Self Concept

[NursingStudent005]

I have to come up with an example of an older adult facing difficulty with self-concept. I understand that with you are having trouble facing the real self- concept one may not see them as an aging person, hard time finding a good quality of life and/or trouble becoming more dependent on others for activities of daily living. The one that sticks out to me would be the last one. What do you think of this example (it can be real or imagined) of an older person who refuses to go to a nursing home or getting home care despite a history of falls. My reasoning behind this is that as one gets older they tend to have an increased risk of falls. I just want to make sure I have the whole concept down?

[amoLucia]

I'm having a hard time understanding your post. If you need to make up a hypothetical situation, I'd select something a bit more detailed - my make-believe pt would be an older, mid-sixty-ish male who now must deal with a right BKA (below knee amputation) secondary to diabetes circulatory complications. I see a loss of mobility as so critical to his sense of self-image and self-worth. His sense of identity is now radically altered r/t his lifestyle change - he has to learn how to get around/walk with or without a prosthetic and how willl he drive???? Loss of those magic keys (even if temporary) can be devastating!!!

He'll still have all the other issues re diabetes and you'll still have safety falls risk. If you make him married and he's now dependent on his wife for more mobility assist, this marital role reversal also seriously impacts his identity/self-concept. Would he still be working? Looking to retire? Already retired? Again, more influences on his self-concept.

This pt may still be facing (OR NOT) nursing home placement or home care but I see alterations in his mobility, ADLS and lifestyle roles as more critical than falls risk. Many frequent fallers really don't see the full picture as they make many subtle adaptations in their daily lifestyles - just as long as there hasn't been a super-duper fall with major injury (ie head trauma with surgery, fractured hip or 911 finding/assisting them up, etc) they'll be fine (or so they think).

Hope this helps some.

[Esme12, ASN, BSN, RN]

We are happy to help with homework but we will not do it for you......

First ask yourself.....What is self concept? What does that mean? Then ask....How is self concept developed or constructed by the individual?

Then list the four components of NANDA self-concept diagnoses, PERSONAL IDENTITY, BODY IMAGE, ROLE PERFORMANCE, SELF ESTEEM.

What are the three dimensions of Self-Concept?

SELF-KNOWLEDGE- abilities, nature, limitations

SELF-EXPECTATION-realistic or unrealistic, SELF EVALUATION- view of oneself in relation to events, situations

Self-Knowledge: is “Who Am I?”

Self-Evaluation: is “How Well Do I Like Myself?”

Then, What are Maslow's two subsets of esteem needs.......

(1) self-esteem needs (strength, achievement, mastery and competence, confidence in the face of the world, independence, and freedom), and

(2) respect needs or the need for esteem from others (status, dominance, recognition, attention, importance, and appreciation).

What developmental Considerations affect Self-Concept: Later years

Loss of significant work (retirement); feelings of uselessness

Death of spouse, significant others

Diminished physical attractiveness, strength, overall health

Multiple stressors

Fear of dependency

Change may be more difficult

How does self concept determine a person's response to crisis?

(1) the person's perception of the event or situation

(2) the person's situational supports (external resources)

(3)the coping mechanisms the person possesses (internal resources.)

All of these factors are related to self-concept. The degree of strength an individual has in each area is related to his or her pre crisis self-concept. Similarly, each of these conditions can alter self-concept either positively or negatively during or after crisis.

So what difficulties do they elderly face? What factors place an individuals concept of "personal identity" at risk?

High-Risk Factors: Body image

Loss of body part or function

Disfigurement

Developmental changes

High-Risk Factors: Self-esteem

Unhealthy interpersonal relationships

Failure to achieve developmental milestones

Failure to achieve life goals

Failure to live up to personal moral code

Sense of powerlessness

High-Risk Factors: Role performance

Loss of valued role

Ambiguous role expectations

Conflicting role expectations

Inability to meet role expectations

reference.......Fundamentals of Nursing/Potter, Patricia A. RN, Ph.D

What can you think of if it happened to you and how would it affect you? and Why.....

If you were injured in an accident and were paralyzed/disfigured...... how would that affect how you look at yourself? How do you think the elderly person looks at themselves when they no longer can work and be valued as contributing members of society and have illnesses/disabilities on fixed incomes when they have been hard working all their lives........Now they have to leave everything they have worked for to be placed in a nursing home void of all freedoms and possessions......How would that make you feel?

Now think of a scenario about you, your mother/father/Aunt/grandmother/sister etc when they become elderly and have to lose independence because the family can't or won't ..... care for them home.

I hope that helps.

[nurseprnRN, BSN, RN]

Another BIG hint: Look in your NANDA-I 2012-2014 (this is THE definitive source for nursing diagnoses, and Amazon will give nursing students free 2-day delivery) for the defining characteristics for the nursing diagnoses in Domain 6, Self-perception, and Domain 7, Role. You will absolutely NAIL this assignment.