Gabby is a firefighter who is very workaholic but a family-centered man. He have 2 kids, a boy and a girl. They are a perfect family. One day when Gabby is on duty, driving their firetruck together with his team, an SUV is approaching fast that ran through their firetruck 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 Celcius, 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 temprature, blood pressure, and pulse rate are normal but his/her blood pressure is categorize as pre-hypertention.
DIAGNOSIS
Decisional conflict related to moral obligation requires performity 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 him/her self, to decide on a short period of time but have enough time to think about his/her 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, 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 misconcepted, correct it and provide him a factual information because this will provide his better decision.
- Choices may have risky, uncertain outcomes and msg reflect a need to make value judgements 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).
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