Fundamentals Of Nursing: Self Concept

Front 1

What is self concept?

Back 1

The mental image of ones self. Includes: physical, moral, personal, family, social, & situation dimensions

Front 2

How is self concept developed or constructed by the individual?

Back 2

Occurs as a result of interacting w/ the environment & reflecting on that interaction thoughout ones life. A process of taking action and then reflecting on what we have done and what others tell us about what we have done.

Front 3

List the four components of NANDA self-concept diagnoses

Back 3

PERSONAL IDENTITY
BODY IMAGE
ROLE PERFORMANCE
SELF ESTEEM

Front 4

What are the three dimensions of Self-Concept?

Back 4

SELF-KNOWLEDGE- abilities, nature, limitations
SELF-EXPECTATION-realistic or unrealistic
SELF EVALUATION- view of oneself in relation to events, situations

Front 5

Self-Knowledge: “Who Am I?”

Back 5

Global or identity, describes sense of individuality & uniqueness:
Personal data (name, age,sex, race, et.al.,), beliefs & values, personality, & character,demographic data, situational characteristics, & talents.

Front 6

What conditions are associated with alterations in self-concept or global self-worth?

Back 6

Developmental changes, life crisis, illness, and loss.

Front 7

Self-Expectations: “Who or What Do I Want to Be?”

Back 7

Develop unconsciously early in childhood and are based on the image of role models such as parents, other caregiving figures, and public figures. These personal expectations might be healthy or unhealthy. Contrast the significance of a child's identifying a rock star or drug dealer as his hero rather than parents, government leaders, or other professional people

Front 8

The ideal self

Back 8

The ideal self constitutes the self one wants to be.

Front 9

A false self

Back 9

A false self might develop in individuals who have the emotional need to respond to the needs and ambitions significant people, such as parents, have for them.

Front 10

Self-Evaluation: “How Well Do I Like Myself?”

Back 10

An internal process that dictates Self-esteem, an on going evaluative component of the self-concept that results in individual's sense of his or her value or worth, described as a favorable or unfavorable attitude toward the self

Front 11

What are Maslow's two subsets of esteem needs:

Back 11

(1) self-esteem needs (strength, achievement, mastery and competence, confidence in the face of the world, independence, and freedom), and (2) respect needs or the need for esteem from others (status, dominance, recognition, attention, importance, and appreciation).

Front 12

Maslow's self-esteem defined as originating from what two sources:

Back 12

How competent children think they are in various aspects of life and how much social support they receive from other people.

Front 13

What are Coopersmith's four bases of self-esteem

Back 13

(1) SIGNIFIGANCE—the way a person feels he or she is loved and approved of by the people important to that person; (2) COMPETANCE—the way tasks that are considered important are performed; (3) VIRTUE—the attainment of moral–ethical standards; and (4) POWER—the extent to which a person influences his or her own and others' lives

Front 14

What did Harter described as the three major self-evaluation feelings or affects in children:

Back 14

(1) PRIDE, based on a positive self-evaluation; (2) GUIlT, based on behaviors incongruent with ideal self; and (3) SHAME, associated with low global self-worth. These affects are learned in early childhood within relationships with significant others and maintained through practice.

Front 15

What did Sullivan propose as the self-representations of “good-me” and “bad-me”

Back 15

Reflected appraisals of the self learned in the context of a child's early relationship with significant others, especially parents. The child's feelings of self-esteem and self-worth develop out of his or her perceptions of the parenting figure's feelings, or affects, expressed in caring for the child.

Front 16

According to Sullivan and Hildegarde Peplau how can nurses have a positive effect on a person's self-esteem/self-concept.

Back 16

Emphasized the fluidity of self-appraisals throughout the life span. They taught that positive interaction at any point in a person's life with new significant others (such as nurses) who are less anxious and more accepting and nurturing than prior figures can have a positive, growth-promoting effect on that person's self-esteem and self-concept.

Front 17

Describe "attachment theory"

Back 17

Developed by Bowlby describes modes a young child develops & maintains feelings about the self as well as values & beliefs about the world. Attachment is a process the child maintains felt security via an interpersonal bond with close caregivers.

Front 18

What are the stages in the development of the self include?

Back 18

SELF-AWARENESS(infancy)
SELF-RECOGNITION(18 months), SELF-DEFINITION (3 years), SELF-CONCEPT(6–7 years)

Front 19

List the developmental Considerations affecting Self-Concept: Infancy

Back 19

Unmet basic human needs
Lack of adequate body and sensory stimulation
Parents' lack of acceptance of the infant's appearance or behavior
Poor match between parent's and child's temperament or needs

Front 20

List the developmental Considerations affecting Self-Concept: Childhood

Back 20

An intact body is important to the young child, who fears bodily mutilation
During middle childhood, a sense of being trusted and loved, of being competent and trustworthy develops
Differences between self and others are strong

Front 21

list the developmental Considerations affecting Self-Concept: Adolescence

Back 21

Inability to accept body
Inability to resolve competing pulls to be both a child and an adult
Unhealthy peer pressure
Identify confusion

Front 22

List the developmental Considerations affecting Self-Concept: Adulthood

Back 22

Inability to fulfill conflicting role expectations
Failure to accept role responsibility (eg, parenting responsibilities)
Unreasonable expectations
Irreversible body change related to trauma, illness
Unsatisfying job
Failure to develop new goals to give meaning and purpose to life
Multiple stressors

Front 23

List the developmental Considerations affecting Self-Concept: Later years

Back 23

Loss of significant work (retirement); feelings of uselessness
Death of spouse, significant others
Diminished physical attractiveness, strength, overall health
Multiple stressors
Fear of dependency
Change may be more difficult

Front 24

Internal and External Resources

Back 24

The degree to which an individual integrates healthy, useful internal resources or personal strengths is associated with how well a person has been able to establish a positive self-concept in the context of nurturing experiences

Front 25

How does self concept determine a person's response to crisis?

Back 25

(1) the person's perception of the event or situation; (2) the person's situational supports (external resources); and (3)the coping mechanisms the person possesses (internal resources.) All of these factors are related to self-concept. The degree of strength an individual has in each area is related to his or her precrisis self-concept. Similarly, each of these conditions can alter self-concept either positively or negatively during or after crisis.

Front 26

What qustion would a nurse ask when assessing self-concept: Personal identity

Back 26

How would you describe yourself to others?
Describe your strengths/weaknesses

Front 27

What qustions would a nurse ask when assessing self-concept: Body image

Back 27

Describe your body to me.
What do you like most/least about your body?
Is there anything about your body that you would like to change?

Front 28

The nurse assessing self-concept: Self-esteem

Back 28

SIGNIFIGANCE: What is your response when you feel unloved or unappreciated by those who are important to you?
COMPETANCE: How do you feel about your ability to do the things in life that are important to you?
VIRTUE: To what degree are you satisfied with the way you are able to live up to your moral standards?
POWER: To what extent do you feel able to control what happens to you in life? How does this make you feel?

Front 29

What qustions would a nurse ask when assessing self-concept:Role performance

Back 29

How do you feel about your ability to do all the things your roles demand of you?
Are these roles satisfying for you?

Front 30

What factors place an individuals concept of "personal identity" at risk?

Back 30

Developmental changes
Trauma
Gender dissonance
Cultural dissonance

Front 31

High-Risk Factors: Body image

Back 31

Loss of body part or function
Disfigurement
Developmental changes

Front 32

High-Risk Factors: Self-esteem

Back 32

Unhealthy interpersonal relationships
Failure to achieve developmental milestones
Failure to achieve life goals
Failure to live up to personal moral code
Sense of powerlessness

Front 33

High-Risk Factors: Role performance

Back 33

Loss of valued role
Ambiguous role expectations
Conflicting role expectations
Inability to meet role expectations

Front 34

Describe adaptive and maladaptive responses to deformity or limitation

Back 34

Adaptive responses: Patient exhibits signs of grief and mourning (shock, disbelief, denial, anger, guilt, acceptance).

Maladaptive responses: Patient continues to deny and to avoid dealing with the deformity or limitation, engages in self-destructive behavior, talks about feelings of worthlessness or insecurity, equates deformity or limitation with whole person, shows a change in ability to estimate relationship of body to environment

Front 35

List adaptive and maladaptive responses to changes in independence–dependence patterns

Back 35

Adaptive responses: Patient assumes responsibility for care (makes decisions); develops new self-care behaviors; uses available resources; interacts in a mutually supportive way with family.

Maladaptive responses: Patient assigns responsibility for his or her care to others; becomes increasingly dependent or stubbornly refuses necessary help.

Front 36

List adaptive and maladaptive responses to changes in Socialization & Communication

Back 36

Adaptive responses: Maintains usual social patterns, communicates needs and accepts offers of help, serves as support for others

Maladaptive responses: Isolates himself or herself, exhibits superficial self-confidence, is unable to express needs (becomes hostile, ashamed, frustrated, depressed)

Front 37

What is Role Performance?

Back 37

Life roles such as our occupation or profession can constitute a major portion of our identity. Our ability to successfully execute societal as well as our own expectations regarding role-specific behaviors

Front 38

List the Nursing diagnostic labels for specific disturbances in self-concept:

Back 38

Disturbed Body Image,
Chronic Low Self-Esteem or Situational Low Self-Esteem or Risk for Situational Low Self-Esteem,Ineffective Role Performance, Readiness for Enhanced Self-Concept, Disturbed Personal Identity

Front 39

When assessment data point to an alteration in self-concept, what is the nurse's first task when determining an accurate diagnoses?

Back 39

To first determine whether the altered self-concept is the problem, the cause of the problem (etiology), or merely a sign that a problem exists (defining characteristics).

Front 40

Examples of Nursing Interventions Classification (NIC)
Selected Self-Awareness Enhancement Activities

Back 40

Encourage patient to recognize and discuss thoughts and feelings.
Assist patient to realize that everyone is unique.
Assist patient to realize the impact of illness on self-concept.
Assist patient to change view of self as victim by defining own rights, as appropriate.
Assist patient to be aware of negative self-statements.
Assist patient to identify guilty feelings.
Explore with patient the need to control.
Assist patient to identify positive attributes of self.

Front 41

Nurses can help patients maintain a sense of self and worth by doing the following:

Back 41

Speech, & judicious touch to communicate worth, acknowledge status, roles, individuality, speak respectfully, converse about his or her life experience.

Front 42

How can a nurse help to modify a Negative Self-Concept?

Back 42

Help the patient identify & describe feelings about situations related to self-concept,explore alternative ways of viewing the same situation, teach faulty thinking behavior as soon as he or she is aware of it, replace negative thinking/ self-talk positive self-image, explore positive dimensions he or she wishes to develop, & incorporate this new knowledge into the self-concept.

Front 43

Describe the nursing interventions for body image disturbances.

Back 43

Express interest & acceptance, allow the patient to share feelings: "How are things?” or “Tell me what's going on with you,” Support the patient through the stages of loss, grief, & mourning

Front 44

Building Self-Esteem in Children: To reinforce the positive qualities,

Back 44

(1) notice examples of ability in many different circumstances and point this out to the child; (2) find occasion to frequently and honestly praise the child; and (3) give the child an opportunity to show ability frequently

Front 45

Building Self-Esteem in Children: To address the negative qualities constructively.

Back 45

(1) What need is being expressed by this behavior? (2) Can I see a positive quality being expressed by this behavior? and (3) How can I help my child express this quality and meet her needs in a more positive way?

Front 46

Building Self-Esteem in Children: Listening

Back 46

Make sure that you are ready to listen.
Give your child your full attention.
Minimize distractions.
Be an active listener.
Invite your child to talk.

Front 47

Building Self-Esteem in Children: Promoting a Feeling of Success

Back 47

To help children have the courage to try new types of experiences, which results from successfully meeting challenges: (1) let a child know what to expect; (2) let your child practice the necessary skills; (3) be patient; and (4) make it safe to fail

Front 48

Enhancing Self-Esteem in Older Adults

Back 48

Identify one's own attitudes & feelings about aging, Respect & affirm seniors' intellect, individuality, personal strengths, culture, and spirituality.
Adjust communication style as needed,encourage sharing of life experiences, identify strengths & coping mechanisms

Front 49

What are the factors that affect self concept?

Back 49

Developmental factors, culture, internal & external forces, history of succsess/failure, crisis/stressors, aging, illness, or trauma.

Front 50

The shock phase of the Alarm Reaction

Back 50

Hormone levels rise to prepare the body to react. The autonomic nervous system initiates the fight-or-flight response, characterized by an increase in energy levels, oxygen intake, cardiac output, blood pressure, and mental alertness

Front 51

The second phase of the Alarm reaction

Back 51

Also known as countershock, where there is a reversal of body changes.

Front 52

Resistance

Back 52

Having perceived the threat and mobilized its resources, the body now attempts to adapt to the stressor. Vital signs, hormone levels, and energy production return to normal. If the stress can be managed or confined to a small area (LAS), the body regains homeostasis.

Front 53

Exhaustion

Back 53

Exhaustion results when the adaptive mechanisms are exhausted. Without defense against the stressor, the body may either rest and mobilize its defenses to return to normal or reach total exhaustion and die.

Front 54

Examples of mind–body interaction

Back 54

It is thought that humans react to threats of danger as if they were physiologic threats. A person perceives the threat on an emotional level, and the body prepares itself either to resist the danger or to run away from it (the fight-or-flight response).

Front 55

Anxiety

Back 55

Various emotional responses to stress may occur, including depression and anger. The most common human response is anxiety. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response; the source is often nonspecific or unknown to the individual. It is also a feeling of apprehension caused by anticipating a danger. Anxiety is experienced at some time by all people and can involve one's body, self-perceptions, and social relationships. It is an altering signal that warns of impending danger and enables the individual to take measures to deal with threat (NANDA, 2005). In contrast, fear (a feeling of dread) is a cognitive response to a known threat. Anxiety is the emotional response to that threat.

Front 56

Mild Anxiety

Back 56

Present in day-to-day living. It increases alertness and perceptual fields (eg, vision and hearing) and motivates learning and growth. Although mild anxiety may interfere with sleep, it also facilitates problem solving. Mild anxiety is often manifested by restlessness and increased questioning

Front 57

Moderate Anxiety

Back 57

Moderate anxiety narrows a person's perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details. Moderate anxiety is manifested by a quavering voice, tremors, increased muscle tension, a complaint of “butterflies in the stomach,” and slight increases in respirations and pulse.

Front 58

Severe Anxiety

Back 58

Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. The person has impaired learning ability and is easily distracted. Severe anxiety is manifested by difficulty verbally communicating, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation.

Front 59

Panic

Back 59

Panic causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought. The person is unable to learn, concentrates only on the present situation, and often experiences feelings of impending doom. This level of anxiety can lead to exhaustion and death. Panic is manifested by difficulty communicating verbally, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure.

Front 60

Coping Mechanisms

Back 60

Anxiety often is managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. Many coping behaviors are learned, based on one's family, past experiences, and sociocultural influences and expectations.

Front 61

Coping mechanisms often used at higher levels of anxiety

Back 61

Task-oriented reactions involve consciously thinking about the stress situation and then acting to solve problems, resolve conflicts, or satisfy needs. These reactions include attack behavior, withdrawal behavior, and compromise behavior

Front 62

Attack behavior

Back 62

occurs when a person attempts to overcome obstacles to satisfy a need; it may be constructive, with assertive problem solving, or destructive, with feelings and actions of aggressive anger and hostility

Front 63

Withdrawal behavior

Back 63

Withdrawal behavior involves physical withdrawal from the threat, or emotional reactions such as admitting defeat, becoming apathetic, or feeling guilty and isolated

Front 64

Compromise behavior

Back 64

is usually constructive, often involving the substitution of goals or negotiation to partially fulfill one's needs

Front 65

Defense Mechanisms

Back 65

Other unconscious reactions to stressors, called defense mechanisms, often occur. These mechanisms protect one's self-esteem and are useful in mild to moderate anxiety. When extreme, however, they distort reality and create problems with relationships. At that point, the mechanisms become maladaptive instead of adaptive.

Front 66

Effects of Stress

Back 66

Physiologic and psychological stress affects all of the human dimensions. It strongly influences how one attains basic human needs; it is a factor in health and illness; and it becomes a component in family reactions to illness. Both long-term stress and crisis situations may seriously affect a person's physical and emotional health

Front 67

Stress in Illness

Back 67

The effects of stress on a sick or injured person are, in contrast, usually negative. Stress can cause illness, and illness causes stress. The presence of an illness or a disability demands new coping skills at a time when homeostasis is challenged

Front 68

Adaptation to acute and chronic illness involves two sets of adaptive tasks

Back 68

(1)General tasks (as in the case of any situational stress) involve maintaining self-esteem and personal relationships and preparing for an uncertain future.
(2)Illness-related tasks include such stressors as losing independence and control, handling pain and disability, and carrying out the prescribed medical regimen

Front 69

Prolonged Stress

Back 69

Prolonged or long-term stress is a serious threat to physical and emotional health. As the duration, intensity, or number of stressors increases, a person's ability to adapt is lessened. The failure of adaptive mechanisms is also influenced by a person's state of health and past experiences with stress

Front 70

Long-term stress affects on physical status

Back 70

High levels of stress are associated with cardiovascular disease, gastrointestinal disorders, and cancer. It is believed that these diseases are the result of various factors, including the effects of the fight-or-flight response, eating patterns, lifestyle, and coping mechanisms. A person who reacts to stress by overeating, smoking, using alcohol or illegal drugs, or becoming hyperactive puts additional strain on the body.

Front 71

Family Stress

Back 71

The stress that affects an ill person also affects the person's family members or significant others. When the family is viewed as a system, the behavior of the individual is influenced by the family, and any alterations in the individual's behavior in turn affect the family. Stressors for the family include changes in family structure and roles, anger and feelings of helplessness and guilt, loss of control over normal routines, and concern for future financial stability.

Front 72

Crisis

Back 72

A crisis is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a threat to self

Front 73

Physiologic Stressors

Back 73

Physiologic stressors have both a specific effect and a general effect. The specific effect is an alteration of normal body structure and function. The general effect is the stress response. Primary physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders.

Front 74

Psychosocial Stressors

Back 74

There are an almost infinite variety of psychosocial stressors, which become so much a part of our daily lives that we often overlook them. To illustrate the many types of psychosocial stressors, consider those listed in Box 32-4. Psychosocial stressors include both real and perceived threats. The person's responses are continuous and include individualized coping mechanisms for responding to anxiety, guilt, fear, frustration, and loss.