Impaired Adjustment
(_)Actual (_) Potential
| (_)
Illness (_) Other:_____________________________ ____________________________________ ____________________________________ |
| Major:
(Must be present) |
(_)
Verbalization of non-acceptance of health status change. (_) Inability to be involved in problem solving or goal setting. |
| Minor:
(May be present) |
(_) Lack
of movement toward independence. (_) Extended period of shock, disbelief, or anger regarding health status change. (_) Lack of future oriented thinking. |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_) Identify the temporary and long term demands of the situation. (_) Differentiate coping behavior that is effective vs. ineffective. (_) Other: |
(_)
Asses the patient's:
(_) Assist patient to identify the stressors. (_) Explore feelings about situation with patient. (_) Identify factors that interfere with or delay effective adjustment:
(_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature