Self-Concept Part II - Class N111 T.Shea

Objectives Explain relationship of psychosocial factors to health and self development Identify factors that influence the development and stability of self-concept Perform a client self-concept assessment Develop nursing diagnoses that identify disturbances in self-concept Discuss strategies that are effective in resolving role-performance conflicts and self-concept problems 1. Explain relationship of psychosocial factors to health and self development 2. Identify factors that influence the development and stability of self-concept 3. Perform a client self-concept assessment 4. Develop nursing diagnoses that identify disturbances in self-concept 5. Discuss strategies that are effective in resolving role-performance conflicts and self-concept problems The Camtasia and Powerpoint will address objectives 1, 2, and 3. We will also do activities in class that will allow you to progress on objectives , 3, 4 and 5.

Components of Self-Concept Identity: The internal sense of individuality, wholeness, and consistency of self Body image: Attitudes related to physical appearance, structure, or function Role performance: Self-appraisal of how an individual fulfills their significant roles Self-esteem: The emotional appraisal of personal value or worth

Self-Concept and the Nursing Process Plan goals and expectations that are realistic for this client. Consider how to incorporate collaborative care. Implementation needs to be targeted to the client at the specific level of care. Consider if the implementation will occur as health promotion, in the acute care, or restorative care setting. With regards to health promotion, nurses are in a unique position to identify lifestyle choices that put a person’s self-concept at risk, as well as to encourage practices that would enhance self-concept, such as adequate sleep, exercise and stress-reducing techniques. In the acute care setting, the nurse needs to be aware that there is typically more than one stressor for the patient. Threats to a person’s self-concept would include fear related unknown diagnoses, the need to modify lifestyle, and change in bodily appearance and/or function. Because patients will need time to adapt to altered body image or function, It will be very important to make use of collaborative care with apropriate follow-up and referals, includeing home care and support groups. In restorative and continuing care, the nurse will have more opportunity to work toward the goal of the patient achieving a more positive self-image. The nurse will need to to help the patient to increase self-awareness, identify positive and negative coping behaviors and collaboratively develop successful coping strategies. Of course, Evaluation is the last link in the process T he nonverbal behavior will , again, be the key indicator of improved self-concept – > . Changes in self-concept take time. Look for incremental signs of progress such as improved coping mechanisms , more positive social interactions, more frequent eye contact, and active participation in plan of care.

Behaviors Suggestive of Altered Self-Concept avoiding eye contact slumped posture unkempt/poor grooming hesitant and apologetic behavior passive attitude difficulty making decisions overly critical frequent and/or inappropriate crying Image retrieved October 23, 3009 from http://www.suite101.com/view_image.cfm/924361

Self-Concept Assessment Direct questions Listen to content of conversation Identify nature, number and intensity of stressors Explore coping behaviors Explore relationship with significant others/family Observation of non-verbal behavior Image retrieved October 30, 2009 from http://www.1st-art-gallery.com/thumbnail/68556/1/Portrait-Of-Diego-Rivera.jpg You Can also ask direct questions as part of the self-concept assessment: Such as: How do you describe yourself? Tell me about your primary roles Can you remember a time when you felt good about yourself? It is important to realize that Nurses actually gather most of the data regarding self-concept through careful observation of patient’s nonverbal behavior as well as thoughtful attention to content of patient’s conversation. Assessment includes consideration of the nature, number and intensity of stressors and knowledge of how a patient has dealt with stressors in the past will provide insight into the patient’s coping strategies. Valuable information about stressors and coping behaviors can be learned from a patient’s family and significant others. In addition, the way that a significant other talks to and about the patient can provide information about the patient’s quality of social support..

Self-concept-related Nursing Diagnoses Caregiver role strain Disturbed body image Altered Self-Concept Situational low self-esteem Disturbed personal identity Ineffective role performance Copyright © 2004 by Allyn and Bacon

Self-Concept and the Nursing Process Assessment Nursing diagnosis Planning Incorporate collaborative care  Will the intervention occur as health promotion, in the acute care, or restorative care setting? Implementation Evaluation When planning care for the client who is experiencing problems with self-concept, you will use both critical thinking and the nursing process. When selecting an appropriate nursing diagnoses, be sure to take into consideration recent events in the person’s life and how the person has viewed him/herself in the past to provide insight into which diagnoses is best. Nanda-approved dx include disturbed body image . . . Plan goals and expectations that are realistic for this client. Consider how to incorporate collaborative care. Implementation needs to be targeted to the client at the specific level of care. Consider if the implementation will occur as health promotion, in the acute care, or restorative care setting. With regards to health promotion, nurses are in a unique position to identify lifestyle choices that put a person’s self-concept at risk, as well as to encourage practices that would enhance self-concept, such as adequate sleep, exercise and stress-reducing techniques. In the acute care setting, the nurse needs to be aware that there is typically more than one stressor for the patient. Threats to a person’s self-concept would include fear related unknown diagnoses, the need to modify lifestyle, and change in bodily appearance and/or function. Because patients will need time to adapt to altered body image or function, It will be very important to make use of collaborative care with apropriate follow-up and referals, includeing home care and support groups. In restorative and continuing care, the nurse will have more opportunity to work toward the goal of the patient achieving a more positive self-image. The nurse will need to to help the patient to increase self-awareness, identify positive and negative coping behaviors and collaboratively develop successful coping strategies. Of course, Evaluation is the last link in the processT he nonverbal behavior will , again, be the key indicator of improved self-concept – > . Changes in self-concept take time. Look for incremental signs of progress such as improved coping mechanisms , more positive social interactions, more frequent eye contact, and active participation in plan of care.

The Nurse’s Effect on the Patient’s Self-Concept 1. Nurses need to remain aware of their own: worries fears feelings values preferences expectations and judgments 2. Check your and put on your Image retrieved November 21, 2009 from news.stanford.edu/news/2007/may23/gifs/scar Lastly, when caring for clients, nurses need to take a personal inventory of their own feelings, expectations, and attitudes regarding health and illness. The nurse’s attitude and acceptance of a patient with change in body appearance or function will set the tone for how the patient views his/her alteration in body appearance and function. A compassionate, realistic and accepting attitude can promote the patient’s self-acceptance. While caring for patients, you will integrate concepts previously discussed regarding therapeutic communication, culture and diversity, and health and wellness.

The Nurse’s Effect on the Patient’s Self-Concept 3. Focus on the person behind the diagnoses 4. Cue the patient/Set the tone Use a positive and matter of fact approach Demonstrate compassion realism acceptance Image retrieved November 13, 2009 from http://4.bp.blogspot.com/_egA0Xam7Hz8/RclpyGlM8II/AAAAAAAAAiY/wpYvoWhPF4g/s1600-h/79.JPG

The Nurse’s Effect on the Patient’s Self-Concept 5. Demonstrate care with your behavior Build trust Be aware of facial and body expressions Use physical touch and eye contact

Review Questions The following slides are review questions The answers are on the “notes” section of the PowerPoint Please come see your instructor if you have trouble with the questions

After undergoing a bilateral mastectomy, a 50-year-old client refuses to eat, discourages visitors, and pays little attention to her appearance. One morning, the nurse enters the room to see the client with her hair combed and makeup applied. Which of the following is the best response from the nurse? A. "What's the special occasion?" B. "You must be feeling better today." C. "This is the first time I've seen you look this good." D. "I see you have combed your hair and put on makeup." D Acknowledging the change in the client's appearance without any interpretation or judgment regarding the client's previous appearance is best. A positive and matter-of-fact approach provides a positive model for the client and family to follow.

A. Form a sense of identity B. Create intimate relationships When developing an appropriate outcome for a 15-year-old girl, the nurse considers that a primary developmental task of adolescence is to: A. Form a sense of identity B. Create intimate relationships C. Separate from parents and live independently D. Achieve positive self-esteem through experimentation. A

The nurse recognizes that a client is experiencing role performance stress when the client: A. Has had a failed marriage B. Reports symptoms of postpartum depression C. Has been diagnosed with a chronic disease D. Expresses difficulty managing a career and a family D Difficulty managing both career and family is a conflict involving the roles of the young adult. A failed marriage may involve self-esteem rather than role performance. Chronic illness is a threat to body image. A change in health is a stressor affecting self-concept.

Several staff members complain about a client’s constant questions, such as , “Should I have a cup of coffee or a cup of tea?” and “Should I take a shower now or wait until later?” Which interpretation of the client’s behavior will help the nurses provide optimal care? A. Asking questions is attention-seeking behavior B. Inability to make decisions reflects a self-concept issue C. Dependence on staff needs to be stopped D. Indecisiveness is aimed at testing how the staff reacts B

A depressed client is crying and verbalizes feelings of low self-esteem such as “I’m such a failure . . .” The best nursing response would be to: A. Remain with the client until the client stops crying B. Tell the client that every person has a purpose in life C. Review recent behaviors or accomplishments that demonstrate skill ability D. Reassure the client that you understand how he is feeling C

When an individual internalizes the beliefs, behavior and values of role models into a personal and unique expression of self, the nurse would document this as: A. Inhibition B. Substitution C. Identification D. Reinforcement-extinction C

When caring for an 87-year-old client, the nurse needs to understand which of the following most directly influences the client’s self-concept A. Attitude and caring behaviors of relatives providing care B. Caring behaviors of the nurse and health care team C. Level of education, economic status and living conditions D. Adjustment to role change, loss of loved ones, and physical energy D

The nurse asks the client, “How do you feel about yourself The nurse asks the client, “How do you feel about yourself? The nurse is assessing the client’s: A. Identity B. Self-esteem C. Body image D. Role-performance B

Helping the client to define her problems clearly The nurse can increase a client’s self-awareness by which of the following? (Choose all that apply.) Helping the client to define her problems clearly Allowing the client to openly explore thoughts and feelings. Reframing the client’s thoughts and feelings in a more positive way. Having the client identify her positive and negative coping mechanisms. A, B, C & D

“It’s normal to feel that way as you age." Following a cerebral vascular aneurysm (CVA), an elderly client says, "I'm no good to anyone anymore." The nurse's best response would be: “It’s normal to feel that way as you age." "Oh, you know how important you are." "Why would you say something like that?“ D. "Tell me what you mean." D - Explore further – Use open ended questions

Self-esteem cannot be changed. More time is needed to meet the goal. A client for whom a goal is improvement of self-esteem continues to avoid eye contact and is hesitant to talk about feelings. The most likely reason that the goal is unmet is that: Self-esteem cannot be changed. More time is needed to meet the goal. The goal is unrealistic for adult clients. The nurse is from a different culture than the client. B Changes in self-esteem occur slowly over time with continued intervention. There is no indication that the goal is unrealistic. Whether the client is an adult or a child is irrelevant. Self-esteem can change, but does so over time. A nurse from a different culture than the client's should be aware of his or her own beliefs, values, and so on, but is fully capable of helping clients of any culture to set and meet goals.

An appropriate nursing diagnosis for an individual who experiences confusion in the mental picture of the physical self is: A. Confusion, acute B. Body image disturbed C. Self-esteem, chronic low D. Self-esteem, situational low B A person with confusion in the mental picture of the self may have a nursing diagnosis of Body image, disturbed. The information given provides no evidence of diagnostic criteria for diagnoses related to confusion or self-esteem.

D. Role performance stressor You are assigned to care for a client who retired 6 months ago. While providing care, you identify that this client is struggling emotionally with change. This situation is most likely associated with the self-concept component of: A. Identity stressor B. Sexuality stressor C. Body image stressor D. Role performance stressor D

The client will deal with stress in appropriate ways. A middle-aged woman who lives with and takes care of her aged mother is given the nursing diagnosis Caregiver role strain. Which of the following is an appropriate goal given this diagnosis? The client will deal with stress in appropriate ways. The nurse will teach the client four actions to deal with stress. The client's mother will decrease the demands made on her daughter. The client will identify two community resources that offer respite care. D Respite care provides the daughter with relief from the role of care giver; in addition, D offers a specific and masureable goals.