I
Disturbed personal Identity
NANDA-I
Related Factors (r/t)
Chronic low self-esteem; cult indoctrination; cultural discontinuity; discrimination; dysfunctional family processes; ingestion of toxic chemicals; inhalation of toxic chemicals; manic states; multiple personality disorder; organic brain syndromes; perceived prejudice; psychiatric disorders (e.g., psychosis, depression, dissociative disorder); situational crisis; situational low self-esteem; social role change; stages of development; stages of growth; use of psychoactive agents
NIC (Nursing Interventions Classification)
Nursing Interventions and Rationales
• Assess and support family strengths of commitment, appreciation, and affection toward each other, positive communication, time together, a sense of spiritual well-being, and the ability to cope with stress and crisis. EBN: Nurses may be more successful in contributing to improved health care outcomes when they engage their clients more in their own health and wellness and encourage them to build on their strengths (Rotegård, Ruland, & Fagermoen, 2011).
Assess for suicidal ideation and make appropriate referral for clients with schizophrenia and bipolar disorder. EB: Clients with schizophrenia have an 8.5-fold greater risk of suicide than the general population (Kasckow, Felmet, & Zisook, 2011). EB: Bipolar disorder is associated with a high risk for suicidal acts (Oquendo et al, 2011).
Assess women with mood disorders for reproductive and metabolic disorders and make appropriate referrals for treatment. EB: Women with mood disorders, especially bipolar disorder (BD), have been shown to have high rates of reproductive and metabolic dysfunction. Many of the psychotropic medications used in the treatment of BD are associated with weight gain, insulin resistance, and dyslipidemia. These metabolic side effects further compound the neuroendocrine system dysregulation in women with BD (Kenna, Jiang, & Rasgon, 2009).
Assess and make appropriate referrals for clients with obesity and depression. EB: The marked alteration of body weight (and appetite) is one of the most frequent of the nine symptoms of major depressive episodes, and these symptoms occur during recurrent episodes of depression with a remarkably high consequence (Rihmer et al, 2008).
Assess lymphocyte counts and make appropriate referrals for clients with bulimia nervosa (BN), who may present with psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms). EB: In this study of clients with BN and psychological instability, hostility was negatively correlated with the number of helper T-cells (CD4+). These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in clients with BN (Vaz-Leal et al, 2007).
• Use empathetic communication and encourage the client and family to verbalize fears, express emotions, and set goals. Be present for clients physically or by telephone. CEB: This study of social support by telephone demonstrated that therapeutic presence facilitated outcomes that included problem solving, adaptive behavior change, and diminished distress (Finfgeld-Connett, 2005). Presence involves knowing the uniqueness of the person, listening intently, and mutually defining changes in the provision of confident caring (Caldwell et al, 2005).
• Empower the client to set realistic goals and to engage in problem solving. EBN: This case study assesses how individuals who have had a stroke use continued problem solving and goal setting. It demonstrates that health care workers need to empower individuals to make decisions about their care so the individuals can achieve life satisfaction (Western, 2007).
• Encourage expression of positive thoughts and emotions. EB: Negative emotions contribute to disturbed personal identity and poor coping (Wegge, Schuh, & Dick, 2012).
• Encourage the client to use spiritual coping mechanisms such as faith and prayer. CEB: Prayer is a powerful way of coping and is practiced by all Western religions and several Eastern traditions (Mohr, 2006). In this study spirituality and religiosity helped clients with schizophrenia cope with their illness (Mohr et al, 2010).
• Help the clients with serious and chronic conditions such as depression, cancer diagnosis, and chemotherapy treatment to maintain social support networks or assist in building new ones. EBN: Health care providers can encourage social support networks to help clients cope with the negative aspects of cancer and chemotherapy (Mattioli, Repinski, & Chappy, 2008).
Refer women facing diagnostic and curative breast cancer surgery for psychosocial support. EB: Psychological distress is a central experience for women facing diagnostic and curative breast cancer surgery. Psychosocial interventions are recommended for both groups (Schnur et al, 2008).
Refer for cognitive-behavioral therapy (CBT). EBN: CBT approaches in adult acute inpatient settings can help clients to cope by facilitating client-caregiver engagement and improving hope-inspiring interventions to reduce distress (Forsyth et al, 2008).
Refer clients with borderline personality disorder (BPD) and dual-diagnosed BPD and substance-dependent female clients for dialectical behavior therapy (DBT) and psychoanalytical-orientated day-hospital therapy. EB: Dialectical behavior therapy included treatment components such as prioritizing an hierarchy of target behaviors, telephone coaching, group skills training, behavioral skill training, contingency management, cognitive modification, exposure to emotional cues, reflection, empathy, and acceptance. DBT seemed to be helpful on a wide range of outcomes, such as admission to hospital or incarceration in prison. Psychoanalytic-orientated day-hospital therapy also seemed to decrease admission and use of prescribed medication and to increase social improvement and social adjustment (Binks et al, 2006). Two randomized controlled trials in 59 clients, female only, with BPD and substance abuse provided the best evidence-based data for the effectiveness of DBT. For dual-focus schema therapy, a single randomized controlled trial indicated a curative effect in a small group of clients with personality disorder and substance dependence (Kienast & Foerster, 2008).
• Refer to the care plans for Readiness for enhanced Communication and Readiness for enhanced Spiritual Well-Being.
Pediatric:• Encourage exercise for children and adolescents to promote positive self-esteem, to enhance coping, and to prevent behavioral and psychological problems. EBN: Physical activity helped to decrease depression and anxiety and to increase coping skills in adolescents (Beauchemin & Manns, 2008).
Evaluate and refer children and adolescents for eating disorder prevention programs to include medical care, nutritional intervention, and mental health treatment and care coordination. EB: The incidence and prevalence of eating disorders have increased in this population. Appropriate management is essential (Rosen, 2010).
• Provide gifted children with low self-esteem with appropriate support. EB: Gifted children in this study manifested a lack of self-esteem, and in particular a lack of academic self-esteem, coupled with depressive symptoms (Bénony et al, 2007).
• Suggest that parents with children diagnosed with cancer use computer-mediated support groups to exchange messages with other parents. EBN: Using computer technology for support was particularly useful for this dispersed group with limited time, helping to decrease depression and anxiety in fathers and mothers (Bragadóttir, 2008).
Geriatric:• Consider the use of telephone support for caregivers of family members with dementia. CEB: Family caregivers can be helped through a variety of social support mechanisms including telephone support (Belle et al, 2006).
• Encourage clients to discuss “life history.” Life history–based interventions and self-esteem and life-satisfaction questionnaires may be used to reinforce personal identity and foster hope (Coleman & Podolskij, 2007).
Refer the older client to self-help support groups, such as the Red Hat Society for older women. EB: A leisure-focused group (Red Hat Society) helped the members to cope with stressors associated with the challenges and losses of old age (Hutchinson et al, 2008).
Refer the client with Alzheimer’s disease who is terminally ill to hospice. EB: The National Institute of Clinical Excellence (NICE) and the National Council for Palliative Care (NCPC) have highlighted the importance of palliative care for people with dementia (Chatterjee, 2008).
Multicultural:• Assess an individual’s sociocultural background in teaching self-management and self-regulation as a means of supporting hope and coping with a diagnosis of type 2 diabetes. EBN: Findings obtained from this study illustrated that self-management of clients with diabetes is highly related to their own sociocultural environment and experiences (Lin et al, 2008).
• Encourage spirituality as a source of support for coping. EBN: Many African Americans and Latinos identify spirituality, religiousness, prayer, and church-based activities as coping resources (Allen & Marshall, 2010; Coon et al, 2004).
Home Care:• The interventions described previously may be adapted for home care use.
• Provide an Internet-based health coach to encourage self-management for clients with chronic conditions such as depression, impaired mobility, and chronic pain. EBN: Clients who have higher self-efficacy and participate actively in their care have better disease management. Client-provider Internet portals offer a new venue for empowering and engaging clients in better management of chronic conditions (Allen et al, 2008).
Refer the client to mutual health support groups. Participating in mutual health support groups led to enhanced coping by improving psychological and social functioning (Pistrang, Barker, & Humphreys, 2008).
Refer the client to a behavioral program that teaches coping skills via “Lifeskills” workshop and/or video. EB: Commercially available, facilitator- or self-administered behavioral training products can have significant beneficial effects on psychosocial well-being in a healthy community sample (Kirby et al, 2006).
Refer prostate cancer clients and their spouses to family programs that include family-based interventions of communication, hope, coping, uncertainty, and symptom management. EBN: Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support (Northouse et al, 2007).
Refer combat veterans and service members directly involved in combat, as well as those providing support to combatants, including nurses, for mental health services. EBN: Early identification and treatment of mental health problems may decrease the psychosocial impact of combat and thus prevent progression to more chronic and severe psychopathology such as depression and post-traumatic stress disorder (PTSD) (Jones et al, 2008). EB: Combat duty in Iraq was associated with high utilization of mental health services and attrition from military service after deployment (Walker, 2010).
Client/Family Teaching and Discharge Planning:
Teach the client about available community resources (e.g., therapists, ministers, counselors, self-help groups, family-education groups). EB: Families need assistance in coping with health changes (Pickett-Schenk et al, 2008).
Teach coping skills to family caregivers of cancer clients. EBN: A coping-skills intervention was effective in improving caregiver quality of life and reducing burdens related to client’s symptoms and caregiver’s tasks, compared with hospice care alone or hospice plus emotional support (McMillan et al, 2006).
Teach caregivers the COPE intervention (creativity, optimism, planning, expert information) to assist with symptom management. EBN: Symptom distress, a measure that encompasses client suffering along with intensity, was significantly decreased in the group in which caregivers were trained to better manage client symptoms (McMillan & Small, 2007).
Refer to ineffective Coping for additional references.
Allen, D., Marshall, E.S. Spirituality as a coping resource for African American parents of chronically ill children. MCN Am J Matern Child Nurs. 2010;35(4):232–237.
Allen, M.B., et al. Improving patient-clinician communication about chronic conditions: description of an Internet-based nurse e-coach intervention. Nurs Res. 2008;57(2):107.
Beauchemin, J., Manns, J. Walking talking therapy. Ment Health Today. 2008;34:2.
Belle, S., et al. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Ann Intern Med. 2006;145(10):727–738.
Bénony, H., et al. Link between depression and academic self-esteem in gifted children. Encephale. 2007;33(1):11–20.
Binks, C., et al, Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev 2006;(1):CD005652.
Bragadóttir, H. Computer-mediated support group intervention for parents. J Nurs Scholarsh. 2008;40(1):32–39.
Caldwell, B., et al. Presencing: channeling therapeutic effectiveness with the mentally ill in a state psychiatric hospital. Issues Ment Health Nurs. 2005;26:853–871.
Chatterjee, J. End-of-life care for patients with dementia. Nurs Older People. 2008;20(2):29–35.
Coleman, P.G., Podolskij, A. Identity loss and recovery in the life stories of Soviet World War II veterans. Gerontologist. 2007;47(1):52–60.
Coon, D.W., et al. Well-being, appraisal, and coping in Latina and Caucasian female dementia caregivers: findings from the REACH study. Aging Ment Health. 2004;8(4):330–345.
Finfgeld-Connett, D. Telephone social support or nursing presence? Analysis of a nursing intervention. Qual Health Res. 2005;15(1):19–29.
Forsyth, A., et al. Implementing cognitive behaviour therapy skills in adult acute inpatient settings. Ment Health Pract. 2008;11(5):24–28.
Hutchinson, S.L., et al. Beyond fun and friendship: the Red Hat Society as a coping resource for older women. Ageing Soc. 2008;28(7):979–1000.
Jones, D.E., et al. Intensive coping skills training to reduce anxiety and depression for forward-deployed troops. Mil Med. 2008;173(3):241–247.
Kasckow, J., Felmet, K., Zisook, S. Managing suicide risk in patients with schizophrenia. CNS Drugs. 2011;25(2):129–143.
Kenna, H.A., Jiang, B., Rasgon, N.L. Reproductive and metabolic abnormalities associated with bipolar disorder and its treatment. Harv Rev Psychiatry. 2009;17(2):138–146.
Kienast, T., Foerster, J. Psychotherapy of personality disorders and concomitant substance dependence. Curr Opin Psychiatry. 2008;21(6):619–624.
Kirby, E.D., et al. Psychosocial benefits of three formats of a standardized behavioral stress management program. Psychosom Med. 2006;68(6):816–823.
Lin, C., et al. Diabetes self-management experience: a focus group study of Taiwanese patients with type 2 diabetes. J Clin Nurs. 2008;17(5a):34.
Mattioli, J.L., Repinski, R., Chappy, S.L. The meaning of hope and social support in patients receiving chemotherapy. Oncol Nurs Forum. 2008;35(5):822–829.
McMillan, S.C., et al. Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial. Cancer. 2006;106(1):214–222.
McMillan, S.C., Small, B.J. Using the COPE intervention for family care-givers to improve symptoms of hospice homecare patients: a clinical trial. Oncol Nurs Forum. 2007;34(2):313–321.
Mohr, S., et al. Delusions with religious content: How they interact with spiritual coping. Psychiatry: Interpersonal & Biological Processes. Summer, 2010;73(2):158–172. CD008063
Mohr, W.K. Spiritual issues in psychiatric care. Perspect Psychiatr Care. 2006;42(3):174–183.
Northouse, L.L., et al. Randomized clinical trial of a family intervention for prostate cancer patients and their spouses. Cancer. 2007;110(12):2809–2818.
Oquendo, M.A., et al. Treatment of suicide attempters with bipolar disorder: a randomized clinical trial comparing lithium and valproate in the prevention of suicidal behavior. Am J Psychiatry. 2011;168(10):1050–1056.
Pickett-Schenk, S.A., et al. Improving knowledge about mental illness through family-led education: the journey of hope. Psychiatr Serv. 2008;59(1):49.
Pistrang, N., Barker, C., Humphreys, K. Mutual help groups for mental health problems: a review of effectiveness studies. Am J Community Psychol. 2008;42(1-2):110–122.
Rihmer, Z., et al. Association of obesity and depression. Neuropsychopharmacology. 2008;10(4):183–189.
Rosen, D.S. Clinical report—identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126(6):1240–1253.
Rotegård, A., Ruland, C., Fagermoen, M. Perceptions and experiences of patient health assets in oncology care: a qualitative study. Res Theory Nurs Pract. 2011;25(4):284–301.
Schnur, J.B., et al. Anticipatory psychological distress in women scheduled for diagnostic and curative breast cancer surgery. Int J Behav Med. 2008;15(1):21.
Vaz-Leal, F.J., et al. Hostility and helper T-cells in patients with bulimia nervosa. Eat Weight Disord. 2007;12(2):83–90.
Walker, S. Assessing the mental health consequences of military combat in Iraq and Afghanistan: a literature review. J Psychiatr Ment Health Nurs. 2010;17(9):790–796.
Wegge, J., Schuh, S., Dick, R. “I feel bad”, “We feel good”?—emotions as a driver for personal and organizational identity and organizational identification as a resource for serving unfriendly customers. Stress Health. 2012;28(2):123–136.
Western, H. Altered living: coping, hope and quality of life after stroke. Br J Nurs. 2007;16(20):1266.
Readiness for enhanced Immunization Status
NOC (Nursing Outcomes Classification)
Client Outcomes
Client/Caregiver Will (Specify Time Frame)
• Review appropriate recommended immunization schedule with provider annually and/or at well check-ups
• Ask questions about the benefits and risks of immunizations prior to scheduled immunization
• Ask questions regarding the risks of choosing not to be immunized prior to scheduled immunization
• Accurately respond to provider’s questions related to pertinent information regarding individual health status as it relates to contraindications for individual vaccines during office visits when immunizations are scheduled
• Inform provider of the health status of close contacts and household members during office visits when immunizations are scheduled and during peak infectious disease seasons
• Provide evidence of an understanding of the risks and benefits of individual immunization decisions during annual physical exam and/or well check-ups
• Provide evidence of an understanding of the benefits of community immunization during peak infectious disease seasons
• Communicate decisions about immunization decisions to provider in relation to personal preferences, values, and goals annually
• Communicate/provide documentation to health care provider ongoing personal record of immunizations annually
• Reinforce the client’s responsibility to maintain an accurate record of immunization annually
NIC (Nursing Interventions Classification)
Nursing Interventions and Rationales
Psychosocial
• Assess barriers to immunization:
Anxiety related to injection/parenteral pharmacological therapy. EBN: If parents become distressed by a child’s discomfort, or are otherwise unhappy with an immunization session, they may not complete a course of immunizations, and they may dissuade others from immunizing their children (Plumridge, Goodyear-Smith, & Ross, 2009).
Anxiety related to immunization side effects. QSEN: Immunization-safety science requires leadership, infrastructure, facilities and human resources, and appropriate long-range planning and funding different from, but appropriately comparable with, the programs that have contributed to the great success of immunization programs (Cooper, Larson, & Katz, 2008).
Knowledge of risk associated with disease. EB: An increasing number of parents express more fear of the vaccine than of the diseases they are designed to prevent (Cooper, Larson, & Katz, 2008).
Cost of health care. EB: Immunization rates within a health plan that implemented a robust piece-rate pay-for-performance program rose at a significantly higher rate than among health plans that did not offer pay-for-performance incentives (Chien & Rosenthal, 2010).
• Assess client-provider relationship. EBN: Nurses need to build good relationships and practical partnerships with parents during immunizations (Plumridge, Goodyear-Smith, & Ross, 2009). EB: The largest proportion of parents who changed their minds about delaying or refusing a vaccination for their child listed “information or assurances from health care provider” as the main reason (Gust et al, 2008).
• Assess client/caregiver level of participation in decision-making process. EB: It is important to note that trust in the child’s health care provider is reported as a key factor in a parent’s immunization decision-making; written materials may aid the provider in discussions with the parent (Gust et al, 2009).
• Assess sources of information client has previously turned to. QSEN: New and existing organizations and websites that portray themselves as official resources for credible information on vaccines continue to appear on the Internet. These sites provide flawed or biased information that serves to fuel public concern regarding the safety of childhood immunizations, which leads to increased rates of immunization refusal or delays in on-time immunization (Committee on Practice and Ambulatory Medicine, 2010).
• Assist client/caregiver to find appropriate educational resources. EBN: Vaccine information statements should be written at an appropriate readability level so that all mothers can have access to needed information (Wilson et al, 2008). EB: Vaccine Information Statements (VISs) are information sheets produced by the Centers for Disease Control and Prevention (CDC) that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine (CDC, 2012).
• Assess cultural or religious beliefs that may relate to either the decision-making process or specific immunizations such as for sexually transmitted diseases. EB: Controversy is grounded in moral, religious, political, economic, and sociocultural arguments including whether the HPV vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, and usurps parental authority (Vamos, McDermott, & Daley, 2008).
Physiological
• Perform comprehensive interview to elicit information regarding the client’s susceptibility to adverse reactions to specific vaccines according to the manufacturer guidelines.
• Identify clients for whom a specific vaccine is contraindicated. EB: Persons who administer vaccines should screen patients for contraindications and precautions to the vaccine before each dose of vaccine is administered (Kroger et al, 2011).
Report potential or actual adverse effects. QSEN: Parents, guardians, legal representatives, and adolescent and adult patients should be informed about the benefits of and risks from vaccines in language that is culturally sensitive and at an appropriate educational level (Kroger et al, 2011).
• Inform client/caregiver of the vaccine-specific risks to both women of childbearing age and the fetus. QSEN: Theoretically the live attenuated virus in a vaccine could cross the placenta and result in viral infection of the fetus. Owing to this concern, most live attenuated vaccines, including the measles-mumps-rubella (MMR) and varicella vaccines, are contraindicated during pregnancy (Bozzo, Narducci, & Einarson, 2011).
• Discuss pregnancy planning with appropriate clients considering immunization. EB: The ACIP continues to recommend that women avoid becoming pregnant for approximately 1 month following vaccination (Bozzo, Narducci, & Einarson, 2011).
• Identify high-risk individuals for specific vaccine-preventable diseases. EB: Older adults are more vulnerable to most infectious disease, including those considered “vaccine preventable” (e.g., influenza), placing a large burden on health care resources (High et al, 2010).
• Identify high-risk groups for specific vaccine-preventable disease. EB: African American seniors (65 and older) are less likely to be vaccinated against influenza than are non-Hispanic white seniors (Cameron et al, 2009).
• Identify high-risk populations for specific vaccine-preventable disease. EB: Largely, health inequities such as lack of health care access and insurance status influence vaccine decision making (Bynum et al, 2011).
• Assess client’s recent travel history and future travel plans. EB: Travel immunizations may be required or recommended based on a customized risk assessment, according to an individual’s travel itinerary (Lyons & Laible, 2011).
• Identify vulnerable populations and marginalized populations. EB: African American seniors (65 and older) are less likely to be vaccinated against influenza than are non-Hispanic white seniors (Cameron et al, 2009). EB: Largely, health inequities such as lack of health care access and insurance status influence vaccine decision-making (Bynum et al, 2011).
• Tailor educational programs specific to these marginalized and vulnerable populations. QSEN: Parents, guardians, legal representatives, and adolescent and adult patients should be informed about the benefits of and risks from vaccines in language that is culturally sensitive and at an appropriate educational level (Kroger et al, 2011).
• Adopt recommendations made by national and international professional groups advocating the use of Immunization Central Registries and standing orders. CEB: In 2003, the National Vaccine Advisory Committee published standards for vaccination. These standards include ensuring vaccine availability, review of records, communicating the risks and benefits of vaccination, use of standing orders, and recommending simultaneous administration of all indicated doses according to the Recommended Immunization Schedule (Kroger et al, 2011).
• Support access to health care that enables clients to access well-preventive care on a walk-in basis during times that are consistent with client schedules. EB: To minimize disparities in vaccine uptake during the 2009-H1N1 pandemic, outreach efforts included the use of alternative vaccination sites, such as retail clinics and school-located clinics; engagement of faith-based organizations; and communication in multiple languages and through ethnic media (Uscher-Pines, Maurer, & Harris, 2011).
Multicultural:• Assess cultural beliefs and practices that may have an impact on the educational and decision-making process specific to immunization as well as vaccine-specific illness. EB: Medical record data indicated that individualized, culturally appropriate, evidence-based interventions increased rates of adult vaccinations in disadvantaged, racially diverse, inner city populations (Norwalk et al, 2008).
• Actively listen and be sensitive to how communication is shared culturally. EB: Cultural sensitivity is the foundation of community outreach (Stauffer, 2008).
• Employ culturally sensitive educational strategies to maximize the individual, family, or community response. EBN: Every participant expressed the view that the immunization encounter should be conducted in the language with which the mother was most comfortable. It was also important that printed educational materials or consent forms be in the preferred language of the mother (Keller, 2008).
Home Care:• The foregoing interventions may be adapted for home care use.
• Develop clinical practice guidelines that include shared decision-making. EBN: The quality of the interaction between nurse and parent/caregiver at the time of administering immunizations is crucial for maintaining an ongoing immunization schedule (Plumridge, Goodyear-Smith, & Ross, 2009).
• Implement home care strategies that will enhance decision-making and ability to maintain current immunization status. EB: Communication and outreach are important to ensuring adequate vaccination coverage for home health care workers and home health care clients (Baron et al, 2009).
• Implement mechanisms to contact the client/caregiver at appropriate intervals with reminder literature or phone contact. EB: To improve immunization coverage in communities, strategies include increasing community demand for vaccinations, enhancing access to vaccination services, and implementing provider- or system-based interventions, such as patient reminder/recall and health care provider prompts about vaccinations (Humiston et al, 2011).
Client/Family Teaching and Discharge Planning:
• Before teaching, evaluate the client preference for involvement with the decision-making process.
• Use community-based and school-based interventions to teach school-age children and thereby provide vicarious education to the family. EBN: Every participant expressed the view that the immunization encounter should be conducted in the language with which the mother was most comfortable. It was also important that printed educational materials or consent forms be in the preferred language of the mother (Keller, 2008).
• Develop curricula and media that enhance immunization education. EBN: Increasing health literacy regarding the HPV vaccination using an information technology format, that is, cell phones and social media, is valuable to promote the health of all young women, regardless of race (Thomas, Stephens, & Blanchard, 2010).
• Employ media and curricula in office waiting rooms. QSEN: Parents, guardians, legal representatives, and adolescent and adult patients should be informed about the benefits of and risks from vaccines in language that is culturally sensitive and at an appropriate educational level (Kroger et al, 2011).
• Develop and distribute client log books that provide record-keeping and foster ownership of the responsibility of current immunization status. EB: Immunization information systems (IIS) are confidential, computerized information systems that collect and consolidate vaccination data from multiple health care providers, generate reminder and recall notifications, and assess vaccination coverage within a defined geographical area (O’Connor et al, 2010).
References
Baron, S., et al. Protecting home health care workers: a challenge to pandemic influenza preparedness planning. Am J Public Health. 2009;99(2):S301–S307.
Bozzo, P., Narducci, A., Einarson, A. Vaccination during pregnancy. Can Fam Physician. 2011;57:555–557.
Bynum, S., et al. Working to close the gap: identifying predictors of HPV vaccine uptake among young African American women. J Health Care Poor Underserv. 2011;22:549–561.
Cameron, K., et al. Using theoretical constructs to identify key issues for targeted message design: African American seniors’ perceptions about influenza vaccination. Health Commun. 2009;24:316–326.
Centers for Disease Control and Prevention (CDC), Vaccine information statements, August 31, 2012 Retrieved September 8, 2012, from http://www.cdc.gov/vaccines/pubs/vis/
Chien, L., Rosenthal, M. Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Serv Res. 2010;45:6. [Part II:1934-1947].
Committee on Practice and Ambulatory Medicine. Increasing immunization coverage. Pediatrics. 2010;125(6):1295–1304.
Cooper, L., Larson, H., Katz, S. Protecting public trust in immunization. Pediatrics. 2008;122(1):149–153.
Gust, D., et al. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics. 2008;122(4):718–725.
Gust, D., et al. Parents questioning immunization: evaluation of an intervention. Am J Health Behav. 2009;33(3):287–298.
High, K., et al. Workshops on immunizations in older adults: identifying future research agendas. J Am Geriatr Soc. 2010;58:765–776.
Humiston, S., et al. Increasing inner-city adult influenza vaccination rates: a randomized controlled trial. Public Health Rep. 2011;126(2):39–47.
Keller, T. Mexican American parent’s perceptions of culturally congruent interpersonal processes of care during childhood immunization episodes—a pilot study. Online J Rural Nurs Health Care. 2008;8(2):33–41.
Kroger, A., et al. General recommendations on immunization recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2011;55(2):3–60.
Lyons, K.M., Laible, B.R. Adult travel immunizations: update for pharmacists. J Am Pharm Assoc. 2011;51(3):440–442.
Norwalk, M.P., et al. Raising adult vaccination rates over 4 years among racially diverse patients at inner-city health centers. J Am Geriatr Soc. 2008;56:1177–1182.
O’Connor, A.C., et al. Health plan use of immunization information systems for quality measurement. Am J Manage Care. 2010;16(3):217–224.
Plumridge, E., Goodyear-Smith, F., Ross, J. Nurse and parent partnership during children’s vaccinations: a conversation analysis. J Adv Nurs. 2009;65(6):1187–1194.
Stauffer, R. Vietnamese American. In: Giger J.N., Davidhizar R., eds. Transcultural nursing: assessment and intervention. St Louis: Mosby, 2008.
Thomas, T., Stephens, D., Blanchard, B. Hip hop, health, and human papilloma virus (HPV): using wireless technology to increase HPV vaccination update. J Nurse Pract. 2010;6(6):464–468.
Uscher-Pines, L., Maurer, J., Harris, K.M. Racial and ethnic disparities in uptake and location of vaccination for 2009-H1N1 and seasonal influenza. Am J Public Health. 2011;101(7):1252–1255.
Vamos, C., McDermott, R., Daley, E. The HPV vaccine: framing the arguments for and against mandatory vaccination of all middle school girls. J Sch Health. 2008;78(6):302–309.
Wilson, F., et al. Using the teach-back and Orem’s self-care deficit nursing theory to increase childhood immunization communication among low-income mothers. Issues Compr Pediatr Nurs. 2008;31:7–22.
Ineffective Impulse Control
NOC (Nursing Outcomes Classification)
Client Outcomes
NIC (Nursing Interventions Classification)
Nursing Interventions and Rationales
Refer to mental health treatment for cognitive-behavioral therapy (CBT). CBT has been beneficial in treating substance use disorders and impulse control disorders (ICDs) (Dempsey, Dyehouse, & Schafer, 2011; O’Sullivan, Evans, & Lees, 2009).
• Implement motivational interviewing for clients with impulse control disorders. Motivational interviewing includes treatment components that involve providing feedback to the client concerning current impulsive behaviors and the likely longer-term effects associated with such behavior (Farmer & Golden, 2009).
• Teach client mindfulness meditation techniques. Mindfulness meditation includes observing experiences in the present moment, describing those experiences without judgments or evaluations, and participating fully in one’s current context. Mindfulness mediation is used to assist the individual to develop an attentional focus on the present that is useful in controlling impulsive behavior (Farmer & Golden, 2009).
• Refer to self-help groups such as Gambler’s Anonymous or Overeaters Anonymous as needed. Methods of psychological and psychosocial management related to specific symptomatology are effective strategies for care of impulse control disorders (Dell’Osso et al, 2008; Gallagher, 2010; Greener, 2011).
• Remove positive reinforcements associated with excessive behavior. Altering reactivity to immediate environmental cues or circumstances is a contingency management approach effective for impulse control disorders (Farmer & Golden, 2009).
• Assist the client to recognize patterns and cues of impulsive behavior. The first step in gaining insight into behaviors is to recognize the causes so long-term therapeutic strategies for stimulus and impulse control can be developed (Dell’Osso et al, 2008).
• Teach clients to utilize urge surfing techniques when impulses are triggered. A core skill associated with urge surfing is the ability to observe within oneself the rise and fall of urges and to “surf” or stay with these urges without acting on them. Urge surfing is a behavioral skill used to facilitate tolerance of urgent action impulses without acting on them (Farmer & Golden, 2009).
• Implement cue elimination procedures as a stimulus control technique. Cue elimination is a stimulus control technique in which cues that signal the availability of rewards for problematic behavior are removed (Farmer & Golden, 2009).
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