NURSING DIAGNOSIS: Body Image disturbed/Role Performance ineffecti!

e "ay be related to Situational crisis: traumatic event, dependent patient role; disfigurement, pain Possibly e!idenced by Negative feelings about body/self, fear of rejection/reaction by others Focus on past appearance, abilities; preoccupation with change/loss Change in physical capacity to resume role; change in social involvement D#SIR#D OU$%O"#S/#&A'UA$ION %RI$#RIA(PA$I#N$ )I'': Body Image *NO%+ ncorporate changes into self!concept without negating self!esteem" #erbali$e acceptance of self in situation" Role Performance *NO%+ %al& with family/S' about situation, changes that have occurred" (evelop realistic goals/plans for the future"

ACTIONS/INTERVENTIONS
Body Image ,or- Role #n.ancement *NI%+

RATIONALE

Inde/endent
)ssess meaning of loss/change to patient/S', including future e*pectations and impact of cultural/religious beliefs" %raumatic episode results in sudden, unanticipated changes, creating feelings of grief over actual/perceived losses" %his necessitates support to wor& through to optimal resolution" )cceptance of these feelings as a normal response to what has occurred facilitates resolution" t is not helpful or possible to push patient before ready to deal with situation" (enial may be prolonged and be an adaptive mechanism because patient is not ready to cope with personal problems"

)c&nowledge and accept e*pression of feelings of frustration, dependency, anger, grief, and hostility" Note withdrawn behavior and use of denial"

ACTIONS/INTERVENTIONS
Body Image ,or- Role #n.ancement *NI%+

RATIONALE

Inde/endent
Set limits on maladaptive behavior +e"g", manipulative/ aggressive," -aintain nonjudgmental attitude while giving care, and help patient identify positive behaviors that will aid in recovery" 0atient and S' tend to deal with this crisis in the same way in which they have dealt with problems in the past" Staff may find it difficult and frustrating to handle behavior that is disrupting/not helpful to recuperation but should reali$e that the behavior is usually directed toward the situation and not the caregiver" /nhances trust and rapport between patient and nurse"

.e realistic and positive during treatments, in health teaching, and in setting goals within limitations" /ncourage patient/S' to view wounds and assist with care as appropriate"

0romotes acceptance of reality of injury and of change in body and image of self as different"

0rovide hope within parameters of individual situation; do not give false reassurance" )ssist patient to identify e*tent of actual change in appearance/body function" 1ive positive reinforcement of progress and encourage endeavors toward attainment of rehabilitation goals" Show slides or pictures of burn care/other patient outcomes, being selective in what is shown as appropriate to the individual situation" /ncourage discussion of feelings about what patient has seen" /ncourage family interaction with each other and with rehabilitation team" 0rovide support group for S'" 1ive information about how S' can be helpful to patient" 2ole!play social situations of concern to patient"

0romotes positive attitude and provides opportunity to set goals and plan for future based on reality" 3elps begin process of loo&ing to the future and how life will be different" 4ords of encouragement can support development of positive coping behaviors" )llows patient/S' to be realistic in e*pectations" )lso assists in demonstration of importance of/necessity for certain devices and procedures"

-aintains/opens lines of communication and provides ongoing support for patient and family" 0romotes ventilation of feelings and allows for more helpful responses to patient" 0repares patient/S' for reactions of others and anticipates ways to deal with them"

%ollaborati!e
2efer to physical/occupational therapy, vocational counselor, and psychiatric counseling, e"g", clinical specialist psychiatric nurse, social services, psychologist, as needed" 3elpful in identifying ways/devices to regain and maintain independence" 0atient may need further assistance to resolve persistent emotional problems +e"g", posttrauma response,"