WEEK 1 TEST.docx

The importance of nursing theory    Theory is important because it helps us to decide what we know and what we need to know.   It helps us distinguish what should form the basis of practice by explicitly describing nursing.   Benefits: it includes patient care, enhanced professional status for nurse...

The importance of nursing theory    Theory is important because it helps us to decide what we know and what we need to know.   It helps us distinguish what should form the basis of practice by explicitly describing nursing.   Benefits: it includes patient care, enhanced professional status for nurses, improved communication between nurses, and guidance for research and education.   It is important to have the theory to analyze and explain what nurses do.   Why nursing theory? Ex. Jehovah witnesses refusing blood, we respect their beliefs or look for alternatives to help them in another way.  Dorothius self care theory; the pt. Has an independence to make their own choices.  What is a theory: purposeful set of assumptions or propositions that identify the relationships between concepts. Concepts: an idea of something formed but mentally combining all its characteristics. Ex. client, nurse, environment.  Allow us to describe, explain, predict or prescribe.    Nursing theory: organize knowledge about nursing to enable nurses to use it in a professional manner Aims to describe, predict and explain the phenomenon of nursing  Provides foundation of ho we practice as nurses    Nursing theories allow nurses to: View client situations from a certain perspective, organize data, provides a method to analyze and interpret information  Guides: Nursing education Nursing practice; supports us, guides us and what action we can take place on patients. The decisions we have to help patients.  Nursing research; we create the best practices laid for us to use.    Types of theories   Grand theory; broad in scope, provide structural framework to direct burning science (narrow range theories) - abstract and broad phenomenon    Middle range; more limited scope, address specific phenomenon and reflect nursing practice - less abstract    Descriptive; explains, relate and sometimes predict why a phenomenon occurs (helps explain nursing client assessment)   Prescriptive; address nursing interventions (treatment) and help predict the consequences of an intervention. - more action oriented.    What is a model?   Models are representations of the beliefs depicted by the theory (known as a conceptual framework - coming from a theory - representing a theory - helps us make decisions) In nursing, models often help to introduce the theory into place  Model = applications of the theory  Ex. Virginia Henderson: needs theory (helps increase a person's independence) >>> roper logan tierney “activity of living model”     Types of theoretical models in nursing    Practices based   Florence nightingale (environment conducive to healing)   Needs    Virginia Henderson (14 basic human needs) - compiling them together, the pt. Feels a lot better.    Interactionist    Hildegard (interpersonal relationship between client and nurse)    Systems   Complex interaction between the parts (subsystems) and the whole system. - the individual is considered to be an open system due to their interaction with their environment (subsystem), the person is the whole system.    Nursing Metaparadigm    The nursing metaparadigm is a group of theories which represents how our professions function.   It includes 4 metaparadigm concepts, all of which individually represent a large body knowelfe.   Person, health, environment/situations, nursing   Together, these four basic nursing metaparadigm concepts point to a holistic view of care.    We are trying to achieve their goals and looking at them as a whole. That is what nursing is all about.      Holistic Care   The nursing metaparadigm points to a holistic view of care   Philosophy of holistic health  All aspect of client's needs: psychological , physical, social, spiritual    Theorizing in the future    Goal is to:    Stimulate thinking and generate new ideas   Generate a greater understanding of the arts and science of nursing    Allow for the intellectual excitement of the discipline to come alive (p. 14)   Self-concept   4 components:   Body image   Image of the physical self.   Perception of size, appearance and functioning of body   Develops partly from others attitudes and responses and partly from the individuals.   Role performance    Role conflict: one person assumes two roles which are contradictory or mutually exclusive. - The inconsistency between expectations leading them to be challenged in fulfilling roles effectively.  Role ambiguity: expectations are unclear and people do not know what to do or how to do it. (rapidly changing job, adolescent) - lack of clarity or uncertainty about the expectations or responsibilities.  Role strain: frustration related to a role expected of the person that does not fit or feel right. (gender role stereotypes) - when a person feels overwhelmed and stress due to conflicting demands within a single role.  Role overload: having more roles or responsibilities that is manageable.    Personal identity: what makes you unique and the experiences that makes you who you are as a person.    Conscious sense of individuality and uniqueness Continually evolving Identity is often view in terms of: Name, gender, race, ethnic origin, or culture, occupation or roles, talents, marital status.  Gender identity: the degree to which a person identifies as male, female,  Sexual orientation: predominant gender preferences of a person's sexual attractions over time GBC positive space program.    Self- esteem    Judgment of one's own worth   How that persons standards and performance compared to others and to one's ideal self   Global: how much one likes one's perceived self as a whole Specific: how much one approves of a certain part of oneself.   Factors that affect self-concept  Development Family and culture Resources History of success and failure Illness Stressors     Why is it important to understand the term self concept?   It influences how nurses perceive themselves and their abilities. A clear self-concept can help nurses establish relationships and empathize with patients.    The Nurse's effect on the client's self-concept   Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgements. Use a positive and matter of fact approach Build a trusting relationship Be aware of facial and body expressions Respect client privacy and sensitivities Listen attentively to client concerns Addressing the client preferred name and pronouns Accept the client's responses   Self-Reflection   Reflection: the process of purposely thinking back and recalling a situation to discover its purpose or meaning. Reflection is necessary for self-evaluation and improvement of nursing practice.   CNO Quality Assurance Program Reflect on practice   What is practice reflection?   Practice reflection is more than just thinking about practice   An intentional process of thinking, analyzing and learning   Identify learning needs   A commitment to action   Why must I reflect on my practice?   A professional expectation   Self-assessment involves: Practice reflection Developing a learning plan Demonstrates a commitment to lifelong learning and continuing competence Its legislated (CNO)   Benefits of practice reflection   Benefits for the nurse Improved critical thinking Empowerment Greater self-awareness Personal and professional growth   Benefits for the client Improved quality of care Improved client outcomes   OBJECTIVES:   Define the key terms listed.   Describe factors that influence the following components of self-concept: identity, body image, and role performance. Identify stressors that affect self-concept and self-esteem. Describe the components of self-concept as related to psychosocial and cognitive developmental stages. Analyze ways in which a nurse’s self-concept and nursing actions can affect a patient’s self-concept and self-esteem. Incorporate research findings to promote evidence-informed practice for addressing identity confusion, disturbed body image, low self-esteem, and role conflict. Examine cultural considerations that affect self-concept. Apply the nursing process to promote a patient’s self-concept.   KEY TERMS   Body image Identity Identity confusion Role ambiguity Role conflict Role overload Role performance Role strain Sick role                Development of self- concept   Self-concept is always changing and is based on the following:   Sense of competency and mastery of prior and new experiences Perceived reactions of other people to one’s body Ongoing perceptions and interpretations of other people’s thoughts and feelings Personal and professional relationships Collective beliefs and images one holds about oneself Academic and employment-related identity Ability to cope with and resolve problems Racial and ethnic identity Gender and sexual identity Personality structure Perceptions of events that have an impact on the self Personal appearance and physical attractiveness Current feelings about the physical, emotional, and social self Self-expectations   Components and interrelated terms of self-concept   A positive self-concept is crucial for individuals as it offers a sense of purpose, completeness, and clarity. A healthy self-concept is characterized by stability, fostering positive emotions towards oneself, and aiding in positive adaptation to stressors. Social scientists identify various components within self-concept, with identity, body image, and role performance being particularly significant for nurses. These elements contribute to an individual's overall well-being and ability to cope with life's challenges.   Identity   involves the internal sense of individuality, wholeness, and consistency of a person over time and in various circumstances.   identity is influenced by age, gender, sexuality, social class, ethnicity, and culture.   Establishing an individual identity is an important developmental task from childhood to adolescence to young adulthood.   Learns through observing - identity is gained through self-observation and from what they are told about themselves - To form an identity, a child must be able to integrate learned behaviours and expectations into a coherent, consistent, and unique whole   Necessary to develop intimate relationships   Sexuality is part of ones identity Gender identity is a complex concept that is based partly on a person’s anatomy (i.e., sexual organs) and partly on the psychology of the individual, which is influenced by culture and tradition.   gender binary, a classification system that assumes either a male or female gender identity and ignores the fact that there are variations in gender identification   The internal conflict between a person’s assigned gender and the gender they identify with is referred to as gender dysphoria   Transgender is the term used to describe individuals whose gender identity, expression, or behaviour differs from those typically associated with their assigned sex at birth   Identity is the sense of individuality, consistency, and uniqueness of a person over time and in various circumstances. It is influenced by age, gender, sexuality, social class, ethnicity, and culture. Establishing an individual identity is an important developmental task from childhood to adulthood. Children learn culturally and socially accepted values, behaviors, and roles through observing others and self-observation. They must integrate learned behaviors and expectations into a coherent, consistent, and unique whole.   Achieving one's identity is crucial for establishing intimate relationships, as individuals express their identity in relational contexts. This includes aspects such as sexuality, which is integral to one's identity. Gender identity, defined as an individual's internal sense of being male, female, or non-binary, along with their sexual orientation, is a central component of self-concept. This identity is shaped by both biological factors, such as anatomy, and psychological factors influenced by culture and tradition. The meaning of gender identity is culturally determined, with values regarding gender-appropriate behavior shaped through socialization processes.   Religious faith plays a role in identity formation by engaging individuals in traditions and rituals. Involvement in a religious community offers powerful identity experiences, shaping an individual's sense of self. The adoption, adaptation, or rejection of religious traditions is a significant avenue for young people to affirm or challenge societal expectations, allowing them to express and define their personal identity.   Race and ethnicity significantly impact identity formation. Racial-ethnic or cultural identity involves a commitment to and belonging in a specific racial or ethnic group, along with pride in its cultural traditions. This identity develops through socialization within the group and integrating responses from individuals outside the group into one's sense of self. Differences in ethnic identity, like Polish Canadian or Lebanese Canadian, are expressed through participation in traditions and rituals. The evolution of cultural identity can be challenging, as seen in cases such as the children of Chinese immigrants navigating different environments daily, like a traditional Chinese home and a predominantly Euro-Canadian school setting.   Indigenous people acknowledge the crucial role of personal and cultural identity, recognizing the impact of assimilation policies, like residential schools, enforced by the Canadian government. Forced assimilation led to the loss of traditional practices, languages, and cultural elements, affecting various aspects of life such as gender roles, child-rearing, and family relationships. This loss of cultural identity has negatively impacted the physical, mental, and emotional health of Indigenous individuals, spanning generations beyond those who attended residential schools. Efforts to reclaim cultural identity involve revitalizing language, history, customs, and traditional practices. A strong racial-cultural identity generally acts as a buffer against prejudice and discrimination, positively influencing self-concept, self-esteem, psychological health, well-being, and the adoption of positive health practices across diverse cultures.   Implications for practice   To improve patients’ self-concept, develop an open, non-restrictive attitude when assessing for and encouraging cultural or religious practices.   Ask patients what they think is important to help them feel better or gain a stronger sense of self. Encourage cultural identity by individualizing self-care practices, dietary choices, and clothing to meet each patient’s self-concept needs. Facilitate culturally sensitive health promotion activities identified through evidence-informed practice that address at-risk behaviors (such as smoking, problematic substance use, premature sexual experiences).   Body image   the perception we have of our bodies, including size, appearance, and functioning. This perception or mental image is affected by both conscious and subconscious thought.   Some body-image distortions have psychological origins, such as those that occur in an eating disorder (e.g., anorexia nervosa). Other alterations occur as a result of situational events, such as an amputation of a limb as a result of trauma, a scar due to surgery, or disfigurement from a caustic burn.   Over time, with repeated humiliation and degradation, she may incorporate this devalued image into her self-concept. Likewise, a patient who has suffered disfiguring burns has to cope with their own psychological reaction to their altered body, as well as with how other people react to them   Body image is affected by cognitive growth and physical development and by normal developmental transitions such as puberty or menopause.   In older persons, changes associated with aging, such as decreasing visual acuity and hearing or loss of physical strength and stamina also can affect body image.   Exposure to societal messages that reflect the sociocultural norm has been shown to have a negative impact on both females and males even as early as late childhood   Body image depends only partly on reality.   Role performance   the way in which individuals perceive their ability to carry out significant roles.   Individuals learn behaviours that are approved by society through the following processes:   Reinforcement-extinction: Certain behaviours become common or are avoided, depending on whether they are approved and reinforced or are discouraged and punished. Inhibition: An individual learns to refrain from certain behaviours, even when tempted to engage in them. Substitution: An individual replaces one behaviour with another, which provides the same personal gratification. Imitation: An individual acquires skills or behaviours by observing and then imitating the skills and behaviours of other members of the family or other social or cultural groups. Identification: An individual internalizes the beliefs, behaviours, and values of role models into a personal, unique expression of self.   To function effectively in multiple roles, a person must know the expected behaviour and values, desire to conform to them, and be able to meet the role requirements. Successful adults learn to distinguish between ideal role expectations and realistic possibilities.   Self-esteem   an individual’s overall sense of self-worth or the emotional appraisal of self-concept. It represents the overall judgement of personal worth or value. It is a subjective feeling and does not always reflect how people are evaluated by others.   Self-esteem is shaped by individuals’ appraisals of how they are perceived by significant others.   In early and middle adolescence, self-esteem remains relatively constant.   the mid-60s represents the highest level of self-esteem across the lifespan. At around 70 years of age, self-esteem declines slightly, which, according to Erikson’s theory of psychosocial development (1963), reflects a diminished need for self-promotion and a shift in self-concept to a more modest and balanced view of the self.   A decline in self-esteem is often associated with an increased need for attention, which may be demonstrated by engaging in risky behaviours. In addition, the influence of peers is strong during adolescence. Research has shown, however, that adolescents with a strong sense of identity are not as susceptible to the influence of peers and are not as likely to engage in risky behaviours compared to adolescents with a weaker sense of identity.   The ideal self is a representation of the attributes the person would like to have—an image of the person ideally. The ideal self acts as a motivator that gives the individual an incentive for future behaviour—providing an image of what they want to be or not be. The ideal self is also used as a standard to evaluate the actual self. The ideal self originates in the preschool years and develops throughout life. Early in life, parents set ideals for their children, to have certain attributes, such as honesty, intelligence, and success.                                                     Stressors Affecting Self-Concept   Self concept: is any real or perceived change that threatens identity, body image, or role performance.   A stressor challenges our adaptive capacities.   To determine our individuals response to stressors, it is important to keep in mind the our perception of the stressor.   Ability to re-establish balance is related to: intensity, duration of the stressors, our health status, and coping mechanisms   Normal process of maturation and development = stressor in physical, emotional, sexual, familial and sociocultural health can affect self-concept.   Adapting to stressors will lead to a positive sense of self.   Health changes can affect our self-concept: physical change and chronic illnesses with our identity and self-esteem   Crisis occurs when people cannot overcome obstacles with their usual methods of problem solving and adaptation. Any crisis potentially threatens self-concept and self-esteem.   The stressors created by a crisis—identity confusion, disturbed body image, low self-esteem, role conflict, role strain, role ambiguity, and role overload—may result in illness. During self-concept crises, supportive and educative resources can help people learn new ways of coping and responding to the stressful event or situation.   Identity stressors   Developmental markers such as puberty, menopause, child-bearing and retirement may affect our identity.   Identity is related to appearance and abilities.   Vulnerable during adolescence = insecurity and anxiety due to developing psychosocial competence like coping strategies.   A positive self-concept in adolescence enhances psychological and physical health in young adulthood.   Adults are more affected by cultural and social stressors rather than personal stressors.   Identity confusion: when people do not maintain a clear, consistent and continuous consciousness of personal identity. It can occur at any stage in life, if the person fails to adapt to identity stressors.   In extreme stress, we can experience personal identity, a state in which differences between the self and others cannot be determined. Ex. Identity confusion is when an adolescent realizes that some of their feelings and behaviours are focused on individuals of the same sex.   Body image stressors   Changes in appearance, structure, or function of a body part require an adjustment in body image.   Changes in body appearance, such as an amputation, facial disfigurement, or scars from burns or surgery, are physically obvious stressors affecting body image.   Chronic illnesses such as heart and renal disease affect body image because the body no longer functions at an optimal level.   The effects of pregnancy, significant weight gain or loss, pharmacological management of illness, or radiation therapy can change body image and lead to adverse health outcomes.   psychological health challenges also can affect body image.   Social media has also been found to have a negative effect on adolescent body image for all genders.   To regain a positive self-concept and self-esteem, each person must adapt to their body image stressors.   Society’s response to an individual’s physical changes may be affected by the conditions surrounding the alteration. Ex. Heroes are praised for self-sacrifice when hurt vs. someone getting hurt due to drink and driving.   Research: In a unique study, Shpigelman and HaGani (2019) examined the impact of the type of disability on self-concept and body image in 119 adults with disabilities who were diagnosed at birth or during childhood or adolescence. They compared adults with a visible physical (or motor) impairment such as cerebral palsy or muscular dystrophy to adults with a mental illness such as an affective disorder or schizophrenia. Results: Results showed that individuals with invisible psychiatric disabilities reported lower levels of self-concept and body image than individuals with visible physical disabilities. Gender, family status, and the severity of the disability were also found to be associated with self-concept and body image. Women reported lower levels of body image than men. Single or divorced individuals reported lower levels of self-concept than married participants, and individuals with severe disabilities reported lower levels of self-concept and body image than participants with mild or moderate disabilities. Implications:   Nurses need to enhance the self-concept and body image of individuals who have invisible disabilities. Nurses should assist individuals to identify strategies that will help them cope with their disability. Nurses should examine their attitudes about caring for individuals with disabilities since it may have an impact on individuals’ well-being. Family members may benefit from support to help the individual with a disability cope.   Role performance stressors   Situational transitions occur when parents, spouses, children, or friends die or when people move, marry, divorce, or change jobs.   health–illness transition is changing from a state of health or well-being to one of illness.   A shift along the continuum from illness to wellness is as stressful as a shift from wellness to illness. Any transition may lead to role conflict, role ambiguity, role strain, or role overload.   Role conflict: results when a person simultaneously assumes two or more roles that are inconsistent, contradictory, or mutually exclusive. example, when a middle-aged woman with teenage children assumes responsibility for caring for her older parents, conflicts may arise in relation to being both the adult child and the parents’ caregiver.   Role conflicts can occur when trying to balance time and energy.   The perceived importance of each conflicting role influences the degree of conflict experienced.   Sick role: involves the expectations of other people and society about how a person should behave when sick.   The conflict of taking care of oneself while getting everything done can be a major challenge.   Role ambiguity: involves unclear role expectations. When expectations are unclear, people may be unsure about what to do or how to behave.   common in adolescence.   Parents, peers, and the media pressure adolescents to assume adultlike roles, but many adolescents may still lack the resources to move beyond the role of dependent children.   can occur in employment situations. Employees may become unsure about job expectations in complex, rapidly changing, or highly specialized organizations.   Role strain: the stress or frustration experienced by individuals when behaviours, expectations, or obligations associated with a single social role are incompatible.   Individuals who feel inadequate or unsuited for a new social role.   example, individuals who marry someone with children often feel unprepared to suddenly assume a parental role.   Role overload: involves having more roles or responsibilities within a role than are manageable.   reflected in unsuccessful attempts to meet the demands of work and family while still having some personal time.     Self-esteem stressors   High self-esteem is associated with more optimal mental and physical health, greater control over circumstances, and greater adaptation and productivity in adulthood.   Low self-worth can contribute to feeling unfulfilled and isolated and can result in depression and unremitting uneasiness or anxiety.   The more the illness interferes with the ability to engage in activities contributing to feelings of worth or success, the more it affects self-esteem.   Children with low self-esteem and self-worth are more likely to experience internalizing disorders such as fear, anxiety, and depression. They are also more likely to bully other children and are more likely to be bullied.   In adolescence, low self-esteem is one of the strongest predictors of depression, risk-taking behaviors, and psychopathology. In older persons, self-concept stressors include health problems, reduced functional ability, and stressful life events and circumstances. Longitudinal studies have found that self-esteem prospectively predicts better health. Thus, having high self-esteem may be an important resource in older adulthood when health problems become more prevalent.   The Family's effect on the development of self-concept   Attachment theory suggests that children who experience sensitive and supportive caring will develop expectations that they are worthy of other people’s love and that other people are supportive.   attachment theory suggests that the quality of the attachment that children develop with their caregivers influences the development of a set of expectations about the self, their interpretations of the actions of other people, and ideas about how to respond to them.   To assist patients in developing a positive self-concept, it is important to assess the family’s style of relating.   The Nurse’s Effect on the Patient’s Self-Concept   Self-awareness is critical in initially understanding and accepting others.   It is important to assess and clarify the following self-concept issues: Thoughts and feelings about lifestyle, health, and illness Awareness of how nonverbal communication may affect patients and families Personal values and expectations and how they affect patients Ability to convey a non-judgemental attitude toward patients Preconceived attitudes toward cultural differences in self-concept and self-esteem   Behaviours Suggestive of Altered Self-Concept   Slumped posture Avoidance of eye contact Unkempt appearance Being overly apologetic Hesitant speech Being overly critical or angry Frequent or inappropriate crying Negative self-evaluation Being excessively dependent Hesitancy in expressing views or opinions Lack of interest in what is happening Passive attitude Difficulty in making decisions   Self-Concept and the Nursing Process   Assessment   nurses must focus on the various components of self-concept: identity, body image, role performance, and self-esteem. Assessment should include observing behaviours suggestive of an altered self-concept (see Box 27.6), actual and potential self-concept stressors (see the earlier case study), and coping patterns.   Nurses need to be sensitive to the effect that cultural influences have on the patient’s behaviours and needs.   example, in many Indigenous and Asian cultures, eye contact is a sign of disrespect.   "Understanding Patient Expectations in Nursing Self-Concept Assessment" Consider patient expectations when assessing self-concept in nursing, collaborating with patients, discussing goals, and modifying approaches based on their beliefs and attitudes towards interventions.   Assessing Self-Concept in Nursing: Considerations and Techniques When assessing self-concept, nurses must consider identity, body image, role performance, and self-esteem, and observe behavioural cues, potential stressors, and coping patterns. They should be mindful of cultural differences and gather comprehensive information from multiple sources. Specific questions should be asked, and nonverbal behavior closely observed to determine the patient's self-concept and developmental stage.   Insights into Patients' Coping Behaviors and Stressors In nursing assessment, understanding patients' previous coping behaviors, stressors, and resources is crucial. Identifying familiar coping patterns can reveal insights into patients' styles and their impact on healthy functioning or problem-creation. For instance, abused women may use substances to cope with abuse, leading to more stressors.   Nursing Diagnosis Nurses use assessment data to identify patients' actual or potential problem areas   Nursing diagnoses related to self-concept include disturbed body image, caregiver role strain, disturbed personal identity, ineffective role performance, chronic low self-esteem, situational low self-esteem, risk for situational low self-esteem, and readiness for enhanced self-concept   Isolated data could be defining characteristics for more than one nursing diagnosis, requiring specific data gathering to validate and differentiate the underlying problem   Differentiating between nursing diagnoses may involve assessing for symptoms of anxiety, negative self-appraisal, recent events in the patient's life, and past self-perception   Priority nursing diagnosis becomes evident as additional data are gathered   Validating critical thinking regarding a nursing diagnosis involves sharing observations and allowing the patient to provide input and verify perceptions to further clarify the situation   "Integrating Knowledge and Critical Thinking for Effective Nursing Care Planning" Planning in nursing involves synthesizing knowledge, experience, critical thinking, and standards to create a care plan. Critical thinking ensures the plan integrates all relevant information about the patient, and professional standards guide effective nursing interventions. Concept maps, such as the one in Figure 27.7, can be used to illustrate the relationships between medical diagnoses, nursing diagnoses, and their interconnections, helping to plan nursing care.   Setting Priorities: "Empowering Self-Concept Alteration: A Comprehensive Care Plan" A care plan for a patient with self-concept alteration includes goals, expected outcomes, and interventions to help them adapt and cope with stressors. The nurse assesses the patient's and family's strengths, providing resources and education to maximize their abilities. Therapeutic communication and patient teaching can help decrease feelings of hopelessness and helplessness by understanding the normality of certain situations.   "Recognizing the Role of Support Systems in Patient Care" "Continuity of Care" discusses the importance of considering patients' support systems and cultural norms when involving family in their care plan. Nurses should take into account the patient's desires for family involvement before making decisions.   "The Role of Nurses in Promoting Self-Concept and Well-Being through Primary Health Care" Primary health care focuses on promoting health and prevention of illness through patient education and self-care. Factors that improve self-concept and overall well-being include proper nutrition, regular exercise, adequate sleep, and stress reduction. Nurses can identify self-concept risks and facilitate patient insight into behaviors, providing health education and community referrals as needed.   Key Concepts   Self-concept is an integrated set of conscious and unconscious attitudes and perceptions about the self. Components of self-concept are identity, body image, and role performance. Each developmental stage involves factors that are important to developing a healthy, positive self-concept. Identity is particularly vulnerable during adolescence. Body image is the mental picture of one’s own body and is not necessarily consistent with a person’s actual body structure or appearance. Body image stressors include changes in physical appearance, structure, or functioning that are caused by normal developmental changes or illness. Self-esteem is the emotional appraisal of self-concept and reflects the overall sense of being capable, worthwhile, and competent. Self-esteem stressors include developmental and relationship changes, illness (particularly chronic illness involving changes in what were once normal activities), surgery, accidents, and the responses of other individuals to changes resulting from these events. Role stressors, including role conflict, role ambiguity, and role strain, may originate in unclear or conflicting role expectations and may be aggravated by illness. The nurse’s self-concept and nursing actions can have an effect on a patient’s self-concept. Planning and implementing nursing interventions for self-concept disturbance involve increasing the patient’s self-awareness, encouraging self-exploration, aiding in self-evaluation, helping formulate goals for adaptation, and assisting the patient to achieve those goals.     Nurse initiated Physician dependent Collaborative   What are we evaluating in this stage of the nursing process? Explain   What does it mean when a goal is: Met Unmet Partially met   Mr. redbreast Case study Subjective: reports pain 6/10, states "he cant do his job properly because of his toe so he keeps calling in sick, how is he supposed to support his family?", complains of pain on his red big toe. Objective: unsteady gait, not wearing shoes, toe is dusky red and swollen, range of motion is limited in the joint, toe is warm to touch and sore, Actual: impaired physical mobility related to acute pain on right big toe as evident by limited range of motion in that joint. Actual diagnosis: Acute pain related to pressure on spinal nerves as evidenced by client moaning and grimacing, reporting pain 8/10. Acute pain related to lower back pain, secondary to herniated disk as evidence by client reporting pain 7/10 and frequently grimacing. Impaired physical activity related to neurological condition (dizziness) AEB pt. stating she feels unsteady. At risk diagnosis: Risk for impaired mobility related to extreme pain in the right big toe and limited range of motion.