NANDA 2018-2020

Domain 5 • Class 4 • Diagnosis Code 00173 Risk for acute confusion Approved 2006 • Revised 2013, 2017 • Level of Evidence 2.2 Definition Susceptible to reversible disturbances of consciousness, attention, cognition and perception that develop over a short period of time, which may compromise health. Risk factors – Pain – Sensory deprivation – Alteration in sleep-wake cycle – Substance misuse – Dehydration – Urinary retention – Impaired mobility – Inappropriate use of restraints – Male gender – Malnutrition – Impaired metabolic functioning At risk population – Infection – Pharmaceutical agent – Age ≥ 60 years – History of cerebral vascular accident Associated condition – Alteration in cognitive functioning – Delirium – Dementia Original literature support available at http://MediaCenter.thieme.com. 276

Domain 5 • Class 4 • Diagnosis Code 00129 Chronic confusion Approved 1994 • Revised 2017 • Level of Evidence 3.1 Definition Irreversible, progressive, insidious, and long-term alteration of intellect, behavior and personality, manifested by impairment in cognitive functions (memory, speech, language, decision making, and executive function), and dependency in execution of daily activities Defining characteristics – Adequate alertness to surroundings – Alteration in social functioning – Alteration in at least one cognitive function other – Inability to perform at least one daily activity – Insidious and irreversible onset in cognitive than memory – Alteration in behavior impairment – Alteration in long-term memory – Long-term cognitive impairment – Alteration in personality – Progressive impairment in cognitive functioning – Alteration in short-term memory Associated condition – Dementia – Cerebral vascular accident Original literature support available at http://MediaCenter.thieme.com. 277

Domain 5 • Class 4 • Diagnosis Code 00251 Labile emotional control Approved 2013 • Revised 2017 • Level of Evidence 2.1 Definition Uncontrollable outbursts of exaggerated and involuntary emotional expression. Defining characteristics – Expression of emotion incongruent with triggering factor – Absence of eye contact – Crying – Involuntary crying – Difficulty in use of facial expressions – Involuntary laughing – Embarrassment regarding emotional expression – Uncontrollable crying – Excessive crying without feeling sadness – Uncontrollable laughing – Excessive laughing without feeling happiness – Withdrawal from occupational situation – Withdrawal from social situation Related factors – Insufficient muscle strength – Social distress – Alteration in self-esteem – Stressors – Emotional disturbance – Substance misuse – Fatigue – Insufficient knowledge about symptom control – Insufficient knowledge of disease Associated condition – Pharmaceutical agent – Physical disability – Brain injury – Psychiatric disorder – Functional impairment – Mood disorder – Musculoskeletal impairment Original literature support available at http://MediaCenter.thieme.com. 278

Domain 5 • Class 4 • Diagnosis Code 00222 Ineffective impulse control Approved 2010 • Revised 2017 • Level of Evidence 2.1 Definition A pattern of performing rapid, unplanned reactions to internal or external stimuli without regard for the negative consequences of these reactions to the impulsive individual or to others. Defining characteristics – Acting without thinking – Irritability – Asking personal questions despite discomfort of – Overly familiar with strangers – Sensation seeking others – Sexual promiscuity – Gambling addiction – Temper outbursts – Inability to save money or regulate finances – Violent behavior – Inappropriate sharing of personal details Related factors – Smoking – Substance misuse – Hopelessness – Mood disorder Associated condition – Organic brain disorder – Personality disorder – Alteration in cognitive functioning – Alteration in development Original literature support available at http://MediaCenter.thieme.com. 279

Domain 5 • Class 4 • Diagnosis Code 00126 Deficient knowledge Approved 1980 • Revised 2017 Definition Absence of cognitive information related to a specific topic, or its acquisition. Defining characteristics – Inappropriate behavior – Insufficient knowledge – Inaccurate follow-through of instruction – Misinformation presented by others – Inaccurate performance on a test – Alteration in memory Related factors – Insufficient information – Insufficient interest in learning – Insufficient knowledge of resources Associated condition – Alteration in cognitive functioning This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 280

Domain 5 • Class 4 • Diagnosis Code 00161 Readiness for enhanced knowledge Approved 2002 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of cognitive information related to a specific topic, or its acquisition, which can be strengthened. Defining characteristics – Expresses desire to enhance learning 281

Domain 5 • Class 4 • Diagnosis Code 00131 Impaired memory Approved 1994 • Revised 2017 • Level of Evidence 3.1 Definition Persistent inability to remember or recall bits of information or skills Defining characteristics – Consistently forgets to perform a behavior at the – Persistent inability to recall familiar names, scheduled time words, or objects – Persistent forgetfulness – Persistent inability to recall if a behavior was performed – Persistent inability to learn a new skill – Persistent inability to retain a new skill – Persistent inability to learn new information – Persistent inability to retain new information – Persistent inability to perform a previously learned skill – Preserved capacity to perform daily activities independently – Persistent inability to recall factual information or events Related factors – Alteration in fluid volume Associated condition – Hypoxia – Mild cognitive impairment – Anemia – Neurological impairment – Brain injury – Parkinson's Disease – Decrease in cardiac output – Electrolyte imbalance Additional modifiable related factors to be developed. Original literature support available at http://MediaCenter.thieme.com. 282

Domain 5 • Class 5 • Diagnosis Code 00157 Readiness for enhanced communication Approved 2002 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of exchanging information and ideas with others, which can be strengthened. Defining characteristics – Expresses desire to enhance communication 283

Domain 5 • Class 5 • Diagnosis Code 00051 Impaired verbal communication Approved 1983 • Revised 1996, 1998, 2017 Definition Decreased, delayed, or absent ability to receive, process, transmit, and/or use a system of symbols. Defining characteristics – Disoriented to person – Disoriented to place – Absence of eye contact – Disoriented to time – Difficulty comprehending communication – Dyspnea – Difficulty expressing thoughts verbally – Inability to speak – Difficulty forming sentences – Inability to speak language of caregiver – Difficulty forming words – Inability to use body expressions – Difficulty in selective attending – Inability to use facial expressions – Difficulty in use of body expressions – Inappropriate verbalization – Difficulty in use of facial expressions – Partial visual deficit – Difficulty maintaining communication – Slurred speech – Difficulty speaking – Stuttering – Difficulty verbalizing – Total visual deficit Related factors – Insufficient information – Insufficient stimuli – Alteration in self-concept – Low self-esteem – Cultural incongruence – Vulnerability – Emotional disturbance – Environmental barrier At risk population – Absence of significant other Associated condition 284

– Alteration in development – Physical barrier – Alteration in perception – Physiological condition – Central nervous system impairment – Psychotic disorder – Oropharyngeal defect – Treatment regimen This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 285

Domain 6. Self-perception Class 1. Self-concept Code Diagnosis 00124 Hopelessness 00185 Readiness for enhanced hope 00174 Risk for compromised human dignity 00121 Disturbed personal identity 00225 Risk for disturbed personal identity 00167 Readiness for enhanced self-concept Class 2. Self-esteem Code Diagnosis 00119 Chronic low self-esteem 00224 Risk for chronic low self-esteem 00120 Situational low self-esteem 00153 Risk for situational low self-esteem Class 3. Body image Code Diagnosis 00118 Disturbed body image NANDA International, Inc. Nursing Diagnoses: Definitions and Classification 2018–2020, 11th Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2017 NANDA International, Inc. Published 2017 by Thieme Medical Publishers, Inc., New York. Companion website: www.thieme.com/nanda-i. 286

Domain 6 • Class 1 • Diagnosis Code 00124 Hopelessness Approved 1986 • Revised 2017 Definition Subjective state in which an individual sees limited or no alternatives or personal choices available and is unable to mobilize energy on own behalf. Defining characteristics – Despondent verbal cues – Inadequate involvement in care – Alteration in sleep pattern – Passivity – Decrease in affect – Poor eye contact – Decrease in appetite – Shrugging in response to speaker – Decrease in initiative – Turning away from speaker – Decrease in response to stimuli – Decrease in verbalization Related factors – Prolonged activity restriction – Social isolation – Chronic stress – Loss of belief in spiritual power – Loss of belief in transcendent values At risk population – History of abandonment Associated condition – Deterioration in physiological condition This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 287

Domain 6 • Class 1 • Diagnosis Code 00185 Readiness for enhanced hope Approved 2006 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of expectations and desires for mobilizing energy on one's own behalf, which can be strengthened. Defining characteristics – Expresses desire to enhance ability to set – Expresses desire to enhance hope achievable goals – Expresses desire to enhance problem-solving to – Expresses desire to enhance belief in possibilities meet goal – Expresses desire to enhance congruency of – Expresses desire to enhance sense of meaning in expectation with goal life – Expresses desire to enhance connectedness with – Expresses desire to enhance spirituality others Original literature support available at http://MediaCenter.thieme.com. 288

Domain 6 • Class 1 • Diagnosis Code 00174 Risk for compromised human dignity Approved 2006 • Revised 2013 • Level of Evidence 2.1 Definition Susceptible for perceived loss of respect and honor, which may compromise health. Risk factors – Cultural incongruence – Intrusion by clinician – Dehumanizing treatment – Invasion of privacy – Disclosure of confidential information – Limited decision-making experience – Exposure of the body – Loss of control over body function – Humiliation – Stigmatization – Insufficient comprehension of health information Original literature support available at http://MediaCenter.thieme.com. 289

Domain 6 • Class 1 • Diagnosis Code 00121 Disturbed personal identity Approved 1978 • Revised 2008, 2017 • Level of Evidence 2.1 Definition Inability to maintain an integrated and complete perception of self. Defining characteristics – Gender confusion – Inability to distinguish between internal and – Alteration in body image – Confusion about cultural values external stimuli – Confusion about goals – Inconsistent behavior – Confusion about ideological values – Ineffective coping strategies – Delusional description of self – Ineffective relationships – Feeling of emptiness – Ineffective role performance – Feeling of strangeness – Fluctuating feelings about self – Low self-esteem – Manic states Related factors – Perceived prejudice – Stages of growth – Alteration in social role – Cult indoctrination – Exposure to toxic chemical – Cultural incongruence – Discrimination – Pharmaceutical agent – Dysfunctional family processes – Psychiatric disorder At risk population – Developmental transition – Situational crisis Associated condition – Dissociative identity disorder – Organic brain disorder 290

Original literature support available at http://MediaCenter.thieme.com. 291

Domain 6 • Class 1 • Diagnosis Code 00225 Risk for disturbed personal identity Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to the inability to maintain an integrated and complete perception of self, which may compromise health. Risk factors – Low self-esteem – Manic states – Alteration in social role – Perceived prejudice – Cult indoctrination – Stages of growth – Cultural incongruence – Discrimination – Situational crisis – Dysfunctional family processes – Pharmaceutical agent At risk population – Psychiatric disorder – Developmental transition – Exposure to toxic chemical Associated condition – Dissociative identity disorder – Organic brain disorder Original literature support available at http://MediaCenter.thieme.com. 292

Domain 6 • Class 1 • Diagnosis Code 00167 Readiness for enhanced self-concept Approved 2002 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of perceptions or ideas about the self, which can be strengthened. Defining characteristics – Expresses satisfaction with body image – Expresses satisfaction with personal identity – Acceptance of limitations – Expresses satisfaction with sense of worth – Acceptance of strengths – Expresses satisfaction with thoughts about self – Actions congruent with verbal expressions – Expresses confidence in abilities – Expresses desire to enhance role performance – Expresses desire to enhance self-concept 293

Domain 6 • Class 2 • Diagnosis Code 00119 Chronic low self-esteem Approved 1988 • Revised 1996, 2008, 2017 • Level of Evidence 2.1 Definition Negative evaluation and/or feelings about one's own capabilities, lasting at least three months. Defining characteristics – Passivity – Poor eye contact – Dependent on others’ opinions – Rejection of positive feedback – Exaggerates negative feedback about self – Repeatedly unsuccessful in life events – Excessive seeking of reassurance – Shame – Guilt – Underestimates ability to deal with situation – Hesitant to try new experiences – Indecisive behavior – Ineffective coping with loss – Nonassertive behavior – Receiving insufficient approval from others – Overly conforming – Spiritual incongruence Related factors – Repeated negative reinforcement – Cultural incongruence – Inadequate affection received – Inadequate belonging – Inadequate group membership – Inadequate respect from others At risk population – Exposure to traumatic situation – Pattern of failure Associated condition – Psychiatric disorder 294

Original literature support available at http://MediaCenter.thieme.com. 295

Domain 6 • Class 2 • Diagnosis Code 00224 Risk for chronic low self-esteem Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to longstanding negative self-evaluating/feelings about self or self- capabilities, which may compromise health. Risk factors – Ineffective coping with loss – Receiving insufficient approval from others – Cultural incongruence – Spiritual incongruence – Inadequate affection received – Inadequate belonging – Repeated negative reinforcement – Inadequate group membership – Inadequate respect from others At risk population – Exposure to traumatic situation – Pattern of failure Associated condition – Psychiatric disorder Original literature support available at http://MediaCenter.thieme.com. 296

Domain 6 • Class 2 • Diagnosis Code 00120 Situational low self-esteem Approved 1988 • Revised 1996, 2000, 2017 Definition Development of a negative perception of self-worth in response to a current situation. Defining characteristics – Self-negating verbalizations – Situational challenge to self-worth – Helplessness – Underestimates ability to deal with situation – Indecisive behavior – Nonassertive behavior – Inadequate recognition – Purposelessness – Pattern of helplessness – Unrealistic self-expectations Related factors – History of neglect – Alteration in body image – History of rejection – Alteration in social role – Pattern of failure – Behavior inconsistent with values – Decrease in control over environment – Physical illness At risk population – Developmental transition – History of abandonment – History of abuse – History of loss Associated condition – Functional impairment This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is 297

completed to bring it up to a level of evidence 2.1 or higher. 298

Domain 6 • Class 2 • Diagnosis Code 00153 Risk for situational low self-esteem Approved 2000 • Revised 2013, 2017 Definition Susceptible to developing a negative perception of self-worth in response to a current situation, which may compromise health. Risk factors – Inadequate recognition – Pattern of helplessness – Alteration in body image – Unrealistic self-expectations – Alteration in social role – Behavior inconsistent with values – History of neglect – Decrease in control over environment – History of rejection – Pattern of failure At risk population – Physical illness – Developmental transition – History of abandonment – History of abuse – History of loss Associated condition – Functional impairment This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 299

Domain 6 • Class 3 • Diagnosis Code 00118 Disturbed body image Approved 1973 • Revised 1998, 2017 Definition Confusion in mental picture of one's physical self. Defining characteristics – Absence of body part – Focus on past appearance – Alteration in body function – Focus on past function – Alteration in body structure – Focus on previous strength – Alteration in view of one's body – Heightened achievement – Avoids looking at one's body – Hiding of body part – Avoids touching one's body – Negative feeling about body – Behavior of acknowledging one's body – Nonverbal response to change in body – Behavior of monitoring one's body – Nonverbal response to perceived change in body – Change in ability to estimate spatial relationship – Overexposure of body part – Perceptions that reflect an altered view of one's of body to environment – Change in lifestyle body appearance – Change in social involvement – Personalization of body part by name – Depersonalization of body part by use of – Personalization of loss by name – Preoccupation with change impersonal pronouns – Preoccupation with loss – Depersonalization of loss by use of impersonal – Refusal to acknowledge change – Trauma to nonfunctioning body part pronouns – Emphasis on remaining strengths – Extension of body boundary – Fear of reaction by others Related factors – Spiritual incongruence – Alteration in self-perception – Cultural incongruence At risk population – Developmental transition 300

Associated condition – Injury – Surgical procedure – Alteration in body function – Trauma – Alteration in cognitive functioning – Treatment regimen – Illness – Impaired psychosocial functioning This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 301

Class 1. Domain 7. Code Role relationship 00061 00062 Caregiving roles 00056 Diagnosis 00057 Caregiver role strain 00164 Risk for caregiver role strain Impaired parenting Class 2. Risk for impaired parenting Code Readiness for enhanced parenting 00058 00063 Family relationships 00060 Diagnosis 00159 Risk for impaired attachment Dysfunctional family processes Class 3. Interrupted family processes Code Readiness for enhanced family processes 00223 00229 Role performance 00207 Diagnosis 00064 Ineffective relationship 00055 Risk for ineffective relationship 00052 Readiness for enhanced relationship Parental role conflict Ineffective role performance Impaired social interaction 302

NANDA International, Inc. Nursing Diagnoses: Definitions and Classification 2018–2020, 11th Edition. Edited by T. Heather Herdman and Shigemi Kamitsuru. © 2017 NANDA International, Inc. Published 2017 by Thieme Medical Publishers, Inc., New York. Companion website: www.thieme.com/nanda-i. 303

Domain 7 • Class 1 • Diagnosis Code 00061 Caregiver role strain Approved 1992 • Revised 1998, 2000, 2017 • Level of Evidence 2.1 Definition Difficulty in fulfilling care responsibilities, expectations and/or behaviors for family or significant others. Defining characteristics Caregiving Activities – Apprehensiveness about future ability to provide – Difficulty completing required tasks care – Difficulty performing required tasks – Dysfunctional change in caregiving activities – Apprehensiveness about future health of care – Preoccupation with care routine receiver – Apprehensiveness about potential institutionalization of care receiver – Apprehensiveness about well-being of care receiver if unable to provide care Caregiver Health Status: Physiological – Fatigue – Hypertension – Gastrointestinal distress – Rash – Headache – Weight change Caregiver Health Status: Emotional – Alteration in sleep pattern – Ineffective coping strategies – Anger – Insufficient time to meet personal needs – Depression – Nervousness – Emotional vacillation – Somatization – Frustration – Stressors – Impatience Caregiver Health Status: Socioeconomic 304

– Change in leisure activities – Refusal of career advancement – Low work productivity – Social isolation Caregiver-Care Receiver Relationship – Difficulty watching care receiver with illness – Uncertainty about changes in relationship with care receiver – Grieving of changes in relationship with care receiver Family Processes – Family conflict – Concern about family member(s) Related factors – Problematic behavior – Substance misuse Care Receiver – Unpredictability of illness trajectory – Unstable health condition – Condition inhibits conversation – Dependency – Discharged home with significant needs – Increase in care needs Caregiver – Insufficient fulfillment of self-expectations – Insufficient knowledge about community – Physical conditions – Substance misuse resources – Unrealistic self-expectations – Insufficient privacy – Competing role commitments – Insufficient recreation – Ineffective coping strategies – Isolation – Inexperience with caregiving – Not developmentally ready for caregiver role – Insufficient emotional resilience – Stressors – Insufficient energy – Insufficient fulfillment of others' expectations Caregiver-Care Receiver Relationship – Abusive relationship – Unrealistic care receiver expectations – Codependency – Violent relationship – Pattern of ineffective relationships – Presence of abuse Caregiving Activities 305

– Around-the-clock care responsibilities – Inadequate physical environment for providing – Change in nature of care activities care – Complexity of care activities – Excessive caregiving activities – Insufficient assistance – Extended duration of caregiving required – Insufficient equipment for providing care – Insufficient respite for caregiver Family Processes – Insufficient time – Unpredictability of care situation – Family isolation – Ineffective family adaptation – Pattern of family dysfunction prior to the – Pattern of family dysfunction caregiving situation Socioeconomic – Pattern of ineffective family coping – Alienation – Insufficient community resources – Difficulty accessing assistance – Insufficient social support – Difficulty accessing community resources – Insufficient transportation – Difficulty accessing support – Social isolation At risk population – Female caregiver – Financial crisis – Care receiver's condition inhibits conversation – Partner as caregiver – Developmental delay of care receiver – Prematurity – Developmental delay of caregiver – Exposure to violence Associated condition – Illness severity Care Receiver – Psychiatric disorder – Psychological disorder – Alteration in cognitive functioning – Chronic illness – Psychological disorder – Congenital disorder Caregiver – Alteration in cognitive functioning – Health impairment 306

Domain 7 • Class 1 • Diagnosis Code 00062 Risk for caregiver role strain Approved 1992 • Revised 2010, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to difficulty in fulfilling care responsibilities, expectations and/or behaviors for family or significant others, which may compromise health. Risk factors – Substance misuse – Unpredictability of illness trajectory Care Receiver – Unstable health condition – Unstable health condition – Dependency – Discharged home with significant needs – Increase in care needs – Problematic behavior Caregiver – Insufficient knowledge about community resources – Substance misuse – Unrealistic self-expectations – Insufficient privacy – Competing role commitments – Insufficient recreation – Ineffective coping strategies – Isolation – Inexperience with caregiving – Not developmentally ready for caregiver role – Insufficient emotional resilience – Physical conditions – Insufficient energy – Stressors – Insufficient fulfillment of others' expectations – Insufficient fulfillment of self-expectations Caregiver-Care Receiver Relationship – Abusive relationship – Unrealistic care receiver expectations – Codependency – Violent relationship – Pattern of ineffective relationships – Presence of abuse Caregiving Activities 307

– Around-the-clock care responsibilities – Excessive caregiving activities – Change in nature of care activities – Extended duration of caregiving required – Complexity of care activities – Insufficient respite for caregiver – Inadequate physical environment for providing – Insufficient time – Unpredictability of care situation care – Insufficient assistance – Insufficient equipment for providing care Family Processes – Pattern of family dysfunction prior to the caregiving situation – Family isolation – Ineffective family adaptation – Pattern of ineffective family coping – Pattern of family dysfunction Socioeconomic – Insufficient community resources – Insufficient social support – Alienation – Insufficient transportation – Difficulty accessing assistance – Social isolation – Difficulty accessing community resources – Difficulty accessing support At risk population – Female caregiver – Financial crisis – Care receiver's condition inhibits conversation – Partner as caregiver – Developmental delay of care receiver – Prematurity – Developmental delay of caregiver – Exposure to violence Associated condition – Illness severity Care Receiver – Psychological disorder – Psychiatric disorder – Alteration in cognitive functioning – Chronic illness – Psychological disorder – Congenital disorder Caregiver – Alteration in cognitive functioning – Health impairment 308

Domain 7 • Class 1 • Diagnosis Code 00056 Impaired parenting Approved 1978 • Revised 1998, 2017 Definition Inability of primary caregiver to create, maintain or regain an environment that promotes the optimum growth and development of the child. Defining characteristics – History of abuse Infant or Child – History of trauma – Impaired social functioning – Behavioral disorder – Insufficient attachment behavior – Delay in cognitive development – Low academic performance – Diminished separation anxiety – Run away from home – Failure to thrive – Frequent accidents – Inappropriate stimulation – Frequent illness – Inconsistent behavior management – Inconsistent care Parental – Inflexibility in meeting needs of child – Neglects needs of child – Abandonment of child – Perceived inability to meet child's needs – Failure to provide safe home environment – Perceived role inadequacy – Decrease in ability to manage child – Punitive – Decrease in cuddling – Rejection of child – Deficient parent-child interaction – Speaks negatively about child – Frustration with child – Hostility – Temperament conflicts with parental expectations – Inadequate child health maintenance – Inappropriate care-taking skills – Inappropriate child-care arrangements Related factors Infant or Child – Prolonged separation from parent 309

Parental – Alteration in sleep pattern – Insufficient parental role model – Conflict between partners – Insufficient prenatal care – Depression – Insufficient problem-solving skills – Failure to provide safe home environment – Insufficient resources – Father of child uninvolved – Insufficient response to infant cues – Inability to put child's needs before own – Insufficient social support – Inadequate child-care arrangements – Insufficient transportation – Ineffective communication skills – Insufficient valuing of parenthood – Ineffective coping strategies – Late-term prenatal care – Insufficient access to resources – Low self-esteem – Insufficient family cohesiveness – Mother of child uninvolved – Insufficient knowledge about child development – Nonrestorative sleep pattern – Insufficient knowledge about child health – Preference for physical punishment – Role strain maintenance – Sleep deprivation – Insufficient knowledge about parenting skills – Social isolation – Stressors – Unrealistic expectations At risk population – Gender other than desired Infant or Child – Prematurity – Developmental delay – Legal difficulty – Difficult temperament – Low educational level – Multiple births Parental – Relocation – Single parent – Change in family unit – Unemployment – Closely spaced pregnancies – Unplanned pregnancy – Difficult birthing process – Unwanted pregnancy – Economically disadvantaged – Work difficulty – High number of pregnancies – Young parental age – History of abuse – History of being abusive – History of mental illness – History of substance misuse – Insufficient cognitive readiness for parenting Associated condition 310

Infant or Child – Chronic illness – Disabling condition – Alteration in perceptual abilities – Behavioral disorder – Physical illness Parental – Alteration in cognitive functioning – Disabling condition This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 311

Domain 7 • Class 1 • Diagnosis Code 00057 Risk for impaired parenting Approved 1978 • Revised 1998, 2013, 2017 Definition Susceptible to primary caregiver difficulty in creating, maintaining or regaining an environment that promotes the optimum growth and development of the child, which may compromise the well-being of the child. Risk factors – Temperament conflicts with parental expectations Infant or Child – Prolonged separation from parent Parental – Alteration in sleep pattern – Insufficient parental role model – Conflict between partners – Insufficient prenatal care – Depression – Insufficient problem-solving skills – Failure to provide safe home environment – Insufficient resources – Father of child uninvolved – Insufficient response to infant cues – Inability to put child's needs before own – Insufficient social support – Inadequate child-care arrangements – Insufficient transportation – Ineffective communication skills – Insufficient valuing of parenthood – Ineffective coping strategies – Late-term prenatal care – Insufficient access to resources – Low self-esteem – Insufficient family cohesiveness – Mother of child uninvolved – Insufficient knowledge about child development – Nonrestorative sleep pattern – Insufficient knowledge about child health – Preference for physical punishment – Role strain maintenance – Sleep deprivation – Insufficient knowledge about parenting skills – Social isolation – Stressors – Unrealistic expectations At risk population 312

Infant or Child – Gender other than desired – Prematurity – Developmental delay – Difficult temperament – Legal difficulty – Low educational level Parental – Multiple births – Relocation – Change in family unit – Single parent – Closely spaced pregnancies – Unemployment – Difficult birthing process – Unplanned pregnancy – Economically disadvantaged – Unwanted pregnancy – High number of pregnancies – Work difficulty – History of abuse – Young parental age – History of being abusive – History of mental illness – History of substance misuse – Insufficient cognitive readiness for parenting Associated condition – Chronic illness Infant or Child – Disabling condition – Alteration in perceptual abilities – Physical illness – Behavioral disorder Parental – Alteration in cognitive functioning – Disabling condition This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 313

Domain 7 • Class 1 • Diagnosis Code 00164 Readiness for enhanced parenting Approved 2002 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of providing an environment for children to nurture growth and development, which can be strengthened. Defining characteristics – Parent expresses desire to enhance emotional support of children – Children express desire to enhance home environment – Parent expresses desire to enhance emotional support of other dependent person – Parent expresses desire to enhance parenting 314

Domain 7 • Class 2 • Diagnosis Code 00058 Risk for impaired attachment Approved 1994 • Revised 2008, 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to disruption of the interactive process between parent or significant other and child that fosters the development of a protective and nurturing reciprocal relationship. Risk factors – Parental conflict resulting from disorganized infant behavior – Anxiety – Child's illness prevents effective initiation of – Parent-child separation – Physical barrier parental contact – Substance misuse – Disorganized infant behavior – Inability of parent to meet personal needs – Insufficient privacy At risk population – Premature infant 315

Domain 7 • Class 2 • Diagnosis Code 00063 Dysfunctional family processes Approved 1994 • Revised 2008, 2017 • Level of Evidence 2.1 Definition Family functioning which fails to support the well-being of its members. Defining characteristics Behavioral – Agitation – Inability to express a wide range of feelings – Alteration in concentration – Inability to meet the emotional needs of its – Blaming – Broken promises members – Chaos – Inability to meet the security needs of its – Complicated grieving – Conflict avoidance members – Contradictory communication pattern – Inability to meet the spiritual needs of its – Controlling communication pattern – Criticizing members – Decrease in physical contact – Inability to receive help appropriately – Denial of problems – Inappropriate anger expression – Dependency – Ineffective communication skills – Difficulty having fun – Insufficient knowledge about substance misuse – Difficulty with intimate relationship – Insufficient problem-solving skills – Difficulty with life-cycle transition – Lying – Disturbance in academic performance in children – Manipulation – Enabling substance use pattern – Nicotine addiction – Escalating conflict – Orientation favors tension relief rather than goal – Failure to accomplish developmental tasks – Harsh self-judgment attainment – Immaturity – Paradoxical communication pattern – Inability to accept a wide range of feelings – Power struggles – Inability to accept help – Rationalization – Inability to adapt to change – Refusal to get help – Inability to deal constructively with traumatic – Seeking of affirmation – Seeking of approval experiences – Self-blame – Unreliable behavior – Social isolation – Special occasions centered on substance use – Stress-related physical illness – Substance misuse 316

– Verbal abuse of children – Verbal abuse of parent – Verbal abuse of partner Feelings – Hurt – Insecurity – Abandonment – Lingering resentment – Anger – Loneliness – Anxiety – Loss – Confuses love and pity – Loss of identity – Confusion – Low self-esteem – Depression – Mistrust – Dissatisfaction – Moodiness – Distress – Powerlessness – Embarrassment – Rejection – Emotional isolation – Repressed emotions – Emotionally controlled by others – Shame – Failure – Taking responsibility for substance misuser's – Fear – Feeling different from others behavior – Feeling misunderstood – Tension – Feeling unloved – Unhappiness – Frustration – Vulnerability – Guilt – Worthlessness – Hopelessness – Hostility Roles and Relationships – Change in role function – Ineffective communication with partner – Chronic family problems – Insufficient cohesiveness – Closed communication system – Insufficient family respect for autonomy of its – Conflict between partners – Deterioration in family relationships members – Diminished ability of family members to relate to – Insufficient family respect for individuality of its each other for mutual growth and maturation members – Disruption in family rituals – Insufficient relationship skills – Disruption in family roles – Neglect of obligation to family member – Disturbance in family dynamics – Pattern of rejection – Family denial – Perceived insufficient parental support – Inconsistent parenting – Triangulating family relationships Related factors – Insufficient problem-solving skills – Addictive personality 317

– Ineffective coping strategies – Substance misuse At risk population – Family history of substance misuse – Genetic predisposition to substance misuse – Economically disadvantaged – Family history of resistance to treatment – Surgical procedure Associated condition – Biological factors – Intimacy dysfunction 318

Domain 7 • Class 2 • Diagnosis Code 00060 Interrupted family processes Approved 1982 • Revised 1998, 2017 Definition Break in the continuity of family functioning which fails to support the well- being of its members. Defining characteristics – Changes in expressions of conflict with community resources – Change in availability for affective responsiveness – Changes in expressions of isolation from community resources – Change in family conflict resolution – Change in family satisfaction – Changes in participation for decision-making – Change in intimacy – Changes in relationship pattern – Change in participation for problem-solving – Decrease in available emotional support – Assigned tasks change – Decrease in mutual support – Change in communication pattern – Ineffective task completion – Change in somatization – Power alliance change – Change in stress-reduction behavior – Ritual change Related factors – Power shift among family members – Shift in family roles – Changes in interaction with community At risk population – Developmental transition – Situational crisis – Change in family finances – Situational transition – Change in family social status – Developmental crisis Associated condition – Shift in health status of a family member 319

This diagnosis will retire from the NANDA-I Taxonomy in the 2021-2023 edition unless additional work is completed to bring it up to a level of evidence 2.1 or higher. 320

Domain 7 • Class 2 • Diagnosis Code 00159 Readiness for enhanced family processes Approved 2002 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of family functioning to support the well-being of its members, which can be strengthened. Defining characteristics – Expresses desire to enhance balance between – Expresses desire to enhance family resilience autonomy and cohesiveness – Expresses desire to enhance growth of family – Expresses desire to enhance communication members pattern – Expresses desire to enhance interdependence with – Expresses desire to enhance energy level of community family to support activities of daily living – Expresses desire to enhance maintenance of – Expresses desire to enhance family adaptation to boundaries between family members change – Expresses desire to enhance respect for family – Expresses desire to enhance family dynamics members – Expresses desire to enhance safety of family members 321

Domain 7 • Class 3 • Diagnosis Code 00223 Ineffective relationship Approved 2010 • Revised 2017 • Level of Evidence 2.1 Definition A pattern of mutual partnership that is insufficient to provide for each other's needs. Defining characteristics – Delay in meeting of developmental goals – Inadequate understanding of partner's appropriate for family life-cycle stage compromised functioning – Dissatisfaction with complementary relationship – Insufficient balance in autonomy between between partners partners – Dissatisfaction with emotional need fulfillment – Insufficient balance in collaboration between between partners partners – Dissatisfaction with idea sharing between – Insufficient mutual respect between partners partners – Insufficient mutual support in daily activities – Dissatisfaction with information sharing between between partners partners – Partner not identified as support person – Dissatisfaction with physical need fulfillment between partners – Unsatisfying communication with partner Related factors – Substance misuse – Unrealistic expectations – Ineffective communication skills – Stressors At risk population – Incarceration of one partner – Developmental crisis – History of domestic violence Associated condition – Alteration in cognitive functioning in one partner 322

Original literature support available at http://MediaCenter.thieme.com. 323

Domain 7 • Class 3 • Diagnosis Code 00229 Risk for ineffective relationship Approved 2010 • Revised 2013, 2017 • Level of Evidence 2.1 Definition Susceptible to developing a pattern that is insufficient for providing a mutual partnership to provide for each other's needs. Risk factors – Substance misuse – Unrealistic expectations – Ineffective communication skills – Stressors At risk population – Incarceration of one partner – Developmental crisis – History of domestic violence Associated condition – Alteration in cognitive functioning in one partner Original literature support available at http://MediaCenter.thieme.com. 324

Domain 7 • Class 3 • Diagnosis Code 00207 Readiness for enhanced relationship Approved 2006 • Revised 2013 • Level of Evidence 2.1 Definition A pattern of mutual partnership to provide for each other's needs, which can be strengthened. Defining characteristics – Expresses desire to enhance satisfaction with emotional need fulfillment for each partner – Expresses desire to enhance autonomy between partners – Expresses desire to enhance satisfaction with idea sharing between partners – Expresses desire to enhance collaboration between partners – Expresses desire to enhance satisfaction with information sharing between partners – Expresses desire to enhance communication between partners – Expresses desire to enhance satisfaction with physical need fulfillment for each partner – Expresses desire to enhance emotional need fulfillment for each partner – Expresses desire to enhance understanding of partner's functional deficit – Expresses desire to enhance mutual respect between partners – Expresses desire to enhance satisfaction with complementary relationship between partners Original literature support available at http://MediaCenter.thieme.com. 325