PN1130 Communication and Therapeutic Relationships Notes PDF

PN1130 Communication and Therapeutic Relationships Objective 2: Discuss the influences of self-concept and self-awareness on caring, communication, and therapeutic relationships. 1 Learner Objectives 2.1 Describe the importance of values, beliefs, and morals in relation to caring. 2.2 Identify at...

PN1130 Communication and Therapeutic Relationships Objective 2: Discuss the influences of self-concept and self-awareness on caring, communication, and therapeutic relationships. 1 Learner Objectives 2.1 Describe the importance of values, beliefs, and morals in relation to caring. 2.2 Identify attributes and components of professional caring. 2.3 Define self-concept. 2.4 Examine self-concept and its relevance to caring, communication and development of therapeutic relationships. 2.5 Describe the features and functions of self–concept. 2.6 Discuss theoretical frameworks related to self-concept. 2.7 Discuss the importance of self-awareness in caring, communication, and therapeutic relationships. 2.8 Describe the characteristics of a healthy personality and self-concept. As there are several objectives we will discuss and cover over 2 classes 2 Beliefs and Attitudes  Belief - Conviction that is accepted as true whether or not they are based on fact  Attitudes – One’s likes or dislikes Objective 2.1 - Describe the importance of values, beliefs, and morals in relation to caring. ________________________ Lets look at some definitions first Beginning of slide These are personal factors, not professional However, these personal factors will be challenged by what you experience professionally It is good for you to have a strong idea of who you are in order to cope with things you will experience professionally Clients have beliefs and attitudes that may conflict with your own Ask of examples of both Belief – idea held as true; comes from different sources 1. own experiences, (eg views on families – get together all the time or never linked to impt of family); 2 cultural / spiritual beliefs (Indigenous person raised with historical residential school system and attempted eradication of long held cultural and family norms); religious (attending 3 church, not eating certain foods (Jewish – no pork; Hindu – no meat)); 3 what people say (teacher in high school tells you you’d make a great nurse, or that you would never succeed in post secondary education. Attitudes: describes one’s outlook; persons’ mental disposition Attitude - a feeling or opinion about something or someone, can be positive or negative (eg poor attitude about work; positive and upbeat) It's often very difficult to change people's attitudes. 3 Attitude is a little thing that makes a big difference. – Winston Churchill 4 What is a Value? • Stable and long lasting idea • Result from multiple influences • Result from beliefs and attitudes • Offers a feeling of worthiness and importance Values: a feeling of worth about an item, idea or behavior . Formed in childhood , shapes our reactions , influences our behavior & reflects the society we live in. As a child , we observe & take on actions of others, learn right from wrong, adopt family values & beliefs. Culture, society, peers and experiences shape our values As beliefs & attitudes develop, values form , which are used in school, games ,sports ,work as we mature. Examples” I value a good education. The relationship with my friends is the most important thing to me. I’m here for a good time not a long time Basis for decision making. Values change over time. 5 The combination for attitudes, beliefs and values combine to influence how we behave. 6 Will give you some understanding or acceptance of client;s choices. Eg smoking cessation, MAID, med noncompliance, abortion It is important to identify your own values as a person and a nurse. It is equally important to identify and acknowledge the values of your clients. 7 Professional Values  Values are very important in nursing and influence how situations are perceived and decisions are made.  See Box 4.1 – Seven Core Values and Ethical Responsibilities of Professional Nursing (CNA, 2017) Values are very important in nursing & entails becoming self-aware Good to identify one’s values Individuals who work in HC usually arrive with strong values, concern for others (altruistic), wanting to help others “Our education helps us acquire a professional values system.” (Mallette & Yong, 2022, P.56 As you experience courses, and more importantly , clinical experiences, you will adopt professional values Box 4.1 7 core values – 1. providing safe, compassionate, competent, and ethical care; 2. promote health and well being; 3. promote and respect informed decision making; 4. honouring dignity; 5. maintaining privacy and confidentiality; 6. promote justice; 7. being accountable. Perhaps things aren’t what you ideally think they will be 8 Morals and Ethics Morals • Influenced by attitudes, beliefs & values. • System of values • Desire to be and do good www.knowswhy.com Ethics • Right versus wrong Very important terms. Attitudes, beliefs & values guide our morals in practice. 9 LPNs are guided by a Code of Ethics and responsibilities they must uphold, promote and to which they are accountable – 5 principles - Responsibilty to the public, clients, profession, colleagues, oneself The 4th Standard of Practice specifies ethical care: “Professional Ethical Practice” Standards of Practice are authoritative statements that define the legal and professional expectations of LPNs These are documents which guide our practice and dictate what is expected of us legally and ethically 10 Professional Values Code of Ethics for Licensed Practical Nurses in Canada. https://www.clpna.com/wpcontent/uploads/2013/02/doc_CCPNR_CLPNA _Code_of_Ethics.pdf  The Code of Ethics state the ethical values and responsibilities that LPNs “uphold and promote”, to which they are accountable 11 Five principles from the Code of Ethics for LPNs 1. 2. 3. 4. 5. 1. Responsibility to the public 2. Responsibility to clients 3. Responsibility to the profession 4. Responsibility to colleagues 5. Responsibility to oneself competent; practice within your scope of practice; culturally appropriate care Assist, support, respect, protect; confidential; client’s right to choice Maintain standards; professional practice Collaborate; communicate; interdisciplinary Trustworthy, honest; recognize your limitations; accept responsibility; life long learning; manage conflict 12 Caring “an intentional human action characterized by commitment and a sufficient level of knowledge and skill to allow you to support the basic integrity of the person” (Mallette & Yonge, 2022, p. 552) Objective 2.2 - Identify attributes and components of professional caring. Caring pages p.9-10; 228-229 We discussed this last class. Important If we do not care, we would not be able to provide treatments and care, or work with clients and their families, or effectively teach. Caring is the foundation of health care and central to helping professions. We all (practically all!) have a universal need for love. We are meant to be loved & be around others. To be cared for and cared about. Caring- considered an essential functional construct in professional nursing practice, (Mallette & Yonge, 2022,) Concern for well being of another & includes behaviors : accepting, comforting, honesty, attentive listening & sensitivity & energy (doing) on which HC practice is built. This does not mean putting ourselves in a situation where we are treated negatively. Caring cannot be taught as a skill. It must be developed, encouraged & molded into the personality of Health care provider. Thus links to professional values and ethics discussed under the last section 2.1 It serves as a thread that is always there Clients subconsciously know if a nurse is caring or just regard them as another client. Before trust can be developed, clients must truly believe the nurse cares. 13 The caring qualities of empathy & advocacy (provides client with information, support &FB to make a decision) are vital . CCC puts the client in a position to take an active role in the management of their illnesses. Caring within nursing allows nurses to apply their professional knowledge, skills, abilities and experiences towards meeting the health needs of the patient. A caring relationship focuses on the client’s needs and promotes empowerment through a patient-centered approach. By using therapeutic communication skills and techniques, the nurse gains information necessary to develop a mutually agreed upon plan of care. You have freely chosen to care for others (clients) or else you would not have entered the nursing profession. . 13 Nurses have developed theories with Caring as the primary focus 14 Human Caring Theory Jean Watson, p.228-229  Caring is central to nursing practice  Caring is offered and provided to a client through a therapeutic relationship.  Watson describes the need to develop and sustain a helping, trusting, caring relationship.  Personal values, beliefs and morals contribute to the caring nature of an individual. Jean Watson – nurse theorist Developed model during the 1970s, have evolved over time 15 The Six C’s of Caring: 1. Compassion 2. Competence 3. Conscience 4. Confidence 5. Commitment 6. Comportment -Caring is the vehicle through which nurses interact with patients and assist them to cope with suffering, to find meaning in their experiences, to promote health and wellbeing, die with dignity -Sister Simone Roach, (1992), stated that caring is the human mode of being & discussed how people in HCP care for others not because they are required to do so as their jobs, but because they are human beings & the trait of caring is intrinsic to all humans . Compassion Compassion is empathy & sensitivity to pain & joy that allows one to enter into the experience of another. Compassion is an essential component of the nurse-client relationship. Competence Refers to having knowledge & skill in the application of therapeutic interventions, and other interventions Conscience Morals, ethics, and legal decision-making which motivates nurses to respond appropriately in ethical dilemmas. Confidence Trust in one’s ability to care for others; nurse’s presence can make a difference. Confidence is developed through the utilization of knowledge & experience. Commitment 16 Maintaining obligations of the nursing profession & assuring the delivery of excellence in care. Comportment Professional presentation of nurses to others in behavior, attitude, appearance, dress, & language which reflect a caring presence. It includes the need for selfawareness. 7th one added - creativity 16 Steps in the Caring Process p. 238 C – Connect A – Appreciate R – Respond E - Empower Focuses on PCC – person-centred care or client-centred care – meaning the client is the focus or most important Connect= with your client & show the intent to care =need to be attentive; introduce the purpose of the encounter, use clients formal name Appreciate= acknowledge the client’s situation. Grant the client the opportunity to express concerns/thoughts Respond= to the client’s needs; what are priorities Empower=Empower the client to partner in problem solving; provide information to make informed decisions; strengths based Caring is not caretaking; is not doing everything 17 Client Centred Care Individualized Care  Client’s active participation  Involvement of caregiver, family, supports  Holistic care involving a collaborative approach  researchgate.net 1. Everyone is unique with individualized needs and care. 2. Helping clients discover new directions & prospects which align with their interests, values, capabilities; Providing support and information to help increase awareness of options for RX, decision making resources & services. 3. Assisting clients/families in coping , & finding meaning, in difficult health circumstances.; Supporting client/families 4. Empowering clients to negotiate/navigate the HC system. Connecting client with appropriate HC professionals for information, guidance & support. 18 Attributes of Caring  Giving  of oneself Involved presence  Intuitive knowing and  Supporting the  Professional empathy client's integrity competence p.10 of your text 19 Empathy  View video on Empathy Empathy The Human Connection to Patient Care https://www.youtube.com/watch?v=f4SYR4EcHlc Empathy is not sympathy. An empathetic nurse understands & perceives the client’s emotions. We must remain objective & not over identify/ internalize the client’s feelings Is our ability to care & demonstrate empathy an ongoing experience? YES It is difficult to process client’s bad news and sadness Must support clients • • • • The ability to be sensitive to and communicate understanding of the patient’s feelings. The ability to put yourself in someone else’s shoes. Empathetic communication is considered a foundational element of developing a therapeutic nurse-client relationship. Discussed in Lab 2 20 What does Professional Caring involve?    Involves a nurse-client encounter Caring in the nurse - client relationship-- effective communication (empathy & respect) and relationship building Professional caring -use of knowledge, skills, and commitment to the client The difference between caring and professional caring is the amount of education, skill, and practice we bring to the relationship. Caring is a crucial component of quality care which helps improve client outcomes. Involves a nurse-client encounter Creation of a sustained relationship Not specifically related to tasks Caring in the nurse - client relationship encompasses the need for effective communication (empathy & respect) and building an effective nurse-client relationship. It is not one specific task, but a creation of a relationship. Professional caring is characterized by the nurses use of knowledge, skills, and commitment of well-being to the client  Focuses on the clients needs and promotes empowerment through a patient- centered approach 21 Caring Relationship      Caring is a commitment by the nurse to become involved. It includes giving freely of oneself to another person through warmth, compassion, concern and interest. Influenced by self-awareness, communication skills, previous experiences A caring relationship provides the nurse an opportunity to apply their professional knowledge, skills, abilities and experiences in helping meet the client’s health needs . Client centered approach 1. As you enter the nursing profession , caring is foundational to the NC relationship. 2. How do my values, beliefs, and attitudes affect how I react /respond to others? What role does my past experiences play in my future relationships? Self awareness entails reflecting on ways you react , hold certain views. Influenced by how we communicate, experiences, by social media, TV 3. It entails commitment, applying your professional skills and knowledge. Being sincere and genuine, compassionate 4. A caring relationship focuses on the client’s needs & promotes empowerment 22 Benefits of Caring  Positive influence on health status and healing  Recognize others as unique individuals with various needs.  Work with the client through the Nursing Process to identify client needs and mutually agree to a plan of care  Improves client satisfaction  Facilitates client decision-making  Promotes adherence to treatment What do you think the benefits of caring would be on the client? Caring within nursing allows nurses to apply their professional knowledge, skills, abilities and experiences towards meeting the health needs of the patient. A caring relationship focuses on the client’s needs and promotes empowerment through a patient-centered approach. By using therapeutic communication skills and techniques, the nurse gains information necessary to develop a mutually agreed upon plan of care. 23 Self-Concept • • • • An internal combination of all the ideas and feelings which every person has as a result of experiences and interactions with other people Integrates a person’s beliefs, attitudes, values, and behaviours A result of everything a person has experienced and is a part of who they are Self-concept influences how one thinks, talks, & acts; how one sees & treats others; & influences decision making Objective 2.3 - Define self-concept. It is an image of oneself that derives from what we knows about ourselves and what we believe others think about us. the person’s perception of their characteristics, abilities& interactions with others, the environment, values & experiences, goals . It is not concrete and can change throughout life. -SC is multi-dimensional, & integrates views of ourselves in various aspects (e.g., social, religious, spiritual, physical, emotional) -It includes gender, name, personality, appearance, race, culture, likes /dislikes, skills nationality, education, family, career, accomplishments, failures, & talents. -When people talk about self-concept, they are referring to their “inner self”. Get class interaction of types of things that affect self concept - Childhood influences, interactions with peers, education • SC develops through childhood and early adulthood when it is more easily changed. A positive self-concept is essential to a person’s mental and physical health. 24 Development of Self-Concept  Life experiences  Social status  Significant relationships  Opportunities Life experiences Social status Significant relationships Opportunities …influence how people define themselves throughout life. Can change through out your life. Part of my self concept is I am a nurse, which can be further broken down into whichever specialty I choose. Now, this has recently changed, and I am now a nurse and a teacher. Whether I think of myself as a “good” nurse/teacher has to do with appraisals made by myself and others, and of course self esteem plays a part. 25 Characteristics of Healthy Self-Concept Fig.10.1 Arnold & Boggs ,2020 26 Nurses need to be very aware of their own self-concept to provide care and interact with clients. This is because your own self-concepts influence how you think, talk and act. We want to make sure that we are not judging anyone on their self-concepts because they may be different based on many different factors. Self-Concept Important to acknowledge your own self-concept. While realizing we are working with clients with their own self concepts. This all affects our interactions 27 Self-Esteem    An individual’s personal sense and judgement of their own worth. The emotional value placed on your own worth Table 10.2 (High and Low self esteem) “Am I good enough?” p.172 The terms self-image, self-concept, & self-perception are used interchangeably to refer to the way individuals view and assess themselves. Bit different; so many confusing and similar terminology Aside: self-clarity – person knows who they are; self-efficacy-person’s beliefs about being able to perform a task Difference: Self-concept is an individual's overall perception of themselves while self-esteem is their perception of their own worth. Self esteem impacts on confidence and may affect your ability as a nurse to communicate with clients and with other health care professionals If your sense of self-worth is low, communication is negatively affected, which impacts negatively on patient care The lower you self-esteem the more challenging communication with others becomes. As your self-esteem improves, so does your confidence and communication. Self esteem declines in old age - why How can you develop confidence throughout this nursing program? – practice in labs, doing clinicals, asking for and being receptive to feedback Table 10.2 – 1. expect people to be critical / value them; 2. have positive or 28 negative views on appearance, skills 3. performs poorly when being observed 4. difficulty or not accepting compliments 5. evaluates their performance realistically or not 6. comfortable or not with people in authority positions 7. generally satisfied or not with life 28 Self-Esteem How can a nurse influence a client’s self esteem? -Reframe a health situation -Enhance resilience -Discuss strengths, supports, resources -Give support and be present -Offer alternatives – wheelchair, assistive devices -Include families, friends to build support -The topic of self-awareness in important for Lab 1. The next two slides are taken from later in the lecture, and will be covered more in depth in the next class. 29 Empathy medicalnewstoday.com Lets revisit empathy for just moment Recall from previous discussion and always keep in the back of your mind and linked with self awareness The ability to be sensitive to and communicate understanding of the patient’s feelings. • • The ability to put yourself in someone else’s shoes. • Empathetic communication is considered a foundational element of developing a therapeutic nurse-client relationship. Discussed in Lab 2 • Empathy is not sympathy. An empathetic nurse understands & perceives the client’s emotions. We must remain objective & not over identify/ internalize the client’s feelings Is our ability to care & demonstrate empathy an ongoing experience? YES It is difficult to process client’s bad news and sadness Must support clients 30 Why is Self-Concept Important?  Protective factor in coping with illness  Helps to explain behaviour  Serves as a source of strength  Shapes expectations  Can be a conceptual framework for decision making -Development of self-concept is ongoing throughout your life. It helps to determine the meaning in life. It is important to remember that self-concept can affect health/treatment outcomes. -The role of the nurse is to identify an individuals’ strengths and to maximize on them Objective 2.4 - Examine self-concept and its relevance to caring, communication and development of therapeutic relationships. 31 The Importance of Self-Concept  A source of strength and significance in decision making  Shapes expectations and explain one’s behavior  Coping Coping Coping!!  Engages & Motivates  A protective factor when faced with an illness or health challenge Self-Concept Helps determine meaning of life It can serve as a source of strength and significance in decision making It helps shape expectations and explain one’s behavior Coping Coping Coping!! Engaging & Motivation It is a protective factor when coping with an illness or health challenge • Development of the self-concept is ongoing; so nurses can affect client’s selfconcept, both positively and negatively. • An individual’s existing personal strengths assist them to work with and through challenging situations, including health challenges. • An individual’s self-concept can affect health/treatment outcomes. • Positive affirmation of self-concept remains; even when unable to “cure” illness. The role of the nurse is to work with an individual to identify an individual’s strengths, coping & optimize the same. 32 Relating Self-Concept, Caring, and the Development of Therapeutic Relationships  Self concept is formed through interactions/relationships with others (clients) and their reactions.  Self concept is enhanced through communicating with others and the provision of client care. Because self concept is formed by all factors in one’s life, the communication between nurse and client becomes part of the client’s self-concept SC is formed through interactions with others & their reactions to us. A positive therapeutic relationship or positive client communications will have a positive effect on the client; by them knowing they can ask for help, or by help with coping, etc 33 “A strong sense of self… is a protective factor in coping with chronic illness”. (Mallette & Yonge, 2022) Consider your client’s self-concept and how that affects their outcomes 34 Features and Functions of Self Concept • Dynamic • Helps a person make sense of their past & present • Helps to communicate in various situations • Helps an individual envision strengths and capabilities • Future oriented Dynamic – changes and develops over time Helps an individual envision strengths and capabilities (physical, mental, spiritual, emotional and intellectual) Future oriented- where do you see yourself in 10 years? Objective 2.5 - Describe the features and functions of self-concept. 35 Factors that Influence the Development of Self Concept  Developmental Stage  Societal and Cultural norms  Environment  Internal /external resources  Stressors  Life experiences (health status, illness, trauma, aging, poverty)  Intrapersonal and interpersonal influences  Social media Developmental stage – age; covered in next objective Societal and cultural norms Culture in which we are born , societal patterns and values & society in which we live. Environment Stable home environments, academic success ,praise, opportunities supportive parents/ mentors can help foster positive self image. Attitudes & beliefs of family. Loss of parent, parental literacy can impact SC, poverty ( negative self concept) Internal and external resources Personal strengths; resilience; external supports. Gender Adults with strong SC explore environment and experiences. Degree of success impacts SC; learn from mistakes ; improve Stressors - perception of the stressors & individual’s ability to use internal/external supports Health, WB, aging, illness, or trauma (may threaten the sense of self); spirituality ( greater meaning) Life Experiences - shape & influence one’s picture of self. Intra(within ) Inter-between Social media –FB, connection, /bullying Nurses play a huge role in helping clients find & keep hope & help them keep focus on the + aspects of an issue. 36 gender roles -Social environment plays an important role in shaping and supporting one’s personal self-concept. Current research supports the idea that a nurturing home environment, participation in activities and interest groups, academic success, religious and spiritual affiliation, professional opportunities, praise for successful accomplishments, and supportive mentors tend to encourage the development of a positive self concept. While factors such as poverty, a chaotic upbringing, loss of a parent, poor educational opportunities, and adverse life events contribute to the development of a negative selfconcept. –However, you will see that some people that have unfortunate circumstances develop a dynamic self-concept as a reaction to their circumstances, creating a resiliency to the impact of negativity. These people are often interested in improving their environment and serve as role models to others about what is possible against all odds. While others with fortunate life circumstances may develop negative self concepts or overinflated positive self concepts with little grounding in reality. Thus, its important as nurses to understand a persons self concept without making assumptions..this will assist in therapeutic relationships and in caring for people during health events. 36 Self-Concept Affected by Interpersonal Relationships When individuals communicate, their perceptions are influenced by their selfconcepts and levels of self-esteem.  Language is influential in forming perceptions of the self and others.  Self-concept can be negatively influenced by methods of communication. When individuals communicate, their perceptions are influenced by Self Concept & Self Esteem. Self-concept is always changing. Language :Language can impact interactions & SC thus important for nurses to be sensitive to language/words we communicate to our clients and colleagues. 37 Microaggression The communication of subtle and often unintentional discrimination 3 Types of Microaggression: Micro assaults 2. Micro insults 3. Micro invalidations 1. Microaggression: subtle communication , unintended discriminatory remarks pertaining to gender, race , ethnicity. “All female nurses are the best in practice”. Microassaults : Often conscious. Verbal/ nonverbal communication that offends the recipient through criticism, stereotypical comments. Meant to hurt the intended victim. Name calling racially focused, POC Identify someone as a social services client when discussing the affordability of medications. Such comments shut down opportunity for communication. Microinsults: (Often unconscious) Behavioral/ verbal comments that convey rudeness, insensitivity & demean a person's heritage or identity-” I was only joking.” Many times, the perpetrator is unaware of the insult. Microinvalidations: communications that invalidate values, feelings, or lifestyle. A person's comment invalidates o/ undermines the experiences of a certain group of people. E.g: Stating to a single mother ”It must be difficult managing child rearing by yourself as a single mom.” A person's comment invalidates or undermines the experiences of a certain group of people. 38 “ Your people must be proud of you.” Underestimating . 38 Other Aspects of Self-Concept  Cultural identity  Gender  Body image  Perception  Cognition  Spiritual Cultural identity – is positively or negatively related to a clear self-concept and selfesteem. Individuals usually associate with multiple groups and are influenced by diverse experiences and values and beliefs that can change over time. Ex. This is influenced by being a new immigrant, discrimination; violence; language barriers; Indigenous issues Gender – a socially constructed role and behaviours that occur in a historical and cultural context that vary across societies and over time. Ex.male dominated society; women still make less money in equivalent jobs; Transgender community – acceptance, discrimination, stigma Body image – people’s perceptions, thoughts and behaviours associated with their physical appearance (not always how they realistically appear to others); This perception can change through out life with aging and is influenced by the appraisals of others. It is also influenced by physical alterations due to illness or accident; visual and hearing impaired; people who use assistive devices (wheelchairs). –a critical dimension is self-esteem which we will talk about later in this slideshow. Perception Cognition and spiritual aspects are discussed further in the next few slides 39 Perception  A process through which we interpret sensory information and whereby a person transforms sensory data into connected personalized understanding  Subjective Picture: www.prforartists.com A process through which we interpret sensory information and whereby a person transforms sensory data into connected personalized understanding Subjective- made up of how information is filtered through memories that feel familiar, have already been experienced, or are similar enough to anticipate their meaning People can perceive situations differently What the client perceives and you perceive need to be congruent Ask for examples.. -How a client interprets information -Often influenced by society -Influenced by memories, past experiences - Keeping communication simple, delivering straightforward messages with compassion and making interactions participatory with a back-and-forth dialogue assist the nurse to understand and better address the persons needs based on perceptions. 40 Cognition • The thinking processes people use in making sense of the world • Cognitive distortions Cognition means thinking process (personal identity) How we think about information and our perceptions of those influences helps us make sense of what is occurring Can our mind process in a way that we believe something that is not true?? For examples of cognitive distortions..Box 10.2 pp. 184- Cognitive distortions 1. All or nothing thinking (black or white, no grey areas) 2. overgeneralizing (one incident but treats like happens all the time) 3. mind reading (assume without asking) 4. personalizing (separate yourself from the situation) 5. acting on “should” (thinking have to do something / or assuming responsibility) without checking 6. “awfulizing” (assuming the worse) Picture: strengthscape.com 41       Varies from client to client May or may not involve religion May change within a client’s life (eg. client may seek out spiritual practices, or may reject once held spiritual practices) Can be a positive influence during times of change, stress and illness Be aware of cultural connection Respect and acknowledge Can provide hope Positive coping Cultural connection – but don’t assume; eg if of certain culture, don’t assume spiritual aspect is important to that individual 42 Theoretical Frameworks • Sullivan • Humanism • Cognitive approaches • Behaviourists • George Mead • Uri Bronfenbrenner Sullivan- described self-concept as a self-system that people develop to 1) present a consistent image of self 2) protect themselves 3)maintain their interpersonal security Humanism (Rogers)- defines “self” as an organized, fluid, but consistent conceptual pattern of perceptions of characteristics and relationships or the “I” and “me” together with values attached to these concepts. So, when the “actual self” and the “idealized self” are similar the person is more likely to have positive self concept and self esteem. –having a coherent self-concept with being mentally healthy and well adjusted. – says self is fluid. Premise is that humans have a basic motive to self-actualize Posthumanism- casts doubt on who is the person and their self-concept within the technological unconsciousness and nonconsciousness of the modern world. – it reflects on the effects of the influence of technology, biotechnology and the sociopolitical, cultural, and environmental influences on who the person is and is in the processs of becoming. Ex. Somone who has a pacemaker which controls abnormal heart rhythms and ensures the heart beats at a normal rate. Thus, the person with the pacemaker relies on it for quality of life. The person depends on the pacemaker and it becomes a part of their self-concept. Using the posthumanism framework the person with a pacemaker no longer retains the classical understanding of what a human is and enters the realm of cybernetics. Cognitive approaches- a person is born without a concept of self from others in the intimate sphere of family, in friendships, and in cultural practices. It requires relating to others and has an interaction with the environment. Behavourists- early childhood interactions foster self-concept of a “good me” and a 43 “bad me” and a “not me”. These influences continue through adulthood and influence a person’s responses to life. George Mead- applies a sociological approach to the study of self-concept. His theory says that the self-concept affects and is influenced by how people experience themselves in relation to others. – Emphasizes the influence of culture, moral norms, and language in framing self-concepts through interpersonal interactions. Uri Bronfenbrenner- systems theory where bioecology affects human development, so a person influences and is influenced by the environment. There have been many theories developed throughout history We’ll focus on one, which you will likely see throughout your nursing education 43 Theoretical Frameworks So, a humanistic approach we discuss quite a bit is Maslow’s hierarchy of needs.. -focuses on how everyone has basic needs, but overall goal is self actualization. 44 Table 10.1 in text goes into more detail- we will be looking at this a bit further in upcoming slides.- Note: that in this table it indicates 9 stages because it splits up identity vs. role confusion into 2 stages. Erikson’s Theory of Psychosocial Development is very influential in personality development Erik Erikson was a therapist; mid 1900s Identity formation is central to the theory. He believes that Identity formation is lifelong Erikson noted that the personality developed in a series of stages and described the impact of social experience across the lifespan via stages Personality develops through 8 stages of psychosocial development, from infancy to adulthood-see next 2 slides At each stage there are specific goals a person must achieve to develop and maintain a positive identity and during each stage a person experiences a psychosocial crisis (developmental challenge) that can 45 have a positive or negative outcome for personality development. Personality develops as a person responds to challenges, it is not linear. -When passing through higher levels of ego development and developmental tasks are mastered, a personal sense of identity evolves Personality development is not linear or sequential 45 Erickson: As each task is completed , one’s self-concept is affected. Mastery of tasks builds on confidence , worth & self-esteem. If tasks are unmet, ineffective behaviors result. (Infants learn to trust as needs are met, toddlers explore their limits, school aged child become aware of different perspectives in life(social norms, morals, teens more complex (identity) & influenced by many factors. Adulthood- enhance SC, if we fail, we feel threatened and may become anxious. 46 Erickson believed that personality develops as the individual responds to developmental changes and that at each stage there are specific goals an individual needs to achieve to develop and maintain a positive identity. Examples: 1. Child neglect. 2. Limits vs exploring 5. Youth pregnancy 7. job satisfaction / family problems 8. looking back on life 47 Self-Awareness  The ability to see oneself clearly and objectively through reflection and introspection  Reflect of values, feelings, attitudes, strengths, and limitations  Realize it is not easy to be honest about our personal limitations / weaknesses Objective 2.7 - Discuss the importance of self-awareness in caring, communication, and therapeutic relationships. Self-Awareness (SA) See one’s strengths, weaknesses and influences on others SA is developed through introspection Analysis of self ( feelings, attitude, reactions, opinions , values & beliefs) We observe and analyze our behaviors in various situations. Basically, SA is the ability to look within. Be in charge of the development and direction of your life. EG. tendency to be overconfident – why? (trying not to look dumb??) – remember that if you are new to a procedure, or situation, you are not expected to know everything Be honest Eg Underconfident – don’t want to try because I might look 48 stupid, do it wrong – remember same as above; safe place; due it while being supervised so you have the opportunity for mistakes, questions, guidance Not speaking up – “shy”; intimidated – you are the client’s advocate; you can only control your own response; at least if you notice a situation of concern, you speak up and can chart that you did; made someone aware Eg too talkative – give others a chance; it’s not all about you Patient centred care – it’s not about you It’s a privilege to be allowed into client care settings; be respectful; pay attention; utilize any learning activity offered (you may never get it until you need to do it when working independently); don’t be lazy 48 Why is Self-Awareness Important in Nursing? • Essential aspect of expectations related to the nursing professional Permits nurses to treat a client as an individual Enhances interpersonal relationships with clients Promotes accountability for one’s actions • Enhances self-care for the nurse • Enhances the delivery of quality nursing care • • • Self-awareness: therapeutic tool used in the nurse-client relationship. The need for self awareness applies to nursing care The intention of self-awareness is to develop personal and interpersonal understanding Recognizing and being self aware of both your unique characteristics & clients allows nurses to provide better care. •Essential aspect of expectations related to the nursing professional •Permits nurses to treat a client as an individual •Enhances interpersonal relationships with clients •Promotes accountability for one’s actions •Enhances self-care for the nurse •Enhances the delivery of quality nursing care EG. If I have a tendency to be quiet & shy & my client is talkative, then I may need to have a greater awareness to engage more EG. If I have a tendency to focus on myself, must be self aware and realize that work is not the time for this (client centred) You will not like all your clients. You will have bad days. This is ok. But by having that self awareness, you can develop ways to deal with those 49 situations 49 Self-Concept vs. Self-Awareness To have a developed self-concept (one that is based in reality), a person must have selfawareness  Self-awareness influences self-concept and involves a conscious awareness of one’s own thoughts, feelings, behaviors, and traits  Increased self-awareness is the foundation for learning to promote positive aspects of self &learning to accept one’s own negative characteristics & take steps to change these. 50 Importance of Having Self-Awareness?       Discover more about ourselves Differentiate ourselves from others Understanding that selfawareness impacts nursing care Increased awareness of client’s strengths and limitations Increased confidence with therapeutic communications Make professional decisions based on facts, not emotions By learning more about oneself, you can be more open to others –you are familiar with your ideas/views. You are aware where you stand on issues Realize situations that challenge you; so you can decide how to handle those eg. me and patients with severe anxiety It is an important aspect of a professional nurse..which we will discuss further on slide 53 51 Why is Self-Awareness Important in Nursing? • Essential aspect of expectations related to the nursing professional • Permits nurses to treat a client as an individual • Enhances interpersonal relationships with clients • Promotes accountability for one’s actions • Enhances self-care for the nurse • Enhances the delivery of quality nursing care Self-awareness: therapeutic tool used in the nurse-client relationship. The need for self awareness applies to nursing care The intention of self-awareness is to develop personal and interpersonal understanding Recognizing and being self aware of both your unique characteristics & clients allows nurses to provide better care. Ex. If I have a tendency to be quiet & shy & my client is talkative, then I may need to have a greater awareness to engage more Ex. If I have a tendency to focus on myself, must be self aware and realize that work is not the time for this (client centred) You will not like all your clients. You will have bad days. This is ok. But by having that self awareness, you can develop ways to deal with those situations 52 Nursing Strategies/Interventions Encouraging patients to engage in open-ended questions related to:  What the patient is coping with, related to self-identity  What the patient is able to do with their circumstances  What supports/resources are needed to support the patient in reconnecting with the person that he or she is capable of being? 53 Developing Self-Awareness What measures may be beneficial to enhance one’s level of self-awareness?  Reflection  Seek feedback  Observe  Learn about nonverbal cues & body language  Participate in self-awareness activities Self Awareness is important & essential to assist with making changes in one’s life. The ability to self reflect , seek Feedback , be cognizant and aware of non-verbal cues. Be accepting of feedback!!! Realize that if more than one person comments on an aspect of your behaviour, there is a good reason. It would be in your best interest to reflect and make changes. Developing an ability to understand one’s emotions, personality, behaviour & how to react to others & situations can lead to personal growth, which can have an impact on interactions. Self-awareness is important for clients as they deal with & manage health issues /concerns. Personal introspection-learn who you are Professional Introspection- reflect on care you provide; how can I enhance knowledge/care Nurses can reflect on client’s strengths, cope more effectively & help minimize areas for enhancement during NC interactions. Improving SA requires caring, insight, acceptance, + outlook, ability to nurture. 54 Characteristics of Healthy Personality and Self-Concept • • • • • • Positive self-esteem Realistic life goals Distinct sense of identity Satisfaction with life roles Satisfaction with body image Emotional and spiritual wellbeing • Overall sense of balance (congruence) between who you are and who you want to be Picture: Why do we need personality tests to tell us who we are? (nbcnews.com) Objective 2.8 - Describe the characteristics of a healthy personality and self concept. How would you like to be treated if you were a client in a health care setting? Characteristics of Healthy Personality?? Here’s one Warm Can you think of some? Friendly Capable of expressing emotion Emotionally stable Resilient Genuine Realize it’s ok to have differences with others Consistency Realistic goals Distinct sense of identity 55 Video: Positive Self-Concept https://youtu.be/vSvRA8jUSxQ VistaPeakpe. (2015). Positive self-concept https://youtu.be/vSvRA8jUSxQ This video is 4:59 minutes long https://www.youtube.com/watch?v=vSvRA8jUSxQ 56 Summary Self-concept is a complex view of oneself and answers the question “Who am I?”  Nurses should reflect on their own self-concept in order to develop better self-awareness so as to provide better care to clients  Self-concept can impact how an individual reacts/responds to a health challenge.  The role of the nurse is to identify patients’ strengths and maximize on them to encourage a positive self-concept.  57 Questions to Think About What are my communication strengths and weaknesses?  How will my social interactions and my therapeutic interactions be different?   Are there any aspects of my personality that I use in social interactions that may help me in the therapeutic setting?  What do I need to learn to help me with stressful situations?  How do my values, beliefs and attitudes affect how I react and respond to people/situations?  Am I always “present” when people are talking to me? 58 Case Study Carl, a 30 year old male, sustained a spinal cord injury in a motor vehicle accident. He has completed rehabilitation and is now at home with his wife Sue and two children. Prior to the accident, Carl was a brick layer and Sue worked part-time in sales. You are a nurse in the neurosurgery clinic that specializes in spinal cord injury patients. Identify questions that the nurse could use to assess for personal strengths regarding this life-changing event? Ask Carl about his views on life and his relationship with his wife, family and friends would be useful. This is a major event in the life of his family. By identifying strengths, Carl may be able to deal with his current life challenges. 59 Case Study Carl has identified that he has many supportive friends and family. However, he is very concerned that their support will not last much longer. Sue seems to be confident that the family can adapt to Carl’s change in mobility and career. Based on Erickson’s stages of development, what developmental tasks should Carl be mastering? What behaviours by Carl would indicate regression? As a young adult, Carl is in the stage of intimacy vs. isolation. He has already established a career and family which are all expected at this age. However, his injury has impacted both his career and relationship. Indicators of problems would include: withdrawl from family, risk-taking behaviours (drugs and alcohol), verbalizing feelings of not knowing his purpose in life, etc. 60 Case Study  During a later clinic visit, Carl tells you that he no longer feels like a man because he cannot work, play sports, and be intimate with his wife  Identify relevant nursing interventions for Carl Using a strengths-based approach, the nurse should ask Carl to identify activities he can currently complete, such as transfers, bowel and bladder care, etc. There are numerous adaptive sports that can be done by those with mobility problems. The nurse should investigate those opportunities with Carl. However, simply listening to Carl and allowing him to vent is therapeutic as well. 61 Case Study  Carl has enrolled in a vocational rehabilitation program that will teach him about computer technologies and should lead to a new job. Sue is planning to increase her hours worked to full-time in order to have health insurance. What other concerns related to role performance might Carl have? Going from a physical career such as a brick layer to one that can be done from a wheelchair is a dramatic change for Carl. He will not be able to complete yard work and home and automobile maintenance as previously. Therefore, he and his family may be more dependent on others, which could be a source of frustration for Carl. Other issues may be related to the need for Sue to work more, etc. 62 Review A 60 yr old patient who had CVA with left-sided weakness is in a rehabilitation center. Previously, he refused to bathe and groom himself. Today he completed most of his personal care independently. What is the best response by the nurse? A. It is great you have already bathed today B. Are you going to a party today? C. I have never seen you look so spiffy D. You look very nice today Correct answer A. The nurse should be providing positive feedback for the specific activity that the patient completed. Options B and C are not specific enough or considered therapeutic responses. Option D is also not specific enough. 63 Review Which of the following patients is demonstrating a positive self-concept? A. 18-year-old who refuses to look at a facial scar from a skiing accident B. 10-year-old who shows his friends the scar on his scalp C. 56-year-old who refuses to leave home after a mastectomy D. 54-year-old who wears long pants all year round to cover burn scars on her legs Answer: B Any of the other responses might be acceptable as a short-term situation but would not be expected to continue over time. 64 References  Code of ethics for licensed practical nurses in Canada. (2013).  Erik Erikson’s Theory of Psychosocial Development (2019). Retrieved from https://www.psychologynoteshq.com/erikerikson/  Gonzalo, A. (2021). Jean Watson: Theory of human caring. https://nurseslabs.com/jean-watsons-philosophy-theorytranspersonalcaring/#theory_of_human_caring_of_jean_watson  Immigration Advisers Authority (nd.). Personal beliefs, values, attitudes and behavour. https://www.iaa.govt.nz/for-advisers/adviser-tools/ethicstoolkit/personal-beliefs-values-attitudes-and-behaviour/ 65 References  Kumar, M. (2022). The relationship between beliefs, values, attitudes and behaviours. Owlcation. https://owlcation.com/socialsciences/Teaching-and-AssessingAttitudes#:~:text=Attitudes%20arise%20out%20of%20core,true%2 0based%20on%20past%20experiences.  Mallette, C. & Yonge, O. (2022). Arnold & Boggs’s Interpersonal relationships: Professional communication skills for Canadian nurses. Elsevier.  Nursing: A world of caring. (2013) https://jaimesorianorn.wordpress.com/lecturehandouts/#:~:text=Sister%20Simone%20Roach%2C%20(1992),is% 20intrinsic%20to%20all%20humans%20.  Standards of practice for licensed practical nurses in Canada (2020). 66 Questions??? 67