Self-Concept and Development

Self-Concept Basics

• Self-concept is a subjective view of oneself with a mixture of conscious and unconscious thoughts, attitudes, and perceptions.
• Self-concept directly affects self-esteem.
• Nurses differentiate self-concept and self-esteem to correctly assess patients and develop individualized care plans.
• Health problems can threaten self-concept and self-esteem.
• Loss of bodily function, decline in activity tolerance, and difficulty managing chronic illness can alter self-concept.
• Alterations in self-concept can be adjusted and components strengthened to promote successful coping and positive health outcomes.

Factors Influencing Self-Concept Development

• Self-concept development is a lifelong process.

Erikson's Psychosocial Development Theory (1963)

• It is useful in understanding key tasks individuals face at various life stages.
• Each stage builds on the tasks of the previous stage.
• Successful mastery of each stage leads to a solid sense of self.
• Recognize failure to achieve an age-appropriate developmental stage or regression to an earlier stage during crisis.
• Erikson's generativity stage explains the rise in self-esteem and self-concept in adulthood-focusing on productivity and creativity while guiding the next generation.
• Self-esteem is highest in childhood, fluctuates in adolescence, rises in adulthood, and diminishes or increases again in old age, based on self-concept clarity.
• Adolescence involves maturational changes and shifting self-esteem levels, setting the stage for rises in young adulthood.

Factors Influencing Self-Concept

• Any real or perceived change that threatens identity, body image, or role performance can affect self-concept.
• Physical, spiritual, emotional, sexual, familial, and sociocultural health changes affect self-concept.
• Health changes and other crises can influence self-concept, too.

Components of Self-Concept

• Identity: Internal sense of individuality, wholeness, and consistency over time.
• Body Image: Attitudes related to physical appearance, structure, or function.
• Role performance also forms part of self-concept.
• Self-esteem is a key component.

Healthcare System Levels

• The U.S. healthcare system has five levels of care: disease prevention, health promotion, primary, secondary, and tertiary health care.

Primary Care (Health Promotion)

• Prenatal and well-baby care is included.
• Nutrition counseling is offered.
• Family planning is a part of this.
• Exercise, yoga, and meditation classes are offered.

Preventive Care

• Blood pressure and cancer screenings available
• Immunizations are given
• Mental health counseling and crisis prevention are offered.

Secondary Acute Care

• Includes emergency care.
• Acute medical-surgical care is provided.
• Radiological procedures for acute problems are performed.

Tertiary Care

• Includes intensive care.
• Subacute care is provided.

Restorative Care

• Cardiovascular and pulmonary rehabilitation are included.
• Orthopedic rehabilitation and home care are provided.
• Sports medicine and spinal cord injury programs are available.

Continuing Care

• Assisted living is an option.
• Psychiatric and older adult day care are available.

Healthcare Delivery System Focus

• Primary/preventive care reduces risk factors and focuses on improved outcomes through collaboration.
• Health promotion programs lower costs by diminishing disease incidence, minimizing complications, and reducing the need for expensive resources.
• Secondary/tertiary care focus on diagnosing and treating disease.
• Disease management is the most common and expensive service.
• Uninsured patients postponing care results in high costs.

Hospitals

• Work redesign and discharge planning take place.
• Intensive care is provided.
• Psychiatric facilities exist
• Rural hospitals exist
• Serves patients recovering from acute or chronic illness/disability.
• Helps individuals regain maximal function and enhance quality of life.
• Home healthcare provides medically related services and equipment for health maintenance, education, illness prevention, diagnosis, treatment, palliation, and rehabilitation.
• Home healthcare involves coordination of services with focus on patient and family independence and is reimbursed by government, insurance, and private pay.

Rehabilitation

• Includes physical, occupational, speech therapy, and social services.
• Begins on admission focusing on preventing complications and maximizing patient function and independence.
• Includes intermediate medical, nursing, or custodial care for patients recovering from acute illness or disabilities.
• Intermediate/skilled nursing facilities provide care until patients can return to their community.

Continuing Care for People with Disabilities

• Continuing care is for people who are disabled, functionally dependent, or terminally ill, and is available in institutional settings or at home.
• Nursing centers/facilities provide 24-hour intermediate and custodial care, nursing, rehabilitation, diet, social, recreational, and religious services for residents of any age with chronic or debilitating illnesses.
• Nursing centers/facilities are regulated by the Omnibus Budget Reconciliation Act of 1987 where interdisciplinary functional assessment is the focus of clinical practice.
• Assisted living offers a long-term care setting, home environment, greater resident autonomy, but has no fee caps.
• Respite care provides short-term relief for caregivers of individuals who are ill, disabled, or frail in settings including home, day care, or healthcare institutions.
• Trained volunteers enable family caregivers to leave home.
• Adult day care centers provide various health and social services to specific patient populations living alone or with family, and may be associated with a hospital or nursing home.
• Hospice is a family-centered care allowing patients to live with comfort, independence, and dignity while easing pains of terminal illness, and focuses on palliative care.
• Many hospice programs offer respite care to maintain the health of the primary caregiver and family.