Nurse's Pocket Guide

• Develop contract with client specifying goals agreed on.
Enhances commitment to plan, optimizing outcomes.
• Treat expressed decisions and desires with respect. Avoid critical
parenting behaviors and communications.
• Provide client opportunities to control as many events as
energy and restrictions of care permit.
• Discuss needs openly with client and set up agreed-on routines
for meeting identified needs. Minimizes use of manipulation.
• Minimize rules and limit continuous observation to the degree
that safety permits to provide sense of control for the client.
• Support client efforts to develop realistic steps to put plan
into action, reach goals, and maintain expectations.
• Provide positive reinforcement for desired behaviors.
• Direct client’s thoughts beyond present state to future when
appropriate.
• Schedule frequent brief visits to check on client, deal with
client needs, and let client know someone is available.
• Involve SO(s) in client care as appropriate.
NURSING PRIORITY NO. 5. To promote wellness (Teaching/
Discharge Considerations):
• Instruct in/encourage use of anxiety and stress-reduction
techniques.
• Provide accurate verbal and written information about what
is happening and discuss with client/SO(s). Repeat as often as
necessary.
• Assist client to set realistic goals for the future.
• Assist client to learn/use assertive communication skills. Use of
I-messages, active-listening, and problem solving encourages
client to be more in control of own life.
• Refer to occupational therapist/vocational counselor, as indicated.
Facilitates return to a productive role in whatever
capacity possible for the individual.
• Encourage client to think productively and positively and take
responsibility for choosing own thoughts.
• Problem solve with client/SO(s). Outcome is more likely to
be accepted when arrived at by all parties involved.
• Suggest periodic review of own needs/goals.
• Refer to support groups, counseling/therapy, and so forth, as
indicated.
Documentation Focus
ASSESSMENT/REASSESSMENT
• Individual findings, noting degree of powerlessness, locus of
control, individual’s perception of the situation.
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
Diagnostic Studies Pediatric/Geriatric/Lifespan Medications 543
POWERLESSNESS