Chapter 034 Self Concept

Chapter 34
Self-Concept
Copyright © 2017, Elsevier Inc. All Rights
Reserved.

 Paul Taylor, a 58-year-old man, suffered an
unexpected and sudden stroke. He did not
know that he had hypertension because he did
not get yearly checkups. He awoke in the
hospital bed to find that he could not move his
hand.
 He was not able to care for himself or even turn
himself for days. His body image has
dramatically changed from that of a man of
strength to that of a helpless individual.
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 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.
3
Reserved.

 Mr. Taylor’s self-esteem lessens as his recovery
and rehabilitation move slowly. His self-
concept has changed from that of a strong
laborer, one who did his own plumbing and
car repairs, to a man who must rely on others.
 Although Mrs. Taylor works, they have not
saved enough money to meet monthly
expenses or to educate their children without
both incomes. Mr. Taylor’s role as primary
breadwinner will change if he does not
improve.
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 Identity
 Internal sense of
individuality, wholeness,
and consistency of a
person over time
 Body image
 Involves attitudes related
to physical appearance,
structure, or function
 Role performance
 Self-esteem
5
Reserved.

 Maria Kendal is a 27-year-old nursing student
assigned to care for Mr. Taylor. She is divorced,
has two school-age children, and works part-
time as a certified nurse assistant at a local
long-term care facility while in school.
 She recognizes that changes in health status
often result in stressors that affect a person’s
self-concept. Such stressors influence a person’s
ability to interact with others and to function
effectively.
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 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
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Identity
stressors
Role
performance
stressors
Body image
stressors
Self-esteem
stressors
Especially
during
adolescence
• Role
conflict
• Role
ambiguity
• Role strain
• Role
overload
Affect
appearance,
structure or
function of a
body part
Vary by
develop-
mental stage
Reserved. 9

 Maria realizes that Mr. Taylor’s stroke resulted
in neurological deficits, which are significant
stressors. Mr. Taylor’s independence is
threatened because he is in the hospital and is
dependent upon the nurses for most of his care.
 He may never be able to go back to work again,
and he does not consider himself a strong man
anymore. Therefore, his family role as provider
is threatened.
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1. You are assigned to care for a patient who
has just undergone a mastectomy for a
malignant tumor. You would most
appropriately classify this self-concept
component as:
A. identity stressor.
B. sexuality stressor.
C. body image stressor.
D. role performance stressor.
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 Family plays key role
 Children develop sense of self from family
caregivers
 Also gain accepted norms from family
 High parental support and parental monitoring
are related to greater self-esteem and lower risk
behaviors
 Positive communication and social support
foster self-esteem and well-being in
adolescence
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 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.
Reserved. 13

2. You are caring for an adolescent patient who
underwent a gastric banding procedure 6 months
previously. This adolescent tells you, “There is still a
fat person inside of me.” This type of statement
illustrates a flaw in the self-concept of:
A. identity.
B. self-esteem.
C. body image.
D. role performance.
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3. You are assigned to care for a patient who
retired 6 months ago. While providing care,
you identify that this patient is struggling
emotionally with change. This situation is
most likely associated with the self-concept
component of:
A. identity stressor.
B. sexuality stressor.
C. body image stressor.
D. role-performance stressor.
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 Care should be patient-centered
 Direct questioning
 Observe patient nonverbal behavior
 Use knowledge of developmental stages
 Through the patient’s eyes
 Coping behaviors
 Significant others
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 Examples of self-concept–related 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
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 If you were Maria, what goal would you write for
Mr. Taylor? Be sure to include observable
behaviors.
 What interventions would you suggest that Maria
consider?
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 During planning synthesize knowledge,
experience, critical thinking attitudes, and
standards
 Use concept map
 Goals and outcomes
 Setting priorities
 Teamwork and collaboration
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 Collaborate with the other team members and
patients to promote healthy self-concept
 Health promotion
 Acute care
 Restorative and continuing care
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 Through the patient’s eyes
 Patient’s perceived success in meeting goals and
outcomes.
 Patient outcomes
 Expected outcomes for a patient with a self-concept
disturbance include displaying behaviors indicating
a positive self-concept, verbalizing statements of
self-acceptance, and validating acceptance of change
in appearance or function.
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 On the last day Maria cared for Mr. Taylor, he
reported that he was going to a rehabilitation
center that specializes in helping people who
have had strokes.
 Mr. Taylor is able to complete most of his bath
independently. Although his gait is unsteady,
he is able to walk short distances with a walker.
During his bath, he jokes, “I think my new
haircut makes me look a lot younger!” Mr.
Taylor also states, “I can’t wait to get better. I
have a lot of things to do, and I have a lot to
live for.”
Reserved. 22

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