This care plan is designed for patients with schizophrenia with a nursing diagnosis of chronic low self esteem may be related to disintegrated thought processes (perception, cognition, affect); loose/disintegration of ego boundaries; perceived threats to the self; and disintegration of behavior, affect possibly evidenced byexpressions of worthlessness, negative feelings about self. impaired judgment, cognition, and perception; protective delusional systems; disturbed sense of self (depersonalization and delusions of control), and role performance deterioration in family, social, and work areas, inadequate development of self-esteem and hopefulness, ambivalence and autism (interfering with acceptance of self and meaning of own existence)
Desired Outcomes: (1) Demonstrate enhanced sense of self by decreasing episodes of depersonalization and delusions; (2) Verbalize feelings of value/worthwhileness and view self as competent and socially acceptable (by self and others); (3) Develop appropriate plans for improvement of role performance that promote highest possible level of adaptive functioning; (4) Demonstrate self-directedness by expressing own needs and desires and making effective decisions; and (5) Participate in activities with others.
Nursing intervention with rationale:
1. Assess the degree of disturbance in client’s self-concept.
Rationale: Documents own and others’ perceptions, client’s goals, significant losses/changes. Provides basis for determination of therapy needs and evaluation of progress.
2. Spend time with client; listen with positive regard and acceptance.
Rationale: Conveys empathy, acceptance, support, which enhances client’s self-esteem. Personal identity is
strengthened as client identifies with the nurse and experiences therapeutic caring within the relationship.
3. Encourage client to verbalize areas of concern/feelings.
Rationale: Self-esteem is improved by increased insight into feelings. Insight is gained as client verbalizes/ identifies feelings (e.g., inadequacy, worthlessness, rejection, loneliness).
4. Help client identify how negative feelings decrease self-esteem.
Rationale: Negative feelings can lead to severe anxiety and/or suspiciousness. Increased awareness/ perception of factors that cause negative feelings can help client recognize how negative feelings cause deterioration.
5. Encourage client to recognize positive characteristics related to self.
Rationale: Discussion of positive aspects of the self-system, such as social skills, work abilities, education, talents, and appearance, can reinforce client’s feelings of being a worthwhile/competent person
6. Review personal appearance and things client can do to enhance hygiene/grooming.
Rationale: Positive personal appearance enhances body image and self-respect.
7. Assist the client to adapt to changing role performance by working with client/significant other(s) to develop strategies for dealing with disturbances in role and enhancing expectations of coping effectively.
Rationale: The client’s eventual level of performance may be positively influenced by a support system that is responsive and caring.
8. Assess the current sense of personal identity, considering if client acknowledges sense of self. (Observe how client addresses self (e.g., may refer to self in third person). Also consider if client expresses feelings of unreadiness, merging with people/objects.
Rationale: Identifies individual needs, appropriate interventions. Inability to identify self poses a major problem that can interfere with person’s interactions with others.
9. Assess presence/severity of factors that affect client’s religious/spiritual orientation. Note presence of religiosity.
Rationale: Disintegrated behaviors create such factors as displaced anger toward God, expression of concern with meaning of life/death/values (may be expressed as delusions, hallucinations). These concerns may negatively affect the individual’s sense of self-worth. Client may use religious beliefs as a defense against fears.
10. Use therapeutic communication skills to support client’s verbalization of sense of self and to discover its relationship to meaning of existence.
Rationale: Therapeutic communications, such as active-listening, summarizing, reflection, can support client to find own solutions.