Self-Concept and Coping Strategies

Self-Concept

  • Defined as the way a person thinks about themselves or their overarching perception of who they are.

  • Characterized as a unique, dynamic, subjective, and evolving process occurring throughout the lifespan, most flexible in early human development.

  • Influences not only one’s identity but also the relationships individuals form throughout their lives.

Distinction Between Self-Concept and Self-Esteem

  • Self-concept vs. Self-esteem:

    • Self-concept: Relates to how a person perceives or thinks about themselves.

    • Self-esteem: Relates to how a person feels about themselves.

  • Over time, self-perceptions may change as individuals experience and respond to new life situations and challenges, influenced by their self-knowledge.

Key Components of Self-Concept

  • Self-image: The way an individual views their unique qualities, including genetic and physical characteristics.

    • It encompasses perceptions of oneself based on physical appearance and abilities.

  • Self-esteem: The evaluative component of self-concept; refers to the assessment of a person’s overall level of self-worth and their feelings about themselves.

  • Ideal self: Represents what a person aspires to be, including values and life goals.

Factors Influencing Development of Self-Concept

  • Emotional Intelligence (EI): The ability to perceive, understand, control, manage, and evaluate emotions effectively.

  • Self-awareness: The ability to see oneself clearly and objectively, often through reflection and introspection.

  • Body Image: A person's perceptions, feelings, and thoughts about their body, which relates to concepts of body shape, size, and physical attractiveness.

  • Self-efficacy: A person's perceived ability to successfully complete a specific task or achieve a goal.

  • Culture: The learned, shared, and transmitted values, beliefs, norms, and lifeways of particular groups influencing decision-making and behaviors.

  • Role Performance: The actual behaviors displayed within specific roles and perceptions of one's ability to fulfill these roles.

Erikson’s Theory of Psychosocial Development

  • Describes eight developmental stages influencing self-concept:

    1. Trust vs. Mistrust (Birth to 1 year)

    2. Autonomy vs. Shame and Doubt (1 to 3 years)

    3. Initiative vs. Guilt (3 to 6 years)

    4. Industry vs. Inferiority (6 to 12 years)

    5. Identity vs. Role Confusion (12 to 19 years)

    6. Intimacy vs. Isolation (20 to mid-40s)

    7. Generativity vs. Stagnation (mid-40s to mid-60s)

    8. Integrity vs. Despair (mid-60s to death)

Identity Formation

  • Concept of identity formation as a lifelong process involving:

    • Understanding oneself within the context of familial, cultural, and social norms.

    • Factors at each developmental stage that contribute to developing a healthy, positive self-concept.

Identity Stressors

  • Factors contributing to identity stress:

    • Body image stressors

    • Self-esteem stressors

    • Role performance stressors

    • Role conflict

    • Role ambiguity

    • Role strain

    • Role overload

Role of Nurses in Self-Concept

  • Nurses play a crucial role in implementing comprehensive, client-centered, holistic care plans to promote a positive self-concept among patients.

Defining Stress

  • Stress is complex and varies by perspective:

    • Defined as the mental, emotional, or physical response and adaptation to real or perceived changes and challenges.

    • Can also be seen as a condition where the body reacts to maintain equilibrium.

Fight or Flight Response

  • Mechanism triggered by stress:

    • The hypothalamus releases corticotropin-releasing factor (CRF).

    • Activates the sympathetic nervous system (SNS) causing release of norepinephrine, epinephrine, and dopamine—known as the “fight or flight” response.

    • Effects include:

    • Increased heart rate

    • Elevated blood pressure

    • Increased cardiac output

    • Dilation of bronchial airways

    • Pupil dilation

    • Elevated blood glucose levels.

Hormonal Response to Stress

  • CRF signaling leads to:

    • Activation of the anterior and posterior pituitary glands and release of adrenocorticotropic hormone (ACTH).

    • ACTH prompts release of cortisol from the adrenal glands, promoting:

    • Mental alertness

    • Focus

    • Reduced pain perception.

General Adaptation Syndrome (GAS)

  • Describes a three-stage reaction to stress:

    1. Alarm stage

    2. Resistance stage

    3. Exhaustion stage

  • The body strives to return to homeostasis regardless of stressor nature (eustress or distress).

Transactional Theory of Stress and Coping

  • Defines stress as an interactive process involving transactions between the individual and their environment:

    • Involves primary and secondary appraisal stages before reacting to stressors.

    • Response determined by individual assessment of the threat and available coping resources.

Sources of Stress

  • Categories of stressors include:

    • Physiological Stressors: Associated with injury or illness, leading to immediate body reactions necessary for survival.

    • Psychological Stressors: Associated with negative or threatening events, interactions, or situations.

Types of Stress

  • Acute Stress: Most common, brief, can be either positive or negative, triggers immediate reactions.

  • Episodic Acute Stress: Occurs with frequent acute stress experiences; can degrade health and relationships.

  • Chronic Stress: Prolonged elevation of stress, leading to disabling conditions.

    • Types of stressors: situational, developmental, adventitious, socioeconomic, cultural.

Stress Disorders

  • Acute Stress Disorder (ASD): Intense reactions to trauma lasting less than a month; if prolonged beyond one month: Post-Traumatic Stress Disorder (PTSD).

Crisis Definition and Severity

  • A crisis is a threatening state causing intense emotional or behavioral responses due to a precipitating event.

  • Severity levels range from Level 1 (least severe) to Level 4 (most severe).

Seven-Stage Model of Crisis Intervention

  1. Conduct a thorough biopsychosocial crisis assessment.

  2. Establish rapport and create a therapeutic environment.

  3. Assess dimensions of the problem or crisis.

  4. Encourage clients to express their emotions.

  5. Explore coping strategies and alternatives from the past.

  6. Implement an action plan.

  7. Establish a follow-up plan.

Types of Defense Mechanisms

  • Ego Defense: Mental operations outside of conscious awareness protecting self-esteem.

    • Denial: Refusal to accept reality to avoid emotional impact.

    • Rationalization: Justifying undesirable behaviors to avoid discomfort.

    • Projection: Attributing unwanted thoughts or feelings onto others.

    • Repression: Concealing painful memories or thoughts to forget them.

    • Regression: Retreating to earlier stages of development for comfort.

    • Compartmentalization: Categorizing life experiences to avoid anxiety in contexts.

Coping Strategies

  • Coping involves strategies to deal with stressors influenced by psychological, sociological, and cultural factors.

  • Healthy coping strategies include:

    • Nutritional diet

    • Daily exercise

    • Personal resilience building

    • Self-care activities (mindfulness, rest, relaxation practices, journaling).

Grief

  • Grief defined as feelings or reactions to any loss, not limited to death.

Types of Grief

  • Normal Grief: Common reaction to the loss of a close individual.

  • Anticipatory Grief: Grief felt before an expected loss.

  • Prolonged Grief Disorder (PGD): Grief lasting over six months affecting functioning.

  • Disenfranchised Grief: Related to unrecognized losses by society.

Kubler-Ross Five Stages of Grief Model

  1. Denial: Refusal to believe the truth, lessening loss pain.

  2. Anger: Emotional distress; questioning "why me?" and feeling unfair treatment.

  3. Bargaining: Making promises in exchange for a better outcome or relief.

  4. Depression: Deep feeling of loss as reality settles in.

  5. Acceptance: Acknowledgment of pain but realization of future okayness.

Dual Process Model of Grief

  • Suggests grieving oscillates between two stressor types:

    • Loss-oriented stressors: Expressed through intense thoughts and feelings of sadness.

    • Restoration grief: Involves coping with secondary losses and rebuilding life without the deceased.

Worden's Four Tasks of Mourning

  1. Accept the reality of loss.

  2. Experience the pain of grief.

  3. Adjust to a life without the loved one.

  4. Create an ongoing connection to the deceased while forming a new life.

Common Grief Reactions

  • Typical reactions include:

    • Shock

    • Anger

    • Anxiety

    • Numbness

    • Denial

    • Guilt

    • Sadness

    • Relief (if anticipated)

    • Depression.

Role of Religious-Spiritual Rituals

  • Religious or spiritual practices can facilitate the grieving process and help individuals cope with loss.

The NURSE Technique

  • Techniques to assist clients through their grief include:

    1. Name: Identify emotions or statements from the client.

    2. Understand: Acknowledge the client's feelings and provide an outlet for expression.

    3. Respect: Show respect for the client’s feelings.

    4. Support: Offer support and availability to the client.

    5. Explore: Use open-ended questions to extend conversations and understanding.

Grief, Loss, and Palliative Care

  • Address aspects of palliative care, including:

    • The nurse's role.

    • Manifestations of approaching death.

    • Post-mortem care guidelines.

    • Discussion of advance directives, living wills, and healthcare proxies.

    • Factors influencing loss, grief, and coping strategies.

Nurse Reactions to Grief

  • Nurses may experience grief after a client's death; expressions vary based on clinical circumstances and personal factors.

  • It is vital for nurses to recognize and manage their grief thoughtfully.