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74 Cards in this Set

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What is self concept?
The mental image of ones self. Includes: physical, moral, personal, family, social, & situation dimensions
How is self concept developed or constructed by the individual?
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.
List the four components of NANDA self-concept diagnoses
PERSONAL IDENTITY
BODY IMAGE
ROLE PERFORMANCE
SELF ESTEEM
What are the three dimensions of Self-Concept?
SELF-KNOWLEDGE- abilities, nature, limitations
SELF-EXPECTATION-realistic or unrealistic
SELF EVALUATION- view of oneself in relation to events, situations
Self-Knowledge: “Who Am I?”
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.
What conditions are associated with alterations in self-concept or global self-worth?
Developmental changes, life crisis, illness, and loss.
Self-Expectations: “Who or What Do I Want to Be?”
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
The ideal self
The ideal self constitutes the self one wants to be.
A false self
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.
Self-Evaluation: “How Well Do I Like Myself?”
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
What are Maslow's two subsets of esteem needs:
(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).
Maslow's self-esteem defined as originating from what two sources:
How competent children think they are in various aspects of life and how much social support they receive from other people.
What are Coopersmith's four bases of self-esteem
(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
What did Harter described as the three major self-evaluation feelings or affects in children:
(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.
What did Sullivan propose as the self-representations of “good-me” and “bad-me”
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.
According to Sullivan and Hildegarde Peplau how can nurses have a positive effect on a person's self-esteem/self-concept.
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.
Describe "attachment theory"
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.
What are the stages in the development of the self include?
SELF-AWARENESS(infancy)
SELF-RECOGNITION(18 months), SELF-DEFINITION (3 years), SELF-CONCEPT(6–7 years)
List the developmental Considerations affecting Self-Concept: Infancy
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
List the developmental Considerations affecting Self-Concept: Childhood
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
list the developmental Considerations affecting Self-Concept: Adolescence
Inability to accept body
Inability to resolve competing pulls to be both a child and an adult
Unhealthy peer pressure
Identify confusion
List the developmental Considerations affecting Self-Concept: Adulthood
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
List the developmental Considerations affecting Self-Concept: Later years
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
Internal and External Resources
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
How does self concept determine a person's response to crisis?
(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.
What qustion would a nurse ask when assessing self-concept: Personal identity
How would you describe yourself to others?
Describe your strengths/weaknesses
What qustions would a nurse ask when assessing self-concept: Body image
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?
The nurse assessing self-concept: Self-esteem
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?
What qustions would a nurse ask when assessing self-concept:Role performance
How do you feel about your ability to do all the things your roles demand of you?
Are these roles satisfying for you?
What factors place an individuals concept of "personal identity" at risk?
Developmental changes
Trauma
Gender dissonance
Cultural dissonance
High-Risk Factors: Body image
Loss of body part or function
Disfigurement
Developmental changes
High-Risk Factors: Self-esteem
Unhealthy interpersonal relationships
Failure to achieve developmental milestones
Failure to achieve life goals
Failure to live up to personal moral code
Sense of powerlessness
High-Risk Factors: Role performance
Loss of valued role
Ambiguous role expectations
Conflicting role expectations
Inability to meet role expectations
Describe adaptive and maladaptive responses to deformity or limitation
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
List adaptive and maladaptive responses to changes in independence–dependence patterns
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.
List adaptive and maladaptive responses to changes in Socialization & Communication
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)
What is Role Performance?
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
List the Nursing diagnostic labels for specific disturbances in self-concept:
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
When assessment data point to an alteration in self-concept, what is the nurse's first task when determining an accurate diagnoses?
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).
Examples of Nursing Interventions Classification (NIC)
Selected Self-Awareness Enhancement Activities
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.
Nurses can help patients maintain a sense of self and worth by doing the following:
Speech, & judicious touch to communicate worth, acknowledge status, roles, individuality, speak respectfully, converse about his or her life experience.
How can a nurse help to modify a Negative Self-Concept?
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.
Describe the nursing interventions for body image disturbances.
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
Building Self-Esteem in Children: To reinforce the positive qualities,
(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
Building Self-Esteem in Children: To address the negative qualities constructively.
(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?
Building Self-Esteem in Children: Listening
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.
Building Self-Esteem in Children: Promoting a Feeling of Success
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
Enhancing Self-Esteem in Older Adults
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
What are the factors that affect self concept?
Developmental factors, culture, internal & external forces, history of succsess/failure, crisis/stressors, aging, illness, or trauma.
The shock phase of the Alarm Reaction
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
The second phase of the Alarm reaction
Also known as countershock, where there is a reversal of body changes.
Resistance
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.
Exhaustion
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.
Examples of mind–body interaction
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).
Anxiety
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.
Mild Anxiety
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
Moderate Anxiety
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.
Severe Anxiety
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.
Panic
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.
Coping Mechanisms
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.
Coping mechanisms often used at higher levels of anxiety
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
Attack behavior
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
Withdrawal behavior
Withdrawal behavior involves physical withdrawal from the threat, or emotional reactions such as admitting defeat, becoming apathetic, or feeling guilty and isolated
Compromise behavior
is usually constructive, often involving the substitution of goals or negotiation to partially fulfill one's needs
Defense Mechanisms
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.
Effects of Stress
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
Stress in Illness
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
Adaptation to acute and chronic illness involves two sets of adaptive tasks
(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
Prolonged Stress
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
Long-term stress affects on physical status
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.
Family Stress
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.
Crisis
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
Physiologic Stressors
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.
Psychosocial Stressors
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.