Self-concept, Sexuality & Spirituality

Self-Concept Definition

• An individual’s view of self

• How one thinks about oneself

• Influences how an individual thinks, acts, and feels

Factors Influencing Self-Concept

• Development

• Culture

• Life experiences

• Relationships

Components of self-concept

• Identity

• Body Image

• Role performance

• Self-esteem

Component of Self-Concept - Identity

• A person’s internal sense of individuality, wholeness, and consistency across time and situations

• Being “oneself” or living an authentic life is the basis

Component of Self-Concept - Body Image

• Attitudes related to the body, including physical appearance, structure or function

• Not always consistent with a person’s actual physical structure or appearance

Component of Self-Concept - Role Performance

• Way in which individuals perceive their ability to carry out significant roles

  • Ex) Parent, friend, partner, supervisor

Component of Self-Concept - Self-Esteem

• Individual’s overall feeling of self-worth

• How one feels feels about oneself

If patient has a positive self-concept…

• Increased confidence

• Better coping mechanisms

If patient has a negative self-concept

• Depression, anxiety

• Risky behaviors such as substance abuse

Self-Concept Alterations (Nursing Process - Assessment)

• Interview the patient

  • Look at non verbal cies

• From the patient’s POV

• Assess for self-concept stressors

  • Focus on each component of self-concept

• Assess for coping skills and support systems

Self-Concept Alterations (Nursing Process - Analysis and Nursing Diagnosis)

• Analyze your assessment findings and formulate a nursing diagnosis

• Differentiate normal versus abnormal findings

Nursing Diagnosis related to altered self-concept

• Disturbed Personal Identity

• Impaired Role Performance

• Situational Low Self-Esteem

• Chronic Low Self-Esteem

Self-Concept Alterations (Nursing Process - Planning Interventions)

Synthesize knowledge, environment, experience, critical thinking attitudes, and standards.

• Identify outcomes

  • Develop andindividualized plan of care

    • Focus on specific needs ot patient

• Establish priorities

  • Consider what is most important to your patient

• Teamwork and collaboration

  • With the patient, their family.significant others, and health care team

  • Create a holistic plan

Self-Concept Alterations (Nursing Process - Implementation and Evaluation)

Approach varies based on level of care required

• Health promotion

  • Support adaptation to stress

  • Ex) Dietary guidance, physical activity

• Promote self-awareness, positive communication, and acceptance

• Identify strengths and limitations

• Provide emotional support

• Assist with goal setting and self-improvement

Evaluate patient’s response to nursing interventions - were the outcomes achieved?

Sexuality definition

All aspects of being sexual, including how you identify sexually and whom you choose to be intimate with

Sexual Identity definition

How a person thinks of himself or herself sexually

Components of Sexual Identity

• Gender identity

• Gender role

• Sexual orientation

Gender identity definition

Private view of maleness and femaleness

Gender role definition

Male and female behavior a person exhibits

Sexual Orientation definition

A person’s gender identity in relation to the gender to which they are attracted

• Heterosexual

• LGBTQ+ continuum

Stages of Sexual Development

1. Infancy and Early Childhood

2. School-Aged

3. Puberty/Adolescence

4. Young Adulthood

5. Middle Adulthood

6. Older Adulthood

Stages of Sexual Development - Infancy and Early Childhood

• Curious about physical differences

• Imitate behaviors

• Repeat behaviors based on caregiver response

• Stage 1

Stages of Sexual Development - School-Aged

• Often segregate by sex

• Questions about physical/emotional aspects of sex

• Stage 2

Stages of Sexual Development - Puberty/Adolescence

• Increased sexual interest

• Often begin exploring sexual identity/orientation and face associated stressors

• Sexual education in schools

• Stage 3

Stages of Sexual Development - Young Adulthood

• Continue exploring and maturing emotionally in relationships

• Intimacy

• Stage 4

Stages of Sexual Development - Middle Adulthood

• Changes in physical appearance, concerns and sexual attractiveness

• Physical changes affecting sexual function

• Stage 5

Stages of Sexual Development - Older Adulthood

• Important aspect of health but often overlooked by health care providers

• Increased rates of STIs and HIV

• Stage 6

LGBTQ+ Sexuality Stressors

• Unique

• My lack family/peer/social support

• Barriers to health care

  • Fear of discrimination, insensitivity, inadequate knowledge of LGBTQ+ specific health needs

Sexuality Stressors

• LGBTQ+ individuals face unique stressors

• Sexual dysfunction

• Concerns of physical attractiveness and changing physical appearance

• Sexually transmitted infections (STIs)

• Sexual abuse

Sexual dysfunction definition

Problems with desire, arousal, or orgasm

Concerns of physical attractiveness and changing physical appearance

• Onset of puberty - hormonal changes

• Older adults, menopause - changes in sexual function

Child - Physical Signs of Sexual Abuse

• Bruises or injury of external genitalia, anus, mouth, or throat

• STIs, UTIs, unusual odor or discharge in genital area

• Stained, torn, or bloody underclothing

• Chronic pain, difficulty sitting/walking

• Unintended pregnancy

• Bedwetting at unusual age

Child - Behavioral Signs of Sexual Abuse

• Physical aggression

• Running away from home

• Sexual acting out, excessive masturbation

• Poor school performance and peer relationships

• Social withdrawal and excessive daydreaming

• Sleep disturbances

• Low self-esteem, substance abuse, suicide attempts

Adult - Physical Signs of Sexual Abuse

• Welts, bruising, swelling, scars, burns, or lacerations on arms, legs, breasts, or abdomen

• Wounds that do not match the patient’s “story”

• Multiple bruises in various stages of healing

• Vaginal/rectal bleeding, trauma to genital area

• Vomiting or abdominal tenderness

Adult - Behavioral Signs of Sexual Abuse

• Facial grimacing

• Absence of facial response or flat affect

• Anxiety, panic attacks

• Depression

• Sleep disturbances

• Slow, unsteady gait

Sexuality (Nursing Process - Assessment General)

1. Assess sexual history - consider physical, functional, relationship, lifestyle, developmental, and self-esteem factors influencing sexual functioning

2. Assess for sexual abuse - if you suspect your patient is being abused, DO NOT ASK THE PATIENT ABOUT ANY ABUSIVE BEHAVIORS IN PRESENCE OF SUSPECTED ABUSER - provide privacy and obtain in protective environment

Sexuality (Nursing Process - Assessment Questions)

1. Assess sexual history

   1. Are you sexually active? With whom (men, women, or both)? How many sexual partners?

   2. How has your illness, medication, or surgery affected your sex life? Any concerns?

   3. Tell me the safe sex practices that you follow (contraceptives, STI prevention)

2. Assess for sexual abuse (ASK DIRECTLY)

   1. Has anyone ever forced you to have sex against your will?

   2. Are you in a relationship in which someone is hurting you?

Nursing diagnosis related to sexual functioning

• Problematic Sexual Behavior

• Difficulty Coping

• Lack of Knowledge of Contraception

• Impaired Sexual Functioning

• Risk for Impaired Reproductive Function

Sexuality (Nursing Process - Planning Interventions)

• GOAL: promote safe environment, maintain dignity, and convey respect

  • Ask and use the patient’s preferred pronouns

• Interventions depend on the problem - Work collaboratively with patient and health care team to set individualized outcomes

  • Remember SMART goals

Sexuality (Nursing Process - Implementation and Evaluation)

• Nonjudgemental environment, open communication

• Health promotion - educate and safe sexual practices, STI prevention, health screenings, HPV vaccine (11-26 if relevant)

• Address patient oncerns

• Provide referrals if indicated

  • Ex) Community resources

• Be sure to evaluate whether the patient achieved the expected outcomes in the plan of care

Spirituality definition

• Awareness of one’s inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself

• Includes personal beliefs that help a person maintain hope and navigate difficult situations

• Broader, more unifying concept

Religion definition

Organized, institution-related practices associated with particular beliefs and faith traditions

Trust vs. Mistrust

• Birth - 18 months

• Spiritual well-being provided by parents

  • Trust provides basis for hope

  • Love, affection, security, and a stimulating environment promote spirituality

Autonomy vs. Shame and Doubt

• 18-36 months

• Fascination with magic and mystery

• Spiritual well-being provided by parents

  • Often believes that illness is related to bad behavior

  • Begins to learn the difference between right and wrong

  • Imitates parents’ spiritual or religious actions; recites prayers and sings simple religious songs, but does not understand their meaning

  • Interprets meanings literally

Initiative vs. Guilt

• 3-6 years

• Feels guilty when not acting responsibly

  • Influenced by spiritual and religious stories, examples, moods, and actions

  • Models moral behaviors of parents

  • Begins to ask about God or Supreme Beings

Industry vs. Inferiority

• 6-12 years

• Wants to learn about spirituality

  • has a clear picture of God or Supreme Being, morality, and the difference between right and wrong

  • Sorts fantasy from fact

  • Demands proof of reality and believes literal meaning of spiritual stories

Identity vs. Identity Confusion

• Adolescence

• Reflects on inconsistencies in stories

  • Begins to question spiritual practices, forms own opinions, and occasionally discards parents’ beliefs

  • Abstract reasoning leads to the exploration of moral issues

  • Spirituality comes from connectedness with family, nature, and God or a Supreme Being

Intimacy vs. Isolation and Loneliness

• Young adulthood

• Establishes self-identity and world view

  • Forms independent beliefs, attitudes, and lifestyles

  • Uses principles to solve problems when individual’s and society’s rules conflict

Generativity vs. Stagnation

• Middle-age adulthood

• Develops an appreciation of past spiritual experiences

  • Embraces people from different faiths and religions

  • Reviews value system during crisis

  • Values others

Ego Identity vs. Despair and Disgust

• Older adulthood

• Values love and interactions with others

  • Focuses on overcoming oppression and violence

  • Beliefs vary based on many factors, such as gender, past experiences, religion, economic status, and ethnic background

Spirituality (Nursing Process - Assessment)

• Assess patient’s viewpoints

  • Observe their beliefs

• Establish a trusting relationship

• Determine how patient is responding physically or psychologically to illness or disability

• Use assessment tools such as the FICA tool

FICA tool description

Four-part spiritual assessment guide in nursing designed to help clinicians understand a patient's spiritual history, meaning, and coping mechanisms

FICA tool components

• Faith and belief

• Importance and influence

• Community

• Address or take action

FICA tool - Faith and belief

• Are there spiritual beliefs that help you cope with stress or difficult times?

• What gives your life meaning?

FICA tool - Importance and influence

• Is spirituality important in your life?

• What influence does spirituality have on how you take care of yourself?

• Are there any particular decisions about your health that might be affected by these beliefs?

FICA tool - Community

Are you part of a spiritual or religious community?

FICA tool - Address or take action

• What can you do with the information shared?

  • Ex) Refer to chaplain or mindfulness program or contact community clergy

• Consult hospital chalplain to familiarize yourself with available resources

Nursing diagnoses related to spiritual health-related problems

• Risk for Spiritual Status

• Decreased Spiritual Distress

• Hopelessness

• Powerlessness

• Spiritual Distress

Spirituality (Nursing Process - Planning Interventions)

• GOAL: patients to be at peace ultimately

• Personalized and vary based on patient’s spiritual needs

• Set outcomes, use SMART goals

Spirituality (Nursing Process - Implementation)

• Health Promotion

• Acute Care

• Restorative/Continuing Care

Spirituality (Nursing Process - Implementation: Health Promotion)

• Establish presence

  • Being physically close with a patient

• Support a healing relationship

Spirituality (Nursing Process - Implementation: Acute Care)

• Support systems

• Diet therapies

  • Ex) No pork, no animal derivatives, kosher meals

• Support rituals

Spirituality (Nursing Process - Implementation: Restorative/Continuing Care

• Prayer

• Mediation

• Supporting grief work