Nursing Diagnosis: Risk for situational low Self-esteem Application of NANDA, NOC, NIC

Nursing Diagnosis: Risk for situational low Self-esteem
Judith R. Gentz

NANDA Definition: At risk for developing negative perception of self-worth in response to a current situation (specify)

Related Factors: See Risk Factors.

Risk Factors: Developmental changes (specify); disturbed body image; functional impairment (specify); loss (specify); social role changes (specify); history of learned helplessness; history of abuse, neglect, or abandonment; unrealistic self-expectations; behavior inconsistent with values; lack of recognition/rewards; failures/rejections; decreased power/control over environment; physical illness (specify)

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
·         Decision-Making
·         Self-Esteem
Client Outcomes
·         Accurate self-appraisal
·         Ability to self-validate
·         Ability to make decisions independent of primary peer group
·         Recognizes effects of media on self-appraisal
·         Recognizes influence of substances on self-esteem
·         Identifies strengths and healthy coping skills
·         Recognizes life events and change as influencing self-esteem

Client Outcomes
Suggested NIC Labels
·         Self-Esteem Enhancement
Nursing Interventions and Rationales
·         Help client to identify environmental factors which increase risk for low self-esteem. Identification is early stage of problem solving process.
·         Help client to identify current behaviors resulting from low self-esteem. Low self-esteem increases risk for unhealthy behaviors (Mcgee, Williams, 2000).
·         Encourage creative problem solving through writing exercises. Using creative writing, allowing clients to "tell their story." Giving positive feedback can increase self-esteem (Chandler, 1999).
·         Encourage client to maintain highest level of functioning, including work schedule. Positive self-esteem is maintained at higher levels in working individuals than in nonworking individuals (VanDongen, 1998).
·         Encourage client to verbalize thoughts and feelings about the current situation. Allowing the client to clarify thoughts and feelings promotes self-acceptance (LeMone, 1991).
·         Help the client to identify what has helped maintain positive self-esteem thus far. Identifying what works empowers the client and encourages positive outcomes.
·         Help the client to identify the resources and social support network available to them at this time. Resourcefulness and social support are significant predictors of self-esteem (Dirksen, 2000).
·         Encourage the client to find a self-help or therapy group that focuses on self-esteem enhancement. Improved self-esteem of such group members is reported (Hakim-Larson, Mruk, 1997).
·         Encourage the client to create a sense of competence through short-term goal setting and goal achievement. Sense of competence is related to global self-esteem (Willoughby et al, 2000).
·         Educate female clients about self-esteem differences between genders, and encourage exploration. Females tend to have lower self-esteem than males no matter what domain is measured (Bolognini et al, 1996).
·         Assess the client for symptoms of depression and anxiety. Refer to specialist as needed. Prompt and effective treatment can prevent exacerbation of symptoms or safety risks.
·         Teach client a systematic problem-solving process. Crisis provides an opportunity for effective change in coping skills.
·         See care plans for Disturbed personal Identity and Situational low Self-esteem.
·         Help the client to identify age-related and/or developmental factors which may be affecting self-esteem. Self-esteem levels vary with the normal aging process and tend to decrease with older age (Dietz, 1996).
·         Assist the client in life review and identifying positive accomplishments. Life review is a developmental task that increases a person's sense of peace and serenity.
·         Help client to establish a peer group and structured daily activities. Social isolation and lack of structure increase a client's sense of feeling lost and worthless.
Home Care Interventions
·         Assess current environmental stresses and identify community resources. Accessing resources to help decrease environmental stress will increase the client's ability to cope.
·         Encourage family members to acknowledge and validate the client's strengths. Validation allows the client to increase self-reliance and to trust personal decisions.
·         Assess the need for establishing an emergency plan. Openly assessing safety risks increases the client's sense of limits, boundaries, and safety.
·         See care plans for Situational low Self-esteem and Chronic low Self-esteem.
Client/Family Teaching
·         Refer the client/family to community-based self-help and support groups.
·         Refer to educational classes on stress management, relaxation training, etc.
·         Refer to community agencies that offer support and environmental resources.

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