Final: Week 14 Self-Concept

11An appropriate nursing diagnosis for an individual who experiences confusion in the mental picture of his physical appearance is: 1Acute confusion. 2Disturbed body image. 3Chronic low self-esteem. 4Situational low self-esteem.

2Disturbed body image. Body image involves attitudes related to the body, including physical appearance, structure, or function. Disturbed body image would be an appropriate nursing diagnosis.

Stressors that Affect Self-Concept

Can be real or imagined Examples: Physical changes Emotional changes Spiritual changes Changes in relationships Changes in standing in society (work, economic)

Implementation

Change behaviors if necessary to achieve the goal Help to adapt to changes (internal or external) Contact support groups (find resources) - professional help Encourage Self-Exploration

Body Image Stressors

Change in body appearance and function (such as changes associated with aging) Often associated with impaired self-concept & self-esteem

Nursing Diagnoses

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

Evaluation

Evaluate client's success in meeting goals Revise plan as needed

Role Performance Stressors

Situational transitions Health-Illness transition

Role overload

ties in with role conflict 4 or 5 roles in life Student, spouse, parent, employee Having more roles or responsibilities within a role than are manageable Can experience role overload with role conflict

Body Image

Attitude about physical appearance Strongly influenced by culture and society Peer pressure

10When developing an appropriate outcome for a 15-year-old girl, the nurse considers that a primary developmental task of adolescence is to: 1Form a sense of identity. 2Create intimate relationships. 3Separate from parents and live independently. 4Achieve positive self-esteem through experimentation.

1Form a sense of identity. Understanding developmental tasks across the life span is essential in designing nursing care. Adolescents are focused on establishing their identity outside the family and should be supported in meeting this developmental task.

9The nurse can increase a patient's self-awareness through which of the following actions? (Select all that apply.) 1Helping the patient define her problems clearly 2Allowing the patient to openly explore thoughts and feelings 3Reframing the patient's thoughts and feelings in a more positive way 4Have family members assume more responsibility during times of stress

1Helping the patient define her problems clearly 2Allowing the patient to openly explore thoughts and feelings 3Reframing the patient's thoughts and feelings in a more positive way These are designed to promote self-awareness and a positive self-concept. Having family members assume more responsibility during stressful times does not help a patient achieve self-awareness; instead it is important to encourage a patient to assume more self-responsibility.

15Based on knowledge of the developmental tasks of Erikson's Industry versus Inferiority, the nurse emphasizes proper technique for use of an inhaler with a 10-year-old boy so he will: 1Increase his self-esteem with mastery of a new skill. 2Accept changes in his appearance and physical endurance. 3Experience success in role transitions and increased responsibilities. 4Appreciate his body appearance and function.

1Increase his self-esteem with mastery of a new skill. The developmental stage of Industry Versus Inferiority (ages 8-12) is focused on incorporating feedback from peers and teachers, increasing self-esteem with new skill mastery, and promoting awareness of strengths and limitations

7A 20-year-old patient diagnosed with an eating disorder has a nursing diagnosis of situational low self-esteem. Which of the following nursing interventions would be best to address self-esteem? 1Offer independent decision-making opportunities 2Review previously successful coping strategies 3Provide a quiet environment with minimal stimuli 4Support a dependent role throughout treatment

1Offer independent decision-making opportunities Offering opportunities for decision making promotes a sense of control, which is essential for promoting independence and enhancing self-esteem. Reviewing successful coping strategies is a priority intervention for the nursing diagnosis of ineffective coping.

5An adult woman is recovering from a mastectomy for breast cancer and is frequently tearful when left alone. The nurse's approach should be based on an understanding of which of the following: 1Patients need support in dealing with the loss of a body part. 2The patient's family should take the lead role in providing support. 3The nurse should explain that breast tissue is not essential to life. 4The patient should focus on the cure of the cancer rather than loss of the breast.

1Patients need support in dealing with the loss of a body part. The nurse should encourage the patient to talk about the threats to body image, including the meaning of the loss, the reactions of others, and the ways in which the patient is grieving.

4A depressed patient is crying and verbalizes feelings of low self-esteem and self-worth such as "I'm such a failure ... I can't do anything right." The best nursing response would be to: 1Remain with the patient until he or she stops crying. 2Tell the patient that is not true and that every person has a purpose in life. 3Review recent behaviors or accomplishments that demonstrate skill ability. 4Reassure the patient that you know how he is feeling and that things will get better.

1Remain with the patient until he or she stops crying. Demonstrating acceptance of the patient by supportively sitting with him or her builds a therapeutic nurse-patient relationship. The nurse's presence signals value and allows the patient to explore issues of self-concept and self-esteem.

Role conflict

2 different roles and conflicting with each other Person has to simultaneously assume two or more roles that are inconsistent or contradictory Examples: Sandwich generation Sick role

3Several staff members complain about a patient's constant questions such as "Should I have a cup of coffee or a cup of tea?" and "Should I take a shower now or wait until later?" Which interpretation of the patient's behavior helps the nurses provide optimal care? 1Asking questions is attention-seeking behavior. 2Inability to make decisions reflects a self-concept issue. 3Dependence on staff must be stopped immediately. 4Indecisiveness is aimed at testing how the staff reacts.

2Inability to make decisions reflects a self-concept issue. Patients with deficits in self-concept often have difficulty making decisions. It is essential for the nurse to remain accepting of the patient and to support him or her in decision making.

12In planning nursing care for an 85-year-old male, the most important basic need that must be met is: 1Assurance of sexual intimacy. 2Preservation of self-esteem. 3Expanded socialization. 4Increase in monthly income.

2Preservation of self-esteem. Self-esteem is essential for physical and psychological health across the life span.

8The nurse asks the patient, "How do you feel about yourself?" The nurse is assessing the patient's: 1Identity. 2Self-esteem. 3Body image. 4Role performance.

2Self-esteem. Self-esteem is how a person feels about himself or herself. Asking open-ended questions about self-esteem is important during the nursing assessment.

2A patient diagnosed with major depressive disorder has a nursing diagnosis of chronic low self-esteem related to negative view of self. Which of the following would be the most appropriate cognitive intervention by the nurse? 1Promote active socialization with other patients 2Role play to increase assertiveness skills 3Focus on identifying strengths and accomplishments 4Encourage journaling of underlying feelings

3Focus on identifying strengths and accomplishments Focusing on strengths and accomplishments to minimize the emphasis on failures assists the patient to alter distorted and negative thinking. The other interventions are important, but they are not designed to impact thoughts.

1Following a bilateral mastectomy, a 50-year-old patient refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which of the following is the best response from the nurse? 1"What's the special occasion?" 2"You must be feeling better today." 3"This is the first time I have seen you look this good." 4"I see that you've combed your hair and put on makeup."

4"I see that you've combed your hair and put on makeup." When the nurse uses a matter-of-fact approach and acknowledges a change in the patient's behavior or appearance, it allows the patient to establish its meaning.

6When caring for an 87-year-old patient, the nurse needs to understand that which of the following most directly influences the patient's current self-concept: 1Attitude and behaviors of relatives providing care 2Caring behaviors of the nurse and health care team 3Level of education, economic status, and living conditions 4Adjustment to role change, loss of loved ones, and physical energy

4Adjustment to role change, loss of loved ones, and physical energy Older adults experience significant challenges to self-concept, including mental and physical changes associated with aging and changes in identity and role following retirement and/or loss of significant others. The adjustment to stressors is most important. The other influences are important but to a lesser degree.

13Based on knowledge of Erikson's stages of growth and development, the nurse plans her nursing care with the knowledge that old age is primarily focused on: 1Intimacy versus Isolation. 2Autonomy versus Shame and Doubt. 3Generativity versus Self-Absorption. 4Ego Integrity versus Despair.

4Ego Integrity versus Despair. The developmental stage of Ego Integrity Versus Despair (Late 60s to Death) is focused on feeling positive about life and its meaning and providing a legacy for the next generation.

14The home health nurse is visiting a 90-year-old man who lives with his 89-year-old wife. He is legally blind and is 3 weeks' post right hip replacement. He ambulates with difficulty with a walker. He comments that he is saddened now that his wife has to do more for him and he is doing less for her. Which of the following is the priority nursing diagnosis? 1Self-care deficit, toileting 2Deficient knowledge regarding resources for the visually impaired 3Disturbed body image 4Risk for situational low self-esteem

4Risk for situational low self-esteem Blindness coupled with difficulty ambulating places him at risk for situational low self-esteem. No doubt he and his wife have adapted to the blindness, but his difficulty with ambulation affects many aspects of his life, including self-esteem. However, this low self-esteem is situational; as his mobility improves, his low self-esteem will also resolve. Nothing in the question suggests that the other answers are true.

Self-Esteem

Highest during childhood Drops in adolescence Rise again in adulthood Drops in elderly Overall feeling of self-worth Ideal self consists of aspirations, goals values, standards of behavior

Self Concept

How a person thinks about himself or herself Directly affects one's self esteem (feeling of self-worth) Continues throughout lifespan & always changing Caregivers influence development of self concept / self esteem

Role Performance

How individual sees their role in society How individuals perceive their ability to carry out roles

Identity Stressors

Identity most vulnerable in adolescence - body image stressors in adolescence Low Self-esteem Risk taking behavior Self-destructive behavior

Identity

Internal sense of individuality Distinctness and separate from others Develops over time Self observations, observing others, and by what one is told about themselves Necessary in order to develop intimacy Gender Identity

Self Concept based upon:

Perceptions of others towards us Personal and professional relationships Academic achievement Employment Personality characteristics Ethnic, racial and spiritual identity

Nurses Effect on Client's Self-Concept

Positive or Negative Convey interest, acceptance & trust Encourage open communication

Health-Illness transition

Role conflict Role ambiguity Role strain Role overload

Older Adults

Self-esteem/Self concept changes can be attributed to emotional and physical changes Changes in health (aging) Changes in socioeconomic status Spousal loss/friends

Expected Outcomes

The client will discuss a minimum of two to three areas of their life where they are functioning well. Focus on abilities, not inabilities

Self-Esteem stressors

Vary with developmental stage Illness, injury, changes in personal life such as relationships and employment

Assessment

Who are their support systems? What are their coping mechanisms? Identify if the patient is showing negative self-concept behaviors

A nurse's self-concept and nursing actions have an effect on

a patient's self-concept.

Identity is particularly vulnerable during

adolescence.

Self-concept

an integrated set of conscious and unconscious attitudes and perceptions about self.

Body image stressors include

changes in physical appearance, structure, or functioning caused by normal developmental changes or illness.

Self-esteem stressors include

developmental and relationship changes, illness, surgery, accidents, and the responses of other individuals to changes resulting from these events.

Substitution

doing something instead because you know there's a positive outcome from it

Inhibition

doing something positive and staying away from negative because you know it's wrong

Role ambiguity

don't know what role is and how to fulfill it; may feel unfit Unclear role expectations Creates stress and confusion Common in Adolescent years

Planning and implementing nursing interventions for self-concept disturbance involve

expanding a patient's self-awareness, encouraging self-exploration, aiding in self-evaluation, helping formulate goals in regard to adaptation, and assisting a patient in achieving these goals

Role strain

feel frustrated in your role Not sure what you should be doing Combination of role conflict and role ambiguity Feeling frustrated with feelings of inadequacy or unsuited for role Often associated with gender role stereotypes

Components of self-concept are

identity, body image, and role performance

Body image

is the mental picture of one's body and is not necessarily consistent with a person's actual body structure or physical appearance.

Imitation

mimicing

Role stressors, including

role conflict, role ambiguity, and role strain, originate in unclear or conflicting role expectations; the effects of illness often aggravate this.

Identification

similar to imitation Look at positive things other people do and copy positive traits of that individual

Reinforcement-Extinction

staying away from doing something because you know you'll get punished