A positive self - concept is essential to a person's mental and physical health. Individuals with a positive self - concept are better able to develop and maintain interpersonal relationships and resist psychological and physical illness.
Self-Concept is one's mental image of oneself OR is an individual's view of self. Self-Concept involves all of the self-perceptions appearance, values and beliefs-that influence behavior and are referred to when using the words I or me.
Self-Concept is a complex mixture of unconsciousness and conscious thoughts, attitudes and perceptions
Self-concept is a complex idea that influences the following:
·        How one thinks, talks, and act
·        How one sees and treats another person
·        Choices one makes
·        Ability to give and receive love
·        Ability to take action and to change things
There are four dimensions of self-concept:
Self-knowledge: the knowledge that one has about oneself, including insights into-one's abilities, nature, and limitation.
Self-expectation: what one expects of oneself; may be a realistic or unrealistic expectation
Social self: how a person is perceived by others and society
Social evaluation: the appraisal of oneself in relationship to others, events, or situations
Me centered
·        How I perceive me
·        Try hard to live up to their own expectations and compete only with themselves, not others.
       Other centered
·        Have a high need for approval from others.
·        Try hard to live up to the expectations of others.
Components of self concept :
There are four components of self- concept: Personal identity, body image, role performance and self-esteem.
 Personal identity is the conscious sense of individuality and uniqueness that is continually evolving throughout life. People often view their identity in terms of name, sex, age, race, ethnic origin or culture, occupation or roles, talents, and other situational characteristics (e.g., marital status and education).
Personal identity also includes beliefs and values, personality, and character. The achievement of identity is necessary for intimate relationships because individuals express identity in relationships with others.
Sexuality is a part of identity, and its focus differs across the life span. E.g. as an adult ages, the focus shifts from procreation to companionship, physical and emotional intimacy and pleasure-seeking
Body Image
The image of physical self, or body image, is how a person perceives the size, appearance, and functioning of the body and its parts. Body image has both cognitive and affective aspects. The cognitive is the knowledge of the material body; the affective includes the sensations of the body, such as pain, pleasure, fatigue, and physical movement.
Body image develops in infancy as the parents or caregivers respond to the child with smiles, holding, and touching and as the child explores its own body sensation during brest feeding, thumb sucking and the bath.
Body image is the sum of a person's conscious and unconscious- attitudes about his or her body. Normal developmental changes such as puberty and aging have a more apparent effect on body image than on other aspects of self-concept.
Hormonal changes during adolescence and menopause influence body image. The development of secondary sex characteristics and the changes in body distribution have a tremendous impact on an adolescent's self- concept.

For both male and female adolescents, negative body image is a risk factor for suicidal  thoughts. Changes associated with aging (e.g. wrinkles, greying hair and decrease in visual acuity, hearing and mobility) also affect body image in an older adult.
Cultural and societal attitudes and values influence body image. Values such as ideal body weight. and shape and attitudes toward piercing and tattoos are culturally based. American society emphasizes youth, beauty and wholeness. Western cultures have been socialized to dread the normal aging process whereas eastern cultures view aging very positively and respect older adult.
Body image issues are often associated with impaired self- concept and self - esteem
Role performance:
A role is a set of expectations about how the person occupying one position behaves.
Role performance relates what a person in a particular role does to the behaviors expected of that role.
Role mastery means that the person's behaviors meet social expectations. Expectations, or standards of behavior of a role, are set by society, a cultural group, or a smaller group to which a person belongs. Each person usually has several roles, such as husband, parent, brother, son, employee, friend, nurse, and church member.
Role development involves socialization into a particular role. For e.g. nursing students are socialized into nursing through exposure to their instructors,' clinical experience, classes, laboratory simulations and seminars.
Role ambiguity occurs when expectations are unclear and people do not know what to do or how to do it and are unable to predict the reactions of others to their behavior. Failure to master a role creates frustration and feelings of inadequacy, often with consequent lowered self-esteem
Role conflicts arise from opposing or incompatible expectations. In an interpersonal conflict, people have different expectation about a particular role.
E.g. A grandparent may have different expectations than the mother about how she should care for her children.
A woman who has little flexibility in her full-time job schedule has a role conflicts if her husband expects her to handle all child care problems.
  Self Esteem:
Self-esteem is one's judgment of one's own worth. It is an individual's overall feeling of self-worth or the emotional appraisal of self - concept. It is the most fundamental self-evaluation because it represents the overall judgment of personal worth or value.
Self-esteem is positive when one feels capable, worthwhile and competent. There are two types of self-esteem: global and specific.
Global self-esteem is how much one likes oneself as a whole.
Specific self-esteem is how much one approves of a certain part of oneself; Global self-esteem is influenced by specific self-esteem.
For example, if a man values his looks, then how he looks will strongly affect his global self-esteem. By contrast, if a man places little value on his cooking skills, then how well or badly he cooks will have little influence on his global self-esteem.    
Self-esteem is derived on self and others. In infancy, self -esteem is related to the care givers evaluations and acceptances.
Later the child's self - esteem is affected by competition with others. As an adult, a person who has high self-esteem.
Factors influencing self concept:
Many factors affect a person's self-concept.
Major factors are:-
·        Stage of development
·        Family and culture
·        Stressors (Identity, Body Image, Role Performance, Self- esteem)
·        Resources
·        History of success and failure
·        Illness

Stage of Development:
As an individual develops, the conditions that affect self - concept change. For example, an infant requires a supportive, caring environment, while a child requires freedom to explore
and learn. Elders' self-concept is based on their experiences in progressing through life's stages.
Family and Culture:
A young child's values are largely influenced by the family and culture. Later on, peers influence the child and thereby affect the sense of self. When the child is confronted by differing expectations from family, culture, and peers, the child's sense of self is often  confused
For example, a child may realize that his parents expect he will not drink alcohol and that he will attend religious services each Saturday evening. At the same time, his peers drink beer and encourage him to spend Saturday evenings with them.
Stressors (Identity, Body Image, Role Performance, Self- esteem)      
Identity stressors
·        Change in physical appearance (e.g. facial wrinkles)
·        Declining physical, mental, or sensory abilities
·        Inability to achieve goals
·        Relationship concerns
·        Sexuality concerns
·        Unrealistic ideal self   
Body image stressors:
·        Loss of body parts (e.g., amputation, mastectomy, hysterectomy)
·        Loss of body functions (e.g., from stroke, spinal cord injury, neuromuscular disease, arthritis, declining mental or sensory abilities)
·        Disfigurement (e.g., through pregnancy, severe burns, facial blemishes, colostomy, tracheostomy)
·        Unrealistic body ideal (e.g., a muscular configuration that cannot be achieved)
Self-esteem stressors:
·        Lack of positive feedback from significant others
·        Repeated failures
·        Unrealistic expectations
·        Abusive relationship
·        Loss of financial security
Role stressors:
·          Loss of parent, spouse, child, or close friend
·          Change or loss of job or other significant role
·          Divorce
·          Illness
·          Ambiguous or conflicting role expectations
·          Inability to meet role expectations
An individual's resources are internal and external. Examples of internal resources include confidence and values, whereas external resources include support network, sufficient finances, and organizations. Generally the greater the number of resources a person has and uses, the more positive the effect on the self-concept.
History of success and failure:
People who have a history of failures come to see themselves as failures, whereas people with a history of successes will have a more positive self-concept. Likewise, persons with a positive self-concept tend to find contentment in their level of success while a negative self-concept can lead to viewing one's life situation as negative.
Illness and trauma can also affect the self-concept,
A woman who has a mastectomy may see herself as less attractive, and the loss may affect how she acts and values herself. People respond to stressors such as illness and alterations in function related to aging in a variety of ways. Acceptance, denial, withdrawal, and depression are common reactions.
Assessment of Psychosocial Assessment:
The nurse assessing self-concept focuses on the four components:
(a)  personal identify
(b) body image
(c)  role performance
(d) self-esteem
Before conducting a psychosocial assessment: the nurse must establish trust and a working relationship with the client.
Guidelines for conducting a psychosocial assessment include the following:
·        Create a quiet, private environment.
·        Minimize interruptions if possible,
·        Maintain appropriate eye contact
·        Sit at eye level with the client.
·        Demonstrate an interest in the client's concerns.
·        Indicate acceptance of the client by not criticizing, frowning, or demonstrating shock.
·        Ask open-ended questions to encourage the client to talk rather than close ended  questions that tend to block free sharing.
·        Avoid asking more personal questions than are actually needed.
·        Minimize writing detailed notes during the interview because this can create client concern that confidential material is being "recorded” as well as interfere with your ability to focus on what the client is saying.
·        Determine whether the family can provide additional information.
·        Maintain confidentiality.
·        Be aware of your own biases and discomforts that could influence the assessment.
·        Consider how the client's behavior is influenced by culture.
Assessment Interview:
Body Image
(a) Is there any part of your body you would like to change?
(b) Are you comfortable discussing your surgery?
(c)  Do you feel different or inferior to others?
(d) How do you feel about your appearance?
(e)  What changes in your body do you expect following your surgery?
(f)   How have significant others in your life reacted to changes in your body?
Personal Interview

·        How would you describe your personal characteristics? or, How do you see yourself as a person?
·        How do others describe you as a person?
·        What do you like about yourself?
·        What do you do well?
·        What are your personal strengths, talents, and abilities?
·        What would you change about yourself if you could?
·        Does it bother you a great deal if you think someone doesn't like you?

Role Performance:
    Family Relationships
(a) Tell me about your family.
(b) What is home like?
(c)  How is your relationship with your spouse/partner/significant other (if appropriate)
(d) What are your relationships like other relatives?
(e)  How are important decisions made in your family?
(f)   What are your responsibilities in the family?
(g) How well do you feel you accomplish what is expected of you?
(h) What about your role or responsibilities would you like changed?
(i)   Are you proud of your family members?
(j)   Do you feel you family members are proud of you?

Work Roles and Social Roles:
·          Do you like your work?
·          How do you get along at work?
·          What about your work would you like to change if you could?
·          How do you spend your free time?
·          Are you involved in any community groups?
·          Are you most comfortable alone, with one other person, or in a group?
·          Who is most important to you?
·          Whom do you seek out for help?
·        Are you satisfied with your life?
·        How do you feel about yourself?
·        Are you accomplishing what you want?
·        What goals in life are important to you?
Nursing Intervention: 
The following nursing techniques may help clients analyze the problem and enhance the self-concept:
·         Encourage clients to appraise the situation and express. their feelings.
·         Encourage clients to ask question,
·         Provide accurate information.
·        Become aware of distortions, inappropriate or unrealistic standards, and faculty labels in clients' speech.
·        Explore client’s positive qualities and strengths.
·        Encourage clients to express positive self-evaluation more than negative self-evaluation.
·         Avoid criticism.
·        Teach clients to substitute negative self-talk ("I can't walk to the store anymore") with positive self-talk ("I can walk half a block each morning"). Negative self-talk reinforces a negative self-concept.

 Nursing diagnoses:
·               Disturbed body image.
·               Ineffective role performance.
·               Chronic low self esteem.
·               Disturbed personal identity.
·               Anxiety related  to changed physical appearance



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