Wandering

Wandering

Domain 4. Activity-rest
Class 3. Energy balance
Diagnostic Code: 00154
Nanda label: Wandering
Diagnostic focus: Wandering

Introduction to Nursing Diagnosis Wandering

Wandering is the so-called unintentional moving from a resident’s room or designated area without any certain destination. This behavior is usually manifested in people with dementia and Alzheimer’s Disease or other conditions that cause confusion. It often includes also wanting to leave the facility or go outside, running and elopement, and general restlessness that overpowers the patient and makes them to wander and roam around, even when they are not supposed to do so.

NANDA Nursing Diagnosis Definition

The official NANDA nursing diagnosis for wandering is defined as “Disorientation in familiar people, place, and situations”. This diagnosis was first introduced by NANDA International (formerly known as North American Nursing Diagnosis Association) in 2018.

Defining Characteristics

The defining characteristics of Disorientation in familiar people, place, and situations which are normally observed for this diagnosis, can be subjectively or objectively observed:

Subjective Defining Characteristics

  • Reports difficulty finding his/her location at home/in the facility.
  • Expresses fear of not knowing where he or she is.
  • Thinks or speaks in a confused way.
  • Claims unable to recognize familiar people.
  • Expression of believing to be in another place or time.

Objective Defining Characteristics

  • Appears lost and disoriented in a familiar environment.
  • Gets confused about the location.
  • Uncoordinated movements.
  • Refuses to follow directions.
  • Inconsistent verbal responses and speech.
  • Clumsiness, bumping into things.

Related Factors

There are different related factors that influence the diagnosis of wandering.

  • Age: The rate of wandering increases significantly with age, especially if there are cognitive problems besides physical incapabilities.
  • Alzheimer’s: Patients with Alzheimer’s disease show a specific impulse control problem which makes them want to explore as if they were children,
  • Lack of Activities: Being bored and having nothing to do can result in pacing, walking around and trying to leave the facility.
  • Boredom: When a person is without any purpose, activities or stimulation, he might just walk around looking for something to engage with.
  • Depression: Patients with depression might wander around looking for an excuse, a distraction, a change of scenery, or a means to occupy their minds with new things.
  • Environmental: An unstructured environment might lead to an unconstrained wandering activity.
  • Visual Impairment: Patients with poor vision or visual impairment might wander away from a safe place, not being able to recognize potential hazards.
  • Medication Side Effects: Prescription drugs can have side effects of dysphoria, agitation and even hallucinations, which eventually could lead to wandering away.

At Risk Population

It is estimated that 6 to 10 % of elderly population that is admitted in long term care facilities were reported to experience wandering behavior. Around 1.9 million people each year with Alzheimer’s or other dementias will wander away. People with cognitive disabilities, such as those with Down syndrome, autism, dementia due to stroke and the like are more likely to wander away.

Associated Conditions

Wandering is a manifestation of something else, but it can also lead to other dangerous behaviors and conditions.

  • Agitation and Anxiety.
  • Exploitation and physical abuse.
  • Increased risk of getting injured.
  • Increased falls and medical issues.
  • Getting lost and abducted.
  • Elopement.
  • Confusion and disorientation.
  • Fatigue and dehydration.

Suggestions of use

As a health care provider, it is important to monitor and manage the patient’s behavior properly in order to provide relief from the wandering syndrome and reduce risk of elopement. Specific interventions should focus on reducing the need to wander, and providing a safe environment for the individual; this may include, creating a structure and activities, providing regular reminders and predictability, helping identify patient’s needs and recognizing areas of potential overload, maintaining appropriate elimination and nutrition, and addressing the underlying cause of the wandering issue.

Suggested Alternative NANDA Nursing Diagnoses

Besides the standard NANDA diagnosis of “Disorientation in familiar people, place, and situations” there are other nursing diagnosis which can be related to wandering.

  • Risk for Injury: The patient is at risk for injury and harm because of wandering.
  • Risk for Falls: The patient is at risk for falls due to disorientation and physical changes.
  • Impaired Mobility: The patient has impaired mobility due to wandering.
  • Activity Intolerance: The patient has activity intolerance due to physical limitations or lack of motivation.
  • Self-Care Deficit: The patient has difficulty with self-care activities due to wandering and lack of motivation.

Usage Tips

For a successful implementation of interventions against wandering, these tips should be taken into consideration:

  • Observe the patient closely to assess causes and triggers of wandering.
  • Identify the patient’s physical and environmental needs.
  • Provide structured and meaningful activities to decrease boredom and frustration.
  • Try to maintain a consistent routine for the patient.
  • Set up limits and boundaries to keep the patient safe.
  • Provide a secure and orienting environment.
  • Develop a plan to prevent accidental injuries during wandering.
  • Educate the patient, family and staff on wandering behavior.

NOC Outcomes

NOC stands for Nursing Outcomes Classification and it comprises the following outcomes related to Wandering:

  • Orientation: The ability to orient to people, place, time and activities.
  • Restless Activity Level: The patient’s consistency in staying motionless and risk of wandering.
  • Safety Awareness: The patient’s awareness of safe places and/or situations.
  • Situation-Based Problem Solving: The quality of decision making in relation to current situation.
  • Knowledge: Skin Integrity: The patient’s knowledge of skin integrity and its importance.

Evaluation Objectives and Criteria

The evaluation objectives and criteria provide criteria for determining how effective interventions against wandering have been.

  • Decrease in disorientation and confusion.
  • Increase in activity level and mobility.
  • Reduced episodes of wandering and elopement.
  • Maintaining appropriate elimination.
  • Decrease in frequency of falls or accidents.
  • Improvement in safety awareness.
  • Improvement in skin integrity.

NIC Interventions

NIC stands for Nursing Interventions Classification and it comprises the following interventions related to Wandering:

  • Protect Skin Integrity: Monitoring for skin breakdown, especially in the feet and legs.
  • Environmental Management: Arranging the physical space for the patient to feel oriented, secure and comfortable.
  • Realistic Goal Setting: Identify the goals and the steps needed to set and achieve them.
  • Activity Performance Support: Providing support and guidance to ensure activities are completed successfully.
  • Safety Promotion: Developing a plan to prevent accidental injuries during wandering.
  • Orientation: Going through a schedule of the patient’s day and remind him/her of the expected activities.
  • Reorienting Person: Establishing trust and support to help the patient identify people, places and things.

Nursing Activities

Nursing Activities for patients with wandering behaviors typically focus on safety prevention and situation-based interventions. This usually includes:

  • Close monitoring of the patient.
  • Ensure the safety of the environment.
  • Making sure the patient is in good physical condition and well-nourished.
  • Make sure the patient does not receive excessive medications that may cause further confusion snd disorientation.
  • Maintain a proper communication between the patient and the healthcare professionals, as well as family members.
  • Obtaining a proper structural and routine stimulation like clocks, calendars, etc.
  • Using wristbands, alarms and other safety measures.
  • Providing visual cues like signs, arrows, and others.
  • Improving the physical environment units and sections are clearly labeled.
  • Limiting access to hazardous areas.
  • Offering activities, hobbies and meaningful occupations which involve the patient.
  • Implementing an effective action plan in case of elopement.

Conclusion

Wandering is a common issue among elderly, dementia and Alzheimer’s patients and it can cause fear and insecurity in both the patient and the family or care provider. The best way to address it is by implementing a holistic approach, and providing an enabling environment, safety and meaningful activities. Early detection of potential risk characteristics can be very effective and together with physical, psychological and nutritional evaluations, appropriate interventions can be implemented.

5 FAQs

  1. What is Wandering?

    Wandering is the unintentional act of moving from the patient’s room or designated area without any certain destination.
  2. Which groups are more likely to have wandering behavior?

    People with cognitive disabilities, such as those with Alzheimer’s and Dementia, Down syndrome, autism, and dementia due to stroke are more likely to wander away
  3. What are the associated conditions of Wandering?

    Some of the conditions associated with Wandering are agitation and anxiety, exploitation and physical abuse, increased risk of injury, falls and medical issues, getting lost and abducted, confusion and disorientation, and fatigue and dehydration.
  4. What are the suggestions of use for Wandering?

    Suggestions of use for Wandering involve reducing the need to wander and providing a safe environment for the individual, such as providing structured and meaningful activities, maintaining a consistent routine, setting limits, offering visual cues, providing education and awareness, and implementing a plan to reduce dangers during wandering.
  5. Which evaluation objectives and criteria should be taken into account?

    The evaluation objectives and criteria for Wandering should include decreasing disorientation and confusion, increasing mobility and activity levels, reducing episodes of wandering and elopement, maintaining appropriate elimination, decreasing frequency of falls and accidents, increasing safety awareness, and improving skin integrity.

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