Risk factors may include
Complexity of therapeutic regimen, knowledge deficits
Decisional conflicts—client and family value system, health beliefs, spiritual values, cultural influences, ethical concerns, perceived seriousness
Perceived barriers, economic difficulties, side effects of therapy, mistrust of regimen and/or healthcare personnel, complexity of healthcare system
Family patterns of healthcare, family conflict, powerlessness
Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)
Desired Outcomes/Evaluation Criteria—Client Will
Treatment Behavior: Illness or Injury
Participate in the development of goals and treatment plan.
Verbalize accurate knowledge of disease and understanding of treatment regimen.
Demonstrate behaviors or changes in lifestyle necessary to incorporate or maintain therapeutic regimen in daily life.
Identify and use available resources.
Nursing intervention with rationale:
1. Review client’s and SO’s knowledge and understanding of the need for treatment or medication as well as consequences of actions and choices. Note ability to comprehend information, including literacy, level of education, and primary language.
Rationale: Provides opportunities to clarify viewpoints or misconceptions. Verifies that client and SO have accurate and factual information with which to make informed choices.
2. Be aware of developmental and chronological age.
Rationale: Impacts ability to understand own needs and incorporate into treatment regimen.
3. Determine cultural, spiritual, and health beliefs and ethical concerns.
Rationale: Provides insight into thoughts and factors related to individual situation. Beliefs will affect client’s perception of situation and participation in treatment regimen. Treatment may be
incongruent with client’s social and cultural lifestyle and perceived role/responsibilities.
4. Review treatment plan with client and SO.
Rationale: Provides opportunities to exchange accurate information and to clarify viewpoints or misconceptions.
5. Contract with client for participation in care.
Rationale: Client who agrees to own responsibility is more apt to adhere to treatment plan.
6. Establish graduated goals or modified regimen as necessary; work out alternate solutions.
Rationale: Promotes client involvement and independence; provides opportunity for compromise and may enhance cooperation with regimen. When client participates in setting goals,
there is a sense of investment that encourages cooperation and willingness to follow through with the program.
7. Assess availability and use of support systems. Identify additional resources, as appropriate.
Rationale: Access to and proper use of helpful resources can assist client in meeting treatment goals and provide purpose for living. Presence of caring, empathic family/SO(s) can help client in
process of recovery.
8. Determine problems that may, or do, interfere with treatment including lack of financial or personal resources, or lack of availability of providers. Assess level of anxiety, locus of control, and sense of powerlessness.
Rationale: Many factors may be involved in behavior that is disruptive to the treatment regimen such as fear of hospitalization or treatment; denial of situation consequences; suspicion
about healthcare system; and physical factors such as pain, hypoxemia, and chemical imbalance.
9. Accept client’s choice or point of view even if it appears to be self-destructive, such as a decision to continue smoking.
Rationale: Client has the right to make own decisions, and acceptance may give a sense of control, which can help client look more clearly at consequences. Confrontation is not beneficial
and may actually be detrimental to future cooperation and goal achievement.
10. Be aware of own and caregiver’s response to client’s treatment choices such as refusal of blood or chemotherapy and living will or advance directive choices.
Rationale: Negative feelings regarding these choices may create power struggles and be expressed in judgmental behaviors that block or interfere with client’s wishes, comfort, and/or care. Note: If resolution cannot be found, providers have the right to terminate their services with appropriate notice.