time (Hrs): 3(T) unit Completion

Learning Outcome Content

Activ&S
Develop basic Components of Self-concept Lecture
understanding of
self-concept Dimensions of Self-concept
Formation of Self-concept Cow
Factors Affecting Self-concept
Nursing Monogement of Po%entswtth
Alterations in Self-concept

Unit Test Record:

Date of test: Maximum marks: Obtained marks:

INTRODUCTION changes over time; and has a powerful Impact on one's

life.
"Self-conceptis the way a person thinks about himself Assessment of self-concept is usually subtle.
or herself." —Brown, 1998 depending upon the patient's developmental level and
Self-concept or self-image is significant to an chronologicalage. The nurse should understand the
individual's health and well-being throughout the life. patient's verbal and nonverbal clues when discusstng
Self-conceptis the mental image of self. Self-concept self-concept, body image, personality, self-esteem or
is the individual's perception of self, affects functional role changes.
abilities,relationships and health. Nursing care aimed
at teaching new health care behaviors may not be COMPONENTSOF SELF-CONCEPT
successfuluntil the patient values him or herself enough
to desire to invest energy and efforts in self-care. The four components of self-concept are personal
Self-concept is unique to the person; can be positive identity, body image, self-esteem and role performance.
or negative; has intellectual, emotional, and functional Thesecomponentsare interrelated to each other as
proportions;changes with the environmentalcontext; depicted in Figure 1.
 self-reflection and others feedback. Erikson's
theory of psychosocial development focuseson the
importance of the family, peers and communityin
Body image establishingthe personal identity.
Body image: Body image is the attitude aboutone's
physical characteristics and attributes. Physical
appearance and performance changes as the body
changes over time. The way one recognizesthe
body image is affected by self-esteem and personal
Personal Components
Self-esteem identity.
identity of self-concep
Self-esteem: It is the perception of personal
performance compared with the self-ideal.Theself-
ideal is constructed on personal standards and self-
expectations. Self-esteem is most threatened during
adolescent period.
Role Role performance: Role is a set of expected
performance
behaviors that are determined by familial,cultural
and social norms. An individual expresseshis/her
self-identity through role performance. For instance,
Fig. 1: Components of self-concept
some people take on a 'sick role', a set of social
expectations met by an ill person, such as being
Personal identity: Personal identity is the exempt from role responsibilities,being obligated
perception of what sets a person apart from others. to get well and looking for help.
It may include the person's name, gender, family
Nursing questions and nursing approachesto assess
status, ethnicity, occupation and responsibilities.
these components is given in Table 1.
Personal identity evolves during childhood from

of self-concept.
Table 1: Enlist the high-risk factors that may affect the components
of
Components High-risk factors Questions and approaches
self-concept
Personalidentity • Developmental changes • How would you describe yourself to others?
• Trauma • Personal characteristics and attributes
Biological sex dissonance • Strengths
e Cultural dissonance • Fears
Body image Loss of body part • Can you describe your body to me?
aboutyour
Loss of function of body part/s • What do you like most about your body? What do you like least
Disfigurement body?
Developmental changes • Is there anything about your body that you would like to change?
Self-esteem Unhealthy interpersonal • Describe your sense of satisfaction about yourself.
relationships • How's your relationship with others?
Failure to achieve • Who is your role model?
developmental milestones • Who or what has influenced your self-expectations?
Failure to achieve life goals • What is your response when you feel not loved or unappreciatedbythose
Failure to live up to personal who are important to you?
degree
beliefs or moral codes • How do you feel about your ability to do the things in life? To what
standards?
Sense of powerlessness are you satisfied with the way you are able to live with your moral
youin
• To what extent do you feel you are able to control what happensto
life?
most
Role performance • Ambiguous role expectations • Which roles (spouse, parent, student, nursing aide, dancer,etc.) are
• Conflicting role expectations of you?
• Inability to meet role • How do you feel about your ability to the actions your roles demand
expectations • Are these roles satisfying for you?
 Unit 12 Self-concept
Alongwith these components several variables
to self-concept. As a person moves Self-expectations: "Who or What do I Want to
of human needs to through
hierarchy higher levels, be?"
and self-actualization needs for
IfRSteem begins to arise. An expectation for the self grows from various roots.
Thebasis for self-esteem is the need The ideal self is derived from the self-one wants to
has to feel good about his/ that an
dividual herself and to be. Self expectations develop through images of role
that other people hold them in high
believe regard. The model such as parents image or celebrity. These self
need self-actualization is
for the need for any
full individual expectationsdevelop unconsciously and may be healthy
toreachhis/her potential through growth
of their or unhealthy.
uniqueabilities.
Example: A child signifies a television 'bad boy' or
a drug dealer as his/her hero rather than parents may
DIMENSIONS OF SELF-CONCEPT lead to development of unhealthy self-expectation.

Allof the feelings, beliefs and values associated with Self-evaluation: "How Well do I Like Myself?"
'I'or 'me' compose self-concept. Dimensions of self-
concept include self-knowledge, self-expectations Self-esteemis the evaluative and affective component
and of the self-concept, sometimes termed self-worth, self-
self-evaluation(Fig. 2).
respect or self-approval. According to Maslow (1954), all
people "have a need or desire for a stable, firmly based,
usually high evaluation of themselves, for self-respect or
self-esteem,and for the esteem of others." Accordingly,
Self- two subsets of esteem needs are:
knowledge
1. Self-esteem needs, such as strength, mastery,
achievement and competence, confidence in the
face of the world, independence, and freedom.
Dimesions 2. Respect needs or the need for esteem from others,
of self- such as status, recognition, dominance, importance,
Self- concept Self- attention and appreciation.
evaluation expectations
Characteristicsof a person with healthy self-esteem
[Mayo Clinic (2017)]:
e Assertive in expressing his/her needs and opinions.
Confident in the ability to make decisions.
Fig. 2: Dimensions of self-concept • Able to form secure and honest relationships and
less likely to stay in unhealthy ones.
Self-knowledge:
"Who am I?" • Realisticin the expectationsand less likely to be
Globalself is the term used to narrate the composite of overcritical of self and others.
allthebasicfacts, traits, qualities, images, and feelings • More resilient and better able to work under stress
a personhold about himself/ herself. These variables and setbacks.
stronglyinfluence a person's ability to control life Three major self-evaluation feelings or affects found
eventsand ensure emotional stability. A person's self- in the people are as follow:
knowledge includes: Pride: Based on a positive self-evaluation.
Basicfacts (age, gender, religion, race, occupation, • Guilt: Based on behaviors incongruent with ideal
culturalbackground). self.
Theperson's position within social groups. • Shame: Associated with low global self-worth.
Qualitiesor traits that describe the behaviors,
feelings,moods and other characteristics of a person FORMATIONOF SELF-CONCEPT
(e.g.,generous, hot headed, ambitious, intelligent,
etc.). Although self-concept is widely considered to be a social
creation that develops as a result of interactions with

725
 others, contemporary nur»ing researchers recognize that are met, where,)" the growing child
some inborn tendencies, such as ternperatnent, when freedom to explore and develop the ability
to
interacting with social and interpersonal experiences, increaQng personal neecl%,
are critical in the fortnation of self«oncept. According
to Freud (1901),inborn traits are also important, such
as innate aggression, because they affect a child's
Developmental
interpersonal experiences and shape self-concept. onsiderations
According to the theoretical formulations, the formation
of self-concept includes the following: Aging, illness
Culture
• An infant learns that the physical self is different or trauma
from the environment. If basic needs are met, Factors
warmth and affection are accomplished and the affecting self-
parents' anxiety is minimized, then the child begins concept
life with positive self-feeling. Internal
• Life crisis or
The child next incorporates other people's attitudes and external
stressors
toward self. Parents or other caregiversplay the resources
most dominant role; peers play the second most History of
influential role. Later, the child continues to behave success and
in ways that confirm this early self-concept. failure
• The child or adult internalizes the standards of
society.
Psychological conditions that foster healthy Fig. 3: Factors affecting self-concept
development of the self in children include: Culture: As a child internalizes the values of parents
Emotionalwarmth and acceptance. and peers, culture begins to affect sense of self.For
Effective structure and discipline. example, an adolescent might realize that parents
Clearly defined standards and limits, so that live by the work ethic and believe it is necessaryto
children understand what goals, procedures and wake-up early every day and plan full day's work
conduct are approved. Internal and external resources: Personalstrengths
Encouragement of competence and self-confidence. are identified, developed and may be used as
Established methods of handling children power, but all this is subjective to the selfconcept.
that produce the desired behavior, discourage For example, one person may use humor as both
misbehavior and deal with infractionswhen they an effective coping mechanism and a successful
occur. interpersonal tool. Another person may use humor
to avoid facing conflict,but may feel bad about
Helping children to meet the challenges.
being known as a 'joker'.
Appropriate role models.
Self-concept is associated with the ability
A stimulating and responsive environment. to identify and use external resources, such as a
support of group of people, adequate financesand
FACTORS AFFECTING SELF-CONCEPT organizational supports.
Almost every life experiencecan influence a person's a
History of success and failure: Failure influences
self-concept. Key factors include developmental person's self-conceptnegatively and that negative
considerations,culture, internal and external resources, self-conceptcauses the person to continueto fail
history of success and failure, stressors and illness or On the other hand, a series of successful experienc+
trauma (Fig. 3). forges a positive self-concept. RepeatedFailure
• enforces negative self-concept, unconsciouslv
Developmental considerations: As individual
person adopts failure options. Successpromote
develops and matures, positive self concept changes
positive self-concept through accepting,nurturing
with experiences.As in infant stage a supportive
& caring relationships, in return fostersexpectati0fl
environment is needed in which all human needs
of success in future.
 crisesor stressors: Stressors Unit 12 Self-concept
Life and
Idsself-concept, because these
t attributes of an two bring Outcome
individual like out Identification and
Planmng
outcome) or substance talent
abuse (negative With all patients,
tome).OUtcomeis dependent on nursing interventions need to be
N perceptionof
The patient will:
illness, or trauma: Sudden
Aging, • Describe
bodilydisfigurement, or even illness, trauma self realistically,
identifying both strengths
or the signs of
the • Describe the relation
between and
in response verbalize realistic
self-conceptand internal beliefs expectations for self, based on
about the who the patient would like to be.
self.
• Identifyfaulty thinkingthat reinforcesa
negative
MANAGEMENT OF PATIENTS self-concept (distortions and denials, faulty
ALTERATIONSIN SELF-CONCEPT WITH categorizing, inappropriate standards).
e Integrate positive self-knowledge into self-concept.
must be comfortable with self and
have an Nursing
„equate
self-conceptbefore they identify and resolve Implementation
*onceptdisturbances in patients. Let's discuss The possible
nursing strategies are explained below:
management of patients with altered self-
2nursing
neptwiththe help of nursing process. HelpingPat;ents to Identifyand use Persono/
Strengths
qursing
Assessment Nurse may help patient to recognize his/her strengths.
Selfconceptassessment shall be an integral part of • Encourage patients to identify their strengths.
comprehensive nursing assessment of the patients. • Notice and reinforce patient's strength.
Itisvitalto identify and label a patient's positive • Replace self-negation with positive thinking.
as it is to notice problems.
self-concept • Help patients cope with necessary dependency
bhenconducting a self-concept assessment,be resulting from aging or illness.
awareof the limitations of self-reporting. Patients • Encourage patients to will for themselves the
mayprovide information, what they believe are strengths they desire and to hy them on.
questions.
acceptable responses to interview
socially
clustered Helping At-riskPatients to Maintain a Sense of Self
Whenthe nursing assessment reveals a
Help patients to maintain a sense of self and worth by
discuss with the patient.
behaviors,
doing the following:
ingDiagnosis • Address the patient by preferred name whenever
entering the patient's room.
Disturbed related to alterationin self- Acknowledge the patient's status, roles,
body image in view Of
Perception as evidenced by alteration
one'sbody.
self-esteemor . Use looks, speech, and judicious touch to
onic (or risk for chronic) low evidenced by
relatedto alteration in body image as Help the patient to recognize strengths and
inconsistent with explore alternatives.
alterationin social role/behavior
values in Speak to the patient respectfully and in a non-
related to disruption patronizingmanner.
ectiverole performance the patient about the patient's life
ceptionof role performance. • Converse with
onal identity experience.
and
between self Acknowledge and allow expression of negative
relatedto inability to distinguish feelings.
727
Textbook of Nursing Foundation- Il

• Offer the patient a simple explanation before a journal/diary only focusing on blessingor what
initiating any procedure. good is in your life.
• Move the patient's body respectfully if the 4. Step 4: Find the right level of generosity: Bein
patient is not able to do so. generous is good but being over generous can lead to
• Respect the patient's privacy and sensibility. burnout or draining of energy. Choose wisely who
• Assistance shall not be perceived as dependence, needs your generosity. Self-love is more important
either by nurse or the patient. than loving others.
5. Step 5: Be Mindful: Mindfulness has poqitive
TeachingSelf-compassion impact on self-compassion.Let's say you are in
• Self-compassionis a powerful tool that nurses can a stressful situation or you had fight with loved
use for themselves as well as for patients. ones or didn't perform well in exam, then you
should practice mindfulness which can be in any
• Self-compassioninvolves acting like always, even
form like deep breathing, meditation or imagery
when you are having a difficult time, fail, or notice
(where you purposely think of something you like)
something that you don't like about yourself.
these are called as Self Compassion break where
• Nurses must educate the patients that instead you are thoughtfully taking break from a stressful
of mercilessly judging and criticizing oneself situation. It not an escape from the responsibilityIt
for various inadequacies or shortcoming, self- a way to keep your calm and recollect your energy
compassion means one is kind and understanding, to complete the task efficientlywithout stressing
when confronted with self doubt, after all whoever
oneself.
said to you to be perfect, need to be perfect himself
first. Be mindful that life will have stressful situation,
things will be out of control, love yourself, acceptthat
How a Student or Novice can Practice Self-compassion you are not perfect but can always be a better version of
what you are now with self compassion.
Self-compassionis a practice of goodwill, not good
feelings... With self-compassion we mindfully accept Modifying a Negative Self-concept
that the moment is painful, and embrace ourselves Helpful nursing interventions to modify
a negative self
with kindness and care in response, remembering that concept are the following:
imperfection is part of the shared human experience.
—Neff, 2019
Help the patient to identify and describe how the
patient thinks and feels about situations related
1. Step 1: Practice forgiveness: "To err is human",
to self-concept. Identify the patient's defective
so it is okay if you make mistake, do not regret or
thinking patterns.
punish yourself by thinking it over and over gain
or reliving the situation in mind, grow form it, learn Explore with the patient the alternative ways of
and let it go. Think of your achievements. viewing the same situation—that is, reframe the
2. Step 2: Employ a growth mind-set: Face challenges patient's thinking about the situation.
instead of avoiding them, let's say you or your Teach the patient to 'red flag' faulty thinking
friend, is criticizingnegatively comparing you with behavior as soon as the patient is aware of it. The
others, change point of view and find an inspiration goal is to replace the negative thinking with thinking
in other persons success or strength with whom and self-talk that will develop a more positive self-
comparison is made. Train your mind not to feel bad image.
about it rather, try to gain an insight for motivation Help the patient to explore the positive dimensions
or inspiration, of the self that the patient wishes to develop,and
3. Step 3: Express gratitude: We commonly feel I
wish help to incorporate this new knowledge into the
I was like that X person or wishing what we do
not self-concept.This can be done by reinforcingthe
have. Instead focus on what we have, appreciate the positive adaptation.
blessings, gratitude for what we have is great way
of decreasing the frustration and feel blessed. Try Developing a Positive Body Image
to
go on walk and count on good things in life or write Nursing interventions may include a combinationof the
following:
 Unit 12 Self-concept
showinterest as well as acceptance
through verbal
andnonverbal expressions. resourcefulness emotional maturitv, and
Explorewith the patient his/her and cons,equences.
feelings about
alteredbody image and the patient's
about the meaning and perceptions Enhancing Self-esteem in Older Adults
consequences of such
When interacting with older adults, adopt nur-,rrg
Supportthe patient through the various interventionqto enhance and maintajn
and stages of in geriatric population.
loss,grief mourning (shock, disbelief,
guilt and denial, Identifyown attitudes and feelingsabout aging ane
anger, acceptance).
older adults.
Useplay therapy with children so that they Address patients reqpectfullv.
can
describetheir feelings and work through and affirm the intellect, individua.l.'t'v%
their
griefusing the nonthreatening medium of dolls personal strengths, culture and spirituality of older
or
animals. patients.
Nurseneed to be careful not to let facial expressions, Adjust communicationstyle to accommodate am
words,or body positioning communicateto the sensory or cognitive deficits.
patientdisgust, fear or rejection. Encourage sharing of life experiences.
Wheneverpossible, provide the patient with honest Assist the patient to identify strengths and coprae
answersto questions or put the patient in touch mechanisms to deal with problems.
withthe appropriate person to give the answers.
Provide a safe environmentfor older adults to
communicate such concerns as interpersonal or
Strengthenthe patient's decision-making ability. physical loss, feelings about illness and death.
Donot provide false hope. sexuality, or financial issues.
Reinforcethe patient's personal strengths and Advocate for patients needing help in attaining
helpthe patient and family to identifyall possible services necessary to meet their health care needy.
resources.
Nursing Evaluation
Developing Self-esteem in Children and Adolescents The patient should be able to meet the
Teachstrategies to parents or teachersfor building outcomes:
self-esteem in children. Because some parents Patient is able to describe self positively.
and educators may not have experience related Patient is comfortable with body image and able to
to strategies of promoting personal growth, it is use it effectively to meet human needs.
beneficialto exhibit role-model behaviors, while Patient is able to meet realistic role exBX*tations
interactingwith children. without undue anxiety and stress.
include
Important learning tasks for children Patient is capable of interacting appropriatelv suth
their environment while recognizing selt to a separate
Understanding and accepting themselves, goals
feelings,for self and others; independence; and and distinct entity.
and purposeful behavior; mastery, competence
Textbookof Nursing Foundation- Il

Summary
• Self-conceptis the way a person thinks about Almost every life experience can influence
himself or herself. a person's self-concept. Key factors include
• The four components of self-conceptare personal developmental considerations, culture, internal
identity, body image, self-esteem and role and external resources, history of success and
performance. failure, stressors and illness or trauma.
• Dimensions of self-concept include the self- Nurses must be comfortable with self and have
knowledge, self-expectations and self-evaluation. an adequate self-conceptbefore they identifyand
resolve self-concept disturbances in patients.

? As Vourseff
Short Answer Questions Long Answer Questions
1. Describe the factors affecting self-concept. 1. What are the strategies nurse can use for developing
2. Explain the dimensions of self-concept. positive body image after mastectomy?
3. Write down the factors that influence a person's self- 2. How a nurse can help to modify negative self-
concept. concept in a patient?
4. What are the components of self-concept. 3. Write nursing management of a patient with altered
self-concept.