Nursing diagnosis: situational low Self-Esteem related to Annoying, debilitating symptoms; confinement or isolation; length of illness and recovery period
Possibly evidenced by
Verbalization of change in lifestyle, fear of rejection or reaction of others, negative feelings about body, feelings of helplessness
Depression, lack of follow-through, self-destructive behavior
Desired Outcomes/Evaluation Criteria—Client Will
Self-Esteem
Verbalize feelings.
Identify methods for coping with negative perception of self.
Verbalize acceptance of self in situation, including length of recovery and need for isolation.
Acknowledge self as worthwhile; be responsible for self.
Nursing intervention with rationale:
1. Contract with client regarding time for listening. Encourage discussion of feelings and concerns.
Rationale: Establishing time enhances trusting relationship. Providing opportunity to express feelings allows client to feel more in control of the situation. Verbalization can decrease anxiety and depression and facilitate positive coping behaviors. Client may need to express feelings about being ill, length and cost of illness, possibility of infecting others, and (in severe illness) fear of death. May have concerns regarding the stigma of the disease.
2. Avoid making moral judgments regarding lifestyle, such as alcohol use, drug abuse, and sexual practices.
Rationale: Client may already feel upset or angry and condemn self; judgments from others will further damage self-esteem.
3. Discuss recovery expectations.
Rationale: Recovery period may be prolonged (months), potentiating family and situational stress and necessitating need for planning, support, and follow-up.
4. Assess effect of illness on economic factors of client and significant other (SO).
Rationale: Financial problems may exist because of loss of client’s role functioning in the family and prolonged recovery.
5. Offer diversional activities based on energy level.
Rationale: Enables client to use time and energy in constructive ways that enhance self-esteem and minimize anxiety and depression.
6. Suggest client wear bright reds or blues and blacks instead of yellows or greens.
Rationale: Enhances appearance because yellow skin tones are intensified by yellow and green colors. Note: Jaundice usually peaks within 1 to 2 weeks, then gradually resolves over 2 to 4 weeks.
7. Make appropriate referrals for help as needed, such as community case manager, social services, and other community agencies.
Rationale: Can facilitate problem-solving and help involved individuals cope more effectively with situation.
Showing posts with label Situational low Self-Esteem. Show all posts
Showing posts with label Situational low Self-Esteem. Show all posts
Tuesday, April 19, 2011
Sunday, March 27, 2011
Disturbed Body Image/chronic low Self-Esteem | NCP Obesity
Nursing diagnosis: disturbed Body Image/chronic low Self-Esteem related to Biophysical factors—changes in health status, Psychosocial factors—client’s view of self; changes in body image, personal identity, Family or subculture encouragement of overeating—slimness is valued in this society, and mixed messages are received when thinness is stressed, Perceived failure at ability to control weight, Control, sex, and love issues
Possibly evidenced by
Verbalization of negative feelings about body—mental image often does not match physical reality
Fear of rejection or reaction by others
Feelings of hopelessness, powerlessness
Preoccupation with change—attempts to lose weight
Lack of follow-through with diet plan
Verbalization of powerlessness to change eating habits
Desired Outcomes/Evaluation Criteria—Client Will
Body Image
Verbalize a more realistic self-image.
Demonstrate some acceptance of self as is rather than an idealized image.
Self-Esteem
Seek information and actively pursue appropriate weight loss.
Acknowledge self as an individual who has responsibility for self.
Nursing intervention with rationale:
1. Determine client’s view of being fat and what it does for the individual.
Rationale: Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications, such as compensation for lack of love and nurturing or a defense against intimacy. In addition, chronically obese client may report long-term discrimination in family, social, and professional settings. She or he may experience mixed feelings of fear and shame or compensate for psychological trauma by developing a strong or “big” personality.
2. Promote open communication, avoiding criticism or judgment about client’s behavior.
Rationale: Supports client’s own responsibility for weight loss, enhances sense of control, and promotes willingness to discuss difficulties and setbacks and to problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.
3. Outline and clearly state responsibilities of client and nurse.
Rationale: It is helpful for each individual to understand area of own responsibility in the program so that misunderstandings do not arise.
4. Graph weight on a weekly basis.
Rationale: Provides ongoing visual evidence of weight changes, reinforcing reality.
5. Ensure availability of properly sized equipment, including gowns; blood pressure cuff; wider and strong wheelchair, bed, commode, and transfer devices, when providing inpatient care.
Rationale: Healthcare providers have a moral and legal obligation to meet the client’s needs for comfort and safety.
6. Encourage client to use imagery to visualize self at desired weight and to practice handling of new behaviors.
Rationale: Mental rehearsal is very useful in helping the client plan for and deal with anticipated change in self-image or occasions that may arise, such as family gatherings or special dinners, where constant decisions about eating many foods will occur.
7. Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.
Rationale: Enhances feelings of self-esteem and promotes improved body image.
8. Encourage buying clothes instead of food treats as a reward for weight loss and life successes.
Rationale: Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.
9. Suggest the client dispose of “fat clothes” as weight loss occurs.
Rationale: Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur or be maintained.
10. Be alert to myths the client and SO may have about weight and weight loss.
Rationale: Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will view me as a sexual object”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.
Possibly evidenced by
Verbalization of negative feelings about body—mental image often does not match physical reality
Fear of rejection or reaction by others
Feelings of hopelessness, powerlessness
Preoccupation with change—attempts to lose weight
Lack of follow-through with diet plan
Verbalization of powerlessness to change eating habits
Desired Outcomes/Evaluation Criteria—Client Will
Body Image
Verbalize a more realistic self-image.
Demonstrate some acceptance of self as is rather than an idealized image.
Self-Esteem
Seek information and actively pursue appropriate weight loss.
Acknowledge self as an individual who has responsibility for self.
Nursing intervention with rationale:
1. Determine client’s view of being fat and what it does for the individual.
Rationale: Mental image includes our ideal and is usually not up-to-date. Fat and compulsive eating behaviors may have deep-rooted psychological implications, such as compensation for lack of love and nurturing or a defense against intimacy. In addition, chronically obese client may report long-term discrimination in family, social, and professional settings. She or he may experience mixed feelings of fear and shame or compensate for psychological trauma by developing a strong or “big” personality.
2. Promote open communication, avoiding criticism or judgment about client’s behavior.
Rationale: Supports client’s own responsibility for weight loss, enhances sense of control, and promotes willingness to discuss difficulties and setbacks and to problem-solve. Note: Distrust and accusations of “cheating” on caloric intake are not helpful.
3. Outline and clearly state responsibilities of client and nurse.
Rationale: It is helpful for each individual to understand area of own responsibility in the program so that misunderstandings do not arise.
4. Graph weight on a weekly basis.
Rationale: Provides ongoing visual evidence of weight changes, reinforcing reality.
5. Ensure availability of properly sized equipment, including gowns; blood pressure cuff; wider and strong wheelchair, bed, commode, and transfer devices, when providing inpatient care.
Rationale: Healthcare providers have a moral and legal obligation to meet the client’s needs for comfort and safety.
6. Encourage client to use imagery to visualize self at desired weight and to practice handling of new behaviors.
Rationale: Mental rehearsal is very useful in helping the client plan for and deal with anticipated change in self-image or occasions that may arise, such as family gatherings or special dinners, where constant decisions about eating many foods will occur.
7. Provide information about the use of makeup, hairstyles, and ways of dressing to maximize figure assets.
Rationale: Enhances feelings of self-esteem and promotes improved body image.
8. Encourage buying clothes instead of food treats as a reward for weight loss and life successes.
Rationale: Properly fitting clothes enhance the body image as small losses are made and the individual feels more positive. Waiting until the desired weight loss is reached can become discouraging.
9. Suggest the client dispose of “fat clothes” as weight loss occurs.
Rationale: Removes the “safety valve” of having clothes available “in case” the weight is regained. Retaining fat clothes can convey the message that the weight loss will not occur or be maintained.
10. Be alert to myths the client and SO may have about weight and weight loss.
Rationale: Beliefs about what an ideal body looks like or unconscious motivations can sabotage efforts to lose weight. Some of these include the feminine thought of “If I become thin, men will view me as a sexual object”; the masculine counterpart, “I don’t trust myself to stay in control of my sexual feelings”; as well as issues of strength, power, or the “good cook” image.
Wednesday, February 16, 2011
Low Self-Esteem | Nursing Care Plan for Multiple Sclerosis
Nursing diagnosis: low Self-Esteem related to Change in structure and function, Disruption in how client perceives own body, Role reversal; dependence
Possibly evidenced by
Confusion about sense of self, purpose, direction in life
Denial, withdrawal, anger
Negative or self-destructive behavior
Use of ineffective coping methods
Change in self or other’s perception of role and physical capacity to resume role
Desired Outcomes/Evaluation Criteria—Client Will
Self-Esteem
Verbalize realistic view and acceptance of body.
View self as a capable person.
Participate in and assume responsibility for meeting own needs.
Recognize and incorporate changes in self-concept and role without negating self-esteem.
Develop realistic plans for adapting to role changes.
Nursing intervention with rationale
1. Establish or maintain a therapeutic nurse-client relationship. Discuss fears and concerns.
Rationale: Therapeutic nurse-client relationships convey an attitude of caring and develop a sense of trust between client and caregiver. The client is free to express fears of rejection, loss of previous functioning, changes in appearance, feelings of helplessness, and powerlessness. Open communication promotes a sense of support and well-being.
2. Note withdrawn behaviors, use of denial, or excessive concern with disease process.
Rationale: These behaviors serve as initial protective responses. If prolonged, these behaviors may impede effective coping.
3. Support use of defense mechanisms. Allow the client to deal with the information in own time and way.
Rationale: Confronting client with reality of situation may result in increased anxiety and lessened ability to cope with actual or perceived changes.
4. Acknowledge reality of grieving process related to actual or perceived changes. Help client deal realistically with feelings of anger and sadness.
Rationale: The nature of the disease leads to ongoing losses and life changes. It could potentially block resolution of grieving process.
5. Review information about course of disease, possibility of remissions, and prognosis.
Rationale: Information regarding the course of the disease helps empower the client to make decisions regarding daily functioning and healthcare decisions.
6. Provide accurate verbal and written information about what is happening and discuss with client and SO.
Rationale: Providing current information facilitates client and SO decision making.
7. Explain that labile emotions are not unusual. Problem-solve ways to deal with these feelings.
Rationale: Therapeutic communication relieves anxiety and promotes expression and management of emotions.
8. Note presence of depression, impaired thought processes, and expression of suicidal ideation; evaluate on a scale of 1 to 10.
Rationale: Adapting to a long-term, progressively debilitating incurable condition is a difficult emotional adjustment. In addition, cognitive impairment may affect adaptation to life changes. A depressed individual may believe that suicide is the best way to deal with what is happening.
9. Assess interaction between client and SO. Note changes in relationship.
Rationale: SO may unconsciously or consciously reinforce negative attitudes and beliefs of client, or issues of secondary gain may interfere with progress and ability to manage situation.
10. Provide an open environment for client and SO to discuss concerns about sexuality, including management of fatigue, spasticity, arousal, and changes in sensation.
Rationale: Physical and psychological changes often create stress in the relationship, affect usual roles and expectations, and potentially further impair self-concept.
Possibly evidenced by
Confusion about sense of self, purpose, direction in life
Denial, withdrawal, anger
Negative or self-destructive behavior
Use of ineffective coping methods
Change in self or other’s perception of role and physical capacity to resume role
Desired Outcomes/Evaluation Criteria—Client Will
Self-Esteem
Verbalize realistic view and acceptance of body.
View self as a capable person.
Participate in and assume responsibility for meeting own needs.
Recognize and incorporate changes in self-concept and role without negating self-esteem.
Develop realistic plans for adapting to role changes.
Nursing intervention with rationale
1. Establish or maintain a therapeutic nurse-client relationship. Discuss fears and concerns.
Rationale: Therapeutic nurse-client relationships convey an attitude of caring and develop a sense of trust between client and caregiver. The client is free to express fears of rejection, loss of previous functioning, changes in appearance, feelings of helplessness, and powerlessness. Open communication promotes a sense of support and well-being.
2. Note withdrawn behaviors, use of denial, or excessive concern with disease process.
Rationale: These behaviors serve as initial protective responses. If prolonged, these behaviors may impede effective coping.
3. Support use of defense mechanisms. Allow the client to deal with the information in own time and way.
Rationale: Confronting client with reality of situation may result in increased anxiety and lessened ability to cope with actual or perceived changes.
4. Acknowledge reality of grieving process related to actual or perceived changes. Help client deal realistically with feelings of anger and sadness.
Rationale: The nature of the disease leads to ongoing losses and life changes. It could potentially block resolution of grieving process.
5. Review information about course of disease, possibility of remissions, and prognosis.
Rationale: Information regarding the course of the disease helps empower the client to make decisions regarding daily functioning and healthcare decisions.
6. Provide accurate verbal and written information about what is happening and discuss with client and SO.
Rationale: Providing current information facilitates client and SO decision making.
7. Explain that labile emotions are not unusual. Problem-solve ways to deal with these feelings.
Rationale: Therapeutic communication relieves anxiety and promotes expression and management of emotions.
8. Note presence of depression, impaired thought processes, and expression of suicidal ideation; evaluate on a scale of 1 to 10.
Rationale: Adapting to a long-term, progressively debilitating incurable condition is a difficult emotional adjustment. In addition, cognitive impairment may affect adaptation to life changes. A depressed individual may believe that suicide is the best way to deal with what is happening.
9. Assess interaction between client and SO. Note changes in relationship.
Rationale: SO may unconsciously or consciously reinforce negative attitudes and beliefs of client, or issues of secondary gain may interfere with progress and ability to manage situation.
10. Provide an open environment for client and SO to discuss concerns about sexuality, including management of fatigue, spasticity, arousal, and changes in sensation.
Rationale: Physical and psychological changes often create stress in the relationship, affect usual roles and expectations, and potentially further impair self-concept.
Saturday, February 5, 2011
Situational low Self-Esteem | Nursing Care Plan for Spinal Cord Injury
Nursing diagonsis: situational low Self-Esteem related to Traumatic injury, situational crisis, forced crisis
Possibly evidenced by
Verbalization of forced change in lifestyle
Fear of rejection or reaction by others
Focus on past strength, function, or appearance
Negative feelings about body
Feelings of helplessness, hopelessness, or powerlessness
Actual change in structure and function
Lack of eye contact
Change in physical capacity to resume role
Confusion about self, purpose, or direction of life
Desired Outcomes/Evaluation Criteria—Client Will
Psychosocial Adjustment: Life Change
Verbalize acceptance of self in situation.
Recognize and incorporate changes into self-concept in accurate manner without negating self-esteem.
Develop realistic plans for adapting to role changes and new role.
Nursing intervention with rationale:
1. Acknowledge difficulty in determining degree of functional incapacity and chance of functional improvement.
Rationale: During acute phase of injury, long-term effects are unknown, which delays the client’s ability to integrate situation into self-concept.
2. Listen to client’s comments and responses to situation.
Rationale: Active listening provides clues to client’s view of self, role changes, needs, and level of acceptance.
3. Assess dynamics of client and SOs, including client’s role in family and cultural factors.
Rationale: Client’s previous role in family unit is disrupted or altered by injury. Role changes add difficulty in integrating selfconcept and level of independence.
4. Encourage SO to treat client as normally as possible, such as discussing home situations and family news.
Rationale: Involving client in family unit reduces feelings of social isolation, helplessness, and uselessness and provides opportunity for SO to contribute to client’s welfare.
5. Provide accurate information. Discuss concerns about prognosis and treatment honestly at client’s level of acceptance.
Rationale: Open discussion of treatment and prognosis may focus on current and immediate needs. Ongoing updates enable assimilation.
6. Discuss meaning of loss or change with client and SO. Assess interactions between client and SO.
Rationale: Actual change in body image may be different from that perceived by client. Distortions may be unconsciously reinforced by SO.
7. Accept client and show concern for individual as a person. Identify and build on client’s strengths; give positive reinforcement for progress noted.
Rationale: Genuine concern and regard for the client as an individual establishes therapeutic atmosphere for self-acceptance and encouragement.
8. Include client and SO in care, allowing client to make decisions and participate in self-care activities, as possible.
Rationale: Encouraging client participation in care decision making recognizes that client is still responsible for own life and provides some sense of control over situation. It sets the stage for future lifestyle, pattern, and interaction required in daily care. Note: Client may reject all help or may be completely dependent during this phase.
9. Be alert to sexually oriented jokes, flirting, or aggressive behavior. Elicit concerns, fears, and feelings about current situation and future expectations.
Rationale: Anxiety develops because of perceived loss and change in masculine or feminine self-image and role. Forced dependency is often devastating, especially in light of change in function and appearance.
10. Be aware of own feelings and reaction to client’s sexual anxiety.
Rationale: Personal reactions to client’s sexual anxiety may be as disruptive as the behavior itself, creating conflicts between client and staff, and can potentially eliminate client’s willingness to work through situation and participate in rehabilitation.
Possibly evidenced by
Verbalization of forced change in lifestyle
Fear of rejection or reaction by others
Focus on past strength, function, or appearance
Negative feelings about body
Feelings of helplessness, hopelessness, or powerlessness
Actual change in structure and function
Lack of eye contact
Change in physical capacity to resume role
Confusion about self, purpose, or direction of life
Desired Outcomes/Evaluation Criteria—Client Will
Psychosocial Adjustment: Life Change
Verbalize acceptance of self in situation.
Recognize and incorporate changes into self-concept in accurate manner without negating self-esteem.
Develop realistic plans for adapting to role changes and new role.
Nursing intervention with rationale:
1. Acknowledge difficulty in determining degree of functional incapacity and chance of functional improvement.
Rationale: During acute phase of injury, long-term effects are unknown, which delays the client’s ability to integrate situation into self-concept.
2. Listen to client’s comments and responses to situation.
Rationale: Active listening provides clues to client’s view of self, role changes, needs, and level of acceptance.
3. Assess dynamics of client and SOs, including client’s role in family and cultural factors.
Rationale: Client’s previous role in family unit is disrupted or altered by injury. Role changes add difficulty in integrating selfconcept and level of independence.
4. Encourage SO to treat client as normally as possible, such as discussing home situations and family news.
Rationale: Involving client in family unit reduces feelings of social isolation, helplessness, and uselessness and provides opportunity for SO to contribute to client’s welfare.
5. Provide accurate information. Discuss concerns about prognosis and treatment honestly at client’s level of acceptance.
Rationale: Open discussion of treatment and prognosis may focus on current and immediate needs. Ongoing updates enable assimilation.
6. Discuss meaning of loss or change with client and SO. Assess interactions between client and SO.
Rationale: Actual change in body image may be different from that perceived by client. Distortions may be unconsciously reinforced by SO.
7. Accept client and show concern for individual as a person. Identify and build on client’s strengths; give positive reinforcement for progress noted.
Rationale: Genuine concern and regard for the client as an individual establishes therapeutic atmosphere for self-acceptance and encouragement.
8. Include client and SO in care, allowing client to make decisions and participate in self-care activities, as possible.
Rationale: Encouraging client participation in care decision making recognizes that client is still responsible for own life and provides some sense of control over situation. It sets the stage for future lifestyle, pattern, and interaction required in daily care. Note: Client may reject all help or may be completely dependent during this phase.
9. Be alert to sexually oriented jokes, flirting, or aggressive behavior. Elicit concerns, fears, and feelings about current situation and future expectations.
Rationale: Anxiety develops because of perceived loss and change in masculine or feminine self-image and role. Forced dependency is often devastating, especially in light of change in function and appearance.
10. Be aware of own feelings and reaction to client’s sexual anxiety.
Rationale: Personal reactions to client’s sexual anxiety may be as disruptive as the behavior itself, creating conflicts between client and staff, and can potentially eliminate client’s willingness to work through situation and participate in rehabilitation.
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