Chapter 34 Self-Concept

Giddens Concepts
Stress: an internal or external event or demand on life experienced by the individual that is perceived
and appraised for scope and meaning on a continuum to determine whether resources and abilities for
management are available, exceeded, or exhausted.
Coping: an ever-changing process involving both cognitive means and behavioral actions, to manage
internal or external situations that are perceived as difficult and/or beyond the individual’s current
resources.

Self Concept
A subjective sense of self and a complex mixture of unconscious and conscious thoughts, attitudes, and
perceptions
 Provides a positive sense of meaning, wholeness, and consistency to a person.
 Provides a high degree of stability and generates positive feelings toward the self.
Factors Influencing the Development of Self Concept
Development of self-concept is a lifelong process.
 Erickson’s psychosocial theory:
o Each stage builds on tasks of the previous stage.
o Successful mastery leads to a sense of self.

Components and Interrelated

Terms of self concept
 Identity
o An internal sense of individuality, wholeness, and consistency of a person over time
o Ideal self, real self, public self
 Body image
o Involves attitudes related to physical appearance, structure, or function
 Role performance
 Self Esteem
o Individual's opinion of self
Factors Influencing Self-concepts
 Any real or perceived change that threatens identity, body image, or role performance can
affect self-concept.
 Changes that occur in physical, spiritual, emotional, sexual, familial, and sociocultural health
affect self-concept.
o Change in health
o Other crises

Stressors Affecting Self-concept

Identity stressors: Especially during adolescence
Role performance stressors:
 Role conflict: results when a person has to simultaneously assume two or more roles that
are inconsistent, contradictory, or mutually exclusive.
 Role ambiguity: involves unclear role expectations, which makes people unsure about what
to do or how to do it, creating stress and confusion.
 Role strain: combines role conflict and role ambiguity
 Role overload: involves having more roles or responsibilities within a role than are
manageable.
Body image stressors: Affect appearance, structure or function of a body part
Self-esteem stressors: Vary by developmental stage

Family Effect on Self-concept Development

Family plays key role
o Children develop sense of self from family caregivers
o Also gain accepted norms from family
 High parental support and parental monitoring are related to greater self-esteem and lower risk
behaviors
 Positive communication and social support foster self-esteem and well-being in adolescence

 How individuals view themselves and their perception of their health are closely related.

Nurse’s Effect on Patient’s Self-concept

Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgments:
o Use a positive and matter of fact approach.
o Build a trusting relationship.
o Be aware of facial and body expressions.

Nursing Process:
Assessment
 Care should be patient-centered
 Direct questioning
 Observe patient nonverbal behavior
 Use knowledge of developmental stages
 Through the patient’s eyes
 Coping behaviors
 Significant others
Subjective Data
  How do you feel about yourself?
 Are you satisfied with your life?
 How do you get along at your work?
 Do you feel different or inferior to others?
 Does it bother you if you think someone doesn’t like you?
 What could you change about yourself if you could?
Objective Data
 Avoidance of eye contact
 Slumped posture
 Unkempt appearance
 Overly apologetic
 Hesitant speech
 Overly critical or angry
 Frequent or inappropriate crying
 Negative self-evaluation
 Excessively dependent
 Hesitant to express views or opinions
 Lack of interest in what is happening
 Passive attitude
 Difficulty in making decisions
Examples of self-concept–related nursing diagnoses:
 Disturbed Body Image
 Caregiver Role Strain
 Disturbed Personal Identity
 Ineffective Role Performance
 Readiness for Enhanced Self-Concept
 Chronic Low Self-Esteem
 Situational Low Self-Esteem
 Risk for Situational Low Self-Esteem
Planning
 During planning synthesize knowledge, experience, critical thinking attitudes, and standards
o Use concept map
o Goals and outcomes
o Setting priorities
o Teamwork and collaboration
Implementation
 Collaborate with the other team members and patients to promote healthy self-concept
o Therapeutic relationship
 Self-awareness
 Communication skills
o Developmental considerations
 Health promotion
 Acute care: mental health professional
o Cognitive behavioral therapy (CBT)
 Focus on immediate problems
 Developing solutions
o Antidepressants
 o Anxiolytics
 Restorative and continuing care
Self-awareness
 Formation of reality-based perception of self
 Ongoing process
o Self-examination
o Connections between past experiences, present actions, insight
o Introspection
 Security and trust
 Identity
 Belonging
 Purpose
 Personal competence
Key Ingredients: Love, acceptance, firmness, consistency, expectations, and a predictable world to live in
Adolescents
 Responsibility
 Appreciation
 Participation
 Realistic goals
Adults
 Positive qualities
 Positive contributions
 Assess internal and external forces
 Avoid comparisons
Elders
 Participation
 Listening
 Stay connected with memories
 Respect and dignity
 Small goals
 Weaving the tapestry of life: self-esteem, love of life, closeness to the God life in oneself and
others
Evaluation
 Through the patient’s eyes: Patient’s perceived success in meeting goals and outcomes.
 Patient outcomes: Expected outcomes for a patient with a self-concept disturbance include
displaying behaviors indicating a positive self-concept, verbalizing statements of self-
acceptance, and validating acceptance of change in appearance or function.

Review Questions
1. A 50-year-old woman is recovering from a bilateral mastectomy. She refuses to eat, discourages
visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the
patient with her hair combed and makeup applied. Which of the following is the best response from the
nurse?
1. “What’s the special occasion?”
2. “You must be feeling beer today.”
3. “This is the first time I’ve seen you look this good.”
4. “I see that you’ve combed your hair and put on makeup.”
2. A 30-year-old patient diagnosed with major depressive disorder has a nursing diagnosis of Situational
Low Self-Esteem related to negative view of self. Which of the following are appropriate interventions
by the nurse? (Select all that apply.)
1. Encourage reconnecting with high school friends.
2. Role-play to increase assertiveness skills.
3. Focus on identifying strengths and accomplishments.
4. Provide time for journaling to explore underlying thoughts and feelings.
5. Explore new job opportunities. 3. A patient who is depressed is crying and verbalizes feelings of low
self-esteem and self-worth, such as “I’m such a failure … I can’t do anything right.” What is the nurse’s
best response?
1. Remain with the patient until he or she validates feeling more stable.
2. Tell the patient that is not true and that every person has a purpose in life.
3. Review recent behaviors or accomplishments that demonstrate skill ability.
4. Reassure the patient that you know how he or she is feeling and that things will get beer.
4. A 20-year-old patient diagnosed with an eating disorder has a nursing diagnosis of Situational Low
Self-Esteem. Which of the following nursing interventions are appropriate to address self-esteem?
(Select all that apply.)
1. Offer independent decision-making opportunities.
2. Review previously successful coping strategies.
3. Provide a quiet environment with minimal stimuli.
4. Support a dependent role throughout treatment.
5. Increase calorie intake to promote weight stabilization.
5. The nurse can increase a patient’s self-awareness and self-concept through which of the following
actions? (Select all that apply.)
1. Helping the patient define personal problems clearly
2. Allowing the patient to openly explore thoughts and feelings
3. Reframing the patient’s thoughts and feelings in a more positive way
4. Having family members assume more responsibility during times of stress
5. Recommending self-help reading materials
6. Which of the following assessment findings suggest an altered self-concept? (Select all that apply.)
1. Uneven gait
2. Slumped posture and poor personal hygiene
3. Avoidance of eye contact when answering a question
4. Requests for visits from the chaplain
5. Frequent use of the call light
7. The home health nurse is visiting a 90-year-old man who lives with his 89-year-old wife. He is legally
blind and is 3 weeks’ post right hip replacement. He ambulates with difficulty with a walker. He
comments that he is saddened now that his wife has to do more for him and he is doing less for her.
Which of the following is the priority nursing diagnosis?
1. Impaired Self Toileting
2. Lack of Knowledge Regarding Resources for the Visually Impaired
3. Disturbed Body Image
4. Risk for Situational Low Self-Esteem
8. A nurse is working with an older adult who recently moved to an assisted-living center because of
declining physical capabilities associated with the normal aging process. Which nursing interventions are
directed at promoting self-esteem in this patient?
1. Commending the patient’s efforts at completing self-care tasks
2. Assuming that the patient’s physical complaints are attention seeking measures
 3. Minimizing time discussing memories and past achievements spent with the patient
4. Limiting decision-making opportunities for the patient to reduce stress
9. A nurse is caring for a 40-year-old male diagnosed with Crohn’s disease several years ago, resulting in
numerous hospitalizations each year for the past 3 years. Which of the following behaviors interfere
with the developmental tasks of middle adulthood? (Select all that apply.)
1. Sends birthday cards to friends and family
2. Refuses visitors while hospitalized
3. Self-absorbed in physical and psychological issues
4. Performs self-care activities 5. Communicates feelings of inadequacy
10. When assessing a patient’s adjustment to the role changes brought about by a medical condition
such as a stroke, the nurse asks about which of the following? (Select all that apply.)
1. What are your thoughts about returning to work?
2. What questions do you have about your medications?
3. How has your health affected your relationship with your partner?
4. What level of physical activity are you able to perform?
5. What concerns do you have about another stroke?

Answers:
1.4;
2.3, 4;
3.1;
4.1, 2;
5.1, 2, 3;
6. 2, 3;
7.4;
8.1;
9.2, 3, 5;
10. 1, 3.