NUSC 1P12 Week 12 Slides PDF

NUSC 1P12: WEEK 12 PART 1: CHAPTER 27 SELF-CONCEPT (Potter et al., 2024) SELF-CONCEPT & SELF-ESTEEM Development of self-concept is a lifelong process o The sum of one’s beliefs about oneself, which develops over time and is influenced by interactions with surroundings Why are self-concept and sel...

NUSC 1P12: WEEK 12 PART 1: CHAPTER 27 SELF-CONCEPT (Potter et al., 2024) SELF-CONCEPT & SELF-ESTEEM Development of self-concept is a lifelong process o The sum of one’s beliefs about oneself, which develops over time and is influenced by interactions with surroundings Why are self-concept and self-esteem relevant to nurses? (consider challenging situations, ability to advocate for patients, challenge physicians. Know when you don’t know something/when to ask questions, ability to accept constructive criticism, belonging, professional identity formation. People with a positive self-concept and self-esteem are better able to cope with illness and stressful life circumstances and events. They are also more likely to engage in health promoting behaviours. WHAT WE KNOW ABOUT SELF-CONCEPT Parents, caregivers and interactions with others influence self-concept. Individuals learn and internalize cultural influences on self-concept and self-esteem during childhood and adolescence. Job satisfaction and job performance in adulthood are linked to self-esteem. The sense of self is often negatively affected in older persons. How has your self-concept changed over the years? How do experiences in life (positive and negative) promote or limit the development of a positive self-concept? SELF-CONCEPT & SELF-ESTEEM Self-Concept (Who am I?) Self-concept: The mental image one has of oneself (conscious/unconscious thoughts, attitudes, perceptions about own identity) ­ Comprises social, emotional, physical, academic domains; identity ­ Affects how a person adapts to challenges, difficult situations, and relationships (resilience) ­ The cognitive aspect of self (how you think) ­ Impacts therapeutic relationships • Who am I and what can I become? ­ Personal à your unique personal qualities (who you are as a person) ­ What is one thing you could do to be more authentic/ true to yourself? • Influenced by • Self-awareness: being conscious of one’s own beliefs, thoughts, motivations, biases, physical and emotional limitations and the impact these components may have on others • Self-reflection: often triggered by a significant incident, ongoing, complex, opportunity to know the deepest part of yourself Self-Esteem (Am I worthy/enough?) Self-esteem: The way you think and feel about yourself (affective and emotional aspect of self; how you feel) Personal characteristics of high and low self-esteem Developed through positive and negative: ­ Life experiences (success/failure; encouragement/discouragement) ­ Parent interactions; interactions with others (family, role models, friends, teachers) ­ Other factors: Race, religion, media, culture, sex, punishment and abuse, poverty, failure, self-criticism High self-esteem: confident, worthy, positive; project a sense of self-worth, belonging, security Low self-esteem: failure, life disappointments, being mistreated by others; feel badly about self COMPONENTS & INTERRELATED TERMS OF SELF-CONCEPT Identity ­Involves the internal sense of individuality, wholeness, and consistency of self (uniqueness) ­Influenced by age, gender, sexuality, social class, ethnicity, and culture ­Gender identity is one of the most central aspects of self-concept and includes psychological sense of being male and/or female and includes sexual orientation. Influenced by socialization and culture (role identity). Body Image ­Involves attitudes related to physical appearance, structure, or function ­Includes feelings related to femininity and masculinity, youthfulness, sexuality, health and vitality ­Some people may experience body image distortions which can present with eating disorders, amputation, scars due to surgery, etc. COMPONENTS & INTERRELATED TERMS OF SELF-CONCEPT Role Performance § Consists of how individuals perceive their ability to carry out significant roles such as parent, child, spouse, employee, student, caregiver (some roles are temporary/finite, some are permanent) Body Image ­ A person’s sense of self-worth (or emotional appraisal of self-concept), overall judgement of worth or value; competence, capability, worthiness ­ In adolescents, positive self-esteem associated with family cohesion, greater number of siblings, parental support, and social and emotional support from other adult role models ­ Highest in children and adults in their mid-60s ­ The ideal self: representation of the attributes a person would like to have, a motivator to give the individual incentive for future behaviour, influenced by parents, school, peers, media Imagine a client who is sick and unable to be involved in society, fulfill the responsibilities of their roles, maybe experiencing an alteration in body image, etc. STRESSORS AFFECTING SELF-CONCEPT Identity stressors ­ Identity confusion ­ Eg. job loss, divorce, neglect, sexual assault, dependency on others, concerns with sexuality, repeated failures, societal attitudes, conflict Body image stressors ­ Eg. stroke, blindness, colostomy, eating disorders, arthritis, incontinence, obesity, amputation, scarring, aging, mastectomy, sexual assault, multiple sclerosis Role performance stressors ­ Role conflict - assuming 2+ roles that are inconsistent, contradictory, or mutually exclusive (e.g. caring for children and aging parents simultaneously) ­ Sick role-social expectations of how a sick person should behave (take care of self), while also meeting professional expectations (not being eligible for sick time or time off) ­ Role ambiguity-unclear role expectations (Eg. nurses working on multiple units, in multiple organizations, etc.) ­ Role strain-stress or frustration experienced when behaviours, expectations, or obligations associated with a social role are incompatible (feeling unprepared or inadequate, Eg. suddenly assuming a caregiver role in response to a sudden onset of illness in a loved one) ­ Role overload-having more roles or responsibilities than are manageable (unsuccessful attempts to meet demands of school, work and family while still having personal time; often seen in periods of illness or change) Self-esteem stressors (dependent on developmental stage) • Inability to meet parental expectations, harsh criticism, inconsistent discipline, unresolved sibling rivalry • Older adults: health problems, reduced functional ability, stressful life events and circumstances THE NURSE’S EFFECT ON THE CLIENT’S SELF-CONCEPT o Nurses need to remain aware of their own feelings, ideas, values, expectations, and judgements. o Nurses who are secure in their own identities (have a positive selfconcept) more readily accept and reinforce clients’ identities. o Nurses should assess and clarify the following self-concept issues: § § § § § Thoughts and feelings about lifestyle, health, and illness Awareness of how nonverbal communication may affect clients and families Personal values and expectations and how they affect clients Ability to convey a non-judgemental attitude toward clients Preconceived attitudes toward cultural differences in self-concept and selfesteem SELF-CONCEPT & THE NURSING PROCESS Self-Concept & The Nursing Process Illness & Self-Concept Self-Concept for your patient ­ How can self-concept influence their experiences in the health care system, with their illness, with you, with physician, with family, etc.? Physical and mental alterations Assessment ­ Behaviours suggesting altered self-concept ­ Actual and potential self-concept stressors ­ Coping patterns ­ Significant others ­ Client’s expectations Views of self/self-concept may be challenged and threatened by illness Sometimes short-term (temporary), sometimes long-term involving a future projection of self ­ Anxiety, depression, stress, trauma reactions Change in independence and functioning ­ Alterations in appearance (body image) ­ Change in role performance SELF-CONCEPT AND THE NURSING PROCESS Examples of nursing diagnoses ­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 ­Readiness for enhanced self-concept PROFESSIONAL IDENTITY IN NURSING Professional Identity Formation: A Concept Analysis (Halverson et al., 2022) https://qaneafi.casn.ca/cgi/viewcontent.cgi?article=1328&context=journal Review: § defining attributes (p. 5) § antecedents (p. 9) § consequences (p. 10) § model case (pp. 6-7) NUSC 1P12: WEEK 12 PART 2:BENNER (2001) FROM NOVICE TO EXPERT The Dreyfus Model of Skill Acquisition Applied to Nursing Benner (2001) From Novice to Expert (see Chapter 2 on Brightspace) CNO (2012) Fact Sheet: Requisite Skills and Abilities for Nursing Practice in Ontario WHAT DO NEW GRADUATES THINK OF THIS? “[Thinking about Benner and expertise], I’m not at the expert level yet, but I think maybe her terms are not necessarily the right terms to be using. In my opinion, I don’t believe in “expertise”. I believe you could be very well experienced and have a really good knowledge of what you’re doing. So I really just take her model as an example and apply it, but there’s always learning to be done. So I don’t think anyone’s an expert.” (Participant “Henry”) If Benner has stuck with Henry almost 2 years into his nursing practice, maybe this model is worth discussing and thinking about… FROM NOVICE TO EXPERT o o o o Patricia Benner is a nursing theorist who suggested nurses develop their skills gradually over time based on education and experience The Dreyfus Model of Skill Acquisition was originally developed by a mathematician and a philosopher (Dreyfus & Dreyfus) based on the study of chess players and airplane pilots This model was later applied to nursing by Patricia Benner after she studied a wide range of nurses in their practice From Novice to Expert was originally published in 1984 What is something you have learned and become good at? A sport? A game? Reading? Writing? Using technology? Think back to the first time(s) you tried this compared to now. What happened in between? How long did it take to master this thing? What factors contribute to the time it takes (e.g. coaching, mentorship, learning the rules, passion/interest)? STAGE 1: NOVICE “Beginners have had no experience of the situations in which they are expected to perform” (Benner, 2001, p. 20) o This will be you when start to learn skills in lab and in clinical “To give them entry to these situations and allow them to gain the experience so necessary for skill development, they are taught about the situations in terms of objective attributes such as weight, intake and output, temperature, blood pressure, pulse, and other such objectifiable, measurable parameters of a patients condition- features of the task world that can be recognized without situational experience” (Benner, 2001, pp. 20-21) o This is where your learning will begin o This is the more “black and white” learning o Remember Doane and Varcoe’s ”reference points”? o You will enter the clinical area as novices; with little understanding of the contextual meaning, or how to identify the most relevant tasks to perform in an actual situationRemember Doane and Varcoe’s reminder to move between what we know and what we don’t know, to expect uncertainty, and to become comfortable asking questions Dependent on procedural lists and objective/measurable findings WHAT DO NEW GRADUATES THINK OF THIS? Remembering her response to her first death, Kelly reflects: “It still gets me that it didn’t dawn on me that my first client in LTC was passed away. I just thought that he was in a very, very deep sleep; I said, ‘He’s dreaming really well’.” Reflecting on how she felt unprepared as a student, Lily recalls: “In second year, my first placement was maternity, so not only did I know nothing about anything, or even how to be a nurse, but I also… I’m not a mom; I was 19 years old. I don’t know anything about breast feeding. So, I spent six weeks floundering. I can’t tell this mom how to breast feed when one, I’m 19 and I look like a child and I don’t even know how to nurse let alone be a mom and then do both. That’s just impossible.” STAGE 2: ADVANCED BEGINNER “Advanced beginners are ones who can demonstrate marginally acceptable performance, ones who have coped with enough real situations to note (or to have pointed out to them by a mentor) the recurring meaningful situational components that are termed ‘aspects of the situation’ in the Dreyfus model” (Benner, 2001, p. 22) The ’aspects of the situation’ are similar to reference points and require prior experience in actual situations for recognition o We only see what we know WHAT DO NEW GRADUATES THINK OF THIS? ”I remember always being very nervous walking onto the unit. My heart would race every time I’d walk up… If I saw that I had a vent next to my name, I would always be very nervous, tip-toeing around the room, trying to make sure that I didn’t upset anything. If the patient coughed on the ventilator, I freaked out, and I find that the more and more I dealt with it, or the more I was forced to try and problem solve it myself. I really applaud my coworkers for helping me do that, instead of them rushing to my aid, and sometimes they would if necessary. They would push me and say, ‘Okay, well what would you do? What do you want to do? What do you think that it is?’. It really is proof; I’ve been able to prove to myself that, ‘You do know what you’re doing, you do know what’s going on’ or ‘it’s not the end of the world’. That’s nice, because I feel like everyone is fragile and I’m going to break them if I touch them or roll them over, but I feel a lot better about that stuff now.” (Participant “Kelly”) Notice Kelly’s tense: “I find vs. I found” “I feel vs. I felt” STAGE 3: COMPETENT “Competence, typified by the nurse who has been on the job in the same or similar situations two to three years” (Benner, 2001, p. 25). o What factors contribute to how long it takes to reach this stage? o Clinical experiences, new environment/ setting, work experiences before graduation, number of patients and experience gained in a short period of time, passion/interest, reflection ++? The nurse can sort which attributes and aspects of the current and projected/ future situation are most important/ relevant and which can be ignored (Benner, 2001) o Prioritization, critical thinking Read example on pp. 26-27 in Benner (2001) “The competent nurse lacks the speed and flexibility of the proficient nurse, but does have a feeling of mastery and the ability to cope with and manage the many contingencies of clinical nursing. The conscious, deliberate planning that is characteristic of this skill level helps achieve efficiency and organization” (Benner, 2001, p. 27) o What does ‘conscious, deliberate planning’ look like? o How might you have already adopted such approaches to achieve efficiency and organization in your life, perhaps as a student? WHAT DO NEW GRADUATES THINK OF THIS? “I think where I am now with my nursing career, with how I’ve grown… being a good listener is one thing that I value, but I also think I really appreciate my problem solving… typical time management, and so on. Same with my critical thinking. …I guess confidence is a word to describe it, but I don’t want to sound like I’m overconfident, because I know I still have lots of learning to go. But I’m proud with how confident I feel with lots of things. Like I’m not nervous anymore to talk to a doctor. I don’t care if they think it’s a silly issue. I have a concern, and I will speak up about that because the way I see it is I’d rather speak up about something that’s insignificant than miss something. And that’s something that I really, really have been trying to work on.” (Participant “Kelly”) Notice how Kelly says she feels confident with “lots of things”, so not all things (still ”lots of learning to go”), suggesting this is gradual, and you don’t suddenly become “competent”. You become competent with some things, then many things, then most things… STAGE 4: PROFICIENT “Proficient nurses understand a situation as a whole because they perceive its meaning in terms of longterm goals” (Benner, 2001, p. 27) o “Ok, here’s this baby, this is where this baby is at, and here’s where I want this baby to be in six weeks. What can I do today to make this baby go along the road to end up being better” (Benner, 2001, p. 28) o Starting to see the big picture and not just a list of tasks to do Learning from experience what typical events to expect in a given situation and how plans need to be modified in response to these events o What should happen next (ability to anticipate and predict), what to do if it doesn’t (troubleshooting, ‘think again’), how to react/respond to a turn of events (e.g. ask for help, re-assess, try something different, call the doctor, call a medical emergency team) WHAT DO NEW GRADUATES THINK OF THIS? “I could talk a little bit about my ambulatory care experience as a practical nurse. That made me very passionate and involved in wound care, because we had a wound care clinic. We would treat maybe 40 wounds a day. Forty people. Right away, I saw that some people would treat the wound and not the person. The way I approached things is I would treat the whole person, and not just the wound. I’d have a conversation with them, how their day was going, everything, while I was doing wound care. Then we would float around… But I always was pulled to surgical or wound care. I loved those. I ended up working with RNAO due to my passion. I still have that passion, but right now I’m working in harm reduction. There are wounds in harm reduction, it’s just not the specialty. So, I still get to practice wound care. I do feel like one day, I’ll go and specialize in wound care.” (Participant “Henry”) Is passion a catalyst for skill acquisition? Does working in a speciality area (e.g. a wound care clinic vs. a surgical floor) fast-track your skill acquisition in wound care specifically? Does seeing the whole person aid in job satisfaction? Do we go back to an earlier stage when we change practice settings/ environments and require new knowledge and skills? STAGE 5: EXPERT The expert nurse no longer relies on rules, guidelines, or maxims (think of a general ‘rule of thumb’) to connect his/her/their understanding of the situation to an appropriate action o The nurse inherently knows what is happening and what to do next based on keen intuition, experience ++, and an ability to focus in on the priority issue o Deep understanding of the total situation, or the big picture o Can be hard for them to explain or convey in words, but they know what they see, they feel what they feel, and they do what feels right WHAT DO NEW GRADUATES THINK OF THIS? “Yeah, the big thing I’ve noticed is either there’s overconfidence or underconfidence, probably a little bit of both. That’s probably for any nurse, but it’s more evident in new nurses because they’re trying to prove themselves as practitioners. Even myself, I think there were times where I was overconfident and probably gave information that wasn’t completely accurate or was false. And you don’t realize it because you’re trying to give the patient an answer and make sure that they know that you’re competent. But I think part of being competent is admitting that you’re wrong, or that you don’t know as well. And even now, I’m still a new nurse in my opinion. Two years isn’t enough experience to know anything.” (Participant “Jay”) SELF-REFLECTION Which stage do you feel you are at as a university student? What do you anticipate will move you to the next stage? How does thinking about these stages of skill acquisition make you feel about nursing? Does it change in any way your expectations of yourself as a nursing student, and/or future nurse? What are the main messages you can take away from Benner’s Novice to Expert model as you prepare to start clinical in the winter term? FINAL EXAM REVIEW