Self -Concept NUR101 Fall 2008 Lecture # 13 K. Burger MSEd, MSN, RN, CNE PPP by: Sharon Niggemeier RN MSN Revised 10/05 kb HUMANS ARE THE ONLY SPECIES WHICH CAN SYSTEMATICALLY STUDY ITS OWN THOUGH PROCESSES THEY ARE THE ONLY SPECIES WITH ENOUGH MENTAL CAPACITY THAT THEY MAY GLORIFY THEMSELVES BY BELIEVING THEY WILL SPEND ETERNITY IN HEAVEN WITH A BOD WHO LOOKS LIKE THEM OR AT THE OTHER EXTREME THEY MAY DENOUNCE AND ABHOR THEMSELVES SO MUCH THE THEY CHOOSE TO END THEIR LIVES ALL OF THIS PHENOMENAL WORLD OF COGNITION IS DUE TO 2 AND ½ POUNDS OF NERVE CELLS INSIDE EACH HUMAN HEAD THE BRAIN WEIGHS LESS THAT 3% OF OUR TOTAL BODY WEIGHT YET BURNS 25% OF OUR TOTAL OXYGEN INTAKE IT IS A BUSY, POWERFUL, PHENOMENAL, MYSTERIOUS PLACE OUR SELF CONCEPT ( KNOWLEDGE ASSUMPTIONS AND FEELINGS ABOUT OURSELVES) IS CENTRAL OT MOST OF THIS MENTAL PROCESSES

Self -Concept Self-concept : self image Each individual is unique with own self-concept View of self affects one’s ability to function as well as health components: self-knowledge self-esteem self-actualization Positive traits? Sense of humor, punctual, friendly Negative traits: easily get angry, jealous of others ONLY WE KNOW WHO WE ARE – WHAT WE HAVE INTENDED TO DO AND ACTUALLY DONE WHAT WE HAVE THOUGH AND FELT AND WHAT WE HAVE HOPED FOR OUR “SELF” IS A LIFELONG ACCUMULATION OF IMPRESSIONS HOW WE SEE AND EVALUATE OURSELVES HAS A TREMENDOUS IMPACT ON SELF-ACCEPTANCE

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

Self-Esteem The emotional appraisal of self-concept. How do you regard yourself?????? Feel about self? Sense of worth or value?? This appraisal is an on-going process so…levels of self-esteem can change. Self esteem- feel about yourself Vs Self-concept how do I see myself

Body Image What do you think you look like physically? ????? What do you think about your appearance?????? Body image is dynamic: the body changes thru normal growth and development. Cultural and societal attitudes affect body image Body image distortions- teens.., too fat, nose too big…big butt…too short, too tall

Roles What is your role????????? What are the expected behaviors you perform???? Simultaneously hold many roles and they change Who do you want to be???? What do you want your role to be??? Role of mother, teacher, friend, spouse, student nurse???? etc… As nurse you start as a detective, proceed, advocate, counselor, teacher… Self-concept is a combo of these 4 components

Roles Self-Actualization A part of self-concept is the way a person perceives their ability to carry out significant roles Health self-concept can distinguish between: Ideal role expectations AND Realistic possibilities

Factors Affecting Self-concept Health status: illness, injury, body chg, loss of control, dependency on others Role stressors; overload, strained, feelings of inadequacy Developmental transitions – aging in our culture Personal “success” or failure history Crisis and/or life events: personal and/or global Internal and external resources Individual perception of crisis Health Status: Illness…produces anxiety….which can compromise recovery...which can lead to decreased self-concept….I’ll never get better or I’m useless now. Roles stressors: roles have responsibility whether mother caring for child, breadwinner in the family, health care giver to family members etc. student homework, office deadlines…Our roles can cause stress which can affect our self-concept…can become stressed, overwhelmed and unable to cope… Developmental changes: going through menopause is a dev. change may feel old….or less womanly etc.. STRESSORS THROUGHOUT DEVELOPMENT – CAN BE RESOLVED POSITIVELY OR NEGATIVELY (ERIKSON) AGING STRESSORS IN OUR CULTURE PARTICULARLY HIGH HX OF SUCCESS OR FAILURES INTERNAL AND EXTERNAL RESOURCES CRISIS OR LIFE STRESSORS: JOB CHANGE, SCHOOL, DIVORCE CRISIS; PERSONAL OR GLOBAL(9/11) A PERSON’S RESPONSE IS DETERMINED BY (3) THINGS: PERCEPTION OF THE CRISIS DEGREE OF EXTERNAL RESOURCES EXTENT OF INTERNAL RESOURCES

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

Erikson- Psychosocial Developmental Theory ID 8 stages from birth to old age Each stage characterized by a developmental task to be mastered Unmet tasks may delay progress through the next stage

Erikson Trust vs Mistrust Infancy Infant relies on caregivers for basic needs Autonomy vs Shame and doubt Toddler Gains independence: If expectations too high or low feelings of inadequacy develop Toddler feeling of inadequacy can reflect on self-concept

Erikson Industry vs inferiority School-age Focuses on achievements and if not accepted develops a lack of self-worth Initiative vs guilt Preschooler Seeks new experiences if restricted becomes hesitant to seek new challenges Preschooler: doesn’t try new experiences will effect self-conpt School age- lack of worth …decreased self-concept

Erikson Identity vs role confusion Adolescence Transition from childhood to adulthood. Acquires sense of who they are. Confusion if unable to establish sense of direction Intimacy vs Isolation Young adulthood Unite self with others –commitments. Fear of commitment results in isolation and loneliness

Erikson Generativity vs stagnation Middle adulthood Desire to make a contribution to the world. Becoming self absorbed results in stagnation Ego integrity vs despair Later adulthood Reminiscence about life -sense of purpose. If believes life was misdirected despair results

Assessing Self-concept Developmental and chronological age Assessing includes questions on identity… body image…self esteem…roles… Patient’s strengths/weaknesses Body image…how will losing a breast to cancer effect you?....how would you describe yourself….what roles /responsibilities to you have

Self-Concept Questionnaire Describe yourself. What are your personal characteristics? What are your strengths? What are your fears or weaknesses? Describe your body. What do you like most about your body? What do you like least about your body? Tell me about some things you do or have done in the past that give you a sense of achievement or accomplishment. Describe the primary roles you fill. How do you feel about your ability to perform these roles? Are these roles satisfying to you? HAVE STUDENTS REFLECT AND ANSWER THESE QUESTIONS ESPECIALLY: DESCRIBE YOUR STRENGTHS AND WEAKNESS WHAT DO YOU LIKE MOST AND LEAST ABOUT YOUR BODY

PUT THIS SLIDE UP FOR DISPLAY WHILE STUDENTS FILL OUT THEIR SELF-CONCEPT QUESTIONNAIRE BODY IMAGE- Jessica Simpson, Halle Berry, Jennifer Lopez, Usher, Paul Walker DID THESE IMAGES AFFECT YOUR SELF PERCEPTION DISCUSS THE IMPACT OF CULTURAL INFLUENCE ON BODY IMAGE

High self-esteem vs Low self-esteem Assertive Self-directed Makes decisions Praises self Speaks clearly Attends to needs Passive “who cares attitude” Excessively Dependent Hesitant to express views Overly Critical of self Monotone voice – lack of emotion & energy Neglects own needs Difficulty making decisions Overly apologetic Avoidance of eye contact WHAT ARE SOME NURSING DIAGNOSES RELATED TO SELF-CONCEPT????????????? SEE NANDA LIST DISTURBED BODY IMAGE LOW SELF ESTEEM – CHRONIC OR SITUATIONAL OTHER DIAGNOSIS IN WHICH LOW SELF CONCEPT IS THE ETIOLOGY INEFFECTIVE HEALTH MAINTANENCE R/T LOW SELF ESTEEM INEFFECTIVE COPING R/T INABILITY TO IDENTIFY PERSONAL STRENGTHS SELF-CARE DEFICIT R/T LEARNED HELPLESSNESS AND LOW SLEF ESTEEM RISK FOR SELF-DIRECTED VIOLENCE R/T DISTRUBED SELF-CONCEPT

Nursing Diagnoses Disturbed body image Low self-esteem; chronic or situational Other Dx in which low self-concept is the etiology: Ineffective health maintenance r/t … Self care deficit r/t … Risk for self-directed violence r/t…

Nursing Interventions Nurse is a role model Can a nurse NEGATIVELY affect a client’s self-concept? Form helping relationship: Focus on client strengths; praise achievements Meet physiological and psychological needs Reduce pain Decrease anxiety Promote positive self-esteem Encourage participation in care Encourage socialization Role model- positive attitude, display high self-esteem Interact and focusing on pt. strengths. i.e. Praising … Needs have to be met to decrease anxiety …leads to more positive self-esteem Promote self esteem- based on dev level Child- educate and support…losing teeth is normal, menstruation is changing body, puberty changes are normal… Increase socialization, encourage participation in care, elicit feedback…, NIC ENCOURAGE PT TO RECOGNIZE AND DISCUSS THOUGHTS AND FEELINGS ASSIST PT TO: REALIZE EVERYONE IS UNIQUE REALIZE THE IMPACT OF ILLNESS ON SELF-CONCEPT CHANGE VIEW OF SELF AS VICTIM BE AWARE OF NEGATIVE SELF-STATEMENTS AND MODIFY THEM ASSIST PT TO GAIN MORE CONTROL ASSIST PT TO IDENTIFY POSITIVE ATTRIBUTES OF SELF ASSIST PT TO IDENTIFY AND USE PERSONAL STRENGTHS ***ENHANCING SELF-ESTEEM IN OLDER ADULTS***** SEE ATTACHED

Nursing Interventions NIC Encourage client to recognize and discuss thoughts and feelings Assist client to: Realize everyone is unique Realize impact of illness on self-concept Be aware of negative self-statements and modify them Gain more control Identify positive attributes of self Identify and use personal strengths

Nursing Evaluation Outcome criteria addressed???? Behavior and attitude changes will indicate altered self-esteem Long term outcome –can take many months or years PATIENT SHOULD BE ABLE TO MEET THE FOLLOWING OUTCOMES: COMFORTABLE WITH BODY IMAGE ABLE TO DESCRIBE SELF POSITIVELY ABLE TO MEET REALISTIC GOALS WITHOUT UNDUE ANXIETY AND/OR FATIGUE CAPABLE OF INTERACTING APPROPRIATELY WITH ENVIRONMENT AND OTHERS

Evaluation (NOC) Client should be able to meet the following outcomes: Be comfortable with body image Be able to describe self positively Be able to meet realistic goals Be capable of interacting appropriately with environment and others

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

Summary Self-concept based on 3 components Need to understand how various factors affect self-concept Understand difference between high & low self-esteem Interventions to promote self-concept Evaluate outcome criteria *****EXERCISE****** HAVE STUDENTS EXPLORE THEIR SELF-CONCEPT BY WRITING ANSWERS TO THE FOLLOWING: HOW DO I PERCEIVE MYSELF WHO AM I WHAT MAKES ME THE WAY I AM HOW DO OTHERS SEE ME DO I RESPECT AND LIKE MYSELF AS I AM ARE THERE WAYS I NEED TO CANGE TO ACHIEVE MY DESIRED SELF-IMAGE WHAT ARE MY GOALS FOR SELF IMPROVEMENT WHAT DOES ALL THIS HAVE TO DO WITH MY PROFESSIONAL PRACTICE Share this with a close friend – discuss and re-evaluate

“No one can make you feel inferior without your consent” - Eleanor Roosevelt