Nurse's Pocket Guide

situational low SELF-ESTEEM
• Support independence in ADLs/mastery of therapeutic regimen.
Individuals who are confident are more secure and
positive in self-appraisal.
• Promote attendance in therapy/support group, as indicated.
• Involve extended family/SO(s) in treatment plan. Increases
likelihood they will provide appropriate support to
client.
• Provide information to assist client in making desired
changes. Appropriate books, DVDs, or other resources allow
client to learn at own pace.
• Suggest participation in group/community activities (e.g.,
assertiveness classes, volunteer work, support groups).
Documentation Focus
ASSESSMENT/REASSESSMENT
• Individual findings, noting precipitating crisis, client’s
perceptions, effects on desired lifestyle/interaction with
others.
• Cultural values/religious beliefs, locus of control.
• Family support, availability/use of resources.
PLANNING
• Plan of care and who is involved in planning.
• Teaching plan.
IMPLEMENTATION/EVALUATION
• Responses to interventions/teaching, actions performed, and
changes that may be indicated.
• Attainment/progress toward desired outcome(s).
• Modifications to plan of care.
DISCHARGE PLANNING
• Long-term needs/goals and who is responsible for actions to
be taken.
• Specific referrals made.
SAMPLE NURSING OUTCOMES & INTERVENTIONS
CLASSIFICATIONS (NOC/NIC)
NOC—Self-Esteem
NIC—Self-Esteem Enhancement
Information in brackets added by the authors to clarify and enhance
the use of nursing diagnoses.
594 Cultural Collaborative Community/Home Care