Self –Concept & Self –Concept & CopingCoping

NUR101 Fall 2010NUR101 Fall 2010

Lecture # 13Lecture # 13K. Burger MSEd, MSN, RN, CNEK. Burger MSEd, MSN, RN, CNEPPP by: Sharon Niggemeier RN MSNPPP by: Sharon Niggemeier RN MSN

Revised 10/05 kbRevised 10/05 kb

Self -ConceptSelf -ConceptSelf-concept : self imageSelf-concept : self image

Each individual is unique with own Each individual is unique with own self-conceptself-concept

View of self View of self affectsaffects one’s ability to one’s ability to

function as well as function as well as healthhealthcomponents: self-knowledgecomponents: self-knowledge

self-esteem self-esteem

self-actualizationself-actualization

IdentityIdentityAn internal sense of individuality and An internal sense of individuality and wholenesswholeness. . Who are you?Who are you?

Name, gender, race, religion, occupation, Name, gender, race, religion, occupation, role, +++so much morerole, +++so much more

Begins during childhood as parents Begins during childhood as parents provide role models provide role models

Continues during adolescence as teens Continues during adolescence as teens establish own identityestablish own identity

Self-EsteemSelf-EsteemThe emotional appraisal of self-The emotional appraisal of self-concept.concept. How do you regard yourself??????How do you regard yourself??????Feel about self?Feel about self?Sense of worth or value??Sense of worth or value??This appraisal is an on-going process This appraisal is an on-going process so…levels of self-esteem can so…levels of self-esteem can change.change.

Body ImageBody ImageWhat do you think you look like What do you think you look like physically? ?????physically? ?????

What do you think about your What do you think about your appearance??????appearance??????

Body image is dynamic: the body changes Body image is dynamic: the body changes thru normal growth and development.thru normal growth and development.

Cultural and societal attitudes affect body Cultural and societal attitudes affect body imageimage

RolesRolesWhat is your role?????????What is your role?????????

What are the expected behaviors you What are the expected behaviors you perform????perform????

Simultaneously hold many roles and Simultaneously hold many roles and they changethey change

Who do you want to be????Who do you want to be????What do you want your role to be???What do you want your role to be???

RolesRolesSelf-ActualizationSelf-Actualization

A part of self-concept is the way a person A part of self-concept is the way a person perceives their ability to carry out perceives their ability to carry out significant rolessignificant roles

Health self-concept can distinguish Health self-concept can distinguish between:between:Ideal role expectationsIdeal role expectationsANDANDRealistic possibilitiesRealistic possibilities

Factors Affecting Self-conceptFactors Affecting Self-concept

Health status: illness, injury, body chg, loss of Health status: illness, injury, body chg, loss of control, dependency on otherscontrol, dependency on othersRole stressors; overload, strained, Role stressors; overload, strained,

feelings of inadequacy feelings of inadequacyDevelopmental transitions – aging in our cultureDevelopmental transitions – aging in our culturePersonal “success” or failure historyPersonal “success” or failure historyCrisis and/or life events: personal and/or globalCrisis and/or life events: personal and/or globalInternal and external resourcesInternal and external resourcesIndividual perception of crisisIndividual perception of crisis

Self-concept: psychosocial Self-concept: psychosocial dimensiondimension

How one develops and grows can How one develops and grows can have an affect on self-concept & healthhave an affect on self-concept & health

Therefore nurses need to understand Therefore nurses need to understand normal stages of growth (physical normal stages of growth (physical changes) & development changes) & development (psychosocial changes).(psychosocial changes).

Erikson- PErikson- Psychosocial sychosocial Developmental TheoryDevelopmental Theory

ID 8 stages from birth to old age ID 8 stages from birth to old age

Each stage characterized by a Each stage characterized by a developmental task to be mastereddevelopmental task to be mastered

Unmet tasks may delay progress Unmet tasks may delay progress through the next stagethrough the next stage

EriksonErikson

Trust vs MistrustTrust vs Mistrust InfancyInfancy

Infant relies onInfant relies oncaregivers for caregivers for basic needsbasic needs

Autonomy vs Autonomy vs Shame and doubtShame and doubt

ToddlerToddler

Gains independence: Gains independence: If expectations too If expectations too high or low feelings high or low feelings of inadequacy of inadequacy developdevelop

EriksonErikson

Initiative vs guiltInitiative vs guilt

PreschoolerPreschooler

Seeks new Seeks new experiences if experiences if restricted becomes restricted becomes hesitant to seek new hesitant to seek new challengeschallenges

Industry vs Industry vs inferiorityinferiority

School-ageSchool-age

Focuses on Focuses on achievements and achievements and if not accepted if not accepted develops a lack of develops a lack of self-worthself-worth

EriksonEriksonIdentity vs role Identity vs role confusionconfusion

AdolescenceAdolescence

Transition from Transition from childhood to childhood to adulthood. Acquires adulthood. Acquires sense of who they sense of who they are. Confusion if are. Confusion if unable to establish unable to establish sense of directionsense of direction

Intimacy vs Intimacy vs IsolationIsolation

Young adulthoodYoung adulthood

Unite self with Unite self with others –others –commitments. Fear commitments. Fear of commitment of commitment results in isolation results in isolation and lonelinessand loneliness

EriksonErikson

Generativity vs Generativity vs stagnationstagnation

Middle adulthoodMiddle adulthood Desire to make a Desire to make a

contribution to the contribution to the world. Becoming world. Becoming self absorbed self absorbed results in results in stagnationstagnation

Ego integrity vs Ego integrity vs despairdespair

Later adulthoodLater adulthood Reminiscence about Reminiscence about

life -sense of life -sense of purpose. If purpose. If believes life was believes life was misdirected misdirected despair results despair results

Assessing Self-conceptAssessing Self-concept

Developmental and chronological ageDevelopmental and chronological age

Assessing includes questions on Assessing includes questions on identity… body image…self esteem…identity… body image…self esteem…roles…roles…

Patient’s strengths/weaknessesPatient’s strengths/weaknesses

High self-esteem vs Low self-esteemHigh self-esteem vs Low self-esteem

AssertiveAssertiveSelf-directedSelf-directedMakes Makes decisionsdecisionsPraises selfPraises selfSpeaks clearlySpeaks clearlyAttends to Attends to needsneeds

Passive “who cares attitude”Passive “who cares attitude”Excessively DependentExcessively DependentHesitant to express viewsHesitant to express viewsOverly Critical of selfOverly Critical of selfMonotone voice – lack of Monotone voice – lack of emotion & energyemotion & energyNeglects own needsNeglects own needsDifficulty making decisionsDifficulty making decisionsOverly apologeticOverly apologeticAvoidance of eye contactAvoidance of eye contact

Nursing DiagnosesNursing Diagnoses

Disturbed body imageDisturbed body imageLow self-esteem; chronic or situationalLow self-esteem; chronic or situational

Other Dx in which Other Dx in which low self-conceptlow self-concept is the is the etiologyetiology::

Ineffective health maintenance r/t …Ineffective health maintenance r/t …Self care deficit r/t …Self care deficit r/t …Risk for self-directed violence r/t…Risk for self-directed violence r/t…

Nursing InterventionsNursing Interventions

Nurse is a role model Nurse is a role model Can a nurse NEGATIVELY affect a client’s self-Can a nurse NEGATIVELY affect a client’s self-concept?concept?Form helping relationship:Form helping relationship:Focus on client strengths; praise achievementsFocus on client strengths; praise achievementsMeet physiological and psychological needsMeet physiological and psychological needsReduce pain Reduce pain Decrease anxietyDecrease anxietyPromote positive self-esteemPromote positive self-esteemEncourage participation in careEncourage participation in careEncourage socializationEncourage socialization

Nursing Interventions NICNursing Interventions NIC

Encourage client to recognize and discuss Encourage client to recognize and discuss thoughts and feelingsthoughts and feelings

Assist client to:Assist client to:Realize everyone is uniqueRealize everyone is uniqueRealize impact of illness on self-conceptRealize impact of illness on self-conceptBe aware of negative self-statements and modify Be aware of negative self-statements and modify themthemGain more controlGain more controlIdentify positive attributes of selfIdentify positive attributes of selfIdentify and use personal strengthsIdentify and use personal strengths

Nursing EvaluationNursing Evaluation

Outcome criteria addressed????Outcome criteria addressed????

Behavior and attitude changes will Behavior and attitude changes will indicate altered self-esteemindicate altered self-esteem

Long term outcome –can take many Long term outcome –can take many months or yearsmonths or years

Evaluation (NOC)Evaluation (NOC)

Client should be able to meet the following Client should be able to meet the following outcomes:outcomes:

Be comfortable with body imageBe comfortable with body imageBe able to describe self positivelyBe able to describe self positivelyBe able to meet realistic goals Be able to meet realistic goals Be capable of interacting appropriately Be capable of interacting appropriately with environment and otherswith environment and others

““Know Thyself”Know Thyself” SocratesSocrates

Nurses need to reflect on their OWN self-Nurses need to reflect on their OWN self-concept in order to effectively assist OTHERs.concept in order to effectively assist OTHERs.

Ask yourself these questions:Ask yourself these questions:How do I perceive myself?How do I perceive myself?How do I think others see me?How do I think others see me?What are my strengths and weaknesses?What are my strengths and weaknesses?What are my goals for self-improvement?What are my goals for self-improvement?What does ALL THIS have to do with my What does ALL THIS have to do with my professional practice?professional practice?

SummarySummary

Self-concept based on 3 componentsSelf-concept based on 3 components

Need to understand how various Need to understand how various factors affect self-conceptfactors affect self-concept

Understand difference between high Understand difference between high & low self-esteem& low self-esteem

Interventions to promote self-conceptInterventions to promote self-concept

Evaluate outcome criteriaEvaluate outcome criteria

““No one can make you No one can make you feel inferior without feel inferior without

your consent”your consent”- Eleanor Roosevelt- Eleanor Roosevelt

Stress & Stress & CopingCoping

StressStressStress- condition when a person responds Stress- condition when a person responds to change to the normal balanced stateto change to the normal balanced state

Stressor- anything an individual perceives Stressor- anything an individual perceives as challenging, demanding or threatening as challenging, demanding or threatening (causes stress).(causes stress).

Coping responses- response due to threat Coping responses- response due to threat or challenge (stressor)or challenge (stressor)

Adaptation- change that occurs due to a Adaptation- change that occurs due to a response from stressorresponse from stressor

Why do we study STRESS?Why do we study STRESS?

Link between stress and healthLink between stress and healthDiseases/conditions linked to stressDiseases/conditions linked to stressAutoimmune disorders: RA, Graves, ColitisAutoimmune disorders: RA, Graves, Colitis Psoriasis PsoriasisCardiovascular disorders: HTN, CANCardiovascular disorders: HTN, CANRespiratory disorders: AsthmaRespiratory disorders: AsthmaGastrointestinal disorders: GERDGastrointestinal disorders: GERDStress directly affects nervous, endocrine, and immune Stress directly affects nervous, endocrine, and immune systemssystemsStress indirectly affects health d/t poor health habits: Stress indirectly affects health d/t poor health habits: smoking, drinking, eating too much, not sleeping smoking, drinking, eating too much, not sleeping enough.enough.

Is all stress BAD for you?Is all stress BAD for you?

What about stress of knowing you have an exam coming What about stress of knowing you have an exam coming up?up?

What about the stress of having to have a job, raise a What about the stress of having to have a job, raise a family, etc.?family, etc.?

What about it’s protective mechanism?What about it’s protective mechanism?(the (the stressstress of crossing a busy street) of crossing a busy street)

DISTRESS (damaging stress)DISTRESS (damaging stress)versusversus

EUSTRESS (motivating and/or protective stress)EUSTRESS (motivating and/or protective stress)

HomeostasisHomeostasisVarious physiological and psychological Various physiological and psychological mechanisms respond to changes in the mechanisms respond to changes in the internal and external environment to internal and external environment to maintain a balanced state maintain a balanced state

To maintain To maintain healthhealth the body’s internal the body’s internal environment needs a balanced state. environment needs a balanced state. STRESS upsets this balance!STRESS upsets this balance!

Physiological Physiological HomeostasisHomeostasis

Regulating mechanisms of the body Regulating mechanisms of the body react to change and keep the body in react to change and keep the body in homeostasishomeostasis

Primarily: Autonomic nervous system Primarily: Autonomic nervous system (sympathetic)(sympathetic) & the endocrine system & the endocrine system (epinephrine, cortisol, aldosterone)(epinephrine, cortisol, aldosterone)

Other: cardiovascular,respiratory, GI Other: cardiovascular,respiratory, GI and renal systems and renal systems

Physiological Indicators of Physiological Indicators of StressStress

Pupils dilatePupils dilateDiaphoresisDiaphoresisIncreased HR/BPIncreased HR/BPPallorPallorIncreased rate/depth Increased rate/depth respirationsrespirationsDry mouthDry mouth

Decreased urinary Decreased urinary outputoutput

Decreased peristalsisDecreased peristalsis

Increased mental Increased mental alertnessalertness

Increased muscle Increased muscle tensiontension

•Intended for short term response to a PHYSICAL stressor

•It is inappropriate (and more harmful ) in response to NON-physical stress

Psychological Psychological HomeostasisHomeostasis

Need to maintain mental well-beingNeed to maintain mental well-being

It uses psychological adaptive behaviors It uses psychological adaptive behaviors ie:ie: Coping mechanisms and defense Coping mechanisms and defense mechanisms to return one to an mechanisms to return one to an emotionally balanced stateemotionally balanced state

Psychological Indicators of Psychological Indicators of StressStress

AnxietyAnxietyMild - PanicMild - Panic

Coping MechanismsCoping Mechanisms(ie: anger, withdrawal, (ie: anger, withdrawal, inappropriate inappropriate laughing and/or laughing and/or crying)crying)

UnconsciousUnconsciousdefense defense mechanismsmechanisms

Defense MechanismsDefense Mechanisms text text

reviewreview

CompensationCompensation

DenialDenial

DisplacementDisplacement

ProjectionProjection

ConversionConversion

DisassociationDisassociation

RationalizationRationalization

Reaction formationReaction formation

RegressionRegression

RepressionRepression

UndoingUndoing

Adaptation to StressAdaptation to Stress

IF IF necessary resources are available to necessary resources are available to deal w/stressor deal w/stressor THEN THEN adaptation adaptation occurs & balance maintained.occurs & balance maintained.

IF IF resources are not available resources are not available THENTHEN adaptation doesn’t occur & stress adaptation doesn’t occur & stress resultsresults

Adaptation is individualizedAdaptation is individualized

Adaptation to StressAdaptation to Stress

Factors in the Process of AdaptationFactors in the Process of Adaptation Perception of Event – realistic OR distortedPerception of Event – realistic OR distorted Situational Support – adequate OR notSituational Support – adequate OR not Coping Mechanisms – adequate OR notCoping Mechanisms – adequate OR not

Leads to either:Leads to either: Positive resolutionPositive resolutionOROR Negative resolutionNegative resolution

Adaptation: LASAdaptation: LAS

Local adaptation syndromeLocal adaptation syndrome (LAS) (LAS)

- localized response of the body to - localized response of the body to stressstress- involves only a specific body part- involves only a specific body part

Short term adaptive responseShort term adaptive response

Examples = reflex pain response & Examples = reflex pain response & inflammatory responseinflammatory response

Adaptation: GASAdaptation: GAS

General adaptation syndromeGeneral adaptation syndrome (GAS) - (GAS) - response to stress is characterized by a response to stress is characterized by a chain of physiological eventschain of physiological events

Theory developed by Hans SelyeTheory developed by Hans Selye

Incorporates 3 stages: alarm reaction, Incorporates 3 stages: alarm reaction, resistance stage & exhaustion stageresistance stage & exhaustion stage

GAS: First StageGAS: First Stage

Alarm reactionAlarm reaction-- stressor (threat) stressor (threat) activates the body’s various defense activates the body’s various defense mechanismsmechanismsAutonomic nervous system responds Autonomic nervous system responds ….Fight or flight response….. Lasts 1 ….Fight or flight response….. Lasts 1 minute –24hrsminute –24hrsNeuroendocrine activity (sympathetic ) Neuroendocrine activity (sympathetic ) increasesincreasesIf stressor persists, body proceeds to If stressor persists, body proceeds to nest stage - Resistancenest stage - Resistance

GAS: Second StageGAS: Second Stage

Resistance stageResistance stage-- body attempts to body attempts to cope with the stressor and brings down cope with the stressor and brings down neuroendocrine responses – neuroendocrine responses – parasympathetic adaptations increase.parasympathetic adaptations increase.

If stress can be managed – homeostasis If stress can be managed – homeostasis results = results = RecoveryRecovery

If stress is too great the third phase of If stress is too great the third phase of GAS continues = GAS continues = ExhaustionExhaustion

GAS: Third StageGAS: Third Stage

Exhaustion stageExhaustion stage-- adaptation adaptation mechanisms are exhausted. mechanisms are exhausted. Body energy stores depleted and no Body energy stores depleted and no longer able to defend with sympathetic longer able to defend with sympathetic response.response.

At the end of this stage the body either At the end of this stage the body either rests & recovers or death will occurrests & recovers or death will occur

Effects of StressEffects of StressStress can be a stimulus or a barrierStress can be a stimulus or a barrier

Effects basic human needs: Effects basic human needs: physiological, Safety/security, physiological, Safety/security, Love/belonging, Self-esteem & Self Love/belonging, Self-esteem & Self actualizationactualization

Effects patient & familyEffects patient & family

Prolonged stress effects ability to adaptProlonged stress effects ability to adapt

Burnout/crisisBurnout/crisis

Sources of StressSources of StressType of StressorsType of Stressors

Sources: Sources: developmental or situationaldevelopmental or situational

Type of stressors: Type of stressors: physiological or psychosocialphysiological or psychosocial

Assessing StressAssessing Stress

Identify stress level by using: Identify stress level by using:

Nursing historyNursing history

Physical assessmentPhysical assessment

Standardized tests or rating scalesStandardized tests or rating scales

Focused AssessmentFocused Assessment

SUBJECTIVESUBJECTIVEWhat is of most concern to What is of most concern to you at this time?you at this time?What have you done in the What have you done in the past to cope with stress?past to cope with stress?Do you smoke, use drugs, Do you smoke, use drugs, caffeine intake?caffeine intake?Do you follow a healthy Do you follow a healthy diet ,exercise regime, see diet ,exercise regime, see you physician regularly?you physician regularly?Change in eating and/or Change in eating and/or sleeping habits?sleeping habits?

OBJECTIVEOBJECTIVE

Observe for:Observe for:

Non-verbal cues Non-verbal cues Eye-contactEye-contactPosturePostureGrooming/hygieneGrooming/hygiene

Irritability / TensionIrritability / Tension

Developmental levelDevelopmental level

Sociocultural factorsSociocultural factors

VSVS

Nursing DiagnosisNursing Diagnosis

EXAMPLE:EXAMPLE:

Anxiety R/T loss of job AEB inability to Anxiety R/T loss of job AEB inability to focus, unable to sleep, decreased appetite focus, unable to sleep, decreased appetite & states “ I’m so nervous worrying about & states “ I’m so nervous worrying about finding a new job”finding a new job”

What are some others???What are some others???

PlanningPlanningPlan to maintain physiological & Plan to maintain physiological & psychological homeostasispsychological homeostasis

Develops plan with patient, support people Develops plan with patient, support people & others as needed& others as needed

Outcome criteria may include decreased Outcome criteria may include decreased anxiety, increased ability to cope or anxiety, increased ability to cope or improved role performanceimproved role performance

ImplementationImplementationNursing InterventionsNursing Interventions

Encourage health promotion strategies: Encourage health promotion strategies: exercise, sleep, proper nutrition, time exercise, sleep, proper nutrition, time management, minimizing anxiety, management, minimizing anxiety, relaxation techniquesrelaxation techniquesEncourage use of support systemsEncourage use of support systemsMay need to make referrals if stress is too May need to make referrals if stress is too great- crisis interventiongreat- crisis intervention

What can nurses do for clients What can nurses do for clients experiencing stressors of experiencing stressors of

hospitalization?hospitalization?

Use calm reassuring approachUse calm reassuring approach

Explain all proceduresExplain all procedures

Listen attentivelyListen attentively

Encourage verbalization of feelingsEncourage verbalization of feelings

Assist client to gain and/or maintain Assist client to gain and/or maintain control of situations as much as possiblecontrol of situations as much as possible

EvaluationEvaluationUse desired outcomes as a guideUse desired outcomes as a guideObserve verbal & nonverbal cuesObserve verbal & nonverbal cuesHas goal been met?Has goal been met?

Example:Example:The client is able to:The client is able to:

-verbalize cause & effect of stress-verbalize cause & effect of stress-identify and use supports-identify and use supports-practice healthy lifestyle -practice healthy lifestyle -utilize effective relaxation techniques-utilize effective relaxation techniques

SummarySummary

Stress affects homeostasis both Stress affects homeostasis both physiologically & psychologicallyphysiologically & psychologically

Adaptation to stress includes LAS, Adaptation to stress includes LAS, GAS, coping & defense mechanismsGAS, coping & defense mechanisms

Various factors affect stress Various factors affect stress

Nursing process is used to aid patients Nursing process is used to aid patients dealing with stressdealing with stress