A state of actual or perceived loss of control or influence over factors or events that affect one's well-being, personal life, or the society (adapted from American Psychology Association)
Delayed recovery
Depressive symptoms
Expresses doubt about role performance
Expresses frustration about inability to perform previous activities
Expresses lack of purpose in life
Expresses shame
Fatigue
Loss of independence
Reports inadequate sense of control
Social alienation
Pathophysiologic
Any disease process, acute or chronic, can cause or contribute to powerlessness. Some common sources are the following:
Related to inability to communicate secondary to:
Stroke
Alzheimer's or Parkinson's disease (dysarthria)
Intubation, mechanical ventilation, or tracheostomy
Related to inability to perform activities of daily living secondary to such conditions as:
Stroke
Cervical trauma
Myocardial infarction
Pain
Related to inability to perform role responsibilities secondary to surgery, trauma, or arthritis
Related to progressive debilitating disease secondary to such diseases as multiple sclerosis, terminal cancer, or AIDS
Related to substance abuse
Related to cognitive distortions secondary to mental health disorders
Situational (Personal, Environmental)
NANDA-I approved*
Related to:
Dysfunctional institutional environment*
Inadequate interpersonal relations*
Anxiety *
Caregiver Role Strain *
Ineffective coping strategies*
Inadequate knowledge to manage a situation*
Inadequate social support*
Low self-esteem*
Pain*
Social marginalization*
Stigmatization
Related to change from curative status to palliative status
Related to feeling of loss of control and lifestyle restrictions secondary to (specify)
Related to overeating patterns
Related to personal characteristics that highly value control (e.g., internal locus of control)
Related to effects of hospital or institutional limitations
Related to elevated fear of disapproval
Related to consistent negative feedback
Related to long-term abusive relationships
Related to oppressive patriarchal values with women
Related to the presence of an abusive relationship with a history of mental illness (Orzeck, Rokach, & Chin, 2010)
Maturational
Older Adult
Related to multiple losses secondary to aging (e.g., retirement, sensory deficits, motor deficits, money, significant others)
AUTHOR'S NOTEPowerlessness is a feeling that all people experience to varying degrees in various situations. Stephenson (*1979) described two types of powerlessness: (1) situational powerlessness occurs in a specific event and is probably short-lived; (2) trait powerlessness is more pervasive, affecting general outlook, goals, lifestyle, and relationships.
Hopelessness differs from powerlessness in that a hopeless individual sees no solution to problems or no way to achieve what is desired, even if he or she feels in control. A powerless individual may see an alternative yet is unable to do anything about it because of perception of lack of control and resources. Prolonged powerlessness may lead to hopelessness.
NOCDepression Control, Health Beliefs, Health Beliefs: Perceived Control, Participation: Healthcare Decisions
The individual will verbalize ability to control or influence situations and outcomes, as evidenced by the following indicators:
- Identify the factors that one can control.
- The client will make decisions regarding his or her care, treatment, and future when possible.
NICMood Management, Teaching: Individual, Decision-Making Support, Self-Responsibility Facilitation, Health System Guidance
Level 3 Specialty Interventions (inpatient, ambulatory settings)
Interventions
Assess for Causative and Contributing Factors
- Lack of knowledge
- Previous inadequate coping patterns (e.g., depression; for discussion, see Ineffective Coping)
- Insufficient decision-making opportunities
Eliminate or Reduce Contributing Factors, if Possible
R:Powerlessness can be ameliorated by implementing coping strategies and by having consistent and reliable nursing care in an individual-centered environment (Haugan, Innstrand, & Moksnes, 2013).
Lack of Knowledge
- Increase effective communication between the individual and healthcare provider.
- Explain all procedures, rules, and options to the individual; avoid medical jargon. Help to anticipate situations that will occur during treatments (provides reality-oriented cognitive images that bolster a sense of control and coping strategies).
- Allow time to answer questions; ask to write questions down so that he or she does not forget them.
- Anticipate questions/interest and offer information. Help to anticipate events and outcomes.
- While being realistic, point out positive changes in their condition, such as serum enzymes decreasing after myocardial infarction or surgical incision healing well.
Provide opportunities for the individual and family to identify with a primary nurse to establish continuity in provision of care and implementation of the care plan.
- If contributing factors are pain or anxiety, provide information about how to use behavioral control techniques (e.g., relaxation, imagery, deep breathing).
R:Feelings of powerlessness and helplessness are closely associated with incurable diseases (Meeker, Waldrop, Schneider, & Case, 2013).
Provide Opportunities for the Individual to Control Decisions and to Identify Personal Goals of Care
- Record the specific choices in care plan to ensure that others and staff acknowledge preferences ("dislikes orange juice," "takes showers," "plan dressing change at 7:30
AM
before shower"). - Keep promises.
- Provide opportunities for the individual and family to participate in care.
- Be alert for signs of paternalism/maternalism in healthcare providers (e.g., making decisions for).
- Plan a care conference to allow staff to discuss methods of individualizing care; encourage each nurse to share at least one action that he or she discovered a particular individual likes.
- Shift emphasis from what one cannot do to what one can do.
- Set goals that are short term, behavioral, practical, and realistic (walk 5 more feet every day; then in 1 week, can walk to the television room).
Allow the individual to experience outcomes that result from his or her own actions.
R:People with chronic illness require adjustments in their perceptions of self as their level of autonomy changes. Integrating the limitations that come with chronic illness can assist the individual toward the maximum state of independence possible (Abad-Corpa, Gonzalez-Gil, Martínez-Hernández et al., 2012).
Actively Involve an Individual with External Locus of Control to Encourage Participation
- Have the individual keep a record (e.g., food intake for 1 week; weight loss chart; exercise program; type and frequency of medications taken).
- Use telephone or e-mail contact to monitor the individual, if feasible.
- Provide explicit written directions (e.g., meal plans; exercise regimen—type, frequency, duration; speech practice lessons for aphasia).
R:Create a learning environment that assists the client to identify self-management strategies that are meaningful and important to him or her.
Assist in Deriving Power from Other Sources if Desired
- Support use of other power sources (e.g., prayer, stress reduction techniques).
- Provide privacy and support for interventions the individual or family may request (e.g., meditation, imagery, special rituals).
- Suggest self-help groups focusing on empowerment.
R:Self-help groups that focused on empowerment issues assisted participants in the direction of valuable progress toward recovery (*Stang & Mittelmark, 2008).
Initiate Health Teaching and Referrals as Indicated (Social Worker, Psychiatric Nurse/Physician, Visiting Nurse, Religious Leader, Self-Help Groups)
Offer referral to faith-based community resources (e.g., religious leaders, faith community nurse, house of worship).
Level 2 Specialty Interventions
Pediatric Interventions
- Provide opportunities for the child to make decisions (e.g., set time for bath, count to 10 and hold still for injection).
- Engage the child in play therapy before and after a traumatic situation (refer to Delayed Growth and Development for specific interventions for age-related development needs).
R:The goals of nursing interventions to treat powerlessness include modifying the environment to resemble the child's home and providing opportunities for acceptable control. Children can gain mastery over stressful situations by participating in play activities while ill or hospitalized (Hockenberry, Rodgers, & Wilson, 2018).