Domain 10. Life principles
Class 3. Value-belief-action congruence
Diagnostic Code: 00242
Nanda label: Impaired emancipated decision-making
Diagnostic focus: Emancipated decisionmaking
Introduction to Nursing Diagnosis Impaired Emancipated Decision-Making
Nursing diagnosis impaired emancipated decision-making is a diagnostic label used to classify a psychological condition whereby an individual’s capacity to engage in physically, mentally, and social decision-making activities is reduced or otherwise impaired. This condition can be the result of a myriad of factors, both physical and mental. In healthcare settings, nurses and other healthcare personnel may encounter numerous instances of individuals who, due to their impairment of decision-making, cannot provide consent for any medical procedure. In such situations, nurses are tasked with providing nursing interventions to improve health outcomes, as well as strategies to improve the quality of life for patients suffering from it.
NANDA Nursing Diagnosis Definition
NANDA, or the North American Nursing Diagnosis Association, is an organization whose primary mission is to develop, refine, publish, and disseminate standardized nursing language. As such, the NANDA Nursing Diagnosis “Impaired Emancipated Decision-Making” is one of the official labels used by nurses and other healthcare personnel to help identify and assess the condition of a patient. In essence, the definition postulates that there is an indication that a person is displaying signs and symptoms of having an impaired capacity to make decisions and provide consent. To accurately diagnose this condition, nurses should be aware of the defining characteristics related to the condition, as well as the risk factors associated with it.
Defining Characteristics (Objectives)
The following objectives characterize a diagnosis of impaired emancipated decision-making:
- Comprehension of verbally presented information is noticeably slow and/or hindered
- Difficulties understanding reasoning processes
- Unable to identify consequences of choices
- Inability to make decisions independently
- Minimized role in selfcare activities
Defining Characteristics (Subjectives)
The following subjectives characterize a diagnosis of impaired emancipated decision-making:
- Decreased level of insight about consequences of poor decisions
- Difficulty remembering previous decisions
- Feelings of being overwhelmed by daily decision making
- Inability to see multiple options when making decisions
- Unable to act rationally in times of stress
Related Factors
The primary factor influencing an impaired emancipated decision-making diagnosis is the physical and mental limitations of the individual. Such factors include, but are not limited to: chronic intoxication caused by substance use, brain infections, brain injuries or diseases, mental illnesses such as depression or anxiety, advanced age, developmental delays, poor judgement due to cultural influences, or poor health literacy. Additionally, certain medications and treatments can influence an individual’s ability to make informed decisions.
At Risk Population
Those at risk of impaired emancipated decision-making includes, but is not limited to, seniors and individuals with substance abuse, mental illness, physical disability, special needs or limited access to healthcare resources.
Suggestions for Use
When assessing individuals for impaired emancipated decision-making, nurses most commonly use a facilitative approach, which involves an interactive question-and-answer session designed to uncover the underlying issues leading to the lack of decision-making capacity. Nurses will also assess an individual’s perception of the decision-making process and its components using specific questions. The nurse must take into account the individual’s past experiences, values, and beliefs in order to truly understand the patient’s thought process when considering a situation. Moreover, during the assessment, nurses should be asking questions geared towards determining the patient’s capabilities in recognizing their own best interests and taking control of their medical decisions.
Suggested Alternative NANDA Nursing Diagnosis
Nurses may seek alternative NANDA nursing diagnoses when caring for an individual who is exhibiting signs and symptoms of impaired emancipated decision-making. These include
- Decisional Conflict (NANDA Code 250)
- Readiness for Enhanced Decision-Making (NANDA Code 259)
- Readiness for Enhance Self-Health Management (NANDA Code 261)
- Social Isolation (NANDA Code 298)
- Ineffective Health Maintenance (NANDA Code 326)
Usage Tips
When diagnosing impaired emancipated decision-making, nurses should adhere to the following:
- Ensure that the individual has a full understanding of the potential consequences of their decisions
- Allow the individual multiple opportunities to make an informed decision
- Assess the individual’s capacity to make informed decisions on each occasion
- Identify any environmental or psychological factors hindering decision-making
- Provide support and reassurance throughout the decision-making process
NOC Outcomes
The following NOC outcomes can be expected for an individual with impaired emancipated decision-making:
- Disease Progression
- Health Behavior
- Knowledge: Disease Process
- Knowledge: Treatment Regimen
- Medication Adherence
- Pain Management
- Physical Self-Care
- Psychosocial Self-Concept
- Treatment Behavior
- Treatment Regimen
Explanation of each outcome
NOC outcomes are measurements of how effective treatment plans are at achieving desired health outcomes. In terms of nursing diagnosis impaired emancipated decision-making, an individual’s disease progression and health behavior can be assessed through monitoring their improved capacity to make decisions and express informed consent. Knowledge: Disease Process and Knowledge: Treatment Regimen examine the person’s level of understanding of the conditions and the treatment plan. Medication adherence, pain management, physical self-care, psychosocial self-concept and Treatment Behavior encompass the individual’s capacity to comprehend and follow any medication instruction, as well as any other suggested treatments for improved health outcomes. Finally, Treatment Regimen examines the extent of compliance with the treatment plan.
Evaluation Objectives and Criteria
In assessing care objectives aimed at improving the condition of impaired emancipated decision-making, nurses should evaluate the individual on a variety of criteria. This includes, but is not limited to, the following:
- Ability to execute decisions independently
- Increased insight into consequences of decisions
- Improved communication skills
- Improved comprehension of treatment plans
- Increased awareness of potential risks
- Prompt recall of past decisions
NIC Interventions
The following NIC interventions can be used when treating individuals with impaired emancipated decision-making:
- Educating patient on the consequences of decisions
- Involving family and caretaker during decision making
- Medication administration
- Model-Based Teaching
- Participation in self-care activities
- Providing information and support to families
- Teaching Memory Stimulation
- Using visual aids when providing information
Explanation of each Intervention
Educating a patient on the consequences of decisions is a key intervention strategy in helping them improve their illness-related decision-making abilities. Model-Based Teaching and Using Visual Aids when providing information are two complementary intervention strategies that can be used to assist with teaching and improved comprehension. Involving a family member or caretaker in the decision making process can help ensure that decisions are made in the patient’s best interests. Providing information and support to the family can help reduce the burden placed on them and improve their level of understanding about their loved one’s condition. Lastly, Memory Stimulation can be used to help an affected individual recall past decisions and assess the efficacy of previous decisions.
Nursing Activities
When caring for an individual suffering from impaired emancipated decision-making, nurses should engage in specific activities to help improve health outcomes. These activities should include, but are not limited to, the following:
- Assessment of current level of decision-making abilities
- Determining the patient’s personal, sociocultural, and financial contexts
- Identifying potential risks and obstacles involved with making decisions
- Developing strategies to minimize these risks and obstacles
- Encouraging the patient to explore various forms of decision making
- Providing emotional and educational support during the decision-making process
- Assisting with modifications to living environments to maximize safety
Conclusion
Nursing diagnosis impaired emancipated decision-making is a complex situation that requires thorough evaluation and specialized care strategies to ensure optimal health outcomes. Its prevalence has become increasingly common in many healthcare settings, where nurses frequently encounter patients who are unable to make decisions on their own. Thus, it is essential for nurses to be familiar with the NANDA Nursing Diagnosis definition, as well as the different factors and populations associated with it. Furthermore, they should be proficient in the suggested usage, alternative NANDA nursing diagnosis, usage tips, NOC outcomes, evaluation objectives, and NIC interventions involved in the diagnosis and treatment of this condition. With the proper knowledge and understanding, nurses will be best equipped to provide comprehensive care to those afflicted with this condition.
Frequently Asked Questions
- What is Nursing Diagnosis Impaired Emancipated Decision Making?
Nursing Diagnosis Impaired Emancipated Decision Making is a psychiatric condition wherein an individual’s capacity to weigh decisions and risks is reduced or otherwise impaired. It is the duty of nurses and other healthcare professionals to observe, assess, and provide interventions to improve health outcomes. - What are the defining characteristics of this condition?
The defining characteristics observed in individuals with impaired emancipated decision-making include comprehension of verbally presented information that is hindered and slow; difficulty in understanding reasoning processes; inability to identify consequences of chosen decisions; incapacity to make decisions on one’s own; and the minimization of roles in self-care activities. - What are the potential risk factors associated with the impaired emancipated decision-making condition?
Some of the factors that can contribute to impaired emancipated decision-making include chronic intoxication caused by substance abuse, brain infections, brain injury or diseases, mental illnesses such as depression and anxiety, advanced age, developmental delays, poor judgement due to cultural influences, and limited access to healthcare resources. - What kind of activities should nurses engage in when caring for an individual with impaired emancipated decision-making?
When caring for an individual with impaired emancipated decision-making, nurses should undertake activities such as assessing the patient’s current decision-making abilities, determining the personal, sociocultural, and financial context; identifying potential risks and obstacles with making decisions; developing strategies to minimize these risks and obstacles; encouraging exploration of decision-making options; providing emotional and educational support; and assisting with modifications to the living environment. - What type of interventions can be used when treating individuals with impaired emancipated decision-making?
Interventions that can be used when treating individuals with impaired emancipated decision-making include educating the patient on the consequences of their decisions, involving family and caretaker during decision-making, administering medications, using model-based teaching, participation in self-care activities, and teaching memory stimulation.
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