Term Paper on "Nursing Care Plan: Low Self-Esteem"

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Pulse: 60 bpm

IV. GOAL

Develop a nursing care plan for this client through use of the nursing process while demonstrating critical thinking skills in formulating the best plan of care for this individual client.

V. BRIEF REVIEW of LITERATURE

The work of Edward P. Lemay and Richard D. Ashmore entitled: "The Relationship of Social Approval Contingency to Trait Self-Esteem: Cause, Consequence, or Moderator?" relates a longitudinal study which examined three theoretical models of the relationship between contingency of self-worth on social approval and trait self-esteem. Lemay and Ashmore state that "Properly speaking, a man has many social selves as there are individual show recognize him and carry an image of him in their mind. To wound any one of these his images is to wound him." James 1890/1950; p.294; as cited in Lemay and Ashmore, 2006; p. 122) in the view of James there are implications of a profound nature in understanding self-esteem especially as regarding the social self and further that "perceived acceptance from others is a determinant of, if not interchangeable with feelings of self-worth." (Lemay and Ashmore, 2005; Murray Rose, Bellavia, Holmes & Kusche, 2002) in another study conducted and reported in the work of Leary et al. (2003) are beliefs that "self-esteem is not contingent on social approval are inaccurate." (2006) it is related in the work of Sprinkle (2006) entitled: "Young, Attractive, Athletic, Popular, Smart and Depressed" that a senior at Scarsdale High who is referred as 'Nicole W.' who was starting to feel the pressures of going to college. It wasn't the college-application process that bothered her, but rather the thought of leaving her secure environment and being out on her own. A big-boned girl who always struggled with her weight, her depression manifested with a drastic exercise regimen and a loss of appetite. Her mother, who she's especially close to, thought seeing her daughter take an interest in her weight was a good thing, and didn't notice any sort of problem. That is, until the dentist mentioned his concerns about Nicole being bulimic. It turns out she had a lot of anxiety and fear about separating from her parents and going to college, and this is how it manifested. Depression was the root of the bulimia, according to Dr. Belkin, who eventually treated her with a combination of therapy and medication."

The work of Gloria J. Evans, entitled: "The Relationship of Attachment and Shame to Anorexia: A Case Study Comparing Restrictive and Normal Eaters" relates that research has provided description of and as well "many clinicians have reported the anorexic patient as socially disconnected, having a disembodied sense of self, perfectionist expectations and inadequate and shameful feelings." The work entitled: "Adolescent Depression" published in the Nevada Kidscount journal Issue One in Winter (2005) relates that each year approximately 50 out of every one-thousand teenagers experience "the torment of major depression. Clinical depression involves overwhelming feelings of being sad for weeks or longer." (Adolescent Depression, Winter 2006) it is stated by the Center for Mental Health Services that 12.5% of teenagers "endure clinical depression." (Evans, 2005) Mood disorders are many times diagnosed among teens as: (1) major depressive disorder; (2) dysthymic disorder; and (3) bipolar disorder. (Evans, 2005)

It is related in a separate case study reported by Zuckerbrot, et al. (2007) in the work entitled: "Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment and Initial Management. Vol. 120, No. 1.Nov 5, 2007 Pediatrics Journal. report that evidence indicates that only a mere fraction of depressed adolescents are identified in clinical settings and approximately one-half of depressed adolescents are diagnosed prior to adulthood. In order to identify those youths who are at high risk, tools are used such as standardized written instruments. Additionally stated is as follows: "The involvement of the family is critical in all phases of management and should be included in the assessment for depressive disorders. Family relationships also may affect the presentation of depression in adolescents." Additionally considered should be other factors such as: (1) family cultural background; (2) substance abuse; (3) anxiety disorder; (4) attention deficit hyperactivity disorder; (5) physical abuse; (6) sexual abuse; and (7) trauma. (Zuckerbrot, et al., 2007) Zuckerbrot et all states that it is critical to "establish relevant links/collaboration with mental health resources in the community which may include patients and families who have dealt with adolescent depression and are willing to serve as resource to other affected adolescents and their family members.

Preparation for Managing Depression in Primary Care

Source: American Academy of Pediatrics (2007)

VI. ASSESSMENT of CLIENT

There are various issues that must be considered carefully when assessing the patient and developing a nursing plan for this client toward implementing the most effective treatment plan possible. The role of the Nurse in this specific case study is one of assisting the patient in achieving the most positive possible outcomes in patient safety and health. First, depression may derive from biological as well as psychological roots. This client is underweight for her height. Furthermore, she is a loner and does not keep in touch with her old friends choosing instead to avoid social situations. Low self-esteem is evident in this particular case. Her siblings are both high-achievers while Jaslyn is not. Depression is clearly a factor affecting this young female. This patient should be tested for not only depression but as well should likely be tested for learning disabilities due to her difficulties in school. The work of Logsdon (nd) entitled: "Depression in Adolescent Girls: Screening and Treatment Strategies for Primary Care Providers" states: "Depressed adolescent girls were less masculine and had parents who were more traditional than did girls who were not depressed. Other studies have found that adolescent girls who are depressed tend to be stressed, lack social support, use physical health services more frequently, and have low socioeconomic status. Adolescent girls experience more stressful events than adolescent boys do and have stronger reactions to these events." Logsdon states that various theoretical frameworks have been created upon which to place the reasoning of why it is that adolescent girls are more likely to experience depression. Three explanations which are provided in Logsdon's work are those as follows: (1)Increased oxytocin present in girls at puberty leads to increases in affiliative behavior and a need for emotional connectiveness." (Logsdon, nd) Logsdon relates that it is common for girls to feel a 'sense of loss leading to depression'. (2) Adolescents girls become aware of society's expectations about proper behavior for women. Girls are sensitive to signals from others that their actions are or are not appropriate, and negative feedback may lead to feelings of depression. Most researchers agree on the importance of relationships to adolescent girls and the role of "disconnected relationships." (Logsdon, nd) and (3) adolescents girls accept the stereo typical ideal of an extremely thin physical appearance which leads to dissatisfaction with their body shape and increased depression." (Logsdon, nd) Evans writes regarding anorexia that "Parental care appears to be a key developmental risk factor to anorexia, whether insufficient care reflects a personal style in the parents or is a consequence of parental separation, marital discord, socioeconomic privation or other factors. A lack of appropriate parental care (responsiveness and acceptance) apparently fixates the individual to a sense of helplessness, engenders feelings of inferiority and self-disparagement, and makes the recipient more vulnerable to frustration or deprivation by subsequent relationships. Bowlby (1977) suggested that such… READ MORE