chapter 33.txt

• Development of self-concept is a lifelong process.
• • Erikson’s psychosocial theory:
• Each stage builds on tasks of the previous stage.
• Successful mastery leads to a sense of self.

• Trust versus Mistrust (Birth to 1 Year)
• • Develops trust following consistency in caregiving and nurturing interactions
• • Distinguishes self from environment
• Autonomy versus Shame and Doubt (1 to 3 Years)
• • Begins to communicate likes and dislikes
• • Increasingly independent in thoughts and actions
• • Appreciates body appearance and function (e.g., dressing, feeding, talking, and walking)
• Initiative versus Guilt (3 to 6 Years)
• • Identifies with a gender
• • Enhances self-awareness
• • Increases language skills, including identification of feelings
• Industry versus Inferiority (6 to 12 Years)
• • Incorporates feedback from peers and teachers
• • Increases self-esteem with new skill mastery (e.g., reading, mathematics, sports, music)
• • Aware of strengths and limitations
• Identity versus Role Confusion (12 to 20 Years)
• • Accepts body changes/maturation
• • Examines attitudes, values, and beliefs; establishes goals for the future
• • Feels positive about expanded sense of self
• Intimacy versus Isolation (Mid-20s to Mid-40s)
• • Has stable, positive feelings about self
• • Experiences successful role transitions and increased responsibilities
• Generativity versus Self-Absorption (Mid-40s to Mid-60s)
• • Able to accept changes in appearance and physical endurance
• • Reassesses life goals
• • Shows contentment with aging
• Ego Integrity versus Despair (Late 60s to Death)
• • Feels positive about life and its meaning
• • Interested in providing a legacy for the next generation

Self concept: a mental self-image of strengths and weaknesses in all aspects of personality. Self-concept depends in part on body image and roles but also includes other aspects of psychology and spirituality

• Identity: Involves the internal sense of individuality, wholeness, and consistency of self
• • Body image: Involves attitudes related to physical appearance, structure, or function
• • Role performance: How individuals carry out their significant roles
• • Self-Esteem: an individual's overall feeling of self-worth or the emotional appraisal of self-concept.

• • 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.
• Change in health
• Other crises

• • Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgments:
• Use a positive and matter of fact approach.
• Build a trusting relationship.
• Be aware of facial and body expressions.

• Encourage self-care
• • Elicit patient’s perceptions of strengths and weaknesses
• • Explore coping responses
• • Reinforce strengths and successes

• In assessing self-concept and self-esteem, first focus on each component of self-concept (identity, body image, and role performance
• • Avoidance of eye contact
• • Slumped posture
• • Unkempt appearance
• • Overly apologetic
• • Hesitant speech
• • Overly critical or angry
• • Frequent or inappropriate crying
• • Negative self-evaluation
• • Excessively dependent
• • Hesitant to express views or opinions
• • Lack of interest in what is happening
• • Passive attitude
• • Difficulty in making decisions Self-Concept and the Nursing Process

• • Disturbed body image
• • Caregiver role strain
• • Disturbed personal identity
• • Ineffective role performance
• • Readiness for enhanced self-concept
• • Chronic low self-esteem
• • Situational low self-esteem
• • Risk for situational low self-esteem

• • Goals and outcomes: Be realistic and inividualize
• • Setting priorities: Focus on adaptations to stressors.
• • Collaborative care: Consider additional resources.

• Health Promotion: Work with patients to help them develop healthy lifestyle behaviors that contribute to a positive self-concept. Measures that support adaptation to stress such as proper nutrition, regular exercise within the patient's capabilities, adequate sleep and rest, and stress-reducing practices contribute to a healthy self-concept.
• Acute Care: In the acute care setting some patients experience potential threats to their self-concept because of the nature of the treatment and diagnostic procedures. Remain sensitive to the patient's level of acceptance of any changes. Forcing confrontation with a change before the patient is ready likely delays the person's acceptance.
• Restorative and Continuing Care: Interventions designed to help a patient reach the goal of adapting to changes in self-concept or attaining a positive self-concept are based on the premise that the patient first develops insight and self-awareness concerning problems and stressors and then acts to solve the problems and cope with the stressors.

• • 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:
• Nonverbal behaviors showing positive self-concept
• Statements of self-acceptance
• Acceptance of change