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
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 Note withdrawn behaviors, use of denial, or excessive concern with disease process.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.