1.

Self-esteem enhancement
2. Self-responsibility facilitation

3. Mutual goal setting

4. Decision-making support

5. Spiritual growth facilitation

Nursing theorist Henderson has defined the nursing role as assisting and supporting the individual in life activities and the attainment of independence. Nurses must assist elderly patients set realistic goals to achieve higher self-esteem and to accept dependence on others, as appropriate. Facilitating an environment and activities that will increase self-esteem is also important in order to prevent further depression and inactivity.

Defined as encouraging a patient to assume more responsibility fr own behavior (Dochterman & Bulechek, 2004, p. 637). Nurses must hold their patients responsible for their own behaviors, encouraging independence but assisting them when

unable to perform, and encouraging them to take as much

responsibility for their self-care as possible. In order for patients to regain some control in their lives, they must take

responsibility for and perform tasks that they are capable of

doing independently.

Defined by Dochterman and Bulechek (2004) as collaborating with a patient to identify and prioritize care goals, then developing a plan for achieving those goals (p. 506). Activities specific to mutual goal setting include assisting patients

to identify realistic, attainable goals, assisting them to set realistic

time limits, focusing on the expected rather than desired outcomes, and encouraging the acceptance of partial goal satisfaction.

Specific activities include facilitating the patients articulation of goals for care, providing the information requested by the patient and respecting their right to either receive or not receive the information, and serving as a liaison among the patient, family, and other health care providers. Through these decision-making activities, trust can be built among the nurse, patient, and family, miscommunication can be avoided, and the patients wishes remain important and can be respected.

Defined as the facilitation of growth in the patients capacity to identify, connect with, and call upon the source of meaning, purpose, comfort, strength, and hope in his/her life (Dochterman & Bulechek, 2004, p. 663). Powerlessness is related to spiritual health. Performing activities such as offering patients individual and/or group prayer support, encouraging them to examine their spiritual commitment, based on their beliefs and values, and referring them to support groups may help boost their self-esteem and acceptance of their situation.

 Identify situational circumstances

Determine clients perception and knowledge of

condition Assess degree of mastery client has exhibited in life Determine if there has been a change in relationship with significant others Ascertain client response to treatment regimen.

 Listen to statements client makes

Note expressions that indicate giving up

Note behavioral responses including expressions of

fear, apathy, agitation, etc. Note lack of communication, flat affect or lack of eye contact

 Show concern for a client as a person

Make time to listen to clients perception and concerns

and encourage questions Accept expression of feelings, including anger and hopelessness Avoid arguing or using logic with hopeless client Encourage client to maintain a sense of perspective about the situation

 Develop contract with client specifying goals agreed

on Treat expressed decisions and desires with respect Discuss needs openly with client and set up agreed-on routines for meeting identified needs Support client efforts to develop realistic steps to put plan into action, reach goals and maintain expectations Involve significant others in client care as appropriate

 Review familial and social history and physiological

history for problems such as history of poor coping abilities Note current familial, social, or physical situation of client Determine coping behaviors and defense mechanisms displayed

 Note behaviors indicative of hopelessness

Determine coping behaviors previously used and

clients perception of effectiveness then and now Evaluate and discuss use of defense mechanism

 Establish a therapeutic and facilitative relationship

Discuss initial signs of hopelessness

Encourage patient to verbalize and explore feelings

and perceptions Discuss current options and list actions that may be taken to gain some control of situation Encourage significant others to express hope to the client

 Provide positive feedback for actions taken to deal

with and overcome feelings of hopelessness Assist client or family members to become aware of factors or situations leading to feelings of hopelessness Facilitate clients incorporation of personal loss Encourage client or family to develop support system in the immediate community Introduce client in a support group before individual therapy is terminated