Risk of Deterioration of Independent Decision Making is an important nursing diagnosis used to describe the altered health states for individuals in which their independent decision making capability is at risk for worsening. This nursing diagnosis should be considered by nurses when designing a potential nursing plan for a patient with a disease process, trauma or environmental challenge that can not only impact their ability to make informed decisions but also cause further deterioration in this area. Risk of Deterioration of Independent Decision Making is most often associated with cognitive dysfunction or diseases, such as Alzheimer’s.
NANDA Nursing Diagnosis Definition
Risk for Deterioration of Independent Decision Making: to diminished capacity to make provocative decisions due to internal (disease) and external (societal) influences.
- Reports difficulty making decisions
- Reports decreased ability to solve problems
- Verbalizes frustration with making decisions
- Verbalizes confusion regarding decisions
- Inability to comprehend choices available
- Engages in inappropriate decision making
- Exhibits indecisiveness
- Easily influenced by others
- Cognitive Impairments: These include reduced mental status, impaired intellectual functions, memory and learning deficits, apraxias, or aphasias.
- Environmental Factors: These include sensory impairment, security problems, privacy issues and cultural and language differences.
- Lack of Knowledge: This may be due to a lack of education, previous experiences, or coping skills.
- Patients with Cognitive Impairment: This includes patients with Alzheimer’s Disease, Dementia and other forms of cognitive impairment.
- Elderly Patients: Older adults often have reduced mental state, physical functioning and social supports, increasing the risk of impaired decision-making.
- Patients with Low Health Literacy: Those who are unfamiliar with their disease process and treatment regimen may be at a higher risk of impaired decision-making.
- Unrealistic Decision Making: A patient may be unable to assess the risks and benefits of a decision, leading to an unrealistic selection.
- Degraded Quality of Care: A patient may unknowingly select a course of action that leads to lower quality of care, impacting his or her overall health.
- Social Isolation: Reduced decision-making ability can lead to a sense of depression and isolation, further impacting health and wellbeing.
Suggestion of Use
The NANDA-I nursing diagnosis Risk for Deterioration of Independent Decision Making should be used for nursing care planning for patients that present with altered cognitive status or functioning, cognitive impairments and/or diminished mental state. It is best used in addition to other interventions and assessments, such as the Buffalo Participatory Narrative Review (BPNR), Comprehensive Adult Assessment Tool (CAAT), Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS).
Suggested Alternative NANDA Diagnosis
- Impaired Social Interaction
- Impaired Verbal Communication
- Ineffective Coping
When assessing for Risk of Deterioration of Independent Decision Making, it is important to look for cues from the patient that could indicate the presence of this nursing diagnosis. These may include reports of difficulty making decisions, decreased ability to solve problems, verbalizations of confusion and frustration, and an inability to comprehend choices that are presented.
- Health Perception: The nurse can assess the patient’s ability to recognize and respond to changes in their health status.
- Health Management: The nurse can evaluate the patient’s adherence to therapeutic regimens, preventive measures and self-care treatments.
- Risk Control: The nurse can assess the patient’s ability to control risks associated with their health.
- Failure-Free Environment: The nurse can facilitate a supportive, safe and secure environment that promotes autonomous decision making.
- Guided Decision Making: The nurse can provide options and strategies to assist the patient with the decision making process.
- Decision Education: The nurse can provide information and direction regarding the long-term consequences of decisions.
Risk of Deterioration of Independent Decision Making can have a major impact on a patient’s overall health and quality of life. Nurses must be aware of the signs and symptom of this nursing diagnosis, as well as its risk factors and associated problems, in order to provide timely and accurate interventions. It is recommended that nurses collaborate with interdisciplinary teams to ensure that all strategies are tailored to the patient’s individual needs.
- What are the defining characteristics of Risk of Deterioration of Independent Decision Making?
- Subjective: Reports difficulty making decisions, decreased ability to solve problems, verbalizes frustration with making decisions, verbalizes confusion regarding decisions.
- Objective: Inability to comprehend choices available, engages in inappropriate decision making, exhibits indecisiveness, easily influenced by others.
- What are the associated problems of Risk of Deterioration of Independent Decision Making?
- Unrealistic Decision Making
- Degraded Quality of Care
- Social Isolation
- What are some NOC Results associated with Risk of Deterioration of Independent Decision Making?
- Health Perception
- Health Management
- Risk Control