Disturbance in mental processes involved in developing concepts and categories, reasoning, and problem solving

• Acute confusion
• Disorientation
• Excessive anxiety
• Excessive fear
• Excessive stress
• Maladaptive grieving
• Non-psychotic depressive symptoms
• Pain
• Substance misuse
• Unaddressed trauma

• Brain injuries
• Critical illness
• Hallucinations
• Mental disorders
• Neurodegenerative diseases
• Pharmaceutical preparations
• Phobic disorders

• Age, gender, level of education, and occupation
• Health history, including use of medications, recent surgery, allergies, history of alcoholism, drug abuse, and depression
• Neurologic status, including level of consciousness (LOC); orientation; thought and speech; mood; affect; memory; visual and spatial ability; judgment and insight; psycho-motor activity; perceptions; delusions, illusions, and hallucinations; pain level; recent behavioral changes; and history of transient ischemic attacks, head injury, early dementia, AIDS, or schizophrenia
• Cardiovascular status, including vital signs, skin color, auscultation of carotid artery and heart sounds, and history of coronary artery disease or hypertension
• Respiratory status, including rate, depth, and pattern of respirations; auscultation for breath sounds; smoking history; shortness of breath; and history of chronic obstructive pulmonary disease, cancer, or tuberculosis
• Sensory status, including results of vision and hearing examination, use of corrective lenses or hearing aid, and history of eye or ear disorders
• Ability to make decisions and/or problem solve
• Nutritional status, including typical daily food intake and weight loss
• Laboratory values for abnormalities (e.g., metabolic alkalosis, hypokalemia, anemia, elevated ammonia levels, and signs of infection)
• Sleep status, including recent change in sleep pattern or environment (recent hospitalization)

• Difficulty communicating verbally
• Difficulty finding solutions to everyday situations
• Difficulty independently performing instrumental activities of daily living
• Difficulty making decisions
• Difficulty performing expected social roles
• Difficulty planning activities
• Difficulty with impulse control
• Disorganized thought sequence
• Impaired interpretation of events
• Impaired judgment
• Inadequate emotional response to situations
• Obsessions
• Suspicions
• Unreal thoughts

• Patient will effectively communicate verbally.
• Patient expresses thoughts and feelings.
• Patient will perform instrumental activities of daily living.
• Patient will have organized thought sequence.
• Patient will express realistic thoughts.
• Patient will interpret events appropriately.
• Patient will exhibit reasonable judgment.
• Patient will find solutions to everyday situations, make decisions, and plan activities.
• Patient will perform expected social roles.
• Patient will exhibit impulse control.
• Patient will use appropriate coping strategies.

Suggested NOC Outcomes

• Assess for underlying problems (brain injury, critical illness, mental disorders, neurodegenerative disorders, or substance misuse). The thought process may improve with treatment of medical problems.
• Assess and reorient to patient to person/place/time as needed. Inability to maintain orientation indicates thought deterioration.
• Provide clear communication and do not challenge illogical thinking. Challenging can lead to distrust or reinforce delusions.
• Use therapeutic touch cautiously. May be perceived as aggression or create anxiety.
• Implement safety measures as needed (e.g., use of side rails, padding, supervision). Disoriented thinking may lead to unsafe behaviors.
• Encourage patient to verbalize thoughts and feelings. Verbalizing feelings in a nonthreatening environment helps patient come identify issues and formulate solutions.
• Encourage patient to participate in social/groups activities. To maximize functioning and thought processes.
• Maintain quiet environment and avoid loud noise and sudden movements. Prevents overstimulation and anxiety.
• Educate patient and family about options for long-term plans. To provide home care, transportation, assistance with care, support, and respite for caregivers.
• Refer to community resources (e.g., support groups, substance rehabilitation, mental health treatment programs). To promote wellness.

Suggested NIC Interventions

• Patient effectively communicates and verbally expresses thoughts and feelings.
• Patient performs instrumental activities of daily living.
• Patient has organized thought sequence.
• Patient expresses realistic thoughts.
• Patient interprets events appropriately.
• Patient exhibits appropriate judgment and decision-making.
• Patient plans activities.
• Patient performs expected social roles.
• Patient exhibits impulse control.
• Patient uses appropriate coping strategies.

• Description of episodes of disturbed thought process
• Assessment of patient's cognitive abilities, behavior, and self-care status
• Changes in patient's mental status as they occur
• Patient's statements of improved thought processes
• Patient's stated goals for activity planning and execution
• Teaching sessions and referrals
• Evaluations for expected outcomes

• Blanke, E. S., Schmidt, M. J., Riediger, M., & Brose, A. (2020). Thinking mindfully: How mindfulness relates to rumination and reflection in daily life. Emotion, 20(8), 1369-1381. http://dx.doi.org/10.1037/emo0000659
• Gehrt, T. B., Frostholm, L., Pallesen, K. J., Obermann, M., & Berntsen, D. (2020). Conscious thought during the resting state in patients with severe health anxiety and patients with obsessive-compulsive disorder. Psychology of Consciousness: Theory, Research, and Practice, 7(3), 207-217. http://dx.doi.org/10.1037/cns0000256
• Larsen, S. E., Fleming, C. J. E., & Resick, P. A. (2019). Residual symptoms following empirically supported treatment for PTSD. Psychological Trauma: Theory, Research, Practice, and Policy, 11(2), 207-215. http://dx.doi.org/10.1037/tra0000384
• Or, G., Levi-Belz, Y., & Aisenberg, D. (2021). Death anxiety and intrusive thinking during the COVID-19 pandemic. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry, 34(4), 201-212. http://dx.doi.org/10.1024/1662-9647/a000268