- Chronic Low Self-Esteem Related to Chronic physical conditions or mental illness and Inability to maintain relationships as evidenced by Rejects positive feedback and
Exaggerates negative self-worth - Caregiver Role Strain related to Increasing care needs and Psychological or cognitive disabilities as evidenced by Caregiver or care receiver suffering a decline in health status and Unable to meet responsibilities of other roles (workplace, parenting)
- Grieving Related to Anticipatory loss (loved one, independence, possessions) and Death of a loved one as evidenced by Changes in sleep patterns and dreams and Processing loss and experiencing growth
| Assessment | Nursing Diagnosis | Planning/Outcomes | Intervention | Evaluation |
| Subjective data: Verbalizes negative self-talk Objective data: -Rejects positive feedback -Exaggerates negative self-worth (“I’m a failure” “No one cares about me”) -Nonassertive, passive, indecisive -Hesitant to try new things | Chronic Low Self-Esteem Related to Chronic physical conditions or mental illness and Inability to maintain relationships as evidenced by Rejects positive feedback and Exaggerates negative self-worth | Patient will verbalize reasons for low self-esteem Patient will incorporate two techniques to improve self-esteem Patient will verbalize feeling a sense of increased self-worth | 1. Develop a therapeutic relationship. Maintain open communication, actively listen, and do not downplay or dismiss the patient’s statements or perceptions. 2. Discuss and confront misconceptions. An outside perspective may aid the patient in recognizing their self-limiting beliefs. The nurse can confront the patient’s negative self-talk, their distortions in thinking, and help the patient realize they are focusing on the negative and worst-case scenarios instead of allowing the opportunity for change. 3. Model positive behavior and assist with goal setting. The nurse can prevent the patient from ruminating on negative concepts by engaging in positive conversations, offering the patient simple decisions, and helping them set and achieve goals. This can increase the patient’s sense of self-esteem in their abilities. 4. Refer to resources and counseling. Chronic low self-esteem may require the help of a mental health professional. Other resources depending on the causes of low self-esteem may include employment assistance or life coaching. | Patient verbalized reasons for low self-esteem Patient incorporated two techniques to improve self-esteem Patient verbalized feeling a sense of increased self-worth |
Subjective data: -Caregiver verbalizes inadequacy or apprehension in providing care Objective data: -Caregiver or care receiver suffering a decline in health status -Unable to meet responsibilities of other roles (workplace, parenting) -Lack of personal or leisure time -Preoccupation with care routine and tasks | Caregiver Role Strain related to Increasing care needs and Psychological or cognitive disabilities as evidenced by Caregiver or care receiver suffering a decline in health status and Unable to meet responsibilities of other roles (workplace, parenting) | Caregiver will identify and utilize resources available to support the caregiver Caregiver will institute two boundaries to manage caregiving with other responsibilities Caregiver will report an improved sense of caregiving abilities | 1. Encourage the caregiver to express difficulties. Caregivers often feel isolated in their duties or may feel that expressing their burden is inappropriate or will result in their family member being placed in a facility. Offer a non-judgmental opportunity for the caregiver to openly express any doubts, fears, and concerns to provide accurate interventions. 2. Educate on signs of burnout and coping strategies. Exhaustion, stress, poor sleep, weight loss, and isolation from friends are signs of burnout. Teach stress management strategies such as asking for help, taking time away from the home, and taking care of one’s self through proper diet and exercise. Remind the caregiver that their ability to give care is only as good as the care they give themselves. 3. Discuss scheduling, coordination, and boundary setting. Help the caregiver create a schedule/routine for caregiving along with other responsibilities including leisure time. Caregivers must implement boundaries and not allow a caregiving role to consume their lives. 4. Provide community resources. Nurses can request referrals for services such as respite programs, home health care, or hospice. The nurse can also research and offer community resources such as support groups, church-provided volunteer services, and financial programs. | Caregiver identified and utilize resources available to support the caregiver Caregiver instituted two boundaries to manage caregiving with other responsibilities Caregiver reported an improved sense of caregiving abilities |
| Subjective data: Verbalization of pain, anger, despair Objective data: -Changes in sleep patterns and dreams -Lack of appetite or overeating -Crying -Withdrawn behavior -Processing loss and experiencing growth | Grieving Related to Anticipatory loss (loved one, independence, possessions) and Death of a loved one as evidenced by Changes in sleep patterns and dreams and Processing loss and experiencing growth | Patient will experience expected feelings of grief Patient will institute one coping strategy to manage grief Patient will verbalize a plan for the future | 1. Educate on the grieving process and answer questions. The nurse can educate the patient on the 5 stages of grief and that they will work through these at their own pace, and not necessarily in order. If anticipating a loss, answer questions honestly and do not provide false reassurances such as “everything will be ok.” 2. Encourage expressions of grief. Encourage the patient to journal or verbalize feelings of loss. Remind them their feelings are normal and remembering their loved one is therapeutic in moving on. 3. Promote family and religious support. The support of friends, family, and chaplains (if religious) is beneficial in working through grief and preventing delayed or complicated grieving. 4. Offer bereavement services and support groups. Loss of a loved one, whether sudden or expected may necessitate additional support. If hospice care was provided, bereavement is offered to family members for 13 months following the loss. Support groups for losses such as children, pets, and suicide can help with coping with these specific situations. | Patient experienced expected feelings of grief Patient instituted one coping strategy to manage grief Patient verbalized a plan for the future |