SELF-CONCEPT

SELF CONCEPT: JESSICA GAY, PH.D., RN C-MNN, CNE

BEFORE WE BEGIN

  • Empowerment Message:
      - You are: Capable and Qualified
      - We believe you have: Brought your best effort today
      - We hold you in: High regard
      - We hold you to: High standards
      - We will provide: Strong academic content
      - This classroom is open to: Shared thinking and learning
      - We encourage you to: Take risks, be curious, be vulnerable in the service of learning
      - We ask you to: Listen to other perspectives and treat one another with respect

OBJECTIVES

  • Define self-concept and differentiate it from related concepts using defining characteristics.

  • Discuss factors impacting a patient's self-concept including cultural considerations and nursing actions.

  • Explore one's own self-concept as a crucial component of patient care.

  • Apply clinical judgment to promote a patient’s self-concept, including the selection of evidence-based nursing interventions.

  • Discuss exemplars of self-concept including etiology, treatments, nursing considerations, patient teaching, and their relationship to the defining characteristics of the concept.

DEFINITION

  • Self Concept: The ideas, thoughts, feelings, and attitudes that a person has about their own worth, capacities, and limitations.

DEFINING CHARACTERISTICS

  • Inclusions:
      - Body image, self-esteem, and personal identity (all interrelated).

  • Development:
      - Develops over a lifetime.
      - It is dynamic and variable.

INTERRELATED CONCEPTS

  • Self Concept is connected with:
      - Mood and Affect
      - Family Dynamics
      - Human Development
      - Caring
      - Safety
      - Communication
      - Diversity
      - Stress and Coping
      - Advocacy
      - Behavior

SELF CONCEPT VS SELF ESTEEM

  • Self Concept: How one thinks about oneself; an individual’s view of oneself.
      - Question: Who am I?

  • Self Esteem: How one feels about oneself, often in comparison to an ideal self.
      - Questions: Am I who I should be? Who do I want to be?
      - Self-esteem is a component of self-concept.

COMPONENTS OF SELF CONCEPT

  • Body Image:
      - Refers to a person’s beliefs and attitudes about their body, including size and attractiveness.
      - Typically more emphasized for women than men.
      - Attitudes related to physical appearance, structure, or function.
      - Mental image may not align with actual image.
      - Affected by developmental changes such as puberty and aging.

  • Self-Esteem:
      - Reflects a person’s overall satisfaction with self.
      - Considered the most fundamental self-evaluation.
      - High self-esteem occurs when self-concept reflects the ideal self.
      - Can be temporarily impacted by situational crises.
      - Includes role performance evaluations.

  • Personal Identity:
      - Encompasses the knowledge of “who I am”.
      - Represents the internal sense of individuality, wholeness, and consistency over time and in various situations.
      - Essential for establishing boundaries and understanding personal strengths and limitations.
      - Learned through experiences, first mainly from parents.
      - Critical for establishing relationships.

FACTORS INFLUENCING SELF CONCEPT

  • Developmental stage throughout the lifespan.

  • Sense of competency:
      - Perceived reactions of others regarding one's body.

  • Ongoing perceptions and interpretations of thoughts and feelings from others.

  • Personal and professional relationship influences.

  • Academic and employment-related identity formation.

  • Perceptions of events impacting the self.

  • Mastery of prior and new experiences.

  • Cultural identity and context.

COMMON STRESSORS

  • Body Image Stressors:
      - Stroke, colostomy, anorexia nervosa, arthritis, incontinence, obesity, multiple sclerosis, amputation, scarring, aging, altered body image, pregnancy, mastectomy, rape, assault.

  • Self-concept/Self-esteem Stressors:
      - Job loss, changes in marital status, abuse or neglect, dependency on others, sexuality concerns, repeated failures, societal attitudes, conflict with others.

  • Role Performance Stressors:
      - Inability to balance career and family responsibilities, physical or emotional deficits preventing role assumption, loss of satisfying role, transitions from school to work, promotion or demotion, changing work environment, empty nest syndrome, and assuming responsibility for aging parents.

POPULATIONS AT RISK

  • Adolescents

  • Elderly individuals

  • Caregivers

  • Individuals post-trauma (whether physical or psychological)

  • Those undergoing major changes (maturational, physical, functional, or role changes)

RISK FACTORS

  • Any real or perceived changes threatening identity, body image, or role performance.

  • Changes in appearance, structure, or body function, e.g., health concerns, sexual function changes:
      - Examples include menopause, benign prostatic hyperplasia (BPH), age spots, mobility changes, injuries.

  • Role Performance Stressors:
      - Role conflict (assuming two or more roles simultaneously), role strain (feeling inadequate for role), role overload (unable to manage multiple roles).

  • Spiritual, emotional, familial, or social changes can also act as risk factors.

ASSESSMENT

  • Elicit the Patient’s Thoughts:
      - Use self-portrait drawing as a tool.
      - Listen to patient statements reflecting negative self-concept, e.g., "I am so fat/ugly/stupid."

  • Interpret both verbal and non-verbal communication cues.

  • Nonverbal Behaviors:
      - Behaviors such as avoiding looking at or touching body parts, hiding oneself in oversized clothing, downward posture, cast-down eyes, or unkempt appearance can indicate issues in self-concept.

  • Consider cultural and ethnic backgrounds in assessments.

ASSESSMENT (CONTINUED)

  • Client Expectations:
      - Understand patient goals, beliefs, and attitudes about interventions.

  • Data Gathering:
      - Look for patient strengths and gather comprehensive information from various sources.
      - Utilize knowledge of developmental stages in understanding self-concept.
      - Nurse’s self-concept can affect assessment outcomes, as nurse behaviors and comments can influence the patient.

POSSIBLE NURSING CLINICAL PROBLEMS

  • Negative self-image

  • Disturbed body image

  • Low self-esteem (chronic or situational) or risk thereof

  • Ineffective individual coping

  • Risk for interpersonal violence or victimization

  • Caregiver role strain or impaired role performance

  • Impaired family dynamics

  • Personal identity confusion

  • Feelings of powerlessness or risk thereof

  • Risk for compromised human dignity

PRIMARY PREVENTION

  • Promote positive self-talk and cultivate a healthy self-image.

  • Strengthen interpersonal relationships and foster a sense of belonging.

  • Minimize stress-related influences.

  • Create positive social behaviors and problem-solving skills to enhance self-esteem.

  • Encourage role attainment and support transitions in roles.

SECONDARY PREVENTION

  • Implement self-esteem screening processes to identify risks early.

TERTIARY CARE: NURSING INTERVENTIONS

  • Communicate effectively with patients and their families.

  • Assist patients in cultivating a healthy lifestyle.

  • Provide guidance on promoting positive self-talk.

  • Encourage active listening to understand feelings.

  • Remain sensitive to patients' feelings while engaging with them.

  • Help patients develop a heightened self-awareness.

THE NURSE’S IMPACT ON THE PATIENT’S SELF-CONCEPT

  • Nurses significantly influence their patients' body image.
      - Patient and family perceptions are shaped by the nurse's response to illness or physical changes.

  • Patients with changes to body appearance or function are hypersensitive to verbal and non-verbal feedback from healthcare professionals.

  • Nurses have the capacity to facilitate positive transformations in self-concept; hence they must be cognizant of their own feelings, beliefs, values, expectations, and judgments, thus recognizing their self-concept influences patient interactions.

NURSING IMPACT ON SELF-CONCEPT: KEEP IN MIND

  • Include discussions on self-concept in care planning and delivery.

  • Establish therapeutic relationships with patients and their families.

  • Communicate with sensitivity about patients' physical changes or illnesses.

  • Practice empathy: consider how it feels to be in a patient's position.

  • Assist in relieving feelings of embarrassment, frustration, anger, and denial.

  • Maintain honesty while using professional language and clinical terms during interactions.

QUESTIONS SO FAR?

  • Engage with the audience to clarify thoughts and encourage discussion.

SELF CONCEPT EXEMPLAR CASE STUDIES: SHELLY AND CHRISSIE

  • Group Activity:
      - Collaborate in teams to answer questions for each case study.
      - Each case will be presented one at a time to facilitate effective communication within groups.
      - Ensure every group member contributes to, understands, and agrees on the final outputs.
      - Teams will be called upon to share their insights during class.

IN CLASS ACTIVITY: COLLAGE OF SELF-CONCEPT

  • Create a Virtual Self-Portrait Collage:
      - Include aspects that represent how you perceive yourself at this moment.
      - Use phrases, images, and other creative elements; think of using bits of magazines or newspapers.
      - Submit your collage to the dropbox at the end of the class.