The following is automatically sent to the approver of a workflow. Can it be cc'ed to another user to inform them that an approver is having difficulty?
Also please confirm that the outcomes listed within this email cannot be edited.
Using Nintex Workflows 2010 version 2.5.1.0
Let me know if you require any additional information.
Hi Paul,
there is no such option right now.
What you can do though is to go to SharePoint Central Administration, navigate to Nintex Workflow Management and edit the LazyApproval Settings.
There you can Edit the LazyApproval notification footer and add some general information or links about who to contact in case of difficulties. This enables your users to also give some context about the issue for your supporters and also will not make your users feel "monitored". 
Hope this helps.
Best regards
Enrico
Thanks for your prompt response and suggestion Enrico.
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