Chapter 43: Self-Concept
the individual’s perception of self, affects relationships,
functional abilities, and health. Self-concept (1) is unique to
the individual; (2) can be positive or negative; (3) has emotional,
intellectual, and functional dimensions; (4) changes with the environmental
context; (5) changes over time; and (6) has a powerful influence
on one’s life.
The components of self-concept
are identity, body image, self-esteem, and role performance. Personal
identity is the sense of what sets a person apart from others. It
may include the person’s name, gender, ethnicity, family status,
occupation, and roles. Personal identity develops during childhood
from self-reflection and feedback from others. Erikson’s psychosocial
theory stresses the importance of the family, peer group, and community
in forming the personal identity.
the attitude about one’s physical attributes and characteristics,
appearance, and performance changes as the body changes over time.
The way one perceives the body is affected by personal identity
and self-esteem. Self-esteem is the judgment of personal
performance compared with the self-ideal. The self-ideal is based
on personal standards and self-expectations. Self-esteem is most
threatened during adolescence. Self-esteem is associated with locus
of control. People with an internal locus of control perceive that
they affect their own destiny, as opposed to people with an external
locus of control, who perceive that others affect their destiny.
is a set of expected behaviors that are determined by familial,
cultural, and social norms. People express their self-identity through
their roles. Some people take on a “sick role,” a set
of social expectations met by an ill person, such as being exempt
from role responsibilities, being obligated to get well, and seeking
develops throughout life. An infant whose needs are met develops
a positive self-concept and develops a sense of self distinct from
the primary caregiver. Toddlers develop a sense of autonomy and
self-image and are self-centered. Positive and negative self-concept
develop based on feedback from significant others. Adolescents are
quite interested in appearances and social status. They cannot separate
their body image from their self-concept and are usually self-critical.
Adults gradually adapt to the changes in self-image resulting from
physical changes and health challenges, at the same time developing
and introducing new roles. The factors affecting self-concept
are altered health status from the loss or disruption of a body
part; developmental processes, such as pregnancy or menopause; and
experience, such as frequently failing.
self-concept is often subtle, depending upon the client’s
developmental level and chronological age. The nurse should attend
to the client’s verbal and nonverbal clues when discussing
self-concept, personality, body image, self-esteem, or role changes.
Determining the client’s strengths to better understand the
person’s ability to form relationships, care for self, and
adapt to stressors is also important. Possible nursing diagnoses
related to self-concept are Disturbed Body Image, Parental Role
Conflict, Disturbed Personal Identity, Ineffective Role Performance,
Chronic Low Self-Esteem, Situational Low Self-Esteem, Disturbed
Personal Identity, Anxiety, Social Isolation, Hopelessness,
and Powerlessness. The major goal of clients with altered
self-concept is to gain a sense of well-being and to facilitate
growth. Interventions to use are supporting healthy defense mechanisms,
examining the client’s options and resources, ensuring the
satisfaction of physical and psychosocial needs, and promoting success.