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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

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Self concept coping l.jpg

Self –Concept & Coping

NUR101 Fall 2010

Lecture # 13

K. Burger MSEd, MSN, RN, CNE

PPP by: Sharon Niggemeier RN MSN

Revised 10/05 kb


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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


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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


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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.


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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


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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???


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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


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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


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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).


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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


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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


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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


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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


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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


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Assessing Self-concept

  • Developmental and chronological age

  • Assessing includes questions on identity… body image…self esteem…roles…

  • Patient’s strengths/weaknesses


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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


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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…


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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


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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


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Nursing Evaluation

  • Outcome criteria addressed????

  • Behavior and attitude changes will indicate altered self-esteem

  • Long term outcome –can take many months or years


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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


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“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?


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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




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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


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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.


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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)


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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!


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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


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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


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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


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AnxietyMild - Panic

Coping Mechanisms(ie: anger, withdrawal, inappropriate laughing and/or crying)

Unconsciousdefense mechanisms

Psychological Indicators of Stress


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Compensation

Denial

Displacement

Projection

Conversion

Disassociation

Rationalization

Reaction formation

Regression

Repression

Undoing

Defense Mechanismstext review


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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


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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


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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


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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


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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


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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


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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


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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


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Sources of StressType of Stressors

  • Sources: developmental or situational

  • Type of stressors: physiological or psychosocial


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Assessing Stress

  • Identify stress level by using:

  • Nursing history

  • Physical assessment

  • Standardized tests or rating scales


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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


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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???


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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


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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


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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


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Evaluation hospitalization?

  • 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


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Summary hospitalization?

  • Stress affects homeostasis both physiologically & psychologically

  • Adaptation to stress includes LAS, GAS, coping & defense mechanisms

  • Various factors affect stress

  • Nursing process is used to aid patients dealing with stress