Nursing Dx

Taxonomy II: Life Principles—Class 3 Value/Belief/Action
Congruence (00083)
[Diagnostic Division: Ego Integrity]
Submitted 1988
Definition: Uncertainty about course of action to be taken when choice among competing actions involves risk, loss, or challenge to personal life values

Related Factors
Unclear personal values/beliefs; perceived threat to value system
Lack of experience or interference with decision making
Lack of relevant information, multiple or divergent sources of information
Support system deficit
[Age, developmental state]
[Family system, sociocultural factors]
[Cognitive, emotional, behavioral level of functioning]

Defining Characteristics
SUBJECTIVE
Verbalized uncertainty about choices or of undesired consequences of alternative actions being considered
Verbalized feeling of distress or questioning personal values and beliefs while attempting a decision
OBJECTIVE
Vacillation between alternative choices; delayed decision making
Self-focusing
Physical signs of distress or tension (increased heart rate; increased muscle tension; restlessness; etc.)

Desired Outcomes/Evaluation
Criteria—Client Will:
• Verbalize awareness of positive and negative aspects of choices/alternative actions.
• Acknowledge/ventilate feelings of anxiety and distress associated with choice/related to making difficult decision.
• Identify personal values and beliefs concerning issues.
• Make decision(s) and express satisfaction with choices.
• Meet psychological needs as evidenced by appropriate expression of feelings, identification of options, and use of resources.
• Display relaxed manner/calm demeanor, free of physical signs of distress.

Actions/Interventions
NURSING PRIORITY NO. 1. To assess causative/contributing factors:
• Determine usual ability to manage own affairs. Clarify who has legal right to intervene on behalf of child (e.g., parent, other relative, or court appointed guardian/advocate). (Family disruption/conflicts can complicate decision process.)
• Note expressions of indecision, dependence on others, availability/involvement of support persons (e.g., lack of/conflicting advice). Ascertain dependency of other(s) on client and/ or issues of codependency.
• Active-listen/identify reason for indecisiveness to help client clarify problem.
• Determine effectiveness of current problem-solving techniques.
• Note presence/intensity of physical signs of anxiety (e.g., increased heart rate, muscle tension).
• Listen for expressions of inability to find meaning in life/ reason for living, feelings of futility, or alienation from God and others around them. (Refer to ND Spiritual Distress as indicated.)

NURSING PRIORITY NO. 2. To assist client to develop/effectively use problem-solving skills:
• Promote safe and hopeful environment, as needed, while client regains inner control.
• Encourage verbalization of conflicts/concerns.
• Accept verbal expressions of anger/guilt, setting limits on maladaptive behavior to promote client safety.
• Clarify and prioritize individual goals, noting where the subject of the “conflict” falls on this scale.
• Identify strengths and presence of positive coping skills (e.g., use of relaxation technique, willingness to express feelings).
• Identify positive aspects of this experience and assist client to view it as a learning opportunity to develop new and creative solutions.
• Correct misperceptions client may have and provide factual information. Provides for better decision making.
• Provide opportunities for client to make simple decisions regarding self-care and other daily activities. Accept choice not to do so. Advance complexity of choices as tolerated.
• Encourage child to make developmentally appropriate decisions concerning own care. Fosters child’s sense of self-worth, enhances ability to learn/exercise coping skills.
• Discuss time considerations, setting time line for small steps and considering consequences related to not making/postponing specific decisions to facilitate resolution of conflict.
• Have client list some alternatives to present situation or decisions, using a brainstorming process. Include family in this activity as indicated (e.g., placement of parent in long-term care facility, use of intervention process with addicted member). Refer to NDs interrupted Family Processes; dysfunctional Family Processes: alcoholism; compromised family Coping.
• Practice use of problem-solving process with current situation/ decision.

• Discuss/clarify spiritual concerns, accepting client’s values in a nonjudgmental manner.
NURSING PRIORITY NO. 3. To promote wellness (Teaching/ Discharge Considerations):
• Promote opportunities for using conflict-resolution skills, identifying steps as client does each one.
• Provide positive feedback for efforts and progress noted. Promotes continuation of efforts.
• Encourage involvement of family/SO(s) as desired/available to provide support for the client.
• Support client for decisions made, especially if consequences are unexpected, difficult to cope with.
• Encourage attendance at stress reduction, assertiveness classes.
• Refer to other resources as necessary (e.g., clergy, psychiatric clinical nurse specialist/psychiatrist, family/marital therapist, addiction support groups).

Documentation Focus
ASSESSMENT/REASSESSMENT
• Assessment findings/behavioral responses, degree of impairment in lifestyle functioning.
• Individuals involved in the conflict.
• Personal values/beliefs.
PLANNING
• Plan of care/interventions and who is involved in the planning process.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Client’s and involved individual’s responses to interventions/ teaching and actions performed.
• Ability to express feelings, identify options; use of resources.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs/referrals, actions to be taken, and who is responsible for doing.
• Specific referrals made.