NCP Nursing Diagnosis: Powerlessness

Nursing Diagnosis: Powerlessness
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels

* Health Beliefs: Perceived Control
* Participation: Health Care Decisions

NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels

* Self-Responsibility Facilitation
* Self-Esteem Enhancement

NANDA Definition: Perception that one’s own actions will not significantly affect an outcome; a perceived lack of control over a current situation or immediate happening

Powerlessness may be expressed at any time during a patient’s illness. During an acute episode, people used to being in control may temporarily find themselves unable to navigate the health care system and environment. The medical jargon, the swiftness with which decisions are expected to be made, and the vast array of health care providers to which the patient has to relate can all cause a feeling of powerlessness. This response is compounded by patients of cultural, religious, or ethnic backgrounds that differ from the dominant health care providers. Patients with chronic, debilitating, or terminal illnesses may have long-term feelings of powerlessness because they are unable to change their inevitable outcomes. Elderly patients are especially susceptible to the threat of loss of control and independence that comes with aging, as well as the consequences of illness and disease. Patients suffering from feelings of powerlessness may be seen in the hospital, ambulatory care, rehabilitation, or home care environments.

* Defining Characteristics: Expression of having no control or influence over situation or outcome
* Nonparticipation in care or decision making when opportunities are provided
* Reluctance to express true feelings
* Diminished patient-initiated interaction
* Passivity, submissiveness, apathy
* Withdrawal, depression
* Aggressive, acting out, and/or violent behavior
* Feeling of hopelessness
* Decreased participation in activities of daily living

* Related Factors: Health care environment
* Illness-related regimen
* Acute or chronic illness
* Inability to communicate effectively
* Dependence on others for activities of daily living
* Inability to perform role responsibilities
* Progressive debilitating disease
* Terminal prognosis
* Loss of control over life decisions
* Lack of knowledge

* Expected Outcomes Patient begins to identify ways to achieve control over personal situation.
* Patient begins to express sense of personal control.
* Patient makes decisions regarding care as appropriate.

Ongoing Assessment

* Assess the patient’s power needs or needs for control. Patients are usually able to identify those aspects of self-governance that they miss most and which are most important to them.
* Assess for feelings of hopelessness, depression, and apathy. These feelings may be a component of powerlessness.
* Identify patient’s locus of control. The degree to which people attribute responsibility to themselves (internal control) versus other forces (external control) determines locus of control.
* Identify situations and/or interactions that may add to the patient’s sense of powerlessness. Many medical routines are superimposed on patients without ever receiving their permission, fostering a sense of powerlessness. It is important for health care providers to recognize the patient’s right to refuse procedures such as feeding tubes and intubation.
* Assess the patient’s decision-making ability. Powerlessness is not the same as the inability to make a decision. It is the feeling that one has lost the implicit power for self-governance.
* Assess the role the illness plays in patient’s powerlessness. Uncertainty about events, duration and course of illness, prognosis, and dependence on others for help and treatments involved can contribute to powerlessness.
* Assess the impact of powerlessness on the patient’s physical condition (e.g., appearance, oral intake, hygiene, sleep habits). Individuals may feel as though they are unable to control very basic aspects of life.
* Determine whether there are differences between the patient’s views of his or her own condition and the view of the health care providers.
* Note whether the patient demonstrates need for information about illness, treatment plan, and procedures. This will differentiate powerlessness from knowledge deficit.
* Evaluate the effects of the information provided on patient’s behavior and feelings. A patient experiencing powerlessness may ignore information. A patient simply experiencing a knowledge deficit may be mobilized to act in his or her own best interest after information is given and options are explored. The act of providing information may heighten a patient’s sense of autonomy.
* Assess whether the patient has an advanced directive, a durable power of attorney for health care, or a living will. These legal documents express the patient’s desires for health care treatment and designate another person to act on their behalf.
* Assess patient’s desires or abilities to be an active participant in self-care.

Therapeutic Interventions

* Encourage verbalization of feelings, perceptions, and fears about making decisions. This creates a supportive climate and sends message of caring.
* Acknowledge patient’s knowledge of self and personal situation.
* Enhance the patient’s sense of autonomy. Do this by involving the patient in decision making, by giving information, and by enabling the patient to control the environment as appropriate. Patients become very dependent in the high-tech, medical environment and may relegate decision making to the health care providers. This may be especially evident in patients of cultures or ethnic heritages different from the dominant health care providers.
* Encourage patient to identify strengths. Review of past coping experiences and prior decision-making skills may assist the patient to recognize inner strengths. Self-confidence and security come with a sense of control.
* Assist the patient to reexamine negative perceptions of the situation. Patient may have misconceptions or unrealistic expectations for the situation.
* Eliminate unpredictability of events by allowing adequate preparation for tests or procedures. Information can provide a sense of control.
* Encourage increased responsibility for self. The perception of powerlessness may negate patient’s attention to areas where self-care is attainable; however, patient may require significant support systems and resources to accomplish goals.
* Implement individualized strategies to provide hygiene, diet, and sleep. Allowing or helping the patient to decide when and how these things are to be accomplished will increase the patient’s sense of autonomy.
* Give the patient control over his or her environment. Encourage patient to furnish the environment with those things that he or she finds comforting. This enhances the patient’s sense of autonomy and acknowledges his or her right to have dominion over controllable aspects of life. It applies to the hospital as well as the extended care or home care environment.
* Assist with creating a timetable to guide increased responsibility in the future. With short hospital stays, patients may find themselves helpless and dependent on discharge, and unrealistically perceive their situation as unchangeable. Use of realistic short-term goals for resuming aspects of self-care may foster confidence in one’s abilities.
* Provide positive feedback for making decisions and participating in self-care. Success fosters confidence in abilities and a sense of control.
* Assist patient to identify the significance of culture, religion, race, gender, and age on his or her sense of powerlessness. Especially in the hospital environment where the patient does not speak the dominant language, food is different, and customs such as bathing, personal space, and privacy differ, patients may retreat and develop a sense of powerlessness. Use of patient advocates and outreach workers from a given ethnic community may provide a bridge to the health care providers.
* Avoid using coercive power when approaching patient. This may intensify patient’s feelings of powerlessness and result in decreased self-esteem.
* Assist the patient in developing advanced directives. Allowing or helping patient to decide when and how things are to be accomplished will increase his or her sense of autonomy.

Education/Continuity of Care

* Assist family members or caregivers to allow independent activities within abilities. Caregivers may foster a sense of dependence in their efforts to be helpful and caring.
* Refer to support groups or self-help groups and community resources as appropriate. Persons who have "been there" may be most helpful in providing the supportive empathy necessary to move patient to the next level of independence and control.