SELF CONCEPT

SELF CONCEPT

A.    Definition of  Self concept

Self concept is all ideas, thought, belief and detachment which understandable individually about her/himself and affecting them in relationship with others (Stuart & Sundeen, 1998). It is including individual awareness for characteristics and capabilities, interaction with others and their environment. The Values in which are related with experience and objects, purpose and his/her interest. Whereas, Beck, William and Rawlins (1984) stated that self a way of looking individually in entire both physical, intellectual emotional, social and spiritual stages.

B.     Factors which influenced self concept

Based of Stuart and Sundeen (1998) there are some factor which influenced developmental of self concept. These factors are developmental theory, Significant Other (person who closest to dominant) and Self Perception.

1.      Developmental theory

Self concept is purely not exist individually in starting of life, and gradually developed since birth as like determining and awareness of differences with others.

2.      Significant Other (person who closest to dominant)

It is where the self concept learned by contact and experience with others, self learning by projection to others such way of self esteem in its self interpretation of the others toward him/herself, in which the children is very influenced by close people, teenager is affected from others which closely related to him/her, interference toward close by surrounding people or in dominant party in entire life cycles, effect of cultural and socialization.

3.      Self Perception

That is individual perception toward his/her and judgment, and individual perception toward their experiments about certain situation.

C.    Continuum of Self Concept Responses

Figure 2.1 Continuum of Self Concept Responses (Reference: Stuart,1998).

According to Stuart (1998) adaptive responses that acceptable by social norms, in general operative at society consists of:

1.      Self actualization (individual ability to expresses self optimal)

2.      Positive self concept (all ideas, belief, and opinion that known individual as self and influence individual in relate to other person).

Stuart (1998) also unfolds if deviate, this matter is maladaptive responses. That response is included as:

1.      Low self esteem response is individual evaluation negative about self achievement with analyzes how far behavior as according to self ideal (standard, aim or value that appointed).

2.      Identity Diffusion, important behaviors that relate to identity diffusion include disruptions in relationships or problems of intimacy. The initial behavior may be withdrawal or distancing.

3.      Depersonalization is a feeling of unreality in which one is unable to distinguish between inner and outer stimuli. In essence, it is a true alienation from oneself. The person has great difficulty distinguishing him from others, and his body has an unreal or strange quality. Depersonalization is the subjective experience of the partial or total disruption of one’s ego and the disintegration and disorganization of one’s self concept.

D.    Classification of Self Concept

Self concepts consist of some parts. The division of these self concepts was given by Stuart and Sundeen (1998), which included:

1.      Body Image (self overview)

Body image is self attitude toward his/her body both aware and unaware. These attitudes include perception and feeling about measure, shape, apparentness function and body potency in recent condition and in the past which gradually modified by new experiment on each person (Stuart & Sundeen, 1998).

The factors which affected toward body image, are stressors which disturbing the integration to body image. These stressors can be:

a.       Surgery.

b.      Body function failure

c.       Doctrines which related to shape and body function.

d.      Dependable of machine.

e.       Related on body shape changing.

f.       Negatively interpersonal feedback

g.      Standard of socio-cultural

Some disturbances on body image is relied as sign and tend to :

a.       Psychological shocks

Psychological shock as emotional reaction toward changing impact and can be happened at first time of action. Psychological shock is become reaction toward anxiety. The information which too numerous and fact of changing the body makes client to be self defiance mechanism as: disaffirm, refuse, and projecting to defense for self balance.

b.      Self

Client is unawareness of fact, run behind of fact, which is impossible, and then the client is emotionally running out. Client is become passive, dependable, has less innovation and less willingness to take part in his/her treatment.

c.       Acceptance or confession in gradual stage

While client realizes the reality then losses or grieves responses will occur. After pass trough this phase the client will conduct reintegration with new body image.

Sign and symptom of self image above is adaptive process, if founded some symptom and sing below permanently then client’s responses assumes maladaptive hence releasing self image disturbance that are:

a.       Refuse to see and touch the part of body that has been changed.

b.      Difficult to accept structure changes and new body function.

c.       Loosening social contact as then self isolation.

d.      Feeling or negative thinking about his/her body.

e.       Preoccupation with part of the body or body function which has been lost.

f.       States for desperation

g.      Stating for fear of being refused

h.      Condition of depersonalization.

i.        Refusing for explaining about the change on his/her body.

2.      Self Ideal

Self Ideal is the person’s perception of how one should behave, based on certain personal standards. The standard may be either a carefully constructed image of the type of person one would like to be or merely a number of aspirations, goals, or values that he would like to achieves (Stuart and Sundeen, 1998).

The self ideal creates self expectations based in part on society’s norms, to which the person tries to conform. Formation of the self ideal begins in childhood and is influenced by significant other, who places certain demands or expectations on the child. With time, the child internalizes these expectations, and they form the basis of the child’s own self ideal. New self ideals that may persist thought life are taken on during adolescence, formed from identification with parents, teacher, and peers. In old age additional adjustments must be made that reflect diminishing physical strength and changing roles and responsibilities (Stuart and Sundeen, 1998).

Various factors influence self ideal. First, a person tends to set goals within a range determined by one’s abilities. A person does not ordinarily set a goal that is accomplished without any effort and that is entirely beyond one’s abilities. Self ideals are also influenced by cultural factors as the person compares one’s self standards with those of peers. Other influencing factors include ambitions and the desire to excel and succeed the need to be realistic, the desire to avoid failure and feeling of anxiety and inferiority. Based on these factors, one’s self ideal may be clear and realistic and thus facilitate personal growth and relations with others, or it may be vague, unrealistic and demanding. The adequately functioning person demonstrates congruence between one’s perception of self and self ideal. That is, a person sees oneself as being very similar to the person one wants to be (Stuart and Sundeen, 1998).

3.      Self esteem

Self esteem is person’s personal judgment of one’s own worth, based on how well one’s behavior conforms to one’s self ideal (Stuart and Sundeen, 1998).

The frequency on reaching purposes will result on low self esteem or high self esteem. If the individual frequent to failure, then it tends to low self esteem. The Self esteem is gained from his/herself and others. Main aspect is being loved and accepting respect from others (Keliat, 1992).

In general, self esteem is vurneable being disturbed in youth and old senile. High self esteem related with low anxiety, effective in group and accepted by others. Low self esteem is related with worst interpersonal relationship and has risk for depression and schizophrenia.

4.      Role

Role is sets of socially expected behavior patterns associated with a person’s functioning in various social groups (Stuart and Sundeen, 1998). Whereas, Keliat (1992) role is values of attitude and behavior and purposes which is hoped from someone based of his/her position in a society.

In the lifetime of individual is frequent to face the changing of roles, both permanently or temporarily which in nature caused by situational. It is called commonly as role transition.

The role transition is categorized to be some parts, such as:

a.       Developmental transition

b.      Situational transition

c.       Healthy-sick transition

The role disturbance factors can be caused by:

a.       Interpersonal role conflict, such inadequate role, lost of important relationship, sexual role changes, ambiguous role, physical stamina changes to show a role related with aging process, less definitive of the role, conflict occurred within some roles applied.

b.      Drug addiction.

c.       Less Social flexibility

d.      Cultural differences

e.       Low self esteem.

5.      Personal Identity

Identity is awareness on self which sourced from observation and assessment which is a synthesis from all self-concept aspect as an intact unity (Stuart and Sundeen, 1998).

Someone with strong identity feeling will see him/herself more different than others. Autonomy occurs from feeling of precious (self aspect), capability and self adaptation. A person who autonomic can manage and accepting his/herself condition. Self identity is gradually develops from childhood joined with developmental self concept. (Keliat, 1992).

Character of self identity can be relied from behavior and feeling of somebody, shaped as:

a.       Individual renounce him/herself as distinct being and differ with others.

b.      Individual recognize or aware of his/her sex.

c.       Individual acclaimed and give respect to some aspect him/herself, role, value, and behavior in harmonic way.

d.      Individual acclaimed and show self esteem as equal from his/her environment.

e.       Individual aware of past, recent, and future relationships.

f.       Individual has purposes which can be reached and realized (Stuart and Sundeen, 1998).

E.     Definition of Low self esteem

Low self esteem is negative overview assessing toward self and capability which expressed in directly or indirectly (Schult and Videbeck, 1998). Low self esteem is generally defined as rejecting of her/himself as valuable human being and has no responsible his / herself life. Mainly, it is failure to adapt for proper behavior and aspiration. 

Self esteem disturbance is drawn as negative feeling of his/ herself including loss of self confidence and occur the self esteem. Low self esteem can be happen situational (trauma) or chronically (prolonged negative self evaluation) and can be expressed either directly or not (real or not).

F.     Etiology

According to Keliat (1995) low self esteem is happening situational and chronically.

1.      Situational, that is happening of incidental trauma, such a must for operation, accident, divorced by husband, fired in job, and so on (Keliat, 1995). Patient with low self esteem will feel less zealous, carelessly physical examination, aspiration for structure, shape, and body function which is not gained   since being treated/sickness/illness. Medical operator which less giving respect to patient (Keliat, 1995).

2.      Chronics, that is negative feeling individually which lasted long ago, such before/while in treatment (Keliat, 1995). Client has negatively thought way, sickness, and the treating is degradation to him/her perception. (Keliat, 1995).

While according to stuart and Sundeen (1998) the causal of low self esteem consisted both predisposition and precipitation stressors.

1.      Predisposing factors

Some factor of predisposition can support for happening of self concept on somebody. This factor is differentiated as:

a.       Development

Some factor which influenced development can affect toward self concept, such as: crises of psycho-social in development age, aspiration which important for somebody, aspirated social role, affected cultural aspect, physical condition, and troubleshooting solution (Stuart and Sundeen, 1998).

b.      Factor which influenced self esteem

Childhood experiences is contributed factor in self concept such as: children is sensitive toward treat and respond from violence parents, hitting, unrespectable for child effort, self uncertainty, children with less care in which such all of the will makes children fail to love their condition and get affective from others (Stuart and Sundeen,1998).

c.       Factor which influenced role performance

The proper role with sex since the past time has been adopted by society that women is less capable, less autonomous, and less objective, and less rational compared with men. Whereas men is assumed as less sensitive, less warmth, and less expressive than women (Stuart and Sundeen,1998).

d.      Factor which influenced personal identity

Constant parental intervention can interfere with adolescent choices. Parental distrust may lead a child to wonder whether his own choices are correct and to feel guilty if he goes against parental ideas. It may also devalue the child’s opinions and lead to indecisiveness, impulsiveness, and acting out in an attempt to achieve some identity. When the parent doest not trust the child, the child ultimately loses respect for the parent (Stuart and Sundeen, 1998).

2.      Precipitating Stressors

Self concept disturbances can be caused both inside and outside. In which individual condition is not supporting to solve their stressors then it will influenced on their body image such as:

a.       Trauma as psychological sexual violence or experienced for threatening occurrence (Stuart and Sundeen, 1998).

b.      Role strain on which related with role or position hoped as individual got frustrated. Role strain is the frustration felt when the person is torn in opposite directions or feels inadequate or unsuited to epact certain roles.

In the course of a lifetime a person faces numerous role transitions. These transitions may require the incorporation of new knowledge and alterations in behavior. There are three categories of role transitions:

a.       Developmental transition is normative change associated with growth. This change is included development stage in individual life or family and social cultural norms or pressured values for adaptation.

b.      Situational transition involve the addition or subtraction of significant others, occurring through birth or death, an example is the birth of one’s first child.

c.       Health-illness transitions involve moving from a well state to an illness state. Each of these role transitions can precipitate a threat to one’s self concept. Such transition is stimulated by loss of body part, size changing, shape, appearance and body function, physical changing, medical procedure, and considered treatment (Stuart and Sundeen, 1998).

G.    Clinical Manifestation

The behaviors overwritten toward self concept disturbance: low self esteem which given by Stuart (1998:324) as:

1.      Criticism of self or others.

2.      Decrease on productivity

3.      Destructiveness

4.      Disruptions in relatedness

5.      Exaggerated sense of self importance

6.      Feelings of inadequacy

7.      Guilt

8.      Irritability or excessive anger

9.      Negative feeling about one’s body.

10.  Perceived role strain

11.  Pessimistic view of life

12.  Physical complaints

13.  Polarizing view of life

14.  Rejection of personal capabilities

15.  Self destructiveness

16.  Self diminution

17.  Social withdrawal

18.  Substance abuse

19.  Withdrawal from reality

20.  Worrying

H.    Coping Mechanisms

Coping mechanism is included of short term coping and long term defenses and by using of ego defense to protect individually in face to self perception which painful (Stuart and Sundeen, 1998).

According to Stuart and Sundeen (1998) long term defense is given as:

1.    Activity which then can give temporary runaway from identity crisis. Such as: music concert, working hard, and watching television.

2.    Activity which then giving temporary successor identity. Such as: join to social activity, religious, political club, certain group.

3.    Activity which then by temporarily strengthening self feeling. Such as: competitive sport, academic gain, and contest for popularity.

 

Long term defense according to Stuart and Sundeen (1998) is included as:

1.    Identity enclosure – premature identity adoption which wanted by important personal asked to individual without considering need, aspiration and self potency of the individual.

2.    Negative identity – identity assumption which not relevance to be accepted by value and hope of surround society.

Ego defense mechanism is included by using of fantasy, disassociation, isolation, projection, turning, splitting, to be get self anger, and amuck Stuart and Sundeen (1998).

I.     Nursing Diagnosis

1.      Body imaging disturbance

2.      Ineffectiveness on coping

3.      Self identity disturbance

4.      Ineffectiveness role perform

5.      Self care deficit

6.      Situational Low self esteem

7.      Sensory perception disturbance : hallucination

8.      Social isolation

9.      Risk of self violence (Nanda, 2001).

J.    Nursing Intervention

1.      Nursing intervention of client with low self esteem

a.       Nursing strategic (client)

1)      Goal:

a)      Identify capabilities and the positive aspects of the client owned

b)      Assess skills that can be used

c)      Establish or choose activities according to ability

d)     Coaching activities are selected according to ability

e)      Planning activities that have been trained.

2)      Outcome: The client can identify capability and positive aspect, assess her capability, choose the appropriate activities and increase her capability.

3)      The first nursing strategic

a)      Identifying capability and positive aspect on client

b)      Helping client to assess her capability

c)      Helping client to choose activity

d)     Training to client to choose the appropriate activities

e)      Giving proper praise toward patient succeeding.

f)       Suggesting to patient to include schedule the daily activity.

4)      The second nursing strategic

a)      Evaluating the daily routine of patient

b)      Training for second capability

c)      Suggesting to patient to include schedule the daily activity.

b.      Nursing strategic (family)

1)      Goal: Families able to care for client with low self-esteem

2)      Outcomes:

a)      The first nursing strategic: The client’s family can explain client’s problems, definition, sign and symptom of client’s problems and stages to support client.

b)      The second nursing strategic: The client’s family can practice to care the client with low self esteem and take care directly to client with low self esteem.

c)      The third nursing strategic: The client’s family can monitoring of client’s activity schedule, medicine for the client and explain client follow up.

3)      The first nursing strategic

a)      Discussing client’s problems and treat the family about the client’s problems

b)      Explaining definition, sign and symptom of client’s problems

c)      Explaining stages to support client.

4)      The second nursing strategic

a)      Training in practicing to care the client with  low self esteem

b)      Training to take care directly to client with low self esteem.

5)      The third nursing strategic

a)      Promote family to schedule of client’ activity

b)      Teach family about medicine

c)      Explains client follow up.

2.      Nursing intervention of client with body image disturbance

a.       Client outcomes: verbalizes a more realistic self-image. Demonstrate acceptance of self as is rather than idealized image. Acknowledges self as an individual who has responsibility for own self.

b.      Interventions:

1)     Obtain accurate assessment of client’s perception of own body image. Recognize that disability is real to the client. Rationale: information about the way in which the individual views self aids in developing accurate plan of care. Denial of client’s feelings in nontherapeutic and impedes the development of trust.

2)     Encourage and give positive feedback for independent self care behaviors, while gradually withdrawing attention from dependent behaviors. Rationale: lack of attention to maladaptive behaviors discourages their repetition. Positive reinforcement enhances self-esteem and promotes repetition of desirable behaviors.

3)     Help client to see that images is distorted and out of proportion to reality of actual changes in structure or function. Rationale: recognition that a misperception exists is necessary before client can accept reality and reduce significance of impairment.

4)     Provide for privacy as care is given. Rationale: may experience sense of shame due to stigma of being birthmark.

5)     Encourage client to use imagery to visualize self at beautiful women. Imagery may also be used to practice handling of new behaviors. Rationale: mental rehearsal is very useful to help the client to plan for and deal with anticipated changes in self image and occasions which may arise, such as family gatherings and gatherings with others.

6)     Discuss the use of makeup properly, hairstyles and ways of dressing to maximize figure assets. Rationale: enhances feelings of self esteem. Promotes improved body image.

7)     Nurse needs to be aware of and deal with own feelings when taking care of these clients. Rationale: judgmental attitudes, feelings of disgust, anger, weariness, and despair can interfere with care.

8)     Assist client to recognize normal feelings associated with the grieving process and offer support as the client progresses toward acceptance of change in self. Rationale: may need to deal with actual impairment as well problematic behavior. Progress through the grieving process is facilitated by client’s recognition of feelings as acceptable and own ability to acknowledge ownership of those feelings.

9)     Encourage verbalization of fears and anxieties associated with identified stressful life situations. Discuss ways in which client may respond more adaptively in the future. Rationale: verbalization of feelings with a trusted individual may help the client come to terms with unresolved issues.  A plan of action formulated with assistance and at a time when anxiety is low may prevent later dysfunctional response by client.

10) Involve family in treatment plan, assisting them to understand underlying reasons for client’s behavior. Rationale: having understanding support from significant others can help client to accept reality of situation and make required changes (Townsend, 1998).