P&P Chapt. 25. Pp 399-406, 412-413 SELF CONCEPT
Self-Concept is defined as how a person thinks about himself or herself. It’s a
subjective sense of self that is formed of a mixture of conscious and unconscious
thoughts, attitudes and perceptions. Self-concept has several domains: social,
emotional, physical, academic and non academic. Self concept strongly effects how a
person manages situations and relationships, therefore it also effects how someone
will behave and react in a health care setting, and when dealing with illness.
-The term Self Esteem often used interchangeably with self concept, but is different.
Self esteem is an evaluative term, and it influences self concept. Whereas self
concept is a descriptive term.
-We develop our self-concepts throughout our lifespan. Self concept becomes more
clearly differentiated during puberty and adolescence. Maturational changes are
generally regarded as positive for boys, but adolescent girls may be more sensitive
about physical changes. In adult hood, men tend to report higher levels of self
esteem than women. Some factors that effect self esteem are job satisfaction and job
performance, aging (emotional and physical changes associated with aging), and
ethnic and cultural differences.
-Individuals perception of themselves and of their health are closely related. If
someone has a positive belief about their personal health, their self concept is more
positive. What people think and how they feel about themselves affects how they
care for themselves and others. People with poor self concepts may not feel worthy
of care, may feel out of control.
Development of Self Concept
-Erikson (1963) described key tasks that individuals face at various stages of
development. Each stage builds on previous. Successful mastery of a stage leads to
positive sense of self.
Stage 1-trust vs mistrust. (birth to age 1)-child develops trust from consistency in
caregiving and nurturing interactions.
Stage 2-Autonomy vs shame and doubt (ages 1-3)-child begins to communicate likes
and dislikes. Increasingly autonomous. Develops self thru modeling, imitation,
socialization.
Stage 3-Initiative vs guilt. (ages 3-6)-child takes initiative, identifies with a gender,
gains enhanced self awareness, increases language skills, sensitive to family.
Stage 4-Industry vs inferiority. (ages 6-12) Child incorporates feedback from
teachers and peers. Increases self esteem with skill mastery, strengthens sexual
identity, becomes aware of strengths and limitations.
Stage 5-Identity vs Role Confusion (age 12-20) accepts body changes and
maturation. Examines attitudes, values, beliefs and establishes goals for future.
Stage 6- Intimacy Vs Isolation (age 20-40) has intimate relationships with family
and significant others, has stable, positive feelings about self. Experiences successful
role transitions and increased responsibilities.
Stage 7- Generativity vs Self Absorption (age 40-60) Accepts change in appearance
and physical endurance. Reasess life goals. Shows contentment with aging.
Stage 8- Ego Integrity vs Despair (age 60 plus) Feels positive about own life and its
meaning. Interested in providing a legacy for next generation.
Self Concept is Based on the Following: Sense of competency, Percieved reactions
of other people to own body, ongoing perceptions and interpretations of other
peoples thoughts and feelings, racial identity, personal and professional
relationships, sexual identity, academic and employment related identity, spiritual
identity, personality structure, mastery of prior and new experiences, self
expectations, current feelings about physical, emotional and social self.
Identity-the internal sense of individuality, wholeness, and consistency of a person
over time and in various circumstances. Identity implies being distinct from others,
a unique person. Sexuality, race, religious faith, are all parts of ones identity.
Body Image- involves attitudes related to the body, including physical appearance,
structure, function. Mental images we have are not always consistent with a persons
actual physical structure. Body image is influenced by culture and society, because
they dictate the norms. In north America, people are socialized to dread the natural
aging process. Youth, beauty and wholeness are emphasized.
Role Performance- the way in which individuals perceive their ability to carry out
significant roles. Eg) being a parent, child, spouse, employee. Individuals learn
behaviors that are approved by society through the following process:
Reinforcement-extinction – certain behaviors become common or avoided
depending on whether they are punished or reinforced.
Inhibition- and individual learns to refrain from certain behaviours even when
tempted to engage in them.
Substitution – one behavior is replaced with another, which provides the same
personal gratification.
Imitation – skills or behaviors are aquired by observing other members of the family
or social groups.
Identification – an individual internalizes the beliefs, behaviors, values of role
models into personal unique expression of self.
Self Esteem – and individuals overall sense of worth, or the emotional appraisal of
self concept. The overall judgement of personal worth or value. Self esteem is
shaped by how person thinks he she is perceived by others. Global self esteem
levels are highest in childhood, then declines in adolescence. Then, self esteem levels
rise gradually during adult hood and sharply decline in old age. The ideal self
consists of a persons aspirations, goals, values, and standards that they strive to
attain. In general, a person whos self concept is close to matching the ideal self, will
have high self esteem.
Stressors affecting Self-Concept
-Any real or perceived change that threatens identity or body image or role
performance is a stressor. It challenges a persons adaptive capacities. The most
important facter in determining a persons response is their perception of the
stressor. Any change in health can be a stressor, which can affect self concept. Eg) a
physical change in body can affect body image, thereby affecting identity and self
esteem.
-Crisis occurs when a person cannot overcome obstacles with his or her usual
methods of problem solving and adaptation. Any crisis can affect self concept and
self esteem. Some stressors created by a crisis like identity confusion, disturbed
body image, role conflict, role strain, low self esteem, can actually result in illness.
-During a self concept crisis, supportive and educational resources can help a person
form new ways of coping and responding to the stressful event or situation.
Identity Stressors
-Are developmental markers like puberty, menopause, retirement, and decreasing
physical abilities.
Identity Confusion-results when people do not maintain a clear, consistent, and
continuous consciousness of personal identity. It may occur at any stage of life, if a
person is unable to adapt to identity stressors.
Body Image Stressors
-changes in appearance, structure, or function of a body part requires an adjustment
in body image. A persons perception of the change and the importance they place
on body image affects the significance of a loss of function or change of appearance.
Burns, amputations, or facial disfigurement are physically obvious stressors that
affect body image.
-chronic illnesses like heart disease can affect body image as well because the body
no longer functions at an optimal level.
Role Performance Stressors
-throughout life, a person undergoes numerous role changes. Normal changes
associated with grown and maturation result in developmental transitions.
Situational transitions occur when parents, spouses, children etc die or move away,
marry, divorce, or change jobs.
-a health-illness transition is changing from a state of health or well being to one of
illness. Any of the transitions listed above could lead to role conflict, ambiguity, role
overload, or strain.
Role Conflict-results when a person simultaneously assumes two or more roles that
are inconsistent, contradictory, or mutually exclusive. Eg) when a middle age
woman with a teenage daughter assumes responsibility of caring for parents as well.
The Sick Role-involves the expectations of other people and society about how a
person should behave when sick.
Role Ambiguity-involves unclear role expectations. When expectations are unclear,
people may be unsure about what to do or how to behave. This is often stressful and
confusing. Common in adolescence.
Role Strain-Is the stress or strain experienced by an individual when behaviors,
expectations, or obligations associated with a single social role are incompatible.
This may be experienced by people feel inadequate or unsuited for a new social role.
Eg) someone who marrys someone who already has children and must assume role
of step parent.
Role Overload- involves having more roles or responsibilities within a role than are
manageable.
Self Esteem Stressors.
-individuals with high self esteem are generally more resilient and are better able to
cope with demands and stressors than are those with low self esteem. High self
esteem is also associated with more optimal mental and physical health, greater
control over circumstances, and greater adaptation and productivity as an adult.
-low self worth can contribute to feeling unfulfilled, and isolated from others and
can result in depression, uneasiness, and anxiety.
-chronic illness affects self worth. The more the illness interferes with the ablitity to
engage in activities, the more it interferes with feelings of worth, success, and the
more it affects self esteem.
-Self esteem stressors vary within developmental stages. Some things that affect a
childs sense of self worth are inconsistent discipline, sibling rivalry, inability to meet
parental expectations.
-Low self esteem takes a toll on children. Children with low self esteem and self
worth are more likely to bully other children, and are also more likely to be bullied.
-Low self esteem in adolescence is a strong predictor of depression.
The Family’s effect on Development of Self Concept
-family plays key role in creating its members self concept. Children develop a basic
sense of who they are from their caregivers.
-Bowlby’s Attatchment theory (1982) suggests that the quality of the attachment
that children develop with their caregivers influences the development of a set of
expectations about the self, their interpretations of the actions of other people, and
ideas about how to respond to them. Children who experience sensitive and
supportive caring will develop expectations that they are worthy of other peoples
love and that other people are supportive.
-parents who are harsh, inconsistent, or have low selfesteem themselves may foster
negative self concepts in their children. Even if they are well meaning, they can still
foster the negative self concept.
The Nurses Effect on the Clients Self Concept
-the nurses acceptance of a client with an altered self concept helps promote change.
Personal self awareness is critical when accepting and understanding others. Nurses
who are secure in their own identities are more able to accept and reinforce their
clients identity.
-Some clients with a change in body appearance are very sensistive to health care
professionals verbal and non verbal responses. A positive and matter of fact
approach to care can provide a model for the client and the family to follow.
-you can have a positive effect by conveying genuine interest and acceptance, and by
building a trusting nurse client relationship, which involves the client appropriately.
-you can significantly affect clients body image by showing acceptance of the scar or
change, for example, a masectomy scar. Clients closely watch other peoples
reactions to their wounds and scars.
Critical Thinking
-Self concept profoundly influences a persons response to illness.
-A critical thinking approach to care is essential. It requires synthesis of knowledge,
experience, information gathered from various resources, and intellectual and
professional standards. Previous experience in caring for clients with alterations in
self concept will assist you in individualizing care for each client.
PP 412-413.
Implementation – as with all steps of the nursing process, a therapeutic nurse
client relationship is central to the implementation phase. Consider nursing
interventions to promote healthy self concept and help the client move towards
meeting these goals. Some approaches to help implement healthy self concept are:
Health promotion-Work with clients to help them develop healthy lifestyle
behaviors.
Acute Care-In an acute care setting, some clients will experience threats to their self
concept because of the nature of the treatment. Threats to the self concept can lead
to anxiety and fear. Nurses in the acute care setting deal with clients who are faced
with the need to adapt to altered body image. A visit from someone who has
undergone the same procedure can be helpful. Timing is very important. Forcing
confrontation with change before client is ready could delay acceptance.
Restorative care-In a long term nurse client relationship in a home care
environment, nurses have the opportunity to work with clients to attain a more
positive self concept. Increasing client self awareness is achieved though the
trusting nurse client relationship. b