Developmental stage, including physical maturity, cognition, beliefs, values, and ethics
Marital status
Family system (nuclear, extended role, and sibling position)
Sociocultural factors, including educational level, occupation, socioeconomic status, ethnic group, sexual preference, and religious beliefs
Psychological status, including level of function, coping mechanisms, support systems, self-image, self-esteem, and attitude toward physical appearance
History of sexual experiences, including experimentation, trauma, and other experiences
Level of functioning (cognitive, emotional, and behavioral)
Patient will describe feelings about current situation.
Patient will discuss benefits and drawbacks of treatment options.
Patient will make decisions related to daily activities.
Patient will express feelings about morals and decision-making.
Patient will discuss conflicts between personal values and social pressures.
Patient will identify desirable and undesirable consequences of undesired activity.
Patient will accept assistance from family, friends, clergy, and other people.
Patient will practice progressive muscle relaxation to decrease tension created by decisional conflict.
Patient will report feeling comfortable about ability to make an appropriate, rational choice.
Suggested NOC Outcomes
Coping; Decision-Making; Family Functioning; Information Processing; Participation in Health Care Decisions; Personal Autonomy
Interventions and Rationales⬆⬇
Encourage expressions of feelings about social patterns and society norms to improve recognition of feelings and foster open discussion.
Assure patient that you're willing to discuss all topics. Assure patient that all information will be kept confidential to encourage honest discussion of concerns.
Encourage the patient to explore feelings related to vital topics to promote trust and provide time when the patient can discuss feelings confidentially.
Listen to patient's concerns about difficulties in making a decision. Use a nonjudgmental approach and encourage expression of feelings to demonstrate acceptance of patient and respect for the patient's culture, beliefs, and value system.
Assist patient with the process of decision-making in relation to daily activities. Learning the process will provide the patient with a framework for decision-making and enhance patient's feelings of self-confidence when making more difficult health care decisions.
Help patient make decisions about daily activities to enhance feelings of autonomy.
Encourage visits with family, friends, and clergy; provide privacy during visits to foster emotional support.
Teach progressive muscle relaxation techniques to decrease physical and psychological signs of tension.
Help patient identify decision-making areas that require assistance from others and provide appropriate referrals. Providing referrals will ensure ongoing support. Putting patient in touch with appropriate community resources will help promote feeling that others are genuinely interested in patient's well-being.
Refer patient for long-term counseling if necessary. Long-standing emotional conflicts may require in-depth intervention.
Suggested NIC Interventions
Active Listening; Assertiveness Training; Counseling; Decision-Making Support; Learning Facilitation; Mutual Goal Setting; Patient Contracting; Self-Responsibility Facilitation; Support System Enhancement
Evaluations for Expected Outcomes⬆⬇
Patient expresses anxiety, tension, and other feelings related to difficult medical treatment decisions.
Patient discusses peer pressure, family conflict, or other factors that may be influencing undesirable behaviors.
Patient describes benefits and drawbacks of treatment options.
Patient makes minor decisions related to daily activities.
Patient identifies available sources of emotional support and requests help, if needed.
Patient accepts assistance from family, friends, clergy, and other people.
Patient practices progressive muscle relaxation to decrease tension created by decisional conflict.
Patient reports feeling at ease with ability to choose treatment option that's appropriate for him or her.
Documentation⬆⬇
Patient's statements that provide insight into conflict regarding treatment options
Cognitive, emotional, and behavioral functioning
Interventions to assist patient with resolving decisional conflict
Patient's response to nursing interventions
Evaluations for expected outcomes
Reference(s)⬆
Boland, L., Kryworuchko, J., Saarimaki, A., & Lawson, M. L. (2017). Parental decision making involvement and decisional conflict: A descriptive study. BMC Pediatrics, 17, 146.
Chen, N., Lin, Y., Liang, S., Tung, H., Tsay, S., & Wang, T. (2018). Conflict when making decisions about dialysis modality. Journal of Clinical Nursing, 27(1/2), e138-e146.
Lamahewa, K., Mathew, R., Iliffe, S., Wilcock, J., Manthorpe, J., Sampson, E. L., & Davies, N. (2018). A qualitative study exploring the difficulties influencing decision making at the end of life for people with dementia. Health Expectations, 21(1), 118-127.
Vella, L., Ring, H. A., Aitken, M. R. F., Watson, P. C., Presland, A., & Clare, I. C. H. (2018). Understanding self-reported difficulties in decision-making by people with autism spectrum disorders. Autism: The International Journal of Research & Practice, 22(5), 549-559.