Self –Concept & Coping

Self –Concept & Coping NUR101 Fall 2010 Lecture # 13 K. Burger MSEd, MSN, RN, CNE PPP by: Sharon Niggemeier RN MSN Revised 10/05 kb

Self -Concept • Self-concept : self image • Each individual is unique with own self-concept • View of self affects one’s ability to function as well as health • components: self-knowledge self-esteem self-actualization

Identity • An internal sense of individuality and wholeness. Who are you? • Name, gender, race, religion, occupation, role, +++so much more • Begins during childhood as parents provide role models • Continues during adolescence as teens establish own identity

Self-Esteem • The emotional appraisal of self-concept. • How do you regard yourself?????? • Feel about self? • Sense of worth or value?? • This appraisal is an on-going process so…levels of self-esteem can change.

Body Image • What do you think you look like physically? ????? • What do you think about your appearance?????? • Body image is dynamic: the body changes thru normal growth and development. • Cultural and societal attitudes affect body image

Roles • What is your role????????? • What are the expected behaviors you perform???? • Simultaneously hold many roles and they change • Who do you want to be????What do you want your role to be???

RolesSelf-Actualization • A part of self-concept is the way a person perceives their ability to carry out significant roles • Health self-concept can distinguish between:Ideal role expectationsANDRealistic possibilities

Factors Affecting Self-concept • Health status: illness, injury, body chg, loss of control, dependency on others • Role stressors; overload, strained, feelings of inadequacy • Developmental transitions – aging in our culture • Personal “success” or failure history • Crisis and/or life events: personal and/or global • Internal and external resources • Individual perception of crisis

Self-concept: psychosocial dimension • How one develops and grows can have an affect on self-concept & health • Therefore nurses need to understand normal stages of growth (physical changes) & development (psychosocial changes).

Erikson- Psychosocial Developmental Theory • ID 8 stages from birth to old age • Each stage characterized by a developmental task to be mastered • Unmet tasks may delay progress through the next stage

Trust vs Mistrust Infancy Infant relies on caregivers for basic needs Autonomy vs Shame and doubt Toddler Gains independence: If expectations too high or low feelings of inadequacy develop Erikson

Initiative vs guilt Preschooler Seeks new experiences if restricted becomes hesitant to seek new challenges Industry vs inferiority School-age Focuses on achievements and if not accepted develops a lack of self-worth Erikson

Identity vs role confusion Adolescence Transition from childhood to adulthood. Acquires sense of who they are. Confusion if unable to establish sense of direction Intimacy vs Isolation Young adulthood Unite self with others –commitments. Fear of commitment results in isolation and loneliness Erikson

Generativity vs stagnation Middle adulthood Desire to make a contribution to the world. Becoming self absorbed results in stagnation Ego integrity vs despair Later adulthood Reminiscence about life -sense of purpose. If believes life was misdirected despair results Erikson

Assessing Self-concept • Developmental and chronological age • Assessing includes questions on identity… body image…self esteem…roles… • Patient’s strengths/weaknesses

Assertive Self-directed Makes decisions Praises self Speaks clearly Attends to needs Passive “who cares attitude” Excessively Dependent Hesitant to express views Overly Critical of self Monotone voice – lack of emotion & energy Neglects own needs Difficulty making decisions Overly apologetic Avoidance of eye contact High self-esteem vs Low self-esteem

Nursing Diagnoses • Disturbed body image • Low self-esteem; chronic or situational Other Dx in which low self-concept is the etiology: • Ineffective health maintenance r/t … • Self care deficit r/t … • Risk for self-directed violence r/t…

Nursing Interventions • Nurse is a role model Can a nurse NEGATIVELY affect a client’s self-concept? • Form helping relationship:Focus on client strengths; praise achievements • Meet physiological and psychological needsReduce pain Decrease anxiety • Promote positive self-esteemEncourage participation in careEncourage socialization

Nursing Interventions NIC • Encourage client to recognize and discuss thoughts and feelings • Assist client to:Realize everyone is uniqueRealize impact of illness on self-conceptBe aware of negative self-statements and modify themGain more controlIdentify positive attributes of selfIdentify and use personal strengths

Nursing Evaluation • Outcome criteria addressed???? • Behavior and attitude changes will indicate altered self-esteem • Long term outcome –can take many months or years

Evaluation (NOC) • Client should be able to meet the following outcomes: Be comfortable with body imageBe able to describe self positivelyBe able to meet realistic goals Be capable of interacting appropriately with environment and others

“Know Thyself”Socrates • Nurses need to reflect on their OWN self-concept in order to effectively assist OTHERs. • Ask yourself these questions:How do I perceive myself?How do I think others see me?What are my strengths and weaknesses?What are my goals for self-improvement?What does ALL THIS have to do with my professional practice?

Summary • Self-concept based on 3 components • Need to understand how various factors affect self-concept • Understand difference between high & low self-esteem • Interventions to promote self-concept • Evaluate outcome criteria

“No one can make you feel inferior without your consent” - Eleanor Roosevelt

Stress & Coping

Stress • Stress- condition when a person responds to change to the normal balanced state • Stressor- anything an individual perceives as challenging, demanding or threatening (causes stress). • Coping responses- response due to threat or challenge (stressor) • Adaptation- change that occurs due to a response from stressor

Why do we study STRESS? • Link between stress and health • Diseases/conditions linked to stressAutoimmune disorders: RA, Graves, Colitis PsoriasisCardiovascular disorders: HTN, CANRespiratory disorders: AsthmaGastrointestinal disorders: GERD • Stress directly affects nervous, endocrine, and immune systems • Stress indirectly affects health d/t poor health habits: smoking, drinking, eating too much, not sleeping enough.

Is all stress BAD for you? • What about stress of knowing you have an exam coming up? • What about the stress of having to have a job, raise a family, etc.? • What about it’s protective mechanism?(the stress of crossing a busy street) • DISTRESS (damaging stress)versus • EUSTRESS (motivating and/or protective stress)

Homeostasis • Various physiological and psychological mechanisms respond to changes in the internal and external environment to maintain a balanced state • To maintain health the body’s internal environment needs a balanced state. STRESS upsets this balance!

Physiological Homeostasis • Regulating mechanisms of the body react to change and keep the body in homeostasis • Primarily: Autonomic nervous system (sympathetic) & the endocrine system (epinephrine, cortisol, aldosterone) • Other: cardiovascular,respiratory, GI and renal systems

Pupils dilate Diaphoresis Increased HR/BP Pallor Increased rate/depth respirations Dry mouth Decreased urinary output Decreased peristalsis Increased mental alertness Increased muscle tension Physiological Indicators of Stress • Intended for short term response to a PHYSICAL stressor • It is inappropriate (and more harmful ) in response to NON-physical stress

Psychological Homeostasis • Need to maintain mental well-being • It uses psychological adaptive behaviors ie:Coping mechanisms and defense mechanisms to return one to an emotionally balanced state

AnxietyMild - Panic Coping Mechanisms(ie: anger, withdrawal, inappropriate laughing and/or crying) Unconsciousdefense mechanisms Psychological Indicators of Stress

Compensation Denial Displacement Projection Conversion Disassociation Rationalization Reaction formation Regression Repression Undoing Defense Mechanismstext review

Adaptation to Stress • IF necessary resources are available to deal w/stressor THEN adaptation occurs & balance maintained. • IF resources are not available THEN adaptation doesn’t occur & stress results • Adaptation is individualized

Adaptation to Stress Factors in the Process of Adaptation • Perception of Event – realistic OR distorted • Situational Support – adequate OR not • Coping Mechanisms – adequate OR not Leads to either: • Positive resolution OR • Negative resolution

Adaptation: LAS • Local adaptation syndrome (LAS) - localized response of the body to stress- involves only a specific body part • Short term adaptive response • Examples = reflex pain response & inflammatory response

Adaptation: GAS • General adaptation syndrome (GAS) - response to stress is characterized by a chain of physiological events • Theory developed by Hans Selye • Incorporates 3 stages: alarm reaction, resistance stage & exhaustion stage

GAS: First Stage • Alarm reaction- stressor (threat) activates the body’s various defense mechanisms • Autonomic nervous system responds ….Fight or flight response….. Lasts 1 minute –24hrs • Neuroendocrine activity (sympathetic ) increases • If stressor persists, body proceeds to nest stage - Resistance

GAS: Second Stage • Resistance stage- body attempts to cope with the stressor and brings down neuroendocrine responses – parasympathetic adaptations increase. • If stress can be managed – homeostasis results = Recovery • If stress is too great the third phase of GAS continues = Exhaustion

GAS: Third Stage • Exhaustion stage- adaptation mechanisms are exhausted. • Body energy stores depleted and no longer able to defend with sympathetic response. • At the end of this stage the body either rests & recovers or death will occur

Effects of Stress • Stress can be a stimulus or a barrier • Effects basic human needs: physiological, Safety/security, Love/belonging, Self-esteem & Self actualization • Effects patient & family • Prolonged stress effects ability to adapt • Burnout/crisis

Sources of StressType of Stressors • Sources: developmental or situational • Type of stressors: physiological or psychosocial

Assessing Stress • Identify stress level by using: • Nursing history • Physical assessment • Standardized tests or rating scales

SUBJECTIVE What is of most concern to you at this time? What have you done in the past to cope with stress? Do you smoke, use drugs, caffeine intake? Do you follow a healthy diet ,exercise regime, see you physician regularly? Change in eating and/or sleeping habits? OBJECTIVE Observe for: Non-verbal cues Eye-contactPostureGrooming/hygiene Irritability / Tension Developmental level Sociocultural factors VS Focused Assessment

Nursing Diagnosis EXAMPLE: • Anxiety R/T loss of job AEB inability to focus, unable to sleep, decreased appetite & states “ I’m so nervous worrying about finding a new job” What are some others???

Planning • Plan to maintain physiological & psychological homeostasis • Develops plan with patient, support people & others as needed • Outcome criteria may include decreased anxiety, increased ability to cope or improved role performance

ImplementationNursing Interventions • Encourage health promotion strategies: exercise, sleep, proper nutrition, time management, minimizing anxiety, relaxation techniques • Encourage use of support systems • May need to make referrals if stress is too great- crisis intervention

What can nurses do for clients experiencing stressors of hospitalization? • Use calm reassuring approach • Explain all procedures • Listen attentively • Encourage verbalization of feelings • Assist client to gain and/or maintain control of situations as much as possible

Evaluation • Use desired outcomes as a guide • Observe verbal & nonverbal cues • Has goal been met? Example: The client is able to: -verbalize cause & effect of stress -identify and use supports -practice healthy lifestyle -utilize effective relaxation techniques

Self –Concept & Coping