Nurs 202 Nursing Care Planning And Nursing Diagnosis

Nurs 202 Nursing Care Planning and Nursing Diagnosis (NANDA, Maslow)

What is required is the development of a comprehensive nursing care plan for a patient experiencing symptoms related to rape-trauma syndrome. This includes a detailed nursing assessment, formulation of nursing diagnoses based on NANDA International classifications and Maslow's hierarchy of needs, planning and setting achievable goals, implementing targeted nursing interventions, and evaluating the effectiveness of these interventions over time.

The nursing assessment in this case reveals subjective data such as feelings of depression, anxiety, and fear, especially when confronted with strangers. Objective data includes results from self-assessment tools indicating that stress management is notably poor, with a score of 2.1 on the Health Promoting Lifestyle Profile instrument in this domain. The patient exhibits signs consistent with rape-trauma syndrome, such as struggle with fear, depression, nightmares, and flashbacks. These symptoms suggest a need for holistic and trauma-informed care to promote emotional recovery and safety.

Nursing diagnoses should be formulated to address both psychological and physiological aspects. For instance, a primary diagnosis could be Ineffective Coping related to trauma and anxiety as evidenced by nightmares, flashbacks, and low stress management scores. Other possible diagnoses include Risk for Post-Trauma Syndrome and Anxiety related to fear of recurrence or ongoing trauma reminders.

In planning care, setting specific, measurable, achievable, relevant, and time-bound (SMART) goals is essential. Goals should aim to stabilize emotional symptoms, improve stress management skills, and foster adaptive coping mechanisms. For example, a goal could be: The patient will report a decrease in anxiety and fear levels within four weeks, demonstrated by self-report and observational assessments. Additionally, enhancing the patient's support network by involving family and friends in the healing process is critical.

Nursing interventions should incorporate evidence-based strategies tailored to trauma survivors. These include facilitating a safe environment, providing emotional support, teaching relaxation techniques such as meditation and prayer, and encouraging participation in counseling sessions. According to Burgess (1983), immediate medical and psychological intervention is crucial for rape victims. Nurses can educate the patient on healthy coping mechanisms and assist in developing personalized stress management plans. Moreover, implementing regular assessments to monitor progress—such as self-report diaries tracked every six months—will help evaluate intervention effectiveness and guide necessary adjustments.

Evaluation involves assessing the patient’s emotional and psychological improvements, indicating whether the nursing interventions have achieved desired outcomes. If goals are not met, interventions should be reevaluated and modified accordingly. Continuous follow-up and support are vital in trauma recovery. The patient’s own diaries and feedback during counseling sessions serve as valuable tools for ongoing assessment.

In conclusion, a structured, empathetic, and multidisciplinary approach is essential for managing rape-trauma syndrome. Integrating nursing theories like Maslow's hierarchy of needs ensures that fundamental safety, psychological stability, and self-actualization are addressed through targeted assessment, diagnosis, planning, intervention, and evaluation.

References

• Burgess, A. W. (1983). Behavioral sciences & the law. American Psychological Association. https://doi.org/10.1002/bsl
• Kozier, B., Erb, G., Berman, A., & Sylvie, R. (2018). Fundamentals of Nursing: Concepts, Process, and Practice (10th ed.). Pearson.
• Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370–396.
• Hogston, R., & Jackson, D. (2019). Nursing Theories and Models. in Medical-Surgical Nursing. Elsevier.
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Resick, P. A., & Monson, C. M. (2017). Cognitive Processing Therapy for PTSD: A Comprehensive Manual. Guilford Publications.
• Foa, E. B., & Rothbaum, B. O. (1998). Treating the aftermath of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
• U.S. Department of Health & Human Services. (2020). Trauma-informed care in behavioral health services. Substance Abuse and Mental Health Services Administration.
• Lee, J., & Jansen, L. (2021). Stress management interventions for trauma survivors. Journal of Psychiatric Nursing, 45(2), 94–102.
• Siegel, J. M., & Schlosser, C. (2016). Recovery from trauma: A nursing perspective. Nursing Clinics of North America, 51(2), 177–188.