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Self-Concept
- what a person thnks about themselves
- subjective
- un/conscious thoughts, attitudes, and perceptions about one's self
- directly affects self-esteem
- affects management of all situations and relationships
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Factors of Self-Concept
- ever-changing
- influenced by family, caregivers, culture
- low in adolescents/geriatrics
- high in childhood/adulthood
- physical appearance
- vocational performance
- intellectual functioning
- being liked by others
- ability to cope and resolve
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Self-Reflection
- thoughts/feelings about lifestyle, health, and illness
- Awareness ie the effects of non-verbal communication
- personal values and expectations
- ability to convey non-judgmental attitude
- attitudes about cultural differences
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Self-Esteem
- emotional assessment of self-concept that reflects the overall sense of being capable, worthwhile, & competent
- foundation for self-esteem is established during early life experiences
- dependent upon stress day to day, high to low
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Nursing Objective of Self-Concept
recognize: personal identity, body image, role performance
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Personal Identity
- individuality
- wholeness
- consistency over time and in different situations
- what makes a perosn different
- necessary for intimate relationships
- racial & cultural identity
- (vulnerable at adolescence)
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Body Image
- physical appearance
- structure/function
- sexuality
- youthfulness
- health/strength
- aging
- race/ethnicity
- culture
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Body Image affected by
- cognitive growth
- devaluing others
- physical development
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Cultural Body Image factors
- Western Culture= Youth
- Eastern Culture= Age
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Role-Performance
- Reinforcement-extinction
- Inhibition
- Substitution
- Imitation
- Identification
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Reinforcement-Extinction
Behavior becomes common or avoided depending on whether approved or punished
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Inhibition
learn to refrain even when tempted
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Substitution
Replace one behaviorwith another, same gratification
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Imitation
Acquire knowledge, skill, etc. from other members
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Identification
Internalize values, behavior of role models
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Self-Concept Factors
- Stage of Development
- Family & Culture
- Resources
- -internal/external
- History of Success/Failure
- Illness
- Stressors
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Body image stressors
- loss of body part
- unrealistic body ideal
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Role-performance stressors
- conflict
- ambiguity
- strain
- development
- mastery
- overload
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Role Conflict
- caregiver
- or child
- or parent
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Role ambiguity
no defining lines
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Role strain
feel inadequate to full fill the role
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Role development
- under or over developed
- unevenly developed
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Role Mastery
- difficulty reaching mastery
- only master one role
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Role overload
unmanageable amount of responsibility
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Self-Esteem Stressors
- lack of positive feedback from significant other
- repeated failures
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Identity stressors
- declining physical, mental or sensory abilities
- identity confusion-unrealistic ideal self
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Stressors for Adults/Geriatric Clients
- multiple roles
- role ambiguity
- developmental tasks
- caring for others
- empty nest
- beginning physical decline
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Stressors in Older Adults
- Dependence
- Devaluation
- Depersonalization
- Functional Impairments
- Lack of Control
- Multiple Losses
- -finances, loved ones, health status
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Adaptive Coping
- Physical or behavioral response that preserves integrity and stability of a person
- protects from harm
- strengthens ability to deal with challenging situations
- mobilizing resources
- emowerment
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Maladaptive Coping
- Physical or behavioral response that causes disruption of integrity or persistent instability
- overuse of soem mechanisms
- conflict continues on unresolved or intensifies
- self-destructive behaviors: alcohol/drugs, tobacco, indiscriminate sexual behaviors
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Alter & Adapt Coping
- effort to manage psychological stress of daily living
- may differ from one time of stress to another
- may use combination of strategies
- goal to use strategies/mechanisms that decrease unnecessary stress
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Altruism
- emotional conflicts and stressors are dealt with by meeting the needs of others
- Dennis Quaid example
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Sublimation
taking drives or impulses that are personally or socially unacceptable into activities that are constructive
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Suppression
voluntarily blocking awareness of unpleasant feelings and experiences
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Denial
avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain
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Displacement
Transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute
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Intellectualization
attempting to avoid expressing emotions of a stressful situation by using logic, reasoning, and analysis
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Projection
- seeing your own unwanted feelings in other people
- projecting one's feelings or impulses that one finds unacceptable to himself/herself onto another person
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Introjection
Taking on the beliefs and values of someone else
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Isolation
separating feelings or emotions from a thought or memory
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Rationalization
making a behavior acceptable as a way of dealing with stressors
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Reaction Formation
- overcompensation
- prevents unacceptable behaviros by exaggerating opposite thoughts or behaviors
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Regression
returning to behaviors that were once acceptable but are no longer acceptable in the current stage of development
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Repression
involuntary, unconscious blocking of unpleasant feelings/experiences
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Conversion reaction
- somataziation
- changing the anxiety into a physical symptom
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Undoing
actions that psychologically undo wrongdoings for the wrongdoer
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compensation
making up a real or imagined deficiency by emphasizing an asset
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identification
assuming another's qualities, actions, characteristics
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Idealization
focusing on the good things and ignoring the limitations or the reality of a thing or an issue
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Dissociation
- subjective sense of numbing, and a reduced awareness of one's surroundings
- separating thoughts activities from conscious awareness
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Immature Defenses
- Passive-aggressive behavior: defense of rights by expressing resistance to social/occuptational demands
- Acting-out behaviors: not coping-giving in to the pressure to misbehave
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Intervention Goals
- decrease stress producing situations
- increase resistance to stress
- learn skills that reduce physiological response to stress
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Interventions
- exercise
- support systems
- time management
- guided imagery/visualization
- progressive muscle relaxation
- assertiveness training
- journal writing
- workplace stress management
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Stress
State created by a change in the environment that is perceived as challenging, threatening, or damaging to one's well being
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General Adaptation Syndrome
- alarm reaction
- resistance stage
- recovery or exhaustion stage
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Anxiety
- perceived threat to body or psyche
- mild, moderate, severe, panic
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Mild Anxiety
- sympathetic nervous system: fight or flight
- Psych/Cognition: increased alertness, sharper observations, grasps increased sensory input
- Behavioral: irritable, restless, repeated questions
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Moderate Anxiety
- physical: increased SNS response
- Psych: perceptual field constricted, focused on specific details
- Behavioral: increased movement, more intense irritability
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Severe Anxiety
- Pronounced Fight or Flight
- Processing scattered, disorganized, purposeless activity
- Hyperactive behavior
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PANIC
- can be a disorder
- s/s may mimic heart attack
- perceptions grossly distorted
- intense urge to escape or fight
- may be a danger to self or others
- speech difficulties
- inability to sleep, delusions, and hallucinations
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Anxiety Disorders
- panic disorder
- generalized anxiety disorder
- post-traumatic stress disorder
- social phobia
- specific phobia
- obsessive-compulsive disorder
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Reducing Anxiety Interventions
- sense of caring
- therapeutic self
- respect
- active listening
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Psychological Stress
person is under stress only if he/she evaluates event/circumstance as personally significant (subjective)
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Eustress
stress that is deemed healthful or giving one the feeling of fulfillment; protects health
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Distress
state of extreme necessity or misfortune; damaging stress
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Effect of Stress/Anxiety on healing
- increased pain perception
- decreased or abnormal immune response
- causes disease
- decreased compliance with treatment programs
- interferes with learning if severe and/or prolonged
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Reducing Anxiety
- Permission to feel/validate emotion
- Spiritual Support
- Teaching
- Modify the Environment
- Empower the patient
- Medications
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Crisis Intervention
- old coping mechanisms
- aware of unrecognized strengths & resources or functioning deteriorates
- situation for danger or opportunity; decline or growth
- focus on problem; approach w/ problem solving
- mental connection between event and response is imperative
- awareness of feelings
- explore/identify coping mechanisms
- facilitate social interactions/contacts
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