Self –Concept &
Coping
NUR101 Fall 2010
Lecture # 13
K. Burger MSEd, MSN, RN, CNE
PPP by: Sharon Niggemeier RN MSN
Revised 10/05 kb
Self -Concept
Self-concept : self image
Each individual is unique with own
self-concept
View of self affects one’s ability to
function as well as health
components: self-knowledge
self-esteem
self-actualization
Identity
An internal sense of individuality
and wholeness. Who are you?
Name, gender, race, religion,
occupation, role, +++so much more
Begins during childhood as parents
provide role models
Continues during adolescence as
teens establish own identity
Self-Esteem
The emotional appraisal of selfconcept.
How do you regard yourself??????
Feel about self?
Sense of worth or value??
This appraisal is an on-going process
so…levels of self-esteem can
change.
Body Image
What do you think you look like physically?
?????
What do you think about your
appearance??????
Body image is dynamic: the body changes
thru normal growth and development.
Cultural and societal attitudes affect body
image
Roles
What is your role?????????
What are the expected behaviors you
perform????
Simultaneously hold many roles and
they change
Who do you want to be????
What do you want your role to be???
Roles
Self-Actualization
A part of self-concept is the way a person
perceives their ability to carry out
significant roles
Health self-concept can distinguish
between:
Ideal role expectations
AND
Realistic possibilities
Factors Affecting Self-concept
Health status: illness, injury, body chg, loss of
control, dependency on others
Role stressors; overload, strained,
feelings of inadequacy
Developmental transitions – aging in our culture
Personal “success” or failure history
Crisis and/or life events: personal and/or global
Internal and external resources
Individual perception of crisis
Self-concept: psychosocial
dimension
How one develops and grows can
have an affect on self-concept & health
Therefore nurses need to understand
normal stages of growth (physical
changes) & development
(psychosocial changes).
Erikson- Psychosocial
Developmental Theory
ID 8 stages from birth to old age
Each stage characterized by a
developmental task to be mastered
Unmet tasks may delay progress
through the next stage
Erikson
Trust vs Mistrust
Infancy
Infant relies on
caregivers for
basic needs
Autonomy vs
Shame and doubt
Toddler
Gains independence:
If expectations too
high or low feelings
of inadequacy
develop
Erikson
Initiative vs guilt
Preschooler
Seeks new
experiences if
restricted becomes
hesitant to seek new
challenges
Industry vs
inferiority
School-age
Focuses on
achievements and
if not accepted
develops a lack of
self-worth
Erikson
Identity vs role
confusion
Adolescence
Transition from
childhood to
adulthood. Acquires
sense of who they
are. Confusion if
unable to establish
sense of direction
Intimacy vs
Isolation
Young adulthood
Unite self with
others –
commitments. Fear
of commitment
results in isolation
and loneliness
Erikson
Generativity vs
stagnation
Middle adulthood
Desire to make a
contribution to the
world. Becoming
self absorbed
results in
stagnation
Ego integrity vs
despair
Later adulthood
Reminiscence about
life -sense of
purpose. If
believes life was
misdirected
despair results
Assessing Self-concept
Developmental and chronological age
Assessing includes questions on
identity… body image…self
esteem…roles…
Patient’s strengths/weaknesses
High self-esteem vs Low self-esteem
Assertive
Self-directed
Makes
decisions
Praises self
Speaks clearly
Attends to
needs
Passive “who cares attitude”
Excessively Dependent
Hesitant to express views
Overly Critical of self
Monotone voice – lack of
emotion & energy
Neglects own needs
Difficulty making decisions
Overly apologetic
Avoidance of eye contact
Nursing Diagnoses
Disturbed body image
Low self-esteem; chronic or situational
Other Dx in which low self-concept is the
etiology:
 Ineffective health maintenance r/t …
 Self care deficit r/t …
 Risk for self-directed violence r/t…
Nursing Interventions
Nurse is a role model
Can a nurse NEGATIVELY affect a client’s selfconcept?
Form helping relationship:
Focus on client strengths; praise achievements
Meet physiological and psychological needs
Reduce pain
Decrease anxiety
Promote positive self-esteem
Encourage participation in care
Encourage socialization
Nursing Interventions NIC
Encourage client to recognize and discuss
thoughts and feelings
Assist client to:
Realize everyone is unique
Realize impact of illness on self-concept
Be aware of negative self-statements and modify
them
Gain more control
Identify positive attributes of self
Identify and use personal strengths
Nursing Evaluation
Outcome criteria addressed????
Behavior and attitude changes will
indicate altered self-esteem
Long term outcome –can take many
months or years
Evaluation (NOC)
Client should be able to meet the following
outcomes:
Be comfortable with body image
Be able to describe self positively
Be able to meet realistic goals
Be capable of interacting appropriately
with environment and others
“Know Thyself”
Socrates
Nurses need to reflect on their OWN selfconcept in order to effectively assist OTHERs.
Ask yourself these questions:
How do I perceive myself?
How do I think others see me?
What are my strengths and weaknesses?
What are my goals for self-improvement?
What does ALL THIS have to do with my
professional practice?
Summary
Self-concept based on 3 components
Need to understand how various
factors affect self-concept
Understand difference between high
& low self-esteem
Interventions to promote self-concept
Evaluate outcome criteria
“No one can make you feel
inferior without your consent”
- Eleanor Roosevelt
Stress &
Coping
Stress
Stress- condition when a person
responds to change to the normal
balanced state
Stressor- anything an individual
perceives as challenging, demanding or
threatening (causes stress).
Coping responses- response due to
threat or challenge (stressor)
Adaptation- change that occurs due to a
response from stressor
Why do we study STRESS?
Link between stress and health
Diseases/conditions linked to stress
Autoimmune disorders: RA, Graves, Colitis
Psoriasis
Cardiovascular disorders: HTN, CAN
Respiratory disorders: Asthma
Gastrointestinal disorders: GERD
Stress directly affects nervous, endocrine, and immune
systems
Stress indirectly affects health d/t poor health habits:
smoking, drinking, eating too much, not sleeping
enough.
Is all stress BAD for you?
What about stress of knowing you have an exam coming
up?
What about the stress of having to have a job, raise a
family, etc.?
What about it’s protective mechanism?
(the stress of crossing a busy street)
DISTRESS (damaging stress)
versus
EUSTRESS (motivating and/or protective stress)
Homeostasis
Various physiological and psychological
mechanisms respond to changes in the
internal and external environment to
maintain a balanced state
To maintain health the body’s internal
environment needs a balanced state.
STRESS upsets this balance!
Physiological
Homeostasis
Regulating mechanisms of the body
react to change and keep the body in
homeostasis
Primarily: Autonomic nervous system
(sympathetic) & the endocrine system
(epinephrine, cortisol, aldosterone)
Other: cardiovascular,respiratory, GI
and renal systems
Physiological Indicators of
Stress
Pupils dilate
Diaphoresis
Increased HR/BP
Pallor
Increased rate/depth
respirations
Dry mouth
Decreased urinary
output
Decreased peristalsis
Increased mental
alertness
Increased muscle
tension
•Intended for short term response to a PHYSICAL stressor
•It is inappropriate (and more harmful ) in response to NON-physical stress
Psychological
Homeostasis
Need to maintain mental well-being
It uses psychological adaptive behaviors
ie: Coping mechanisms and defense
mechanisms to return one to an
emotionally balanced state
Psychological Indicators of
Stress
Anxiety
Mild - Panic
Coping Mechanisms
(ie: anger, withdrawal,
inappropriate
laughing and/or
crying)
Unconscious
defense
mechanisms
Defense Mechanisms
text
review
Compensation
Denial
Displacement
Projection
Conversion
Disassociation
Rationalization
Reaction formation
Regression
Repression
Undoing
Adaptation to Stress
IF necessary resources are available to
deal w/stressor THEN adaptation
occurs & balance maintained.
IF resources are not available THEN
adaptation doesn’t occur & stress
results
Adaptation is individualized
Adaptation to Stress
Factors in the Process of Adaptation
 Perception of Event – realistic OR
distorted
 Situational Support – adequate OR not
 Coping Mechanisms – adequate OR not
Leads to either:
 Positive resolution
OR
 Negative resolution
Adaptation: LAS
Local adaptation syndrome (LAS)
- localized response of the body to
stress
- involves only a specific body part
Short term adaptive response
Examples = reflex pain response &
inflammatory response
Adaptation: GAS
General adaptation syndrome (GAS) response to stress is characterized by a
chain of physiological events
Theory developed by Hans Selye
Incorporates 3 stages: alarm reaction,
resistance stage & exhaustion stage
GAS: First Stage
Alarm reaction- stressor (threat)
activates the body’s various defense
mechanisms
Autonomic nervous system responds
….Fight or flight response….. Lasts 1
minute –24hrs
Neuroendocrine activity (sympathetic )
increases
If stressor persists, body proceeds to
nest stage - Resistance
GAS: Second Stage
Resistance stage- body attempts to
cope with the stressor and brings down
neuroendocrine responses –
parasympathetic adaptations increase.
If stress can be managed – homeostasis
results = Recovery
If stress is too great the third phase of
GAS continues = Exhaustion
GAS: Third Stage
Exhaustion stage- adaptation
mechanisms are exhausted.
Body energy stores depleted and no
longer able to defend with sympathetic
response.
At the end of this stage the body either
rests & recovers or death will occur
Effects of Stress
Stress can be a stimulus or a barrier
Effects basic human needs:
physiological, Safety/security,
Love/belonging, Self-esteem & Self
actualization
Effects patient & family
Prolonged stress effects ability to adapt
Burnout/crisis
Sources of Stress
Type of Stressors
Sources:
developmental or situational
Type of stressors:
physiological or psychosocial
Assessing Stress
Identify stress level by using:
Nursing history
Physical assessment
Standardized tests or rating scales
Focused Assessment
SUBJECTIVE
What is of most concern to
you at this time?
What have you done in the
past to cope with stress?
Do you smoke, use drugs,
caffeine intake?
Do you follow a healthy diet
,exercise regime, see you
physician regularly?
Change in eating and/or
sleeping habits?
OBJECTIVE
Observe for:
Non-verbal cues
Eye-contact
Posture
Grooming/hygiene
Irritability / Tension
Developmental level
Sociocultural factors
VS
Nursing Diagnosis
EXAMPLE:
Anxiety R/T loss of job AEB inability to
focus, unable to sleep, decreased appetite
& states “ I’m so nervous worrying about
finding a new job”
What are some others???
Planning
Plan to maintain physiological &
psychological homeostasis
Develops plan with patient, support people
& others as needed
Outcome criteria may include decreased
anxiety, increased ability to cope or
improved role performance
Implementation
Nursing Interventions
Encourage health promotion strategies:
exercise, sleep, proper nutrition, time
management, minimizing anxiety,
relaxation techniques
Encourage use of support systems
May need to make referrals if stress is too
great- crisis intervention
What can nurses do for clients
experiencing stressors of
hospitalization?
Use calm reassuring approach
Explain all procedures
Listen attentively
Encourage verbalization of feelings
Assist client to gain and/or maintain
control of situations as much as possible
Evaluation
Use desired outcomes as a guide
Observe verbal & nonverbal cues
Has goal been met?
Example:
The client is able to:
-verbalize cause & effect of stress
-identify and use supports
-practice healthy lifestyle
-utilize effective relaxation techniques
Summary
Stress affects homeostasis both
physiologically & psychologically
Adaptation to stress includes LAS,
GAS, coping & defense mechanisms
Various factors affect stress
Nursing process is used to aid patients
dealing with stress