1. Chapter 19 Self-Concept Fundamentals of Nursing: Standards & Practices, 2E

2.  Copyright 2002 by Delmar, a division of Thomson Learning 19-2 Self-Concept  Self-concept is an individual’s perception of self and is what helps make each individual unique.  Everyone has both positive and negative self-assessments in the physical, emotional, intellectual, and functional dimensions. These change over time.  One’s view of self affects the ability to function and influences health status.

3.  Copyright 2002 by Delmar, a division of Thomson Learning 19-3 Components of Self-Concept  Identity  Body image  Self-esteem  Role performance

4.  Copyright 2002 by Delmar, a division of Thomson Learning 19-4 Identity  A sense of personal identity is what sets one person apart as a unique individual.  Identity may include a person’s name, gender, ethnic identity, family status, occupation, and roles.  A person begins to develop identity during childhood and constantly reinforces and modifies it throughout life.

5.  Copyright 2002 by Delmar, a division of Thomson Learning 19-5 Body Image  Body image is attitudes about one’s physical attributes and characteristics, appearance, and performance.  Body image is dynamic because any change in body structure or function, including the normal changes of growth and development, can affect it.

6.  Copyright 2002 by Delmar, a division of Thomson Learning 19-6 Self-Esteem  Self-esteem is an individual’s generalized sense of worth and value, or how a person regards one’s self.  Individuals will calculate their self-esteem on the basis of achievement of factors they value most highly (for example, physical attributes, social accomplishments).

7.  Copyright 2002 by Delmar, a division of Thomson Learning 19-7 Role Performance  Role refers to a set of expected behaviors that are determined by familial, cultural, and social norms.  Individuals fulfill several roles simultaneously - parent, sibling, friend, spouse, student nurse.  Each role has a set of expected behaviors.

8.  Copyright 2002 by Delmar, a division of Thomson Learning 19-8 Development of Self-Concept  Self-concept evolves throughout life and depends to an extent on an individual’s developmental level.  A child’s sense of self is shaped by family experiences and interactions with parents.

9.  Copyright 2002 by Delmar, a division of Thomson Learning 19-9  The numerous changes in physical, emotional, and psychosocial status during the adolescent years bring about rapid changes in self-concept.  The adult’s perception of self continues to develop as adults learn to adapt to the numerous physical changes that normally occur with aging.

10.  Copyright 2002 by Delmar, a division of Thomson Learning 19-10 Factors Affecting Self-Concept  Altered health status  Developmental transitions  Experience

11.  Copyright 2002 by Delmar, a division of Thomson Learning 19-11 Nursing Process and Self-Concept  Assessment Consider both the client’s developmental level and chronological age when assessing self-concept. Determine the client’s strengths. This enables assessment of characteristics that can be used for coping and problem solving.

12.  Copyright 2002 by Delmar, a division of Thomson Learning 19-12 Encourage clients to make a list of all the positive things they have done, then review the list. Ask clients to describe their appearance and abilities. Determine what clients know about their strengths and limitations.

13.  Copyright 2002 by Delmar, a division of Thomson Learning 19-13  Diagnosis Individuals experiencing self-concept disturbances usually have feelings of anxiety, hostility, guilt, and shame. Self-concept alterations affect every aspect of a person’s life: emotions, relationships, functional ability.

14.  Copyright 2002 by Delmar, a division of Thomson Learning 19-14 Nursing diagnoses associated with self-concept disturbances  Disturbed body image  Parental role conflict  Disturbed personal identity  Ineffective role performance  Chronic low self-esteem

15.  Copyright 2002 by Delmar, a division of Thomson Learning 19-15  Situational low self-esteem  Anxiety  Social isolation  Hopelessness  Powerlessness

16.  Copyright 2002 by Delmar, a division of Thomson Learning 19-16  Outcome identification and planning A major nursing goal is to promote the client’s sense of well-being and to facilitate growth. Planning includes teaching coping skills and the effective use of personal resources.

17.  Copyright 2002 by Delmar, a division of Thomson Learning 19-17  Implementation The nurse will  Initiate therapeutic interaction  Support healthy defense mechanisms  Ensure satisfaction of needs

18.  Copyright 2002 by Delmar, a division of Thomson Learning 19-18  Evaluation A client’s behavior and attitudes will reflect the degree of progress toward restoring an altered self-concept. The nurse must reconsider the alignment of the client’s targeted self- concept with the plan of care to assess if the two are still congruent.

19.  Copyright 2002 by Delmar, a division of Thomson Learning 19-19  Because self-concept is based on personal attitudes and feelings, it often requires months or years to change.  Nurses, clients, and families all need to learn to be patient and to work together to improve or restore a client’s self-concept.