An Indigenous Patient Had a Nursing Diagnosis of Situational Low

An Indigenous patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient's self-esteem, but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario?

A) The patient's eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
B) The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
C) The patient's poor eye contact is indicative of anger and hostility that were unaddressed.
D) The nurse should have assessed the patient's culture before making this diagnosis and plan.