Joe who is very depressed exhibits psychomotor retardation, a flat affect, and apathy. The nurse in charge observes Joe to be in need of grooming and hygiene. Which of following nursing actions would be most appropriate?

Correct Answer: D. Stating to the client that it’s time for him to take a shower

The client with depression is preoccupied, has decreased energy, and is unable to make decisions. The nurse presents the situation, “It’s time for a shower”, and assists the client with personal hygiene to preserve his dignity and self-esteem. Encourage the use of soap, washcloth, toothbrush, shaving equipment, make-up, etc. Being clean and well-groomed can temporarily increase self-esteem.

• Option A: Allow the patient to perform personal care activities. Paying attention to grooming serves as a first step towards achieving a positive self-image. Give positive feedback after a task is achieved. Positive reinforcement has a big part in building self-esteem.
• Option B: Work with the client to identify cognitive distortions that encourage negative self-appraisal. Cognitive distortions reinforce a negative, inaccurate perception of self and the world. Evaluate the client’s need for assertiveness training tools to pursue things he or she wants or needs in life. Arrange for training through community-based programs, personal counseling, literature, etc. Low self-esteem individuals often have feelings of unworthiness and have difficulty determining their needs and wants.
• Option C: Give step-by-step reminders such as “Brush the teeth “Clean the outer surfaces of your upper teeth, then your lower teeth. . .” Slowed thinking and difficulty concentrating make organizing simple tasks difficult. Involve the client in activities that he or she wants to improve by using problem-solving skills. Assess and evaluate the need for more teaching in this area. Feelings of low self-esteem can interfere with usual problem-solving abilities.