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INEFFECTIVE DENIAL Nursing Care Plan

Ineffective Denial

NANDA-I Definition
Conscious or unconscious attempt to disavow the knowledge or
meaning of an event to reduce anxiety and/or fear, leading to the
detriment of health
Defining Characteristics**
Major* (Must Be Present)
Delays seeking or refuses health care attention
Does not perceive personal relevance of symptoms or danger
Minor (May Be Present)
Uses home remedies (self-treatment) to relieve symptoms
Does not admit fear of death or invalidism*
Minimizes symptoms*
Displaces the source of symptoms to other areas of the body
Cannot admit the effects of the disease on life pattern
Makes dismissive gestures when speaking of distressing events*
Displaces the fear of effects of the condition
Displays inappropriate affect*

Related Factors
Pathophysiologic
Related to inability to tolerate consciously the consequences of
(any chronic or terminal illness) secondary to:
AIDS
Cancer
HIV infection
Progressive debilitating disorders
(e.g., multiple sclerosis,
myasthenia gravis)
Treatment Related
Related to prolonged treatment with no positive results
Psychological
Related to inability to tolerate consciously the consequences of:
Loss of a job
Financial crisis
Negative self-concept, inadequacy,
guilt, loneliness,
despair, sense of failure
Smoking
Obesity
Loss of spouse/significant other
Domestic abuse
Related to physical and emotional dependence on (Varcarolis, 2011):
Alcohol
Cocaine, crack
Stimulants
Opiates
Cannabis
Barbiturates/sedatives
Hallucinogens
Related to long-term self-destructive patterns of behavior and lifestyle
(Varcarolis, 2011)
Related to feelings of increased anxiety/stress, need to escape personal
problems, anger, and frustration
Related to feelings of omnipotence
Related to culturally permissive attitudes toward alcohol/drug use
Related to genetic origins of alcoholism

Author's Notes
Ineffective Denial differs from denial in response to loss. Denial in
response to illness or loss is necessary and beneficial to maintain
psychological
equilibrium. Ineffective Denial is not beneficial when the
person will not participate in regimens to improve health or the situation
(e.g., denies substance abuse). If the cause is not known, Ineffective
Denial related to unknown etiology can be used, such as Ineffective Denial
related to unknown etiology as evidenced by repetitive refusal to admit
barbiturate use is a problem.

Goal
The client will use alternative coping mechanism in response to
stressor instead of denial as evidenced by the following indicators:
• Acknowledge the source of anxiety or stress.
• Use problem-focused coping skills.

Interventions
Initiate a Therapeutic Relationship
• Assess effectiveness of denial.
• Avoid confronting the client that he or she is using denial.
• Approach the client directly, matter-of-factly, and
nonjudgmentally.
Encourage the Client to Share Perceptions of the Situation
(e.g., Fears, Anxieties)
• Focus on the feelings shared.
• Use reflection to encourage more sharing.
When Appropriate, Help the Client With Problem Solving
• Attempt to elicit from the client a description of the problem.
Assist the Client to Understand Addictions
• Be nonjudgmental.
• Assist the client to gain an intellectual understanding that this
is an illness, not a moral problem.
• Provide opportunities to perform successfully; gradually
increase
responsibility.
• Provide educational information about the progressive nature
of substance abuse and its effects on the body and interpersonal
relationships.
• Explain that “addiction does not cure itself” and that it
requires abstinence and treatment of the underlying issues.
(Varcarolis, 2011, p. 336).
• Provide opportunities to share fears and anxieties.
• Assist in lowering anxiety level (see Anxiety for additional
interventions).
• Avoid confronting person on use of denial.
• Carefully explore with person his or her interpretation of the
situation:
• Reflect self-reported cues used to minimize the situation
(e.g., “a little,” “only”).
• Identify recent detrimental behavior and discuss the effects
of this behavior on health.
• Emphasize strengths and past successful coping.
• Provide positive reinforcement for any expressions of insight.
• Do not accept rationalization or projection. Be polite, caring,
but firm.
• If substance abuse is present:
• Review observations and findings with client and family.
• Present evidence of damage (e.g., physical, social, financial,
spiritual, familial).
• Establish goals.
• Provide self-help manuals or other pamphlets.
• Acquire commitment to keep daily log of alcohol/drug use.
• At next visit:
• Review log.
• Review progress.
• Refer those who are dependent and desire to continue
abstinence.
• Explain why women are more affected by alcohol than are
men.
• “Expect sobriety. Reinforce for individuals to view their
commitment
to one day at a time” (Varcarolis, 2011, p. 339).
• Refer the client to AA, Al-Anon, or Alateen.
• Refer the client to a treatment facility for a structured treatment
program.
• Reinforce healthy living choices (e.g., balanced diet, exercise,
recreation, rest).

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