Self Concept
How a person thinks about himself or herself
Directly affects one's self esteem (feeling of self-worth)
Continues throughout lifespan & always changing
Caregivers influence development of self concept / self esteem
Self Concept based upon:
Perceptions of others towards us
Personal and professional relationships
Academic achievement
Employment
Personality characteristics
Ethnic, racial and spiritual identity
Identity
Internal sense of individuality
Distinctness and separate from others
Develops over time
Self observations, observing others, and by what one is told about themselves
Necessary in order to develop intimacy
Gender Identity
Body Image
Attitude about physical appearance
Strongly influenced by culture and society
Peer pressure
Role Performance
How individual sees their role in society
How individuals perceive their ability to carry out roles
Imitation
mimicing
Reinforcement-Extinction
staying away from doing something because you know you'll get punished
Inhibition
doing something positive and staying away from negative because you know it's wrong
Substitution
doing something instead because you know there's a positive outcome from it
Identification
similar to imitation
Look at positive things other people do and copy positive traits of that individual
Self-Esteem
Highest during childhood
Drops in adolescence
Rise again in adulthood
Drops in elderly
Overall feeling of self-worth
Ideal self consists of aspirations, goals
values, standards of behavior
Stressors that Affect Self-Concept
Can be real or imagined
Examples:
Physical changes
Emotional changes
Spiritual changes
Changes in relationships
Changes in standing in society (work, economic)
Identity Stressors
Identity most vulnerable in adolescence - body image stressors in adolescence
Low Self-esteem
Risk taking behavior
Self-destructive behavior
Body Image Stressors
Change in body appearance and function (such as changes associated with aging)
Often associated with impaired self-concept & self-esteem
Role Performance Stressors
Situational transitions
Health-Illness transition
Health-Illness transition
Role conflict
Role ambiguity
Role strain
Role overload
Role conflict
2 different roles and conflicting with each other
Person has to simultaneously assume two or more roles that are inconsistent or contradictory
Examples:
Sandwich generation
Sick role
Role ambiguity
don't know what role is and how to fulfill it; may feel unfit
Unclear role expectations
Creates stress and confusion
Common in Adolescent years
Role strain
feel frustrated in your role
Not sure what you should be doing
Combination of role conflict and role ambiguity
Feeling frustrated with feelings of inadequacy or unsuited for role
Often associated with gender role stereotypes
Role overload
ties in with role conflict
4 or 5 roles in life
Student, spouse, parent, employee
Having more roles or responsibilities within a role than are manageable
Can experience role overload with role conflict
Self-Esteem stressors
Vary with developmental stage
Illness, injury, changes in personal life such as relationships and employment
Older Adults
Self-esteem/Self concept changes can be attributed to emotional and physical changes
Changes in health (aging)
Changes in socioeconomic status
Spousal loss/friends
Nurses Effect on Client's Self-Concept
Positive or Negative
Convey interest, acceptance & trust
Encourage open communication
Assessment
Who are their support systems?
What are their coping mechanisms?
Identify if the patient is showing negative self-concept behaviors
Nursing Diagnoses
Disturbed body image
Caregiver role strain
Disturbed personal identity
Ineffective role performance
Readiness for enhanced self-concept
Chronic low self-esteem
Situational low self esteem
Risk for situational low self-esteem
Expected Outcomes
The client will discuss a minimum of two to three areas of their life where they are functioning well.
Focus on abilities, not inabilities
Implementation
Change behaviors if necessary to achieve the goal
Help to adapt to changes (internal or external)
Contact support groups (find resources) - professional help
Encourage Self-Exploration
Evaluation
Evaluate client's success in meeting goals
Revise plan as needed
Self-concept
an integrated set of conscious and unconscious attitudes and perceptions about self.
Components of self-concept are
identity, body image, and role performance
Identity is particularly vulnerable during
adolescence.
Body image
is the mental picture of one's body and is not necessarily consistent with a person's actual body structure or physical appearance.
Body image stressors include
changes in physical appearance, structure, or functioning caused by normal developmental changes or illness.
Self-esteem stressors include
developmental and relationship changes, illness, surgery, accidents, and the responses of other individuals to changes resulting from these events.
Role stressors, including
role conflict, role ambiguity, and role strain, originate in unclear or conflicting role expectations; the effects of illness often aggravate this.
A nurse's self-concept and nursing actions have an effect on
a patient's self-concept.
Planning and implementing nursing interventions for self-concept disturbance involve
expanding a patient's self-awareness, encouraging self-exploration, aiding in self-evaluation, helping formulate goals in regard to adaptation, and assisting a patient in achieving these goals
1Following a bilateral mastectomy, a 50-year-old patient refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which of the foll
4"I see that you've combed your hair and put on makeup."
When the nurse uses a matter-of-fact approach and acknowledges a change in the patient's behavior or appearance, it allows the patient to establish its meaning.
2A patient diagnosed with major depressive disorder has a nursing diagnosis of chronic low self-esteem related to negative view of self. Which of the following would be the most appropriate cognitive intervention by the nurse?
1Promote active socializatio
3Focus on identifying strengths and accomplishments
Focusing on strengths and accomplishments to minimize the emphasis on failures assists the patient to alter distorted and negative thinking. The other interventions are important, but they are not design
3Several staff members complain about a patient's constant questions such as "Should I have a cup of coffee or a cup of tea?" and "Should I take a shower now or wait until later?" Which interpretation of the patient's behavior helps the nurses provide opt
2Inability to make decisions reflects a self-concept issue.
Patients with deficits in self-concept often have difficulty making decisions. It is essential for the nurse to remain accepting of the patient and to support him or her in decision making.
4A depressed patient is crying and verbalizes feelings of low self-esteem and self-worth such as "I'm such a failure ... I can't do anything right." The best nursing response would be to:
1Remain with the patient until he or she stops crying.
2Tell the pa
1Remain with the patient until he or she stops crying.
Demonstrating acceptance of the patient by supportively sitting with him or her builds a therapeutic nurse-patient relationship. The nurse's presence signals value and allows the patient to explore is
5An adult woman is recovering from a mastectomy for breast cancer and is frequently tearful when left alone. The nurse's approach should be based on an understanding of which of the following:
1Patients need support in dealing with the loss of a body part
1Patients need support in dealing with the loss of a body part.
The nurse should encourage the patient to talk about the threats to body image, including the meaning of the loss, the reactions of others, and the ways in which the patient is grieving.
6When caring for an 87-year-old patient, the nurse needs to understand that which of the following most directly influences the patient's current self-concept:
1Attitude and behaviors of relatives providing care
2Caring behaviors of the nurse and health c
4Adjustment to role change, loss of loved ones, and physical energy
Older adults experience significant challenges to self-concept, including mental and physical changes associated with aging and changes in identity and role following retirement and/or lo
7A 20-year-old patient diagnosed with an eating disorder has a nursing diagnosis of situational low self-esteem. Which of the following nursing interventions would be best to address self-esteem?
1Offer independent decision-making opportunities
2Review pr
1Offer independent decision-making opportunities
Offering opportunities for decision making promotes a sense of control, which is essential for promoting independence and enhancing self-esteem. Reviewing successful coping strategies is a priority interven
8The nurse asks the patient, "How do you feel about yourself?" The nurse is assessing the patient's:
1Identity.
2Self-esteem.
3Body image.
4Role performance.
2Self-esteem.
Self-esteem is how a person feels about himself or herself. Asking open-ended questions about self-esteem is important during the nursing assessment.
9The nurse can increase a patient's self-awareness through which of the following actions? (Select all that apply.)
1Helping the patient define her problems clearly
2Allowing the patient to openly explore thoughts and feelings
3Reframing the patient's tho
1Helping the patient define her problems clearly
2Allowing the patient to openly explore thoughts and feelings
3Reframing the patient's thoughts and feelings in a more positive way
These are designed to promote self-awareness and a positive self-concept.
10When developing an appropriate outcome for a 15-year-old girl, the nurse considers that a primary developmental task of adolescence is to:
1Form a sense of identity.
2Create intimate relationships.
3Separate from parents and live independently.
4Achieve
1Form a sense of identity.
Understanding developmental tasks across the life span is essential in designing nursing care. Adolescents are focused on establishing their identity outside the family and should be supported in meeting this developmental task.
11An appropriate nursing diagnosis for an individual who experiences confusion in the mental picture of his physical appearance is:
1Acute confusion.
2Disturbed body image.
3Chronic low self-esteem.
4Situational low self-esteem.
2Disturbed body image.
Body image involves attitudes related to the body, including physical appearance, structure, or function. Disturbed body image would be an appropriate nursing diagnosis.
12In planning nursing care for an 85-year-old male, the most important basic need that must be met is:
1Assurance of sexual intimacy.
2Preservation of self-esteem.
3Expanded socialization.
4Increase in monthly income.
2Preservation of self-esteem.
Self-esteem is essential for physical and psychological health across the life span.
13Based on knowledge of Erikson's stages of growth and development, the nurse plans her nursing care with the knowledge that old age is primarily focused on:
1Intimacy versus Isolation.
2Autonomy versus Shame and Doubt.
3Generativity versus Self-Absorptio
4Ego Integrity versus Despair.
The developmental stage of Ego Integrity Versus Despair (Late 60s to Death) is focused on feeling positive about life and its meaning and providing a legacy for the next generation.
14The home health nurse is visiting a 90-year-old man who lives with his 89-year-old wife. He is legally blind and is 3 weeks' post right hip replacement. He ambulates with difficulty with a walker. He comments that he is saddened now that his wife has to
4Risk for situational low self-esteem
Blindness coupled with difficulty ambulating places him at risk for situational low self-esteem. No doubt he and his wife have adapted to the blindness, but his difficulty with ambulation affects many aspects of his l
15Based on knowledge of the developmental tasks of Erikson's Industry versus Inferiority, the nurse emphasizes proper technique for use of an inhaler with a 10-year-old boy so he will:
1Increase his self-esteem with mastery of a new skill.
2Accept changes
1Increase his self-esteem with mastery of a new skill.
The developmental stage of Industry Versus Inferiority (ages 8-12) is focused on incorporating feedback from peers and teachers, increasing self-esteem with new skill mastery, and promoting awareness