Self-Concept and Sexuality - 307

Definition: Self-concept refers to how individuals feel about and view themselves, encompassing conscious and unconscious thoughts, attitudes, beliefs, and perceptions.
Components of Self-Concept:
- Includes self-identity, body image, attitudes, role performance, and self-esteem.
- Body Image: A specific aspect of self-concept that refers to how individuals perceive their appearances, sizes, and body structures/functions.
Influences on Self-Concept:
- Self-concept, body image, gender identity, and sexual orientation are integrated into individuals’ personalities and general health.
- A positive self-concept tends to correlate with higher self-esteem, helping individuals cope with life's stressors such as unrealistic expectations, surgery, chronic illness, and changes in role performance.

Nurse Responsibility:
- Assess personal comfort levels with issues related to sexuality; discomfort can be sensed by clients.
- Maintain knowledge of sexual growth and development and understand how health issues and treatments can impact sexuality.

Developmental Changes:
- Body image evolves with cognitive growth and physical development.
- Teenage years: Hormonal changes lead to the development of secondary sex characteristics.
- Older adults: Mobility loss, hair thinning, graying, and decreased sensory functions can impact body image.
Stressors Affecting Body Image:
- Loss of body parts (e.g., amputation, mastectomy, hysterectomy).
- Loss of functions (e.g., due to arthritis, stroke).
- Unrealistic body ideals promoted by media and societal standards.
Correlations:
- Negative body image can lead to increased risks of suicidal ideation.

Scenario Example: Identify issues with self-concept.
- A client declaring, "I’ll never be able to care for this at home. Can’t you just send a nurse to the house?" indicates a poor self-concept.

Conceptual Understanding:
- Sexuality encompasses physical and emotional connections and is pivotal to identity.
- Sexual health is a multidimensional well-being aspect related to sexuality and sexual activity.
Developmental Variations:
- Changes occur throughout life – e.g., during adolescence (development of sexual characteristics and practices).
- Sexual orientation may evolve over time and can be influenced by cultural perspectives.
Health Factors:
- Health issues can impact sexual expression; sexually transmitted infections can create anxiety affecting desire and functioning.
- Medications (e.g., diuretics, antidepressants) may affect sexual functioning and desires.

Assessment Steps:
- Evaluate the client's feelings about sexuality and past sexual history, consider conditions affecting sexual health (e.g., diabetes, heart conditions).
- Employ the PLISSIT model to guide discussions:
- P: Permission - encourage openness;
- LI: Limited information - provide contextual sexual health knowledge;
- SS: Specific suggestions - based on assessment data;
- IT: Intensive therapy - refer to specialists as needed.

Promoting Healthy Lifestyles:
- Encourage physical activities, nutritious diets, and stress management.
- Facilitate discussions for clients to express fears or anxieties related to self-concept and body image.
- Use therapeutic communication to boost self-awareness and coping skills, reinforcing personal successes.

Building Relationships:
- Establish a trusting relationship to foster productive communication.
- Maintain privacy to ensure clients feel safe addressing sensitive issues (e.g., surgical alterations).
- Recognize emotions like anger, depression, or denial as common upon experiencing body changes.

Understanding Roles:
- Define roles as functions individuals assume, which are often multifaceted and interrelated (e.g., parent, employee).
- Recognize that sickness can alter a client’s roles, creating temporary or permanent changes in societal expectations and behaviors.
Types of Role Problems:
- Role Conflict: Incompatibility in expectations between multiple roles (e.g., duties of caregiver vs. personal health).
- Sick Role: Societal expectations regarding conduct when ill.
- Role Ambiguity: Uncertainty about expectations when adopting new roles.
- Role Strain: Inadequate coping in fulfilling roles, often leading to caregiver burden or feeling overwhelmed.

Identify Roles: Assess client and significant others’ roles to evaluate role-related stress or changes.
Grief for Role Loss: Pay attention to emotional responses to losing a role.
Referral Strategies: If role changes are substantial, consider referrals for services that assist in adaptation to new situations.
Caregiver Burden Indicators: Look for signs like fatigue or health decline in caregivers.