Scientific Basis:
Self-esteem is one’s judgment of one’s own worth, that is, how that person’s standards and performances compare to others and to one’s ideal self. As an adult, a person who has high self-esteem has feelings of significance, of competence, of the ability to cope with life, and of control over one’s destiny, stress related to prolonged illness can substantially lower a person’s self-esteem. In health care, persons who believe that their condition is viewed negatively by society may have lower self-esteem.
Often client experience emotional crisis because of the physical effect of the disease. A client may have a grief of these perceived changes in the body image. The feelings of loss on the visibility of the loss, the function of the loss and the amount investment.
The state in which an individual who previously had positive self-esteem, experiences negative feelings about self in response to an event (loss, change), continuation of these negative self-appraisals over time can lead to chronic low self-esteem.
Moyet, 2006; Berman, et al, 2008; Ignatavicius and Workman, 2002
Intervention and Rationale
I: Ask what client would like to be called.
R: Shows courtesy/respect and acknowledges person.
I: Identify SO from whom client derives comfort and who should be notified in case of emergency.
R: Allows provisions to be made for specific person(s) to visit or remain close, and provides needed support for client. Note: May or may not be legal next of kin.
I: Identify basic sense of self-esteem; image client has of existential, physical, psychological self. Identify locus of control.
R: May provide insight into whether this is a single episode or recurrent/chronic situation and can help determine needs and treatment plan. It is helpful to know whether the individual’s locus of control is internal or external to provide most helpful interventions.
I: Determine client’s perception of threat to self.
R: client’s perception is more important than what is really happening and needs to be dealt with before reality can be addressed.
I: Active-Listen client concerns and fears.
R: Conveys sense of caring and can be helpful in identifying patient’s needs, problems, and coping strategies and how effective they are. Provides opportunity to duplicate and begin a problem-solving process.
I: Assess degree to which patient feels loved and respect by others.
R: The manner in which one treated by others influence self-esteem. Feeling loved and respected despite disabilities implies that one is valued by others support self-esteem.
I: Encourage verbalization of feelings, accepting what is said.
R: Helps client/SO begin to adapt to change, and reduces anxiety about altered function/lifestyle.
I: Discuss stages of grief and the importance of grief work.
R: Grieving is a necessary step for integration of change/loss into self-concept.
I: Provide non threatening environment, listen and accept client as presented.
R: Promotes feelings of safety, encouraging verbalization
I: Observe nonverbal communication, e.g., body posture and movements, eye contact, gestures, use of touch.
R: Nonverbal language is a large portion of communication and therefore is extremely important. How the person uses touch provides information about how it is accepted and how comfortable the individual is with being touched.
I: Reflect back to client what has been said, e.g., “it upset you when he told you that.”
R: Clarification and verification of what has been heard promotes understanding and allows client to validate information, otherwise assumptions may be inaccurate.
I: Observe and describe behavior in objective terms.
R: All behavior has meaning, some of which is obvious and some of which needs to be identified. This is a process of educated guesswork and requires validation by client.
I: Identify age and developmental level.
R: Age is an indicator of the stage of life patient is experiencing, e.g., adolescence, middle age. However, developmental level may be more important than chronological age in anticipating and identifying some of client’s needs. Some degree of regression occurs during illness, depending on many factors such as the normal coping skills of the individual, the severity of the illness, and family/cultural expectations.
I: Discuss client’s view of body image and how illness/ condition might affect it.
R: Client’s perception of a change in body image may occur suddenly or over time (e.g., actual loss of a body part through injury/surgery, or a perceived loss) or be a continuous subtle process (e.g., chronic illness or aging). Awareness can alert the nurse to the need for appropriate interventions tailored to the individual need.
I: Encourage discussion of physical changes in a simple, direct, and factual manner. Give realistic feedback and discuss future options, e.g., rehabilitation services.
R: Provides opportunity to begin incorporating actual changes in an accepting and hopeful atmosphere.
I: Acknowledge efforts at problem solving, resolution of current situation, and future planning.
R: Provides encouragement and reinforces continuation of desired behaviors.
I: Recognize client’s pace for adaptation to demands of current situation.
R: Failure to acknowledge client’s need to take time and/or pressuring client to “get on with it” conveys a lack of acceptance of the person as an individual and may result in feelings of lowered self-esteem.
I: Introduce tasks at client’s level of functioning, progressing to more complex activities as tolerated.
R: Provides opportunity for client to experience successes, reaffirming capabilities and enhancing self-esteem.
I: Ascertain how client sees own role within the family system, e.g., breadwinner, homemaker, husband/father.
R: Illness may create a temporary or permanent problem in role expectations. Sexual role and how client views self in relation to the current illness also play important parts in recovery.
I: Assist client/SO with clarifying expected roles and those that may need to be relinquished or altered.
R: Provides opportunity to identify misconceptions and begin to look at options; promotes reality orientation.
I: Determine client awareness of own responsibility for dealing with situation, personal growth.
R: Conveys confidence in client’s ability to cope. When client acknowledges own part in planning and carrying out treatment plan, he has more investment in following through on decisions that have been made.
I: Assess impact of illness/surgery on sexuality.
R: Sexuality encompasses the whole person in the total environment. Many times problems of illness are superimposed on already existing problems of sexuality and can affect client’s sense of self-worth. Some problems are more obvious than others, such as illness involving the reproductive parts of the body. Others are less obvious, such as sexual values, role in family, e.g., wage earner and parent.
I: Be alert to comments and innuendos, which may mean client has a concern in the area of sexuality.
R: People are often reluctant and/or embarrassed to ask direct questions about sexual/sexuality concerns.
I: Be aware of caregiver’s feelings about dealing with the subject of sexuality.
R: Nurses/caregivers are often as reluctant and embarrassed in dealing with sexuality issues as most clients.
I: Provide information and referral to hospital and community resources.
R: Enables client/SO to be in contact with interested groups with access to assistive and supportive devices, services, and counseling.
I: Support participation in group/community activities, e.g., assertiveness classes, volunteer work, support groups.
R: Promotes skills of coping and sense of self-worth.
I: May refer to psychiatric support/therapy group, social services, as indicated.
R: May be needed to assist client/SO to achieve optimal recovery.
I: May refer to appropriate resources for sex therapy as need indicates.
R: May be someone with comfort level and knowledge who is available, or may be necessary to refer to professional resources for additional help and support.
Doenges, et al, 2008; Kruse, et al, 2003; Gulanick, 2007
Self-esteem is one’s judgment of one’s own worth, that is, how that person’s standards and performances compare to others and to one’s ideal self. As an adult, a person who has high self-esteem has feelings of significance, of competence, of the ability to cope with life, and of control over one’s destiny, stress related to prolonged illness can substantially lower a person’s self-esteem. In health care, persons who believe that their condition is viewed negatively by society may have lower self-esteem.
Often client experience emotional crisis because of the physical effect of the disease. A client may have a grief of these perceived changes in the body image. The feelings of loss on the visibility of the loss, the function of the loss and the amount investment.
The state in which an individual who previously had positive self-esteem, experiences negative feelings about self in response to an event (loss, change), continuation of these negative self-appraisals over time can lead to chronic low self-esteem.
Moyet, 2006; Berman, et al, 2008; Ignatavicius and Workman, 2002
Intervention and Rationale
I: Ask what client would like to be called.
R: Shows courtesy/respect and acknowledges person.
I: Identify SO from whom client derives comfort and who should be notified in case of emergency.
R: Allows provisions to be made for specific person(s) to visit or remain close, and provides needed support for client. Note: May or may not be legal next of kin.
I: Identify basic sense of self-esteem; image client has of existential, physical, psychological self. Identify locus of control.
R: May provide insight into whether this is a single episode or recurrent/chronic situation and can help determine needs and treatment plan. It is helpful to know whether the individual’s locus of control is internal or external to provide most helpful interventions.
I: Determine client’s perception of threat to self.
R: client’s perception is more important than what is really happening and needs to be dealt with before reality can be addressed.
I: Active-Listen client concerns and fears.
R: Conveys sense of caring and can be helpful in identifying patient’s needs, problems, and coping strategies and how effective they are. Provides opportunity to duplicate and begin a problem-solving process.
I: Assess degree to which patient feels loved and respect by others.
R: The manner in which one treated by others influence self-esteem. Feeling loved and respected despite disabilities implies that one is valued by others support self-esteem.
I: Encourage verbalization of feelings, accepting what is said.
R: Helps client/SO begin to adapt to change, and reduces anxiety about altered function/lifestyle.
I: Discuss stages of grief and the importance of grief work.
R: Grieving is a necessary step for integration of change/loss into self-concept.
I: Provide non threatening environment, listen and accept client as presented.
R: Promotes feelings of safety, encouraging verbalization
I: Observe nonverbal communication, e.g., body posture and movements, eye contact, gestures, use of touch.
R: Nonverbal language is a large portion of communication and therefore is extremely important. How the person uses touch provides information about how it is accepted and how comfortable the individual is with being touched.
I: Reflect back to client what has been said, e.g., “it upset you when he told you that.”
R: Clarification and verification of what has been heard promotes understanding and allows client to validate information, otherwise assumptions may be inaccurate.
I: Observe and describe behavior in objective terms.
R: All behavior has meaning, some of which is obvious and some of which needs to be identified. This is a process of educated guesswork and requires validation by client.
I: Identify age and developmental level.
R: Age is an indicator of the stage of life patient is experiencing, e.g., adolescence, middle age. However, developmental level may be more important than chronological age in anticipating and identifying some of client’s needs. Some degree of regression occurs during illness, depending on many factors such as the normal coping skills of the individual, the severity of the illness, and family/cultural expectations.
I: Discuss client’s view of body image and how illness/ condition might affect it.
R: Client’s perception of a change in body image may occur suddenly or over time (e.g., actual loss of a body part through injury/surgery, or a perceived loss) or be a continuous subtle process (e.g., chronic illness or aging). Awareness can alert the nurse to the need for appropriate interventions tailored to the individual need.
I: Encourage discussion of physical changes in a simple, direct, and factual manner. Give realistic feedback and discuss future options, e.g., rehabilitation services.
R: Provides opportunity to begin incorporating actual changes in an accepting and hopeful atmosphere.
I: Acknowledge efforts at problem solving, resolution of current situation, and future planning.
R: Provides encouragement and reinforces continuation of desired behaviors.
I: Recognize client’s pace for adaptation to demands of current situation.
R: Failure to acknowledge client’s need to take time and/or pressuring client to “get on with it” conveys a lack of acceptance of the person as an individual and may result in feelings of lowered self-esteem.
I: Introduce tasks at client’s level of functioning, progressing to more complex activities as tolerated.
R: Provides opportunity for client to experience successes, reaffirming capabilities and enhancing self-esteem.
I: Ascertain how client sees own role within the family system, e.g., breadwinner, homemaker, husband/father.
R: Illness may create a temporary or permanent problem in role expectations. Sexual role and how client views self in relation to the current illness also play important parts in recovery.
I: Assist client/SO with clarifying expected roles and those that may need to be relinquished or altered.
R: Provides opportunity to identify misconceptions and begin to look at options; promotes reality orientation.
I: Determine client awareness of own responsibility for dealing with situation, personal growth.
R: Conveys confidence in client’s ability to cope. When client acknowledges own part in planning and carrying out treatment plan, he has more investment in following through on decisions that have been made.
I: Assess impact of illness/surgery on sexuality.
R: Sexuality encompasses the whole person in the total environment. Many times problems of illness are superimposed on already existing problems of sexuality and can affect client’s sense of self-worth. Some problems are more obvious than others, such as illness involving the reproductive parts of the body. Others are less obvious, such as sexual values, role in family, e.g., wage earner and parent.
I: Be alert to comments and innuendos, which may mean client has a concern in the area of sexuality.
R: People are often reluctant and/or embarrassed to ask direct questions about sexual/sexuality concerns.
I: Be aware of caregiver’s feelings about dealing with the subject of sexuality.
R: Nurses/caregivers are often as reluctant and embarrassed in dealing with sexuality issues as most clients.
I: Provide information and referral to hospital and community resources.
R: Enables client/SO to be in contact with interested groups with access to assistive and supportive devices, services, and counseling.
I: Support participation in group/community activities, e.g., assertiveness classes, volunteer work, support groups.
R: Promotes skills of coping and sense of self-worth.
I: May refer to psychiatric support/therapy group, social services, as indicated.
R: May be needed to assist client/SO to achieve optimal recovery.
I: May refer to appropriate resources for sex therapy as need indicates.
R: May be someone with comfort level and knowledge who is available, or may be necessary to refer to professional resources for additional help and support.
Doenges, et al, 2008; Kruse, et al, 2003; Gulanick, 2007
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