Nursing Diagnoses 2015-2017 - Definitions and Classification, 10th Edition (Nanda Internation

Domain 6. Self-Perception Class 2. Self-Esteem 00119 Chronic low self-esteem (1988, 1996, 2008; LOE 2.1) Definition Longstanding negative self-evaluating/feelings about self or self- capabilities. Defining Characteristics ■■ Dependent on others’ opinions ■■ Overly conforming 6. Self-Perception ■■ Exaggerates negative feedback ■■ Passivity ■■ Poor eye contact about self ■■ Rejection of positive feedback ■■ Excessive seeking of reassurance ■■ Repeatedly unsuccessful ■■ Guilt ■■ Hesitant to try new in life events ■■ Shame experiences ■■ Underestimates ability to deal ■■ Indecisive behavior ■■ Nonassertive behavior with situation Related Factors ■■ Cultural incongruence ■■ Receiving insufficient affection ■■ Exposure to traumatic situation ■■ Receiving insufficient approval ■■ Inadequate belonging ■■ Inadequate respect from others from others ■■ Ineffective coping with loss ■■ Repeated failures ■■ Insufficient group membership ■■ Repeated negative ■■ Psychiatric disorder reinforcement ■■ Spiritual incongruence Original literature support available at www.nanda.org  Class 2: Self-Esteem  271

Domain 6. Self-Perception Class 2. Self-Esteem 00224 Risk for chronic low self-esteem (2010, 2013; LOE 2.1) Definition Vulnerable to longstanding negative self-evaluating/feelings about self or self-capabilities, which may compromise health. Risk Factors 6. Self-Perception ■■ Cultural incongruence ■■ Insufficient feeling of ■■ Exposure to traumatic situation belonging ■■ Inadequate affection received ■■ Inadequate group membership ■■ Psychiatric disorder ■■ Inadequate respect from others ■■ Repeated failures ■■ Ineffective coping with loss ■■ Repeated negative reinforcement ■■ Spiritual incongruence Original literature support available at www.nanda.org 272  Domain 6: Self-Perception

Domain 6. Self-Perception Class 2. Self-Esteem 00120 Situational low self-esteem (1988, 1996, 2000) Definition Development of a negative perception of self-worth in response to a current situation. Defining Characteristics ■■ Situational challenge to 6. Self-Perception self-worth ■■ Helplessness ■■ Indecisive behavior ■■ Underestimates ability to deal ■■ Nonassertive behavior with situation ■■ Purposelessness ■■ Self-negating verbalizations ■■ Functional impairment ■■ History of loss Related Factors ■■ History of rejection ■■ Inadequate recognition ■■ Alteration in body image ■■ Pattern of failure ■■ Alteration in social role ■■ Behavior inconsistent with values ■■ Developmental transition  Class 2: Self-Esteem  273

Domain 6. Self-Perception Class 2. Self-Esteem 00153 Risk for situational low self-esteem (2000, 2013) Definition Vulnerable to developing a negative perception of self-worth in response to a current situation, which may compromise health. Risk Factors 6. Self-Perception ■■ Alteration in body image ■■ History of loss ■■ Alteration in social role ■■ History of neglect ■■ Behavior inconsistent with ■■ History of rejection ■■ Inadequate recognition values ■■ Pattern of failure ■■ Decrease in control over ■■ Pattern of helplessness ■■ Physical illness environment ■■ Unrealistic self-expectations ■■ Developmental transition ■■ Functional impairment ■■ History of abandonment ■■ History of abuse (e.g., physical, psychological, sexual) 274  Domain 6: Self-Perception

Domain 6. Self-Perception Class 3.  Body Image 00118 Disturbed body image (1973, 1998) Definition Confusion in mental picture of one’s physical self. Defining Characteristics ■■ Absence of body part ■■ Focus on past appearance 6. Self-Perception ■■ Alteration in body function ■■ Focus on past function ■■ Alteration in body structure ■■ Focus on previous strength ■■ Alteration in view of one’s ■■ Heightened achievement ■■ Hiding of body part body (e.g., appearance, ■■ Negative feeling about body structure, function) ■■ Nonverbal response to change ■■ Avoids looking at one’s body ■■ Avoids touching one’s body in body (e.g., appearance, ■■ Behavior of acknowledging structure, function) one’s body ■■ Nonverbal response to ■■ Behavior of monitoring one’s perceived change in body body (e.g., appearance, structure, ■■ Change in ability to estimate function) spatial relationship of body to ■■ Overexposure of body part environment ■■ Perceptions that reflect an ■■ Change in lifestyle altered view of one’s body ■■ Change in social involvement appearance ■■ Depersonalization of body part ■■ Personalization of body part by use of impersonal pronouns by name ■■ Depersonalization of loss by ■■ Personalization of loss use of impersonal pronouns by name ■■ Emphasis on remaining ■■ Preoccupation with change strengths ■■ Preoccupation with loss ■■ Extension of body boundary ■■ Refusal to acknowledge change (e.g., includes external object) ■■ Trauma to nonfunctioning ■■ Fear of reaction by others body part  Class 3: Body Image  275

Related Factors ■■ Alteration in body function (due ■■ Illness to anomaly, disease, medication, ■■ Impaired psychosocial pregnancy, radiation, surgery, trauma, etc.) functioning ■■ Injury ■■ Alteration in cognitive ■■ Spiritual incongruence functioning ■■ Surgical procedure ■■ Trauma ■■ Alteration in self-perception ■■ Treatment regimen ■■ Cultural incongruence ■■ Developmental transition 276  Domain 6: Self-Perception

Domain 7 Role Relationships DOMAIN 7. ROLE RELATIONSHIPS The positive and negative connections or associations between people or groups of people and the means by which those connections are demonstrated Class 1. Caregiving Roles Socially expected behavior patterns by people providing care who are not healthcare professionals Code Diagnosis Page 00061 Caregiver role strain 279 00062 Risk for caregiver role strain 282 00056 Impaired parenting 283 00164 Readiness for enhanced parenting 286 00057 Risk for impaired parenting 287 Class 2. Family Relationships Associations of people who are biologically related or related by choice Code Diagnosis Page 00058 Risk for impaired attachment 289 00063 Dysfunctional family processes 290 00060 Interrupted family processes 293 00159 Readiness for enhanced family processes 294 NANDA International, Inc. Nursing Diagnoses: Definitions & Classification 2015–2017, Tenth Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2014 NANDA International, Inc. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/nursingdiagnoses

Class 3. Role Performance Quality of functioning in socially expected behavior patterns Code Diagnosis Page 00223 Ineffective relationship 295 00207 Readiness for enhanced relationship 296 00229 Risk for ineffective relationship 297 00064 Parental role conflict 298 00055 Ineffective role performance 299 00052 Impaired social interaction 301 278  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 1.  Caregiving Roles 00061 Caregiver role strain (1992, 1998, 2000) Definition Difficulty in performing family/significant other caregiver role. Defining Characteristics Caregiving Activities ■■ Difficulty completing required 7. Role Relationships ■■ Apprehensiveness about future tasks ability to provide care ■■ Difficulty performing required ■■ Apprehensiveness about tasks future health of care ■■ Dysfunctional change in receiver caregiving activities ■■ Apprehensiveness about potential institutionalization of ■■ Preoccupation with care care receiver routine ■■ Apprehensiveness about well-being of care receiver if unable to provide care Caregiver Health Status: Physiological ■■ Headache ■■ Cardiovascular disease ■■ Hypertension ■■ Diabetes mellitus ■■ Rash ■■ Fatigue ■■ Weight change ■■ Gastrointestinal distress Caregiver Health Status: Emotional ■■ Ineffective coping strategies ■■ Alteration in sleep pattern ■■ Insufficient time to meet ■■ Anger ■■ Depression personal needs ■■ Emotional vacillation ■■ Nervousness ■■ Frustration ■■ Somatization ■■ Impatience ■■ Stressors Caregiver Health Status: Socioeconomic ■■ Refusal of career advancement ■■ Change in leisure activities ■■ Social isolation ■■ Low work productivity Class 1: Caregiving Roles  279

Caregiver–Care Receiver Relationship ■■ Uncertainty about changes ■■ Difficulty watching care in relationship with care receiver receiver with illness ■■ Grieving of changes in relationship with care receiver Family Processes ■■ Family conflict ■■ Concern about family member(s) 7. Role Relationships Related Factors ■■ Problematic behavior ■■ Psychiatric disorder Care Receiver Health Status ■■ Substance abuse ■■ Alteration in cognitive ■■ Unpredictability of illness functioning trajectory ■■ Chronic illness ■■ Unstable health ■■ Codependency ■■ Dependency condition ■■ Illness severity ■■ Increase in care needs Caregiver Health Status ■■ Insufficient fulfillment of ■■ Alteration in cognitive self-expectations functioning ■■ Physical conditions ■■ Codependency ■■ Substance abuse ■■ Ineffective coping strategies ■■ Unrealistic self-expectations ■■ Insufficient fulfillment of others’ expectations Caregiver–Care Receiver Relationship ■■ Unrealistic care receiver ■■ Abusive relationship expectations ■■ Care receiver’s condition ■■ Violent relationship inhibits conversation ■■ Pattern of ineffective relationships Caregiving Activities ■■ Excessive caregiving activities ■■ Around-the-clock care ■■ Recent discharge home with responsibilities significant care needs ■■ Change in nature of care activities ■■ Unpredictability of care ■■ Complexity of care activities ■■ Duration of caregiving situation 280  Domain 7: Role Relationships

Family Processes ■■ Pattern of ineffective family ■■ Pattern of family dysfunction coping Resources ■■ Insufficient emotional ■■ Caregiver not developmentally resilience ready for caregiver role ■■ Insufficient energy ■■ Difficulty accessing assistance ■■ Insufficient equipment for ■■ Difficulty accessing community providing care resources ■■ Insufficient knowledge about ■■ Difficulty accessing support ■■ Financial crisis (e.g., debt, community resources ■■ Insufficient physical insufficient finances) ■■ Inexperience with caregiving environment for providing care ■■ Insufficient assistance ■■ Insufficient social support ■■ Insufficient caregiver privacy ■■ Insufficient time ■■ Insufficient community ■■ Insufficient transportation resources (e.g., respite, recreation, social support) Socioeconomic ■■ Insufficient recreation 7. Role Relationships ■■ Alienation ■■ Social isolation ■■ Competing role commitments Class 1: Caregiving Roles  281

Domain 7.  Role Relationships Class 1.  Caregiving Roles 00062 Risk for caregiver role strain (1992, 2010, 2013; LOE 2.1) Definition Vulnerable to difficulty in performing the family/significant other c­ aregiver role, which may compromise health. Risk Factors 7. Role Relationships ■■ Alteration in cognitive func- ■■ Ineffective caregiver coping tioning in care receiver pattern ■■ Care receiver discharged home ■■ Ineffective family adaptation with significant needs ■■ Inexperience with caregiving ■■ Instability in care receiver’s ■■ Care receiver exhibits bizarre behavior health ■■ Insufficient caregiver ■■ Care receiver exhibits deviant behavior recreation ■■ Insufficient respite for ■■ Caregiver health impairment ■■ Caregiver isolation caregiver ■■ Caregiver not developmentally ■■ Partner as caregiver ■■ Pattern of family dysfunction ready for caregiver role ■■ Caregiver’s competing role prior to the caregiving situation commitments ■■ Pattern of ineffective relation- ■■ Caregiving task complexity ship between caregiver and ■■ Codependency care receiver ■■ Congenital disorder ■■ Prematurity ■■ Developmental delay ■■ Presence of abuse (e.g., ■■ Developmental delay of physical, psychological, sexual) caregiver ■■ Psychological disorder in ■■ Excessive caregiving activities caregiver ■■ Exposure to violence ■■ Psychological disorder in care ■■ Extended duration of receiver ■■ Stressors caregiving required ■■ Substance abuse ■■ Family isolation ■■ Unpredictability of illness ■■ Female caregiver trajectory ■■ Illness severity of care receiver ■■ Inadequate physical environ- ment for providing care 282  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 1.  Caregiving Roles 00056 Impaired parenting (1978, 1998) Definition Inability of the primary caretaker to create, maintain, or regain an environment that promotes the optimum growth and development of the child. Defining Characteristics ■■ History of abuse (e.g., physical, 7. Role Relationships psychological, sexual) Infant or Child ■■ Behavior disorder (e.g., ■■ History of trauma (e.g., physical, psychological, attention deficit, oppositional sexual) defiant) ■■ Delay in cognitive ■■ Impaired social functioning development ■■ Insufficient attachment ■■ Diminished separation anxiety behavior ■■ Failure to thrive ■■ Low academic performance ■■ Frequent accidents ■■ Runaway ■■ Frequent illness Parental ■■ Inappropriate stimulation ■■ Abandonment (e.g., visual, tactile, auditory) ■■ Decrease in ability to manage ■■ Inconsistent behavior child management ■■ Decrease in cuddling ■■ Deficient parent-child ■■ Inconsistent care ■■ Inflexibility in meeting needs interaction ■■ Frustration with child of child ■■ History of childhood abuse (e.g., ■■ Neglects needs of child ■■ Perceived inability to meet physical, psychological, sexual) ■■ Hostility child’s needs ■■ Inadequate child health ■■ Perceived role inadequacy ■■ Punitive maintenance ■■ Rejection of child ■■ Inappropriate care-taking skills ■■ Speaks negatively about child ■■ Inappropriate child-care ■■ Unsafe home environment arrangements Class 1: Caregiving Roles  283

Related Factors Infant or Child ■■ Disabling condition ■■ Alteration in perceptual ■■ Gender other than desired ■■ Multiple births abilities ■■ Parent-child separation ■■ Behavior disorder (e.g., attention ■■ Prematurity ■■ Temperament conflicts with deficit, oppositional defiant) ■■ Chronic illness parental expectations ■■ Developmental delay ■■ Difficult temperament Knowledge ■■ Insufficient knowledge about ■■ Alteration in cognitive parenting skills functioning ■■ Insufficient response to ■■ Ineffective communication skills infant cues ■■ Insufficient cognitive readiness ■■ Low educational level for parenting ■■ Preference for physical ■■ Insufficient knowledge about punishment child development ■■ Unrealistic expectations ■■ Insufficient knowledge about 7. Role Relationships child health maintenance Physiological ■■ Physical illness Psychological ■■ History of mental illness ■■ Alteration in sleep pattern ■■ History of substance ■■ Closely spaced pregnancies ■■ Depression abuse ■■ Difficult birthing process ■■ Insufficient prenatal care ■■ Disabling condition ■■ Sleep deprivation ■■ High number of pregnancies ■■ Young parental age Social ■■ History of being abusive ■■ Change in family unit ■■ Inability to put child’s needs ■■ Compromised home before own environment ■■ Inadequate child-care ■■ Conflict between partners ■■ Economically disadvantaged arrangements ■■ Father of child not involved ■■ Ineffective coping strategies ■■ History of abuse (e.g., physical, ■■ Insufficient family psychological, sexual) cohesiveness 284  Domain 7: Role Relationships

■■ Insufficient parental role model ■■ Low self-esteem ■■ Insufficient problem-solving ■■ Mother of child not involved ■■ Relocation skills ■■ Single parent ■■ Insufficient resources (e.g., ■■ Social isolation ■■ Stressors financial, social, knowledge) ■■ Unemployment ■■ Insufficient social support ■■ Unplanned pregnancy ■■ Insufficient transportation ■■ Unwanted pregnancy ■■ Insufficient valuing of ■■ Work difficulty parenthood ■■ Legal difficulty 7. Role Relationships Class 1: Caregiving Roles  285

Domain 7.  Role Relationships Class 1.  Caregiving Roles 00164 Readiness for enhanced parenting (2002, 2013; LOE 2.1) Definition A pattern of providing an environment for children or other dependent person(s) to nurture growth and development, which can be strengthened. Defining Characteristics ■■ Parent expresses desire to enhance emotional support ■■ Children express desire to of other dependent person enhance home environment 7. Role Relationships ■■ Expresses desire to enhance parenting ■■ Parent expresses desire to enhance emotional support of children 286  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 1.  Caregiving Roles 00057 Risk for impaired parenting (1978, 1998, 2013) Definition Vulnerable to inability of the primary caretaker to create, maintain, or regain an environment that promotes the optimum growth and develop- ment of the child, which may compromise the well-being of the child. Risk Factors ■■ Gender other than desired 7. Role Relationships ■■ Illness Infant or Child ■■ Multiple births ■■ Alteration in perceptual ■■ Prematurity ■■ Prolonged separation from abilities ■■ Behavior disorder (e.g., parent ■■ Temperament conflicts with attention deficit, oppositional defiant) parental expectations ■■ Developmental delay ■■ Difficult temperament ■■ Disabling condition Knowledge ■■ Insufficient knowledge about ■■ Alteration in cognitive parenting skills functioning ■■ Insufficient response to infant ■■ Ineffective communication skills cues ■■ Insufficient cognitive readiness ■■ Low educational level for parenting ■■ Preference for physical ■■ Insufficient knowledge about punishment child development ■■ Unrealistic expectations ■■ Insufficient knowledge about child health maintenance Physiological ■■ Physical illness Psychological ■■ Difficult birthing process ■■ Closely spaced pregnancies ■■ Disabling condition ■■ Depression Class 1: Caregiving Roles  287

■■ High number of pregnancies responsibilities, parenting ■■ History of mental illness practices, sleep partner) ■■ History of substance abuse ■■ Sleep deprivation ■■ Nonrestorative sleep pattern ■■ Young parental age (i.e., due to caregiver 7. Role Relationships Social ■■ Insufficient social support ■■ Change in family unit ■■ Insufficient transportation ■■ Compromised home ■■ Insufficient valuing of environment parenthood ■■ Conflict between partners ■■ Late-term prenatal care ■■ Economically disadvantaged ■■ Legal difficulty ■■ Father of child not involved ■■ Low self-esteem ■■ History of abuse (e.g., physical, ■■ Mother of child not psychological, sexual) involved ■■ History of being abusive ■■ Parent-child separation ■■ Inadequate child-care ■■ Relocation ■■ Role strain arrangements ■■ Single parent ■■ Ineffective coping strategies ■■ Social isolation ■■ Insufficient access to resources ■■ Stressors ■■ Insufficient family ■■ Unemployment ■■ Unplanned pregnancy cohesiveness ■■ Unwanted pregnancy ■■ Insufficient parental role model ■■ Work difficulty ■■ Insufficient prenatal care ■■ Insufficient problem-solving skills ■■ Insufficient resources (e.g., financial, social, knowledge) 288  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 2.  Family Relationships 00058 Risk for impaired attachment (1994, 2008, 2013; LOE 2.1) Definition Vulnerable to disruption of the interactive process between parent/­ significant other and child that fosters the development of a protective and nurturing reciprocal relationship. Risk Factors ■■ Anxiety ■■ Parental conflict resulting from 7. Role Relationships ■■ Child’s illness prevents effective disorganized infant behavior initiation of parental contact ■■ Parent-child separation ■■ Disorganized infant behavior ■■ Physical barrier (e.g., infant in ■■ Inability of parent to meet isolette) personal needs ■■ Prematurity ■■ Insufficient privacy ■■ Substance abuse Class 2: Family Relationships  289

Domain 7.  Role Relationships Class 2.  Family Relationships 00063 Dysfunctional family processes (1994, 2008; LOE 2.1) Definition Psychosocial, spiritual, and physiological functions of the family unit are chronically disorganized, which leads to conflict, denial of problems, resistance to change, ineffective problem-solving, and a series of self- perpetuating crises. Defining Characteristics 7. Role Relationships Behavioral ■■ Harsh self-judgment ■■ Agitation ■■ Immaturity ■■ Alteration in concentration ■■ Inability to accept a wide range ■■ Blaming ■■ Broken promises of feelings ■■ Chaos ■■ Inability to accept help ■■ Complicated grieving ■■ Inability to adapt to change ■■ Conflict avoidance ■■ Inability to deal constructively ■■ Contradictory communication with traumatic experiences pattern ■■ Inability to express a wide ■■ Controlling communication range of feelings pattern ■■ Inability to meet the emotional ■■ Criticizing ■■ Decrease in physical contact needs of its members ■■ Denial of problems ■■ Inability to meet the security ■■ Dependency ■■ Difficulty having fun needs of its members ■■ Difficulty with intimate ■■ Inability to meet the spiritual relationship needs of its members ■■ Difficulty with life-cycle ■■ Inability to receive help transition appropriately ■■ Disturbance in academic ■■ Inappropriate anger performance in children expression ■■ Enabling substance use pattern ■■ Ineffective communication ■■ Escalating conflict ■■ Failure to accomplish develop- skills ■■ Insufficient knowledge about mental tasks substance abuse ■■ Insufficient problem-solving skills 290  Domain 7: Role Relationships

■■ Lying ■■ Seeking of approval ■■ Manipulation ■■ Self-blame ■■ Nicotine addiction ■■ Social isolation ■■ Orientation favors tension ■■ Special occasions centered on relief rather than goal substance use attainment ■■ Stress-related physical illness ■■ Paradoxical communication ■■ Substance abuse pattern ■■ Unreliable behavior ■■ Power struggles ■■ Verbal abuse of children ■■ Rationalization ■■ Verbal abuse of parent ■■ Refusal to get help ■■ Verbal abuse of partner ■■ Seeking of affirmation Feelings ■■ Hurt 7. Role Relationships ■■ Abandonment ■■ Insecurity ■■ Anger ■■ Lingering resentment ■■ Anxiety ■■ Loneliness ■■ Confuses love and pity ■■ Loss ■■ Confusion ■■ Loss of identity ■■ Depression ■■ Low self-esteem ■■ Dissatisfaction ■■ Mistrust ■■ Distress ■■ Moodiness ■■ Embarrassment ■■ Powerlessness ■■ Emotional isolation ■■ Rejection ■■ Emotionally controlled by ■■ Repressed emotions ■■ Shame others ■■ Surgical procedure ■■ Failure ■■ Taking responsibility for ■■ Fear ■■ Feeling different from others substance abuser’s behavior ■■ Feeling misunderstood ■■ Tension ■■ Feeling unloved ■■ Unhappiness ■■ Frustration ■■ Vulnerability ■■ Guilt ■■ Worthlessness ■■ Hopelessness ■■ Hostility Roles and Relationships ■■ Diminished ability of family ■■ Change in role function members to relate to each ■■ Chronic family problems other for mutual growth and ■■ Closed communication system maturation ■■ Conflict between partners ■■ Deterioration in family ■■ Disrupted family rituals ■■ Disrupted family roles relationships Class 2: Family Relationships  291

■■ Disturbance in family ■■ Insufficient family respect for dynamics individuality of its members ■■ Economically disadvantaged ■■ Insufficient relationship skills ■■ Family denial ■■ Intimacy dysfunction ■■ Inconsistent parenting ■■ Neglect of obligation to family ■■ Ineffective communication member with partner ■■ Pattern of rejection ■■ Insufficient cohesiveness ■■ Perceived insufficient parental ■■ Insufficient family respect support for autonomy of its ■■ Triangulating family members relationships 7. Role Relationships Related Factors ■■ Genetic predisposition to substance abuse ■■ Addictive personality ■■ Biological factors ■■ Ineffective coping strategies ■■ Family history of resistance to ■■ Insufficient problem-solving treatment skills ■■ Family history of substance ■■ Substance abuse abuse 292  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 2.  Family Relationships 00060 Interrupted family processes (1982, 1998) Definition Change in family relationships and/or functioning. Defining Characteristics ■■ Changes in expressions of 7. Role Relationships conflict with community ■■ Alteration in availability for resources affective responsiveness ■■ Changes in expressions of ■■ Alteration in family conflict isolation from community resolution resources ■■ Alteration in family ■■ Changes in participation for satisfaction decision-making ■■ Alteration in intimacy ■■ Changes in relationship pattern ■■ Alteration in participation for ■■ Decrease in available emotional problem-solving support ■■ Assigned tasks change ■■ Decrease in mutual support ■■ Change in communication ■■ Ineffective task completion ■■ Power alliance change pattern ■■ Ritual change ■■ Change in somatization ■■ Change in stress-reduction behavior Related Factors ■■ Power shift among family members ■■ Alteration in family finances ■■ Change in family social status ■■ Shift in family roles ■■ Changes in interaction with ■■ Shift in health status of a community family member ■■ Developmental crisis ■■ Situational crisis ■■ Developmental transition ■■ Situational transition Class 2: Family Relationships  293

Domain 7.  Role Relationships Class 2.  Family Relationships 00159 Readiness for enhanced family processes (2002, 2013; LOE 2.1) Definition A pattern of family functioning to support the well-being of family members, which can be strengthened. Defining Characteristics 7. Role Relationships ■■ Expresses desire to enhance ■■ Expresses desire to enhance balance between autonomy growth of family members and cohesiveness ■■ Expresses desire to enhance ■■ Expresses desire to enhance interdependence with communication pattern community ■■ Expresses desire to enhance ■■ Expresses desire to enhance energy level of family to maintenance of boundaries support activities of daily living between family members ■■ Expresses desire to enhance ■■ Expresses desire to enhance family adaptation to change respect for family members ■■ Expresses desire to enhance ■■ Expresses desire to enhance family dynamics safety of family members ■■ Expresses desire to enhance family resilience 294  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 3.  Role Performance 00223 Ineffective relationship (2010; LOE 2.1) Definition A pattern of mutual partnership that is insufficient to provide for each other’s needs. Defining Characteristics ■■ Delay in meeting of ■■ Inadequate understanding of 7. Role Relationships developmental goals partner’s compromised appropriate for family life-cycle functioning (e.g., physical, stage psychological, social) ■■ Dissatisfaction with ■■ Insufficient balance in complementary relationship autonomy between partners between partners ■■ Insufficient balance in ■■ Dissatisfaction with emotional collaboration between partners need fulfillment between partners ■■ Insufficient mutual respect between partners ■■ Dissatisfaction with idea sharing between partners ■■ Insufficient mutual support in daily activities between ■■ Dissatisfaction with information partners sharing between partners ■■ Partner not identified as ■■ Dissatisfaction with physical support person need fulfillment between partners ■■ Unsatisfying communication with partner Related Factors ■■ Alteration in cognitive ■■ Ineffective communication functioning in one partner skills ■■ Developmental crisis ■■ Stressors ■■ History of domestic violence ■■ Substance abuse ■■ Incarceration of one partner ■■ Unrealistic expectations Original literature support available at www.nanda.org Class 3: Role Performance  295

Domain 7.  Role Relationships Class 3.  Role Performance 00207 Readiness for enhanced relationship (2006, 2013; LOE 2.1) Definition A pattern of mutual partnership to provide for each other’s needs, which can be strengthened. Defining Characteristics 7. Role Relationships ■■ Expresses desire to enhance ■■ Expresses desire to enhance autonomy between partners satisfaction with idea sharing between partners ■■ Expresses desire to enhance collaboration between partners ■■ Expresses desire to enhance satisfaction with ■■ Expresses desire to enhance information sharing between communication between partners partners ■■ Expresses desire to enhance ■■ Expresses desire to enhance satisfaction with physical emotional need fulfillment for need fulfillment for each each partner partner ■■ Expresses desire to enhance ■■ Expresses desire to enhance mutual respect between partners understanding of partner’s functional deficit (e.g., physical, ■■ Expresses desire to enhance psychological, social) satisfaction with complementary relationship between partners ■■ Expresses desire to enhance satisfaction with emotional need fulfillment for each partner Original literature support available at www.nanda.org 296  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 3.  Role Performance 00229 Risk for ineffective relationship (2010, 2013; LOE 2.1) Definition Vulnerable to developing a pattern that is insufficient for providing a mutual partnership to provide for each other’s needs. Risk Factors ■■ Alteration in cognitive ■■ Ineffective communication 7. Role Relationships functioning in one partner skills ■■ Developmental crisis ■■ Stressors ■■ History of domestic violence ■■ Substance abuse ■■ Incarceration of one partner ■■ Unrealistic expectations Original literature support available at www.nanda.org Class 3: Role Performance  297

Domain 7.  Role Relationships Class 3.  Role Performance 00064 Parental role conflict (1988 ) Definition Parental experience of role confusion and conflict in response to crisis. 7. Role Relationships Defining Characteristics ■■ Frustration ■■ Guilt ■■ Anxiety ■■ Perceived inadequacy to ■■ Concern about change in provide for child’s needs parental role (e.g., physical, emotional) ■■ Concern about family (e.g., ■■ Perceived loss of control over decisions relating to child functioning, communication, ■■ Reluctance to participate in health) usual caregiver activities ■■ Disruption in caregiver routines ■■ Fear Related Factors ■■ Change in marital status ■■ Intimidated by invasive ■■ Home care of a child with modalities (e.g., intubation) special needs ■■ Intimidated by restrictive ■■ Interruptions in family life due modalities (e.g., isolation) to home care regimen (e.g., ■■ Living in nontraditional setting treatments, caregivers, lack of (e.g., foster, group or respite) institutional care) ■■ Parent–child separation 298  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 3.  Role Performance 00055 Ineffective role performance (1978, 1996, 1998) Definition A pattern of behavior and self-expression that does not match the environmental context, norms, and expectations. Defining Characteristics ■■ Insufficient confidence 7. Role Relationships ■■ Insufficient external support ■■ Alteration in role perception ■■ Anxiety for role enactment ■■ Change in capacity to ■■ Insufficient knowledge of role resume role requirements ■■ Change in others’ perception ■■ Insufficient motivation ■■ Insufficient opportunity for of role ■■ Change in self-perception role enactment ■■ Insufficient self-management of role ■■ Insufficient skills ■■ Change in usual pattern of ■■ Pessimism ■■ Powerlessness responsibility ■■ Role ambivalence ■■ Depression ■■ Role conflict ■■ Discrimination ■■ Role confusion ■■ Domestic violence ■■ Role denial ■■ Harassment ■■ Role dissatisfaction ■■ Inappropriate developmental ■■ Role strain ■■ System conflict expectations ■■ Uncertainty ■■ Ineffective adaptation to change ■■ Ineffective coping strategies ■■ Ineffective role performance Related Factors ■■ Low educational level ■■ Unrealistic role expectations Knowledge ■■ Insufficient role model ■■ Insufficient role preparation (e.g., role transition, skill rehearsal, validation) Class 3: Role Performance  299

Physiological ■■ Neurological defect ■■ Alteration in body image ■■ Pain ■■ Depression ■■ Physical illness ■■ Fatigue ■■ Substance abuse ■■ Low self-esteem ■■ Mental health issue (e.g., depression, psychosis, personality disorder, substance abuse) Social ■■ Insufficient resources ■■ Conflict (e.g., financial, social, ■■ Developmental level knowledge) inappropriate for role ■■ Insufficient rewards expectation ■■ Insufficient role socialization ■■ Domestic violence ■■ Insufficient support system ■■ Economically disadvantaged ■■ Stressors ■■ High demands of job schedule ■■ Young age ■■ Inappropriate linkage with the healthcare system 7. Role Relationships 300  Domain 7: Role Relationships

Domain 7.  Role Relationships Class 3.  Role Performance 00052 Impaired social interaction (1986) Definition Insufficient or excessive quantity or ineffective quality of social exchange. Defining Characteristics ■■ Discomfort in social ■■ Dysfunctional interaction with situations others ■■ Dissatisfaction with social ■■ Family reports change in engagement (e.g., belonging, interaction (e.g., style, pattern) caring, interest, shared history) ■■ Impaired social functioning Related Factors ■■ Insufficient knowledge about 7. Role Relationships how to enhance mutuality ■■ Absence of significant other ■■ Communication barrier ■■ Insufficient skills to enhance ■■ Disturbance in self-concept mutuality ■■ Disturbance in thought ■■ Sociocultural dissonance processes ■■ Therapeutic isolation ■■ Environmental barrier ■■ Impaired mobility Class 3: Role Performance  301



Domain 8 Sexuality DOMAIN 8. SEXUALITY Sexual identity, sexual function, and reproduction Class 1. Sexual identity The state of being a specific person in regard to sexuality and/or gender Code Diagnosis Page None at present time Class 2. Sexual function The capacity or ability to participate in sexual activities Code Diagnosis Page 00059 Sexual dysfunction 305 00065 Ineffective sexuality pattern 306 Class 3. Reproduction Any process by which human beings are produced Code Diagnosis Page 00221 Ineffective childbearing process 307 00208 Readiness for enhanced childbearing process 309 00227 Risk for ineffective childbearing process 310 00209 Risk for disturbed maternal–fetal dyad 311 NANDA International, Inc. Nursing Diagnoses: Definitions & Classification 2015–2017, Tenth Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2014 NANDA International, Inc. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/nursingdiagnoses



Domain 8. Sexuality Class 2.  Sexual Function 00059 Sexual dysfunction (1980, 2006; LOE 2.1) Definition A state in which an individual experiences a change in sexual function during the sexual response phases of desire, excitation, and/or orgasm, which is viewed as unsatisfying, unrewarding, or inadequate. Defining Characteristics ■■ Alteration in sexual activity ■■ Decrease in sexual desire ■■ Alteration in sexual excitation ■■ Perceived sexual limitation ■■ Alteration in sexual satisfaction ■■ Seeks confirmation of ■■ Change in interest toward desirability others ■■ Undesired change in sexual ■■ Change in self-interest ■■ Change in sexual role function Related Factors 8. Sexuality ■■ Absence of privacy ■■ Insufficient knowledge about ■■ Absence of significant other sexual function ■■ Alteration in body function ■■ Misinformation about sexual (due to anomaly, disease, function medication, pregnancy, radiation, surgery, trauma, etc.) ■■ Presence of abuse (e.g., ■■ Alteration in body structure physical, psychological, sexual) (due to anomaly, disease, pregnancy, radiation, surgery, ■■ Psychosocial abuse (e.g., trauma, etc.) controlling, manipulation, ■■ Inadequate role model verbal abuse) ■■ Value conflict ■■ Vulnerability Original literature support available at www.nanda.org Class 2: Sexual Function  305

Domain 8. Sexuality Class 2.  Sexual Function 00065 Ineffective sexuality pattern (1986, 2006; LOE 2.1) Definition Expressions of concern regarding own sexuality. Defining Characteristics ■■ Alteration in relationship with ■■ Change in sexual role significant other ■■ Difficulty with sexual activity ■■ Difficulty with sexual behavior ■■ Alteration in sexual activity ■■ Value conflict ■■ Alteration in sexual behavior Related Factors 8. Sexuality ■■ Absence of privacy ■■ Impaired relationship with a ■■ Absence of significant other significant other ■■ Conflict about sexual orientation ■■ Conflict about variant ■■ Inadequate role model ■■ Insufficient knowledge about preference ■■ Fear of pregnancy alternatives related to ■■ Fear of sexually transmitted sexuality ■■ Skill deficit about alternatives infection related to sexuality Original literature support available at www.nanda.org 306  Domain 8: Sexuality

Domain 8. Sexuality Class 3. Reproduction 00221 Ineffective childbearing process (2010; LOE 2.1) Definition Pregnancy and childbirth process and care of the newborn that does not match the environmental context, norms, and expectations. Defining Characteristics ■■ Ineffective management of unpleasant symptoms in During Pregnancy pregnancy ■■ Inadequate prenatal care ■■ Inadequate prenatal lifestyle ■■ Insufficient access of support system (e.g., elimination, exercise, nutrition, personal hygiene, ■■ Insufficient respect for unborn sleep) baby ■■ Inadequate preparation of newborn care items ■■ Unrealistic birth plan ■■ Inadequate preparation of the home environment During Labor and Delivery ■■ Inappropriate response to 8. Sexuality ■■ Decrease in proactivity during onset of labor labor and delivery ■■ Insufficient access of support ■■ Inadequate lifestyle for stage of system labor (e.g., elimination, ■■ Insufficient attachment behavior exercise, nutrition, personal hygiene, sleep) After Birth ■■ Inappropriate breast care ■■ Inadequate baby care ■■ Insufficient access of support techniques system ■■ Inadequate postpartum ■■ Insufficient attachment lifestyle (e.g., elimination, behavior exercise, nutrition, personal ■■ Unsafe environment for an hygiene, sleep) ■■ Inappropriate baby feeding infant techniques Class 3: Reproduction  307

Related Factors ■■ Domestic violence ■■ Insufficient support system ■■ Inconsistent prenatal health ■■ Low maternal confidence ■■ Maternal powerlessness visits ■■ Maternal psychological distress ■■ Insufficient knowledge of ■■ Substance abuse ■■ Unplanned pregnancy childbearing process ■■ Unrealistic birth plan ■■ Inadequate maternal nutrition ■■ Unsafe environment ■■ Insufficient parental role ■■ Unwanted pregnancy model ■■ Insufficient prenatal care Original literature support available at www.nanda.org 8. Sexuality 308  Domain 8: Sexuality

Domain 8. Sexuality Class 3. Reproduction 00208 Readiness for enhanced childbearing process (2008, 2013; LOE 2.1) Definition A pattern of preparing for and maintaining a healthy pregnancy, child- birth process, and care of the newborn for ensuring well-being, which can be strengthened. Defining Characteristics ■■ Expresses desire to enhance prenatal lifestyle (e.g., During Pregnancy elimination, exercise, nutrition, ■■ Expresses desire to enhance personal hygiene, sleep) knowledge of childbearing ■■ Expresses desire to enhance process preparation for newborn ■■ Expresses desire to enhance management of unpleasant pregnancy symptoms During Labor and Delivery ■■ Expresses desire to enhance 8. Sexuality ■■ Expresses desire to enhance proactivity during labor and delivery lifestyle appropriate for stage of labor (e.g., elimination, exercise, nutrition, personal hygiene, sleep) After Birth ■■ Expresses desire to enhance ■■ Expresses desire to enhance postpartum lifestyle (e.g., elimination, exercise, attachment behavior nutrition, personal hygiene, ■■ Expresses desire to enhance sleep) baby care techniques ■■ Expresses desire to enhance ■■ Expresses desire to enhance use of support system baby feeding techniques ■■ Expresses desire to enhance breast care ■■ Expresses desire to enhance environmental safety for the baby Original literature support available at www.nanda.org Class 3: Reproduction  309

Domain 8. Sexuality Class 3. Reproduction 00227 Risk for ineffective childbearing process (2010, 2013; LOE 2.1) Definition Vulnerable to not matching environmental context, norms and expecta- tions of pregnancy, childbirth process, and the care of the newborn. Risk Factors ■■ Domestic violence ■■ Insufficient prenatal care ■■ Inconsistent prenatal health ■■ Insufficient support system ■■ Low maternal confidence visits ■■ Maternal powerlessness ■■ Insufficient cognitive readiness ■■ Maternal psychological distress ■■ Substance abuse for parenting ■■ Unplanned pregnancy ■■ Insufficient knowledge of ■■ Unrealistic birth plan ■■ Unwanted pregnancy childbearing process ■■ Inadequate maternal nutrition ■■ Insufficient parental role model 8. Sexuality Original literature support available at www.nanda.org 310  Domain 8: Sexuality

Domain 8. Sexuality Class 3. Reproduction 00209 Risk for disturbed maternal–fetal dyad (2008, 2013; LOE 2.1) Definition Vulnerable to disruption of the symbiotic maternal-fetal dyad as a result of comorbid or pregnancy-related conditions, which may compromise health. Risk Factors ■■ Alteration in glucose ■■ Inadequate prenatal care 8. Sexuality metabolism (e.g., diabetes ■■ Pregnancy complication mellitus, steroid use) (e.g., premature rupture of ■■ Compromised fetal oxygen membranes, placenta previa/ transport (due to anemia, abruption, multiple gestation) asthma, cardiac disease, ■■ Presence of abuse (e.g., hypertension, seizures, physical, psychological, sexual) premature labor, ■■ Substance abuse hemorrhage, etc.) ■■ Treatment regimen Original literature support available at www.nanda.org Class 3: Reproduction  311



Domain 9 Coping/Stress Tolerance DOMAIN 9. COPING/STRESS TOLERANCE Contending with life events/life processes Class 1. Post-trauma responses Reactions occurring after physical or psychological trauma Code Diagnosis Page 00141 Post-trauma syndrome 315 00145 Risk for post-trauma syndrome 317 00142 Rape-trauma syndrome 318 00114 Relocation stress syndrome 319 00149 Risk for relocation stress syndrome 320 Class 2. Coping responses The process of managing environmental stress Code Diagnosis Page 00199 Ineffective activity planning 321 00226 Risk for ineffective activity planning 322 00146 Anxiety 323 00071 Defensive coping 325 00069 Ineffective coping 326 00158 Readiness for enhanced coping 327 00077 Ineffective community coping 328 00076 Readiness for enhanced community coping 329 NANDA International, Inc. Nursing Diagnoses: Definitions & Classification 2015–2017, Tenth Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2014 NANDA International, Inc. Published 2014 by John Wiley & Sons, Ltd. Companion website: www.wiley.com/go/nursingdiagnoses

Class 2. Coping responses (continued) Code Diagnosis Page 00074 Compromised family coping 330 00073 Disabled family coping 332 00075 Readiness for enhanced family coping 333 00147 Death anxiety 334 00072 Ineffective denial 335 00148 Fear 336 00136 Grieving 338 00135 Complicated grieving 339 00172 Risk for complicated grieving 340 00241 Impaired mood regulation 341 00187 Readiness for enhanced power 342 00125 Powerlessness 343 00152 Risk for powerlessness 344 00210 Impaired resilience 345 00212 Readiness for enhanced resilience 346 00211 Risk for impaired resilience 347 00137 Chronic sorrow 348 00177 Stress overload 349 Class 3. Neurobehavioral stress Page Behavioral responses reflecting nerve and brain function 350 351 Code Diagnosis 352 00049 Decreased intracranial adaptive capacity 354 00009 Autonomic dysreflexia 356 00010 Risk for autonomic dysreflexia 00116 Disorganized infant behavior 357 00117 Readiness for enhanced organized infant behavior 00115 Risk for disorganized infant behavior 314  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 1. Post-Trauma Responses 00141 Post-trauma syndrome (1986, 1998, 2010; LOE 2.1) Definition Sustained maladaptive response to a traumatic, overwhelming event. Defining Characteristics ■■ Headache 9. Coping/Stress Tolerance ■■ Heart palpitations ■■ Aggression ■■ History of detachment ■■ Alienation ■■ Hopelessness ■■ Alteration in concentration ■■ Horror ■■ Alteration in mood ■■ Hypervigilence ■■ Anger ■■ Intrusive dreams ■■ Anxiety ■■ Intrusive thoughts ■■ Avoidance behaviors ■■ Irritability ■■ Compulsive behavior ■■ Neurosensory irritability ■■ Denial ■■ Nightmares ■■ Depression ■■ Panic attacks ■■ Dissociative amnesia ■■ Rage ■■ Enuresis ■■ Reports feeling numb ■■ Exaggerated startle response ■■ Repression ■■ Fear ■■ Shame ■■ Flashbacks ■■ Substance abuse ■■ Gastrointestinal irritation ■■ Grieving ■■ Guilt Related Factors ■■ Exposure to event involving multiple deaths ■■ Destruction of one’s home ■■ Event outside the range of ■■ Exposure to war ■■ History of abuse (e.g., physical, usual human experience ■■ Exposure to disaster (natural psychological, sexual) ■■ History of being a prisoner of war or man-made) ■■ Exposure to epidemic Class 1: Post-Trauma Responses  315

■■ History of criminal ■■ Serious injury to loved one victimization ■■ Serious threat to loved one ■■ Serious threat to self ■■ History of torture ■■ Witnessing mutilation ■■ Self-injurious behavior ■■ Witnessing violent death ■■ Serious accident (e.g., industrial, motor vehicle) 9. Coping/Stress Tolerance 316  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 1. Post-Trauma Responses 00145 Risk for post-trauma syndrome (1998, 2013) Definition Vulnerable to sustained maladaptive response to a traumatic, over- whelming event, which may compromise health. Risk Factors ■■ Human service occupations (e.g., police, fire, rescue, ■■ Diminished ego strength corrections, emergency room, ■■ Displacement from home mental health) ■■ Duration of traumatic event ■■ Environment not conducive ■■ Insufficient social support ■■ Perceives event as traumatic to needs ■■ Survivor role ■■ Exaggerated sense of responsibility 9. Coping/Stress Tolerance Class 1: Post-Trauma Responses  317

Domain 9.  Coping/Stress Tolerance Class 1. Post-Trauma Responses 00142 Rape-trauma syndrome (1980, 1998) Definition Sustained maladaptive response to a forced, violent, sexual penetration against the victim’s will and consent. 9. Coping/Stress Tolerance Defining Characteristics ■■ Hyperalertness ■■ Impaired decision-making ■■ Aggression ■■ Low self-esteem ■■ Agitation ■■ Mood swings ■■ Alteration in sleep pattern ■■ Muscle spasm ■■ Anger ■■ Muscle tension ■■ Anxiety ■■ Nightmares ■■ Change in relationship(s) ■■ Paranoia ■■ Confusion ■■ Perceived vulnerability ■■ Denial ■■ Phobias ■■ Dependency ■■ Physical trauma ■■ Depression ■■ Powerlessness ■■ Disorganization ■■ Self-blame ■■ Dissociative identity disorder ■■ Sexual dysfunction ■■ Embarrassment ■■ Shame ■■ Fear ■■ Shock ■■ Guilt ■■ Substance abuse ■■ Helplessness ■■ Thoughts of revenge ■■ History of suicide attempt ■■ Humiliation Related Factors ■■ Rape 318  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 1. Post-Trauma Responses 00114 Relocation stress syndrome (1992, 2000) Definition Physiological and/or psychosocial disturbance following transfer from one environment to another. Defining Characteristics ■■ Alienation ■■ Increase in verbalization 9. Coping/Stress Tolerance ■■ Aloneness of needs ■■ Alteration in sleep pattern ■■ Anger ■■ Insecurity ■■ Anxiety ■■ Loneliness ■■ Concern about relocation ■■ Loss of identity ■■ Dependency ■■ Loss of self-worth ■■ Depression ■■ Low self-esteem ■■ Fear ■■ Pessimism ■■ Frustration ■■ Unwillingness to move ■■ Increase in illness ■■ Withdrawal ■■ Increase in physical symptoms ■■ Worried Related Factors ■■ Insufficient support system ■■ Language barrier ■■ Compromised health status ■■ Move from one environment ■■ History of loss ■■ Impaired psychosocial to another ■■ Powerlessness functioning ■■ Social isolation ■■ Ineffective coping strategies ■■ Unpredictability of experience ■■ Insufficient predeparture counseling Class 1: Post-Trauma Responses  319

Domain 9.  Coping/Stress Tolerance Class 1. Post-Trauma Responses 00149 Risk for relocation stress syndrome (2000, 2013) Definition Vulnerable to physiological and/or psychosocial disturbance following transfer from one environment to another that may compromise health. Risk Factors ■■ Move from one environment to another ■■ Compromised health status ■■ Deficient mental competence ■■ Powerlessness ■■ History of loss ■■ Significant environmental ■■ Ineffective coping strategies ■■ Insufficient predeparture change ■■ Unpredictability of counseling ■■ Insufficient support system experience 9. Coping/Stress Tolerance 320  Domain 9: Coping/Stress Tolerance