42Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 42 Self Concept

A nurse is performing a psychological assessment of an adolescent patient who has Down syndrome with mild intellectual disability. The patient tells the nurse, “I’m a good helper. I can carry things because I’m strong, but I’m not real smart, so I help with things I know how to do.” What findings for self-concept and self-esteem would the nurse document for this patient?

a Negative self-concept and low self-esteem

b Negative self-concept and high self-esteem

c Positive self-concept and fairly high self-esteem

d Positive self-concept and low self-esteem

c. The data point to the patient’s positive self-concept (“I’m a good helper”) and fairly high self-esteem (realizes their strengths and limitations). Stating, “But I’m not really smart” is likely accurate compared to non-disable peers and is not an indication of a negative self-concept.

A nurse asks a 25-year-old patient to describe themself with a list of 20 words. After 15 minutes, the patient listed, “25 years old, male, named Joe,” then declared he could not think of anything else. What should the nurse document regarding this patient?

aThis patient presents with lack of self-esteem.

b The patient does not possess self-knowledge.

c This person has unrealistic expectations of themselves.

d There is an inability to evaluate himself realistically.

b. The patient’s inability to list more than three items about themselves indicates deficient self-knowledge and lack of familiarity with their own qualities and traits. There is insufficient data to determine whether they lack self-esteem, have unrealistic self-expectations, or are unable to evaluate themselves.

A nurse asks a patient who has few descriptors of themselves to list facts, traits, or qualities that they would like to apply to themselves. The patient quickly lists 25 traits of a successful person, stating, “My father is like this; I wish I were like him.” How does the nurse best interpret the discrepancy between the patient’s description of themselves as they are and how they would like to be seen?

a The patient suffers from a negative self-concept.

b This person demonstrates modesty (lack of conceit).

c This individual has a disturbed body image.

d The patient likely has a low self-esteem.

d. The nurse can obtain a quick indication of a patient’s self-esteem by using a graphic description of self-esteem as the discrepancy between the “real self” (what we think we really are) and the “ideal self” (what we think we would like to be). The greater the discrepancy, the lower the self-esteem; the smaller the discrepancy, the higher the self-esteem.

A nurse is counseling a couple who have decided that the wife will provide financial support for the family while the husband attends pharmacy school. The husband plans to work 16 hours weekly, while attending school and states, “I was always an A student, but I might have to settle for Bs now because I don’t want to neglect my family.” How would the nurse document the husband’s self-expectations?

a Realistic and positively motivating their development

b Unrealistic and negatively motivating their development

c Unrealistic but positively motivating their development

d Realistic but negatively motivating their development

a. The patient’s self-expectations are realistic, given their multiple commitments, and seem to be positively motivating their self-development.

A school nurse is teaching parents how to foster a healthy development of self in their children. Which statement made by one of the parents requires further teaching?

“I love my child so much I ‘hug him to death’ every day.”

“I think children need challenges, don’t you?”

“My partner and I grew up in restrictive families; we want our children to be free to do whatever they want.”

“We have different ideas about discipline, but we’ve continued our discussions so we can be consistent.”

c. Each option with the exception of c correctly addresses some aspect of fostering healthy development in children. Because children need effective structure and development, giving them total freedom to do as they please may actually hinder their development.

A mother of an outspoken school-aged child tells the nurse: “I feel incompetent as a parent and have difficulty disciplining my child.” What should be the nurse’s first action when counseling this patient?

a Recommending that she discipline her child more strictly and consistently

b Making a “to-do” list for the child’s father to allow her more time to focus on improving her parenting skills

c Assisting the mother to identify both what she thinks is successful and what she can do to improve

d Exploring how the child can improve their behavior and make the mother’s role as a parent easier

c. The nurse assesses the issue first, helping the mother identify what they believe is working and what is preventing them from being an effective parent. Next the nurse can explore solutions aimed at improving their parenting skills. Without assessment, there is no indication the child needs more strict discipline or assistance of the father. The child is not responsible for making the mother’s parental role easier.

A nurse is conducting a parent workshop on how to build self-esteem in children. Which teaching points would the nurse include to help parents achieve this goal? Select all that apply.

a Reinforce their child’s positive qualities.

b Overlook occasional negative behavior.

c Ignore neutral behavior that is a matter of personal preference.

d Listen and “fix things” for their children.

e Describe the child’s behavior and judge it.

f Let their children practice skills and make it safe to fail.

a, c, f.

The nurse should include the following teaching points for parents: (1) reinforce their child’s positive qualities; (2) address negative qualities constructively; (3) ignore neutral behavior that is a matter of taste, preference, or personal style. Parents should allow children to be challenged or fail, rather than “fix things” for their children; avoid judgmental observations and let their child know what to expect, practice the necessary skills, be patient, and make it safe to fail.

A nurse practicing in a health clinic assesses patient’s self-concept during the patient intake. Which of these patients would the nurse identify has risk for problems related to self-concept?

a Older adult scheduled for a hysterectomy next week

b Young adult pastor whose vocal cords were paralyzed after a surgical procedure

c Young accountant who survives a heart attack and near-death experience

d Model who just learned that they have breast cancer

e Adolescent recovering from a spinal cord injury who will be wheelchair “mobile”

b, c, d, e.

Based on the data, those who are at risk for negative self-concept include the pastor who will face challenges without his voice, the survivor of the near-death experience, and the model, whose work and livelihood depends on their physical appearance. The older adult would be least likely to experience body image or role performance disturbance because they are beyond childbearing years, and the surgery should not impair their functional ability. The young clergyperson’s inability to preach, the 32-year-old’s massive myocardial infarction, and the model’s breast resection have much greater potential to result in self-concept problems.

A patient who has been in the United States only 3 months has recently suffered the loss of partner and job. They state that nothing feels familiar—”I don’t know who I am supposed to be here”—and says “I miss home terribly.” For what alteration in self-concept is this patient most at risk?

a Disturbed (or Risk for Disturbed) Personal Identity

b Disturbed Body Image

c Chronic (or Risk for Chronic) Low Self-Esteem or Situational (or Risk for Situational) Low Self-Esteem

d Impaired Role Performance

a. An unfamiliar culture, coupled with traumatic life events such as loss of husband and job, result in this patient’s total loss of their sense of self, supported by the statement: “I don’t know who I am supposed to be here.”

A sophomore in high school has missed a great deal of school due to treatment of leukemia. They stated they feel that they are falling behind in everything, and miss “hanging out at the mall” with friends most of all. What statement by the nurse is most appropriate?

a “It sounds like you don’t know who you are anymore…”

b “Have the changes in your body since your diagnosis affected you?”

c “How are you viewing yourself these days?”

d “This must be difficult as adolescents’ friends are very important to them.”

d. Important roles for this adolescent include student and a friend; the illness is preventing them from doing either of these well, which reflects a disturbance in role performance. Stating that it sounds like you don’t know who you are anymore is a question related to personal identity disturbance; asking about changes in the body would relate to disturbed body image; asking how are you viewing yourself these days relates to self-esteem disturbance.

A college student visits the health clinic for a refill of a prescription for acne medication. In response to the nurse’s question about how her semester is going the student bursts into tears and cries, “No one will ever ask me out on a date. I just want to be thin and pretty like the other girls.” What response by the nurse could promote the student’s examination of their self-esteem?

a “You seem to have a negative body image and poor self-esteem.”

b “What are some things you’d like to change about your body.”

c “Most college students want to fit in; tell me what you enjoy doing.”

d “You are quite pretty and have a lovely figure.”

c. The nurse first assesses the patient's response to the accident before documenting a health problem and etiology. The nurse takes cues from the patient regarding their traumatic injuries, their fiancé's failure to contact them, and their withdrawal, which point to potential problems with both body image and self-esteem. The burn/trauma team would likely recommend plastic surgery, if indicated.

A young adult businessperson attends counseling, attempting to deal with a history of sexual abuse by their father. “I should feel satisfied with what I’ve achieved, but nothing I accomplish makes me feel good about myself. . . . I hate my father for making me feel like I’m no good. This is an awful way to live.” What statement by the nurse would be most helpful?

a “You’ve managed to overcome a lot since your childhood.”

b “Can you identify some positive attributes about yourself.”

c “Perhaps it’s time to accept you’re an adult and the abuse is in the past.”

d “What might make you feel more content? Go after it!

d. This patient’s self-concept disturbance is mainly one of devaluing themselves and thinking that they are no good. The nurse assists the patient in reframing their negative thoughts into positive thoughts.

A patient is admitted through the emergency department with severe facial burns and cuts to the face after a car accident in in which their fiancé was the driver. Three weeks later, their fiancé has not yet contacted them. The patient states that they are too tired to have visitors anyway and frequently lies with their eyes closed and head turned away. Based on this information, what action would the nurse take first?

a Identify a disturbance in self-concept.

b Question the patient about disturbances of body image.

c Ask the patient how the accident has affected her.

d Explain that the wounds are healing well, but she can consult a plastic surgeon after discharge if needed.

b. This patient is likely expressing concern with body image and self-esteem. The nurse seeks further information to support this, rather than suggesting the student has a negative body image or glossing over the student’s concern and offering their opinion about the student’s appearance or suggesting that their body needs changing. The nurse identifies the etiology of the student’s concern, needing to fit in and be desired.

A nurse is providing care for a patient with cancer who is approaching the end of life. Which nursing interventions will the nurse use to help the patient to maintain a positive sense of self? Select all that apply.

a Making a point to address the patient by name upon entering the room

b Avoiding fatiguing the patient by performing all procedures in silence

c Performing care in a manner that respects the patient’s privacy and preferences

d Offering the patient a simple explanation before moving them in any way

e Ignoring the patient’s negative feelings since they are part of the grieving process

f Avoiding conversing with the patient about their life, family, and occupation

a, c, d.

Interventions to assist the patient to maintain a positive sense of self include addressing the patient by name when entering the room; performing care in a manner that respects the patient’s privacy; offering simple explanations before moving the patient; acknowledging the patient’s status, role, and individuality; and conversing with the patient about the patient’s life experiences.

An older adult patient has a health problem of Disturbed Body Image documented on their care plan. The nurse discovers that patient feels they look old and feeble when ambulating with an assistive device often walking without it. The patient has fallen several times. What is an appropriate goal for this patient?

a The patient will state the need to use the assistive device both inside and outside the house.

b The patient will demonstrate proper use of the assistive device as observed by the nurse and physical therapist.

c The patient will discuss their feelings about the device and compare that with the need for safety.

d The patient will be given a wheelchair for mobility, as it is safer.

b. The patient is demonstrating a maladaptive response. Patients who deny and avoid dealing with limitations or deformity, engage in self-destructive behavior, or fail to estimate relationship of body to environment are experiencing a disturbed self-concept. The patient will need to grieve the loss of mobility as they age as well as realize that safety is a priority to prevent injury. The other interventions focus on the negative without helping the patient reframe the situation or allowing the patient to discuss their feelings.

A school nurse is meeting with the parent of a child who stated the child’s other parent has been given a lengthy prison sentence. Which action by the nurse would be most helpful to mitigate an adverse child experience?

a Assessing the student’s grades and ability to complete class work

b Suggesting a mentoring program for children of incarcerated parents

c Asking the parent to tell you what happened

d Suggesting the parent help the child identify their strengths

b. Factors that can mitigate adverse child experiences include strengthening economic support to families; promoting social norms that protect against violence and adversity; and ensuring a strong start for children including support groups, mentoring, and teaching needed skills.

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