St.

Paul College of Ilocos Sur

(Member, St. Paul University System)

St. Paul Avenue 2727, Bantay, Ilocos Sur

NCM 103: FUNDAMENTALS OF NURSING

PRACTICE

SELF – CONCEPT

SUBMITTED BY: KRISTINE ANGIE RAMOS BSN1 - A

PAUL ADRIANE RENON BSN1 - A
Learning Objectives:
1. Describe the dimensions and components of self-concept.
2. Identify common stressors affecting self-concept and coping strategies.
3. Describe the essential aspects of assessing role relationships.
4. Identify nursing diagnoses related to altered self-concept.
5. Describe nursing interventions designed to achieve identified outcomes for clients with altered self-
concept.

SELF-CONCEPT
Introduction

 Self-concept is one’s mental image of oneself. A positive self-concept is essential to a person’s mental and
physical health. Individuals with a positive self-concept are better able to develop and maintain
interpersonal relationships and resist psychological and physical illness. An individual possessing a strong
self-concept should be better able to accept or adapt to changes that may occur over the life span. How
one views oneself affects one’s interaction with others.

 Nurses have a responsibility to assess clients for a negative self-concept and to identify the possible
causes in order to help them develop a more positive view of themselves. Individuals who have a poor self-
concept may express feelings of worthlessness, self-dislike, or even self-hatred. They may feel sad or
hopeless, and may state they lack energy to perform even the simplest of tasks.

4 DIMENSIONS OF SELF-CONCEPT

1. Self-knowledge
- insight into one’s own abilities, nature, and limitations.
2. Self-expectation
- what one expects of oneself; may be realistic or unrealistic expectations.
3. Social self
- how a person is perceived by others and society
4. Social evaluation
- the appraisal of oneself in relationship to others, events, or situations

COMPONENTS OF SELF-CONCEPT

.
 Identity
- A sense of personal identity is what sets one person apart as a unique individual.
- Identity may include a person’s name, gender, age, race, ethnic origin or culture, occupation or roles, talents,
and other situational characteristics (e.g., marital status and education).
- A person begins to develop identity during childhood and constantly reinforces and modifies it throughout.

 Body Image
- Body image is attituded about one’s physical attributes and characteristics, appearance, and performance.
- Body image has both cognitive and affective aspects. The cognitive is the knowledge of the material body;
the affective includes the sensations of the body, such as pain, pleasure, fatigue, and physical movement.
- A person’s body image develops partly from others’ attitudes and responses to that person’s body and partly
from the individual’s own exploration of the body. For example, body image develops in infancy as the parents
or caregivers respond to the child with smiles, holding, and touching, and as the child explores its own body
sensations during breast-feeding, thumb sucking, and the bath. Cultural and societal values also influence a
person’s body image.

 Role Performance
- Role performance is the way in which individuals perceive their ability to carry out significant roles (e.g.,
parent, supervisor, or close friend). Normal changes associated with maturation result in changes in role
performance.
- For example, when a man has a child, he becomes a father. The new role of father involves many changes in
behavior if the man is going to be successful. Group interventions aimed at improving fathering experiences
have led to significant improvements in the father’s participation in the family, including role performance,
involvement, communication, self-esteem, a sense of increased competence, and decreased stress in
parenting.

 Self Esteem
- Self-esteem is an individual’s overall feeling of self-worth or the emotional appraisal of self-concept. It is the
most fundamental self-evaluation because it represents the overall judgment of personal worth or value. Self-
esteem is positive when one feels capable, worthwhile, and competent.
2 Types of Self Esteem
1. Global self-esteem is how much one likes oneself as a whole.
2. Specific self-esteem is how much one approves of a certain part of oneself.

FACTORS THAT AFFECT SELF-CONCEPT

 Stage of Development
- As an individual develops, the conditions that affect the self-concept change. For example, an infant requires
a supportive, caring environment, whereas a child requires freedom to explore and learn. Older adults’ self-
concept is based on their experiences in progressing through life’s stages

 Family and Culture

- A young child’s values are largely influenced by the family and culture. Later on, peers influence the child and
thereby affect the sense of self. When the child is confronted by differing expectations from family, culture, and
peers, the child’s sense of self is often confused.

 Stressor
- Stressors can strengthen the self-concept as an individual copes successfully with problems. On the other
hand, overwhelming stressors can cause maladaptive responses including substance abuse, withdrawal, and
anxiety. The ability of a person to handle stressors will largely depend on personal resources. It is important for
the nurse to identify any stressors that may affect aspects of the self-concept.

Stressor Affecting Self-Concept

▫ IDENTITY STRESSORS - Change in physical appearance (e.g., facial

wrinkles).
- Declining physical, mental, or sensory abilities.
- Inability to achieve goals.
- Relationship concerns.
- Sexuality concerns.
- Unrealistic ideal self.

▫ BODY IMAGE STRESSORS - Loss of body part can affect

- Some degree of body dissatisfaction
- Health status can alter distortions in body image
- Other’s views and the feedback provided can
impact
- Affected by cognitive growth and physical
development
 - Adolescent changes impact
- Cultural and societal attitudes
- Changes associated with aging
- Depends only partly on the reality of the bod

▫ ROLE STRESSORS - Loss of parent, spouse, child, or close friend

- Change or loss of job or another significant role
- Divorce
- Illness of self or others that affects role
performance
- Ambiguous or conflicting role expectations
- Inability to meet role expectations

▫ SELF-ESTEEM STRESSORS - Lack of positive feedback from significant others

- Repeated failures
- Unrealistic expectations
- Abusive relationship
- Loss of financial security

 Resources
- An individual’s resources are internal and external. Examples of internal resources include confidence and
values, whereas external resources include support network, sufficient finances, and organizations. Generally,
the greater the number of resources a person has and uses, the more positive the effect on the self-concept.

 History of Success and Failure

- People who have a history of failures come to see themselves as failures, whereas people with a history of
successes will have a more positive self-concept. Likewise, individuals with a positive self-concept tend to find
contentment in their level of success, whereas a negative self-concept can lead to viewing one’s life situation
as negative.

 Illness
- Illness and trauma can also affect an individual’s self-concept. People respond to stressors such as illness
and alterations in function related to aging in a variety of ways. Acceptance, denial, withdrawal, and depression
are common reactions.

NURSING MANAGEMENT ASSESING

Personal Identity
- When assessing self-concept, the information the nurse first needs is about the client’s personal identity. This
involves who the client believes he or she is. See the accompanying Assessment Interview for examples of
questions to ask.

ASSESSMENT INTERVIEW PERSONAL IDENTITY

• How would you describe your personal characteristics? Or How do you see yourself as a person?
• How do others describe you as a person?
• What do you like about yourself?
 • What do you do well?
• What are your personal strengths, talents, and abilities?
• What would you change about yourself if you could?
• How do you feel if you think someone does not like you?

Body Image
- If there are indications of a body image disturbance, the nurse should assess the client carefully for possible
functional or physical problems. See the accompanying Assessment Interview for examples of questions to ask
about body image.

ASSESSMENT INTERVIEW BODY IMAGE

• Is there any part of your body you would like to change?
• Do you feel different or inferior to others?
• How do you feel about your appearance?
• What changes in your body do you expect following your surgery/treatment/illness?
• How have significant others in your life reacted to changes in your body?

Role Performance
- The nurse assesses the client’s satisfactions and dissatisfactions as- sociated with role responsibilities and
relationships: family roles, work roles, student roles, and social roles. Family roles are especially important to
people because family relationships are particularly close.
- Assessment of family role relationships may begin with structural aspects such as the number in the family
group, ages, and residence location. To obtain data related to the client’s family relationships and satisfaction
or dissatisfaction with work roles and social roles, the nurse might ask some of the questions shown in the
accompanying Assessment Interview. (Keep in mind, however, that questions need to be tailored to the
individuals and their culture, age, and situation.)

ASSESSMENT INTERVIEW ROLE PERFORMANCE

 FAMILY RELATIONSHIPS
• Tell me about your family.
• What is home like?
• How is your relationship with your spouse/partner/significant other (if appropriate)?
• What are your relationships like with your other relatives?
• How are important decisions made in your family?
• What are your responsibilities in the family?
• How well do you feel you accomplish what is expected of you?
• What about your role or responsibilities would you like to change?
• Are you proud of your family members?
• Do you feel your family members are proud of you?

WORK ROLES AND SOCIAL ROLES

• Do you like your work?
• How do you get along at work?
• What about your work would you like to change if you could?
• How do you spend your free time?
• Are you involved in any community groups?
• Are you most comfortable alone, with one other person, or in a group?
• Who is most important to you?
• Whom do you seek out for help?

Self Esteem
- It is important for the nurse to determine the client’s cultural background first in order to not misinterpret
specific behaviors.

ASSESSMENT INTERVIEW SELF ESTEEM

• Are you satisfied with your life?
• How do you feel about yourself?
• Are you accomplishing what you want?
• What goals in life are important to you?

The following behaviors might reflect low self-esteem or may be misinterpreted due to the client’s cultural
background:
• Avoids eye contact.
• Stoops in posture and moves slowly.
• Is poorly groomed and has an unkempt appearance.
• Is hesitant or halting in speech.
• Is overly critical of self (e.g., “I’m no good,” “I’m ugly,” or “People don’t like me.”).
• May be overly critical of others.
• Is unable to accept positive remarks about self.
• Apologizes frequently.
• Verbalizes feelings of hopelessness, helplessness, and powerlessness, such as “I really don’t care what
happens,” “I’ll do whatever anyone wants,” or “Whatever is destined will happen.”
Diagnosing
- A positive self-concept can serve as a resource to a client when facing health challenges. Sometimes, as
supported by data, the client has a problem in the area of self-perception and the classes of self-concept, self-
esteem, and body image.
 Nursing Diagnoses Associated with Self-Concept Disturbance
• Disturbed Body Image
• Ineffective Role Performance
• Chronic Low Self-Esteem (and Risk for).
• Disturbed Personal Identity (and Risk for)
• Anxiety related to changed physical appearance (e.g., amputation, mastectomy)
• Ineffective Coping with role change related to death of spouse
• Grieving or Complicated Grieving related to change in physical appearance
• Hopelessness
• Powerlessness (and Risk for)
• Parental Role Conflict
• Readiness for Enhanced Self-Concept
• Disturbed Sleep Pattern
• Social Isolation
• Spiritual Distress

Planning
- A major nursing goal is to promote the client’s sense of well-being and to facilitate growth. Planning includes
teaching coping skills and the effective use of personal resources.

Implementing
- Nursing interventions to promote or enhance a positive self-concept include helping a client to identify areas
of strength. In addition, for clients who have an altered self-concept, nurses should establish a therapeutic
relationship and assist clients to evaluate themselves and make behavioral changes.
▫ Identifying Areas of Strength

- When a client has difficulty identifying personality strengths and assets, the nurse provides the client with a
set of guidelines or a framework for identifying personality strengths.
Specific strategies to reinforce strengths:
• Stress positive thinking rather than self-negation.
• Notice and verbally reinforce client strengths.
• Encourage the setting of attainable goals.
• Acknowledge goals that have been attained.
• Provide honest, positive feedback.
Enhancing Self-Esteem
- Nurses assisting clients who have an altered self-concept or self- esteem must establish a therapeutic
relationship.

- To do this the nurse must have self-awareness and effective communication skills. The following nursing
techniques may help clients analyze the problem and enhance their self-esteem:
• Encourage clients to appraise the situation and express their feelings.
• Encourage clients to ask questions.
• Provide accurate information.
• Become aware of distortions, inappropriate or unrealistic standards, and faulty labels in clients’ speech.
• Explore clients’ positive qualities and strengths.
• Encourage clients to express positive self-evaluation more than negative self-evaluation.
• Avoid criticism.
• Teach clients to substitute negative self-talk (“I can’t walk to the store anymore”) with positive self-talk (“I can
walk half a block each morning”). Negative self-talk reinforces a negative self-concept.

Evaluating
- To determine whether client goals or desired outcomes have been achieved, the nurse uses data collected
during interactions with the client and significant others. If outcomes are not achieved, the nurse should
explore the reasons.
Example.
• Have old situations recurred, triggering feelings or behaviors associated with low self-esteem?
• Have new stressful situations occurred with which the client feels unable to cope, resulting in continuing or
recurrent low self-Esteem?
• Are new or additional roles causing increased stress in adapting?
• Are significant others supporting the client adequately in attempts to improve self-esteem?
• Did the client follow through on referrals to appropriate agencies?
• Were the client’s expectations too high in relation to the time needed for successful resolution of self-esteem
problems?