Powerlessness

Published on Saturday March 10th , 2007

Powerlessness

(_)Actual (_) Potential

**Related To:**
*[Check those that apply]*
(_) Inability to communicate:________________________ (_) Inability to perform ADL:________________________ (_) Inability to perform role responsibilities:_____________ ______________________________________________ (_) Progressive debilitating disease:_________________ (_) Hospital or institutional limitations:_________________ ______________________________________________ (_) Other:______________________________________ ______________________________________________ ______________________________________________

**As evidenced by:**
*[Check those that apply]*
Major: (Must be present)	(_) Overt or covert expressions of dissatisfaction over inability to control situation. (exg: illness, prognosis, care, recovery rate)
Minor: (May be present)	(_) Refuses or is reluctant to participate in decision-making (_) Apathy (_) Resignation (_) Aggressive/violent/acting out behavior (_) Anxiety (_) Uneasiness (_) Depression

Date &
Sign.

Plan and Outcome
[Check those that apply]

Target
Date:

Nursing Interventions
[Check those that apply]

Date
Achieved:

The patient will:

(_) Identify factors that can be controlled:

(_) Makes decisions regarding treatment and future when possible.

(_) Other:

(_) Assess causative or contributing factors.

(_) Assess patient's usual response to problems:

(_) Increase communication

(_) Allow time to answer questions (15 min. ea shift)

(_) Realistically point out positive changes in person's condition.

(_) Allow patient to make as many decisions as possible.

(_) Provide opportunities for patient and family to participate in care.

(_) Encourage participation from patient who depends on others to make own decisions.

(_) Encourage patient to verbalize feelings and concerns.

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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