Klp. III.

Keputusasaan

Silakan tiap kelompok mendiskusikan: definisi, batasan karakteristik dan intervensinya.

Hopelessness (00124)

Definisi

Subjective state in which an individual sees limited or no alternatives or

personal choices available and is unable to mobilize energy on own behalf

Keadaan Subjektif dimana seseorang melihat adanya keterbatasan atau tidak adanya alternatif atau
pilihan yang tersedia, dan tidak dapat mengerahkan energi untuk kepentingan sendiri.

Batasan Karakteristik

Perubahan pada pola tidur

Penurunan nafsu makan

Penurunan respons terhadap rangsangan

Penurunan verbalisasi

Menunjukan Verbal yang sulit ( co : saya tidak bisa, mendesah)

Ketidakadekuatan untuk terlibat dalam perawatan

Pasif

Jarang kontak mata

Mengangkat bahu untuk menanggapi pembicara

Berpaling dari pembicara

NOC : Hope dan Psychomotor Energy

Indikasi HOPE NOC :

Mengungkapkan harapan yang positif pada masa depan

Mengungkapkan Kepercayaan
 Mengungkapkan keinginan untuk hidup

Mengungkapkan alas an untuk hidup

Mengungkapkan arti hidup

Mengungkapkan optimism

Mengungkapkan kepercayaan pada diri sendiri

Mengungkapkan kepercayaan pada orang lain

Mengungkapkan kedamaian dalam diri

Mengungkapkan rasa kontrol diri

Menunjukkan semangat hidup

Menetapkan tujuan

Psychomotor Energy

Menunjukkan hal yang mempengaruhi pada situasi yang sesuai

Menujukkan konsentrasi

Memelihara perawatan pribadi dan kebersihan

Menunjukkan nafsu makan normal

Sesuai dengan rejimen pengoabtan

Sesuai dengan rejimen terapeutik

Menunjukkan minat pada sekitar

Menunjukkan tingkat energy yang stabil

Menunjukkan kemampuan untuk mencapai tugas harian.

\NIC HOPE
Complex Relationship Building

Identify own attitude toward the patient and situation, repeat as

needed
Determine the ethical boundaries of the relationship, as needed
Deal with personal feelings evoked by the patient that may interfere
with the effectiveness of therapeutic interactions
Provide for physical comfort before interactions
Discuss confidentiality of information shared
Create climate of warmth and acceptance
Reassure patient of your interest in him/her as a person, as
appropriate
Use self-disclosure, as appropriate
Return at established time to demonstrate trustworthiness and
interest in the patient
Maintain open body posture
Adjust physical distance between nurse and patient, as appropriate
Monitor patients nonverbal messages
Seek clarification of nonverbal messages, as appropriate

Respond to patients nonverbal messages, as appropriate

Reflect the main ideas back to the patient in your own
words
Return conversation to main subject, as needed
Develop special ways of communicating (e.g., images, other
words), as needed
Establish mutually acceptable agreement on time and length of
meetings, as appropriate
Discuss responsibilities of patient in the one-to-one, nursepatient
relationship
Assist patient to identify areas of need to be addressed during
meetings
Set limits of acceptable behavior during therapeutic sessions, as
appropriate
Establish time of next interaction before ending the meeting
each time
Summarize conversation at end of the discussion
Use summary as a starting point for future conversations
Identify patients readiness to explore identified problems and
develop strategies for change
Encourage patient to take the time needed to express himself/
herself
Assist the patient to identify feelings that impede ability to
interact with others (e.g., anger, anxiety, hostility, or sadness)
Support patients efforts to interact with others in a positive
manner
Prepare for termination of relationship, as appropriate
 Facilitate patients attempts to review therapeutic relationship
experiences
Convey recognition of accomplishments during relationship

Emotional Support

Discuss with the patient the emotional experience(s)

Explore with patient what has triggered emotions
Make supportive or empathetic statements
Embrace or touch patient supportively
Support the use of appropriate defense mechanisms
Assist patient in recognizing feelings, such as anxiety, anger, or
sadness
Encourage the patient to express feelings of anxiety, anger, or
sadness
Discuss consequences of not dealing with guilt and shame
Listen to/encourage expressions of feelings and beliefs
Facilitate patients identification of usual response pattern in
coping with fears
Provide support during denial, anger, bargaining, and acceptance
phases of grieving
Identify the function that anger, frustration, and rage serve for
the patient
Encourage talking or crying as means to decrease the emotional
response
Stay with the patient and provide assurance of safety and security
during periods of anxiety
Provide assistance in decision making
Reduce demand for cognitive functioning when patient is ill or
fatigued
Refer for counseling, as appropriate

Decision-Making Support

Determine whether there are differences between the patients

view of own condition and the view of health care providers
Assist patient to clarify values and expectations that may
assist in making critical life choices
Inform patient of alternative views or solutions in a clear and
supportive manner
Help patient identify the advantages and disadvantages of each
alternative
Establish communication with patient early in admission
 Facilitate patients articulation of goals for care
Obtain informed consent, when appropriate
Facilitate collaborative decision making
Be familiar with institutions policies and procedures
Respect patients right to receive or not to receive information
Provide information requested by patient
Help patient explain decision to others, as needed
Serve as a liaison between patient and family
Serve as a liaison between patient and other health care
providers
Use interactive computer software or web-based decision aides
as an adjunct to professional support
Refer to legal aid, as appropriate
Refer to support groups, as appropriate

Coping Enhancement

Assist the patient in identifying appropriate short- and longterm

goals
Assist the patient in examining available resources to meet the
goals
Assist the patient in breaking down complex goals into small,
manageable steps
Encourage relationships with persons who have common interests
and goals
Assist the patient to solve problems in a constructive manner
Appraise a patients adjustment to changes in body image, as
indicated
Appraise the impact of the patients life situation on roles and
relationships
Encourage patient to identify a realistic description of change
in role
Appraise the patients understanding of the disease process
Appraise and discuss alternative responses to situation
Use a calm, reassuring approach
Provide an atmosphere of acceptance
Assist the patient in developing an objective appraisal of the event
Help patient to identify the information he/she is most interested
in obtaining
Provide factual information concerning diagnosis, treatment,
and prognosis
Provide the patient with realistic choices about certain aspects
of care
Encourage an attitude of realistic hope as a way of dealing with
feelings of helplessness
 Evaluate the patients decision-making ability
Seek to understand the patients perspective of a stressful
situation
Discourage decision making when the patient is under severe stress
Encourage gradual mastery of the situation
Encourage patience in developing relationships
Encourage social and community activities
Encourage the acceptance of limitations of others
Acknowledge the patients spiritual/cultural background
Encourage the use of spiritual resources, if desired
Explore patients previous achievements
Explore patients reasons for self-criticism
Confront patients ambivalent (angry or depressed) feelings
Foster constructive outlets for anger and hostility
Arrange situations that encourage patients autonomy
Assist patient in identifying positive responses from others
Encourage the identification of specific life values
Explore with the patient previous methods of dealing with life
problems
Introduce patient to persons (or groups) who have successfully
undergone the same experience
Support the use of appropriate defense mechanisms
Encourage verbalization of feelings, perceptions, and fears
Discuss consequences of not dealing with guilt and shame
Encourage the patient to identify own strengths and abilities
Reduce stimuli in the environment that could be misinterpreted
as threatening
Appraise patient needs/desires for social support
Assist the patient to identify available support systems
Determine the risk of the patient inflicting self-harm
Encourage family involvement, as appropriate
Encourage the family to verbalize feelings about ill family
member
Provide appropriate social skills training
Assist the patient to identify positive strategies to deal with
limitations and manage needed lifestyle or role changes
Instruct the patient on the use of relaxation techniques, as
needed
Assist the patient to grieve and work through the losses of
chronic illness and/or disability, if appropriate
Assist the patient to clarify misconceptions
Encourage the patient to evaluate own behavior

Energy Management
 Assess patients physiologic status for deficits resulting in
fatigue within the context of age and development
Encourage verbalization of feelings about limitations
Use valid instruments to measure fatigue, as indicated
Determine patient/significant others perception of causes of
fatigue
Correct physiologic status deficits (e.g., chemotherapy-induced
anemia) as priority items
Select interventions for fatigue reduction using combinations
of pharmacologic and non-pharmocologic categories, as appropriate
Determine what and how much activity is required to build
endurance
Monitor nutritional intake to ensure adequate energy resources
Consult with dietitian about ways to increase intake of highenergy
foods
Negotiate desired mealtimes which may or may not coincide
with standard hospital schedules
Monitor patient for evidence of excess physical and emotional
fatigue
Monitor cardiorespiratory response to activity (e.g., tachycardia,
other dysrhythmias, dyspnea, diaphoresis, pallor, hemodynamic
pressures, respiratory rate)
Encourage aerobic workouts as tolerated
Monitor/record patients sleep pattern and number of sleep
hours
Monitor location and nature of discomfort or pain during
movement/activity
Reduce physical discomforts that could interfere with cognitive
function and self-monitoring/regulation of activity
Set limits with hyperactivity when it interferes with others or
with the patient
Assist the patient to understand energy conservation principles
(e.g., the requirement for restricted activity or bedrest)
Teach activity organization and time management techniques
to prevent fatigue
Assist the patient in assigning priority to activities to accommodate
energy levels
Assist the patient/significant other to establish realistic activity
goals
Assist the patient to identify preferences for activity
Encourage the patient to choose activities that gradually build
endurance
Assist the patient to identify tasks that family and friends can
perform in the home to prevent/relieve fatigue
Consider electronic communication (e.g., email or instant messaging)
to maintain contact with friends when visits are not
practical or advisable
Assist the patient to limit daytime sleep by providing activity
that promotes wakefulness, as appropriate
Limit environmental stimuli (e.g., light and noise) to facilitate
relaxation
Limit number of and interruptions by visitors, as appropriate
Promote bedrest/activity limitation (e.g., increase number of
rest periods) with protected rest times of choice
Encourage alternate rest and activity periods
Arrange physical activities to reduce competition for oxygen
supply to vital body functions (e.g., avoid activity immediately
after meals)
Use passive and/or active range-of-motion exercises to relieve
muscle tension
Provide calming diversional activities to promote relaxation
Offer aids to promote sleep (e.g., music or medications)
Encourage an afternoon nap, if appropriate
Assist patient to schedule rest periods
Avoid care activities during scheduled rest periods
Plan activities for periods when the patient has the most
energy
Assist patient to sit on side of bed (dangle), if unable to transfer
or walk
Assist with regular physical activities (e.g., ambulation, transfers,
turning, and personal care), as needed
Monitor administration and effect of stimulants and depressants
Encourage physical activity (e.g., ambulation, performance
of activities of daily living) consistent with patients energy
resources
Evaluate programmed increases in levels of activities

Assess patients physiologic status for deficits resulting in

fatigue within the context of age and development
Encourage verbalization of feelings about limitations
Use valid instruments to measure fatigue, as indicated
Determine patient/significant others perception of causes of
fatigue
Correct physiologic status deficits (e.g., chemotherapy-induced
anemia) as priority items
Select interventions for fatigue reduction using combinations
of pharmacologic and non-pharmocologic categories, as appropriate
Determine what and how much activity is required to build
endurance
Monitor nutritional intake to ensure adequate energy resources
Consult with dietitian about ways to increase intake of highenergy
foods
 Negotiate desired mealtimes which may or may not coincide
with standard hospital schedules
Monitor patient for evidence of excess physical and emotional
fatigue
Monitor cardiorespiratory response to activity (e.g., tachycardia,
other dysrhythmias, dyspnea, diaphoresis, pallor, hemodynamic
pressures, respiratory rate)
Encourage aerobic workouts as tolerated
Monitor/record patients sleep pattern and number of sleep
hours
Monitor location and nature of discomfort or pain during
movement/activity
Reduce physical discomforts that could interfere with cognitive
function and self-monitoring/regulation of activity
Set limits with hyperactivity when it interferes with others or
with the patient
Assist the patient to understand energy conservation principles
(e.g., the requirement for restricted activity or bedrest)
Teach activity organization and time management techniques
to prevent fatigue
Assist the patient in assigning priority to activities to accommodate
energy levels
Assist the patient/significant other to establish realistic activity
goals
Assist the patient to identify preferences for activity
Encourage the patient to choose activities that gradually build
endurance
Assist the patient to identify tasks that family and friends can
perform in the home to prevent/relieve fatigue
Consider electronic communication (e.g., email or instant messaging)
to maintain contact with friends when visits are not
practical or advisable
Assist the patient to limit daytime sleep by providing activity
that promotes wakefulness, as appropriate
Limit environmental stimuli (e.g., light and noise) to facilitate
relaxation
Limit number of and interruptions by visitors, as appropriate
Promote bedrest/activity limitation (e.g., increase number of
rest periods) with protected rest times of choice
Encourage alternate rest and activity periods
Arrange physical activities to reduce competition for oxygen
supply to vital body functions (e.g., avoid activity immediately
after meals)
Use passive and/or active range-of-motion exercises to relieve
muscle tension
Provide calming diversional activities to promote relaxation
 Offer aids to promote sleep (e.g., music or medications)
Encourage an afternoon nap, if appropriate
Assist patient to schedule rest periods
Avoid care activities during scheduled rest periods
Plan activities for periods when the patient has the most
energy
Assist patient to sit on side of bed (dangle), if unable to transfer
or walk
Assist with regular physical activities (e.g., ambulation, transfers,
turning, and personal care), as needed
Monitor administration and effect of stimulants and depressants
Encourage physical activity (e.g., ambulation, performance
of activities of daily living) consistent with patients energy
resources
Evaluate programmed increases in levels of activities