copyright © 2014. f.a. davis company promoting self-esteem chapter 15

Copyright © 2014. F.A. Davis Company

Promoting Self-EsteemPromoting Self-EsteemChapter 15Chapter 15


IntroductionIntroduction

• Healthy self-esteem has been described as essential for psychological survival.

• An awareness of self is an important differentiating factor between humans and other animals.


Components of Self-ConceptComponents of Self-Concept

• Self-concept has been defined as “the cognitive or thinking component of the self, and generally refers to the totality of a complex, organized, and dynamic system of learned beliefs, attitudes, and opinions that each person holds to be true about his or her personal existence.”

(Huitt, 2011)


• Self-concept consists of the following three components:– The physical self or body image– Personal identity– Self-esteem

Components of Self-Concept Components of Self-Concept (cont.)(cont.)


1. The physical self or body image—a personal appraisal of one’s physical being

– Body image may not coincide with actual appearance.

– Disturbances in body image may occur when individuals undergo alterations in structure or function.



2. Personal Identity

– The moral-ethical self– The self-consistency– The self-ideal/self-expectancy



3. Self-Esteem

– The degree of regard or respect that individuals have for themselves and is a measure of worth that they place on their abilities and judgments



1. A client with a new ileostomy tells the nurse, “I’m disgusting. This ileostomy makes me so ugly.” Which correctly written nursing diagnosis would be appropriately assigned to address this client’s problem?

A. Situational low self-esteem related to disturbed body image evidenced by client statement “I’m disgusting”

B. Risk for complicated grieving related to loss of normal GI function evidenced by expressions of anger

C. Disturbed thought processes related to ileostomy evidenced by altered body image

D. Anxiety related to cancer of the colon evidenced by ileostomy



• Correct answer: A– The client’s statement of “I’m disgusting” is

evidence of the client’s negative perception of self brought about by the new ileostomy (a current situation). This has impaired the client’s self-esteem. This is a correctly written nursing diagnosis.



The Development of Self-EsteemThe Development of Self-Esteem

• Coopersmith has identified the following antecedent conditions of positive self-esteem:– Power– Significance– Virtue– Competence– Consistently set limits


2. After his wife left him, the husband, diagnosed with depression, is admitted to a psychiatric unit. He states that he was proud of receiving job commendations that led to a promotion. Which condition that would affect self-esteem has contributed to the client’s depression?

A. The lack of powerB. The lack of significanceD. The lack of virtueD. The lack of competence

The Development of Self-Esteem The Development of Self-Esteem (cont.)(cont.)


• Correct answer: B– Significance is a condition that enhances self-

esteem by promoting feelings of love, respect, and care. The client has a lack of significance due to the fact that his significant other has abandoned him.



• Warren lists the following as important for parents and others who work with children to emphasize and encourage healthy self-esteem:– A sense of competence– Unconditional love– A sense of survival– Realistic goals– A sense of responsibility– Reality orientation



• Other factors influential to the development of self-esteem:– Responses of others– Hereditary factors– Environmental conditions



3. A mother berates her child for breaking a cup and says, “You are bad and so destructive.” This statement discourages the development of positive self-esteem by not meeting which parenting focus as described by Warren?

A. A sense of competenceB. Unconditional loveC. A sense of survivalD. Realistic goals



• Correct answer: B– According to Warren, parents promote self-

esteem when they provide unconditional love for their children. Children need to know that they are loved and accepted regardless of successes or failures. Criticism of behavior should not be linked with criticism of the child. In the situation presented, the mother discourages the development of positive self-esteem by not meeting the child’s need for unconditional love.



Developmental Progression of Self-Developmental Progression of Self-EsteemEsteem

• Erikson’s theory of personality development provides a useful framework for illustration of self-esteem development.– Trust versus mistrust– Autonomy versus shame and doubt– Initiative versus guilt– Industry versus inferiority– Identity versus role confusion– Intimacy versus isolation– Generativity versus stagnation– Ego integrity versus despair


Manifestations of Low Self-EsteemManifestations of Low Self-Esteem

• Behaviors that reflect low self-esteem manifest themselves according to three types of stimuli:– Focal stimuli– Contextual stimuli– Residual stimuli

• Symptoms of low self-esteem are many.


BoundariesBoundaries

• Boundaries consist of the personal space, both physical and psychological, that individuals identify as their own.

• Boundaries are sometimes referred to as “limits.”

• Individuals who are aware of their boundaries have a healthy self-esteem because they must know and accept their inner selves.


• Types of physical boundaries include physical closeness, touching, sexual behavior, eye contact, privacy, and pollution.

• Touching someone who does not want to be touched is an example of an invasion of a physical boundary.

Boundaries Boundaries (cont.)(cont.)


• Types of psychological boundaries include beliefs, feelings, choices, needs, time alone, interests, confidences, individual differences, and spirituality.

• Being criticized for doing something differently from others is an example of an invasion of a psychological boundary.



• Boundary Pliancy. Boundaries can be rigid, flexible, or enmeshed.– Rigid boundaries occur when people have a very

narrow perspective on life. They perceive that things must be one way and refuse to change for any reason.

– Flexible boundaries occur when people are able to let go of their boundaries as appropriate. Healthy boundaries are flexible.



Boundary Pliancy (cont.)– Enmeshed boundaries occur when two people’s boundaries are so blended together that neither can be sure where one stops and the other begins. An individual with an enmeshed boundary is unable to differentiate his or her wants and needs from those of the other person.



Establishing Boundaries• Boundaries are established in childhood.• Unhealthy boundaries are the products of unhealthy,

troubled, or dysfunctional families and may result from:– Negative role-modeling– Abuse or neglect



The Nursing ProcessThe Nursing Process

• Assessment– The Self-Esteem Inventory

• Diagnosis/Outcome Identification– Nursing diagnoses

• Chronic low self-esteem• Situational low self-esteem• Risk for chronic low self-esteem• Risk for situational low self-esteem

– Outcome criteria


• Planning/Implementation– Nursing care of individuals with problems related

to self-esteem includes:• Helping the client recognize positive self-attributes and

abandon judgmental self-perceptions• Helping the client identify sources of threat to self-

esteem• Helping the client work through the grief process

related to loss or failure• Assisting the client with preservation of self-esteem

during an episode of situational threat

The Nursing Process The Nursing Process (cont.)(cont.)


• Evaluation– Evaluation is based on achievement of previously

established outcome criteria.

The Nursing Process The Nursing Process (cont.)(cont.)

copyright © 2014. f.a. davis company promoting self-esteem chapter 15

Documents