Saturday, November 20, 2010

Nursing Diagnosis: Disturbed Body Image (with Rationale)

Related Factors:
  • Situational changes (e.g., pregnancy, temporary presence of a visible drain or tube, dressing, attached equipment)
  • Permanent alterations in structure and/or function (e.g., mutilating surgery, removal of body part [internal or external])
  • Malodorous lesions
  • Change in voice quality
NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
  • Body Image                      
  • Self-Esteem
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
  • Body Image Enhancement
  • Grief Work Facilitation
  • Coping Enhancement                             
  • Assess perception of change in structure or function of body part (also proposed change).--The extent of the response is more related to the value or importance the patient places on the part or function than the actual value or importance. Even when an alteration improves the overall health of the individual (e.g., an ileostomy for an individual with precancerous colon polyps), the alteration results in a body image disturbance.
  • Assess perceived impact of change on activities of daily living (ADLs), social behavior, personal relationships, and occupational activities.
  • Assess impact of body image disturbance in relation to patient’s developmental stage.--Adolescents and young adults may be particularly affected by changes in the structure or function of their bodies at a time when developmental changes are normally rapid, and at a time when developing social and intimate relationships is particularly important.
  • Note patient’s behavior regarding actual or perceived changed body part or function.--There is a broad range of behaviors associated with body image disturbance, ranging from totally ignoring the altered structure or function to preoccupation with it.
  • Note frequency of self-critical remarks.

Therapeutic Interventions
  • Acknowledge normalcy of emotional response to actual or perceived change in body structure or function.--Stages of grief over loss of a body part or function is normal, and typically involves a period of denial, the length of which varies from individual to individual.
  • Help patient identify actual changes.--Patients may perceive changes that are not present or real, or they may be placing unrealistic value on a body structure or function.
  • Encourage verbalization of positive or negative feelings about actual or perceived change.--It is worthwhile to encourage the patient to separate feelings about changes in body structure and/or function from feelings about self-worth.
  • Assist patient in incorporating actual changes into ADLs, social life, interpersonal relationships, and occupational activities.--Opportunities for positive feedback and success in social situations may hasten adaptation.
  • Demonstrate positive caring in routine activities.--Professional caregivers represent a microcosm of society, and their actions and behaviors are scrutinized as the patient plans to return to home, to work, and to other activities.
  • Teach patient about the normalcy of body image disturbance and the grief process.
  • Teach patient adaptive behavior (e.g., use of adaptive equipment, wigs, cosmetics, clothing that conceals altered body part or enhances remaining part or function, use of deodorants).--This compensates for actual changed body structure and function.
  • Help patient identify ways of coping that have been useful in the past.--Asking patients to remember other body image issues (e.g., getting glasses, wearing orthodontics, being pregnant, having a leg cast) and how they were managed may help patient adjust to the current issue.
  • Refer patient and caregivers to support groups composed of individuals with similar alterations.--Lay persons in similar situations offer a different type of support, which is perceived as helpful (e.g., United Ostomy Association, Y Me?, I Can Cope, Mended Hearts).


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