Domain 9. Coping-stress tolerance
Class 2. Coping responses
Diagnostic Code: 00072
Nanda label: Ineffective denial
Diagnostic focus: Denial
The first step to providing effective nursing care is accurately assessing the patient’s current condition. A nursing diagnosis is a statement that identifies and describes a patient’s unhealthy tangible or intangible state. Through properly assessing a patient’s condition and identifying an individualized plan of care, nurses are able to ensure that their patient has the best possible outcome. Ineffective Denial is identified as a diagnosable nursing condition that is defined as a pattern characterized by avoidance of thoughts, feelings, and responsibilities that arises from having experienced an unrealistically optimistic view of potential personal strengths in relation to realistic threats.
NANDA Nursing Diagnosis Definition for Ineffective Denial
According to the North American Nursing Diagnosis Association (NANDA), Ineffective Denial is defined as “A pattern of avoiding thoughts, feelings, and responsibilities that arises from having experienced an unrealistically optimistic view of potential personal strengths in relation to realistic threats.”
The defining characteristics of Ineffective Denial include:
- Subjective: Patient may report feeling nothing when presented with emotionally overwhelming situation, appearing calm on the outside while feeling shocked, despair, fear, or anger on the inside.
- Objective: Patient’s cognitive closure with respect to future risks and past fears may be impaired, lack of interest in discussing future plans and worries, avoidance of dealing with difficult emotions, difficulty in making decisions.
There are several related factors for Ineffective Denial that contribute to the individual’s inability to make decisions and deal with difficult emotions. These include:
- Environment: Negative atmosphere, chaotic surroundings, significant stressors such as job loss or family illness.
- Personal/Psychological: Poor problem-solving skills, lack of confidence in own ability, actual or perceived restrictions on behavior.
- Expected Outcome: The patient is able to accept a proposed plan of action, recognize the need to take personal responsibility, and identify sustainable means of emotional self-regulation.
Suggested Use of the NANDA Nursing Diagnosis
The NANDA Nursing Diagnosis of Ineffective Denial should be used when a patient is presented with an overwhelming situation but appears to be unable to cope and takes no meaningful action. This diagnosis can help nurses recognize the need for emotional support and to provide practical problem-solving tips to the patient.
Suggested Alternative NANDA Nursing Diagnoses
The NANDA Nursing Diagnosis of Ineffective Denial may be similar to two other diagnoses: Impaired Adjustment and Risk-prone Health Behaviour. While these diagnoses have similar characterisrics to Ineffective Denial, they differ in terms of their associated expected outcome. Impaired Adjustment focuses on the patient’s normalizing their behaviour in reaction to the particular stressor, while Risk-prone Health Behaviour looks at the patient’s overall management of risk-related health behaviours.
When addressing the NANDA Nursing Diagnosis of Ineffective Denial, nurses should take into consideration the following usage tips in order to best assess and treat this condition:
- Identify the source of the patient’s difficulty in dealing with the situation.
- Be aware of any potential negative behaviors that may result from the patient’s feelings of insecurity or hopelessness.
- Reassure the patient of the trustworthiness and credibility of their own opinion.
- Provide useful solutions to the patient, such as a plan of action or further resources.
- Empower the patient to adopt behaviors that will ultimately help them manage their emotions.
The following are the Nursing Outcomes Classification (NOC) identified outcomes that can be expected when addressing Ineffective Denial:
- Coping: A level of acquired ability to readily adjust to sudden changes which are necessary for maintaining effective internal homeostasis.
- Problem Solving: Ability to select suitable actions from relevant alternatives and act upon them in order to respond positively to given challenges.
- Self-care Requirement: The magnitude of role responsibilities relative to sustaining life that the patient undertakes.
- Health Seeking Behaviour: Demonstration of any proactive activities that are taken to protect or maintain one’s wellbeing.
Expected Evaluation Objectives and Criteria
When evaluating the patient’s condition under the Ineffective Denial NANDA Nursing Diagnosis, the nurse should expect objective improvement in the patient’s ability to accept personal responsibility, demonstrate appropriate coping strategies, and utilize suitable problem-solving techniques.
The Nurse Interventon Classification (NIC) categorizes interventions into four main categories:
- Counselling and Support: Dialogical processes designed to promote understanding and learning in the patient through shared reflection and involvement.
- Risk Identification and Management: Assesses the patient’s risk for potential negative outcomes and selects suitable interventions to mitigate this risk.
- Education and Preparation for Self-Care: Patient education and modeling of appropriate personal behaviour to help the patient become independent in their self-care.
- Emotional Support: Providing emotional support to the patient by expressing acceptance and understanding to help encourage feelings of security and self-worth.
In order to best address the NANDA Nursing Diagnosis of Ineffective Denial, the nurse should focus on the following activities while caring for the patient:
- Encourage the patient to openly talk about their feelings without fear of judgement.
- Establish an empathic and supportive relationship with the patient.
- Help the patient recognize coping strategies and problem-solving skills.
- Discouraging pessimistic thoughts and promoting realistic assessment of personal capabilities.
- Verbally restating the patient’s understanding of the situation.
At its core, the NANDA Nursing Diagnosis of Ineffective Denial aims to help improve the patient’s psychological health by encouraging more effective problem-solving skills and more secure and stable emotion-processing. By correctly assessing and diagnosing a patient’s condition with Ineffective Denial NANDA Nursing Diagnosis, nurses can actively plan and implement a treatment plan that will both empower the patient to take their own initiative and to develop the ability to appropriately respond to various stimuli.
- What is NANDA nursing diagnosis of Ineffective Denial? – NANDA nursing diagnosis of Ineffective Denial is a pattern characterized by avoiding thoughts, feelings, and responsibilities that arises from having experienced an unrealistically optimistic view of potential personal strengths in relation to realistic threats.
- What are the expected evaluation objectives and criteria for Ineffective Denial? – When evaluating a patient under the Ineffective Denial NANDA Nursing Diagnosis, the nurse should expect objective improvement in the patient’s ability to accept personal responsibility, demonstrate appropriate coping strategies, and utilize suitable problem-solving techniques.
- What are the relevant NIC Interventions? – The relevant Nurse Interventon Classification (NIC) interventions include Counselling and Support, Risk Identification and Management, Education and Preparation for Self-Care, and Emotional Support.
- What are the NOC outcomes for Ineffective Denial? – The relevant Nursing Outcomes Classification (NOC) outcomes for Ineffective Denial include Coping, Problem Solving, Self-care Requirement, and Health Seeking Behaviour.
- What are the usual nursing activities for Ineffective Denial? – The usual nursing activities for Ineffective Denial include encouraging open dialogue about feelings, establishing an empathetic relationship, helping the patient recognize problem-solving skills and coping strategies, discouraging pessimistic thoughts and promoting realistic assessments, and verbally restating the patient’s understanding of the situation.