SELF-PERCEPTION AND SELF-CONCEPT

1.SELF-CONCEPT
Learning objectives
Up on completing this chapter, you will be able to:
Describe normal functions of self and self-concept
Define self-concept, self-perception, self-knowledge,
self-expectation, social self, and self-evaluation
Discuss factors affecting self-concept
Identify manifestations of altered self-concept
Plan care for a person with altered self-concept

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 NORMAL FUNCTIONS OF SELF CONCEPT
• Self is elusive (not tangible) and can be defined variously

• May defined as a person’s unique dimensions,

potentials, and purposes

• Self-concept is:
– Mental image one has of one self
– A person’s meaning w/n stated as “I” or “me”
– Frame of reference that influences how one handles
life situations and relationships

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CX’S OF NORMAL SELF-CONCEPT
• Clear sense of self and others
• Ability to distinguish self as separate individual
• Ability to acknowledge self strengths, weaknesses,
and emotions/feelings.
• Realistic view of others
• Ability to relate to people in a satisfying, intimate and
loving manner
• Ability to deal with realities and problems of life with
appropriate coping behaviors

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 SELF-PERCEPTION
• A filtering process that evaluates events and enter them
into subconscious (hidden mind)

• Prevents feelings of guilt, anxiety, and unworthiness from

developing

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Dimensions of Self-perception
1. Self-knowledge (self awareness)
• Cognitive process w/c involves basic understanding
of one self
• Also involves basic facts (age, weight, sex,…) and
qualities (sincere, intelligence,…) of one self
related to who one is

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 Dimensions cont’d

2. Self-expectation:
• Involves ideal self/the self a person wants to be

• Setting of goals for present and future

• May be attainable (if realistic) or not

• Influenced by significant others like mother, spouse,

friends, etc

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 Dimensions cont’d

3. Social self:
• How one sees one self in relation to social situations

• Includes behaviors and interaction with others

• One can never fully know how others see one self,
but can only guess (w/c may be far from reality)

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 Dimensions cont’d
4. self-evaluation:
• Conscious assessment of self

• Leads to self-respect or self-worth

• The way one appreciate (look) one’s physical

appearance, knowledge, and all your act
• Involves self-esteem

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 Normal functional self-concept patterns

1. Positive body image:

• Body image is how one pictures ones body and feels
about one’s body
• Human body is physical manifestation of self
• Body image is influenced by culture and social
experiences

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 Normal Patterns cont’d
2. Self-esteem:
• Judgment one makes regarding one’s self

• Affective in nature and made up of thoughts and feelings

• Its two main sources are self and others

• Fundamentals of high self-esteem are: parental

acceptance, clear expectations, limitations, and
freedom to express opinions

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 Self-esteem cont’d
• Core self-esteem is the person’s overall appraisal of self

• Persons with high self-esteem accept others, experience

less anxiety, functions effectively in social situations

• Criteria for self-appraisal are:

– Power: ability to influence people and events
– Meaning: the sense of being valued and worth
– Competence: ability to achieve personal goals
– Virtue: behaving consistent with personal values
(moral and ethical standards)

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 Normal pattern cont’d
3. Strong personal identity:
• The awareness one is a distinct individual separate from
others
• Strong sense of personal identity contributes to integrated
self-esteem, body image, and various roles into integrated
whole self
• Personal identity depends on intact body boundaries (this is
my hand; this is your hand) and ego boundaries (this is my
feeling; not your thought)
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 Normal pattern cont’d
4. Role performance:
• Role: the expected cx’s behavior of a person in a social
position
• Roles can be ascribed or assumed
Ascribed roles: roles a person hold with out choice
(e.g being son or daughter)
Assumed roles: roles a person holds based on his
personal preference (e.g being father, mother, nurse)
• Roles overlap and a person must combine many roles to
achieve a unified pattern of functioning

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 Factors affecting normal self- concept

1. Biologic make up
• Height, weight, skin color, and attractiveness or
unattractiveness are biological factors that can affect
self-concept
• They are self-perceived and perceived by others

2. Culture, values and beliefs

• During growth; individuals internalize the culture, values
and beliefs to w/c they are exposed
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 Factors affecting cont’d
3. Coping and stress tolerance
 People able to adapt to stress and resolve conflicts
through coping tend to develop healthy self-concept
4. Previous experience
• success and failure are experiences that can affect self-
concept
• Success produce feeling of self-esteem where as failure
may cause the opposite

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 ... cont’d
5. Developmental level
• Developmental stages can reinforce or alter self-concept
• Accomplishment of tasks at each developmental stage
enhances self-concept

6. Illness
• Positive self-concept is usually based on healthy self
• Acute or chronic illness, trauma, or surgery can
adversely affect self-esteem and body image and hence
self-concept

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Potentials for altered self-concept
1. Stressful life events
• Financial difficulties, problems r/ to job, r/ship
concerns, sexuality concerns, divorce, loss of loved
one, etc. are among the stressful life events
• They may paralyze the person and damage self-
concept

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 Potentials cont’d
2. Inadequate coping
• Lack of support system, and inability to prioritize and
solve problems
3. Incomplete dev’tal tasks
 Adolescence is particularly, a difficult time due to
many changes like physical, emotional and sexual
changes occur
 Body image and identity are not secure

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 Cont…
4. Role transitions

Multiple role transitions occur during life time

Two types of role transitions: -

1. Dev’tal role transition- associated with growth and
aging, e.g transition from student to wage earner

2. Situational role transition- associated with changes

in relationships, e.g changes in status from single
to married, from married to widowed, etc.
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 Cont…
5. Illness, trauma, and surgery
• Produces stress, role strain, reduced self-esteem, and
altered body image, e.g loss of body part

• Amputation, mastectomy, burns, and facial trauma cause

significant change in body structures and appearance

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 Manifestations of altered self concept

1. self-care deficit

• Include unwillingness to take medications, disregarding

special diet instructions, not keeping follow up

appointments, poor personal hygiene, lack of health

seeking behavior, etc.

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 Manifestations cont’d

2. Emotional and behavioral changes

• Emotional changes are feeling of depersonalization,
hopelessness, helplessness, fear of rejection, etc
• Behavioral changes are lack of interest in activities,
inability to make decisions, isolation, refusing to look at
self in mirror, refusal to make eye contact, negative
verbalization about self, withdrawal from social
situations
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 Manifestations cont’d
3. Anxiety and depression
 Common psychological manifestations of self-concept
dysfunction

4. Self-destructive behavior
• Manifested through substance abuse (alcohol, drug),
sexual promiscuity/indiscriminte/, gambling, over
eating

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ASSESSMENT
Subjective Data
Functional pattern identification
Ask questions about self concept like:
How would you describe your self?
Most of time, how do you feel about your self?
Are you experiencing changes in the way you feel
about your self?
Do you find things frequently make you feel
angry, anxious, frustrated, afraid, or sad? If so
what helps?

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 Subjective data cont’d
 Risk identification
Consider the following about the patient during risk
assessment:
Dev’tal stages
Previous experience
Intensity of the stressor or threat
Self-expectations
Assess difference b/n real self and ideal self

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 Subjective data cont’d

Dysfunction identification

Assess the following:

Patient’s thought and feelings

Feelings of inferiority, self-doubt, and self-dislike

Whether the problem is with self-esteem, role

function, personal identity, or body image

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 Objective Data
Observe the following during your physical
assessment:
Behavioral manifestations as refusing eye contact
A missing body part or function
Concealed (covered, hidden) body part
Anxious behaviors such as hand-wringing, shallow
breathing, etc
Grief behaviors such as weeping/cry

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 NURSING DIAGNOSES
1. Body image disturbance
• Definition: disruption in the way one perceives one’s
body image
• Defining cx’s:
– Verbal responses to actual or perceived change in
structure and/or function e.g verbalization of change in
life style, fear of rejection, etc
– Non verbal responses like not looking at body part,
hiding or over exposing body part, etc
• Related factors: biophysical, cognitive/perceptual,
psychological, cultural or spiritual factors
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 Nursing Dx cont’d
2. self-esteem disturbance
• Definition: negative self-evaluation/feelings about self or
self capabilities
• Defining cx’s: negative self verbalization, expression of
shame/guilt, evaluating self as unable to deal with events,
rejects positive feedbacks and exaggerates negative
feedbacks about self

3. Personal identity disturbance

Definition:
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 Nursing Dx cont’d

4. Altered role performance

• Definition: disruption in the way one perceives one’s role
performance
• Defining cx’s: denial role, conflict in roles, lack of
knowledge of role, change in usual pattern of
responsibility, etc

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 Nursing Dx cont’d
• Related nursing diagnoses
– Anxiety
– Ineffective individual/family coping
– Fear
– Altered family process
– Anticipatory grief
– Hopelessness
– Powerlessness
– Social isolation
– Altered thought process
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 Nursing interventions
• Nursing interventions to promote health and
functions of self-concept
Identifying patient strengths and promotion through
support
Promoting sense of self in patient
Promote dev’t of self-concept
• Nursing interventions for altered self-concept
Creating therapeutic relationship with the patient
Promoting positive self-evaluation of the patient
Promoting behavioral change

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