Nursing Lecture Notes – Self-Concept & Self-Esteem

Self-Concept: Foundational Overview

• Self-concept: the totality of thoughts, feelings, values, and attitudes people hold about “who I am.”
• Can be POSITIVE or NEGATIVE; quality directly influences health, healing, coping, relationships, adherence to treatment, & life-long well-being.
• Key Goal: align “who I WANT to be” (ideal self) with “who I AM” (real/actual self).
• Nursing imperative: identify each client’s current self-concept state and intervene when misalignment hinders recovery or self-care.

Positive vs. Negative Self-Concept

• Positive self-concept
– Encourages growth, healthy risk-taking, resilience in crisis.
– Clients more likely to seek information, engage in rehab, take meds, mobilise support.
• Negative self-concept
– “Deficiency mind-set”; diminishes self-care (“lost my job, so why get dressed?”).
– Reduces motivation for recovery behaviours; education often “goes in one ear and out the other.”
– Common sequelae: anxiety, depression, hopelessness, non-adherence.

Core Elements of Self-Concept

• Subjective (Personal) Self – internal answer to “Who am I?”
• Body Image – perceptions, attitudes, & feelings about physical appearance/function.
• Social Self – view of role & status within society/family/peer groups.
• Ideal Self – desired, aspirational picture of one’s future character, roles, or abilities.

The Continuum Analogy

• Humans “bounce” along a continuum from highly negative → highly positive self-concept.
• Example given: nursing students fluctuate by exam success (“failed a test, step down the line; finish clinical smoothly, move up”).
• Visualise as a mental number line $Position\;x\;\in\;[-1,1]$ where $x=-1$ = maximal negativity; $x=1$ = maximal positivity.

In-Depth Constructs

• Self-Knowledge (personal identity): demographics, roles, orientation, culture; “Who am I?”
• Ideal Self: can be realistic or unrealistic; shaped by positive role models.
• False Self: facade adopted to meet external expectations; living “only for others.”
– Example: pursued medicine only to please parents yet wishes to paint → false-self conflict.
• Self-Evaluation (self-esteem): evaluative & affective component – pride, shame, guilt.
– High self-esteem: varied roles, realistic goals, multitasking, confidence.
– Low self-esteem: narrow roles, irrational perspective, depressive/anxious features.

Four Bases of Self-Esteem

• Significance – feeling loved/important to people who matter.
• Competence / Confidence – belief in ability to perform tasks or meet standards.
• Virtue – moral integrity, congruence between stated & enacted values.
• Power – sense of control & impact over one’s life and environment ("super-powers").

Classroom NCLEX-Style Question & Rationale (1)

• Scenario: Became doctor for parental pride but longs to be painter.
• Q: Disturbed dimension?
– Correct: Self-EXPECTATIONS (ideal vs. false self).
– Distractor analysis: Self-knowledge = who I am; Self-evaluation = value statements; Self-esteem = overall liking of self.

Classroom NCLEX-Style Question & Rationale (2)

• Child failing tests yet father always proud.
• Correct answer: Significance with HIGH self-esteem (loved regardless of grades).
• Confidence wrong because focus is not grades; Virtue/Power not addressed.

Development of Self-Concept Across the Lifespan

• Infancy
– Initial distinction of “self vs. non-self.”
– Sensitive to adequacy of basic needs; parental affection & sleep/feeding patterns crucial.
– Disturbances: unmet needs, difficult temperament.

• Childhood
– Awareness of body integrity; extreme fear of injury ("skin knee = end of world").
– Trust, love, confidence built through simple language & comfort during procedures.
– Disturbances: dysfunctional family, over/under-structure.

• Adolescence
– Rapid physical (puberty) & psychosocial change; integration of identity, orientation, expression, sexuality.
– Peer acceptance & body image dominate; unhealthy peer pressure common.
– Disturbances: body dissatisfaction, identity confusion.
– Nursing: assess understanding of changes, counsel on independence & safety.

• Adulthood
– Self-concept measured against societal roles (career success, beauty standards).
– Evaluate realism of expectations; manage role strain, irreversible body changes (e.g., mastectomy).
– Disturbances: job dissatisfaction, chronic illness, caregiver burden.

• Older Adult
– Physical & cognitive decline, losses (spouse, work), fear of dependency.
– Goal: maintain maximum control & independence, validate life achievements, supply resources (bereavement groups, home services).
– Heightened risk of depression & substance misuse.

Variables Influencing Self-Concept (All Ages)

• Developmental stage ‑ criteria for “success” shifts (e.g., toddler vs. retiree).
• Cultural/Value conflicts (home vs. peer or host culture).
• Internal resources – humour, self-talk; may be sarcastic/critical or supportive.
• External resources – family, friends, gyms, advisers.
• Success vs. Failure history – repeated failures can cloud perception of available supports.
• Stressors – exams, divorce, greying hair; coping style determines impact.
• Illness – sudden threats (open-heart surgery) assault body image & autonomy.

Internal vs. External Coping Examples

• Internal-Positive: deep breathing before cleaning → readiness to act.
• External-Positive: reliable gym partner for accountability.
• External-Negative: failing exam but refusing tutor/SSC help.
• Internal-Negative: rumination/procrastination instead of task completion.

Nursing Process & Self-Concept (ADPIE)

• Assessment
– Collect subjective & objective data about self-perception, body image, roles.
– Note incongruence: “I’m in control” vs. not taking meds.
– Ask open prompts: “Describe your body,” “Tell me something special you can do.”
• Diagnosis
– Label problems: Disturbed Body Image, Chronic Low Self-Esteem, Ineffective Role Performance.
• Planning (SMART Goals)
– Example 1: “By DISCHARGE the client will identify $\ge 2$ positive body qualities.”
– Example 2: “By end of Day 1 client will list $\ge 2$ strategies to improve self-esteem.”
• Implementation (Interventions)
– Empower independence, advocate self-decision, emphasise personal strengths.
– Maintain respect, privacy, person-first language.
– Avoid “doing for” when client can “do with” support.
• Evaluation
– Re-assess whether goals met; recognise non-linear progress; modify plan.

Body-Image Disturbance: Ostomy Example

• Possible client trajectory: denial → anger → guilt → acceptance.
• Negative coping: refusal to change bag, ripping it off, social withdrawal.
• Positive coping: proactive learning, peer support groups, reframing benefits.
• Nursing: assess phase of adjustment, supply education, model problem-solving techniques.

Classroom NCLEX-Style Question & Rationale (3)

• Preparing child for labs before appendectomy.
• Best statement: “I’m going to use this needle to get some blood. It should take a minute. When we’re done you get a sticker & band-aid.”
– Provides simple, honest explanation & reward; avoids lying ("won’t hurt"), threats, or vague commands.

Classroom NCLEX-Style Question & Rationale (4)

• Pregnant client fears spouse won’t like postpartum body.
• Highest risk disturbance: Body Image.
• Personal identity & self-esteem may also shift, but primary threat = physical appearance.

Therapeutic Communication & Professional Self-Reflection

• Nurses must monitor their own self-concept & non-verbal cues; negativity transmits to clients.
• Optimism: convey belief that change is possible.
• Respect elders’ experiences; invite storytelling.
• Ethical check: “Are patients/families better because I was part of their care?”

Classroom Activity: “Assumption Balls/Paper Airplanes”

• Students wrote negative assumptions, crumpled into balls, threw them away → symbolic discarding of self-doubt.
• Follow-up: instructor read assumptions (mostly negative) to illustrate prevalence & challenge to self-concept.
• Take-away: If still “not OK” after extended period, SEEK HELP (friends, faculty, counselling).

Student Reflections One Year Later

• Jacqueline: once rooted in doubt/fear; now celebrates progress over perfection, speaks with kindness to self.
• Chelsea: A-B-C mantra – Always trust yourself, Be forgiving, Celebrate progress; underscores ongoing self-concept evolution.

Practical Tips & Ethical/Philosophical Implications

• Acknowledge life milestones & losses during assessment; leverage them as strengths.
• Provide resources (bereavement groups, rehab, home health) early – discharge planning starts on admission.
• Foster autonomy while safeguarding safety – negotiate control.
• Remember: “Family/sleep > school” – holistic priorities modelled by instructor.
• Guard against threats to dignity (dependency, bodily changes) through respectful language & privacy.

Quick Formula Cheat-Sheet (applied conceptually)

• Positive Self-Concept probability roughly increases with:
$P_{positive}=f(Significance, Confidence, Virtue, Power,\text{Successful Coping})$
• Alignment metric:
$\Delta = |\text{Ideal Self} - \text{Real Self}|$
– Small $\Delta$ ⇒ High self-esteem; large $\Delta$ ⇒ Low self-esteem.

Key Take-Home Messages

• Self-concept is fluid, context-dependent, yet highly modifiable.
• Nurses act as assessors, educators, motivators, & mirrors reflecting patient strengths.
• Use SMART goals & evidence-based interventions to restore congruence between real & ideal selves.
• Prioritise person over diagnosis; every interaction can elevate (or erode) self-concept.
• Continually examine and nurture your OWN self-concept to provide authentic, hopeful care.