Foundations Exam 2 (Self Concept, Complementary and Integrative Health)

Self Concept

-How an individual views and evaluates themselves

-The learned beliefs, values, and perceptions about their abilities, personality traits, social roles, and connections with various social groups

-Influences behavior, choices, and interactions with others

-Evolves throughout the lifespan

Self image

-The way an individual views their unique qualities

-Genetic and physical characteristics, intelligence, and talent

-Does not always align with reality

Self esteem

Assessment of a persons overall level of self worth and how people feel about themselves

Negative self esteem

-Inadequate

-Devalued

-Unworthy

Postive self esteem

-Capable

-Valued

-Worthy

Roberts theory of self concept

Global self:

-Who am I?

-Composite of all the basic facts, qualities, traits, images, and feelings

Ideal self:

-Who do I desire to be?

False self:

-Emotional need to respond to the needs and ambitions of significant people

Congruence

Ideal self is consistent with life experiences

Incongruence

Ideal self is inconsistent with life experiences

Factors affecting self concept: Emotional intelligence

-Individual is able to perceive, understand, control, manage, and evaluate emotions

-High = strong sense of self understanding and ability to discern the emotions of others

Emotional intelligence

-Self awareness

-Self regulation

-Motivation

-Empathy

-Social skills

Factors affecting self concept: Self awareness

-Ability to see oneself clearly and objectively through reflection and introspection

-Ability to understand our emotions and their effects on others, to know what we are feeling and why, and to sense how we are perceived by others

High self awareness = adaptable and resilient

Factors affecting self concept: Body image

-One's feelings, perceptions, behaviors, and attitudes toward one's own physical appearance

-Dynamic process that changes throughout the lifespan

-Adolescents are most vulnerable to body dissatisfaction

-Situational and health related factors

Factors affecting self concept: Disability

Disabilities affect:

-2 in 5 adults > 65 years old

-1 in 4 women

-2 in 5 non-Hispanic American Indian / Alaskin Native

Patients with disabilities:

-1 in 3 do not have a usual health care plan

-1 in 3 have an unmet healthcare need

-1 in 4 have not had a routine check up in the year prior

Factors affecting self concept: Self Efficacy

-A persons perceived ability and aptitude to successfully complete a task

-Determines how individuals feel, think, behave, and motivate themselves

-Cognitive, motivational, affecting, and selection processess

Factors affecting self concept: Culture

-The learned, shared, and transmitted values, beliefs, norms, and life ways of a particular group

-Guides thinking, decisions, and actions in patterned ways

-Not all individuals from a specific culture share the same cultural experience

-How the nurse's culture influences patient interactions

Factors affecting self concept: Role performance

Role: a set of expected behaviors determined by family, culture, and societal norms

-The specific behaviors that a person displays within each role and the perceptions of their ability to successfully fulfill the roles

-Simultaneous and multiples roles that change often

Trust vs. Mistrust (birth to 1 year)

Infants develop a sense of trust when caregivers provide reliable care and affection

Autonomy vs. shame ( 1 - 3 years old)

Children develop a sense of control and independence. Success leads to feelings of self reliance; failure results in feelings of shame and uncertainty

Initiate vs. guilt (3 - 6 years old)

Children develop a sense of self awareness and assert control and power over their environment. Success leads to a sense of purpose. Exerting too much power may result in disapproval and feelings of guilt

Industry vs. inferiority (6 - 12 years)

Children begin to cope with new social and school interactions and feedback from peers and teachers. Success leads to sense of competence, while failure results in a feeling of inadequacy

Identity vs. role confusion (12 -19 years)

Adolescents develop a sense of self and personal identity. Exploration leads to a positive sense of self, while failure leads to role confusion and a weakened sense of self.

Intimacy vs. isolation (20 - mid 40s)

Young adults form intimate, stable relationships with others and achieve successful role transition. Success leads to healthy relationships, while failure results in loneliness and isolation

Generative vs. stagnation (mid 40s - mid 60s)

Adults accept life changes, reassess life goals, and create positive change that benefits other people. Success leads to feelings of usefulness and accomplishment, while failure results in lack of involvement and meaning

Integrity vs. despair (mid 60s to death)

Older adults reflect on life and feel a sense of fulfilment. Success at this state leads to a feeling of wisdom, while failure results in regret, bitterness, and despair

Identity formation

Identity is fluid:

-Complex, lifelong process whereby individuals develop an understanding of themselves within the context of family, cultural, and societal norms

-First identity is often not the last

Exploration: active searching

Commitment: demonstrated investment

Adolescence identity formation

Experiment with difference personas, roles, identities before committing to an identity in a variety of life domains

-Ideology

-Occupation

-Relationships

-Gender roles

Self concept stressor

An event or perception that has a negative impact on how a person perceives themselfe

Self concept

-Identity

-Body image

-Role performance

-Self esteem

Role performance

Set of assigned or expected behaviors and obligations based on social position or one's place in the world

Role conflict

Faced with two or more role expectations and are unable to meet them at the same time

Role ambiguity

Lack of clarity about the actions that need to be taken to achieve prosed goals!

Role overload

Roles and responsibilities placed on individuals are greater than their ability to effectively manage them or when they find themselves pressured to respond to the many roles they hold

Role strain

Difficulty meeting the responsibilities of a particular life role or when incompatible demands are placed on an individual

Body image

Societal attitudes about physical attributes, appearance, and performance that can impact a patient's self perception of their body image

Stressors:

-puberty

-aging

-chronic illness

-weight stigmatization

High self esteem

Favorable evaluation of self that contributes to better health and serves as a buffer against the impact of negative stressors

Low self esteem

Unfavorable view of themselves that can reduce an individuals quality of life and ability to deal with health alteractions

Self esteem stressors

-Disability

-Chronic illness

-Loss of career

-Change in financial status

-Feeling irrelevant due to retirement

-Loss of social support

Identity confusion

Unclear sense of self, individuality, and personality from the inability to adapt to identify stressors

Well developed identity

Enhances self concept and confidence

Poorly developed identity

Increased risk of mental health conditions

Identity stressors

-Gender dysphoria

-End of relationship

-Change in employment

-Marginalization and discrimination

Adverse childhood experiences

-Violence

-Abuse

-Neglect

-Substance misuse

-Mental health

-Familial instability

Prevent adverse childhood experiences

-Strengthen economic support

-Promote social norms that deter violence

-Ensure a strong start for children

-Teach skills

-Connect youth to caring adults and activities

-Intervene to lessen harm

Assessment of self concept

Who:

-patient

-significant other

Why:

-perceptions of their health status and condition

-identify health alterations related to self concept

-actual or potential stressors: impact, intensity, nature

-coping strategies and their effectiveness

How:

-verbal statements, body language, and nonverbal indicators

Therapeutic communication: direct questions, open ended questions, active listening, clarifying information

Assessment: Identity

-How would you describe yourself?

-What words might others use to describe you?

-How is you identity influenced by others or by society?

-How do the opinions of others impact how you see youself?

Assessment: Body image

-How would you describe your physical appearance?

-Which aspects of your body or physical appearance do you like and appreciate?

-Which aspects of your body or physical appearance do you dislike or wish you could change

-How important is it to always look your best?

Assessment: Self esteem

-What are some of you accomplishments or qualities that make you feel good about yourself

-How do you respond when you experience failure

-How comfortable are you expressing your opinions and ideas?

-How much do you worry about what others think of you?

Assessment: Role Performance

-Describe two or three of your primary roles.

-If your roles conflict, how do you cope or adapt to fulfill them?

-What kind of support do you have to fulfill your various roles

-Which feelings do you experience when thinking about some of your primary role?

Self concept: diagnosis

-Altered body image perception

-Chronic low self esteem

-Denial

-Impaired role performance

-Situational low self esteem

-Nonadherence

-Readiness for enhanced self concept

-Coping impairment

-Self harm risk

Self concept: Planning

-Verbalizes that self if linked

-Describes self realistically, including strengths and weaknesess

-Verbalize realistic expectations for self, based on ideal self

-Utilize healthy coping strategies and support systems

-Verbalizing acceptance and showing adaptation to an altered health condition

-Assume role related responsibilities with confidence

-Take practical steps toward achieving independence at home and work

Self concept: implement

-Identify and promote personal strengths

-Enhance self esteem of older adults

-Develop a positive body image

-Modify a negative self concept

-Teach self compassion

Implement: body image

Response to to deformity or limitation:

Adaptive Response: signs of grief or mourning

Maladaptive Response: denial and avoids dealing with the deformity or limitations, feelings of worthiness or insecurity, self destructive behavior

Independence / dependence patterns:

Adaptive response: assumes responsibility for care, develops new self care behaviors, uses resources

Maladaptive response: assigns responsibility for his / her care to others, increasingly dependent refuses necessary help

Evaluate self concept

-Validate acceptance of body image, function, and appearance

-Able to verbalize self acceptance and self worth

-Able to meet realistic goals and role expectations

-Capable of interacting approprately with environment

-Utilizes healthy coping mechanisms

Allopathic (conventional) medicine

-Drugs, surgeries, radiation, and medical procedures

-Body and mind are separate

-Health = absence of disease

-Emphasis on disease and technology

Comparison:

-Treats disease

-Focus on symptoms

-Medications and surgeries

Complementary health approaches (CHAs)

-Used alongside conventional medicine

ex: Yoga for anxiety while taking prescription medication

Comparison:

-Used with conventional care

-Supports healing and wellness

-Meditation, yoga, acupuncture

Integrative health

-Combines conventional medicine and CHAs in a coordinated way

-Focuses on the whole person

Comparison:

-combines both approaches

-focus on whole person care

-coordinated treatment plan

Holism

Recognizes interconnected dimensions

-Physical

-Mental

-Emotional

-Social

-Cultural spiritual

-Sexual

-Energetic

Holistic nursing

-Focuses on healing the whole person

-Promotes wellness and self care

-May incorporate CHAs into practice

Holistic health promotion

-Healthy diet

-Exercise

-Stress management

-Positive relationships

-Adequate sleep

-Spiritual well being

Prevalence of holistic health

-30% of adults

-Women > men

-Caucasian > hispanic > african american

-Ages 30-69

-Higher level of education

-Higher socioeconomic status

-Private insurance

-West coast

Reasons for holistic health

-Improve health and well being

-Relieve symptoms of chronic disease

-Relieve side effect of conventional treatment

-Greater control over one's own health

-Holistic health philosophy

-Transformational experience

Integrative care and nursing

Nursing responsibilities:

-assess use of CHAs

-respect patient beliefs and preferences

-educate patients on safety

-collaborate with healthcare team

-evaluate effectiveness of therapies

Categories of complementary health approaches

-Diet and natural products

-Mind body practices

-Energy healing therapies and other CHAs

Diet and natural products

-Herbs

-Vitamins

-Nutritional supplements

Mind body practices

-Meditation

-Yoga

-Tai Chi

-Guided imagery

-Biofeedback

Energy healing therapies and other CHAs

-Acupuncture

-Massage

-Reiki

Holistic food approaches

-Reduce intake of processed foods

-Reduce soft drinks

-Avoid preservatives

-Reduce natural sugars

-Reduce artificial sweeteners

-Reduce dairy products

-Eat organic

-Eat "in season foods"

Botanicals and nutritional supplements

-May reduce symptoms

-Vitamins, minerals, enzymes, amino acids, and more

-Not classified as drugs and not regulated for quality and potency

-Wide range of safety and effectiveness

Mind and body practices

-Meditation

-Guided imagery

-Relaxation techniques

-Aromatherapy

-Yoga

-Tai Chi and Qi Gong

Meditation

-Become mindful of thoughts, feelings, and sensations

-Quiet environment

-Comfortable position

-Focus on attention

-Open attitude

Guided imagery

-Uses all five senses

-Promotes relaxation

-Visualize the outcome

Relaxation techniques

-Deep breathing

-Promotes parasympathetic nervous system activity

-Anxiety reduction

-Decreased pain and muscle tension

-Improved rest and sleep

-Improved immune system function

Aromatherapy

-Affect the amygdala, where emotions and memories are stored and released

-Essential oils

-Treat a variety of symptoms

Yoga

-Promotes strength and flexibility

-Increases endurance

-Promotes relaxation and sleep

-Reduces response to stress

Tai Chi and Qi Gong

-System of postures, exercises, breathing techniques, and visualizations

-Improves balance and coordination

-Reduces falls

Manipulative and body based practices

-Massage therapy

-Chiropractic care

-Osteopathy

-Acupuncture

Massage therapy

-Reduces muscle tension

-Improves relaxation

Chiropractic crae

-Spinal manipulation

-Corrects alignment problems

-Alleviates pain

-Improves functioning

-Supports the body's healing

Osteopathy

Uses manipulation to support health

Acupuncture

-Addresses Qi (energy flow) to restore the balance of yin and yang

-Uses thin needles

-Reduces pain

-Reduces N/V

-Promotes adherence to substance abuse programs

Energy healing therapies

-Therapeutic touch (TT)

-Healing touch (HT)

-Sound healing

-Reiki

Therapeutic touch

-Uses hands near body

-Promotes relaxation

Healing touch

-Enhances self healing

-Balance physical, emotional, mental, and spiritual well being

Sound healing

-Vibrational energy of tone, music, charts, song, and sound production instruments

-Relaxation, improves sleep, and decreases anxiety

-used sound vibrations to promote relaxation

Reiki

Energy healing practice

Natural products

Herbal products:

-ginger

-turmeric

-echinacea

Nutritional supplements:

-omega 3 fatty acids

-vitamins

-minerals

Purpose:

-health promotion

-symptom management

Important safety considerations of supplements

-FDA regulates dietary supplements differently than medications

-Products may vary in quality

-Follow label directions

-Monitor for side effects

-Purchase from reputable companies

Nursing role in the safe use of supplements

-Ask patients about supplement use

-Assess for drug interactions

-Provide evidence based education!

Herbal supplement nursing example

Patient takes:

-Warfarin

-Ginkgo biloba supplement

Nursing concern:

-Increased bleeding risk

Nursing action:

-assess supplement use

-notify provider

-educate patient regarding risks

Medical cannabis

Used for:

-chronic pain

-nausea

-appetite stimulation

CBD (cannabidiol)

-Found in cannabis and hemp

-Available OTC

Nursing education of Cannabis and CBD

-Products may not be regulated

-Not proved to treat all advertised conditions

-Discuss use with health care provider

Traditional Chinese medicine

Concepts:

-balance of yin and yang

-harmony within the body

Therapies:

-acupuncture

-Tai Chi

-herbal remedies

Nursing example:

-patient uses acupuncture to help manage chemotherapy related nausea

Homeopathy

Uses diluted substances

Naturopathy

-Supports body's natural healing abilities

-Emphasizes lifestyle changes

Shamanism

-One of the older healing traditions

-Spiritual and cultural healing practices

Nursing considerations of homeopathy, naturopathy, and shamanism

Respect patient choices while providing evidence based care

Nursing implications of complementary health approaches

-assess patient use of CHA's

-evaluate safety and effectiveness

-respect cultural beliefs

-educate patients using evidence based information

-promote informed decision making

-incorporate appropriate self care strategies

Self care for nurses

Examples:

-meditation

-yoga

-exercise

-healthy diet

-sleep hygiene

-positive work relationships

Benefits:

-reduced stress

-improved resilience

-prevention of burnout

-enhanced patient care