Chapter 33
Self-Concept
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Self-Concept
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A subjective sense of self and a complex
mixture of unconscious and conscious
thoughts, attitudes, and perceptions
A positive self-concept gives a sense of
meaning, wholeness, and consistency to a
person.
A healthy self-concept has a high degree of
stability and generates positive feelings
toward the self.
Self-esteem is closely related.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study
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Paul Taylor, a 58-year-old man, suffered an
unexpected and sudden stroke. He did not
know that he had hypertension because he
did not get yearly checkups. He awoke in the
hospital bed to find that he could not move
his hand.
He was not able to care for himself or even
turn himself for days. His body image has
dramatically changed from that of a man of
strength to that of a helpless individual.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Scientific Knowledge Base
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Parents and primary caregivers have
tremendous influence on the development of
a child’s self-concept.
Individuals learn and internalize cultural
influences on self-concept and self-esteem in
childhood and adolescence.
In adulthood, job satisfaction and job
performance are linked to self-esteem.
The sense of self is often negatively affected
in older adulthood.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Family Effect on Self-Concept
Development
Family plays a key role.
Children develop a basic sense from family.
Strong parental support and parental
monitoring create positive effects.
Family and cultural influences can be positive
or negative.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nursing Knowledge Base:
Development of Self-Concept
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Development of selfconcept is a lifelong
process.
Erikson’s psychosocial
theory:
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Each stage builds on
tasks of the previous
stage.
Successful mastery
leads to a sense of self.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Mr. Taylor’s self-esteem lessens as his recovery and
rehabilitation move slowly. His self-concept has
changed from that of a strong laborer, one who did
his own plumbing and car repairs, to a man who must
rely on others.
Although Mrs. Taylor works, they have not saved
enough money to meet monthly expenses or to
educate their children without both incomes. Mr.
Taylor’s role as primary breadwinner will change if he
does not improve.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Components of Self-Concept
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Identity
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Body image
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Involves the internal sense
of individuality, wholeness,
and consistency of self
Involves attitudes related to
physical appearance,
structure, or function
Role performance
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How individuals carry out
their significant roles
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Maria Kendal is a 27-year-old nursing student
assigned to care for Mr. Taylor. She is
divorced, has two school-aged children, and
works part-time as a certified nurse assistant
at a local long-term care facility while in
school.
She recognizes that changes in health status
often result in stressors that affect a person’s
self-concept. Such stressors influence a
person’s ability to interact with others and to
function effectively.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Factors Affecting Self-Concept
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Any real or perceived change that threatens
identity, body image, or role performance can
affect self-concept.
Changes that occur in physical, spiritual,
emotional, sexual, familial, and sociocultural
health affect self-concept.
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Change in health
Other crises
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Stressors Affecting Self-Concept
Identity
stressors
Role
performance
stressors
Body image
stressors
Self-esteem
stressors
Especially
during
adolescence
Role ambiguity
Affect
appearance,
structure or
function of a
body part
Vary by
developmental stage
Role overload
Role conflict
Role strain
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Maria realizes that Mr. Taylor’s stroke
resulted in neurological deficits, which are
significant stressors. Mr. Taylor’s
independence is threatened because he is in
the hospital and is dependent upon the
nurses for most of his care.
He may never be able to go back to work
again, and he does not consider himself a
strong man anymore. Therefore, his family
role as provider is threatened.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
1. You are assigned to care for a patient who
has just undergone a mastectomy for a
malignant tumor. You would most
appropriately classify this self-concept
component as
A. Identity stressor.
B. Sexuality stressor.
C. Body image stressor.
D. Role performance stressor.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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The Nurse’s Effect on the Patient’s
Self-Concept
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Nurses need to remain aware of their own
feelings, ideas, values, expectations, and
judgments:
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Use a positive and matter of fact approach.
 Build a trusting relationship.
 Be aware of facial and body expressions.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Adolescent Self-Concept
Identity confusion
Disturbed body image
Self-esteem
Role conflict
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Older-Adult Self-Concept
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Can be negatively affected in older adulthood
because of a number of life changes.
However, in some individuals, aging
promotes improved coping strategies that
protect against declining feelings of selfesteem, despite the physical and emotional
changes associated with aging.
Nursing interventions aimed at enhancing
self-concept and self-esteem in older adults
are essential.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
2. You are caring for an adolescent patient who
has undergone a gastric banding procedure 6
months previously. This adolescent tells you,
“There is still a fat person inside of me.” This
type of statement illustrates a flaw in the selfconcept of
A. Identity.
B. Self-esteem.
C. Body image.
D. Role performance.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Cultural Considerations
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Develop an open, nonrestrictive attitude for
assessing and encouraging cultural practices to
improve patients’ self-concept.
Ask patients what they think is important to help them
feel better or gain a stronger sense of self.
Encourage cultural identity by individualizing self-care
practices and offering treatment choices to meet
patients’ self-concept needs.
Facilitate culturally sensitive health promotion
activities that address at-risk behaviors identified
through evidence-based practice.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
3. You are assigned to care for a patient who
retired 6 months ago. While providing care,
you identify that this patient is struggling
emotionally with change. This situation is
most likely associated with the self-concept
component of
A. Identity stressor.
B. Sexuality stressor.
C. Body image stressor.
D. Role performance stressor.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Self-Concept and the Nursing
Process: Assessment
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Avoidance of eye contact 
Slumped posture
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Unkempt appearance
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Overly apologetic
Hesitant speech
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Overly critical or angry
Frequent or
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inappropriate crying
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Negative self-evaluation
Excessively dependent
Hesitant to express
views or opinions
Lack of interest in what is
happening
Passive attitude
Difficulty in making
decisions
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Self-Concept and the Nursing Process:
Nursing Diagnosis and Planning
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Goals and outcomes
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Setting priorities
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Be realistic.
Focus on adaptations to stressors.
Collaborative care
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Consider additional resources.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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If you were Maria, what goal would you write
for Mr. Taylor? Be sure to include observable
behaviors.
What interventions would you suggest that
Maria consider?
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Self-Concept and the Nursing
Process: Implementation
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Goal: reduce
situational low selfesteem
Target the level of
care:
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Health promotion
Acute care
Restorative care
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Encourage self-care
Elicit patient’s
perceptions of
strengths and
weaknesses
Explore coping
responses
Reinforce strengths
and successes
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Self-Concept and the Nursing
Process: Evaluation
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Frequent evaluation of patient progress is necessary.
Apply knowledge of behaviors and characteristics of
a healthy self-concept when reviewing the actual
behaviors patients display.
Expected outcomes for a patient with a self-concept
disturbance:
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Nonverbal behaviors showing positive self-concept
Statements of self-acceptance
Acceptance of change
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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On the last day Maria cared for Mr. Taylor, he
reported that he was going to a rehabilitation center
that specializes in helping people who have had
strokes.
Mr. Taylor is able to complete most of his bath
independently. Although his gait is unsteady, he is
able to walk short distances with a walker. During his
bath, he jokes, “I think my new haircut makes me
look a lot younger!” Mr. Taylor also states, “I can’t
wait to get better. I have a lot of things to do, and I
have a lot to live for.”
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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