Nursing interventions

Problem: Loss of self-esteem related to altered body image. Goal: Patients acknowledge change in body image and expresses their feelings about this change.

In the early stages, following the circumstances which led to an altered body image, some patients appear to be quite euphoric. This is due to simple relief at having survived. After a while the patient's attitude is likely to change. Common problems that can occur include:

• a sense of loss, similar to bereavement

anxiety related to diagnosis, especially if it is cancer

• loss of sexual function which may be related to type of surgery or trauma or to either of the previous problems

• a withdrawal from social relationships with family or significant others, possibly due to a malodorous wound or any of the previous problems.

The role of the nurse is to assist the patient to develop a re-integrated body image (Burgess, 1994). This may be achieved in a variety of ways. Perhaps the most important is to accept the patient as he is, at whatever stage he has reached. Allowing a patient to express his feelings and providing him with matter-of-fact information, such as an honest appraisal of the progress of his wound, is beneficial. It is also essential to include family and/or significant others in the patient's care and in any education programme. Good management of the wound should prevent odour or leakage which helps to boost confidence. Burgess also suggests that if patients are having difficulty coping it may be necessary to emphasise the importance of the surgery for the health of the individual and the fact that it does not change them as a person.

As already discussed under Communicating (Section 2.2.2), preoperative information and counselling are most important. Kelly (1989) studied 67 patients who had undergone head and neck surgery. Generally, they said they were more anxious before surgery than after. Some 42% of men and 21% of women would have liked more information. Another study by Elspie et at. (1989) found that 41% of patients suffered psychological stress following major surgery for intraoral cancer.

In many areas, specialist nurses are employed to give help and support to patients, such as stoma nurses or breast care nurses. They can build up a relationship with their patients which give the patients the confidence to express their feelings freely. In other circumstances, it may be a nurse who has a good relationship with a patient who is able to provide this service.

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