Domain 5. Perception-cognition
Class 1. Attention
Diagnostic Code: 00123
Nanda label: Unilateral neglect
Diagnostic focus: Unilateral neglect
Unilateral neglect is one of the most common and debilitating neurological deficits that can result from damage to the brain. It involves decreased attention, awareness and/or reactivity to sensory information on one side of the body or environment. When a person is in a state of unilateral neglect, they do not pay attention to one side of the space in which they are located, with the result being difficulty reading, writing, or performing tasks that require both hands. The effects of unilateral neglect can be debilitating and life-altering, having a profound influence on a person’s ability to perform activities of daily living and requiring intensive interventions to maximize their independence.
NANDA Nursing Diagnosis Definition
The NANDA nursing diagnosis for unilateral neglect is defined as “an impaired ability to orient toward or respond to stimuli or objects that are isolated to one side or direction of space”. It includes a decrease in awareness of, and an inability to orient to, objects and/or stimuli located entirely on one side of space.
Subjective indicators of unilateral neglect include reports of decreased attention and responsiveness to individuals, environments, or objects located exclusively on one side of space. Objectively, patients will have poor performance on tests which require orientation to, and response to, objects that are located in one direction or side of space. Examples of such tests include drawing and matching objects, visual exploration tasks, focusing on personal property tasks, spatial recognition tasks, and behavioral tests.
The related factors that contribute to unilateral neglect include a focal brain injury or stroke, age-related changes, environmental distractions, and cognitive deficits. Focal brain injuries such as stroke, tumor or trauma may impair the patient’s ability to process information, orient to or respond to stimuli or objects on one side of space. Age-related changes in cognitive processes, sensory perception, and motor skills can contribute to the development of unilateral neglect. Environmental distractions, including noise or lighting, can also contribute by limiting the patient’s ability to focus or concentrate. Finally, comorbid cognitive deficits, particularly in executive functioning, have been associated with increased risk of unilateral neglect.
In addition to unilateral neglect, other conditions may occur in association with it. These include disorientation, confabulation, spatial illusions and delusions, visual field deficits, balance deficits, and agnosia. Disorientation can occur due to damage to the frontostriatal circuits of the brain, resulting in a decreased sense of direction and location. Confabulation, the incorrect recollection of events or details, may occur in association with unilateral neglect due to the patient’s distorted perception of space. Visual field deficits, such as hemianopia, may be present when unilateral neglect is caused by a focal brain injury or stroke. Balance deficits can also occur if the affected area of the brain controls equilibrium. Finally, agnosia, an impairment of recognition or comprehension, may be present if the patient has had an injury to the temporal lobes.
Suggestions For Use
In order to assist with the diagnosis and treatment of unilateral neglect, a number of strategies can be employed. Assessment of attention span, spatial awareness, concentration, orientation, and recall can provide valuable information regarding the severity and extent of neglect. The use of compensatory strategies such as using rulers, color-coding objects, and providing verbal cues can be used to reduce the impact of neglectful behavior. Occupational and physical therapies may also be beneficial in assisting the patient to regain some of their functional abilities. Finally, providing a supportive and calming environment can help prevent further lapses in concentration or disease progression.
Suggested Alternative NANDA Nursing Diagnoses
As part of the treatment and management of unilateral neglect, alternative or supplemental care plans may be developed. Suggested alternatives for NANDA Nursing Diagnoses include: impaired orientation; impaired spatial summation; impaired understanding of instructions; impaired ability to perform sequential activities; impaired recognition of others in environment; impaired perception of safety; and impaired cognition. Each of these additional diagnoses will have their own intervention and evaluation guidelines which must be taken into account.
When implementing interventions for unilateral neglect, several tips should be kept in mind. First, it is important to limit extraneous noise and visual stimuli to allow for more accurate assessment of the patient’s degree of neglect. Second, break down tasks into smaller units to make them more achievable by the patient and easier to measure progress. Third, introduce simple cueing techniques and environmental prompts in order to call the patient’s attention to stimuli on one side of their environment. Finally, develop comprehensive, customized goals that are focused on improving quality of life and functioning.
NOC Outcomes are a set of measurable goals that are utilized in the calculation of appropriate levels of nursing care. The following NOC Outcomes can be used to assist in the treatment and management of unilateral neglect.
- Attention Span: This outcome measures the patient’s ability to focus and maintain the required focus in order to process the requested information and respond correctly.
- Spatial Orientation and Awareness: This outcome measures the patient’s ability to locate, locate and recognize objects and sensations in their environment.
- Concentration: This outcome measures the patient’s ability to maintain focus on tasks over an extended period of time.
- Memory: This outcome measures the patient’s ability to accurately recall and store information.
- Risk Management: This outcome measures the patient’s understanding of, and ability to utilize, strategies that reduce the risk of injury or harm.
- Self-Care and Mobility: This outcome measures the patient’s ability to attend to personal needs, such as dressing and grooming, with minimal assistance.
Evaluation Objectives and Criteria
The evaluation objectives and criteria for unilateral neglect have been designed to measure the patient’s ability to complete tasks while maintaining attention and concentration. Examples of evaluation objectives can include the ability to orient to and respond to stimuli on one side of space; to identify objects or letters on one side of space; to independently perform self-care tasks; or to identify and remember objects located in a particular area of the room. Evaluation criteria should include accuracy and speed of task completion, and appropriate use of cueing and environmental prompts.
NIC Interventions are a set of standardized interventions that are utilized to attain the desired outcome when treating patients with unilateral neglect. Examples of NIC Interventions for unilateral neglect include: compensatory orientation interventions; habilitation activities; vestibular stimulation; and compensatory sensory aids. Compensatory orientation interventions involve activities designed to improve the patient’s spatial orientation and awareness. Habilitation activities are designed to improve functional abilities, such as ADLs, and to promote independence. Vestibular stimulation is designed to reduce dizziness and correct perception of body position. Finally, compensatory sensory aids, such as mirrors and tactile guides, are used to remind the patient of forgotten information or to draw attention to relevant objects in the environment.
Nursing activities that are beneficial to patients suffering from unilateral neglect include: monitoring symptoms and reactions while interacting with patients; providing technical support as needed during activities of daily living; utilizing verbal and physical prompts to orient the patient to relevant environmental cues; providing activities that build upon previously mastered steps; implementing creative strategies to adjust and modify task levels; and providing emotional support and therapeutic touch. Additionally, encouragement and reinforcement should be provided upon the completion of individual tasks or activities.
Unilateral neglect is an often devastating and life-altering neurological deficit resulting from damage to the brain. As with any condition, it is important for healthcare professionals to align tests and treatments with the diagnosis, including NANDA Nursing Diagnoses, NOC Outcomes, NIC Interventions, as well as other strategies that may benefit the patient. With timely, comprehensive and personalized care, those suffering from unilateral neglect can experience improved quality of life and regaining some of their lost functioning.
- What is unilateral neglect?
Unilateral neglect is a neurological deficit that results in decreased attention, awareness and/or reactivity to sensory information a single side of the body or environment.
- What are the defining characteristics of unilateral neglect?
The defining characteristics of unilateral neglect include reports of decreased attention to stimuli or objects that are isolated to one side or direction of space, as well as objectively poor performance on tests which require orientation to, or response to, the same.
- What types of associated conditions may occur with unilateral neglect?
Common associated conditions include disorientation, confabulation, spatial illusions and delusions, visual field deficits, balance deficits and agnosia.
- What NOC outcomes can be assessed to evaluate unilateral neglect?
NOC outcomes that can be used to assess unilateral neglect include Attention Span, Spatial Orientation and Awareness, Concentration, Memory, Risk Management and Self-Care and Mobility.
- What nursing activities can improve the effects of unilateral neglect?
Nursing activities that can prove beneficial to multilateral neglect include monitoring symptoms, providing technical support, employing verbal and physical prompts, adapting activities to task levels, and providing emotional support and therapeutic touch.