INEFFECTIVE DENIAL Nursing Care Plan

Mr. Lopez, 51 years old, CEO of local smartphone company. Mr. Lopez is a vegetarian and active in dissemination of information about positive benefits of being a vegetarian. He went to various seminars as a speaker to spread what he knew was right and will help others to be healthy and prolonged life. He wrote books about wonderful effects of vegetables and the dangerous effects of meat to human body. Though many people oppose what he believe, he have numerous followers and companion for his revolutionary act. Unfortunately, Mr. Lopez is experiencing stomachache for the past 12 days and the pain keeps escalating. Mr. Lopez was worried so he went to the hospital for a check-up and found out that he had a colon cancer by means of several test results. Below is a sample of nursing care plan about ineffective denial of Mr. Lopez. 

Assessment:

Subjective: "I don't have cancer, the test was wrong, I'm a vegetarian, I can't have cancer." As verbalized by the patient.

Objectives:

- Delays seeking or refuses health care attention

- Does not perceive personal relevance of symptoms or danger
- Uses home remedies for self-treatment to relieve symptoms
- Does not admit fear of death
- Cannot admit the effects of the disease on life pattern
- Displaces the fear of effects of the condition
- Displays inappropriate affect

Diagnosis:

Ineffective denial related to inability to tolerate consciously the consequences secondary to cancer.

Planning:

The patient will use alternative coping mechanism in response to cancer instead of denial as evidenced by the acknowledge the illness and use problem-focused coping skills.

Interventions:

- Initiate a therapeutic relationship to Mr. Lopez. Assess effectiveness of his denial. Avoid confronting to Mr. Lopez that he is using denial. Approach Mr. Lopez directly, matter-of-factly, and non-judgmentally.

- Encourage Mr. Lopez to share his perceptions of the situation like fears or anxieties. Focus on the feelings shared. Use reflection to encourage more sharing.

- Attempt to elicit from Mr. Lopez a description of his problem. Assist him to gain an intellectual understanding that this is an illness, not a moral problem. Provide opportunities to perform successfully; gradually increase his responsibility. Provide opportunities to share his fears and anxieties. Assist in lowering anxiety level (see Anxiety for additional interventions).

- Avoid confronting person on use of denial. Carefully explore Mr. Lopez's interpretation of the situation. Reflect self-reported cues used to minimize the situation like "a little,” or “only”. Identify his recent detrimental behavior and discuss the effects of his behavior on health. Emphasize Mr. Lopez's strengths and past successful coping. Provide him positive reinforcement for any expressions of insight. Do not accept his rationalization or projection. Be polite, caring, but firm. It is important to help the person you care for keep a sense of control. A cancer diagnosis may make him feel little control over life. Start by asking if you can help with a specific task or decision instead of doing it on your own. Mr. Lopez may no longer be able to actively participate in activities he enjoys. So look for other ways to encourage involvement.

- Provide self-help manuals or other pamphlets.

Evaluation:

The patient used alternative coping mechanism in response to cancer instead of denial and acknowledged the illness and used problem-focused coping skills.

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