Nurse's Pocket Guide

POWERLESSNESS
• Note availability/use of resources.
• Investigate caregiver practices. Do they support client control/
responsibility?
NURSING PRIORITY NO.2.To assess degree of powerlessness experienced
by client:
• Listen to statements client makes: “They don’t care”; “It won’t
make any difference”; “Are you kidding?”
• Note expressions that indicate “giving up,” such as “It won’t do
any good.”
• Note behavioral responses (verbal and nonverbal) including
expressions of fear, interest or apathy, agitation, withdrawal.
• Note lack of communication, flat affect, and lack of eye
contact.
• Identify the use of manipulative behavior and reactions of
client and caregivers. Manipulation is used for management
of powerlessness because of distrust of others, fear of intimacy,
search for approval, and validation of sexuality.
NURSING PRIORITY NO. 3.To assist client to clarify needs relative
to ability to meet them:
• Show concern for client as a person.
• Make time to listen to client’s perceptions and concerns and
encourage questions.
• Accept expressions of feelings, including anger and hopelessness.
• Avoid arguing or using logic with hopeless client. Client will
not believe it can make a difference.
• Deal with manipulative behavior by being straightforward
and honest with your communication and letting client know
that this is a better way to get needs met.
• Express hope for the client. (There is always hope of something.)
• Identify strengths/assets and past coping strategies that were
successful. Helps client to recognize own ability to deal with
difficult situation.
• Assist client to identify what he or she can do for self. Identify
things the client can/cannot control.
• Encourage client to maintain a sense of perspective about the
situation.
NURSING PRIORITY NO.4.To promote independence:
• Use client’s locus of control to develop individual plan of care
(e.g., for client with internal control, encourage client to take
control of own care and for those with external control, begin
with small tasks and add, as tolerated).
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
542 Cultural Collaborative Community/Home Care