Chapter 15
Promoting Self-Esteem
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Introduction
• Healthy self-esteem has been described as
essential for psychological survival.
• An awareness of self is an important
differentiating factor between humans and
other animals.
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Components of Self-Concept
• Self-concept has been defined as “the
cognitive or thinking component of the self,
and generally refers to the totality of a
complex, organized, and dynamic system of
learned beliefs, attitudes, and opinions that
each person holds to be true about his or her
personal existence.”
(Huitt, 2011)
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Components of Self-Concept (cont.)
• Self-concept consists of the following three
components:
– The physical self or body image
– Personal identity
– Self-esteem
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Components of Self-Concept (cont.)
1. The physical self or body image—a
personal appraisal of one’s physical
being
– Body image may not coincide with actual
appearance.
– Disturbances in body image may occur
when individuals undergo alterations in
structure or function.
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Components of Self-Concept (cont.)
2. Personal Identity
– The moral-ethical self
– The self-consistency
– The self-ideal/self-expectancy
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Components of Self-Concept (cont.)
3. Self-Esteem
– The degree of regard or respect that individuals
have for themselves and is a measure of worth
that they place on their abilities and judgments
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Components of Self-Concept (cont.)
1. A client with a new ileostomy tells the nurse, “I’m
disgusting. This ileostomy makes me so ugly.” Which
correctly written nursing diagnosis would be
appropriately assigned to address this client’s problem?
A. Situational low self-esteem related to disturbed body
image evidenced by client statement “I’m disgusting”
B. Risk for complicated grieving related to loss of normal GI
function evidenced by expressions of anger
C. Disturbed thought processes related to ileostomy
evidenced by altered body image
D. Anxiety related to cancer of the colon evidenced by
ileostomy
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Components of Self-Concept (cont.)
• Correct answer: A
– The client’s statement of “I’m disgusting” is
evidence of the client’s negative perception of self
brought about by the new ileostomy (a current
situation). This has impaired the client’s selfesteem. This is a correctly written nursing
diagnosis.
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The Development of Self-Esteem
• Coopersmith has identified the following
antecedent conditions of positive selfesteem:
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Power
Significance
Virtue
Competence
Consistently set limits
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The Development of Self-Esteem
(cont.)
2. After his wife left him, the husband, diagnosed with
depression, is admitted to a psychiatric unit. He
states that he was proud of receiving job
commendations that led to a promotion. Which
condition that would affect self-esteem has
contributed to the client’s depression?
A.
B.
D.
D.
The lack of power
The lack of significance
The lack of virtue
The lack of competence
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The Development of Self-Esteem
(cont.)
• Correct answer: B
– Significance is a condition that enhances selfesteem by promoting feelings of love, respect,
and care. The client has a lack of significance due
to the fact that his significant other has
abandoned him.
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The Development of Self-Esteem
(cont.)
• Warren lists the following as important for
parents and others who work with children to
emphasize and encourage healthy selfesteem:
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A sense of competence
Unconditional love
A sense of survival
Realistic goals
A sense of responsibility
Reality orientation
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The Development of Self-Esteem
(cont.)
• Other factors influential to the development
of self-esteem:
– Responses of others
– Hereditary factors
– Environmental conditions
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The Development of Self-Esteem
(cont.)
3. A mother berates her child for breaking a cup and
says, “You are bad and so destructive.” This statement
discourages the development of positive self-esteem
by not meeting which parenting focus as described by
Warren?
A.
B.
C.
D.
A sense of competence
Unconditional love
A sense of survival
Realistic goals
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The Development of Self-Esteem
(cont.)
• Correct answer: B
– According to Warren, parents promote selfesteem when they provide unconditional love for
their children. Children need to know that they
are loved and accepted regardless of successes or
failures. Criticism of behavior should not be
linked with criticism of the child. In the situation
presented, the mother discourages the
development of positive self-esteem by not
meeting the child’s need for unconditional love.
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Developmental Progression of SelfEsteem
• Erikson’s theory of personality development
provides a useful framework for illustration of
self-esteem development.
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Trust versus mistrust
Autonomy versus shame and doubt
Initiative versus guilt
Industry versus inferiority
Identity versus role confusion
Intimacy versus isolation
Generativity versus stagnation
Ego integrity versus despair
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Manifestations of Low Self-Esteem
• Behaviors that reflect low self-esteem manifest
themselves according to three types of stimuli:
– Focal stimuli
– Contextual stimuli
– Residual stimuli
• Symptoms of low self-esteem are many.
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Boundaries
• Boundaries consist of the personal space,
both physical and psychological, that
individuals identify as their own.
• Boundaries are sometimes referred to as
“limits.”
• Individuals who are aware of their boundaries
have a healthy self-esteem because they must
know and accept their inner selves.
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Boundaries (cont.)
• Types of physical
boundaries include
physical closeness,
touching, sexual behavior,
eye contact, privacy, and pollution.
• Touching someone who does not want to be
touched is an example of an invasion of a
physical boundary.
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Boundaries (cont.)
• Types of psychological boundaries include
beliefs, feelings, choices, needs, time alone,
interests, confidences, individual differences,
and spirituality.
• Being criticized for doing something
differently from others is an example of an
invasion of a psychological boundary.
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Boundaries (cont.)
• Boundary Pliancy. Boundaries can be rigid,
flexible, or enmeshed.
– Rigid boundaries occur when people have a very
narrow perspective on life. They perceive that
things must be one way and refuse to change for
any reason.
– Flexible boundaries occur when people are able
to let go of their boundaries as appropriate.
Healthy boundaries are flexible.
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Boundaries (cont.)
Boundary Pliancy (cont.)
– Enmeshed boundaries occur when two
people’s boundaries are so blended together
that neither can be sure where one stops and
the other begins. An individual with an
enmeshed boundary is unable to
differentiate his or her wants and needs from
those of the other person.
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Boundaries (cont.)
Establishing Boundaries
• Boundaries are established in childhood.
• Unhealthy boundaries are the products of unhealthy,
troubled, or dysfunctional families and may result
from:
– Negative role-modeling
– Abuse or neglect
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The Nursing Process
• Assessment
– The Self-Esteem Inventory
• Diagnosis/Outcome Identification
– Nursing diagnoses
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•
•
•
Chronic low self-esteem
Situational low self-esteem
Risk for chronic low self-esteem
Risk for situational low self-esteem
– Outcome criteria
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The Nursing Process (cont.)
• Planning/Implementation
– Nursing care of individuals with problems related
to self-esteem includes:
• Helping the client recognize positive self-attributes and
abandon judgmental self-perceptions
• Helping the client identify sources of threat to selfesteem
• Helping the client work through the grief process
related to loss or failure
• Assisting the client with preservation of self-esteem
during an episode of situational threat
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The Nursing Process (cont.)
• Evaluation
– Evaluation is based on achievement of previously
established outcome criteria.
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