FON Exam 4 Psychosocial Issues Grief, Loss, and Dying (Week 11)
For Psychosocial Diagnoses what is *Post-trauma syndrome*?
- there is a maladaptive learned response to a traumatic and distressing event **Must determine cause and effect**
What are the Kublar ross stages of grieving?
1.Denial 2.Anger 3.Bargaining 4.Depression 5. Acceptance -individuals may not experience every stage or go through the stages in a linear order - individuals may experience two or more stages simultaneously
What is Stage 1 of the Kublar Ross Stages of grief?
1.Denial - "Not me." "This cannot be happening." "I don't believe it."
What are the 3 types of body image?
1.Ideal -what you would ideally like to look like 2.Perceived - what you think you look like 3.Actual - what you actually look like
What is Stage 2 of the Kublar Ross Stages of grief?
2.Anger - "Why me?" "Why is this happening?"
What is Stage 3 of the Kublar Ross Stages of grief?
3.Bargaining - "If only I can live until ..." "Yes me, but ..."
What is Stage 4 of the Kublar Ross Stages of grief?
4.Depression - a withdrawn sadness, not to be confused with clinical depression
What is Stage 5 of the Kublar Ross Stages of grief?
5.Acceptance - coming to terms with it and ceasing to fight it
What % of people who attempt suicide give verbal or indirect cues before attempting?
80% of those who attempt suicide give some prior verbal or indirect cues
What is *Mourning*?
Action associated with grief
How does *Unresolved Conflict* affect grief?
Conflict existing at the time of death; a conflict left unresolved may cause prolonged grief
This occurs when the drug is at its lowest concentration, right before the next dose is due: A.Peak level B.Trough level C.Therapeutic level D.Biological half-life
Correct answer = B
The nurse is caring for a client in a persistent vegetative state (PVS). Which finding would the nurse expect to observe? A.Is aware of family, but can't respond to them B.Obeys the nurse's commands C.Has occasional grimaces and tears D.Speaks intermittently
Correct answer = C
Which ones of the following are classified as secondary effects (unintended or nontherapeutic effects)? Select all that apply: A.Adverse reactions B.Toxic reactions C.Palliative effects D.Idiosyncratic reactions E.Allergic reactions
Correct answers = A, B, D, E
How do we *Meet the psychological needs* of a dying client?
Everyone involved with the client should know exactly what the client and the family have been told - most clients want to know their prognosis as soon as possible so that they can put personal affairs in order, share their feelings with family members, and come to terms with their life and death
How do we *care for the body* during postmortem care?
Follow agency policies and respect cultural and spiritual preferences
How does *Circumstances of the loss* affect grief?
If the circumstances of the loss leave the bereaved feeling guilty or responsible, his or her healing process may be impeded
How does *Previous Loss* affect grief?
If the person has sustained more than one loss in a short period of time, the grieving process can become more complicated
What is *Assisted Suicide*?
Means making available that which is needed for the client to end his or her own life (e.g., pharmacological agents or weapons) -**the client is physically capable of ending his or her own life, has expressed the intention to do so, and has turned to the health care provider merely to supply the means**
What is *Bereavement*?
Mourning and adjustment time following a loss
Will we as RN's ever make the DIAGNOSIS of depression for a client?
NO!! -Depression is a psychiatric diagnosis, so you will not make that diagnosis
Can an an ordinary power of attorney make health care decisions for the client?
NO!!! - **only a durable power of attorney for health care decisions can make health care decisions for a client**
What happens when a client is *Days or Hours* prior to death?
Often a surge of energy brings mental clarity and a desire to eat and talk with family members; -however, as death approaches, clients tend to become dehydrated and have difficulty swallowing, which results in decreased blood volume; -in the final hours of life, many clients become restless and agitated; this response may be caused by medications, liver failure, cerebral hypoxia, renal failure, stool impaction, distended bladder, increased pain, or unresolved emotional or spiritual issues; -near to the time of death, some people unexpectedly become more coherent and energized for a time; others become less communicative, quiet, and withdrawn; - fatigue is common
how do we encourage *Recalling memories* to help facilitate grief?
One way to encourage recall is to go through photo albums with them and ask questions about the people in the pictures; also look for objects of sentiment (e.g., a family heirloom) in the environment and ask the dying or bereaved person to share their significance
How should a person with a "healthy self-concept" feel about themselves in the terms of these concepts
POSITIVE I *LOOK* good I *THINK* good I *FUK* good I *WORK* good I *FRIEND* good I *SOLVE PROBLEMS* and *COPE* good I AM UNIQUELY TALENTED!!!!!!!!!
What is *Grief*?
Physical, psychological, and spiritual responses to a loss -The intensity of the grief depends on the meaning the person attaches to the loss
How do we *Meet the physiological needs* of a dying client?
Physiological needs during this time include mobility, oxygenation, safety, nutrition, fluids, elimination, personal hygiene, and control of pain and symptoms (nausea, vomiting)
How do we help families dealing with the death of a loved one?
Provide emotional support immediately after the death - Provide Grief education - Help children deal with the loss
How do we *Address the cultural needs* of a dying client?
Some cultures may emphasize keeping emotions more subdued and limiting expressions of grief to private settings, whereas others gauge the value of the deceased by the amount of crying
How do we help children deal with loss?
Some families may need information about helping children deal with grief, especially when there is a death in the family - you may need to explain that children perceive death differently from adults
How does *Spiritual/cultural beliefs and practices* affect grief?
Spirituality and religious beliefs can help or hinder the grieving process; most cultures engage in rituals (e.g., funerals) that help the bereaved begin the grieving process by openly expressing their emotions and pain; some cultures may emphasize keeping emotions more subdued and limiting expressions of grief to private settings
What Act provides guidance on *Organ Donation*?
The Uniform Anatomical Gift Act (UACA) provides guidance on tissue, eye, and organ donation
How does *Support system* affect grief?
The amount of support for the bereaved; people with more emotional and psychosocial support typically have less complicated grief
What is *Higher Brain Death*?
The brainstem can still be functioning, so both respiratory and cardiac activity may continue even though the person does not make purposive responses to external stimuli, cephalic reflexes are absent, and the electroencephalogram (EEG) shows no activity
What happens to a client *moments* prior to death?
The dying person does not respond to touch or sound and cannot be awakened; typically, there is a short series of long-spaced breaths before breathing ceases entirely and the heart stops beating
How do we *Address the Spiritual needs* of a dying client?
The person may be looking for forgiveness and/or acceptance or be reaching out to feel connected - ways to address this need include (but are not limited to) empathetic listening, contacting pastoral care or clergy if the client asks for this service, special rituals, praying with the client, music, meditation, or special readings
What are *Psychological (internal) losses*?
They are commonly seen in the areas of sexuality, control, fairness, meaning, and/or trust; loss of youth, limbs, body disfigurement, or body functions can negatively impact one's perception of self; the effect is loss of hope, faith, or dreams
For Psychosocial Diagnoses what is *Impaired Social Interaction*?
a goal statement may call for the client to develop the skills of "engagement, assertiveness, compromise, confrontation, and consideration **Must determine cause and effect**
What are *Advanced Directives*?
a group of instructions (written or oral) stating a person's wishes regarding his or her health care if he or she were incapacitated or unable to make that decision
What is an Autopsy?
a medical examination of the body to determine the cause of death that involves removal of the organs and extractions of tissue samples
For Psychosocial Diagnoses what is *Parental role conflict*?
a parent shows significant role confusion and/or conflict in response to crises **Must determine cause and effect**
What is a *Coma*?
a prolonged, deep state of unconsciousness lasting days or even years; the client cannot be aroused and may or may not have decreased brainstem reflexes
What is *Role Performance*?
actions a person takes and the behaviors he/she demonstrates in fulfilling a role; instead of expectations, role performance is the reality
What is *Palliative care*?
aggressively planned, holistic comfort care; a client does not necessarily have to be "actively dying" to receive palliative care; it is also provided over a long period of time for those who have slowly progressive diseases; the overall goal of palliative care is increased client/family satisfaction, improved symptom control, and cost savings for hospitals
What is a DNR/ANA order?
an order to not attempt resuscitation of the client in the event of a cardiac or respiratory failure -the ANA recommends "allow natural death -DNR = Do Not Resuscitate
What are *External losses*?
are actual losses of objects with sentimental or monetary value (e.g., jewelry, a home)
What is *PANIC Anxiety*?
becomes unreasonable and irrational
What is Chronic grief?
begins as normal grief but continues long term, with little resolution of feelings and inability to rejoin normal life
What is body image?
defined as your mental image of your physical self
What are defense mechanisms for dealing with anxiety?
each person develops unique patterns of coping with anxiety; are used consciously or unconsciously to relieve the anxiety •Denial - refusing to acknowledge the existence of a real situation or associated feelings •Displacement - transferring feelings from one target to another that seems less threatening
What is one of the things that a nurse should do when caring for a client with depression?
encourage the client to discuss feelings
What is *Severe Anxiety*?
focus is totally on self and the need to relieve the anxiety
What is *Physical loss*?
includes 1) injuries (e.g., limb amputation), 2) organ removal (e.g., hysterectomy), or 3) loss of function (e.g., paralysis)
What is *postmortem care*?
includes care of the client's body after death and fulfilling any legal obligations, such as arranging transportation to the morgue or funeral home and determining the disposition of the client's belongings
What is *actual loss*?
includes the death of a loved one (or relationship), theft, deterioration, destruction, and natural disaster; the loss can be identified by others, not just by the person experiencing it (e.g., hair loss during chemotherapy)
What are *Environmental losses*?
involves a change in the familiar, even if the change is perceived as positive (e.g., moving to a new home, getting a new job, and going to college)
What is *Bibliotherapy*?
is a counseling technique used for grief therapy - it uses guided reading to increase client awareness and understanding and promote healing -poems, novels, essays, and self-help literature can help produce new insights, either as the client retells the story or is guided to discuss his feelings and thoughts about the characters in the story
What is Dysfunctional/Complicated grief?
is distinguished from uncomplicated grief by length of time and intensity of emotion - the person's responses are maladaptive, dysfunctional, unusually prolonged, or overwhelming -complicated grief results when the grieving process has been impeded for some reason (e.g., something keeps the person "stuck" in the grief process
What is Disenfranchised grief?
is experienced in connection with a loss that is not socially supported or acknowledged by the usual rites or ceremonies - disenfranchised grief may be experienced by the unplanned termination of a foster child placement or a mistress whose lover dies - in each of these instances, the bereaved person lacks the communal support that is helpful in grieving
What is delayed grief?
is grief that is put off until a later time (e.g., "I'll think about it later. Right now, I'm busy trying to keep a roof over our heads and care for my children")
What is *Perceived loss*?
is internal; it is identified only by the person experiencing it
What is Uncomplicated (normal) grief?
is the natural response to a loss - the bereaved person experiences the feelings, behaviors, and cognitions that are expected in light of his or her culture, social status, and relationship to the lost person or object - the emotions are intense but gradually diminish over time
What is *Mild Anxiety*?
normal anxiety in response to the events of day-to-day living; perception is heightened
What is masked grief?
occurs when the person is grieving but expressing the grief through other types of behavior
What is *Euthanasia*?
refers to the deliberate ending of a life of someone suffering from a terminal or incurable illness -active euthanasia occurs as a result of a direct action (e.g., giving an overdose of medication) -passive euthanasia occurs as a result of a lack of action (e.g., withholding medications or food necessary to sustain life)
For Psychosocial Diagnoses what is *Risk for Violence: Directed at Others*?
situations in which a person threatens or uses aggression or violence to harm others; the intention of harm may not be limited to physical harm **Must determine cause and effect**
Who is the client MOST in need for a mental health referral?
the client who verbalizes the feeling of loneliness and emptiness
What is *Moderate Anxiety*?
the perceptual field narrows; person begins to focus on self and the need to relieve discomfort
For Psychosocial Diagnoses what is *Social Isolation*?
the person experiences significant aloneness that has a negative impact on health, or perceives the isolation as a threat to health **Must determine cause and effect**
For Psychosocial Diagnoses what is *Risk for Loneliness*?
the person is separated from persons, culture, objects, or environments to which a person may have ongoing attachments **Must determine cause and effect**
How does *The Uniform Law Comission* define death?
they redefined death broadly as the "irreversible cessation of all functioning of the brain, including the brainstem" as determined by reasonable medical standards. This definition did not provide clear guidance to states
What is the definition of psychosocial theory?
understanding people as a combination of psychological and social events -remember, the physical body is only one dimension of a person; what clients are thinking and feeling is equally important to their healing process
For Psychosocial Diagnoses what is *Family coping*?
usual support (comfort and assistance) from a significant other is either compromised (insufficient or withdrawn) or disabled (competing or maladapted), causing a significant health challenge **Must determine cause and effect**
What is *Personal Identity*?
your view of yourself as a unique human being, different and separate from all others; develops over time
What are *Functional Abilities*?
•Day-to-day ability to contend with environmental and social tasks; includes activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
What are the signs of a Coma/ Peripheral Vegetative State?
•Does not purposefully respond to stimuli •Is unaware of the environment •Has no cognition or affective mental functions •Cannot speak or obey commands •May look somewhat normal and may occasionally grimace, cry, or laugh
What are the "self concepts" of how one views one's overall self?
•Physical appearance •Intellectual abilities •Sexual performance •Success in the workplace •Friendships •Problem-solving and coping abilities •Unique talents
What is *Loss of significant relationships*?
•includes, but is not limited to, actual loss of spouses, siblings, family members, or significant others through death, divorce, or separation
Can nurses participate in assisted suicide?
"The ANA (2013) prohibits nurses' participation in assisted suicide and euthanasia because these acts are in direct violation of the nurses' ethical traditions and goals of the profession, and its covenant with society."
How do we help families of dying clients?
**KNOW THIS SLIDE** •When a client is dying, it is important to view the family as your unit of care •If the client is unresponsive, you may find yourself spending most of your care time with the family providing education, support, and a listening ear •Have family help with care, if able •Encourage questions •Provide follow-up for referrals as needed •Encourage visit to chapel or to talk with clergy •Provide anticipatory guidance •Acknowledge feelings of family •Explore coping mechanisms •Remind family members and significant others to take care of themselves •Teach what to expect and provide reassurance •Ask directly if family wants to be present at time of death •At the moment of death, do not intrude **Its a lot of shit, but there will probably be a question on it**
What is the priority job of a nurse in regards to organ donation in a comatose patient?
*maintaining the viability of the organs* until a decision is made regarding their donation or not
What do you do when you determine that loss or grieving are the *Etiology*?
- loss and grieving as the etiology occurs when they create problems in other areas of client or family function
What is the difference between Palliative care and hospice care?
A client does NOT necessarily have to be DYING to receive palliative care -palliative care simply means it is care aimed at treating symptoms not resolving causes of the symptoms -Hospice care is primarily for DYING people
What happens when a client is *1-2 weeks* prior to death?
A host of physical changes indicate the body is beginning to lose its ability to maintain itself
how do we implement *Finding the meaning* to help facilitate grief?
Begin by asking about the various aspects of the client's life, commenting on pictures in the room, or picking up on verbal cues that are expressed
How should the nurse dispose of a contaminated needle after administering an injection? A.Place the needle in a specially marked, puncture-proof container. B.Recap the needle, and carefully place it in the trashcan. C.Recap the needle, and place it in a puncture-proof container. D.Place the needle in a biohazard bag with other contaminated supplies.
Correct answer = A
This occurs when the drug is at its highest concentration (when the rate of absorption is equal to the rate of elimination); after that, metabolic and excretory processes begin to remove the drug from the tissues and blood: A.Peak level B.Trough level C.Therapeutic level D.Biological half-life
Correct answer = A
The nurse had been caring for a client in a hospice facility for 1 month. When the client dies, the family invites the nurse to attend the calling hours and funeral. What is the most appropriate action for the nurse to take? A.Attend the services, if the nurse wishes to do so, as this can help to diffuse the nurse's feelings of loss and can be meaningful to the family. B.Ask another nurse for an opinion on this matter, because the nurse's own judgment may not be reliable at this time. C.Do not attend the service, because nurses cannot become attached or overly involved with family members after the death of their clients. D.Be present at the service but stay for only a short period of time, as these occasions are reserved for close friends and family.
Correct answer = A -Nurses are always allowed to attend services if they wish to do so
In assessing clients who may be experiencing a depressive disorder, what should the nurse determine as a priority? A.Onset and severity of symptoms B.Risk of self-harm C.Previous history of depression D.Family and community supports
Correct answer = B
The elder client's daughter is vice president of a large company. She is experiencing great conflict in trying to care for her mother while managing her work-related responsibilities. In planning to help the daughter, the nurse focuses on which component of the daughter's self-concept? A.Body image B.Role performance C.Personal identity D.Self-esteem
Correct answer = B
A client with terminal cancer requires increasing doses of an opioid pain medication to obtain relief from pain. This client is exhibiting signs of drug: A.Abuse B.Misuse C.Tolerance D.Dependence
Correct answer = C
A young woman's fiancé died in a car accident one month prior to their wedding day. Since his death, she has become an alcoholic. What type of grief, if any, is the woman displaying? A.Chronic B.Disenfranchised C.Masked D.No grief
Correct answer = C
This is the concentration of a drug in the blood serum that produces the desired effect without toxicity: A.Peak level B.Trough level C.Therapeutic level D.Biological half-life
Correct answer = C
A client with anxiety is completely focused on himself and the need to relieve his problem. In which stage of anxiety is this client? A.Panic B.Mild C.Moderate D.Severe
Correct answer = D
Which component is contained within the definition of the Uniform Determination of Death Act? A.Cessation of blood flow to vital organs B.Cessation of spontaneous respirations C.Irreversible cessation of higher-brain functions D.Irreversible cessation of brain and brainstem function
Correct answer = D
Your 55-year-old client was just informed that she has metastatic pancreatic cancer and has 4 months to live. After the provider leaves, she says to you, "I don't want my family to know. But they have to know. Please don't tell them. Please tell me what to do, help me." What is your best response? A."I know this is difficult for you. Take time to think about it." B."You should get a second opinion before you alarm your family." C."Let me hold your hand to make you feel better." D."Tell me how you are feeling right now."
Correct answer = D -We want to go with the response that is **NONJUDGEMENTAL**
How does *Timeliness of death* affect grief?
The death of a child or a young person is almost universally more difficult to accept than the death of an older person; in addition to loss of the person, there is a sense of unfairness because of the loss of potential - of what the child might have become or achieved; you may hear someone ask, "Why was her life cut short?" or state, "He had so much going for him, but God didn't give him a chance"
What happens when a client is *1 to 3 months* prior to death?
The dying person begins to withdraw from the world and people; sleep increases; it becomes difficult for the body to digest food, especially meats; and appetite and food intake decrease; liquids are preferred; anorexia may be protective; the resulting ketosis can diminish pain and increase the person's sense of well-being
How do we provide grief education?
The grieving person may be fatigued from not sleeping, may be disoriented or unable to concentrate, and so on - he or she may be concerned about what such symptoms mean; reassure the person that such responses are expected and that there is no single right way to grieve -Also assure him or her that although the grief process takes time, the symptoms will not last forever
For Psychosocial Diagnoses what is *Interrupted family processes*?
change in family relationships or functioning; or a family that normally functions effectively then experiences dysfunction **Must determine cause and effect**
What is Anticipatory grief?
it is experienced before a loss occurs - the potential negative outcome of anticipatory grief is that the survivor may detach from a dying person too early in the dying process, leaving the person without emotional support during that period - this does not always happen
What do you do when you determine that loss or grieving are the *Problem*?
various nursing diagnoses may be appropriate for a person who is dying or grieving; the most obvious ones is Grieving
What is *The Uniform Determination of Death Act*?
•An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead •A determination of death must be made in accordance with accepted medical standards •Providers use several methods to assess for functioning of the brainstem (e.g., pupils fixed and unresponsive to light, no corneal reflex, and absence of vestibulo-ocular reflexes)
What are the Guidelines of the Uniform Anatomical Gift Act (UACA)?
•As a rule, general donors must be at least 18 years of age or an emancipated minor •Next of kin can donate organs when a person dies, unless an objection is known •Relatives cannot revoke a person's donation, even after death •The person making the gift can amend or revoke it at any time •In many institutions, a transplant coordinator contacts the family and makes the request for organ and tissue donation •If there is conflict then maintaining the viability of the organs has the highest priority until a resolution is made
What has a negative body image been associated with?
•Depression •Initiation of smoking among adolescents •Increased risk for unintended pregnancy and sexually transmitted infections •Increased incidence of being bullied
What do we need to assess for a dying client?
•Determine whether there are burial or cremation plans or other such tasks (e.g., calling family members) when the client and family are ready to discuss these topics •Determine whether the dying client has advance directives (e.g., living will, durable power of attorney for health care) and organ donation documents
What are some *interventions* that we should plan for when dealing with end of life?
•Emotional support: Support family through stages of grief •Encourage discussions of previous loss •Include significant others in discussions and decisions, as appropriate •Therapeutic Play: Encourage children to express their feelings •Active Listening: Listen to expressions of grief •Support Group: Identify sources of community support •Crisis Intervention •Spiritual Support
How can we help facilitate grief?
•Encourage questions, and respond to them within a reasonable time •Sit beside the head of the bed; do not appear rushed •When you observe the client or family member expressing feelings, either verbally or nonverbally, encourage him or her to continue •Expect and accept a wide range of feelings, including anger, fear, and loneliness •Ask, "How would you like me to help?" "What do you need?" •Be sure that everyone on the health care team understands and follows the care plan •Ask yourself what you would do if this were your family member •Do not compare another person's loss to your own experience. For example, avoid comments such as, "I know how you feel." Instead, say, "Tell me how you feel."
What factors affect "self-concept"?
•Gender •Developmental level •Socioeconomic status •Family •Peer relationships •Locus of control: -Internal - people feel they can exert control over their lives -External - people attribute control of their situation to external factors Illness
What are some *outcomes* that we should plan for when dealing with end of life?
•Grief resolution (Resolves feeling about loss) •Coping •Progresses through stages of grief •Expresses positive expectations about the future •Seeks social support
What do we as RN's need to ask if we suspect a pt may be suicidal?
•Have you had thoughts of hurting yourself? •Has there been a previous suicide attempt? When? •Do you have a plan to commit suicide? •Is there a means to carry out the plan?
What are the three diagnoses that may be useful in describing the feelings and moods of clients who are depressed
•Hopelessness •Powerlessness •Suicide Risk
What are the stages of anxiety?
•Mild •Moderate •Severe •Panic
What is *Hospice care*?
•Primary purpose: provide comfort and support for dying clients and their families -based on two key premises: 1) the quality of life is as important as the length of life and 2) those who are terminally ill should be allowed to face death with dignity and surrounded by the comfort of their homes and families -Emphasis is on symptom management, advance care planning, spiritual care, and family support, including bereavement
What are the Factors that affect grief?
•Significance of the loss •Support system •Unresolved conflict •Circumstances of the loss •Previous loss •Spiritual/cultural beliefs and practices •Timeliness of death
What are general issues for most end-of-life-care clients?
•Supporting families and caregivers •Ensuring continuity of care •Ensuring respect for persons •Ensuring informed decision making •Attending to emotional and spiritual concerns •Supporting function and survival duration •Managing symptoms (e.g., pain, dyspnea, depression)
For Psychosocial Diagnoses what is *Ineffective individual coping*?
•The client fails to comprehend and effectively judge stressors when he/she perceives incorrect or dangerous life choices as normal, and when there is an inability to use available resources •Inability to identify strengths and resources may be secondary to low self-esteem **Must determine cause and effect**
What is *Self Efficacy*?
•The degree of confidence persons have in their ability to successfully perform specific behaviors (Bandura)
How does *Significance of the loss* affect grief?
•The meaning the person has attached to the person or object lost will be different for each person; the more attachment to the relationship or object, the more difficult is the grieving
What should we keep in mind for *OURSELVES* as nurses when it comes to dealing with the loss of a client?
•When you become involved with dying persons and their families at such an intimate time in their lives, you become connected to them •It is normal for the nurse to feel grief when a client dies •You must also take care of yourself •Recognize that feelings of grief and loss are normal, so do not be afraid to confront grief •If you deny your feelings and focus on caring for others, you will begin to wear down physically and emotionally •Talk with other colleagues about your feelings
What are the WARNING SIGNS for suicide?
•Withdrawal from social contact •Desire to be left alone •Preoccupation with death and dying, or violence •Risky or self-destructive behavior, such as drug use or unsafe driving •Changes in routine, sleeping patterns •Changes in eating habits •Giving away belongings or getting affairs in order •Personality changes, such as becoming very outgoing after being shy •Saying goodbye to people as if they won't be seen again Talking about suicide MOST OF THESE ARE FAIRLY OBVIOUS
What is *Self Esteem*?
•how well a person likes him/herself -When we succeed beyond our ambitions, we experience a high sense of self-esteem -When we aim for an ideal self beyond our capabilities, we risk loss of self-esteem
