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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Ongoing Assessment
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Nursing Diagnosis: Disturbed Body Image

NOC Outcomes (Nursing Outcomes Classification)

  • Body Image
  • Self-Esteem

NIC Interventions (Nursing Interventions Classification)

  • Body Image Enhancement
  • Grief Work Facilitation
  • Coping Enhancement

NANDA Definition: Confusion in mental picture of one’s physical self

Body image is the attitude a person has about the actual or perceived structure or function of all or part of his or her body. This attitude is dynamic and is altered through interaction with other persons and situations and influenced by age and developmental level. As an important part of one’s self-concept, body image disturbance can have profound impact on how individuals view their overall selves.

Throughout the life span, body image changes as a matter of development, growth, maturation, changes related to childbearing and pregnancy, changes that occur as a result of aging, and changes that occur or are imposed as a result of injury or illness.

In cultures where one’s appearance is important, variations from the norm can result in body image disturbance. The importance that an individual places on a body part or function may be more important in determining the degree of disturbance than the actual alteration in the structure or function. Therefore the loss of a limb may result in a greater body image disturbance for an athlete than for a computer programmer. The loss of a breast to a fashion model or a hysterectomy in a nulliparous woman may cause serious body image disturbances even though the overall health of the individual has been improved. Removal of skin lesions, altered elimination resulting from bowel or bladder surgery, and head and neck resections are other examples that can lead to body image disturbance.

The nurse’s assessment of the perceived alteration and importance placed by the patient on the altered structure or function will be very important in planning care to address body image disturbance.

    Defining Characteristics:
  • Verbalization about altered structure or function of a body part
  • Verbal preoccupation with changed body part or function
  • Naming changed body part or function
  • Refusal to discuss or acknowledge change
  • Focusing behavior on changed body part and/or function
  • Actual change in structure or function
  • Refusal to look at, touch, or care for altered body part
  • Change in social behavior (e.g., withdrawal, isolation, flamboyance)
  • Compensatory use of concealing clothing or other devices
    Related Factors:
  • Situational changes (e.g., pregnancy, temporary presence of a visible drain or tube, dressing, attached equipment)
  • Permanent alterations in structure and/or function (e.g., mutilating surgery, removal of body part [internal or external])
  • Malodorous lesions
  • Change in voice quality
    Expected Outcomes
  • Patient demonstrates enhanced body image and self-esteem as evidenced by ability to look at, touch, talk about, and care for actual or perceived altered body part or function.

Ongoing Assessment

  • Assess perception of change in structure or function of body part (also proposed change). The extent of the response is more related to the value or importance the patient places on the part or function than the actual value or importance. Even when an alteration improves the overall health of the individual (e.g., an ileostomy for an individual with precancerous colon polyps), the alteration results in a body image disturbance.
  • Assess perceived impact of change on activities of daily living (ADLs), social behavior, personal relationships, and occupational activities.
  • Assess impact of body image disturbance in relation to patient’s developmental stage. Adolescents and young adults may be particularly affected by changes in the structure or function of their bodies at a time when developmental changes are normally rapid, and at a time when developing social and intimate relationships is particularly important.
  • Note patient’s behavior regarding actual or perceived changed body part or function. There is a broad range of behaviors associated with body image disturbance, ranging from totally ignoring the altered structure or function to preoccupation with it.
  • Note frequency of self-critical remarks.

Therapeutic Interventions

  • Acknowledge normalcy of emotional response to actual or perceived change in body structure or function. Stages of grief over loss of a body part or function is normal, and typically involves a period of denial, the length of which varies from individual to individual.
  • Help patient identify actual changes. Patients may perceive changes that are not present or real, or they may be placing unrealistic value on a body structure or function.
  • Encourage verbalization of positive or negative feelings about actual or perceived change. It is worthwhile to encourage the patient to separate feelings about changes in body structure and/or function from feelings about self-worth.
  • Assist patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities. Opportunities for positive feedback and success in social situations may hasten adaptation.
  • Demonstrate positive caring in routine activities. Professional caregivers represent a microcosm of society, and their actions and behaviors are scrutinized as the patient plans to return to home, to work, and to other activities.

Education/Continuity of Care

  • Teach patient about the normalcy of body image disturbance and the grief process.
  • Teach patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body part or enhances remaining part or function, use of deodorants). This compensates for actual changed body structure and function.
  • Help patient identify ways of coping that have been useful in the past. Asking patients to remember other body image issues (e.g., getting glasses, wearing orthodontics, being pregnant, having a leg cast) and how they were managed may help patient adjust to the current issue.
  • Refer patient and caregivers to support groups composed of individuals with similar alterations. Lay persons in similar situations offer a different type of support, which is perceived as helpful (e.g., United Ostomy Association, Y Me?, I Can Cope, Mended Hearts).

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