00072 Ineffective Denial

Domain 9: coping/stress tolerance
Class 2: coping responses
Diagnostic Code: 00072
Nanda label: ineffective denial
Diagnostic focus: denial
Approved 1988 • Revised 2006 • Evidence level 2.1

NANDA Nursing Diagnosis Definition

The Nanda nursing diagnosis « ineffective denial ” is defined as: conscious or unconscious attempt to overlook the knowledge or meaning of an event to reduce anxiety and/or fear, which leads to a detriment of health.

Definite characteristics

  • Delay in the search for health care
  • Denial of fear of death
  • denial of the fear of disability
  • Displacement of the origin of the symptoms
  • Does not accept the impact of the disease on life
  • Does not perceive the relevance of danger
  • Does not perceive the relevance of symptoms
  • Fear of displacement in relation to the impact of the condition
  • Inappropriate affection
  • Minimize symptoms
  • Reject health care
  • Use rejection comments when talking about painful events
  • Use rejection gestures when talking about painful events
  • Use treatments not prescribed by health professionals

Related factors

  • Anxiety
  • Excessive stress
  • Fear of death
  • Fear of losing personal autonomy
  • Fear of separation
  • Inappropriate emotional support
  • Inadequate control sensation
  • Ineffective coping strategies
  • Perception of inadequacy when dealing with strong emotions
  • Threat of an unpleasant reality

Suggestions of use

  • It is necessary that the patient shows a certain degree of denial in response to the disease or other crises to be able to face the situation.
  • This normal denial is gradually replaced by acceptance or the attempt to change the situation, and does not interfere with the treatment regime. The ineffective denial should be used when the denial of the patient persists or interferes with the treatment.
  • For example, a freshly diagnosed patient of myocardial infarction could react with denial and not make the necessary changes in his lifestyle to prevent more heart damage.

Suggested alternative diagnostics

  • Defensive coping
  • Ineffective coping
  • Complicated duel
  • Failure (specify)
  • Traumatic violation syndrome

NOC Results

  • Acceptance: Health status: Reconciliation with an important change in health situation
  • Compliance behavior: personal actions aimed at achieving levels of well -being, recovery and rehabilitation, recommended by a health professional
  • Symptom control: personal actions to minimize adverse changes perceived in physical and emotional functioning
  • Beliefs on health: perceived threat: conviction that a possible personal health problem is serious and has potential negative consequences for lifestyle
  • Anxiety level: severity of the manifestation of apprehension, tension or restlessness, caused by an unidentified source

Evaluation objectives and criteria

  • The patient does not use ineffective denial, as manifested by acceptance: health status, level of anxiety, compliance behavior, health beliefs (perceived threat) and control of symptoms
  • The patient demonstrates acceptance: health status, as the following indicators reveal (specify from 1 to 5: never, sometimes, sometimes, often or usually):
    • Abandon the previous personal health concept
    • Recognize the reality of your health status
    • Look for health information
    • Face your health status
    • Make decisions about your health
  • Other examples

    The patient will be able to:

    • Recognize and accept the importance of symptoms
    • Inform about important symptoms
    • Do not show physical and behavioral manifestations of anxiety
    • Recognize your vulnerability to the health problem

    NIC Interventions

    • Emotional support: provision of comfort, acceptance and encouragement during moments of tension
    • SUPPORT FOR AMMINATION: Reinforcement of a self -directed change and initiated by the patient to achieve objectives of personal interest
    • Advice: use of an interactive process of help focused on the needs, problems or feelings of the patient and their loved ones, to improve or strengthen coping, problem solving and interpersonal relationships
    • Increased self -awareness: Help a patient to explore and understand his thoughts, feelings, motivations and behaviors
    • Increased self -efficacy: Strengthening of individual’s confidence in their ability to exhibit healthy behavior
    • Health Education: Preparation and supply of information and teachings to facilitate the voluntary adoption of health behaviors in individuals, families, groups or communities
    • Teaching: disease process: Help the patient to understand the information related to a specific disease process
    • Facilitation of personal responsibility: impulse to a patient to assume greater responsibility for their own behavior
    • Safety promotion: Intensification of the sensation of physical and psychological security of the patient
    • Improvement of coping: Help the patient to adapt to the stress, changes or perceived threats that interfere with the satisfaction of the demands and the roles of life
    • Anxiety reduction: decrease the maximum of apprehension, fear, omen or discomfort, related to the anticipation of an unknown danger of origin
    • Cognitive restructuring: challenge for a patient so that it modifies their patterns of distorted thoughts and see himself and the world in a more realistic way

    Nursing Activities

    Valuations

    • Evaluate the understanding of symptoms and disease
    • Assess anxiety signs
    • Determine if the patient has a realistic perception of their health status
    • (NIC) Anxiety reduction:
      • Determine the patient’s decision -making capacity
      • Identify when the level of anguish changes

    Patient education

    • Teach you to recognize the desired symptoms and answers
    • (NIC) Anxiety reduction: offer factual information regarding diagnosis, treatment and prognosis

    Collaboration activities

    • Channel to psychiatric care, if indicated
    • Include the patient and the family at a multidisciplinary meeting to prepare an action plan, which can include:
      • Organize follow -up support after hospital discharge
      • Meetings with patients in similar situations to learn new ways to face and reduce anxiety and fear

    Others

    • Establish a therapeutic relationship with the patient that allows the exploration of denial
    • Take any opportunity to strengthen the consequences of patient’s actions
    • Involve the patient in a conversation about anxiety, fears, symptoms and effects of the disease
    • Identify and reinforce patient strengths
    • Demonstrate empathy, warmth and authenticity
    • (NIC) Anxiety reduction:
      • Try to understand the patient’s point of view in an distressing situation
      • Strengthen the behavior, if adequate
      • Promote the verbal expression of feelings, perceptions and fears
      • Support the use of appropriate defense mechanisms
      • Help the patient make a realistic description of an event to come

    At home

    • Evaluate family interactions to determine if the patient uses denial in order to protect a family member
    • Provide emergency services numbers and help telephone lines

    Older people

    • Evaluate patient perceptions and provide feedback to reinforce realistic perceptions
    • Evaluate recent losses (of the functions, of the couple) that could delay the adaptation of the patient to the changes in their state of health