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Chapter 41 (Taylor)

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Elizabeth E

on 19 November 2013

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Transcript of Chapter 41 (Taylor)

Chapter 41 (Taylor)

By: Elizabeth Espinoza
(mental image or picture of self) has the power to either encourage or thwart personal growth
-Pt with deficient self-concept may lack motivation to learn self-care behaviors in response to illness, injury, and trauma.

-The need for
is the need to feel good about oneself and to believe that others hold one in high regard
-The need for
is the need to reach one's potential through full development of one's unique ability

-Other end of the spectrum:
identity diffusion
: failure to integrate various childhood
identifications into a harmonious adult psychosocial
: the subjective experience of the
partial or total disruption of one's ego and the
disintegration and disorganization of one's self-concept
Maladaptive Responses
Adaptive Responses
I. Overview of Self-Concept
A. Dimensions of Self-Concept
-all of the feelings, beliefs, and values associated
with "I" or "me"
-specifics components of self-concept:
-personal identity, body image, self-esteem,
role performance
-dimensions of self-concept:
-self-knowledge, self-expectations, self-

1. Self-Knowledge: "Who Am I?"
global self
: term used to describe the
composite of all the basic facts, qualities,
traits, images and feelings one holds
about oneself
+strongly influences a person's ability
to manage life events
-BASIC FACTS: sex, age, race, occupation,
sexual orientation
-Person's position w/i social groups
-Qualities or traits the describe typical
2. Self-Expectations: "Who or What Do I Want to Be?"
ideal self
: constitutes the self one wants to be
+develops in early childhood
+based on image of role models (parents)
+personal expectations may be healthy or unhealthy
(villain on tv or drug dealer)

false self:
develops in individuals who have the
emotional need to respond to the ambitions others
have for them (parents)
3. Self-Evaluation: "How Well Do I Like Myself?"
-Maslow identified two subsets of esteem needs:
1)self-esteem needs: strength, achievement, mastery
competence, confidence, independence, freedom
2)respect needs (from others): status, dominance,
recognition, attention, appreciation

: identified the four bases of self-
esteem as:
1) significance- the way a person feels he or she is
loved and approved of by the people important
to that person
2) competence- the way tasks that are considered
important are performed
3) virtue- the attachment of moral-ethical standards
4) power- the extent to which a person influences
his or her own and other's lives

-Harter's- Three Major Self-Evaluation Feelings in
>learned in early childhood within relationships
>pride, guilt, shame

-Sullivan: "good me" "bad me"
-Bowlby: attachment theory

B. Formation of Self-Concept
-1)the infant learns that the physical self is different
form the environment.
>meet basic needs= + feelings about self
-2)the child next internalizes other people's attitudes
toward self
-3)the child or adult internalizes the standard of society

~Stages in Development of Self~
+self-awareness (infancy)
+self-recognition (18 months)
+self-definition (3 years)
+self-concept (6-7 years)
Fostering Healthy Development
of the Self in Children
-emotional warmth and acceptance
-effective structure and discipline
-clearly defined standards and limits
-established methods of handling children
that produce the desired behavior,
discourage misbehavior, and deal with
infractions when they occur
-encourage of competence and self-
-a stimulating and responsive environment
C. Factors Affecting Self-Concept
1. Developmental Considerations
>infants need a supportive environment (all needs met)
>growing child needs the freedom to explore
>Later Years

2. Culture
-influences sense of self
-confusion with different cultural expectations
-children of immigrants>cultural dissonance>conflict
between parents and children occur

3. Internal and External Resources
-internal resources are our personal strengths that we use
to cope
-external resources (support people, finances)

4. History of Success and Failure
-fear success>find it easier to fail
-successful experiences>positive self-concept
>need to develop internal resources to be able to adapt to
to failure

5. Crises or Life Stressors
-major stressors place anyone at risk for maladaptive
responses such as:
>extreme anxiety
>substance abuse
>exacerbation of physical illness

described 3 factors that 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)
3)the coping mechanisms the person posses (internal)

6. Aging, Illness, Trauma
-response to this varies
-threats to self-concept

II. The Nursing Process
-before nurses can successfully identify and resolve self-concept disturbances in pts, they must be comfortable with themselves and posses an adequate

A. Assessing
-the nurse assessing self-concept focuses on the pt's personal identity, body
image, self-esteem, and role performance.
1. Personal Identity
-pt's description of self
personal identity
describes an individuals conscious sense of who he or
she is. "How would you describe yourself to others?"
2. Personal Strengths
-ask questions to identify positive factors
3. Body Image
-the subjective view a person has about his or her physical appearance
a)Response to Deformity of Limitation
adaptive responses
: pts exhibits signs of grief and mourning (shock,
disbelief, denial, anger, guilt, acceptance)
maladaptive responses
: pt denies and avoids deformity/limitation,
engages in self-destructive behavior, talks about feelings of worthlessness.
b)Independence-Dependence Patterns
-adaptive responses: pt assumes responsibility for care, develops new self-
care behaviors
-maladaptive responses: pt assigns responsibility for his or her care to
others, becomes dependent or refuses help

4. Self-Esteem
-does the pt like himself or herself?
-"Tell me what you like about yourself?
-question the pt about self-expectations
-Goals? Future? Realistic? Are they doing it for
someone else?
a)Socialization and Communication
-"changes in meeting and interacting with others?"
-"Does it bother you when you feel unloved or when
others fail to appreciate you?"
-"How important to you is it to feel that others value
your work?"
-"Tell me about the
principles that
govern your life"
-What is it that makes you feel not in control?
5. Role Performance
-assess how illness has affected their life roles

B. Diagnosing
1. Disturbances in Self-Concept as the Problem
-Disturbed Body Image
-Chronic Low Self-Esteem
-Ineffective Role Performance
-Disturbed Personal Identity
2. Disturbance in Self-Concept as the Etiology
-Anxiety r/t change in body image
-Ineffective Coping r/t low self-esteem
-Ineffective Health Maintenance r/t low-self-esteem
-Hopelessness r/t overwhelming role demands
-Self-Care Deficit
*important to determine whether the altered self-concept is the problem, etiology, or a sign that a problem exists

C. Outcome Id and Planning
-the pt will verbalize self is liked
-describe self realistically
-report feeling better about himself or herself

D. Implementing
1. Helping Pts Identify and Use Personal Strengths
2. Helping At Risk Pts Maintain a Sense of Self
-acknowledge pt by preferred name
3. Modifying a Negative Self-Concept
4. Developing a Positive Body Image
5. Developing Self-Esteem in Children/Teens
6. Enhancing Self-Esteem in Older Adults
- losses associated with aging:
>diminished strength and personal health
>interpersonal losses
>shrinking income

E. Evaluating
-pt's self report/ observed behaviors
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