The nursing diagnosis Disturbed Personal Identity is defined by NANDA as the inability to distinguish between self and nonself.
Disturbed Personal Identity Related To (Etiology)
- Biochemical imbalance
- Impaired neurologic development or dsyfunction
- Failure to develop attachment behaviors resulting in fixation at autistic phase of development
- Interrupted or uncompleted seperation/individuation process resulting in extreme seperation anxiety
As Evidenced By (Assessment Findings/Diagnostic Cues)
- Seemingly unaware of or uninterested in others or their activities
- Unable to identify parts of the body or bodily sensations (enuresis, encopresis)
- Fails to imitate others or not able to stop imitating other’s actions or words (echolalia, echopraxis)
- Fails to distinguish parent/caregiver as a whole person, instead relates to body parts (e.g., takes person’s hand and places it on doorknob)
- Becomes distressed by bodily contract with others
- Spends long periods of time in self-stimulating behaviors (self-touching,sucking,rocking)
- Needs ritualistic behaviors and sameness to control anxiety
- Has extreme distress reactions to changes in routines or the environment
- Cannot tolerate being separated from parent/caregiver
Disturbed Personal Identity Nursing Care Plan Outcome Criteria
- Demonstrate recognition of self-boundaries and being separate from others
- Adjust to changes in activities and the environment within 9 months
- Seek comfort and physical contact from others within 1 to 2 months
- Relate to caregiver by name with eye contract and verbal requests within 6 months
- Recognize body parts, body boundaries, and sexual identity within 6 months
- Show an interest in the activities of others and tolerate their presence within 3 to 6 months
- Spend more time in purposeful activities rather than rituals and self-stimulating activities in 2 to 6 months
- Recognize body sensations (pain, hunger, fatigue, elimination needs)within 2 to 6 months
- Express a full range of feelings within 4 to 6 months
- Recognize the feelings and activities of others as separate within 6 months
- Adjust to changes in activities and the environment within 5 to 9 months
Disturbed Personal Identity Nursing Interventions and Rationales
- Use one-on-one interaction to engage the client in a safe relationship with nurse/caregiver. R: A consistent caregiver provides for the development of trust needed for a sense of safety and security.
- Use names and descriptions of others to reinforce their separateness. R: Consistent reinforcement will help break into the client’s autistic world.
- Draw the client’s attention to the activities of others and events that are happening in the environment. R: Interrupts the client’s self-absorption and stimulates outside interests.
- Limit self-stimulating and ritualistic behaviors by providing alternative play activities or by providing comfort when stressed. R: Redirecting the client’s attention to favorite or new activities, or giving comfort, reduces anxiety.
- Foster self-concept development; reinforce identity; sexual identity, and body boundaries through drawing, stories, and play activities. R: Learning body parts and sexual identity is necessary and fun in play activities.
- Help client distinguish body sensations and how to meet bodily needs by picking up on cues and using ADLs to teach self-care. R: The lack of self-awareness contributes to problems with self-care, especially toileting.
- Provide play opportunities for the client that identify the feelings of others (stories, puppet play, peer interactions). R: Consistent feedback about the feelings of others helps with self-differentiation and the development of empathy.
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*Nursing Care Plan for Disturbed Personal Identity