Ch 33 Flashcards
Self-concept
-an individual’s view of self. It is subjective and involves a complex mixture of unconscious and conscious thoughts, adaptive development, cultural identify, coping style, attitudes, and perceptions
-Self-concept, or how one thinks about oneself, directly affects self-esteem, or how one feels about oneself.
Identity
involves the internal sense of individuality, wholeness, and consistency of a person over time and in different situations. It implies being distinct and separate from others. Being “oneself ” or living an authentic life is the basis of true identity.
Body image
involves attitudes related to the body, including physical appearance, structure, or function. Feelings about body image include those related to sexuality, femininity and mascu- linity, youthfulness, health, and strength. These mental images are not always consistent with a person’s actual physical structure or appear- ance
Role performance
the way in which individu- als perceive their ability to carry out significant roles (e.g., parent, supervisor, partner, or close friend). Normal changes associated with maturation result in changes in role performance.
Self-esteem
an individual’s overall feeling of self-worth or how individuals value, like, and accept themselves and is considered to be one of the critical elements that affect future behav- ioral choice and action
Identity confusion
results when people do not maintain a clear, consistent, and continuous conscious- ness of personal identity. Inability to adapt to identity stressors can result in identity confusion regardless of stage of life.
Role conflict
results when a person has to simultaneously assume two or more roles that are inconsistent, contradictory, or mutually exclusive. For example, when a middle-age woman with teenage chil- dren assumes responsibility for the care of her older parents, conflicts occur in relation to being both a parent to her children and the child of her parents.
sick role
involves the expectations of others and society regarding how an individual behaves when sick. Role con- flict occurs when general societal expectations (take care of yourself and you will get better) and the expectations of co-workers (need to get the job done regardless of illness) collide. The conflict of taking care of oneself while getting everything done is often a major challenge.
Role ambiguity
involves unclear role expectations, which makes people unsure about what to do or how to do it, creating stress and confusion. Role ambiguity is common in the adolescent years. Parents, peers, and the media pressure adolescents to assume adultlike roles; yet many lack the resources to move beyond the role of a dependent child.
Role strain
combines role conflict and role ambiguity. Some express role strain as a feeling of frustration when a person feels inadequate or unsuited to a role such as providing care for a disabled child or a family member with dementia or terminal cancer
Role overload
nvolves having more roles or responsibilities within a role than are manageable. This is common in an individual who unsuc- cessfully attempts to meet the demands of work and family while carving out some personal time. Often during periods of illness or change, those involved either as the one who is ill or as a significant other find them- selves in role overload.
Summary
• Components of self-concept including identity, body image, and role performance can be affected by developmental milestones and life events.
• Self-concept and self-esteem stressors include developmental and relationship changes, illness (particularly chronic illness involving changes in what were normal activities), surgery, accidents, and the responses of other individuals to changes resulting from these events.
• Self-concept and self-esteem change with developmental milestones and the person’s response to those events.
• Health care providers can influence a patient’s self-concept.
• A health care provider’s self-concept is influenced by the practice
environment and is positively affected by effective teamwork.
• Be aware of how cultural variations affect a patient’s self-concept
and self-esteem and incorporate culturally sensitive interventions.
• Assessing a patient’s self-concept includes obtaining information about the patient’s perception of self, family’s and significant oth-
er’s perceptions, and coping strategies.
• Planning care for self-concept alterations must include collaboration
with the patient in identifying measurable outcomes and methods to
help patients achieve these outcomes of care.
• Implementing nursing interventions for self-concept disturbance
involves using evidence-based care to expand the patient’s self- awareness, encourage self-exploration, aid in self-evaluation, and help patients achieve outcomes of care.
• Evaluation for self-concept alterations must include the patient’s re- sponse to nursing interventions and perceptions of changes in self- concept in addition to the health care evaluation of change.
REFLECTIVE LEARNING
From the ongoing case study in this chapter, you know that Mrs. Johnson is 52 years old and is recovering from a left radical mastectomy. She is in her room requesting that the curtains remain drawn at the window and lights off. She doesn’t initiate any interaction with hospital staff when they enter her room. She cries frequently and tells her nurse that she cannot even look at her chest, at its bandages and drains, because to her they are symbols of her disfigure- ment. She states, “I don’t think I feel good as a person, let alone as a woman. Heaven knows what my chest will look like after the bandages are removed. I don’t want to see it.” She does not request medication, and often her pain increases to 9/10 prior to administration of pain medication; following admin- istration her pain level drops to 3/10.
Mrs. Johnson had a routine mammogram 1 month ago and an abnor- mality was noted. Following diagnostic screening, scans, and testing, it was determined that surgery was needed. During surgery, two lymph nodes were positive for cancer, which resulted in a radical mastectomy. She thought she was just going to have a lumpectomy, so the radical mastectomy was unexpected.
An initial self-concept nursing diagnosis was Disturbed Body Image related to negative view of self after mastectomy. However, Mrs. Johnson also said that she is not sleeping well and is restless. She still has some Acute Pain related to mastectomy incision, and this is a priority diagnosis.
Mrs. Johnson is ready for discharge and will recover at home. Her husband will be home with her and they are planning to go to the com- munity breast cancer support group together.
• Think about the type of additional assessment data that would indi-
cate Mrs. Johnson is at increased risk for ongoing low self-esteem
during discharge and recovery at home. (Recognize Cues)
• Considering the fact that Mrs. Johnson is discharged to home and is in the recovery phase of an unexpected radical mastectomy, identify additional assessment data and cues that support additional nursing
diagnoses. (Analyze Cues)
• Consider all the information in the case study, care plan, and concept
map and the additional postdischarge nursing diagnoses you just identified. What are the priority home care needs for Mrs. Johnson? (Prioritize Diagnoses)
• Review the case study information, Mrs. Johnson’s nursing care plan, and the concept map. Describe additional nursing interven- tions to help resolve any ongoing situational low self-esteem during recovery at home. (Generate Solutions)
• Continue to review the case study, care plan, concept map, and dis- charge needs, and from the list below identify the appropriate nursing intervention to help reduce Mrs. Johnson’s anxiety during recovery at home. List in order of priority, with number 1 being the most impor- tant. (Take Action)
1. Teach and, if needed, demonstrate comfort measures for post- operative incisional pain.
2. Provide community health resources.
3. Provide time for Mrs. Johnson to discuss her fears and concerns. 4. Encourage Mr. and Mrs. Johnson to identify and discuss strate-
gies they learned through the community breast cancer support
group to comfort one another.
5. Teach Mrs. Johnson techniques regarding basic hygiene care,
methods for dressing changes, pain management, and other
needs.
• Evaluate the discharge plan. What criteria support achievement of dis-
charge expected outcomes or support revision? (Evaluate Outcomes)
A 50-year-old woman is recovering from a bilateral mastectomy. She refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which of the following is the best response from the nurse?
1. “What’sthespecialoccasion?”
2. “Youmustbefeelingbettertoday.”
3. “ThisisthefirsttimeI’veseenyoulookthisgood.”
4. “Iseethatyou’vecombedyourhairandputonmakeup.”
4
A 30-year-old patient diagnosed with major depressive disorder has a nursing diagnosis of Situational Low Self-Esteem related to negative view of self. Which of the following are appropriate interventions by the nurse? (Select all that apply.)
1. Encourage reconnecting with high school friends.
2. Role-play to increase assertiveness skills.
3. Focus on identifying strengths and accomplishments.
4. Provide time for journaling to explore underlying thoughts and
feelings.
5. Explore new job opportunities.
3.,4.,
