1. Self –Concept & Coping NUR101 Fall 2010 Lecture # 13 K. Burger MSEd, MSN, RN, CNE PPP by: Sharon Niggemeier RN MSN Revised 10/05 kb

2. 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-esteem self-actualization self-actualization

3. 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

4. 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.

5. 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

6. 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???

7. 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

8. 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

9. 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).

10. Erikson- P sychosocial 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

11. Erikson Trust vs Mistrust Infancy Infant relies on caregivers for basic needs Autonomy vs Shame and doubt Toddler Toddler Gains independence: If expectations too high or low feelings of inadequacy develop

12. Erikson Initiative vs guilt Preschooler Preschooler Seeks new experiences if restricted becomes hesitant to seek new challenges Seeks new experiences if restricted becomes hesitant to seek new challenges Industry vs inferiority School-age Focuses on achievements and if not accepted develops a lack of self-worth Focuses on achievements and if not accepted develops a lack of self-worth

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

14. 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 Later adulthood Reminiscence about life -sense of purpose. If believes life was misdirected despair results Reminiscence about life -sense of purpose. If believes life was misdirected despair results

15. Assessing Self-concept Developmental and chronological age Assessing includes questions on identity… body image…self esteem…roles… Patient’s strengths/weaknesses

16. High self-esteem vs Low self-esteem AssertiveSelf-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

17. 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…

18. 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

19. 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

20. Nursing Evaluation Outcome criteria addressed???? Behavior and attitude changes will indicate altered self-esteem Long term outcome –can take many months or years

21. 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

22. “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?

23. 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

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

25. Stress & Coping

26. Stress Stress- condition when a person responds to change to the normal balanced state Stressor- anything an individual perceives as challenging, demanding or threatening (causes stress). Coping responses- response due to threat or challenge (stressor) Adaptation- change that occurs due to a response from stressor

27. Why do we study STRESS? Link between stress and health Diseases/conditions linked to stress Autoimmune disorders: RA, Graves, Colitis Psoriasis Cardiovascular disorders: HTN, CAN Respiratory disorders: Asthma Gastrointestinal disorders: GERD Stress directly affects nervous, endocrine, and immune systems Stress indirectly affects health d/t poor health habits: smoking, drinking, eating too much, not sleeping enough.

28. Is all stress BAD for you? What about stress of knowing you have an exam coming up? What about the stress of having to have a job, raise a family, etc.? What about it’s protective mechanism? (the stress of crossing a busy street) DISTRESS (damaging stress) versus EUSTRESS (motivating and/or protective stress)

29. Homeostasis Various physiological and psychological mechanisms respond to changes in the internal and external environment to maintain a balanced state To maintain health the body’s internal environment needs a balanced state. STRESS upsets this balance!

30. Physiological Homeostasis Regulating mechanisms of the body react to change and keep the body in homeostasis Primarily: Autonomic nervous system (sympathetic) & the endocrine system (epinephrine, cortisol, aldosterone) Other: cardiovascular,respiratory, GI and renal systems

31. Physiological Indicators of Stress Pupils dilate Diaphoresis Increased HR/BP Pallor Increased rate/depth respirations Dry mouth Decreased urinary output Decreased peristalsis Increased mental alertness Increased muscle tension Intended for short term response to a PHYSICAL stressor It is inappropriate (and more harmful ) in response to NON-physical stress

32. Psychological Homeostasis Need to maintain mental well-being It uses psychological adaptive behaviors ie: Coping mechanisms and defense mechanisms to return one to an emotionally balanced state

33. Psychological Indicators of Stress Anxiety Mild - Panic Coping Mechanisms (ie: anger, withdrawal, inappropriate laughing and/or crying) Unconscious defense mechanisms

34. Defense Mechanisms text review CompensationDenialDisplacementProjectionConversionDisassociationRationalization Reaction formation RegressionRepressionUndoing

35. Adaptation to Stress IF necessary resources are available to deal w/stressor THEN adaptation occurs & balance maintained. IF resources are not available THEN adaptation doesn’t occur & stress results Adaptation is individualized

36. Adaptation to Stress Factors in the Process of Adaptation  Perception of Event – realistic OR distorted  Situational Support – adequate OR not  Coping Mechanisms – adequate OR not Leads to either:  Positive resolution OR  Negative resolution

37. Adaptation: LAS Local adaptation syndrome (LAS) - localized response of the body to stress - involves only a specific body part - localized response of the body to stress - involves only a specific body part Short term adaptive response Examples = reflex pain response & inflammatory response

38. Adaptation: GAS General adaptation syndrome (GAS) - response to stress is characterized by a chain of physiological events Theory developed by Hans Selye Incorporates 3 stages: alarm reaction, resistance stage & exhaustion stage

39. GAS: First Stage Alarm reaction- stressor (threat) activates the body’s various defense mechanisms Autonomic nervous system responds ….Fight or flight response….. Lasts 1 minute –24hrs Neuroendocrine activity (sympathetic ) increases If stressor persists, body proceeds to nest stage - Resistance

40. GAS: Second Stage Resistance stage- body attempts to cope with the stressor and brings down neuroendocrine responses – parasympathetic adaptations increase. If stress can be managed – homeostasis results = Recovery If stress is too great the third phase of GAS continues = Exhaustion

41. GAS: Third Stage Exhaustion stage- adaptation mechanisms are exhausted. Body energy stores depleted and no longer able to defend with sympathetic response. At the end of this stage the body either rests & recovers or death will occur

42. Effects of Stress Stress can be a stimulus or a barrier Effects basic human needs: physiological, Safety/security, Love/belonging, Self-esteem & Self actualization Effects patient & family Prolonged stress effects ability to adapt Burnout/crisis

43. Sources of Stress Type of Stressors Sources: developmental or situational Type of stressors: physiological or psychosocial Type of stressors: physiological or psychosocial

44. Assessing Stress Identify stress level by using: Nursing history Physical assessment Standardized tests or rating scales

45. Focused Assessment SUBJECTIVE What is of most concern to you at this time? What have you done in the past to cope with stress? Do you smoke, use drugs, caffeine intake? Do you follow a healthy diet,exercise regime, see you physician regularly? Change in eating and/or sleeping habits? OBJECTIVE Observe for: Non-verbal cues Eye-contact Posture Grooming/hygiene Irritability / Tension Developmental level Sociocultural factors VS

46. Nursing Diagnosis EXAMPLE: Anxiety R/T loss of job AEB inability to focus, unable to sleep, decreased appetite & states “ I’m so nervous worrying about finding a new job” What are some others???

47. Planning Plan to maintain physiological & psychological homeostasis Develops plan with patient, support people & others as needed Outcome criteria may include decreased anxiety, increased ability to cope or improved role performance

48. Implementation Nursing Interventions Encourage health promotion strategies: exercise, sleep, proper nutrition, time management, minimizing anxiety, relaxation techniques Encourage use of support systems May need to make referrals if stress is too great- crisis intervention

49. What can nurses do for clients experiencing stressors of hospitalization? Use calm reassuring approach Explain all procedures Listen attentively Encourage verbalization of feelings Assist client to gain and/or maintain control of situations as much as possible

50. Evaluation Use desired outcomes as a guide Observe verbal & nonverbal cues Has goal been met? Example: The client is able to: -verbalize cause & effect of stress -identify and use supports -practice healthy lifestyle -utilize effective relaxation techniques

51. Summary Stress affects homeostasis both physiologically & psychologically Adaptation to stress includes LAS, GAS, coping & defense mechanisms Various factors affect stress Nursing process is used to aid patients dealing with stress