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

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00199 Ineffective activity planning (2008; LOE 2.2) Definition Inability to prepare for a set of actions fixed in time and under certain conditions. Defining Characteristics ■■ Insufficient resources (e.g., financial, social, knowledge) ■■ Absence of plan ■■ Excessive anxiety about a task ■■ Pattern of failure ■■ Pattern of procrastination to be undertaken ■■ Unmet goals for chosen activity ■■ Fear about a task to be ■■ Worried about a task to be undertaken undertaken ■■ Insufficient organizational skills Related Factors 9. Coping/Stress Tolerance ■■ Flight behavior when faced ■■ Insufficient social support with proposed solution ■■ Unrealistic perception ■■ Hedonism of event ■■ Insufficient information- ■■ Unrealistic perception of processing ability personal abilities Original literature support available at www.nanda.org Class 2: Coping Responses  321

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00226 Risk for ineffective activity planning (2010, 2013; LOE 2.1) Definition Vulnerable to an inability to prepare for a set of actions fixed in time and under certain conditions, which may compromise health. Risk Factors ■■ Flight behavior when faced ■■ Insufficient social support with proposed solution ■■ Pattern of procrastination ■■ Unrealistic perception of event ■■ Hedonism ■■ Unrealistic perception of ■■ Insufficient information personal abilities processing ability Original literature support available at www.nanda.org 9. Coping/Stress Tolerance 322  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00146 Anxiety (1973, 1982, 1998) Definition Vague, uneasy feeling of discomfort or dread accompanied by an ­autonomic response (the source is often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting sign that warns of impending danger and enables the individual to take measures to deal with that threat. Defining Characteristics ■■ Poor eye contact 9. Coping/Stress Tolerance ■■ Restlessness Behavioral ■■ Scanning behavior ■■ Decrease in productivity ■■ Worried about change in life ■■ Extraneous movement ■■ Fidgeting event ■■ Glancing about ■■ Hypervigilence ■■ Jitteriness ■■ Insomnia ■■ Overexcitement ■■ Rattled Affective ■■ Regretful ■■ Anguish ■■ Self-focused ■■ Apprehensiveness ■■ Uncertainty ■■ Distress ■■ Worried ■■ Fear ■■ Feeling of inadequacy ■■ Shakiness ■■ Helplessness ■■ Trembling ■■ Increase in wariness ■■ Voice quivering ■■ Irritability Physiological ■■ Facial tension ■■ Hand tremors ■■ Increase in perspiration ■■ Increase in tension Class 2: Coping Responses  323

9. Coping/Stress Tolerance Sympathetic ■■ Heart palpitations ■■ Alteration in respiratory ■■ Increase in blood pressure ■■ Increase in heart rate pattern ■■ Increase in respiratory rate ■■ Anorexia ■■ Pupil dilation ■■ Brisk reflexes ■■ Superficial vasoconstriction ■■ Cardiovascular excitation ■■ Twitching ■■ Diarrhea ■■ Weakness ■■ Dry mouth ■■ Facial flushing ■■ Fatigue ■■ Nausea Parasympathetic ■■ Tingling in extremities ■■ Abdominal pain ■■ Urinary frequency ■■ Alteration in sleep pattern ■■ Urinary hesitancy ■■ Decrease in heart rate ■■ Urinary urgency ■■ Decreased blood pressure ■■ Diarrhea ■■ Diminished ability to ■■ Faintness problem-solve Cognitive ■■ Fear ■■ Alteration in attention ■■ Forgetfulness ■■ Alteration in concentration ■■ Preoccupation ■■ Awareness of physiological ■■ Rumination ■■ Tendency to blame others symptoms ■■ Blocking of thoughts ■■ Confusion ■■ Decrease in perceptual field ■■ Diminished ability to learn Related Factors ■■ Conflict about life goals ■■ Maturational crisis ■■ Exposure to toxin ■■ Situational crisis ■■ Family history of anxiety ■■ Stressors ■■ Heredity ■■ Substance abuse ■■ Interpersonal contagion ■■ Threat of death ■■ Interpersonal transmission ■■ Threat to current status ■■ Major change (e.g., economic ■■ Unmet needs ■■ Value conflict status, environment, health status, role function, role status) 324  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00071 Defensive coping (1988, 2008; LOE 2.1) Definition Repeated projection of falsely positive self-evaluation based on a self- protective pattern that defends against underlying perceived threats to positive self-regard. Defining Characteristics ■■ Alteration in reality testing ■■ Insufficient follow through 9. Coping/Stress Tolerance ■■ Denial of problems with treatment ■■ Denial of weaknesses ■■ Difficulty establishing ■■ Insufficient participation in treatment relationships ■■ Difficulty maintaining ■■ Projection of blame ■■ Projection of responsibility relationship(s) ■■ Rationalization of failures ■■ Grandiosity ■■ Reality distortion ■■ Hostile laughter ■■ Ridicule of others ■■ Hypersensitivity to a discourtesy ■■ Superior attitude toward ■■ Hypersensitivity to criticism others Related Factors ■■ Conflict between self-perception ■■ Insufficient resilience and value system ■■ Insufficient self-confidence ■■ Insufficient support ■■ Fear of failure ■■ Fear of humiliation system ■■ Fear of repercussions ■■ Uncertainty ■■ Insufficient confidence in others ■■ Unrealistic self-expectations Original literature support available at www.nanda.org Class 2: Coping Responses  325

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00069 Ineffective coping (1978, 1998) Definition Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources. Defining Characteristics 9. Coping/Stress Tolerance ■■ Alteration in concentration ■■ Inability to deal with a situation ■■ Alteration in sleep pattern ■■ Inability to meet basic needs ■■ Change in communication ■■ Inability to meet role pattern expectation ■■ Destructive behavior toward ■■ Ineffective coping strategies ■■ Insufficient access of social others ■■ Destructive behavior toward self support ■■ Difficulty organizing ■■ Insufficient goal-directed information behavior ■■ Fatigue ■■ Insufficient problem resolution ■■ Frequent illness ■■ Insufficient problem-solving ■■ Inability to ask for help ■■ Inability to attend to skills ■■ Risk-taking behavior information ■■ Substance abuse Related Factors ■■ Inadequate resources ■■ Ineffective tension release ■■ Gender differences in coping strategies strategies ■■ Insufficient sense of control ■■ High degree of threat ■■ Insufficient social support ■■ Inability to conserve adaptive ■■ Maturational crisis ■■ Situational crisis energies ■■ Uncertainty ■■ Inaccurate threat appraisal ■■ Inadequate confidence in ability to deal with a situation ■■ Inadequate opportunity to prepare for stressor 326  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00158 Readiness for enhanced coping (2002, 2013; LOE 2.1) Definition A pattern of cognitive and behavioral efforts to manage demands related to well-being, which can be strengthened. Defining Characteristics ■■ Expresses desire to enhance use of emotion-oriented ■■ Awareness of possible strategies environmental change ■■ Expresses desire to enhance ■■ Expresses desire to enhance use of problem-oriented knowledge of stress strategies management strategies ■■ Expresses desire to enhance ■■ Expresses desire to enhance use of spiritual resource management of stressors ■■ Expresses desire to enhance social support 9. Coping/Stress Tolerance Class 2: Coping Responses  327

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00077 Ineffective community coping (1994, 1998) Definition A pattern of community activities for adaptation and problem-solving that is unsatisfactory for meeting the demands or needs of the community. Defining Characteristics ■■ High incidence of community problems (e.g., homicides, ■■ Community does not meet vandalism, terrorism, robbery, expectations of its members abuse, unemployment, poverty, militancy, mental illness) ■■ Deficient community participation ■■ Perceived community powerlessness ■■ Elevated community illness rate ■■ Perceived community vulnerability ■■ Excessive community conflict ■■ Excessive stress 9. Coping/Stress Tolerance Related Factors ■■ Exposure to disaster (natural ■■ Insufficient community or man-made) resources (e.g., respite, recreation, social support) ■■ History of disaster (e.g., natural, man-made) ■■ Nonexistent community systems ■■ Inadequate resources for problem-solving 328  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00076 Readiness for enhanced community coping (1994, 2013) Definition A pattern of community activities for adaptation and problem-solving for meeting the demands or needs of the community, which can be strengthened. Defining Characteristics ■■ Expresses desire to enhance 9. Coping/Stress Tolerance community planning for ■■ Expresses desire to enhance predictable stressors availability of community recreation programs ■■ Expresses desire to enhance community resources for ■■ Expresses desire to enhance managing stressors availability of community relaxation programs ■■ Expresses desire to enhance community responsibility for ■■ Expresses desire to enhance stress management communication among community members ■■ Expresses desire to enhance problem-solving for identified ■■ Expresses desire to enhance issue communication between aggregates and larger community Class 2: Coping Responses  329

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00074 Compromised family coping (1980, 1996) Definition A usually supportive primary person (family member, significant other, or close friend) provides insufficient, ineffective, or compromised sup- port, comfort, assistance, or encouragement that may be needed by the client to manage or master adaptive tasks related to his or her health challenge. Defining Characteristics 9. Coping/Stress Tolerance ■■ Assistive behaviors by support ■■ Protective behavior by support person produce unsatisfactory person incongruent with results client’s need for autonomy ■■ Client complaint about support ■■ Support person reports person’s response to health inadequate understanding problem that interferes with effective behaviors ■■ Client concern about support person’s response to health ■■ Support person reports problem insufficient knowledge that interferes with effective ■■ Limitation in communication behaviors between support person and client ■■ Support person reports preoccupation with own ■■ Protective behavior by support reaction to client’s need person incongruent with client’s abilities ■■ Support person withdraws from client 330  Domain 9: Coping/Stress Tolerance

Related Factors ■■ Coexisting situations affecting ■■ Misinformation obtained by the support person support person ■■ Developmental crisis ■■ Misunderstanding of experienced by support person information by support person ■■ Exhaustion of support person’s ■■ Preoccupation by support capacity person with concern outside of family ■■ Family disorganization ■■ Family role change ■■ Prolonged disease that ■■ Insufficient information exhausts capacity of support person available to support person ■■ Insufficient reciprocal support ■■ Situational crisis faced by ■■ Insufficient support given by support person client to support person ■■ Insufficient understanding of information by support person 9. Coping/Stress Tolerance Class 2: Coping Responses  331

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00073 Disabled family coping (1980, 1996, 2008; LOE 2.1) Definition Behavior of primary person (family member, significant other, or close friend) that disables his or her capacities and the client’s capacities to effectively address tasks essential to either person’s adaptation to the health challenge. 9. Coping/Stress Tolerance Defining Characteristics ■■ Impaired ability to structure a meaningful life ■■ Abandonment ■■ Adopts illness symptoms of ■■ Impaired individualism ■■ Intolerance client ■■ Neglect of basic needs of client ■■ Aggression ■■ Neglect of relationship with ■■ Agitation ■■ Client dependence family member ■■ Depression ■■ Neglect of treatment regimen ■■ Desertion ■■ Performing routines without ■■ Disregard for client’s needs ■■ Distortion of reality about regard for client’s needs ■■ Prolonged hyperfocus on client client’s health problem ■■ Psychosomatic symptoms ■■ Family behaviors detrimental ■■ Rejection to well-being ■■ Hostility Related Factors ■■ Ambivalent family ■■ Differing coping styles between relationships support persons ■■ Chronically unexpressed ■■ Inconsistent management of feelings by support person family’s resistance to treatment ■■ Differing coping styles between support person and client 332  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00075 Readiness for enhanced family coping (1980, 2013) Definition A pattern of management of adaptive tasks by primary person (family member, significant other, or close friend) involved with the client’s health change, which can be strengthened. Defining Characteristics ■■ Expresses desire to acknowledge ■■ Expresses desire to growth impact of crisis enhance enrichment of lifestyle ■■ Expresses desire to choose experiences that optimize ■■ Expresses desire to enhance wellness health promotion ■■ Expresses desire to enhance 9. Coping/Stress Tolerance connection with others who have experienced a similar situation Class 2: Coping Responses  333

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00147 Death anxiety (1998, 2006; LOE 2.1) Definition Vague, uneasy feeling of discomfort or dread generated by perceptions of a real or imagined threat to one’s existence. Defining Characteristics ■■ Fear of prolonged dying process ■■ Concern about strain on the caregiver ■■ Fear of suffering related to dying ■■ Deep sadness ■■ Fear of developing terminal ■■ Fear of the dying process ■■ Negative thoughts related to illness ■■ Fear of loss of mental abilities death and dying ■■ Powerlessness when dying ■■ Worried about the impact of ■■ Fear of pain related to dying ■■ Fear of premature death one’s death on significant other 9. Coping/Stress Tolerance Related Factors ■■ Anticipation of adverse ■■ Nonacceptance of own consequences of anesthesia mortality ■■ Anticipation of impact of death ■■ Observations related to death on others ■■ Perceived imminence of death ■■ Uncertainty about ■■ Anticipation of pain ■■ Anticipation of suffering encountering a higher power ■■ Confronting the reality of ■■ Uncertainty about life after terminal disease death ■■ Discussions on the topic of ■■ Uncertainty about the death existence of a higher power ■■ Experiencing dying process ■■ Uncertainty of prognosis ■■ Near-death experience Original literature support available at www.nanda.org 334  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00072 Ineffective denial (1988, 2006; LOE 2.1) Definition Conscious or unconscious attempt to disavow the knowledge or m­ eaning of an event to reduce anxiety and/or fear, leading to the detriment of health. Defining Characteristics ■■ Delay in seeking healthcare ■■ Inappropriate affect 9. Coping/Stress Tolerance ■■ Denies fear of death ■■ Minimizes symptoms ■■ Denies fear of invalidism ■■ Refusal of healthcare ■■ Displaces fear of impact of the ■■ Use of dismissive gestures condition when speaking of distressing ■■ Displaces source of symptoms event ■■ Does not admit impact of ■■ Use of dismissive comments when speaking of distressing disease on life event ■■ Does not perceive relevance of ■■ Use of treatment not advised by healthcare professional danger ■■ Does not perceive relevance of symptoms Related Factors ■■ Anxiety ■■ Insufficient emotional support ■■ Excessive stress ■■ Insufficient sense of control ■■ Fear of death ■■ Perceived inadequacy in ■■ Fear of losing autonomy ■■ Fear of separation dealing with strong emotions ■■ Ineffective coping strategies ■■ Threat of unpleasant reality Original literature support available at www.nanda.org Class 2: Coping Responses  335

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00148 Fear (1980, 1996, 2000) Definition Response to perceived threat that is consciously recognized as a danger. 9. Coping/Stress Tolerance Defining Characteristics ■■ Increase in blood pressure ■■ Increase in tension ■■ Apprehensiveness ■■ Jitteriness ■■ Decrease in self-assurance ■■ Muscle tension ■■ Excitedness ■■ Nausea ■■ Feeling dread ■■ Pallor ■■ Feeling of fear ■■ Pupil dilation ■■ Feeling of panic ■■ Vomiting ■■ Feeling of terror ■■ Feeling of alarm ■■ Identifies object of fear ■■ Stimulus believed to be Cognitive ■■ Decrease in learning ability a threat ■■ Decrease in problem-solving ■■ Impulsiveness ability ■■ Increase in alertness ■■ Decrease in productivity ■■ Diarrhea Behaviors ■■ Dry mouth ■■ Attack behaviors ■■ Dyspnea ■■ Avoidance behaviors ■■ Fatigue ■■ Focus narrowed to the source ■■ Increase in perspiration ■■ Increase in respiratory rate of fear Physiological ■■ Anorexia ■■ Change in physiological response (e.g., blood pressure, heart rate, respiratory rate, oxygen saturation, and end-tital CO2) 336  Domain 9: Coping/Stress Tolerance

Related Factors ■■ Phobic stimulus ■■ Sensory deficit (e.g., visual, ■■ Innate releasing mechanism to external stimuli hearing) (e.g., neurotransmitters) ■■ Separation from support ■■ Innate response to stimuli system (e.g., sudden noise, height) ■■ Unfamiliar setting ■■ Language barrier ■■ Learned response 9. Coping/Stress Tolerance Class 2: Coping Responses  337

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00136 Grieving (1980, 1996, 2006; LOE 2.1) Definition A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or p­ erceived loss into their daily lives. 9. Coping/Stress Tolerance Defining Characteristics ■■ Disorganization ■■ Finding meaning in a loss ■■ Alteration in activity level ■■ Guilt about feeling relieved ■■ Alteration in dream pattern ■■ Maintaining a connection to ■■ Alteration in immune the deceased functioning ■■ Pain ■■ Alteration in neuroendocrine ■■ Panic behavior ■■ Personal growth functioning ■■ Psychological distress ■■ Alteration in sleep pattern ■■ Suffering ■■ Anger ■■ Blaming ■■ Despair ■■ Detachment Related Factors ■■ Anticipatory loss of significant ■■ Loss of significant object object (e.g., possession, job, (e.g., possession, job, status, status) home, body part) ■■ Anticipatory loss of significant other ■■ Death of significant other Original literature support available at www.nanda.org 338  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00135 Complicated grieving (1980, 1986, 2004, 2006; LOE 2.1) Definition A disorder that occurs after the death of a significant other, in which the  experience of distress accompanying bereavement fails to follow n­ ormative expectations and manifests in functional impairment. Defining Characteristics ■■ Feelings of emptiness 9. Coping/Stress Tolerance ■■ Insufficient sense of well-being ■■ Anger ■■ Longing for the deceased ■■ Anxiety ■■ Avoidance of grieving person ■■ Decrease in functioning in life ■■ Low levels of intimacy ■■ Mistrust roles ■■ Nonacceptance of a death ■■ Depression ■■ Persistent painful memories ■■ Disbelief ■■ Preoccupation with thoughts ■■ Distress about the deceased about a deceased person person ■■ Rumination ■■ Excessive stress ■■ Searching for a deceased ■■ Experiencing symptoms the person deceased experienced ■■ Self-blame ■■ Fatigue ■■ Separation distress ■■ Feeling dazed ■■ Traumatic distress ■■ Feeling of detachment from ■■ Yearning for deceased person others ■■ Feeling of shock ■■ Feeling stunned Related Factors ■■ Death of significant other ■■ Insufficient social support ■■ Emotional disturbance Original literature support available at www.nanda.org Class 2: Coping Responses  339

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00172 Risk for complicated grieving (2004, 2006, 2013; LOE 2.1) Definition Vulnerable to a disorder that occurs after death of a significant other in which the experience of distress accompanying bereavement fails to ­follow normative expectations and manifests in functional impairment, which may compromise health. Risk Factors ■■ Death of significant other ■■ Insufficient social support ■■ Emotional disturbance Original literature support available at www.nanda.org 9. Coping/Stress Tolerance 340  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00241 Impaired mood regulation (2013; LOE 2.1) Definition A mental state characterized by shifts in mood or affect and which is comprised of a constellation of affective, cognitive, somatic, and/or physiological manifestations varying from mild to severe. Defining Characteristics ■■ Impaired concentration ■■ Influenced self-esteem ■■ Changes in verbal behavior ■■ Irritability ■■ Disinhibition ■■ Psychomotor agitation ■■ Dysphoria ■■ Psychomotor retardation ■■ Excessive guilt ■■ Sad affect ■■ Excessive self-awareness ■■ Withdrawal ■■ Excessive self-blame ■■ Flight of thoughts ■■ Hopelessness Related Factors 9. Coping/Stress Tolerance ■■ Alteration in sleep pattern ■■ Pain ■■ Anxiety ■■ Psychosis ■■ Appetite change ■■ Recurrent thoughts of death ■■ Chronic illness ■■ Recurrent thoughts of suicide ■■ Functional impairment ■■ Social isolation ■■ Hypervigilance ■■ Substance misuse ■■ Impaired social functioning ■■ Weight change ■■ Loneliness Original literature support available at www.nanda.org Class 2: Coping Responses  341

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00187 Readiness for enhanced power (2006, 2013; LOE 2.1) Definition A pattern of participating knowingly in change for well-being, which can be strengthened. Defining Characteristics 9. Coping/Stress Tolerance ■■ Expresses desire to enhance ■■ Expresses desire to enhance awareness of possible changes knowledge for participation in change ■■ Expresses desire to enhance identification of choices that ■■ Expresses desire to enhance can be made for change participation in choices for daily living ■■ Expresses desire to enhance independence with actions for ■■ Expresses desire to enhance change participation in choices for health ■■ Expresses desire to enhance ■■ Expresses desire to enhance involvement in change power Original literature support available at www.nanda.org 342  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00125 Powerlessness (1982, 2010; LOE 2.1) Definition The lived experience of lack of control over a situation, including a p­ erception that one’s actions do not significantly affect an outcome. Defining Characteristics ■■ Alienation ■■ Inadequate participation ■■ Dependency in care ■■ Depression ■■ Doubt about role performance ■■ Insufficient sense of control ■■ Frustration about inability to ■■ Shame perform previous activities Related Factors ■■ Complex treatment regimen ■■ Insufficient interpersonal 9. Coping/Stress Tolerance ■■ Dysfunctional institutional interactions environment Original literature support available at www.nanda.org Class 2: Coping Responses  343

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00152 Risk for powerlessness (2000, 2010, 2013; LOE 2.1) Definition Vulnerable to the lived experience of lack of control over a situation, including apperception that one’s actions do not significantly affect the outcome, which may compromise health. Risk Factors ■■ Anxiety ■■ Low self-esteem ■■ Caregiver role ■■ Pain ■■ Economically disadvantaged ■■ Progressive illness ■■ Illness ■■ Social marginalization ■■ Ineffective coping strategies ■■ Stigmatization ■■ Insufficient knowledge to ■■ Unpredictability of illness manage a situation trajectory ■■ Insufficient social support 9. Coping/Stress Tolerance Original literature support available at www.nanda.org 344  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00210 Impaired resilience (2008, 2013; LOE 2.1) Definition Decreased ability to sustain a pattern of positive responses to an adverse situation or crisis. Defining Characteristics ■■ Decrease interest in academic ■■ Impaired health status activities ■■ Ineffective coping strategies ■■ Low self-esteem ■■ Decrease interest in vocational ■■ Renewed elevation of distress activities ■■ Shame ■■ Social isolation ■■ Depression ■■ Guilt Related Factors ■■ Community violence ■■ Insufficient impulse control 9. Coping/Stress Tolerance ■■ Demographics that increase ■■ Large family size ■■ Low intellectual ability chance of maladjustment ■■ Low maternal educational level ■■ Economically disadvantaged ■■ Parental mental illness ■■ Ethnic minority status ■■ Perceived vulnerability ■■ Exposure to violence ■■ Psychological disorder ■■ Female gender ■■ Substance abuse ■■ Inconsistent parenting Original literature support available at www.nanda.org Class 2: Coping Responses  345

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00212 Readiness for enhanced resilience (2008, 2013; LOE 2.1) Definition A pattern of positive responses to an adverse situation or crisis, which can be strengthened. Defining Characteristics 9. Coping/Stress Tolerance ■■ Demonstrates positive outlook ■■ Expresses desire to enhance ■■ Exposure to a crisis resilience ■■ Expresses desire to enhance ■■ Expresses desire to enhance available resources self-esteem ■■ Expresses desire to enhance ■■ Expresses desire to enhance communication skills sense of control ■■ Expresses desire to enhance ■■ Expresses desire to enhance environmental safety support system ■■ Expresses desire to enhance ■■ Expresses desire to enhance goal-setting use of conflict management ■■ Expresses desire to enhance strategies involvement in activities ■■ Expresses desire to enhance ■■ Expresses desire to enhance use of coping skills own responsibility for action ■■ Expresses desire to enhance ■■ Expresses desire to enhance use of resource progress toward goal ■■ Expresses desire to enhance relationships with others Original literature support available at www.nanda.org 346  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00211 Risk for impaired resilience (2008, 2013; LOE 2.1) Definition Vulnerable to decreased ability to sustain a pattern of positive response to an adverse situation or crisis, which may compromise health. Risk Factors ■■ Chronicity of existing crisis ■■ New crisis (e.g., unplanned ■■ Multiple coexisting adverse pregnancy, loss of housing, death of family member) situations Original literature support available at www.nanda.org 9. Coping/Stress Tolerance Class 2: Coping Responses  347

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00137 Chronic sorrow (1998) Definition Cyclical, recurring, and potentially progressive pattern of pervasive s­adness experienced (by a parent, caregiver, individual with chronic ­illness or disability) in response to continual loss, throughout the ­trajectory of an illness or disability. Defining Characteristics ■■ Overwhelming negative feelings ■■ Feelings that interfere with well-being (e.g., personal, ■■ Sadness (e.g., periodic, social) recurrent) Related Factors 9. Coping/Stress Tolerance ■■ Chronic disability ■■ Death of significant other (e.g., physical, mental) ■■ Length of time as a caregiver ■■ Missed milestones ■■ Chronic illness ■■ Missed opportunities ■■ Crisis in disability management ■■ Crisis in illness management ■■ Crisis related to developmental stage 348  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 2.  Coping Responses 00177 Stress overload (2006; LOE 3.2) Definition Excessive amounts and types of demands that require action. Defining Characteristics ■■ Increase in impatience ■■ Negative impact from stress ■■ Excessive stress ■■ Feeling of pressure (e.g., physical symptoms, ■■ Impaired decision-making psychological distress, ■■ Impaired functioning feeling sick) ■■ Increase in anger ■■ Tension ■■ Increase in anger behavior Related Factors ■■ Excessive stress ■■ Repeated stressors 9. Coping/Stress Tolerance ■■ Insufficient resources (e.g., ■■ Stressors financial, social, knowledge) Original literature support available at www.nanda.org Class 2: Coping Responses  349

Domain 9.  Coping/Stress Tolerance Class 3. Neurobehavioral Stress 00049 Decreased intracranial adaptive capacity (1994) Definition Intracranial fluid dynamic mechanisms that normally compensate for increases in intracranial volumes are compromised, resulting in repeated disproportionate increases in intracranial pressure (ICP) in response to a variety of noxious and non-noxious stimuli. Defining Characteristics ■■ Baseline intracranial pressure ■■ Volume-pressure response test (ICP) ≥ 10 mmHg variation (volume: pressure ratio 2, pressure-volume ■■ Disproportionate increase in index < 10) intracranial pressure (ICP) following stimuli ■■ Wide-amplitude ICP waveform ■■ Elevated P2 ICP waveform 9. Coping/Stress Tolerance ■■ Repeated increase in intracranial pressure (ICP) ≥ 10 mmHg for ≥ 5 minutes following external stimuli Related Factors ■■ Sustained increase in intracranial pressure (ICP) of ■■ Brain injury (e.g., 10–15 mmHg cerebrovascular impairment, neurological illness, trauma, ■■ Systemic hypotension with tumor) intracranial hypertension ■■ Decreased cerebral perfusion ≥ 50–60 mmHg 350  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 3. Neurobehavioral Stress 00009 Autonomic dysreflexia (1988) Definition Life-threatening, uninhibited sympathetic response of the nervous s­ ystem to a noxious stimulus after a spinal cord injury at T7 or above. Defining Characteristics ■■ Blurred vision ■■ Horner’s syndrome 9. Coping/Stress Tolerance ■■ Bradycardia ■■ Metallic taste in mouth ■■ Chest pain ■■ Nasal congestion ■■ Chilling ■■ Pallor (below injury) ■■ Conjunctival congestion ■■ Paresthesia ■■ Diaphoresis (above the injury) ■■ Paroxysmal hypertension ■■ Headache (diffuse pain in ■■ Pilomotor reflex ■■ Red blotches on skin different areas of the head and not confined to any nerve (above the injury) distribution area) ■■ Tachycardia Related Factors ■■ Insufficient knowledge of disease process ■■ Bladder distention ■■ Bowel distention ■■ Skin irritation ■■ Insufficient caregiver knowledge of disease process Class 3: Neurobehavioral Stress  351

Domain 9.  Coping/Stress Tolerance Class 3. Neurobehavioral Stress 00010 Risk for autonomic dysreflexia (1998, 2000, 2013) Definition Vulnerable to life-threatening, uninhibited response of the sympathetic nervous system post-spinal shock, in an individual with spinal cord injury or lesion at T6 or above (has been demonstrated in patients with injuries at T7 and T8), which may compromise health. Risk Factors ■■ Pulmonary emboli Cardiopulmonary Stimuli ■■ Deep vein thrombosis 9. Coping/Stress Tolerance Gastrointestinal Stimuli ■■ Gallstones ■■ Bowel distention ■■ Gastric ulcer ■■ Constipation ■■ Gastrointestinal system ■■ Difficult passage of feces ■■ Digital stimulation pathology ■■ Enemas ■■ Hemorrhoids ■■ Esophageal reflux disease ■■ Suppositories ■■ Fecal impaction Musculoskeletal-Integumentary ■■ Pressure over genitalia Stimuli ■■ Range of motion exercises ■■ Cutaneous stimulation ■■ Spasm ■■ Sunburn (e.g., pressure ulcer, ingrown ■■ Wound toenail, dressings, burns, rash) ■■ Fracture ■■ Heterotopic bone ■■ Pressure over bony prominence Neurological Stimuli ■■ Painful stimuli below level ■■ Irritating stimuli below level of injury of injury 352  Domain 9: Coping/Stress Tolerance

Regulatory Stimuli ■■ Temperature fluctuations ■■ Extremes of environmental temperature Reproductive Stimuli ■■ Ovarian cyst ■■ Ejaculation ■■ Pregnancy ■■ Labor and delivery ■■ Sexual intercourse period ■■ Menstruation Situational Stimuli ■■ Substance withdrawal ■■ Constrictive clothing (e.g., narcotic, opiate) (e.g., straps, stockings, shoes) ■■ Surgical procedure ■■ Pharmaceutical agent ■■ Positioning Urological Stimuli ■■ Renal calculi ■■ Bladder distention ■■ Surgical procedure ■■ Bladder spasm ■■ Urethritis ■■ Cystitis ■■ Urinary catheterization ■■ Detrusor sphincter dyssynergia ■■ Urinary tract infection ■■ Epididymitis ■■ Instrumentation 9. Coping/Stress Tolerance Class 3: Neurobehavioral Stress  353

Domain 9.  Coping/Stress Tolerance Class 3. Neurobehavioral Stress 00116 Disorganized infant behavior (1994, 1998) Definition Disintegrated physiological and neurobehavioral responses of infant to the environment. Defining Characteristics Attention-Interaction System ■■ Impaired response to sensory stimuli (e.g., difficult to soothe, unable to sustain alertness) 9. Coping/Stress Tolerance Motor System ■■ Hyperextension of extremities ■■ Alteration in primitive ■■ Impaired motor tone ■■ Jitteriness reflexes ■■ Tremor ■■ Exaggerated startle response ■■ Twitching ■■ Finger splaying ■■ Uncoordinated movement ■■ Fisting ■■ Hands to face Physiological ■■ Feeding intolerance ■■ Abnormal skin color (e.g., pale, ■■ Tachycardia ■■ Time-out signals (e.g., gaze, dusky, cyanosis) ■■ Arrhythmia hiccough, sneeze, slack jaw, ■■ Bradycardia open mouth, tongue thrust) ■■ Desaturation Regulatory Problems ■■ Inability to inhibit startle reflex ■■ Irritability State-Organization System ■■ Quiet-awake (e.g., staring, gaze ■■ Active-awake (e.g., fussy, aversion) worried gaze) ■■ State oscillation ■■ Diffuse alpha EEG activity with eyes closed ■■ Irritable crying 354  Domain 9: Coping/Stress Tolerance

Related Factors Caregiver ■■ Cue misreading ■■ Insufficient knowledge of ■■ Environmental overstimulation behavioral cues Environmental ■■ Insufficient sensory stimulation ■■ Inadequate physical ■■ Sensory deprivation ■■ Sensory overstimulation environment ■■ Insufficient containment within environment Individual ■■ Low postconceptual age ■■ Illness ■■ Prematurity ■■ Immature neurological functioning Postnatal ■■ Malnutrition ■■ Feeding intolerance ■■ Oral impairment ■■ Impaired motor functioning ■■ Pain ■■ Invasive procedure Prenatal ■■ Genetic disorder ■■ Congenital disorder ■■ Exposure to teratogen 9. Coping/Stress Tolerance Class 3: Neurobehavioral Stress  355

Domain 9.  Coping/Stress Tolerance Class 3. Neurobehavioral Stress 00117 Readiness for enhanced organized infant behavior (1994, 2013) Definition A pattern of modulation of the physiological and behavioral systems of functioning (i.e., autonomic, motor, state-organization, self-regulatory, and attentional-interactional systems) in an infant, which can be strengthened. Defining Characteristics ■■ Parent expresses desire to enhance recognition of infant’s ■■ Parent expresses desire to self-regulatory behaviors enhance cue recognition 9. Coping/Stress Tolerance 356  Domain 9: Coping/Stress Tolerance

Domain 9.  Coping/Stress Tolerance Class 3. Neurobehavioral Stress 00115 Risk for disorganized infant behavior (1994, 2013) Definition Vulnerable to alteration in integration and modulation of the p­ hysiological and behavioral systems of functioning (i.e., autonomic, motor, state-organization, self-regulatory, and attentional-interactional systems), which may compromise health. Risk Factors ■■ Parent expresses desire to enhance environmental ■■ Impaired motor functioning conditions ■■ Insufficient containment ■■ Prematurity within environment ■■ Procedure ■■ Invasive procedure ■■ Oral impairment ■■ Pain 9. Coping/Stress Tolerance Class 3: Neurobehavioral Stress  357



Domain 10 Life Principles DOMAIN 10. LIFE PRINCIPLES Principles underlying conduct, thought, and behavior about acts, customs, or institutions viewed as being true or having intrinsic worth Class 1. Values The identification and ranking of preferred modes of conduct or end states Code Diagnosis Page None at this time Class 2. Beliefs Opinions, expectations, or judgments about acts, customs, or institutions viewed as being true or having intrinsic worth Code Diagnosis Page 00068 Readiness for enhanced spiritual well-being 361 Class 3. Value/Belief/Action Congruence The correspondence or balance achieved among values, beliefs, and actions Code Diagnosis Page 00184 Readiness for enhanced decision-making 363 00083 Decisional conflict 364 00242 Impaired emancipated decision-making 365 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. Value/Belief/Action Congruence (continued) Page Code Diagnosis 366 00243 Readiness for enhanced emancipated 367 decision-making 368 00244 Risk for impaired emancipated decision-making 369 00175 Moral distress 370 00169 Impaired religiosity 371 00171 Readiness for enhanced religiosity 372 00170 Risk for impaired religiosity 374 00066 Spiritual distress 00067 Risk for spiritual distress 360  Domain 10: Life Principles

Domain 10.  Life Principles Class 2. Beliefs 00068 Readiness for enhanced spiritual well-being (1994, 2002, 2013; LOE 2.1) Definition A pattern of experiencing and integrating meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/ or a power greater than oneself, which can be strengthened. Defining Characteristics Connections to Self ■■ Expresses desire to enhance 10. Life Principles ■■ Expresses desire to enhance meditative practice acceptance ■■ Expresses desire to enhance ■■ Expresses desire to enhance purpose in life coping ■■ Expresses desire to enhance ■■ Expresses desire to enhance satisfaction with philosophy of life courage ■■ Expresses desire to enhance ■■ Expresses desire to enhance self-forgiveness hope ■■ Expresses desire to enhance joy ■■ Expresses desire to enhance ■■ Expresses desire to enhance serenity (e.g., peace) love ■■ Expresses desire to enhance ■■ Expresses desire to enhance surrender meaning in life ■■ Expresses desire to enhance interaction with spiritual Connections with Others leaders ■■ Expresses desire to enhance ■■ Expresses desire to enhance forgiveness from others service to others ■■ Expresses desire to enhance ■■ Expresses desire to enhance interaction with significant spiritual reading other ■■ Expresses desire to enhance Connections with Art, Music, time outdoors Literature, and Nature ■■ Expresses desire to enhance creative energy (e.g., writing, poetry, music)  Class 2: Beliefs  361

Connections with Power Greater ■■ Expresses desire to enhance than Self prayerfulness ■■ Expresses desire to ■■ Expresses desire to enhance enhance mystical experiences reverence ■■ Expresses desire to enhance participation in religious activity 10. Life Principles 362  Domain 10: Life Principles

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00184 Readiness for enhanced decision-making (2006, 2013; LOE 2.1) Definition A pattern of choosing a course of action for meeting short- and long- term health-related goals, which can be strengthened. Defining Characteristics ■■ Expresses desire to enhance ■■ Expresses desire to enhance 10. Life Principles congruency of decisions with risk-benefit analysis of sociocultural goal decisions ■■ Expresses desire to enhance ■■ Expresses desire to enhance congruency of decisions with understanding of choices for sociocultural values decision-making ■■ Expresses desire to enhance ■■ Expresses desire to enhance congruency of decisions understanding of meaning with goal of choices ■■ Expresses desire to enhance ■■ Expresses desire to enhance congruency of decisions with use of reliable evidence for values decisions ■■ Expresses desire to enhance decision-making Original literature support available at www.nanda.org Class 3: Value/Belief/Action Congruence  363

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00083 Decisional conflict (1988, 2006; LOE 2.1) Definition Uncertainty about course of action to be taken when choice among competing actions involves risk, loss, or challenge to values and beliefs. Defining Characteristics ■■ Questioning of moral values while attempting a decision ■■ Delay in decision-making ■■ Distress while attempting ■■ Questioning of personal beliefs while attempting a decision a decision ■■ Physical sign of distress ■■ Questioning of personal values while attempting a decision (e.g., increase in heart rate, restlessness) ■■ Recognizes undesired ■■ Physical sign of tension consequences of actions ■■ Questioning of moral being considered principle while attempting a decision ■■ Self-focused ■■ Questioning of moral rule ■■ Uncertainty about choices while attempting a decision ■■ Vacillating among choices 10. Life Principles Related Factors ■■ Conflict with moral obligation ■■ Moral principle supports ■■ Conflicting information mutually inconsistent actions sources ■■ Moral rule supports mutually ■■ Inexperience with inconsistent actions decision-making ■■ Moral value supports mutually ■■ Insufficient information inconsistent actions ■■ Insufficient support system ■■ Interference in ■■ Perceived threat to value system ■■ Unclear personal beliefs decision-making ■■ Unclear personal values Original literature support available at www.nanda.org 364  Domain 10: Life Principles

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00242 Impaired emancipated decision-making (2013; LOE 2.1) Definition A process of choosing a healthcare decision that does not include personal knowledge and/or consideration of social norms, or does not occur in a flexible environment, resulting in decisional dissatisfaction. Defining Characteristics ■■ Inability to choose a healthcare option that best fits current ■■ Delay in enacting chosen lifestyle healthcare option ■■ Inability to describe how ■■ Distress when listening to option will fit into current other’s opinion lifestyle ■■ Excessive concern about what ■■ Limited verbalization about others think is the best healthcare option in other’s decision presence ■■ Excessive fear of what others think about a decision ■■ Feeling constrained in describing own opinion Related Factors 10. Life Principles ■■ Decrease in understanding of ■■ Insufficient privacy to openly all available healthcare options discuss healthcare options ■■ Inability to adequately ■■ Limited decision-making verbalize perceptions about experience healthcare options ■■ Traditional hierarchical family ■■ Inadequate time to discuss ■■ Traditional hierarchical healthcare options healthcare system Original literature support available at www.nanda.org Class 3: Value/Belief/Action Congruence  365

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00243 Readiness for enhanced emancipated decision-making (2013; LOE 2.1) Definition A process of choosing a healthcare decision that includes personal knowl- edge and/or consideration of social norms, which can be strengthened. Defining Characteristics 10. Life Principles ■■ Expresses desire to enhance ■■ Expresses desire to enhance ability to choose healthcare comfort to verbalize healthcare options that best fit current options in the presence of others lifestyle ■■ Expresses desire to enhance ■■ Expresses desire to enhance confidence in decision-making ability to enact chosen healthcare option ■■ Expresses desire to enhance confidence to discuss ■■ Expresses desire to enhance healthcare options openly ability to understand all available healthcare options ■■ Expresses desire to enhance decision-making ■■ Expresses desire to enhance ability to verbalize own ■■ Expresses desire to enhance opinion without constraint privacy to discuss healthcare options Original literature support available at www.nanda.org 366  Domain 10: Life Principles

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00244 Risk for impaired emancipated decision-making (2013; LOE 2.1) Definition Vulnerable to a process of choosing a healthcare decision that does not include personal knowledge and/or consideration of social norms, or does not occur in a flexible environment resulting in decisional dissatisfaction. Risk Factors ■■ Inadequate time to discuss ■■ Insufficient self-confidence in healthcare options decision-making ■■ Insufficient confidence to openly ■■ Limited decision-making discuss healthcare options experience ■■ Insufficient information ■■ Traditional hierarchical regarding healthcare options family ■■ Insufficient privacy to openly ■■ Traditional hierarchical discuss healthcare options healthcare systems Original literature support available at www.nanda.org 10. Life Principles Class 3: Value/Belief/Action Congruence  367

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00175 Moral distress (2006; LOE 2.1) Definition Response to the inability to carry out one’s chosen ethical/moral ­decision/ action. Defining Characteristics ■■ Anguish about acting on one’s moral choice (e.g., powerlessness, anxiety, fear) Related Factors 10. Life Principles ■■ Conflict among ■■ Cultural incongruence decision-makers ■■ End-of-life decisions ■■ Loss of autonomy ■■ Conflicting information ■■ Physical distance of decision- available for ethical decision- making maker ■■ Time constraint for decision- ■■ Conflicting information available for moral making decision-making ■■ Treatment decision Original literature support available at www.nanda.org 368  Domain 10: Life Principles

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00169 Impaired religiosity (2004; LOE 2.1) Definition Impaired ability to exercise reliance on beliefs and/or participate in rituals of a particular faith tradition. Defining Characteristics ■■ Desire to reconnect with ■■ Distress about separation from previous belief pattern faith community ■■ Desire to reconnect with ■■ Questioning of religious belief previous customs patterns ■■ Difficulty adhering to ■■ Questioning of religious prescribed religious beliefs customs ■■ Difficulty adhering to prescribed religious rituals (e.g., ceremonies, regulations, clothing, prayer, services, holiday observances) Related Factors ■■ Life transition 10. Life Principles Developmental and Situational ■■ Pain ■■ Aging ■■ End-stage life crisis ■■ Insecurity ■■ Insufficient social support Physical ■■ Personal crisis ■■ Illness ■■ Insufficient social integration Psychological ■■ Insufficient sociocultural ■■ Anxiety ■■ Fear of death interaction ■■ History of religious manipulation ■■ Ineffective coping strategies ■■ Suffering Sociocultural ■■ Cultural barrier to practicing religion ■■ Environmental barrier to practicing religion Spiritual ■■ Spiritual crises Original literature support available at www.nanda.org

Domain 10.  Life Principles Class 3. Value/Belief/Action Congruence 00171 Readiness for enhanced religiosity (2004, 2013; LOE 2.1) Definition A pattern of reliance on religious beliefs and/or participation in rituals of a particular faith tradition, which can be strengthened. Defining Characteristics ■■ Expresses desire to enhance ■■ Expresses desire to enhance belief patterns used in the past participation in religious practices (e.g., ceremonies, ■■ Expresses desire to enhance regulations, clothing, prayer, connection with a religious services, holiday observances) leader ■■ Expresses desire to enhance ■■ Expresses desire to enhance religious customs used in the past forgiveness ■■ Expresses desire to enhance ■■ Expresses desire to enhance religious options participation in religious experiences ■■ Expresses desire to enhance use of religious material 10. Life Principles Original literature support available at www.nanda.org 370  Domain 10: Life Principles