- Ineffective Denial related to personal vulnerability and lack of control over substance use as evidenced by delay in seeking or refusal to seek medical consult and uses manipulation to avoid responsibility for self.
- Ineffective coping related to negative role modeling, inadequate preparation for stress and ineffective stress relief strategies as evidenced by impaired problem-solving skills and impaired adaptive behavior.
- Powerlessness related to failed attempts at recovery and substance addiction with or without periods of abstinence as evidenced by ineffective recovery attempts and statements of inability to stop behavior or requests for help.
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective Data: Expresses unpleasant behaviours and being Vulnerable Objective Data: -Personal vulnerability -Lack of control over substance use -The threat of unpleasant reality -Inadequate emotional support -Previously ineffective coping skills -Learned response patterns -Personal or family value systems -Cultural factors | Ineffective Denial related to personal vulnerability and lack of control over substance use as evidenced by delay in seeking or refusal to seek medical consult and uses manipulation to avoid responsibility for self. | The patient will report awareness of the substance abuse problem The patient will verbalize acceptance of responsibility for their behavior The patient will engage in the planning and implementation of the treatment regimen related to substance abuse | 1. Convey an attitude of acceptance while separating the individual from their behavior. This will help promote feelings of self-worth and dignity for the patient. The nurse must remain non-judgemental when treating a patient with addiction. 2. Provide accurate information about the patient’s condition. Providing unbiased information will help the patient make informed decisions regarding accepting their problem and choosing an appropriate treatment. 3. Answer the patient’s questions honestly and factually. This helps promote trust, which is the basis of a therapeutic relationship and necessary when navigating delicate situations. 4. Discuss the consequences of continued substance abuse. A patient who dismisses the magnitude of the situation may need consequences presented matter-of-factly. Provide factual statistics regarding morbidity and mortality. 5. Provide positive feedback for expressing denial awareness in self and others. Positive feedback can enhance the patient’s self-esteem and reinforces insight into the patient’s behavior. 6. Encourage and support the patient’s ability to take responsibility for their recovery. Denial is addressed when the patient can accept their responsibility. Encouragement and support are necessary to turn denial into positive action. | The patient reported awareness of the substance abuse problem The patient verbalized acceptance of responsibility for their behavior The patient engaged in the planning and implementation of the treatment regimen related to substance abuse |
| Subjective Data: -Verbalizes an inability to cope and handle stressors -Complaints of secondary concerns from lack of coping (sleep disturbances, fatigue, lack of appetite) Objective Data: -Not caring for basic needs (poor grooming and hygiene, not eating nutritionally adequate meals) -Insufficient skills to meet goals, problem-solve or reach resolutions -Behaviors that impede progress (defensive speech, making excuses, manipulation) -Inability to handle life responsibilities and activities of daily living -Use of drugs, alcohol, or medication as coping mechanisms | Ineffective Coping related to negative role modeling, inadequate preparation for stress and ineffective stress relief strategies as evidenced by impaired problem-solving skills and impaired adaptive behavior. | The patient will recognize instances that cause increased stress and a desire to use substances The patient will use appropriate coping and problem-solving skills in place of substance use | 1. Set limits and confront the patient’s efforts in making excuses. Patients suffering from substance abuse tend to exhibit manipulative behaviors to get what they want. Following through on the consequences of failure to maintain these limits is necessary for effective treatment. 2. Encourage the patient to verbalize fears, feelings, and anxiety. This enables a trusting relationship that will help the patient to come to terms with unresolved or unconscious problems in life that contribute to substance abuse. 3. Explore alternative coping strategies with the patient. The patient may have limited knowledge of appropriate ways to respond to stress. Providing alternative coping strategies will help the patient explore more appropriate options for managing stress, feelings, and relationships without abusing substances. 4. Assist in relaxation techniques, visualizations, and diversions. This allows the patient to relax and develop new ways to deal with problems and stress. Diversional activities are a useful coping mechanism when learning to replace prior behavior. 5. Encourage support available for the patient. Support groups and programs for managing substance use are available and will help patients with follow-through care after discharge. The patient may also select a sponsor who they can contact whenever cravings arise. | Patient identified their disruptive behaviors and how they prevent them from coping effectively. Patient verbalized appropriate coping strategies and resources to prevent ineffective coping. Patient expressed confidence in handling their stressors and when to ask for help. |
| Subjective Data: Verbalizes unable to stop the substance use and feeling weak Objective Data: -Statements of inability to stop behavior or requests for help -Expresses doubt about role performance -Continuous thinking about drug or alcohol use -Alteration in occupational, personal, and social life -Feelings of anger or guilt -Verbalizes a lack of self-control | Powerlessness related to failed attempts at recovery and substance addiction with or without periods of abstinence as evidenced by ineffective recovery attempts and statements of inability to stop behavior or requests for help. | The patient will verbalize areas where they have control over their substance abuse The patient will participate in the therapeutic regimen and group peer support | 1. Show genuine concern. A patient who is lost to powerlessness may believe they are beyond help. If a healthcare provider can show genuine concern and a vested interest in helping the patient overcome their substance abuse, it can provide a sense of hope. 2. Develop a contract. A contract can lay out agreed-upon goals which can enhance a commitment to the plan. 3. Role-play assertive behaviors. A patient who is not used to feeling control over their behavior may need help in creating healthy dynamics. The nurse can assist the patient in acting out scenarios that display assertive and confident responses. 4. Help identify areas of control. Overcoming substance abuse can seem impossible, especially if the patient has experienced multiple failures. Help them identify areas where they do have control such as implementing other healthy habits, setting boundaries, and reducing contact with those who are a negative influence | The patient verbalized areas where that they have control over their substance abuse The patient participated in the therapeutic regimen and group peer support |