Impaired Emancipated Decision Making   739

Documentation
• Patient’s perception of present situation
• Emotions expressed by patient
• Observations of patient’s behaviors
• Interventions performed to help patient develop coping skills
• Patient’s response to nursing interventions
• Evaluations for expected outcomes
REFERENCES
Jacobs, N. L., Dehue, F., Völlink, T., & Lechner, L. (2014). Determinants of adolescents’ ineffective
and improved coping with cyberbullying: A Delphi study. Journal of Adolescence, 37(4), 373–385.
doi:10.1016/j.adolescence.2014.02.011
Meredith, P. J., Rappel, G., Strong, J., & Bailey, K. J. (2015). Sensory sensitivity and strategies for
coping with pain. American Journal of Occupational Therapy, 69(4), 1–10. doi:10.5014/
ajot.2015.014621
Regier, N. G., & Parmelee, P. A. (2015). The stability of coping strategies in older adults with
osteoarthritis and the ability of these strategies to predict changes in depression, disability, and pain.
Aging & Mental Health, 19(12), 1113–1122. doi:10.1080/13607863.2014.1003286

IMPAIRED EMANCIPATED DECISION MAKING

related to decrease in understanding of all available health care options; limited decision-making experience

Definition
A process of choosing a health care decision that does not include personal knowledge and/
or consideration of social norms, or does not occur in a flexible environment, resulting in
decisional dissatisfaction

Assessment
• Levels of consciousness and orientation • Presence of cognitive impairment
• Age • Level of education
• Stage of development • Language fluency

Defining Characteristics
• Delay in enacting chosen health care option
• Distress when listening to other’s opinion
• Excessive concern about what others think is the best decision
• Feeling constrained in describing own opinion
• Inability to choose a health care option that best fits current lifestyle
• Inability to describe how option will fit into current lifestyle
• Limited verbalization about health care option in other’s presence

Expected Outcomes
• The patient will demonstrate consideration of how available health care choices fit with
their values, beliefs, preferences, and lifestyle.
• The patient will express consideration of their own values, beliefs, and preferences, inde-
pendent of those of others in considering the available health care options.

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 740  PART VI – Psychiatric and Mental Health

• The patient will verbalize opinion freely.

• The patient will make a health care choice.
• The patient will verbalize satisfaction with health care choice based on the available
options.

Suggested NOC Outcomes

Decision-Making; Information Processing; Participation in Health Care Decisions

Interventions and Rationales

• Engage the patient in the therapeutic relationship. Demonstrate an attitude of
respect, patience, and acceptance. Persons who feel cared for, understood, and
respected in health care situations are better motivated to collaboratively participate
in their care.
• Continually assess for readiness to make a health care choice to promote timely decision
making.
• Ensure privacy for one-to-one interaction between patient and nurse. The patient’s
status in relationships with family/loved ones may inhibit frank discussion in their
presence.
• Ensure that communications and information provided are at a level consistent with the
patient’s cognitive abilities to ensure understanding.
• Avoid limiting choices based on health care provider preference, values, or beliefs and
avoid encouraging one choice over another. The health care team is accountable to the
patient to provide appropriate information on all available options and to promote
autonomous decision making.
• Explore with the patient the meaning of experience of making a health care decision.
Ask what meanings the current health care situation and having to make a health
care decision have for the patient. The health care need and necessity to make a
health care decision may represent a crisis for the patient. Understanding the patient’s
experience of this can direct the identification of other necessary assessments and
interventions.
• Discuss the patient’s emotional experience of needing to make a health care choice. The
patient may feel anger, fear, anxiety, pressured, or overwhelmed by the need to choose or
the choices offered.
• Validate the patient’s experience, and ask permission to discuss the patient’s thoughts
and feelings about own choices. Identify any anxiety or fear related to making a decision.
Fear and anxiety can lead to anger, feeling pressured or overwhelmed, procrastination,
and/or excessive seeing of reassurance or opinions from others.
• If fear or anxiety is present, validate the patient’s experience to promote self-esteem,
strengthen the therapeutic relationship, and promote autonomous decision making.
• Provide clarifying information about choices, if needed. Misinterpretations of informa-
tion may lead to difficulty making a decision.
• Refer to professional support to address anxious distorted thoughts, if needed. Counsel-
ing may be required to assist the patient to work through distorted thoughts and deter-
mine own best course of action.
• Share with the patient observation of distress when hearing other’s opinion. Ask the pa-
tient to share thoughts that are leading to distress. Sharing thoughts that lead to distress
regarding others’ opinions may reveal relationship barriers to decision making. Indecision
may arise from dissonance between the patient’s own values, beliefs, and preferences and

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 Impaired Emancipated Decision Making   741

those of loved ones or health care providers. Validate those thoughts. Validation of the
patient’s distressing thoughts promotes self-esteem, builds the therapeutic relationship,
and promotes autonomous decision making.
• If needed, clarify perceptions of health care team decisional preference. The patient may
feel pressured to make an unwanted choice by a perceived power differential within the
therapeutic relationship.
• Engage the patient to use a problem-solving framework to identify and to evaluate the
possible available choices. Ask the patient to list the advantages and drawbacks to each
choice, as well as personal values, goals, and preferences related to each choice. Encour-
age the patient to identify personal and social barriers to enacting any of the choices.
Then ask the patient to rate the suitability of each choice based on appraisal of each one.
Use of a problem-solving framework in consideration of health care choices encourages
the patient to consider health care options from the context of own experience, and to
identify own best choices given the patient’s life situation.

Suggested NIC Interventions

Active Listening; Assertiveness Training; Decision-Making Support; Learning Facilitation;

Mutual Goal Setting

Evaluations for Expected Outcomes

• The patient states how available health care choices fit with their values, beliefs, prefer-
ences, and lifestyle.
• The patient expresses own values, beliefs, and preferences in making the health care deci-
sion, comparing and contrasting how they differ from loved ones.
• The patient does not perceive pressure to choose or preference of a choice by the health
care team.
• The patient freely verbalizes own opinion.
• The patient chooses health care option and expresses satisfaction with own choice based
on the options available.

Documentation
• Assessment findings
• Health teaching regarding the patient’s health need and available health care
choices
• Patient verbatim statements regarding perceptions of health care situation and available
choices
• Patient verbatim statements regarding own emotional experience of making a health care
decision, related interventions undertaken, and patient response
• Observations of patient distress when hearing others’ opinions, related interventions en-
acted, and patient response
• Use of problem-solving framework and patient response to same
REFERENCES
Kramer-Roy, D. (2015). Using participatory and creative methods to facilitate emancipatory research
with people facing multiple disadvantage: A role for health and care professionals. Disability and
Society, 30(8), 1207–1224.
Olesen, M. L., Graungaard, A. H., & Husted, G. R. (2015). Deciding treatment for miscarriage—
Experiences of women and health care professionals. Scandinavian Journal of Caring Sciences, 29(2),
386–394.

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 742  PART VI – Psychiatric and Mental Health

Welzel, C., & Delhey, J. (2015). Generalizing trust: The benign force of emancipation. Journal of Cross-
Cultural Psychology, 46(7), 875–896.
Wittmann-Price, R. A., & Price, S. W. (2014). Development and revision of the Wittmann-Price
emancipated decision-making scale. Journal or Nursing Measurement, 22(3), 361–367.

READINESS FOR ENHANCED EMANCIPATED DECISION MAKING

related to decrease in understanding of all available health care options; limited decision-making experience

Definition
A process of choosing a health care decision that includes personal knowledge and/or consid-
eration of social norms, which can be strengthened

Assessment
• Levels of consciousness and orientation • Presence of cognitive impairment
• Age • Level of education
• Stage of development • Language fluency

Defining Characteristics
• Expresses desire to enhance ability to choose health care options that best fit current
lifestyle
• Expresses desire to enhance ability to enact chosen health care option
• Expresses desire to enhance ability to understand all available health care options
• Expresses desire to enhance ability to verbalize own opinion with constraint
• Expresses desire to enhance comfort to verbalize health care options in the presence of
others
• Expresses desire to enhance confidence in decision making
• Expresses desire to enhance confidence to discuss health care options openly
• Expresses desire to enhance decision making
• Expresses desire to enhance privacy to discuss health care options

Expected Outcomes
• The patient will engage with the nurse to meet needs for privacy
• The patient will openly seek information, and verbalize that the patient’s information
needs are met
• The patient will assertively communicate own opinions regarding own health care
choices
• The patient will self-select a health care choice that meets the patient’s lifestyle needs and
reflects the patient’s values, beliefs, and preferences
• The patient will verbalize satisfaction with own health care decision given the available
choices

Suggested NOC Outcomes

Decision-Making; Information Processing; Participation in Health Care Decisions

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 Readiness for Enhanced Emancipated Decision Making   743

Interventions and Rationales

• Collaborate with the patient to determine strategies to meet the patient’s needs for pri-
vacy. To promote self-care, self-esteem, and decision making.
• Provide information proactively in anticipation of the patient’s needs, as well as upon
request by the patient. Encourage the patient to ask questions and provide meaningful
answers to them. To promote psychological readiness to make a decision, self-esteem, and
confidence in knowledge.
• Avoid the use of technical terms when at all possible; explain the meaning of technical
terms when they must be used in communication with or in the presence of the patient.
To prevent a perceived power differential, which can be a barrier to patient understand-
ing and self-esteem, and impede the therapeutic relationship.
• Ensure that communications and information provided are at a level consistent with the
patient’s cognitive abilities to ensure understanding.
• Promote self-esteem through active listening, validation of concerns, knowledge and
feelings, conveyance of respect for the patient’s values, beliefs, and preferences. To
promote psychological readiness to make a decision, and to strengthen the therapeutic
relationship.
• Use active listening to identify and reflect back to the patient the opinions of choices
available to the patient. To promote autonomous consideration of options by the patient
and confidence in own opinions.
• Ask the patient to verbalize what lifestyle, social, and other factors the patient needs to
consider in making a decision, and how these would impact or be impacted by the health
care choices available to the patient. To promote consideration of the context of the pa-
tient’s decision making.
• Ask the patient about strategies used in the past to make decisions. Validate the patient’s
past choices in strategies. Engage the patient in realistic appraisal of the applicability of
past strategies to current situation. To identify and draw on personal experiences and
strengths in decision making.
• Teach the patient about the utility of problem-solving frameworks to assist in decision
making. As desired, ask the patient to use a problem-solving framework to identify and
to evaluate the possible choices available. Ask the patient to list the advantages and
drawbacks to each choice, as well as personal values, goals and preferences related to
each choice. Encourage the patient to identify personal and social barriers to enacting
any of the choices. Then ask the patient to rate the suitability of each choice based on
the patient’s appraisal of each one. Use of a problem-solving framework in consider-
ation of health care choices encourages the patient to consider health care options from
the context of own experience, and to identify own best choices given the patient’s life
situation.
• As needed, assist the patient to practice assertive expression of opinions. Encourage the
patient to communicate in a way that is authentic, and simultaneously respectful of own
feelings, values, beliefs, and wishes, as well as those of others. Assertive expression of
opinions promotes self-esteem within and after interpersonal interactions.
• Role playing assertive expression of opinions may be helpful to prepare the patient to do
so in real-life situations. Role play can be an effective strategy toward the development of
skill mastery.

Suggested NIC Interventions

Active Listening; Assertiveness Training; Decision-Making Support; Learning Facilitation;

Mutual Goal Setting

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 744  PART VI – Psychiatric and Mental Health

Evaluations for Expected Outcomes

• The patient collaborates on meeting own needs for privacy
• The patient openly seeks information.
• The patient verbalizes having sufficient information to make own health care
decision.
• The patient communicates own opinions regarding health care choices while remaining
respectful of those of others.
• The patient self-selects a health care choice that meets the patient’s lifestyle needs and re-
flects the patient’s values, beliefs, and preferences
• The patient verbalizes satisfaction with health care decision given the available choices

Documentation
• Assessment findings
• Patient engagement in planning and enacting interventions to ensure privacy; interven-
tions taken to ensure privacy.
• Information sought and health teaching provided, including patient response.
• Past decision-making strategies used and patient’s verbatim perceptions of utility for ap-
plication in current situation.
• Patient’s verbatim opinions of the available health care choices.
• Patient response to education regarding problem-solving framework, and as appropriate,
the patient’s use of it in the current situation.
• Patient-identified factors in making own health care decision.
• As applicable, patient engagement in practice of assertive expression of opinions.
• Decision made by patient.
• Patient verbalizations regarding satisfaction with choices and own decision.

REFERENCES
Kayser, J. W., Cossette, S., & Alderson, M. (2014). Autonomy-supportive intervention: An evolutionary
concept analysis. Journal of Advanced Nursing, 70(6), 1254–1266.
Linehan, M. (2014). DBT skills training manual (2nd ed.). New York: Guilford Press.
Olesen, M. L., Graungaard, A. H., & Husted, G. R. (2015). Deciding treatment for miscarriage—
Experiences of women and health care professionals. Scandinavian Journal of Caring Sciences, 29(2),
386–394.
Welzel, C., & Delhey, J. (2015). Generalizing trust: The benign force of emancipation. Journal of Cross-
Cultural Psychology, 46(7), 875–896.

RISK FOR IMPAIRED EMANCIPATED DECISION MAKING

related to insufficient information regarding health care options; insufficient self-confidence in decision making

Definition
Vulnerable to a process of choosing a health care decision that does not include personal
knowledge and/or consideration of social norms, or does not occur in a flexible environment,
resulting in decisional dissatisfaction

Assessment
• Levels of consciousness and orientation
• Age

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 Risk for Impaired Emancipated Decision Making   745

• Stage of development • Level of education

• Presence of cognitive impairment • Language fluency

Risk Factors
• Inadequate time to discuss health care options
• Insufficient confidence to openly discuss health care options
• Insufficient privacy to openly discuss health care options
• Limited decision-making experience
• Traditional hierarchical family
• Traditional hierarchical health care systems

Expected Outcomes
• The patient will verbalize own opinion freely
• The patient will verbalize own values, beliefs, and preferences
• The patient will identify any disparities between self and others’ values, beliefs, and
preferences
• The patient’s information needs will be met
• The patient will make an autonomous health care choice

Suggested NOC Outcomes

Decision-Making; Information Processing; Participation in Health Care Decisions

Interventions and Rationales

• Engage the patient in the therapeutic relationship. Demonstrate an attitude of respect,
patience, and acceptance. Persons who feel cared for, understood, and respected in health
care situations are better motivated to collaboratively participate in own care.
• Ensure privacy for one-to-one interaction between patient and nurse. The patient’s status in
relationships with family/loved ones may inhibit frank discussion in their presence. If neces-
sary, move the interaction, modify the environment, or remove others to ensure privacy.
• Avoid limiting choices based on health care provider preference, values, or beliefs and
avoid encouraging one choice over another. The health care team is accountable to the
patient to provide appropriate information on all available options and to promote au-
tonomous decision making.
• Ensure that communications and information provided are at a level consistent with the
patient’s cognitive abilities to ensure understanding.
• Ask the patient about understanding of the patient’s health care need and the available
choices. To identify any misperceptions.
• Validate the patient’s understanding to promote self-esteem, confidence in knowledge,
and strengthen the therapeutic relationship.
• Accept the patient’s personal knowledge as relevant to the decision-making process. Dis-
courage the patient from discounting personal knowledge and deferring to others’ knowl-
edge to promote self-empowerment, confidence, and self-esteem.
• Provide education as needed in an accepting, nonjudgmental, supportive manner. Avoid
taking a stance of correcting the patient; rather build on the patient’s knowledge and un-
derstanding to build knowledge capacity while preserving self-esteem.
• Respectfully inquire as to the patient’s cultural background, including gender roles, gen-
erational roles, and social expectations. The patient is the best source of knowledge of
own particular culture.

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 746  PART VI – Psychiatric and Mental Health

• Encourage the patient to explore any cultural considerations in health care decision mak-
ing, and to share what it is like for the patient to include those considerations. Negative or
conflicting emotions, or indecision may arise in the patient due to incongruence between
the patient’s cultural values and beliefs and personal values, beliefs, and preferences.
• Explore with the patient the meaning of experiencing making a health care decision. Ask
what meaning the current health care situation and having to make a health care decision
has for the patient. The health care need and necessity to make a health care decision
may represent a crisis for the patient. Understanding the patient’s experience of this can
direct the identification of other necessary assessments and interventions.
• Ask the patient about strategies used in the past to make decisions. Validate the patient’s
past choices in strategies. Reinforce independent strategies. To identify and draw on per-
sonal experiences and strengths in decision making.
• If past experience in decision making is limited, engage the patient to use a problem-solving
framework to identify and to evaluate the possible available choices. Ask the patient to list
the advantages and drawbacks to each choice, as well as personal values, goals, and prefer-
ences related to each choice. Encourage the patient to identify personal and social barriers
to enacting any of the choices. Then ask the patient to rate the suitability of each choice
based on appraisal of each one. Use of a problem-solving framework in consideration of
health care choices encourages the patient to consider health care options from the context
of own experience, and to identify own best choices given the patient’s life situation.

Suggested NIC Interventions

Active Listening; Assertiveness Training; Decision-Making Support; Learning Facilitation;

Mutual Goal Setting

Evaluations for Expected Outcomes

• The patient freely verbalizes personal opinions about the available health care choices
• The patient verbalizes how health care choices align with personal values, beliefs, and
preferences
• The patient identifies conflicts between own choice and others’ values, beliefs, and
preferences
• The patient verbalizes feeling informed about own choices
• The patient makes an autonomous health care choice
• The patient verbalizes satisfaction with own health care choice given the available options

Documentation
• Assessment findings
• Interventions taken to ensure privacy, and patient and loved ones response
• Patient verbatim statements regarding the patient’s understanding and perceptions of
own health care choices, own cultural identification and norms, and the meaning the pa-
tient makes of own health concern and the need to make a health care decision. Related
interventions undertaken and patient response.
• Past decision-making strategies used and utility for application in current situation
• Health teaching regarding health care choices, including patient response
• Any use of a problem-solving framework and patient response to same
• Patient’s decision made and verbatim statements regarding the patient’s satisfaction with
it given the choices available

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 Labile Emotional Control   747

REFERENCES
Kramer-Roy, D. (2015). Using participatory and creative methods to facilitate emancipatory research
with people facing multiple disadvantage: A role for health and care professionals. Disability and
Society, 30(8), 1207–1224.
Olesen, M. L., Graungaard, A. H., & Husted, G. R. (2015). Deciding treatment for miscarriage—
Experiences of women and health care professionals. Scandinavian Journal of Caring Sciences, 29(2),
386–394.
Papastavrou, E., Efstathiou, G., Tsangari, H., Karlou, C., Patiraki, E., Jarosova, D., … Suhonen, R.
(2016). Patients’ decisional control over care: A cross-national comparison from both the patients’ and
nurses’ points of view. Scandinavian Journal of Caring Sciences, 30(1), 26–36.
Welzel, C., & Delhey, J. (2015). Generalizing trust: The benign force of emancipation. Journal of Cross-
Cultural Psychology, 46(7), 875–896.
Wittmann-Price, R., & Price, S. (2014). Development and revision of the Wittmann-Price emancipated
decision-making scale. Journal or Nursing Measurement, 22(3), 361–367.

LABILE EMOTIONAL CONTROL

related to brain injury; emotional disturbance; stressors

Definition
Uncontrollable outbursts of exaggerated and involuntary emotional expression

Assessment
• Physiologic status, including patterns of nutrition, pain, elimination, activity, and rest
• Developmental delay or disability
• History of or current neurologic disease and/or traumatic brain injury
• History of or current exposure to trauma involving own or a loved one’s death or the
threat of death, serious injury, or sexual violence
• History of or current mental illness, including ADHD, mood, anxiety, eating, somato-
form, autism spectrum, or borderline personality disorders
• History of impulse control disorder
• Mental status exam, including appearance, affect, mood, sensorium, cognition, motor
(i.e., speech, movements, gait), thought process, thought content, perceptual disturbance)
• Childhood experience of parental responsiveness to emotional and psychological needs
• Substance use, including alcohol, street drugs, and prescription medications used differ-
ently than as prescribed, and patient’s perceived benefits of substance use
• Usual pattern of emotional response. For areas of distress intolerance, specific types of
stressors, frequency, and maladaptive response(s)
• Presence of rumination on stressors, or a typical pattern of rumination on stressors
• Patient’s perception of health situation
• Patient’s perception of own exaggerated and involuntary emotional expression

Defining Characteristics
• Absence of eye contact
• Difficulty in use of facial expressions
• Embarrassment regarding emotional expression
• Excessive crying without feeling sadness
• Excessive laughing without feeling happiness

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 748  PART VI – Psychiatric and Mental Health

• Expression of emotion incongruent with triggering factor

• Involuntary crying
• Involuntary laughing
• Tearfulness
• Uncontrollable crying
• Uncontrollable laughing
• Withdrawal from occupational situation
• Withdrawal from social situation

Expected Outcomes
• Patient will identify the personal and social impacts of emotional outbursts, and own
goals for managing/limiting outbursts.
• Patient will discuss bodily, cognitive, and situational experiences correlating with periods
of emotional outbursts.
• Patient will practice strategies to promote emotional control.
• Patient will express positive self-esteem.

Suggested NOC Outcomes

Aggression Control; Anxiety Control; Coping; Impulse Control; Self-Esteem;

Self-Mutilation Restraint; Social Interaction Skills

Interventions and Rationales

• Do not attempt to teach new skills/information while the patient is in the midst of an in-
tense emotional outburst as the patient’s cognitive capacity may be reduced at this time.
• Teach new skills when the patient is calm. Emotional outbursts physiologically are
time-limited.
• During the outburst, use a calm tone and communicate in short, direct, specific state-
ments. Expect that the patient may need extra time to process information and that
instructions may need to be repeated as diminished cognitive capacity may impact pro-
cessing of information.
• When the outburst has ended, ensure that the patient’s immediate physiologic needs (i.e.,
rest, nutrition, hydration, elimination) are addressed prior to engaging in interventions to
reduce and prevent future outbursts. Basic physiologic needs must be met for the patient
to be able to engage therapeutically.
• Teach the patient about the social impact of the patient’s emotional outbursts (as needed).
Ask the patient to identify at least one person, besides self, who has been impacted by
emotional outbursts. Ask the patient to identify at least one way the patient has been
impacted socially, and one way the patient has been impacted occupationally (i.e., work,
school) by outbursts to promote insight and stimulate motivation to engage in strategies
to limit outbursts.
• Use nonjudgmental, matter-of-fact language to promote self-esteem.
• Engage the patient in discussion of how life would be different if the patient had better
control over emotional outbursts to foster motivation and engagement in care.
• Ask the patient to decide at least one reason why the patient wants to better control emo-
tional expression to foster motivation and engagement in interventions, and to promote
self-efficacy.

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 Labile Emotional Control   749

• Teach the patient to practice awareness of bodily sensations to help learn the early signs
of emotional arousal.
• Assist the patient to make linkages between bodily sensations and emotional state. Teach
strategies to decrease physiologic arousal to help the patient to limit unwanted emotional
outbursts.
• Assist the patient to identify environmental and situational triggers to physiologic
arousal, and engage the patient to create a plan to limit physiologic arousal to promote
self-efficacy in proactive management of emotional outbursts.
• Promote self-esteem. Emphasize therapeutic gains made by the patient and encourage
nonjudgmental, realistic appraisal of therapeutic challenges. Higher self-esteem promotes
cognitive self-regulatory capacity.
• Assist the patient to identify and practice strategies to manage distressing/exciting situa-
tions and strong emotions. Use vicarious learning or role play exercises to practice plan
of response to limit emotional outbursts. Practice of strategies in a safe and controlled
environment develops skills in strategies and builds confidence to apply strategies in trig-
gering situations.
• Involve the patient in own care. Provide options and solicit feedback on the patient’s ex-
perience of care. Partnering with the patient promotes self-efficacy and self-esteem, and
strengthens the therapeutic alliance.
• Solicit the patient’s thoughts and experience of bodily sensations during care. Reinforce
and support use of adaptive coping strategies to limit emotional outbursts. To help the
patient further develop awareness of signs and triggers, and to promote use of strategies
to limit/prevent outbursts.
• Communicate continuous nonjudgmental acceptance of the patient through
verbal and meta-communication. To strengthen the therapeutic alliance, promote
self-esteem.
• Provide the patient with specific, simple, step-by-step information on what to expect in care
to reduce/prevent emotional arousal, communicate respect, and engage patient in care.
• Chunk information according to immediate care requirements, and provide updates as
each stage of care ensues. Chunking information decreases cognitive stress and promotes
retention.
• Assist the patient with referral to specialized resources in Mindfulness, Dialectical
Behavior Therapy, and/or Cognitive Behavioral Therapy, as indicated, in consultation
with the interdisciplinary care team. Mindfulness improves attention and body awareness,
and promotes cognitive control and attentional capability in situations of high emotion.
Mindfulness, Dialectical Behavioral Therapy, and Cognitive Behavior Therapy each have
applications for improving cognitive control and emotional dysregulation.

Suggested NIC Interventions

Anger Control Assistance; Anxiety Reduction; Cognitive Restructuring; Coping Enhance-

ment; Impulse Control Training; Support Group

Evaluations for Expected Outcomes

• The patient discusses experience of own emotional outbursts, and identifies ways they
have affected the patient. Also, there is discussion on ways emotional outbursts have im-
pacted the patient socially, including the effects on other people, relationships, social, and
occupational opportunities. The patient identifies reasons to work toward better control
of emotional expression.

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 750  PART VI – Psychiatric and Mental Health

• The patient identifies bodily sensations/changes, thoughts, and situations antecedent to

emotional outbursts. The patient notes any trends in antecedents.
• The patient practices strategies to notice own physiologic, cognitive and emotional states,
and practices strategies to decrease physiologic and emotional arousal.
• The patient identifies achievements inherent in decision to engage in interventions to limit
emotional outbursts, setting goals, skills learned, skills practiced, and positive gains made
in treatment.

Documentation
• Food and fluid intake, assessment of pain (if present), bowel and bladder activity, sleep
patterns, activity, and exercise
• Relevant medical, developmental, and psychiatric history
• History of trauma
• Substance use, (if applicable) the patient’s reasons for using, and relationship of substance
use to emotional outbursts
• Patient, family, and nurse’s observations of emotional outbursts, antecedents, impacts of
and responses to outbursts
• Interventions implemented to limit uncontrolled emotional outbursts, including patient
engagement and response
• Evaluations for expected outcomes
• Referrals to other services
REFERENCES
Grecucci, A., Pappaianni, E., Siugzdaite, R., Theuninck, A., & Job, R. (2015). Mindful emotion regulation:
Exploring the neurocognitive mechanisms behind mindfulness. BioMed Research International, 1–9.
Linehan, M. (2014). DBT skills training manual (2nd ed.). New York: Guilford Press.
Sullivan-Bolyai, S., Johnson, K., Cullen, K., Hamm, T., Bisordi, J., Blaney, K., … Melkus, G.
(2014). Tried and true: Self-regulation theory as a guiding framework for teaching parents diabetes
education using human patient simulation. Advances in Nursing Science, 37(4), 340–349.
Thomson, K., Burnham Riosa, P., & Weiss, J. (2015). Brief report of preliminary outcomes of an
emotion regulation intervention for children with autism spectrum disorder. Journal of Autism and
Developmental Disorders, 45(11), 3487–3495.
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DYSFUNCTIONAL FAMILY PROCESSES

related to family history of substance abuse; substance abuse

Definition
Psychosocial, spiritual, and physiological functions of the family unit are chronically disor-
ganized, which leads to conflict, denial of problems, resistance to change, ineffective problem
solving, and a series of self-perpetuating crises

Assessment
• Family status, including alcoholic family member’s ability to function in occupational and
family roles, ability of other family members to function in their roles, family conflicts,
financial status, and rituals during holidays and family celebrations

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