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Fundamentals of Nursing

32.1 Foundations of Self-Concept

Fundamentals of Nursing32.1 Foundations of Self-Concept

Learning Objectives

By the end of this section, you will be able to:

  • Identify components of self-concept
  • Explain the measurements of self-concept
  • Describe the development of self-concept

Understanding self-concept, the various components that collectively contribute to an individual’s perception of themselves, involves recognizing its multifaceted nature. Measuring self-concept involves employing various assessment tools and methodologies to quantitatively (measurable data, typically involving numbers and statistics) and qualitatively (descriptive data, typically involving observations and non-numerical insights) evaluate various aspects of an individual’s self-perception. Objective measurements may include standardized self-report questionnaires, such as the Rosenberg Self-Esteem Scale, which assesses global self-esteem. Qualitative measurements involve exploring personal narratives, reflective journals, and interviews, offering deeper insights into the subjective aspects of self-concept. Through these assessments, learners develop an understanding of the diversity in self-concept measurements and the importance of considering both quantitative and qualitative approaches to capture the richness and complexity of an individual’s self-perception.

Self-concept is a dynamic construct, an abstract concept or theoretical entity that is not directly observable but is inferred from measurable behaviors or responses, that evolves over the life span. Its development is influenced by numerous factors, including social interactions, cultural contexts, personal experiences, and feedback from significant others. During childhood, interactions with family members and peers significantly impact the formation of self-concept. Adolescence introduces identity exploration, contributing to a more complex understanding of oneself. Adulthood involves continued refinement as individuals navigate relationships, work, and societal expectations. Learners exploring the development of self-concept delve into the psychological and sociological theories that clarify the intricate processes shaping one’s self-perception over time. Understanding this development is crucial for healthcare professionals, educators, and counselors to provide effective support and interventions tailored to an individual’s evolving self-concept.

Components of Self-Concept

The construct of self helps us, as individuals, identify and relate within the world around us. How we communicate with others, maneuver through life, and describe ourselves are aspects of our concept of self. Humanistic psychologist Carl Rogers was instrumental in defining the paradigm (a distinct set of concepts, theories, methods, and standards that defines a scientific discipline or intellectual approach) of self-concept through three intertwined components: self-image, self-esteem, and ideal self (attributes that individuals aspire to possess) (Figure 32.2). The overall value and worth one assigns to oneself is one’s self-esteem, while self-image involves the mental and emotional view of one’s physical appearance and abilities. Personal characteristics, roles, and affiliations that define an individual are one’s self-identity. Additionally, social identity, the concept of self that is formed through connections with societal groups, influences self-concept. Rogers defined this as “the organized, consistent set of perceptions and beliefs about oneself” (McLeod, 2024). Our personal identity and self-concept, according to Rogers, develop throughout the life span beginning in childhood and are molded by experiences, perceptions, and evaluation of others.

Image of a red, six sided cube, with three sides labeled with: Self-image, Ideal self, and Self-esteem.
Figure 32.2 Self-concept is a three-dimensional aspect of an individual incorporating the ideal self, self-image, and self-esteem. (credit: modification of “Würfel” by “Schlurcher”/Wikimedia Commons, CC BY 3.0)

The concepts of ideal self, self-image, and self-esteem are interrelated components that together form an individual’s self-concept and are fundamental in developing personal identity, body image, and role performance. The ideal self, encompassing goals, ambitions, and desired traits and abilities, is often shaped by personal values, societal standards, and aspirations. Self-image, including personal views of one’s appearance, abilities, and personality, are influenced by feedback from others, experiences, and personal reflections. Self-esteem is the evaluative component, reflecting how one feels about oneself based on the alignment between self-image and ideal self. High self-esteem occurs when there is congruence between the two, while discrepancies can lead to psychological distress resulting in anxiety, poor self-esteem, and body dysmorphic disorders. The following sections explore how personal identity, body image, self-esteem, and role performance contribute to the overall self-concept, examining the roles each plays in shaping our comprehensive understanding and evaluation of ourselves.

Personal Identity

The sense of individuality and uniqueness that distinguish a person from others is one’s personal identity. It involves the recognition and internalization of personal traits, values, and beliefs, contributing significantly to how individuals perceive themselves within the broader context of society. This aspect of self-concept evolves as individuals experience personal growth and self-discovery and navigate the complexities of relationships and societal expectations.

Body Image

An individual’s perception and evaluation of their physical appearance make up one’s body image. This aspect of self-concept is heavily influenced by societal standards, cultural norms, and personal experiences. A positive body image correlates with a healthy self-concept, promoting self-acceptance and overall well-being. On the contrary, negative body image can lead to self-esteem issues, impacting mental health. As healthcare professionals engage with individuals, understanding the intricacies of body image within the context of self-concept becomes crucial for providing holistic and sensitive care.

Cultural Context

Cultural Considerations and Body Image

Cultural considerations related to body image are crucial to understanding how individuals perceive and interact with their bodies within different cultural contexts. Cultural norms, values, beliefs, and practices significantly influence how body image is constructed and experienced across diverse societies. In many cultures, societal standards of beauty and attractiveness play a central role in shaping perceptions of body image. These standards can vary widely between cultures and may be influenced by factors such as historical traditions, religious beliefs, media representation, and socioeconomic status. Nurses should gather information from their patients and their families that helps assess each patient’s views on body image. Here are a few specific cultural examples to illustrate the diversity of beliefs and attitudes toward body image:

  • Western cultures (United States, Western Europe): In Western cultures, there is often an emphasis on thinness as a beauty ideal, especially for women. Media portrayals frequently feature slim, toned bodies as the standard of beauty, influencing individuals to strive for a particular body size and shape. However, there is growing awareness and advocacy for body positivity and acceptance of diverse body shapes and sizes within Western cultures, challenging traditional beauty standards and promoting self-acceptance (Eisenberg et al., 2005).
  • East Asian cultures (China, Japan, South Korea): In East Asian cultures, there is often a preference for thinness as well, but with variations. In countries like China, Japan, and South Korea, there may be a cultural ideal of “slimness with curves,” where a slender body is desired but with some emphasis on certain curves and proportions. Moreover, fair skin is often associated with beauty and elegance in many East Asian cultures, leading to the popularity of skin-lightening products and practices (Noh et al., 2018).
  • Latin American cultures: In Latin American cultures, there is often a greater acceptance of fuller body types, and curves are often celebrated as symbols of beauty and femininity. This cultural preference for a curvier figure is reflected in media representations and beauty ideals. Additionally, there may be cultural rituals and celebrations, such as the quinceañera, where young women aged 15 years are celebrated and embraced for their natural beauty and femininity, regardless of body size or shape (United Nation Children’s Fund [UNICEF], 2023).
  • Pacific Islander and Polynesian cultures: In Pacific Islander and Polynesian cultures, there is often a cultural appreciation for larger body sizes, which are associated with health, fertility, and prosperity. This cultural attitude toward body size is reflected in traditional dances, where fuller figures are celebrated and admired (Brewis et al., 1998).
  • African cultures: In various African cultures, there is often a preference for larger body sizes, especially among women, which are associated with beauty, health, and fertility. Fuller figures are often celebrated and desired, reflecting cultural ideals of femininity and attractiveness (Naigaga et al., 2018).

These examples illustrate the diversity of cultural attitudes toward body image, emphasizing the importance of understanding and respecting cultural differences when addressing body image concerns in diverse populations.

The connection between body image and mental health is evident, with higher body dissatisfaction posing a risk for mental health problems such as depression, anxiety, and suicidal thoughts. A survey conducted by the Mental Health Foundation in 2019 revealed that over one-third of adults felt anxious or depressed due to body image concerns, and one in eight experienced suicidal thoughts or feelings (Mental Health Foundation, 2019). These findings align with research associating body dissatisfaction with a poorer quality of life, psychological distress, and an increased likelihood of depression symptoms. Furthermore, the report emphasizes the link between body image and mental health disorders like body dysmorphic disorder (BDD) (a mental health condition characterized by obsessive preoccupation with perceived flaws or defects in physical appearance that are not observable or appear minor to others) (Figure 32.3) and eating disorders (Mental Health Foundation, 2023). While body image concerns are identified as a risk factor for such mental health conditions, the report underscores that addressing body image extends beyond specific disorders, emphasizing the need for comprehensive mental health interventions and preventive measures.

Illustration of a slim person looking in a tall mirror and seeing the reflection as a heavier person.
Figure 32.3 Body dysmorphic disorder occurs when individuals have a distorted or impaired self-image, perceiving themselves as having a different body form than reality. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Concerns and worries about body image are prevalent among young people, with a survey by BE REAL indicating that 79 percent of 11- to 16-year-olds in the United Kingdom find their appearance important, and over half often worry about it (Mental Health Foundation, 2023). The Mental Health Foundation’s survey of young people aged 13 to 19 years further reveals that 35 percent frequently feel worried about their body image. Despite affecting all genders, girls are more likely to report dissatisfaction, with 46 percent expressing frequent worry compared to 25 percent of boys (Mental Health Foundation, 2023). Body image concerns in young people are identified as the third biggest challenge causing harm, following lack of employment opportunities and educational failure. The impact of body dissatisfaction extends beyond psychological distress, influencing risk-taking behaviors, such as dieting, cosmetic surgery consideration, and steroid use among adolescents. Studies in the United States showed similar findings. In 2021, the YouGov Body Image Study found that 51 percent of Americans feel pressured to achieve specific body types, and 62 percent of those in relationships worry about how their partners perceive them (YouGov, 2021).

The factors contributing to poor body image in children and young people are multifaceted. Pressure to conform to an “ideal” body type, shaming and bullying from peers and family, and emotional distress associated with a mindset of nonconformity all contribute to body dissatisfaction. Such ideals differ between genders, with young women pressured to be the typical thin, hourglass body type, and young men expected to be tall and muscular. These expectations are internalized through exposure to media representations of ideal bodies. The survey indicates that 25 percent of young people attribute their worries about body image to celebrities and 19 percent attribute them to TV shows (Mental Health Foundation, 2023). Social media exacerbates these concerns, with 40 percent of young people reporting that social media images cause them worry (Mental Health Foundation, 2023). Peer influence also plays a significant role, with friends contributing to worries about body image for 40 percent of young people (Mental Health Foundation, 2023). Family dynamics, parental behavior, and bullying further impact body image in children and adolescents, with appearance-based bullying linked to detrimental effects on mental health and body image (Mental Health Foundation, 2023).

Life-Stage Context

Body Image in Adulthood

In adulthood, the components of self-concept, particularly related to body image, play a crucial role in overall well-being. Increased body dissatisfaction has been correlated with higher rates of depressive symptoms, psychological distress, and development of disordered eating (e.g., skipping meals, restrictive eating, excessive exercise) and eating disorders (e.g., anorexia, bulimia, binge eating). Conversely, positive body image in adults is associated with better overall well-being and quality of life. A Mental Health Foundation survey highlighted that 34 percent of adults reported feeling anxious, and 35 percent reported feeling depressed due to concerns about their body image (Mental Health Foundation, 2023). Moreover, a concerning one in eight adults experienced suicidal thoughts or feelings related to their body image. The survey also revealed that body image concerns were associated with behaviors such as photo editing (7 percent) and contemplating cosmetic procedures like surgery, fillers, or Botox (8 percent) (Mental Health Foundation, 2023).

The impact of body image in adulthood extends beyond emotional well-being and is interconnected with relationships and sexual health. Positive body image has been linked to more positive sexual experiences, especially for women, while body image concerns may contribute to self-consciousness and negatively impact sexual experiences and responses. The survey indicated that one in five adults reported that their sex life had been negatively affected by their body image, and 15 percent mentioned a negative impact on their relationships in the past year (Mental Health Foundation, 2023).

Several factors influence body image in adulthood, similar to childhood, with internalization of “ideal” body types and social comparisons playing pivotal roles. The media, including advertising and social media, contributes significantly to body dissatisfaction, with approximately one in five adults expressing concerns about their body image due to images in advertising and social media. Peer interactions, workplace dynamics, pregnancy, new parenthood, and physical appearance further contribute to shaping body image perceptions in adulthood. Understanding these factors is crucial for devising interventions and support mechanisms to promote positive body image and mental well-being in adults (Mental Health Foundation, 2023).

Self-Esteem

Self-esteem, perhaps one of the most recognized components, represents the overall subjective evaluation of one’s worth and value. It is a composite of various factors, including achievements, interpersonal relationships, and societal comparisons. Healthy self-esteem is associated with resilience, positive coping mechanisms, and the ability to navigate life’s challenges. In contrast, low self-esteem may contribute to feelings of inadequacy, anxiety, and vulnerability. Recognizing the dynamic nature of self-esteem within the broader framework of self-concept is essential for healthcare professionals and behavioral counselors to support individuals in fostering a positive self-image.

Role Performance

How individuals perceive and execute their roles in different contexts within the family, work, or social environment is called role performance. This component integrates personal identity, body image, and self-esteem into action, influencing behavior and interactions. Effective role performance contributes to a sense of purpose, fulfillment, and positive reinforcement of self-concept. Understanding the interconnectedness of these components provides valuable insights for professionals aiming to empower individuals in developing and maintaining a healthy self-concept across diverse life stages and circumstances.

Measurements of Self-Concept

Trying to understand how people see themselves and how this can change in different situations can be challenging. To glean an accurate depiction, there are a few things healthcare providers should consider. For example, a patient may find it hard to determine their ideal self if they are in a fairly stable environment that does not require them to question themselves or consider new things about themselves. There are also differences in how comfortable people are in finding new things about themselves and their surroundings. Those who are somewhat flexible or feel comfortable in uncertain situations are more likely to change how they perceive themselves compared to someone who prefers stability and organization.

To understand how people see themselves, healthcare providers also should consider how people define themselves in certain areas of their lives. For example, some people base their identity heavily on close relationships, and changes in those relationships can lead to changes in how they view themselves. Determining a common scale on which to study and measure these changes can be daunting and often unreliable. To do this well, it is suggested to use different methods, consider how the study relates to real-life situations, and make sure the study is as close to a natural setting as possible. Table 32.1 presents some examples of self-concept tools commonly used by providers in different settings.

Test Description Format
Self-Concept and Identity Measure (SCIM) Assesses consolidated identity, disturbed identity, and lack of identity The questionnaire contains twenty-seven statements that aim to measure self-concept across six different aspects:
  • physical
  • social
  • temperamental
  • educational
  • moral
  • intellectual
The Personal Self-Concept Questionnaire (PSQ) A shorter measurement tool that provides an accurate representation of self-concept overall The questionnaire is made up of twenty-two statements, divided into four subcategories:
  • self-fulfillment
  • autonomy
  • honesty
  • emotional self-concept
The Five-Factor Self-Concept Questionnaire (AF5) Assesses five specific dimensions: academic, social, familial, emotional, and physical
*Developed in Spain and used primarily with Spanish-speaking patients
Thirty items, six for each dimension
Rating using a continuous response on a ninety-nine-point scale ranging from one (complete disagreement) to ninety-nine (complete agreement)
The Piers-Harris Children’s Self-Concept Scale A self-reporting tool that assesses self-concept in children and adolescents; can be used as a research tool, to monitor change in self-concept over time, and as a screening tool for identifying individuals who need further testing or treatment This is a sixty-question tool where the child circles “yes” or “no” to answer questions, covering six subcategories:
  • behavioral adjustment
  • intellectual and school status
  • physical appearance and attributes
  • freedom from anxiety
  • popularity
  • happiness and satisfaction
The Rosenberg Self-Esteem Scale A widely used self-report instrument for evaluating individual self-esteem A ten-item scale that measures global self-worth by measuring both positive and negative feelings about the self. The scale is believed to be unidimensional. All items are answered using a four-point Likert-type scale format, ranging from strongly agree to strongly disagree.
The Dimensions of Self-Concept (DOSC) A self-report survey for measuring noncognitive factors that are associated with self-concept or self-esteem in the school setting Seventy to eighty questions (depending on grade level) that measure the following:
  • level of anxiety
  • aspirations
  • academic interest and satisfaction
  • leadership and initiative
  • identification versus alienation
Table 32.1 Self-Concept Tools

Self-knowledge, self-expectations, and self-evaluation play crucial roles in the measurement and understanding of self-concept. Together, these components contribute to comprehensive measurements of self-concept by capturing both descriptive aspects (self-knowledge) and evaluative aspects (self-expectations and self-evaluation). By integrating these dimensions, researchers and practitioners can assess and understand how individuals perceive themselves across different contexts and domains, informing interventions aimed at promoting positive self-concept and psychological well-being.

Self-Knowledge

A philosophical term, self-knowledge is used to identify one’s own recognition of mental state—what one believes, feels, perceives, and desires. Self-knowledge serves as the cognitive foundation on which self-concept is constructed, providing the content and data that individuals use to formulate their perceptions and evaluations of themselves. Self-knowledge is genuine information one possesses about oneself, and components of self-knowledge encompass emotional states, personality traits, relationships, behavioral patterns, opinions, beliefs, values, needs, goals, preferences, and social identity. Self-knowledge results from self-reflective and social processes, deriving not only from introspection but also from five sources: the physical world, social comparisons, reflected appraisals, introspection, and self-perception (Wilson, 2021). Additionally, Schaffner (2020) includes cognitive-behavioral therapy (CBT) (a structured talk therapy that focuses on problematic thinking and behaviors and helps to create healthy thinking, behaviors, and coping skills) and mindfulness techniques as sources of self-knowledge.

Self-concept measurements rely on individuals’ awareness and understanding of themselves. Self-knowledge provides the foundational data about one’s traits, values, abilities, and experiences, which are essential for assessing how individuals perceive themselves in various domains. For example, self-knowledge informs responses to questionnaires or assessments that inquire about personal characteristics and behaviors.

Understanding oneself is crucial for healthy functioning and promoting realistic decision-making regarding key aspects of life. Lack of self-knowledge can adversely affect life partner choices, education and career decisions, and lifestyle choices. Deficits in self-knowledge may lead to exaggeration of subjective strengths, impacting life satisfaction and academic performance negatively. The importance of self-knowledge for psychological growth includes satisfying the desire to learn from experiences, preventing discord between self-perceptions and the perceptions of others, releasing oneself from unconscious notions, facilitating proactive responses, and serving as a necessary first step for positive change. Furthermore, self-knowledge promotes emotional balance; reduces work frustration, insecurity, and envy; decreases stress; enhances responsibility for emotions; fosters empathy and compassion; and shapes understanding of others (Wilson, 2021).

Self-knowledge also plays a crucial role in nursing and healthcare contexts, as it helps nurses manage stress related to patient care and workplace dynamics, fostering a deeper understanding of their own emotions and reactions. Self-knowledge also supports nurses in taking responsibility for their emotional responses, which is vital in maintaining professional boundaries and providing empathetic care to patients. By understanding their own strengths, limitations, and values, nurses can cultivate empathy and compassion toward patients and colleagues alike. This self-awareness also contributes to a deeper understanding of patients’ perspectives and needs, thereby improving overall patient care and outcomes in healthcare settings.

Global Self

The concept that we are all part of a collective being is called global self, like a global family where our actions have far-reaching impacts. It emphasizes the interconnectedness of people and cultures around the world. Various types of global self are highlighted, including cultural global self, shaped by exposure to diverse cultures; environmental global self, emphasizing responsible interaction with the planet; social global self, focusing on global friendships and community impact; digital global self, reflecting our online presence and connections; and economic global self, recognizing the influence of our purchasing choices on the world economy. These types encourage a holistic understanding of our role in a global context, extending beyond geographical and cultural boundaries.

Self-Expectations

Expectations are personal beliefs about what should or will happen. They include influential and challenging self-expectations regarding what individuals should do, think, or feel. These expectations, often shaped by societal influences, cultural norms, and personal values, guide behavior and judgments. While some expectations can be positive, providing motivation to face challenges and pursue dreams, unrealistic expectations may lead to conflict, frustration, and self-doubt. Self-awareness in managing expectations is significant, particularly when unrealistic self-expectations contribute to negative self-beliefs and potential mental health issues, like anxiety and compassion fatigue. Balancing needs, desires, values, and beliefs is integral, emphasizing the importance of cultivating realistic expectations for nurturing a healthy self-esteem and experiencing fulfillment in life.

Self-concept measurements often include assessments of individuals’ expectations and aspirations for themselves. These expectations reflect their ideal self, encompassing goals, desires, and future-oriented aspects of identity. By measuring self-expectations, researchers and practitioners gain insights into how individuals perceive their potential and aspirations relative to their current self-perceptions.

The broader impact of expectations extends beyond self-expectations to include expectations of others. Individuals can unintentionally set expectations for themselves based on assumptions of how others will react, potentially leading to feelings of failure and resentment. Unrealistic expectations in various aspects of life, from striving for constant happiness to setting standards based on societal perceptions and social media influences, can have a negative impact on the quality of life. While setting high expectations often stems from a desire for a perfect outcome, acknowledging and learning from mistakes is crucial for personal growth and success. By highlighting the importance of recognizing strengths and weaknesses as a means of cultivating self-awareness, people are able to manage expectations effectively, building a more satisfying life.

Real RN Stories

When High Expectations Lead to Burnout

Nurse: Beth, BSN
Clinical setting: Medical-surgical unit
Years in practice: 2
Facility location: Inner city Washington, DC

I had just landed my dream job at a prestigious hospital downtown and had high self-expectations. I wanted to be a “rock star” nurse and save lives, just like you see on TV. I was super busy throughout all of my shifts and hardly had time to eat at work; however, I kept pushing through because I needed to be the rock star nurse my patients needed. My personal life was deteriorating (my husband and I were like distant roommates), and I dreaded going home, so I would pick up more shifts at the hospital. I was always so tired when I got home, all I wanted to do was sleep. I hardly talked to my friends or did anything fun because I worked so much and was utterly exhausted all the time. I didn’t realize it at the time, but I pushed myself way too hard and quickly became burned out.

One day while I was at work, I passed out. As embarrassing as that was, it was my wake-up call. I was forced to take time off from work and face the real world as well as my personal problems. During my mandatory time off, I had conversations with my husband, and we decided to separate. I also began to see a therapist and take medication for depression. When it was finally time for me to return to work, I had developed a stronger sense of work-life balance and developed healthy self-expectations. It’s still a work in progress, but I’ve decided to make myself a priority.

Ideal Self

The concept of the self encompasses different aspects, including the actual self, ideal self, and ought self. The actual self, or real self, represents the attributes believed to be possessed by an individual, as perceived by oneself or others (Figure 32.4). On the other hand, the ideal self consists of attributes one or others aspire for the individual to possess, while the ought self refers to the internalized expectations and standards that individuals believe they should or must adhere to in order to meet external demands, social norms, or moral obligations.

These different facets of the self can lead to internal conflicts, manifesting as disparities between the actual self and the ideal or ought self. Such discrepancies can serve as motivational factors, prompting individuals to undertake actions for self-improvement. For example, imagine a registered nurse who sees themself as compassionate and dedicated to patient care (actual self). However, their ideal self-image includes becoming a nurse practitioner specializing in oncology. Meanwhile, their ought self involves meeting the expectations of their healthcare team and adhering to clinical protocols and patient safety standards. The gap between their current role as a nurse and their ideal self as a nurse practitioner may motivate them to pursue further education, seek certification, and gain clinical experience in oncology. Simultaneously, balancing their ought self with patient care demands and clinical responsibilities requires them to integrate compassionate care with procedural adherence and team collaboration.

Two ovals that overlap. Left oval is labeled Real Self (Actualizing tendency, Positive regard, Self-regard) while right oval is labeled Ideal self (Striving, Ambitious, Self-worth.)
Figure 32.4 When our real self and ideal self overlap, harmony occurs. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Moreover, conflicts between the ideal and ought selves can induce heightened stress, particularly when individuals, such as professional women with both career aspirations and maternal duties, perceive a misalignment between their ideal vision and perceived obligations. The resulting actual self may fall short of meeting expectations in either realm. These disparities extend beyond cognitive unease, influencing emotional, behavioral, and communicative responses. When assessing the actual self in comparison to ideal self and external expectations, distinct patterns of emotional and behavioral consequences emerge. Mismatch with personal ideals may evoke feelings of disappointment and frustration, as exemplified by the financial discipline scenario. Similarly, discrepancies with others’ ideals can elicit emotions such as shame and embarrassment, as experienced when academic performance falls short of expectations. Conflicts with perceived duties or obligations may lead to agitation and fear of potential repercussions, exemplified by the dilemma of following familial expectations versus personal aspirations. Last, incongruence with one’s own sense of duties may evoke feelings of guilt and inadequacy. For example, in nursing, when a nurse’s actual self, ideal self (aiming for specialized expertise in critical care), and ought self (fulfilling hospital protocols and team expectations) are not aligned, it can evoke feelings of guilt and inadequacy. The nurse may feel guilty when unable to dedicate enough time to specialized patient care during demanding shifts, leading to a sense of inadequacy in meeting both patient needs and professional standards. This overview outlines the four potential discrepancies between selves and the associated emotional outcomes, emphasizing the intricate interplay between internal and external expectations on individuals’ well-being and self-perception.

False Self

Donald Winnicott, a pediatrician and psychoanalyst, stressed how important it is to keep our mental energy strong when there is constant pressure to fit in. His focus was on the individual’s ability to be “alive” and spontaneous, and how these qualities can be lost when we start to take on what society expects from us (Ehrlich, 2021). This pressure ultimately causes issues of frustration, anger, and sadness. Winnicott believed that the false self, pretending to be someone we are not, begins in infancy due to unmet maternal needs.

The pervasive impact of shame, marked by a sense of inherent inadequacy and unworthiness, often compels individuals to construct a false self in the pursuit of acceptance. The fear of rejection and humiliation drives an individual to garner approval, perpetuating anxiety and a diversion of embracing one’s genuine, authentic self. In a quest for safety, individuals alter their identities and expend a considerable amount of energy to meet perceived expectations for love and acceptance. This self-imposed pressure to conform leads many to showcase attributes such as intelligence and skill, beauty, or accomplishments, at the cost of authenticity. Shame and authenticity share an intertwined relationship, influencing self-perception and external presentation. When rooted in the belief of personal flaws, shame disconnects individuals from innate, spontaneous joy, inhibiting the development of self-worth. Recognizing the presence of shame enables individuals to break free from destructive influence, empowering the true self despite external judgments. The journey toward authenticity is viewed as an ongoing process of mindful self-awareness, disentangled from the corrosive influences of shame and inner criticism, allowing individuals to navigate complexities, acknowledge existence without being defined by it, and ultimately spread their wings to savor the richness of life (Amodeo, 2020).

Self-Evaluation

In psychology, self-evaluation refers to the process by which individuals assess and judge their own thoughts, feelings, behaviors, and overall sense of self. It involves reflective thinking about one's own characteristics, performance, and experiences. Self-evaluation can encompass various aspects, including self-esteem, self-worth, self-perception, and self-reflection.

Key components of self-evaluation include the following:

  • Self-esteem: The overall positive or negative evaluation of oneself. It reflects an individual’s feelings of self-worth and confidence. For example, despite facing a challenging shift, a nurse may experience high self-esteem when they maintain composure and effectively manage multiple patient care tasks, feeling confident in their abilities as a caregiver.
  • Self-perception: How individuals perceive themselves in terms of their abilities, competencies, and characteristics is self-perception. A nurse's self-perception as a compassionate caregiver, for instance, may be affirmed when they receive positive feedback from a patient’s family for their attentive and empathetic approach during a difficult shift.
  • Self-reflection: Thoughtful contemplation about one’s actions, motivations, and personal growth is self-reflection. It involves assessing one’s values, goals, and the alignment between behaviors and personal standards. For instance, a nurse may engage in self-reflection after a particularly demanding shift, considering how their communication with patients and families could be improved to provide clearer information and emotional support during stressful times.
  • Self-awareness: Recognizing and understanding one’s emotions, thoughts, and behaviors is self-awareness. A nurse’s self-awareness, for example, allows them to recognize feelings of frustration and burnout during a busy shift, prompting them to take breaks and seek support from colleagues to better manage stress and maintain quality patient care.

Self-evaluation can be influenced by various factors, including social comparisons (comparing oneself to others), cultural norms, feedback from others, and personal experiences. It plays a significant role in shaping an individual’s self-concept and can impact mental well-being.

Self-concept measurements involve evaluating how individuals assess their own qualities, abilities, and behaviors. This self-evaluation component reflects their self-esteem (positive or negative feelings about oneself) and the alignment between their perceived self and ideal self. Self-evaluation measurements assess the degree of satisfaction or dissatisfaction individuals feel about their self-perceptions, which is crucial for understanding their overall self-concept. Psychologists often study self-evaluation processes to understand how individuals perceive themselves, how they cope with successes and failures, and how these perceptions influence behavior and mental health. The ability to engage in constructive and realistic self-evaluation is considered essential for personal development and psychological well-being (Song, 2021).

Significance

When people assess themselves, they tend to think of their ideal selves—an almost perfect version of who they want to be. This idealized view can lead to biased evaluations. Even if individuals cannot always act like their ideal selves, they often rate themselves more positively during self-evaluation. It is common for people to think less critically of themselves than they do of others. Understanding that these evaluations can be biased helps individuals form a more balanced self-concept. People may overestimate their abilities, and when they face failure, they tend to attribute the reasons to external factors rather than themselves (Song, 2021).

Recognizing that individuals might sometimes misjudge their capabilities allows them to develop a clearer self-concept. Social comparison, where people constantly compare themselves to others, can lead to assimilation in self-evaluations, making an individual’s assessment more like their peers. Providing people with a realistic view of their capabilities helps them gain a better understanding of what they can do and reduces assimilation to some extent.

Competence

The degree of effectiveness and proficiency individuals perceive in themselves is called competence. It involves not only objective assessments of performance but also subjective evaluations relative to personal standards and aspirations. Individuals gauge their competence in academic, professional, social, and personal spheres, reflecting on their achievements, strengths, and areas for improvement. Positive self-perceptions of competence foster confidence, motivation, and a sense of efficacy, empowering individuals to pursue their goals and navigate life’s challenges with resilience. Conversely, perceived deficits in competence may lead to feelings of inadequacy, self-doubt, and impostor syndrome (a psychological pattern in which individuals doubt their skills, talents, or accomplishments and have a persistent internalized fear of being exposed as a “fraud”), hindering personal growth and well-being.

Virtue

The moral dimension of self-evaluation, virtue, encompasses individuals’ reflections on their character, values, and ethical conduct. It involves assessing the alignment between one’s actions, intentions, and moral principles, as well as the perceived consistency with societal or cultural norms of virtuous behavior. Positive self-evaluations of virtue contribute to feelings of moral integrity, self-respect, and authenticity, fostering a sense of purpose and meaningful connection with others. Conversely, negative self-perceptions in this domain, such as feelings of guilt, shame, or moral conflict, may arise when individuals perceive a disconnect between their actions and their values, leading to inner turmoil and existential questioning.

Power

An individual’s perception of their ability to influence or control outcomes, resources, or other individuals within their social environment is called power. It encompasses both personal agency and social influence, spanning domains such as work, relationships, and community involvement. Positive self-evaluations of power cultivate feelings of autonomy, assertiveness, and efficacy, enabling individuals to assert their needs, pursue their goals, and advocate for change. However, perceived powerlessness or lack of control may engender feelings of frustration, helplessness, or vulnerability, undermining individuals’ sense of agency and impeding their ability to effect change in their lives and communities. Recognizing and leveraging personal sources of power can empower individuals to assert themselves confidently, navigate power dynamics effectively, and strive for greater equity and justice in society.

Development of Self-Concept

Just as forming strong connections is a crucial milestone in infancy, a significant step in childhood is developing a positive sense of self. Initially, babies do not recognize themselves in a mirror until they are approximately 18 months old. Between ages 24 and 36 months, children can point to themselves in pictures, demonstrating self-recognition (Archer, 1992).

From ages 2 to 4 years, children become more social after establishing a self-concept. They enjoy playing with other kids but might find it challenging to share their belongings. Through play, they explore gender roles and can label themselves as a girl or boy. By the age of 4 years, children can cooperate, share, and separate from parents with less anxiety, displaying autonomy by initiating tasks and carrying out plans. Success in these areas contributes to a positive self-concept. At 6 years old, children identify themselves in terms of group memberships, like being a first grader. They start comparing themselves to peers, recognizing their strengths and areas for improvement. This self-awareness continues into adolescence, where teens form their identities and internalize messages about their strengths and weaknesses, contributing to their ability to positively impact society. Developing a positive self-concept is vital for healthy growth, influencing confidence, academic performance, independence, and a willingness to try new activities.

Reflected Appraisal

The process by which our self-concept is affected by what other people think of us is called reflected appraisal; how we see ourselves is influenced by how others see us. Sociologist Charles H. Cooley described reflected appraisal as a concept called the “looking glass self” (Figure 32.5) (Cooley, 1902). In his assumption, Cooley suggested that how we understand others’ perception of us impacts the development of our self-concept. In other words, social interactions, especially those that are important to us, play an integral role in the development of our sense of self. Words used to describe us, such as smart or athletic, have an effect on how we aspire to encompass these characteristics as well as how we portray ourselves. When asked to describe ourselves, we often will use these same words as they are now part of our self-concept. In contrast, words such as “withdrawn” or “lazy” can negatively impact the way we portray ourselves, as self-concept has been affected in a negative way.

Drawing titled “The Looking Glass Self” depicts figure in front of four mirrors reflecting image in different ways: with halo (How my parents see me), with wings above their arms (How my partner sees me), with wings underneath their arms (How my older sibling sees me), with devil horns (How my ex-partner sees me).
Figure 32.5 The concept of the “looking glass self” represents the dynamics of reflected appraisal. (modification of “The looking glass self” by “Rcragun”/Wikipedia, CC BY 3.0)

According to symbolic interactionism, the way we see ourselves is influenced by how others see us. Self-concept is developed during childhood and continues to be refined through adolescence. The foundation of self-concept is based on three basic conditions: (1) a connection between children’s self-perceptions and their perceptions of how others see them (reflected appraisals), (2) a link between children’s reflected appraisals and others’ actual appraisals, and (3) a relationship between children’s self-perceptions and others’ actual appraisals. The model suggests that actual appraisals of significant others influence reflected appraisals, which, in turn, affect self-perception (Hergovich et al., 2002). For example, mothers, fathers, and teachers have an impact on different areas of self-concept, mothers generally being more influential.

Social Comparison

Human nature drives individuals to measure themselves against others, assessing looks, success, friendships, and social status. In 1954, psychologist Leon Festinger suggested that we evaluate ourselves in comparison to others, and those judgments influence our self-concept. This concept is known as social comparison theory. Some influence our self-concept more than others. Upward social comparison occurs when we compare ourselves with those we see as better than us. These comparisons tend to focus on the desire to improve ourselves. Downward social comparison occurs when we compare ourselves with those we see as worse off than us. These comparisons often focus on making us feel better about ourselves and our abilities.

Clinical Safety and Procedures (QSEN)

Understanding Social Comparison in Health Care

Social comparison theory suggests that individuals evaluate themselves and their abilities by comparing themselves to others. In healthcare settings, patients may engage in social comparison with peers, benchmarks, or societal norms, influencing their perceptions of health, treatment adherence, and satisfaction with care.

  • Patient perceptions:
    • Patient-centered care: Recognize patients’ unique perspectives and experiences, acknowledging the impact of social comparison on their self-perception and well-being.
    • Communication: Foster open dialogue with patients, encouraging them to express concerns or challenges related to social comparison and providing empathetic support.
    • Teamwork and collaboration: Collaborate with interdisciplinary teams to address patients’ psychosocial needs and develop personalized care plans that consider the influence of social comparison dynamics.
  • Treatment adherence:
    • Evidence-based practice: Implement evidence-based strategies to enhance treatment adherence, considering the role of social comparison in influencing patient behavior and decision-making.
    • Quality improvement: Identify opportunities to improve patient education and support systems to mitigate the negative effects of social comparison on treatment adherence and health outcomes.
  • Satisfaction with care:
    • Patient-centered care: Tailor care approaches to meet patients’ individual needs and preferences, fostering a sense of autonomy and empowerment that mitigates the impact of social comparison on satisfaction with care.
    • Informatics: Utilize health informatics tools to monitor patient satisfaction metrics and identify areas for improvement in addressing social comparison dynamics within healthcare delivery systems.
  • Implications for practice:
    • Encourage healthcare professionals to be mindful of the influence of social comparison dynamics on patient behavior and well-being.
    • Foster open communication and supportive relationships with patients, addressing individual needs and preferences to minimize the effects of social comparison.
    • Promote a strengths-based approach to care that emphasizes each patient’s unique journey and progress, helping patients focus on their own goals and achievements rather than comparing themselves to others.

By recognizing the role of social comparison in patient care, nurses and healthcare professionals can adopt strategies to support patients effectively, enhance treatment adherence, and improve overall satisfaction with care. Through empathy, understanding, and patient-centered approaches, healthcare providers can mitigate negative effects of social comparison and foster positive patient outcomes.

Stages

Development of a positive self-concept is important to healthy development. Children with a positive self-concept tend to be more confident, do better in school, act more independently, and are more willing to try new activities (Ferrer & Fugate, 2003; Maccoby, 1980). Formation of a positive self-concept begins in Erikson’s toddlerhood stage, when children establish autonomy and become confident in their abilities. Development of self-concept continues in elementary school, when children compare themselves to others. When the comparison is favorable, children feel a sense of competence and are motivated to work harder and accomplish more. Self-concept is reevaluated in Erikson’s adolescence stage, as teens form an identity. They internalize the messages they have received regarding their strengths and weaknesses, keeping some messages and rejecting others. Adolescents who have achieved identity formation are capable of contributing positively to society (Erikson, 1968).

Patient Conversations

Developing Self-Concept

Scenario: A parent asks his child’s nurse if he can speak to the nurse privately. After the child is led outside by another nurse, the parent explains that the child just turned 12 years old and is experiencing problems in school that are affecting her self-concept. In particular, the child is struggling to earn passing grades in math, and following a recent growth spurt, she lacks the coordination needed to do well in gym class.

Nurse: Have you talked to the child about these problems?

Parent: No. I’m not sure what to say. I talked to her teacher, and the teacher said that all children have problems occasionally. The teacher suggested that I should be patient and let the problems sort themselves out. But my daughter seems depressed, and in recent weeks, she has refused to socialize with her friends. She also claimed to be sick one day last week and again this week, missing school as a result. That’s why I brought her to see you. If she’s sick, she needs to be treated. But I’m concerned that her real problem is frustration with math and gym classes, and she’s feeling down on herself. What should I do?

Nurse: Twelve can be a difficult age as children prepare to become teenagers. I recommend talking to your daughter and encouraging her to tell you why she seems down. Tell her that everyone goes through times in life when things seem challenging and even scary. Tell her about times in your life when you felt down. Make sure she understands that you understand and that it’s okay for her to tell you about any problems that she is having.

Parent: Aside from talking to her, what else should I do?

Nurse: It is important to make sure she feels safe and secure. Focus on her accomplishments and praise her for things that she does well. If you feel comfortable doing it, mention the math and gym classes and explain that everyone has areas in their lives where they struggle and even fail. Make sure she understands that it’s okay to fail, and you still love her. Also, offer to help her. Maybe a tutor can help her understand math, and if you play basketball or another sport with her, maybe you can help her improve her coordination. Help her set realistic goals in these areas that are achievable, and then give her the tools she needs to reach those goals.

Parent: Thank you for listening and offering suggestions. I will try these things.

Self-Awareness (Infancy)

During infancy, the development of self-concept begins with the foundation of self-awareness. Infants gradually become aware of their own bodies and sensations, distinguishing themselves from their environment. This initial stage is marked by simple sensory experiences, such as recognizing their own movements, sounds, and bodily sensations. Infants may display rudimentary forms of self-recognition, such as looking at their own hands or exploring their reflections in a mirror. When babies encounter a mirror, their first instinct is to hit it, not realizing it is a reflection of themselves. This early stage signifies a lack of self-recognition, where babies do not yet comprehend that the image in the mirror is a reflection of themselves. However, newborns do have an innate ability to differentiate between their image and the background as well as between themselves and their surroundings, indicating an early sense of self as a distinct entity.

Around 2 months old, babies start manipulating the mirror image, or gaining awareness of how their bodies relate to the environment. This stage is critical as it marks the beginning of understanding their physical presence in the world. An example is being able to estimate the distance to an object and then reaching for it. Studies indicate that even though newborns can mimic facial expressions, it is around 2 months of age that they learn to manipulate their bodies in response to the environment (Krisch, 2023). As they enter into 3 and 4 months of age, they begin to demonstrate their ability to imitate an adult sticking out their tongue in a specific direction and reach for objects around them. These behaviors reflect a growing recognition of their own actions and their effects on the environment, reinforcing their developing self-concept.

Caregivers play a crucial role in nurturing self-awareness during infancy through responsive interactions and sensitive attunement to the infant’s cues and needs. By providing loving care and attention, caregivers help infants develop a sense of security and trust in their own bodies and surroundings, laying the groundwork for further exploration and self-discovery.

Self-Recognition (18 Months)

Just as attachment is the main psychosocial milestone of infancy, the primary psychosocial milestone of childhood is the development of a positive sense of self. How does self-awareness develop? Infants do not have a self-concept, which is an understanding of who they are. If you place a baby in front of a mirror, the baby will reach out to touch their image, thinking it is another baby. However, by about 18 months, a toddler will recognize that the person in the mirror is themself. How do we know this? In a well-known experiment, a researcher placed a red dot of paint on children’s noses before putting them in front of a mirror (Amsterdam, 1972). Commonly known as the mirror test, this behavior is demonstrated by humans and a few other species and is considered evidence of self-recognition (Archer, 1992). At 18 months old, they would touch their own noses when they saw the paint, surprised to see a spot on their faces. By 24 to 36 months old, children can name and/or point to themselves in pictures, clearly indicating self-recognition.

This newfound self-recognition reflects cognitive advances and an emerging sense of identity. Toddlers start to understand that they have personal attributes and characteristics that distinguish them from others. This awareness lays the groundwork for the development of self-esteem and self-concept, as children begin to form judgments about themselves based on their perceptions and experiences.

Caregivers and parents continue to play a crucial role during this stage by providing positive reinforcement and encouragement. They validate the child’s emerging sense of self by acknowledging and celebrating their achievements, preferences, and individuality. By offering praise, affection, and support, caregivers contribute to the development of a positive self-image and self-esteem in the child.

Additionally, social interactions with peers become increasingly important during this stage, as children start to compare themselves to others. Through play and exploration with peers, toddlers learn more about their own abilities, preferences, and social roles. These interactions provide valuable opportunities for self-discovery and understanding as children navigate social dynamics and learn to negotiate their place within their peer group.

Self-Definition (3 Years)

By the age of 3 years, children enter a stage of self-concept development known as self-definition, where they begin to form a more coherent and elaborate understanding of themselves. During this crucial period, children start to describe themselves in concrete terms, using characteristics such as age, gender, physical attributes, and preferences to define their identity.

Language skills play a significant role in this process, as children become increasingly adept at expressing their thoughts, feelings, and perceptions. They may use phrases like, “I am a big boy/girl,” “I like to play with dolls/cars,” or “I have brown hair and blue eyes” to describe themselves to others. These self-descriptions reflect their growing awareness of personal attributes and preferences, as well as their ability to distinguish themselves from others.

Caregivers and educators continue to play a vital role in supporting children’s self-definition during this stage. By providing opportunities for self-expression, validation, and positive reinforcement, adults help children develop a positive self-image and self-esteem. Encouraging children to talk about their interests, accomplishments, and feelings fosters a sense of autonomy and confidence in their identity.

Social interactions with peers also contribute to the development of self-definition. Through play, cooperation, and conflict resolution, children learn more about their own abilities, strengths, and limitations in relation to others. They begin to understand their social roles and develop a sense of belonging within their peer group, further shaping their self-concept.

At this stage, children’s self-definition is still largely concrete and based on observable characteristics. However, it lays the groundwork for more complex aspects of self-concept to emerge in later stages of development. As children continue to grow and mature, their self-definition will become more nuanced and multifaceted, incorporating factors such as personality traits, values, beliefs, and aspirations. Through ongoing exploration, reflection, and social interaction, children gradually construct a richer and more comprehensive understanding of themselves and their place in the world.

Self-Concept (6 to 7 Years)

Between the ages of 6 and 7 years, children undergo significant development in their self-concept, which encompasses their beliefs, perceptions, and evaluations of themselves. During this stage, children begin to internalize and integrate various aspects of their identity, including their abilities, personality traits, social roles, and relationships with others.

One key aspect of self-concept development during this stage is the emergence of social comparison and self-evaluation. Children become more aware of how they stack up against their peers in terms of academic performance, athletic abilities, social skills, and other domains. They may start to compare themselves to others and form judgments about their own competence and worth based on these comparisons. For example, 10-year-old Layla may say, “I’m kind of shy. I wish I could be more talkative like my friend Alexa.”

At the same time, children’s self-concept becomes increasingly influenced by feedback from others, including parents, teachers, peers, and media. Positive reinforcement and encouragement from significant others can bolster children’s self-esteem and confidence, while criticism or negative feedback may lead to feelings of inadequacy or self-doubt.

Children also begin to develop a more differentiated and nuanced understanding of themselves, recognizing their strengths and weaknesses across different domains. They may identify specific interests, talents, and preferences that shape their sense of identity and self-worth. Additionally, children become more aware of societal norms and expectations, which can influence their beliefs about what it means to be “good,” “smart,” or “successful.”

During this stage, caregivers and educators play a crucial role in supporting children’s self-concept development. By providing opportunities for success, offering constructive feedback, and fostering a supportive and inclusive environment, adults can help children develop a positive and realistic sense of self. Encouraging children to explore their interests, set goals, and pursue their passions can also contribute to their self-confidence and self-esteem.

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