Self -ConceptSelf -ConceptNUR101 Fall 2009NUR101 Fall 2009Lecture # 13Lecture # 13K. Burger MSEd, MSN, RN, CNEK. Burger MSEd, MSN, RN, CNEPPP by: Sharon Niggemeier RN MSNPPP by: Sharon Niggemeier RN MSNRevised 10/05 kbRevised 10/05 kb

Self -ConceptSelf -ConceptSelf-concept : self imageSelf-concept : self imageEach individual is unique with own Each individual is unique with own self-conceptself-concept

View of self View of self affectsaffects one’s ability to one’s ability to function as well as function as well as healthhealthcomponents: self-knowledgecomponents: self-knowledge

self-esteem self-esteem self-actualizationself-actualization

IdentityIdentityAn internal sense of individuality and An internal sense of individuality and wholenesswholeness. . Who are you?Who are you?Name, gender, race, religion, occupation, Name, gender, race, religion, occupation, role, +++so much morerole, +++so much moreBegins during childhood as parents provide Begins during childhood as parents provide role models role models Continues during adolescence as teens Continues during adolescence as teens establish own identityestablish own identity

Self-EsteemSelf-EsteemThe emotional appraisal of self-The emotional appraisal of self-concept.concept. How do you regard yourself??????How do you regard yourself??????Feel about self?Feel about self?Sense of worth or value??Sense of worth or value??This appraisal is an on-going process This appraisal is an on-going process so…levels of self-esteem can so…levels of self-esteem can change.change.

Body ImageBody ImageWhat do you think you look like What do you think you look like physically? ?????physically? ?????What do you think about your What do you think about your appearance??????appearance??????Body image is dynamic: the body changes Body image is dynamic: the body changes thru normal growth and development.thru normal growth and development.Cultural and societal attitudes affect body Cultural and societal attitudes affect body imageimage

RolesRolesWhat is your role?????????What is your role?????????What are the expected behaviors you What are the expected behaviors you perform????perform????Simultaneously hold many roles and Simultaneously hold many roles and they changethey changeWho do you want to be????Who do you want to be????What do you want your role to be???What do you want your role to be???

RolesRolesSelf-ActualizationSelf-Actualization

A part of self-concept is the way a person A part of self-concept is the way a person perceives their ability to carry out perceives their ability to carry out significant rolessignificant rolesHealth self-concept can distinguish Health self-concept can distinguish between:between:Ideal role expectationsIdeal role expectationsANDANDRealistic possibilitiesRealistic possibilities

Factors Affecting Self-conceptFactors Affecting Self-concept

Health status: illness, injury, body chg, loss of Health status: illness, injury, body chg, loss of control, dependency on otherscontrol, dependency on othersRole stressors; overload, strained, Role stressors; overload, strained,

feelings of inadequacy feelings of inadequacyDevelopmental transitions – aging in our cultureDevelopmental transitions – aging in our culturePersonal “success” or failure historyPersonal “success” or failure historyCrisis and/or life events: personal and/or globalCrisis and/or life events: personal and/or globalInternal and external resourcesInternal and external resourcesIndividual perception of crisisIndividual perception of crisis

Self-concept: psychosocial Self-concept: psychosocial dimensiondimension

How one develops and grows can How one develops and grows can have an affect on self-concept & healthhave an affect on self-concept & healthTherefore nurses need to understand Therefore nurses need to understand normal stages of growth (physical normal stages of growth (physical changes) & development changes) & development (psychosocial changes).(psychosocial changes).

Erikson- PErikson- Psychosocial sychosocial Developmental TheoryDevelopmental Theory

ID 8 stages from birth to old age ID 8 stages from birth to old age

Each stage characterized by a Each stage characterized by a developmental task to be mastereddevelopmental task to be mastered

Unmet tasks may delay progress Unmet tasks may delay progress through the next stagethrough the next stage

EriksonEriksonTrust vs MistrustTrust vs Mistrust

InfancyInfancy

Infant relies onInfant relies oncaregivers for caregivers for basic needsbasic needs

Autonomy vs Autonomy vs Shame and doubtShame and doubt

ToddlerToddlerGains independence: Gains independence:

If expectations too If expectations too high or low feelings high or low feelings of inadequacy of inadequacy developdevelop

EriksonEriksonInitiative vs guiltInitiative vs guilt

PreschoolerPreschooler

Seeks new Seeks new experiences if experiences if restricted becomes restricted becomes hesitant to seek new hesitant to seek new challengeschallenges

Industry vs Industry vs inferiorityinferiority

School-ageSchool-age

Focuses on Focuses on achievements and achievements and if not accepted if not accepted develops a lack of develops a lack of self-worthself-worth

EriksonEriksonIdentity vs role Identity vs role confusionconfusion

AdolescenceAdolescence Transition from Transition from

childhood to childhood to adulthood. Acquires adulthood. Acquires sense of who they sense of who they are. Confusion if are. Confusion if unable to establish unable to establish sense of directionsense of direction

Intimacy vs Intimacy vs IsolationIsolation

Young adulthoodYoung adulthood

Unite self with Unite self with others –others –commitments. Fear commitments. Fear of commitment of commitment results in isolation results in isolation and lonelinessand loneliness

EriksonEriksonGenerativity vs Generativity vs stagnationstagnation

Middle adulthoodMiddle adulthood Desire to make a Desire to make a

contribution to the contribution to the world. Becoming world. Becoming self absorbed self absorbed results in results in stagnationstagnation

Ego integrity vs Ego integrity vs despairdespair

Later adulthoodLater adulthood Reminiscence about Reminiscence about

life -sense of life -sense of purpose. If purpose. If believes life was believes life was misdirected misdirected despair results despair results

Assessing Self-conceptAssessing Self-concept

Developmental and chronological ageDevelopmental and chronological age

Assessing includes questions on Assessing includes questions on identity… body image…self esteem…identity… body image…self esteem…roles…roles…

Patient’s strengths/weaknessesPatient’s strengths/weaknesses

High self-esteem vs Low self-esteemHigh self-esteem vs Low self-esteem

AssertiveAssertiveSelf-directedSelf-directedMakes Makes decisionsdecisionsPraises selfPraises selfSpeaks clearlySpeaks clearlyAttends to Attends to needsneeds

Passive “who cares attitude”Passive “who cares attitude”Excessively DependentExcessively DependentHesitant to express viewsHesitant to express viewsOverly Critical of selfOverly Critical of selfMonotone voice – lack of Monotone voice – lack of emotion & energyemotion & energyNeglects own needsNeglects own needsDifficulty making decisionsDifficulty making decisionsOverly apologeticOverly apologeticAvoidance of eye contactAvoidance of eye contact

Nursing DiagnosesNursing Diagnoses

Disturbed body imageDisturbed body imageLow self-esteem; chronic or situationalLow self-esteem; chronic or situational

Other Dx in which Other Dx in which low self-conceptlow self-concept is the is the etiologyetiology::

Ineffective health maintenance r/t …Ineffective health maintenance r/t …Self care deficit r/t …Self care deficit r/t …Risk for self-directed violence r/t…Risk for self-directed violence r/t…

Nursing InterventionsNursing InterventionsNurse is a role model Nurse is a role model Can a nurse NEGATIVELY affect a client’s self-Can a nurse NEGATIVELY affect a client’s self-concept?concept?Form helping relationship:Form helping relationship:Focus on client strengths; praise achievementsFocus on client strengths; praise achievementsMeet physiological and psychological needsMeet physiological and psychological needsReduce pain Reduce pain Decrease anxietyDecrease anxietyPromote positive self-esteemPromote positive self-esteemEncourage participation in careEncourage participation in careEncourage socializationEncourage socialization

Nursing Interventions NICNursing Interventions NIC

Encourage client to recognize and discuss Encourage client to recognize and discuss thoughts and feelingsthoughts and feelingsAssist client to:Assist client to:Realize everyone is uniqueRealize everyone is uniqueRealize impact of illness on self-conceptRealize impact of illness on self-conceptBe aware of negative self-statements and modify Be aware of negative self-statements and modify themthemGain more controlGain more controlIdentify positive attributes of selfIdentify positive attributes of selfIdentify and use personal strengthsIdentify and use personal strengths

Nursing EvaluationNursing Evaluation

Outcome criteria addressed????Outcome criteria addressed????

Behavior and attitude changes will Behavior and attitude changes will indicate altered self-esteemindicate altered self-esteem

Long term outcome –can take many Long term outcome –can take many months or yearsmonths or years

Evaluation (NOC)Evaluation (NOC)

Client should be able to meet the following Client should be able to meet the following outcomes:outcomes:Be comfortable with body imageBe comfortable with body imageBe able to describe self positivelyBe able to describe self positivelyBe able to meet realistic goals Be able to meet realistic goals Be capable of interacting appropriately Be capable of interacting appropriately with environment and otherswith environment and others

““Know Thyself”Know Thyself” SocratesSocrates

Nurses need to reflect on their OWN self-Nurses need to reflect on their OWN self-concept in order to effectively assist OTHERs.concept in order to effectively assist OTHERs.Ask yourself these questions:Ask yourself these questions:How do I perceive myself?How do I perceive myself?How do I think others see me?How do I think others see me?What are my strengths and weaknesses?What are my strengths and weaknesses?What are my goals for self-improvement?What are my goals for self-improvement?What does ALL THIS have to do with my What does ALL THIS have to do with my professional practice?professional practice?

SummarySummary

Self-concept based on 3 componentsSelf-concept based on 3 componentsNeed to understand how various Need to understand how various factors affect self-conceptfactors affect self-conceptUnderstand difference between high Understand difference between high & low self-esteem& low self-esteemInterventions to promote self-conceptInterventions to promote self-conceptEvaluate outcome criteriaEvaluate outcome criteria

““No one can make you No one can make you feel inferior without feel inferior without

your consent”your consent”- Eleanor Roosevelt- Eleanor Roosevelt