Chapter 11 Self-Perception and Self-Concept Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1

Lesson 11.1 Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 2

Objectives  Discuss the concepts of self-perception and self-concept.  Describe how self-perception and self- concept change with aging.  Describe methods of assessing changes in self-perception and self-concept.  Identify older adults who are most at risk for experiencing problems related to self- perception and self-concept. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3

Normal Self-Perception and Self-Concept Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4

Self-Identity  The attitudes and perceptions people have about themselves, their abilities, and their self-worth  People form their self-identities from their values, life experiences, and interactions with others Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5

Self-Identity (cont.)  People with good self-worth and high self- esteem  Have strong personal values and believe that they have the ability to control their lives  Have had positive life experiences and have received positive feedback from others Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6

Self-Identity (cont.)  People with poor self-worth and low self- esteem  Tend to have weak personal values and think that they have little control over their lives  Have had primarily negative life experiences and have received negative feedback from others Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7

Self-Perception  Feedback from others affects our perception of ourselves  People who feel capable of controlling what happens perceive things far differently from those who perceive no control over their lives  Choices regarding activities of daily living are determined by and are reflections of an adult’s self-perception and level of self- esteem Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8

Self-Perception (cont.)  Problems related to self-perception and self- esteem are not as obvious as are physical problems Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9

Audience Response System Question 1 In today’s society, people usually have more negative experiences than positive ones. A.True B.False Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10

Self-Perception, Self-Concept, and Aging Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11

Attitudes Toward Aging  Aging individuals develop their own perceptions of aging  Many older adults express dismay with the realization and can even identify a particular moment when they perceived themselves as old  Successful aging is not so much a matter of years lived or health status, but rather a matter of perception and attitude Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12

Level of Self-Esteem Throughout Life  Older adults who have had a poor self- concept throughout their lives are not likely to gain self-esteem with aging  Older adults who had a healthy level of self- esteem during their younger days may experience some problems during aging, but these are most often a result of societal attitudes Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13

Audience Response System Question 2 Successful aging has sometimes been described as: A.ageism. B.mind over matter. C.great body image. D.being over the hill. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14

Lesson 11.2 Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15

Objectives  Discuss the effects of disease processes on self-perception and self-concept.  Identify selected nursing diagnoses related to self-perception or self-concept.  Describe nursing interventions appropriate for older adults experiencing problems related to self-perception and self-concept.  Describe methods of assessing changes in self-perception and self-concept. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16

Objectives (cont.)  Identify selected nursing diagnoses related to self-perception or self-concept problems.  Describe nursing interventions appropriate for older adults experiencing problems related to self-perception and self-concept. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17

Extent of Physical Change  Many people do all within their power to avoid the physical signs of aging  In an attempt to maintain their sense of self- worth, aging persons with adequate financial resources may try cosmetic surgery, hair dye, and hair transplants  The greater the amount of change, the more likely the person is to experience problems related to self-concept Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18

Emotional Support Systems  Although losses of physical and functional abilities are damaging to self-worth, loss of the emotional support of loved ones is even more devastating  The friends and loved ones who made life worthwhile slip away, one by one  The positive messages that a person is worthwhile, lovable, and loved become less frequent, and the reasons for living disappear Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19

Emotional Support Systems (cont.)  Older adults who are separated from their families and significant others are at increased risk for experiencing diminished self-worth Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20

Lesson 11.3 Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21

Objectives  Describe methods of assessing changes in self-perception and self-concept.  Identify selected nursing diagnoses related to self-perception or self-concept problems.  Describe nursing interventions appropriate for older adults experiencing problems related to self-perception and self-concept. Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22

Depression and Aging  Difficult to recognize because typical indicators may be similar to those seen with a variety of medical disorders  May be related to a wide range of factors, including loss of independence or loved ones, increased medical problems, or use of medications to treat disease Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23

Changes That Warrant Further Investigation  Stopping normal routines  Neglected self-care  Unwillingness to talk  Agitation and irritability  Suspiciousness or unjustified fears  Mood swings Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 24

Changes That Warrant Further Investigation (cont.)  Isolation and withdrawal  Increased use of alcohol or mood-altering drugs  Unexplained injuries  Verbalization of worthlessness  Verbalization of suicidal thoughts Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 25

Suicide and Aging  Older adults at risk for suicide because of depression, severe emotional/physical pain, a recent loss, stressful event, or terminal illness  A large percentage of those who attempt to take their own lives have often presented to health care providers with various physical complaints  Older adults have a higher rate of successful suicides than other age groups Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 26

Audience Response System Question 3 Older adults have a higher rate of __________ suicides than do other age groups. A.successful B.unintentional C.accidental D.unsuccessful Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29

Nursing Process for Disturbed Self-Perception and Self-Concept  When an older adult has a poor self-concept, fears and anxieties increase  As control over one’s life decreases, self- esteem plummets even lower, and older adults fall victim to feelings of hopelessness and powerlessness, which lead to depression  Depression leads to isolation from others, further decreasing the sense of self-worth Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 28

Nursing Process for Disturbed Body Image  People experiencing body image disturbance are likely to refuse to look at or touch the affected body parts  In severe disturbances, the individual may deny that the change has occurred and act as though nothing has happened  Likely to verbalize feelings of worthlessness and powerlessness Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 29

Nursing Interventions for Disturbed Body Image  Assess the older individual’s perceptions of self, including strengths and support systems  Establish a trusting relationship  Provide care in a nonjudgmental manner  Encourage the person to look at and touch affected body areas  Focus on abilities, not disabilities Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 30

Nursing Interventions for Disturbed Body Image (cont.)  Assist in selecting clothing and/or dressing older adults in a manner that deemphasizes body changes  Ensure that the person is carefully groomed  Coordinate rehabilitative care with other departments Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 31

Nursing Interventions for Situational Low Self-Esteem  Explore feelings and concerns  Demonstrate acceptance of older adults as people with value and self-worth  Encourage participation in self-care activities  Provide opportunities for reminiscence  Encourage the family to participate in reminiscence by providing pictures or items that bring back memories of happy times  Encourage families to communicate positive feelings to the older person Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 32

Active Participation in Care Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 33

Reminiscing Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 34

Self-Esteem in Aging Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 35

Nursing Process for Fear  Fear is a feeling of dread or apprehension regarding an identified source  Most common fears identified in older adults  Fear of disruption in lives or routines  Crime and victimization  Loss of loved ones  Disease, injury, pain and suffering  Loss of independence  Financial destitution  Loneliness Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 36

Nursing Interventions for Fear  Provide opportunities for expression of fears  Remove or reduce the most common sources of fear  Provide explanations for all care procedures  Encourage older adults to verbalize their thoughts and feelings  Provide a quiet environment and reduce excessive stimulation  Provide distraction or diversion Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 37

Crafts Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 38

Hopelessness  Hopelessness is a subjective state in which people feel unable to solve problems or establish goals  They feel that they have no alternatives or choices, even when they actually can control what occurs  Hopeless persons express feelings of complete apathy in response to problems Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 39

Nursing Interventions for Hopelessness  Visit older adults frequently and spend time exploring the factors that contribute to feelings of hopelessness  Assess the potential for self-destructive behaviors or suicide  Allow older adults to make choices whenever possible Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 40

Nursing Interventions for Hopelessness (cont.)  Encourage older adults to do as much as possible for themselves  Adapt the environment to encourage independent activity  Explain the reasons for any changes in the plan of care  Avoid being overprotective or directive  Respect older adults’ right to refuse Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 41

Nursing Process for Powerlessness  Powerlessness occurs when older adults feel they have lost control of what happens to them  May result from the loss of control of physical functions or body parts or from loss of a body part  Powerlessness is common with hospitalization or placement in an extended- care facility Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 42

Assertiveness Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 43

Nursing Interventions for Powerlessness  Allow older adults to make choices when possible  Encourage older adults to do as much as possible for themselves  Adapt the environment to encourage independent activity  Explain the reasons for any changes in the plan of care  Avoid being overprotective or directive  Respect older adults’ right to refuse Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 44

Audience Response System Question 4 One of the most common fears of older adults is death. A.True B.False Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 47