Lesson 15.1: Mental health promotion

Early childhood: initiative vs. guilt

Demonstrating original thought

5 to 6 years

Development of the genitals to adult size takes about

adolescence, 12 to 13

During __ or ages __ primary and secondary sex characteristics continue to develop, necessitating more information about body changes. For boys, the testes and scrotum increase in size, the skin over the scrotum becomes darker, pubic hair grows, and axillary sweating begins. For girls, the pelvis and hips broaden, the breast tissue develops, pubic hair grows, axillary sweating begins, and vaginal secretions become milky and change from an alkaline to an acid pH.

core self-concept

Each person's self-concept is like a piece of art. At the center of the art are the beliefs and images that are most vital to the person's identity. They constitute "I am very smart/of average intelligence" or "I am male/female."

Toddlerhood: autonomy vs. shame and doubt

Easily accepting deferment of a wish fulfillment

Adolescence: identity vs. role confusion

Establishing close interpersonal relationships

- Stage of development - Family and culture - Resources - History of success and failure - Illness

Factors that affect self-concept

menstruation

Girls need to be taught about this (monthly uterine bleeding) and related self-care.

• 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

Identity stressors may include

low self-concept

If a person's self-esteem does not match with the ideal self, then this results.

Early school years: industry vs. inferiority

Not organizing work

Negative self-concept

Nurses have a responsibility to assess clients who have this and to identify the possible causes in order to help them develop a more positive view of themselves. Individuals 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.

- Identifying areas of strength - Enhancing self-esteem

Nursing interventions to promote or enhance a positive self-concept include

introspection

One important component of the process of being self-aware is __, which involves the nurse reflecting on his or her own beliefs, attitudes, motivations, strengths, and limitations.

Toddlerhood: autonomy vs. shame and doubt

Overly concerned about being clean

• Vocational performance • Intellectual functioning • Personal appearance and physical attractiveness • Sexual attractiveness and performance • Being liked by others • Ability to cope with and resolve problems • Independence • Particular talents

People are thought to base their self-concept on how they perceive and evaluate themselves in these areas:

me-centered

People who value "how I perceive me" above "how others perceive me" can be termed They try hard to live up to their own expectations and compete only with themselves, not others. The positive self-concept; formed with limited reference to others' opinions.

• Lack of positive feedback from significant others • Repeated failures • Unrealistic expectations • Abusive relationship • Loss of financial security

Self-esteem stressors

Infancy: trust vs. mistrust

Sharing time, opinions, and experiences

Positive self-concept

is essential to a person's mental and physical health. Individuals with this are better able to develop and maintain interpersonal relationships and resist psychological and physical illness.

role performance

is how a person in a particular role behaves in comparison to the behaviors expected of that role.

Specific self-esteem

is how much one approves of a certain part of oneself.

Global self-esteem

is how much one likes oneself as a whole. is influenced by specific self-esteem.

ideal self

is how we should be or would prefer to be; is the individual's perception of how one should behave based on certain personal standards, aspirations, goals, and values. sometimes realistic, sometimes not.

role strain

are frustrated because they feel or are made to feel inadequate or unsuited to a role; often associated with sex role stereotypes.

Expectations/standards of behavior

are set by society, a cultural group, or a smaller group to which a person belongs

role conflicts

arise from opposing or incompatible expectations. In an interpersonal conflict, people have different expectations about a particular role.

self-esteem

is one's judgment of one's own worth, that is, how that person's standards and performances compare to others' standards and to one's ideal self.

Affective aspect of body image

includes the sensations of the body, such as pain, pleasure, fatigue, and physical movement.

Self knowledge

insight into one's own abilities, nature, and limitations.

Role development

involves socialization into a particular role. For example, nursing students are socialized into nursing through exposure to their instructors, clinical experience, classes, laboratory simulations, and seminars.

role

is a set of expectations about how the person occupying a particular position behaves.

Sexuality

is an individually expressed and highly personal phenomenon that evolves from life experiences.

Self-concept

is one's mental image of oneself. An individual possessing a strong __ 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.

Personal identity

is the conscious sense of individuality and uniqueness that is continually evolving throughout life. name, gender, age, race, ethnic origin or culture, occupation or roles, talents, and other situational characteristics. also includes beliefs and values, personality, and character. For instance, is the person outgoing, friendly, reserved, generous, selfish?

Cognitive aspect of body image

is the knowledge of the material body.

role mastery

means that the person's behaviors meet role expectations.

Role ambiguity

occurs when expectations are unclear, and people do not know what to do or how to do it and are unable to predict the reactions of others to their behavior

Self-expectation

what one expects of oneself; may be realistic or unrealistic expectations.

external resources

include support network, sufficient finances, and organizations

Toddlerhood: autonomy vs. shame and doubt

- Accepting the rules of a group but also expressing disagreement when it is felt - Expressing one's own opinion

Adolescence: identity vs. role confusion

- Asserting independence - Planning realistically for future roles

Preschooler (4-5 years)

- Becomes increasingly aware of self. - Explores own and playmates' body parts. - Learns correct names for body parts.

Middle-aged adults: generativity vs. stagnation

- Being willing to share with another person - Guiding others - Establishing a priority of needs, recognizing both self and others

Early school years: industry vs. inferiority

- Completing a task once it has been started - Working well with others

Toddler (1-3 years)

- Continues to develop gender identity. - Able to identify own gender. - Body exploration and genital fondling is normal. - Use names for body parts. - Children from single-parent homes should have contact with adults of both sexes.

Older adults: integrity vs. despair

- Crying and being apathetic - Not accepting changes - Demanding unnecessary assistance and attention from others

Early adulthood: intimacy vs. isolation

- Establishing a close, intimate relationship with another person - Making a commitment to that relationship, even in times of stress and sacrifice

Infancy (birth - 18 months)

- External genitals are sensitive to touch. - Male infants have penile erections; females, vaginal lubrication.

Adolescence: identity vs. role confusion

- Failing to assume responsibility for directing one's own behavior - Failing to set goals in life

Toddlerhood: autonomy vs. shame and doubt

- Failing to express needs - Not expressing one's own opinion when opposed

Infancy (birth - 18 months)

- Given gender assignment of male or female. - Differentiates self from others gradually. - Self-manipulation of the genitals is normal. - Caregivers need to recognize these behaviors as common in children.

Early childhood: initiative vs. guilt

- Imitating others rather than developing independent ideas - Apologizing and being very embarrassed over small mistakes

Preschooler (4-5 years)

- Learns correct names for body parts. - Learns to control feelings and behavior. Focuses love on parent of the other sex. - Answer questions about "where babies come from" honestly and simply. - Parental overreaction to exploration of genitals and masturbation can lead to feelings that sex is "bad."

Early school years: industry vs. inferiority

- Not completing tasks started - Not assisting with the work of others

Early adulthood: intimacy vs. isolation

- Remaining alone - Avoiding close interpersonal relationships

Infancy: trust vs. mistrust

- Requesting assistance and expecting to receive it - Expressing belief of another person.

Infancy: trust vs. mistrust

- Restricting conversation to superficialities Refusing to provide a person with personal information - Refusing to provide a person with personal information

Early childhood: initiative vs. guilt

- Starting projects eagerly - Expressing curiosity about many things

Middle-aged adults: generativity vs. stagnation

- Talking about oneself instead of listening to others - Showing concern for oneself in spite of the needs of others - Being unable to accept interdependence

Older adults: integrity vs. despair

- Using past experience to assist others - Maintaining productivity in some areas - Accepting limitations

• 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?

A nurse can ask the following questions to determine a client's self-esteem:

Early adulthood: intimacy vs. isolation

Accepting sexual behavior as desirable

Adolescence: identity vs. role confusion

Accepting the values of others without question

Erikson

According to __ (1963), throughout life people face developmental tasks associated with eight psychosocial stages that provide a theoretical framework. The success with which a person copes with these developmental tasks largely determines the development of self-concept.

- Disturbed Personal Identity - Anxiety - Ineffective Coping - Grieving or Complicated Grieving - Hopelessness

Additional nursing diagnoses that may apply to clients with problems of self-concept include the following:

- internal - external

An individual's resources may be either

9 or 10

Around age __, the first physical changes of puberty begin—the development of breast buds in girls and the growth of pubic hair.

- testosterone - estradiol

As the adrenal glands mature, they produce more these two which contributes to the first experiences of sexual attraction to another person.

Infancy: trust vs. mistrust

Being unable to accept assistance

- cognitive aspects - affective aspects

Body image has both of these aspects.

• Loss of body parts • Loss of body functions • Disfigurement • Unrealistic body ideal

Body image stressors may include

2 1/2 or 3

By this age, children have beginning awareness of genital differences between males and females.

3

By this age, more purposeful masturbation (excitation of one's own or another's genital organs by means other than sexual intercourse) begins and the orgasmic response is quite common, although males do not ejaculate until after puberty.

• Loss of parent, spouse, child, or close friend • Change or loss of job or other significant role • Divorce • Illness of self or others that affects role performance • Ambiguous or conflicting role expectations • Inability to meet role expectations

Role stressors may include

• How one thinks, talks, and acts • How one sees and treats another person • Choices one makes • Ability to give and receive love • Ability to take action and to change things

Self-concept influences the following:

appearance values beliefs

Self-concept involves all of the self-perceptions—__,__, and __ that influence behavior and are referred to when using the words I or me.

• Disturbed Body Image • Ineffective Role Performance • Chronic Low Self-Esteem

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. Three of the NANDA International nursing diagnostic labels relating specifically to this domain:

• The infant learns that the physical self is separate and different from the environment. • The child internalizes others' attitudes toward self. • The child and adult internalize the standards of society.

The development of one's self-concept consists of three broad steps:

Role performance

The nurse assesses the client's satisfactions and dissatisfactions associated with role responsibilities and relationships, family roles, work roles, student roles, and social roles.

- personal identity - body image - role performance - self-esteem

The nurse assessing self-concept focuses on its four components

- Global self-esteem - Specific self-esteem

The two types of self-esteem are

Early school years: industry vs. inferiority

Using time effectively

Early childhood: initiative vs. guilt

Verbalizing fear about starting a new project

personal identity

When assessing self-concept, the information the nurse first needs is about the client's __. This involves who the client believes he or she is.

"normal" sexual expression

can be described as whatever behaviors give pleasure and satisfaction to those adults involved, without threat of coercion or injury to self or others. varies among cultures and religions.

stressors

can strengthen the self-concept as an individual copes successfully with problems. On the other hand, overwhelming __ can cause maladaptive responses including substance abuse, withdrawal, and anxiety.

- personal identity - body image - role performance - self-esteem

components of self-concept

masturbation

excitation of one's own or another's genital organs by means other than sexual intercourse

- Self-knowledge - Self-expectation - Social self - Social evaluation

four dimensions of self-concept:

other-centered

have a high need for approval from others and try hard to live up to the expectations of others, comparing, competing, and evaluating themselves in relation to others. They tend to have difficulty asserting themselves, and fear disapproval.

Social self

how a person is perceived by others and society.

Body image

image of physical self; is how a person perceives the size, appearance, and functioning of the body and its parts. includes clothing, makeup, hairstyle, jewelry, and other things intimately connected to the person. includes body prostheses, such as artificial limbs, dentures, and hairpieces, as well as devices required for functioning, such as wheelchairs, canes, and eyeglasses.

sex

refers primarily to the biology of being male, female, or some other anatomic state, and to sexual activity.

global self

refers to the collective beliefs and images one holds about oneself. It is the most complete description that individuals can give of themselves at any one time. It is also a person's frame of reference for experiencing and viewing the world.

gender

refers to the psychologic sense of being feminine or masculine and is related to the terms man and woman.

Self-awareness

refers to the relationship between one's perception of himself or herself and others' perceptions of him or her. is a process that requires time and energy and is never complete.

internal resources

resources include confidence and values

- identity stressors - body image stressors - role stressors - self-esteem stressors

stressors can be

Social evaluation

the appraisal of oneself in relationship to others, events, or situations.