Self-Esteem, situational low, Amputation NCPs

Nursing Diagnosis

• Self-Esteem, situational low

May be related to

• Loss of body part/change in functional abilities

Possibly evidenced by

• Anticipated changes in lifestyle; fear of rejection/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 stump
• Perceived change in usual patterns of responsibility/physical capacity to resume role

Desired Outcomes

• 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/role modifications.

Nursing Interventions & Rationale

Nursing Interventions	Rationale
Assess/consider patient’s preparation for and view of amputation.	Research shows that amputation poses serious threats to patient’s psychological and psychosocial adjustment.Patient who views amputation as life-saving or reconstructive may be able to accept the new self more quickly.Patient with sudden traumatic amputation or who considers amputation to be the result of failure in other treatments is at greater risk for self-concept disturbances.
Encourage expression of fears, negative feelings, and grief over loss of body part.	Venting emotions helps patient begin to deal with the fact and reality of life without a limb.
Reinforce preoperative information including type/location of amputation, type of prosthetic fitting if appropriate (i.e., immediate, delayed), expected postoperative course, including pain control and rehabilitation.	Provides opportunity for patient to question and assimilate information and begin to deal with changes in body image and function, which can facilitate postoperative recovery.
Assess degree of support available to patient.	Sufficient support by SO and friends can facilitate rehabilitation process.
Ascertain individual strengths and identify previous positive coping behaviors.	Helpful to build on strengths that are already available for patient to use in coping with current situation.
Encourage participation in ADLs. Provide opportunities to view/care for stump, using the moment to point out positive signs of healing.	Promotes independence and enhances feelings of selfworth. Although integration of stump into body image can take months or even years, looking at the stump and hearing positive comments (made in a normal, matter-offact manner) can help patient with this acceptance.
Encourage/provide for visit by another amputee, especially one who is successfully rehabilitating.	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.
Note withdrawn behavior, negative self-talk, use of denial, or overconcern with actual/perceived changes.	Identifies stage of grief/need for interventions.
Provide open environment for patient to discuss concerns about sexuality.	Promotes sharing of beliefs/values about sensitive subject, and identifies misconceptions/myths that may interfere with adjustment to situation.
Discuss availability of various resources, e.g., psychiatric/ sexual counseling, occupational therapist.	May need assistance for these concerns to facilitate optimal adaptation and rehabilitation.