A 56-year-old psychiatric inpatient has had recurring episodes of depression and chronic low self-esteem. She feels that her family does not want her around,experiences a sense of helplessness, and has a negative view of herself. To assist the client in focusing on her strengths and positive traits, a strategy used by the nurse would be to?

Appeared in: NORCET 5 mains

Explanation

This strategy focuses on providing the client with opportunities for success in a controlled and manageable way.
Engaging in simple, achievable activities provides immediate positive reinforcement, which directly counters feelings of helplessness and worthlessness.
According to psychiatric nursing principles, providing simple and easily achievable activities promotes feelings of self-worth and independence (SRC_554).
This approach helps the client to gradually rebuild confidence and focus on their strengths, which is a core goal in treating low self-esteem.
It breaks the cycle of negative thinking by creating new, positive experiences of competence.

Option A: This is too demanding and can be overwhelming for a client with depression, who often lacks the energy (anergia) and motivation to participate in numerous activities. Failure to meet this expectation could worsen feelings of guilt and inadequacy.
Option C: Clients with depression often struggle with indecisiveness and ambivalence. Burdening them with making 'all' decisions can increase anxiety and a sense of being overwhelmed, which is counter-therapeutic.
Option D: This approach is punitive and non-therapeutic. While independence is a long-term goal, a client with severe depression and low self-esteem requires support to build the necessary confidence. Abruptly denying support can reinforce feelings of worthlessness and abandonment.

Clinical Relevance

Nursing practice connection: Use the key finding related to Therapeutic nursing interventions for low self-esteem in clients with depression to guide bedside assessment, documentation, and the next nursing action.
A nurse's primary role in psychiatric care is to create a therapeutic milieu that promotes safety, trust, and personal growth. This includes selecting activities that match the client's current functional level.
Failing to properly support a client with severe depression and helplessness can increase their risk of self-harm. Interventions must be carefully chosen to build hope, not create more opportunities for perceived failure.
What if the client refuses to attend even a simple activity? The nurse should use therapeutic communication to explore the client's feelings, offer to accompany them, or break the activity down into even smaller steps (e.g., 'Let's just walk to the door of the activity room together'). The goal is gentle encouragement, not coercion.

How to Approach the Question

First, identify the client's core problem from the scenario: The client has depression and chronic low self-esteem, leading to feelings of helplessness and a negative self-view.
Next, analyze the goal of the nursing intervention: To help the client focus on strengths and positive traits.
Evaluate each option based on established therapeutic principles for depression. Ask yourself: 'Is this option supportive? Is it realistic for someone with low energy and motivation? Does it build confidence or create pressure?'
The best intervention will be one that is gradual, supportive, and provides a high chance of success to counteract the client's negative self-perception.
Eliminate options that are too demanding (attending 'all' activities), anxiety-provoking (making 'all' decisions), or punitive (disallowing dependency).
The correct option will be the one that offers a small, concrete step towards building self-worth, such as succeeding at a simple task.

Concept Tested & Keywords

Concept Tested: Therapeutic nursing interventions for low self-esteem in clients with depression.
Stem keywords: psychiatric inpatient, depression, chronic low self-esteem, helplessness, negative view of herself
Lead-in keywords: assist the client, strategy used by the nurse
Clinical cues: The client's diagnosis of recurring depression and chronic low self-esteem are key indicators for selecting an intervention that is supportive and success-oriented.

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E6 Guide to Mental Health & PSYCHIATRIC NURSING R Sreevani— Part 1 (pp 26-289 of 579) p. 218-220

E6 Nursing Fundamentals Taylor p. 980-982

Practise the full NORCET 5 mains

Attempt every question from this paper in a timed mock, then review the full solution for each one.