NURSING DIAGNOSIS: Self-concept disturbance*

related to dependence on others to meet basic needs, feelings of powerlessness, and change in body functioning and usual roles and lifestyle associated with physical limitations and/or prescribed activity restrictions.

*This diagnostic label includes the nursing diagnoses of body image disturbance, self-esteem disturbance, and altered role performance.

Desired Outcome
The client will demonstrate beginning adaptation to changes in body functioning, lifestyle, roles, and level of independence as evidenced by:
  1. verbalization of feelings of self-worth
  2. maintenance of relationships with significant others
  3. active participation in activities of daily living
  4. verbalization of a beginning plan for adapting lifestyle to changes resulting from the injury or disease and/or its treatment.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for signs and symptoms of a self-concept disturbance (e.g. verbalization of negative feelings about self, withdrawal from significant others, lack of participation in activities of daily living, lack of plan for adapting to necessary changes in lifestyle).
  2. Determine the meaning of feelings of dependency and changes in body functioning, lifestyle, and roles to the client by encouraging the verbalization of feelings and by noting nonverbal responses to the changes experienced.
  3. Discuss with client improvements in body functioning and ability to resume usual roles and lifestyle that can realistically be expected.
  4. Implement measures to assist client to increase self-esteem (e.g. limit negative self-assessment, encourage positive comments about self, assist to identify strengths, give positive feedback about accomplishments).
  5. Assist client to identify and use coping techniques that have been helpful in the past.
  6. Assist client with usual grooming and makeup habits if necessary.
  7. Implement measures to reduce client's feelings of powerlessness (see Diagnosis 15, actions c - n).
  8. Support behaviors suggesting positive adaptation to changes that have occurred (e.g. verbalization of feelings of self-worth, maintenance of relationships with significant others).
  9. Assist client's and significant others' adjustment by listening, facilitating communication, and providing information.
  10. Encourage visits and support from significant others.
  11. Encourage client to continue involvement in interests and hobbies if possible. If previous interests and hobbies cannot be pursued, encourage development of new ones.
  12. Provide information about and encourage use of community agencies and support groups (e.g. vocational rehabilitation; family, individual, and/or financial counseling).
  13. Consult appropriate health care provider about psychological counseling if client desires or seems unwilling or unable to adapt to changes that have occurred as a result of the disease or injury and its treatment.