Gabby is a firefighter
who is very workaholic but a family-centered man. He has 2 kids, a boy and a
girl. They are a perfect family. One day when Gabby is on duty, driving their fire
truck together with his team, an SUV is approaching fast that ran through their
fire truck head on. Other crew incurred minor scratches but Gabby attained leg
injury. Fortunately, the first diagnostic examinations and treatments lead to
Gabby to go back to work again. As days past, Gabby have been experiencing leg
pain. Although he can manage it and ignore, he decided to have a doctor to
check it and found out that blood clots are accumulating in his leg
muscles and tissues and a need for surgery is necessary to remove those clots
and prevent it from coming back. The doctor said that after the surgery Gabby needs
to rest and take a leave from his work for 3 months for a full recovery which
is Gabby don't want to agree and keep delaying his surgery. Below is a sample
of decisional conflict nursing care plan of Gabby, a firefighter who do not
want to take 3 months leave since his family needs financial assistance.
ASSESSMENT
Subjective:
"I want to start my surgery but it will take 3 months before I will fully recover. My family depends on me and the 3-month absences in my work would cause us to much trouble," as verbalized by the patient.
Objectives:
I observed that the
patient is vacillating between alternative choices. Because of that, there is a
delay on decision-making and self-focus. Restlessness also observed as the
client can find his/her comfort and cannot stay still.
Vital signs are taken
and noted as follows: Body temperature is 36.6 degrees Celsius, blood pressure
is 130/80 mmHg, respiratory rate is 18 cycles per minute, and pulse rate is 112
beats per minute. The client's body temperature, blood pressure, and pulse rate
are normal but his/her blood pressure is categorized as pre-hypertension.
DIAGNOSIS
Decisional conflict
related to moral obligation requires performed or not performing actions as
manifested by delayed decision-making.
PLANNING
After 4 hours of nursing
intervention the patient will be able to make decision and express satisfaction
with the choice and free of physical signs of distress. (Why 4 hours? the
primary goal is to help the client make the best decision for himself, to
decide on a short period of time but have enough time to think about his
decision).
INTERVENTION
- Before you start any
intervention, try to actively listen to the reason of Gabby, your patient, for
indecisiveness because this will clarify his problem and work toward to a
solution. While listening to the patient, you will determine his usual ability
to manage own affairs. Note for his expressions of indecision and dependence on
others. Note: Remember that accurate and clearly understood information about
situation will help Gabby to make the best decision for himself. Also you must
accept verbal expressions of anger or guilt but you need to set limits on
maladaptive behavior to promote the patient's safety. If you find something
that Gabby was misinterpreted or misconnected, correct it and provide him factual
information because this will provide his better decision.
- Choices may have
risky, uncertain outcomes reflect a need to make value judgments or may
generate anticipated regret over having to reject positive choice and accept
negative consequences. Just support Gabby for decisions he made, especially if
consequences are unexpected or difficult to cope with. Provide positive
feedback for efforts and progress noted.
EVALUATION
After 4 hours of nursing intervention the patient was able to make decision and expressed satisfaction with the choice and free of physical signs of distress. (It's okay if the patient took much more time to completely decide but if the patient is still can't decide on his/her own. Try to reassess the patient and make a nursing care plan again).
For more samples of nursing care plan you are free to check it out in our NCP LIST page.
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