Psychosocial Needs SelfConcept SelfConcept Ones mental image of

Psychosocial Needs

Self-Concept

Self-Concept One’s mental image of oneself Appearance, values, beliefs Influences behavior Dimensions of self-concept Self-knowledge – Self-expectation Social self – Social evaluation Me-centered versus other-centered Self-awareness

Formation of Self-Concept Develops as a result of social interactions Erikson Broad steps in development of self-concept Global self Base self-concept on several areas Maintaining self-concept ongoing process Ideal self – Nurses’ view of selves

Components Personal Identity Body image Role performance Self-esteem

Role Performance Behaviors Reinforcement-extinction Inhibition Substitution Imitation Identification

Self-Concept Stressors Identity stressors Body image stressors Role performance stressors Conflict Ambiguity Strain Overload Self-esteem stressors

Factors that Affect Self-Concept Stage of Development Family and Culture History of Success and Failure Resources Stressors Illness

Alterations Exhibited in a variety of ways Alterations may be temporary Lower self-esteem Eating disorders Set of maladaptive responses to stress Cause low self-esteem, self-hatred, fear

Eating Disorders Anorexia nervosa Extreme perfectionism Weight fear Bulimia nervosa Cycles of binge eating followed by purging Syndromes with multiple predisposing factors Two disorders can occur in same person

Eating Disorders, continued Binge-eating disorder Binge eating with no purging Other disorders Purging disorder Nocturnal sleep-related eating disorder Prader-Willi syndrome Congenital disorder Appetite becomes insatiable Behavioral problems

Personality Disorders Enduring pattern of inner experience, behavior Deviates from expectation of individuals culture Pervasive, inflexible Begins in adolescence, young adulthood 11 types of personality disorders, 3 clusters

Personality Disorders, continued Odd and eccentric Dramatic and emotional Anxiety and fear-based personality disorders Common clinical features Impaired sense of self Thinking patterns Emotions Behaviors Vicious cycle of personality disorders

Assessment Psychosocial assessment Personality identity Body image Role performance Self-esteem Establish trust, working relationship Guidelines for psychosocial assessment

Assessment, continued Personal identity Body image Role performance Self-esteem Cultural background affects behaviors Assessment interview

Caring Interventions Identify areas of strength Framework for identifying personality strengths Specific strategies to reinforce strengths Enhancing self-esteem Therapeutic relationship requires Self-awareness Communication skills Developmental considerations

Pharmacologic Therapies Eating disorders Antidepressants Drug trials disappointing for anorexia Personality disorders Medications used to target specific symptoms Decrease behaviors SSRIs, clonidine, guanfacine, Overall treatment includes therapy Group, family, behavioral

Nursing Diagnoses Examples Disturbed personal identity Ineffective coping Disturbed body image Chronic low self esteem

Planning Goals and outcomes Priorities Continuity of care Cultural considerations

Implementation Health promotion Acute care Restorative care

Evaluation Client care Client expectations

Grief and Loss

Loss Actual loss Perceived loss Maturational loss Situational loss

Grief Mourning Bereavement Anticipatory Grief

Kubler-Ross Stages of Grief (1969) DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE

Types of Grief Anticipatory grief Complicated grief Disenfranchised grief

Assessment Type and stage of grief Grief reactions Factors that affect grief End-of-life decisions (Advance Directives, Allow Natural Death) Nurse’s experiences Client expectations

Factors Influencing Loss and Grief Age Significance of the Loss Culture Spiritual Beliefs Gender Socioeconomic Status Support System Cause of Loss or Death

Culture and Death Rituals, Mourning Practices

Death Rituals by Culture African American Chinese Hindu Jewish Mexican Arab Japanese

Nursing Diagnoses Grieving Complicated Grieving Interrupted Family Processes Risk-prone Health Behavior Risk for Loneliness

Planning Goals and outcomes Setting priorities Continuity of care

Implementation Facilitating Grief Work Providing Emotional Support

Palliative Care Symptom control Maintaining dignity and self-esteem Preventing abandonment and isolation Providing a comfortable and peaceful environment Therapeutic Communication Promote spiritual comfort

Physiologic Changes in the Dying Patient Pain Dyspnea Anorexia, Nausea Dehydration Altered levels of Consciousness Hypotension

Supportive Care Support for the grieving family Assist with end of life decision making Hospice care Care after death (postmortem care) Grieving nurse Caring for Dying Children

Evaluation Client care Client/family wishes Client expectations

Sexuality

Reproductive Anatomy and Physiology Male Female

Sexual Development (pg 1692) Infancy Toddler Preschooler School-age years Puberty/adolescence Young adulthood Middle adulthood Late adulthood

Sexual Health Sexual Self-Concept Body Image Gender Identity Gender-role Behavior Androgyny Sexual Orientation

Sexual Response Cycle Desire Arousal Orgasm

Factors Influencing Sexuality Family Culture Religion Personal Expectations and Ethics

Alterations in Sexual Function Sexual Desire Disorders Sexual Arousal Disorders Orgasmic Disorders Sexual Pain Disorders Problems with Satisfaction Erectile Dysfunction

Contraception Nonprescription methods Abstinence Fertility Awareness Methods Barrier methods Spermicides

Contraception Prescription/health care intervention methods Hormonal Intrauterine devices Diaphragm/cervical cap Sterilization

Sexually Transmitted Infections Syphilis Gonorrhea Chlamydia Trichomoniasis Human papillomavirus (HPV) Genital warts Herpes simplex virus (HSV) Genital Herpes

Sexually Transmitted Diseases Human immunodeficiency virus (HIV) AIDS Transmission Exposure categories Education Cultural considerations

Sociocultural Influences on Sexuality Pregnancy and menstruation Discussing sexual issues

Decisional Issues Related to Sexuality Contraception Abortion STD prevention

Alterations in Sexual Health Infertility Sexual abuse Menstrual Dysfunction Sexual Dysfunction Erectile Dysfunction

Menopause Physiology and Etiology Clinical manifestations Diagnostic Tests Pharmacologic Therapies Alternative/Complementary Therapies

Assessment Factors affecting sexuality Sexual health history Sexual dysfunction Physical assessment Client expectations Nursing diagnosis Cultural considerations

Nursing Diagnosis Sexual Dysfunction Situational Low Self Esteem Risk for Disturbed Body Image Deficient Knowlwdge Ineffective Sexual Pattern Anxiety Acute. Pain

Planning Goals and outcomes Priorities Continuity of care

Implementation Health promotion Acute care Restorative care

Evaluation Client care Client expectations

Spiritual Health

Components of Spirituality Spiritual Needs Spiritual Health & Well-Being Spiritual Distress Core Aspects of Spirituality Spiritual Development

Spiritual Practices/Beliefs Affecting Nursing Care Food & Nutrition Healing Body Coverings Birth & Death

Religion and Medical Care Judaism Islam Roman Catholic Protestant Christianity Hinduism Buddhism Jehovah’s Witness

Spiritual Assessment TJC mandate Clinical Assessment Interview Assess religious and spiritual needs

Nursing Diagnoses Spiritual distress Readiness for enhanced spiritual well-being Fear Hopelessness Impaired religiosity Readiness for Enhanced religiosity

Planning Goals and outcomes Setting priorities Continuity of care

Implementation Establishing presence Supporting a healing relationship Support systems Diet therapies Supporting rituals Prayer Meditation Supporting grief work Pastoral Care/Spiritual Counseling

Evaluation Client care Client expectations