Long-standing self-negation fits the chronic label
The client says, "Ever since I was a small child, I have known I am worthless. I never do anything right." She avoids eye contact and rejects praise from staff. Negative self-evaluation that has lasted a long time, here since childhood, together with rejection of positive feedback, fits Chronic inadequate self-esteem. The NANDA International (NANDA-I) 2024 to 2026 labels use the wording "inadequate self-esteem" in place of the older "low self-esteem", and the defining characteristics remain negative self-statements, rejection of positive feedback, poor eye contact, and exaggerated negative feedback about self.
Chronic versus situational
The key to choosing between the two forms is time course. Chronic inadequate self-esteem describes a long-standing pattern of negative self-evaluation, often beginning early in life, that persists across situations. Situational inadequate self-esteem describes a negative self-view that develops in response to a current event, such as job loss or divorce, in a person who previously valued herself. Her statement that she has felt worthless since childhood points clearly to the chronic form.
| Label | Time course | Fits her? |
|---|
| Chronic inadequate self-esteem | Long-standing, since childhood | Yes |
| Situational inadequate self-esteem | New, in response to a current situation | No |
| Risk for chronic inadequate self-esteem | Problem not yet present | No: already present |
| Maladaptive coping | Ineffective responses to stressors | No: cluster centers on self-evaluation |
Why the other labels do not fit
A risk diagnosis is used only when the problem has not yet developed but risk factors are present; her negative self-evaluation already exists and is long-standing, so a risk label understates the problem. Maladaptive coping describes ineffective responses to stressors, and while depression may involve poor coping, the data cluster here centers on how she evaluates herself. The diagnosis should match the main pattern in the data.
Watch out! Her weight loss, reduced intake, and poor sleep with worrying thoughts support other diagnoses, but the question asks about the cluster of self-statements, avoidance of eye contact, and rejection of praise. Match the label to the cluster the stem presents.
Exam takeaway
Key point! Chronic means long-standing and pervasive; situational means a recent change triggered by an event. Nursing care includes helping her identify strengths, setting small achievable tasks, giving honest and specific feedback, and challenging negative self-statements gently.