
- Cognitive Impairment: A decrease in intellectual functioning due to damage, disease, or hereditary factors.
- Environmental Factors: Unstable or chaotic family or home environment which may lead to difficulty making decisions.
- Development Delay: Readiness for making decisions may be delayed if the individual encounters developmental delays in certain life stages.
- Personality Defects/Disorders: A person may have difficulty making decisions due to underlying psychiatric disorder.
Risk Population
Patients in the following populations are at risk for developing deterioration of independent decision making:
- Children and Adolescents: Young people, who do not yet have the emotional maturity, practical experience, and self-confidence to make sound decisions.
- Older Adults: Advancing age can lead to declines in physical, emotional, and cognitive functioning that can limit one's ability to make decisions.
- Chronically Ill Patients: Prolonged illness can wear down an individual's energy and impact their physical and mental health, making it harder to make decisions.
Associated Problems
Individuals suffering from deterioration of independent decision making often experience feelings of sadness, anxiety and confusion. This can lead to further psychological and social challenges such as depression and loneliness.
Suggestions of Use
Deterioration of independent decision making can complicate treatments and long-term care. Nurses can assess the patient’s ability to make independent decisions as part of the initial assessment. This will help to determine the patient’s needs and plan the most appropriate course of care. Nurses can also provide support when making decisions by helping the individual to identify options and weigh pros and cons.
Suggested Alternatives NANDA Diagnosis
- Ineffective Coping: An individual's ineffective responses to stresses and demands that interfere with his/her well-being.
- Ineffective Health Maintenance: An individual's inability to engage in healthy behaviors that promote, maintain, and restore health.
- Ineffective Self-Health Management: Poor skills that undermine an individual's engagement in day-to-day health-promoting behaviors.
Usage Tips
When selecting this diagnosis, the nurse must consider the individual's age, stage of development, and lifestyle. All related factors must be identified, as they can influence the degree to which the individual is able to make independent decisions.
NOC Results
Patients affected by deterioration of independent decision making may experience the following nursing outcomes, as classified by the NOC system:
- Health Promotion: Demonstrates healthy habits to facilitate well-being.
- Problem Solving: Uses appropriate problem-solving skills to address influences in health.
- Coping: Adapts or modifies behavior or thought processes to address problems.
- Self-Care: Demonstrates appropriate performance of self-care and health maintenance behaviours.
NIC Interventions
The following nurse interventions are suggested for this diagnosis, as classified by NIC:
- Emotional Support: Provides a supportive environment to recognize and process emotions.
- Decision Making Support: Facilitates the decision-making process in a caring, non-judgmental manner.
- Home Environmental Support: Assists with environmental modifications needed for safe decision-making.
- Health Teaching: Educates the individual on making safe and healthy decisions.
Conclusion
It is important for nurses to be aware of deterioration of independent decision making in order to provide patient-centered, holistic care. The nurse should assess the individual's capacity to make decisions independently and intervene where deficits are identified.
FAQ
- What is Deterioration of Independent Decision Making? Deterioration of independent decision making is a nursing diagnosis identified by the North American Nursing Diagnosis Association (NANDA), which is defined as the lessening of an individual's capacity to make sound decisions based on personal beliefs or values.
- Who is at Risk for Developing Deterioration of Independent Decision Making? Patients in the following populations are at risk for developing deterioration of independent decision making: children and adolescents, older adults, and chronically ill patients.
- How to Address Deterioration of Independent Decision Making? Nurses can assess the patient’s ability to make independent decisions as part of the initial assessment. This will help to determine the patient’s needs and plan the most appropriate course of care. Nurses can also provide support when making decisions by helping the individual to identify options and weigh pros and cons.
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