Chapter 41: Self-Concept

Introduction to Self-Concept

• Definition: Self-concept encompasses an individual's self-image, what makes them unique, and all factors contributing to their identity. It's crucial for nurses to consider patients' self-image, especially during illness.
• Three Dimensions of Self-Concept:
  • Self-knowledge
  • Self-expectation
  • Self-evaluation

Variables Contributing to Self-Concept

• Self-Esteem:
  • An individual's need to feel good about themselves.
  • The belief that others hold the individual in high regard.
  • As per Maslow's hierarchy of needs, self-esteem is an upper-level psychological need.
• Self-Actualization:
  • The need to reach one's full potential through the complete development of unique individual capabilities.
  • Example: Pursuing a career in medicine to fulfill one's potential (Answer to Question $1$).
• Positive Self-Concept:
  • Associated with more diversified and extensive self-knowledge.
  • Leads to more realistic perceptions and expectations.
  • Results in a higher self-evaluation (higher self-esteem).
• Negative Self-Concept:
  • Characterized by poorer self-knowledge.
  • Results in less realistic perceptions and expectations.
  • Correlates with lower self-esteem.
  • Significantly impacts daily interactions and a patient's outlook.

Maslow's Subsets of Esteem Needs

• Maslow believed all people desire a stable, firmly based, high evaluation of themselves, self-respect, and the esteem of others.
• Self-Esteem Needs: Strength, achievement, mastery, competence, confidence, independence, and freedom.
• Respect Needs: Status, dominance, recognition, attention, importance, and appreciation.

Cooper Smith's Four Bases of Self-Esteem (Page $1635$)

• Significance: The extent to which individuals feel loved and approved by important people in their lives (e.g., friends, family, significant others). It reflects the desire for social approval.
• Competence: How well individuals perform tasks they consider important. Nurses, for example, are expected to be competent in procedures.
• Virtue: The attainment of moral and ethical standards.
• Power: The degree to which individuals can influence their own lives and the lives of others.

Major Self-Evaluation Feelings

• The "ideal self" constitutes the person one wishes to be (True/False question: True). Attaining this ideal self is not always possible.
• These three self-evaluation feelings (affects) are learned in early childhood through interactions with significant others and are maintained through practice:
  • Pride: Based on a positive self-evaluation.
  • Guilt: Arises from behaviors that are inconsistent with the ideal self.
  • Shame: Associated with an overall low global self-worth.

Formation of Self-Concept

• Self-concept is not innate (people are not born with it, similar to morals); it is developed over time.
• Infant Stage: Learning that the physical self is distinct from the environment.
• Childhood Development:
  • Positive feelings of self develop when basic needs are met.
  • Children internalize other people's attitudes towards them, which can have long-lasting impacts.
  • Children and adults internalize societal standards and norms, learning what is acceptable.

Psychological Conditions Fostering Healthy Development in a Child (Page $1636$)

• Emotional warmth and acceptance.
• Effective structure and discipline.
• Clearly defined standards and limits.
• Appropriate role models.
• A stimulating environment.
• Encouragement of self-confidence and competence.
• Assistance for the child in meeting challenges.

False Self and Stages in Development of Self

• False Self: May develop in individuals who feel an emotional need to meet the ambitions or expectations significant people (like parents) have for them, even if it contradicts their true desires (True/False question: True).
  • Example: Pursuing a career chosen by parents rather than personal inclination.
• Stages in Development of Self:
  • Self-awareness.
  • Self-recognition.
  • Self-definition (around $3$ years of age).
  • Self-concept development (around $6$ to $7$ years of age, e.g., when starting school).
• Important Note: People are not born with self-concept; it is a learned attribute, heavily influenced by environment and family.

Factors Affecting Self-Concept

• Developmental Considerations: The criteria for a positive self-concept change as an individual matures (Page $1637$).
• Internal and external resources.
• History of Success and Failure: Numerous successes can build a strong self-concept, while repeated failures or lack of support can weaken it.
• Crisis or Life Stressors: Illness, hospitalization, or other major life events can significantly impact a patient's self-concept.
• Aging: The process of aging can affect an individual's self-perception.
• Illness and Trauma: These factors often lead to changes in self-concept, influencing patient behaviors and perspectives.

Assessing Self-Concept (Page $1640$)

• Nurses assess a patient's self-concept by focusing on four key areas, which should be part of every comprehensive nursing assessment:
  • Personal Identity: Who the patient perceives themselves to be (e.g., parent, spouse, professional) and their associated roles.
  • Body Image: A critical component in society. Anything that physically alters the body (e.g., amputation, severe surgical scars, colostomy, tracheostomy, burns) can risk lowering self-concept.
  • Self-Esteem: How the patient feels about themselves and how they believe others view them.
  • Role Performance: The patient's ability to fulfill their established roles. Inability to perform these roles due to illness or disability (either temporarily or permanently) can drastically alter their life and self-concept.
• A focused assessment can be found on page $1641$.

Assessing Self-Esteem (continued)

• Socialization and communication patterns.
• Significance (perceived importance).
• Competence: An individual's ability to perform a role or job effectively.
  • Example: Asking a patient, "How important is it to you to believe that your work has value to others?" assesses competence (Answer to Question $5$).
• Virtue.
• Power.

Adaptive and Maladaptive Responses (Page $1642$)

• Adaptive Responses (Positive):
  • Maintain usual social patterns.
  • Communicate needs and accept offers of help readily.
  • Serve as support for others.
• Maladaptive Responses (Negative):
  • Isolate oneself from friends and family.
  • Exhibit superficial self-confidence that lacks genuine depth.
  • Are unable to express needs, often leading to hostility, shame, frustration, or depression.
• Nurses should observe changes in patient behavior, as maladaptive responses may indicate deeper distress beyond physical pain.

Self-Concept Continuum

• Self-concept exists on a continuum, allowing patients to move between different states based on circumstances.
• Positive End: Characterized by a positive self-concept, self-actualization, and adaptive responses.
• Middle: Indicates developing low self-esteem.
• Negative End: Reflects identity diffusion, dissociation, and depersonalization (maladaptive responses).

Nursing Strategies to Identify Personal Strengths (Page $1645$)

• Help patients identify and utilize their individual strengths.
• Assist at-risk patients in maintaining their sense of self, especially when illness threatens their identity.
• Enhance or modify the self-concept to foster positive growth.
• Develop a positive body image, particularly if physical changes have occurred.
• Collaborate with parents and educators to build self-esteem in children, adolescents, and older adults.

Helping Patients Maintain a Sense of Self (Page $1646$)

• Communicating Worth: Convey value through appropriate looks, speech, and judicious (careful, thoughtful) touch.
• Acknowledging Status, Role, and Individuality:
  • Address patients by their preferred name (avoid informal terms unless requested).
  • Speak respectfully to them.
• Providing Explanations: Offer simple, clear explanations for all procedures before acting.
• Respectful Physical Care: Move the patient's body with respect, treating them as one would a loved one.
• Ensuring Privacy: Respect the patient's privacy and sensibilities, especially when procedures require uncovering them.
• Allowing Emotional Expression: Acknowledge and permit the expression of negative feelings; patients sometimes need to vent.
• Recognizing Strengths: Highlight what patients can still do, especially when they are losing abilities, to maintain hope and self-worth. It is important for patients to not feel like there is nothing left. The nurse must recognize and support the patient's self-worth and strengths. This involves emphasizing remaining capabilities when some are lost due to illness or trauma.