Self-Concept
Self-Concept
 One’s mental image of oneself
 Appearance, values, beliefs
 Influences behavior
 Dimensions of self-concept
 Self-knowledge
– Self-expectation
 Social self
– Social evaluation
 Me-centered versus other-centered
 Self-awareness
Formation of Self-Concept
 Develops as a result of social interactions
 Erikson
 Broad steps in development of self-concept
 Global self
 Base self-concept on several areas
 Maintaining self-concept ongoing process
 Ideal self – Nurses’ view of selves
Components
 Personal Identity
 Body image
 Role performance
 Self-esteem
Role Performance Behaviors
 Reinforcement-extinction
 Inhibition
 Substitution
 Imitation
 Identification
Self-Concept Stressors
 Identity stressors
 Body image stressors
 Role performance stressors
 Conflict
 Ambiguity
 Strain
 Overload
 Self-esteem stressors
Factors that Affect Self-Concept
 Stage of Development
 Family and Culture
 History of Success and Failure
 Resources
 Stressors
 Illness
Alterations
 Exhibited in a variety of ways
 Alterations may be temporary
 Lower self-esteem
 Eating disorders
 Set of maladaptive responses to stress
 Cause low self-esteem, self-hatred, fear
Eating Disorders
 Anorexia nervosa
 Extreme perfectionism
 Weight fear
 Bulimia nervosa
 Cycles of binge eating followed by purging
 Syndromes with multiple predisposing factors
 Two disorders can occur in same person
Eating Disorders, continued
 Binge-eating disorder
 Binge eating with no purging
 Other disorders
 Purging disorder
 Nocturnal sleep-related eating disorder
 Prader-Willi syndrome



Congenital disorder
Appetite becomes insatiable
Behavioral problems
Personality Disorders
 Enduring pattern of inner experience, behavior
 Deviates from expectation of individuals culture
 Pervasive, inflexible
 Begins in adolescence, young adulthood
 11 types of personality disorders, 3 clusters
Personality Disorders, continued
 Odd and eccentric
 Dramatic and emotional
 Anxiety and fear-based personality disorders
 Common clinical features
 Impaired sense of self
 Thinking patterns
 Emotions
 Behaviors

Vicious cycle of personality disorders
Assessment
 Psychosocial assessment
 Personality identity
 Body image
 Role performance
 Self-esteem
 Establish trust, working relationship
 Guidelines for psychosocial assessment
Assessment, continued
 Personal identity
 Body image
 Role performance
 Self-esteem
 Cultural background affects behaviors
 Assessment interview
Caring Interventions
 Identify areas of strength
 Framework for identifying personality strengths
 Specific strategies to reinforce strengths
 Enhancing self-esteem
 Therapeutic relationship requires


Self-awareness
Communication skills
 Developmental considerations
Pharmacologic Therapies
 Eating disorders
 Antidepressants
 Drug trials disappointing for anorexia
 Personality disorders
 Medications used to target specific symptoms


Decrease behaviors
SSRIs, clonidine, guanfacine,
 Overall treatment includes therapy

Group, family, behavioral
Nursing Diagnoses
 Examples
 Disturbed personal identity
 Ineffective coping
 Disturbed body image
 Chronic low self esteem
Planning
 Goals and outcomes
 Priorities
 Continuity of care
 Cultural considerations
Implementation
 Health promotion
 Acute care
 Restorative care
Evaluation
 Client care
 Client expectations
Grief and Loss
Loss
 Actual loss
 Perceived loss
 Maturational loss
 Situational loss
Grief
 Mourning
 Bereavement
 Anticipatory Grief
Kubler-Ross Stages
of Grief (1969)
 DENIAL
 ANGER
 BARGAINING
 DEPRESSION
 ACCEPTANCE
Types of Grief
 Anticipatory grief
 Complicated grief
 Disenfranchised grief
Assessment
 Type and stage of grief
 Grief reactions
 Factors that affect grief
 End-of-life decisions (Advance Directives, Allow
Natural Death)
 Nurse’s experiences
 Client expectations
Factors Influencing Loss
and Grief
 Age
 Significance of the Loss
 Culture
 Spiritual Beliefs
 Gender
 Socioeconomic Status
 Support System
 Cause of Loss or Death
Culture and Death Rituals,
Mourning Practices
Death Rituals by Culture
 African American
 Chinese
 Hindu
 Jewish
 Mexican
 Arab
 Japanese
Nursing Diagnoses
 Grieving
 Complicated Grieving
 Interrupted Family Processes
 Risk-prone Health Behavior
 Risk for Loneliness
Planning
 Goals and outcomes
 Setting priorities
 Continuity of care
Implementation
 Facilitating Grief Work
 Providing Emotional Support
Palliative Care
 Symptom control
 Maintaining dignity and self-esteem
 Preventing abandonment and isolation
 Providing a comfortable and peaceful environment
 Therapeutic Communication
 Promote spiritual comfort
Physiologic Changes in the
Dying Patient
 Pain
 Dyspnea
 Anorexia, Nausea
 Dehydration
 Altered levels of Consciousness
 Hypotension
Supportive Care
 Support for the grieving family
 Assist with end of life decision making
 Hospice care
 Care after death (postmortem care)
 Grieving nurse
 Caring for Dying Children
Evaluation
 Client care
 Client/family wishes
 Client expectations
Sexuality
Reproductive Anatomy and
Physiology
 Male
 Female
Sexual Development (pg 1692)
 Infancy
 Toddler
 Preschooler
 School-age years
 Puberty/adolescence
 Young adulthood
 Middle adulthood
 Late adulthood
Sexual Health
 Sexual Self-Concept
 Body Image
 Gender Identity
 Gender-role Behavior
 Androgyny
 Sexual Orientation
Sexual Response Cycle
 Desire
 Arousal
 Orgasm
Factors Influencing Sexuality
 Family
 Culture
 Religion
 Personal Expectations and Ethics
Alterations in Sexual Function
 Sexual Desire Disorders
 Sexual Arousal Disorders
 Orgasmic Disorders
 Sexual Pain Disorders
 Problems with Satisfaction
 Erectile Dysfunction
Contraception
 Nonprescription methods
 Abstinence
 Fertility Awareness Methods
 Barrier methods
 Spermicides
Contraception
 Prescription/health care intervention methods
 Hormonal
 Intrauterine devices
 Diaphragm/cervical cap
 Sterilization
Sexually Transmitted
Infections
 Syphilis
 Gonorrhea
 Chlamydia
 Trichomoniasis
 Human papillomavirus (HPV) Genital warts
 Herpes simplex virus (HSV) Genital Herpes
Sexually Transmitted Diseases
 Human immunodeficiency virus (HIV)
 AIDS
 Transmission
 Exposure categories
 Education
 Cultural considerations
Sociocultural Influences
on Sexuality
 Pregnancy and menstruation
 Discussing sexual issues
Decisional Issues Related
to Sexuality
 Contraception
 Abortion
 STD prevention
Alterations in Sexual Health
 Infertility
 Sexual abuse
 Menstrual Dysfunction
 Sexual Dysfunction
 Erectile Dysfunction
Menopause
 Physiology and Etiology
 Clinical manifestations
 Diagnostic Tests
 Pharmacologic Therapies
 Alternative/Complementary Therapies
Assessment
 Factors affecting sexuality
 Sexual health history
 Sexual dysfunction
 Physical assessment
 Client expectations
 Nursing diagnosis
 Cultural considerations
Nursing Diagnosis
 Sexual Dysfunction
 Situational Low Self Esteem
 Risk for Disturbed Body Image
 Deficient Knowlwdge
 Ineffective Sexual Pattern
 Anxiety
 AcutePain
Planning
 Goals and outcomes
 Priorities
 Continuity of care
Implementation
 Health promotion
 Acute care
 Restorative care
Evaluation
 Client care
 Client expectations
Spiritual Health
Components of Spirituality
 Spiritual Needs
 Spiritual Health & Well-Being
 Spiritual Distress
 Core Aspects of Spirituality
 Spiritual Development
Spiritual Practices/Beliefs
Affecting Nursing Care
 Food & Nutrition
 Healing
 Body Coverings
 Birth & Death
Religion and Medical Care
 Judaism
 Islam
 Roman Catholic
 Protestant Christianity
 Hinduism
 Buddhism
 Jehovah’s Witness
Spiritual Assessment
 TJC mandate
 Clinical Assessment
 Assessment Interview
 Assess religious and spiritual needs
Nursing Diagnoses
 Spiritual distress
 Readiness for enhanced spiritual well-being
 Fear
 Hopelessness
 Impaired religiosity
 Readiness for Enhanced religiosity
Planning
 Goals and outcomes
 Setting priorities
 Continuity of care
Implementation
 Establishing presence
 Supporting a healing relationship
 Support systems
 Diet therapies
 Supporting rituals
 Prayer
 Meditation
 Supporting grief work
 Pastoral Care/Spiritual Counseling
Evaluation
 Client care
 Client expectations