Cultural Project

Andrew Jo
NUR2488 Mental Health
Ebony Wilhelm
 John/Chanelle Lewis
Transgendered (MTF) patient who is 28 years old, white, atheist,
single, no children and lives in a studio apartment.
Legally named John, but when the nurse meets her for the first time,
she is presented as a woman and calls herself Chanelle (she cant
afford a legal name change yet).
She is going through physical transitions and is making her feel self-
conscious about herself.
The nurse is working at the government facility that provides
hormone therapy for Chanelle.

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 Assessment
Find out how Chanelle is responding to her hormone
therapy. Is she accepting these changes well?
Screen for the presence of any sort of mental illness or risk
factors (change of mood, level of anxiety, etc.).
Identify support systems and resources that patient has.
Pay attention to verbal cues: posture, position, eye contact,
facial expression, hand gestures, and behavior. These could
indicate the patients mood.

(Kamitsuru & Herdman, 2014).

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Diagnosis

Social Isolation: absence of support system, insecurity in

public, desire to be alone, sad affect.
What if Chanelle is having second thoughts? What if she is
not confident to be seen in a government building as
trans.
Chronic low self-esteem: shame, exaggerates negative
feedback about self, dependent on others opinions.
Chanelle may knew about herself for a long time and life
may or may not have led her to have chronic low self-
esteem.
Disturbed Personal Identity: confusion about goals, gender
confusion, ineffective coping strategies.
Disturbed is probably too harsh of a word, but if Chanelle
is not feeling confident about her new self with these
physical changes, perhaps some of these characteristics
manifest.

(Kamitsuru & Herdman, 2014).

Planning

NOC Labels:
Self-esteem, psychosocial adjustment: life
change, body image.
Indicators:
Fear of rejection/reaction by others
Negative feelings about body
Actual change in structure or function
(body part)

(Roberts, 2013).
 Implementation
NIC Labels:
Body image enhancement, Self-esteem enhancement, Milieu Therapy.
Activities:
Address client by identified name, acknowledge depression and denial as
normal for psychosocial adjustment, avoid looks of distaste
(countertransferance).
Discover Chanelles resources/support groups if any and provide more
community-based resources for her.
(Roberts, 2013)..

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Evaluation
Upon every visit for hormone
therapy, assess nonverbal cues from
Chanelle to read her mood. Is she
outgoing and expressive or reserved
and has a sad affect?
Upon every visit for hormone
therapy, ask Chanelle how things are
going.
If she was socially isolated, see if
she has returned to previous
social involvement.
Document each response and
compare to previous responses
to check for social isolation.

(Roberts, 2013).

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References
Kamitsuru, S., Herdman, T. H., & North American Nursing Diagnosis,
A. (2014). Nursing Diagnoses 2015-17 : Definitions and
Classification. Chichester: Wiley-Blackwell. Retrieved from:
http://ezproxy.rasmussen.edu/login?url=http://search.ebscohos
.com/login.aspx?direct=true&db=nlebk&AN=827337&site=ehos
-live,
Roberts, D. (2013). Psychosocial Nursing Care : A Guide to Nursing the
Whole Person. Berkshire: McGraw-Hill Education. Retrieved
from:
http://ezproxy.rasmussen.edu/login?url=http://search.ebscohos
.com/login.aspx?direct=true&db=e000xna&AN=524771&site=eh
ost-live.