Nursing diagnosis: situational low Self-Esteem related to loss of body part, change in functional abilities
Possibly evidenced by
Anticipated changes in lifestyle, fear of rejection or reaction by others
Negative feelings about body; focus on past strength, function, or appearance
Feelings of helplessness, powerlessness
Preoccupation with missing body part, not looking at or touching residual limb
Perceived change in usual patterns of responsibility or physical capacity to resume role
Desired Outcomes/Evaluation Criteria—Client Will
Begin to show adaptation and verbalize acceptance of self in situation (amputee).
Recognize and incorporate changes into self-concept in accurate manner without negating self-esteem.
Develop realistic plans for adapting to new role or role modifications.
Nursing intervention with rationale:
1. Assess and consider client’s preparation for and view of amputation.
Rationale: Research shows that amputation poses serious threats to client’s psychological and psychosocial adjustment. Client who views amputation as life-saving or reconstructive may be able to accept the new self more quickly. Client with sudden traumatic amputation or who considers amputation to be the result of failure in other treatments is at greater risk for disturbances in self-concept.
2. Encourage expression of fears, negative feelings, and grief over loss of body part.
Rationale: Venting emotions helps client begin to deal with the fact and reality of life without a limb.
3. Reinforce preoperative information, including type and location of amputation, type of prosthetic fitting if appropriate (i.e., immediate, delayed), and expected postoperative course, including pain control and rehabilitation.
Rationale: Provides opportunity for client to question and assimilate information and begin to deal with changes in body image and function, which can facilitate postoperative recovery.
4. Assess degree of support available to client.
Rationale: Sufficient support by significant other (SO) and friends can facilitate rehabilitation process.
5. Discuss client’s perceptions of self, related to change, and how client sees self in usual lifestyle and role functioning.
Rationale: Aids in defining concerns in relation to previous lifestyle and facilitates problem-solving. For example, client likely fears loss of independence and ability to work or express sexuality and may experience role and/or relationship changes.
6. Ascertain individual strengths and identify previous positive coping behaviors.
Rationale: Helpful to build on strengths that are already available for client to use in coping with current situation.
7. Encourage participation in activities of daily living (ADLs). Provide opportunities to view and care for residual limb, using the moment to point out positive signs of healing.
Rationale: Promotes independence and enhances feelings of self-worth. Although integration of residual limb into body image can take months or even years, looking at the residual limb and hearing positive comments made in a normal, matter-of-fact manner can help client with this acceptance.
8. Encourage or provide for a visit by another amputee, especially one who is successfully rehabilitating.
Rationale: A peer who has been through a similar experience serves as a role model and can provide validity to comments and hope for recovery and a normal future.
9. Provide open environment for client to discuss concerns about sexuality.
Rationale: Promotes sharing of beliefs and values about sensitive subject, and identifies misconceptions or myths that may interfere with adjustment to situation.
10. Note withdrawn behavior, negative self-talk, use of denial, or overconcern with actual or perceived changes.
Rationale: Identifies stage of grief and need for interventions.