MS. RITIKA SONI ASS. PROFESSOR SHIMLA

1. Promoting
Self-Esteem
Presenter :Ms. Ritika
Soni

2. OUTLINE
SELF CONCEPT
COMPONENTS OF SELF CONCEPT
SELF- ESTEEM
DEVELOPMENT OF SELF-ESTEEM
DEVELOPMENTAL PROGRESSION OF SELF-
ESTEEM THROUGHOUT LIFESPAN
MENIFESTATIONS OF LOW SELF-ESTEEM
SYMPTOMS OF LOW SELF –ESTEEM
BOUNDARIES
ESTABLISHING BOUNDARIES
NURSING PROCESS

3. Self-Concept
Self-concept is the cognitive or thinking
component of the self, and generally refers to
the totality of a complex, organized, and
dynamic system of learned beliefs, attitudes
and opinions that each person holds to be
true about his or her personal existence
(Huitt, 2004).

4. COMPONENTS OF SELF-CONCEPT
1. Physical Self or Body Image:
• An individual’s body image is a subjective perception
of one’s physical appearance based on self-evaluation
and on reactions and feedback from others.
• Body image is the mental picture a person has of his or
her own body. It significantly influences the way a
person thinks and feels about his or her body as a
whole, its functions, and the internal and external
sensations associated with it.
• It also includes perceptions of the way others see the
person’s body and is central to self-concept and self-
esteem.

5. • A disturbance in one’s body image may occur
with changes in structure or function.
Examples of changes in bodily structure
include amputations, mastectomy, and facial
disfigurements. Functional alterations are
conditions such as colostomy, paralysis, and
impotence.
• Alterations in body image are often
experienced as losses.

6. 2. Personal Identity:
This component of the self-concept is composed of the
moral–ethical self, the self-consistency, and the self ideal/
self-expectancy.
a) The moral–ethical self is that aspect of the personal
identity that evaluates who the individual says he or she
is. This component of the personal self observes,
compares, sets standards, and makes judgments that
influence an individual’s self-evaluation.
b) Self-consistency is the component of the personal identity
that strives to maintain a stable self-image. Even if the self-
image is negative, because of this need for stability and
self-consistency, the individual resists letting go of the
image from which he or she has achieved a measure of
constancy.

7. c) Self-ideal/self-expectancy relates to an
individual’s perception of what he or she
wants to be, to do, or to become. The concept
of the ideal self arises out of the perception
one has of the expectations of others.
 Disturbances in self-concept can occur when
individuals are unable to achieve their ideals
and expectancies.

8. Self-Esteem
• Self-esteem refers to the degree of regard or
respect that individuals have for themselves
and is a measure of worth that they place on
their abilities and judgments.

9. Self-Esteem
Warren (1991) states:
Self-esteem breaks down into two components:
(1) the ability to say that “I am important,” “I matter,”.
(2) the ability to say “I am competent,” “I have
something to offer to others and the world.

10. • Maslow (1970) postulates that individuals
must achieve a positive self-esteem before
they can achieve self actualization

11. DEVELOPMENT OF SELF-
ESTEEM
Cooper smith (1981) identified the
following antecedent conditions of
positive self-esteem.
1. Power:
It is important for individuals to
have a feeling of control over their
own life situation and an ability to
claim some measure of influence
over the behaviors of others.
2. Significance:
Self-esteem is enhanced when
individuals feel loved, respected, and
cared for by significant others.

12. 3. Virtue:
Individuals feel good about themselves when
their actions reflect a set of personal, moral, and
ethical values.
4. Competence:
Positive self-esteem develops out of one’s ability to
perform successfully or achieve self expectations
and the expectations of others.
5. Consistently set limits:
A structured lifestyle demonstrates acceptance
and caring and provides a feeling of security.

13. • Warren (1991) outlined the following focus
areas to be emphasized by parents and others
who work with children when encouraging the
growth and development of positive self-
esteem:

14. 1.A Sense of Competence:
Everyone needs to feel skilled at something.
Warren (1991) states, “Children do not
necessarily need to be THE best at a skill in
order to have positive self-esteem; what they
need to feel is that they have accomplished
their PERSONAL best effort.”

15. 2. Unconditional Love:
Children need to know that they are loved and accepted by family and
friends regardless of success or failure. This is demonstrated by
expressive touch, realistic praise, and separation of criticism of the
person from criticism of the behavior.
3. A Sense of Survival:
Everyone fails at something from time to time. Self-esteem is
enhanced when individuals learn from failure and grow in the
knowledge that they are stronger for having experienced it.
4. Realistic Goals:
Low self-esteem can be the result of not being able to achieve
established goals. Goals can be unrealistic when they are beyond a
child’s capability to achieve, require an inordinate amount of effort
to accomplish, and are based on exaggerated fantasy.

16. 5. A Sense of Responsibility:
Children gain positive self-worth when they are
assigned areas of responsibility or are expected
to complete tasks that they perceive are valued
by others.
6. Reality Orientation:
Personal limitations abound within our world, and
it is important for children to recognize and
achieve a healthy balance between what they can
possess and achieve, and what is beyond their
capability or control.

17. • Other factors that have been found to be influential
in the development of self-esteem include:
1. The Responses of Others:
The development of self esteem can be positively
or negatively influenced by the responses of
others, particularly significant others, and by how
individuals perceive those responses.
2. Hereditary Factors:
Factors that are genetically determined, such as
physical appearance, size, or inherited infirmity, can
have an effect on the development of self-esteem.
3. Environmental Conditions:
The development of self-esteem can be influenced by
demands from the environment. For example,
intellectual prowess may be incorporated into the
self-worth of an individual who is reared in an
academic environment.

18. Developmental Progression of Self-Esteem
Through the Life Span

19. • The development of self-esteem progresses
throughout the life span.
• Erikson’s (1963) theory of personality
development provides a useful framework for
illustration.
• When an individual fails to achieve the tasks
associated with a developmental stage,
emotional growth is inhibited, and he or she is
less able to cope with subsequent
maturational or situational crises.

20. 1. Trust Versus Mistrust
(Birth to 18 months)
- The development of trust results in a feeling of
confidence in the predictability of the
environment.
- Achievement of trust results in positive self-
esteem through the instillation of self-
confidence, optimism, and faith in the
gratification of needs.
- Unsuccessful resolution results in the individual
experiencing emotional dissatisfaction with the
self and suspiciousness of others, thereby
promoting negative self-esteem.

21. 2. Autonomy Versus Shame and Doubt
(18 months to 3 years)
- With motor and mental development come greater
movement and independence within the environment.
- The child begins active exploration and experimentation.
- Achievement of the task results in a sense of self-control
and the ability to delay gratification, as well as a feeling of
self-confidence in one’s ability to perform.
- This task remains unresolved when the child’s independent
behaviors are restricted or when the child fails because of
unrealistic expectations.
- Negative self-esteem is promoted by a lack of self-
confidence, a lack of pride in the ability to perform, and a
sense of being controlled by others.

22. 3. Initiative Versus Guilt
(3 to 6 years)
- Positive self-esteem is gained through initiative when
creativity is encouraged and performance is recognized and
positively reinforced.
- In this stage, children strive to develop a sense of purpose
and the ability to initiate and direct their own activities.
- This is the stage during which the child begins to develop a
conscience.
- He or she becomes vulnerable to the labeling of behaviors
as “good” or “bad.”
- Guidance and discipline that rely heavily on shaming the
child creates guilt and results in a decrease in self-esteem.

23. 4. Industry Versus Inferiority
(6 to 12 years)
- Self-confidence is gained at this stage through
learning, competing, performing successfully, and
receiving recognition from significant others,
peers, and acquaintances.
- Negative self-esteem is the result of non-
achievement, unrealistic expectations, or when
accomplishments are consistently met with
negative feedback. The child develops a sense of
personal inadequacy.

24. 5. Identity Versus Role Confusion
(12 to 20 years)
- During adolescence, the individual is striving to redefine
the sense of self. Positive self-esteem occurs when
individuals are allowed to experience independence by
making decisions that influence their lives.
- Failure to develop a new self-definition results in a sense of
self-consciousness, doubt, and confusion about one’s role
in life.
- This can occur when adolescents are encouraged to remain
in the dependent position; when discipline in the home has
been overly harsh, inconsistent, or absent; and when
parental support has been lacking. These conditions are
influential in the development of low self-esteem.

25. 6. Intimacy Versus Isolation
(20 to 30 years)
- Intimacy is achieved when one is able to form a lasting
relationship or a commitment to another person, a
cause, an institution, or a creative effort
- Positive self-esteem is promoted through this capacity
for giving of oneself to another.
- Failure to achieve intimacy results in behaviors such as
withdrawal, social isolation, aloneness, and the
inability to form lasting intimate relationships.
- Isolation occurs when love in the home has been
deprived or distorted through the younger years,
causing a severe impairment in self-esteem.

26. 7. Generativity Versus Stagnation
(30 to 65 years)
- Generativity promotes positive self-esteem
through gratification from personal and
professional achievements, and from meaningful
contributions to others.
- Failure to achieve Generativity occurs when
earlier developmental tasks are not fulfilled and
the individual does not achieve the degree of
maturity required to derive gratification out of a
personal concern for the welfare of others.
- He or she lacks self-worth and becomes
withdrawn and isolated.

27. 8. Ego Integrity Versus Despair
(65 years to death)
- Ego integrity results in a sense of self-worth and self
acceptance as one reviews life goals, accepting that some
were achieved and some were not.
- The individual has little desire to make major changes in
how his or her life has progressed. Positive self-esteem is
evident.
- Individuals in despair possess a sense of self-contempt and
disgust with how life has progressed. They feel worthless
and helpless, and they would like to have a second chance
at life.
- Earlier developmental tasks of self confidence, self-identity,
and concern for others remain unfulfilled. Negative self-
esteem prevails.

28. MANIFESTATIONS OF LOW
SELF-ESTEEM
• Roy (1976) categorized
behaviors according to the
type of stimuli that give rise
to these behaviors and
affirmed the importance of
including this type of
information in the nursing
assessment.
• Stimulus categories are
identified as focal,
contextual, and residual.

29. 1. Focal Stimuli:
A focal stimulus is the immediate concern that is causing
the threat to self-esteem and the stimulus that is
engendering the current behavior.
- Examples of focal stimuli include termination of a
significant relationship(divorce), loss of employment, and
failure to pass the nursing state board examination.
2. Contextual Stimuli:
Contextual stimuli are all of the other stimuli present in the
person’s environment that contribute to the behavior being
caused by the focal stimulus.
-Examples of contextual stimuli related to the previously
mentioned focal stimuli might be a child of the relationship
becoming emotionally disabled in response to the divorce,
advanced age interfering with obtaining employment, or a
significant other who states, “I knew you weren’t smart
enough to pass state boards.”

30. 3. Residual Stimuli:
• Residual stimuli are factors that may influence
one’s maladaptive behavior in response to focal
and contextual stimuli. An individual conducting a
self-esteem assessment might presume from
previous knowledge that certain beliefs,
attitudes, experiences, or traits have an effect on
client behavior, even though it cannot be clearly
substantiated.
- For example, being reared in an atmosphere of
ridicule and deprecation may be affecting current
adaptation to failure on the state board
examination.

31. Symptoms of Low Self-Esteem
1. Loss of appetite/weight loss
2. Overeating
3. Constipation or diarrhea
4. Sleep disturbances (insomnia or difficulty falling or staying
asleep)
5. Hypersomnia
6. Complaints of fatigue
7. Poor posture
8. Withdrawal from activities
9. Difficulty initiating new activities
10. Decreased libido
11. Decrease in spontaneous behavior
12. Expression of sadness, anxiety, or discouragement
13. Expression of feeling of isolation, being unlovable,
unable to express or defend oneself, and too weak to confront
or overcome difficulties
14. Fearful of angering others
15. Avoidance of situations of self-disclosure or public
exposure
16. Tendency to stay in background; be a listener rather
than a participant
17. Sensitivity to criticism; self-conscious
18. Expression of feelings of helplessness
19. Various complaints of aches and pains
20. Expression of being unable to do anything “good”
or productive; expression of feelings of
worthlessness and inadequacy
21. Expressions of self-deprecation, self-dislike, and
unhappiness with self
22. Denial of past successes/accomplishments and of
possibility for success with current activities
23. Feeling that anything one does will fail or be
meaningless
24. Rumination about problems
25. Seeking reinforcement from others; making
efforts to gain favors, but failing to reciprocate
such behavior
26. Seeing self as a burden to others
27. Alienation from other by clinging and self-
preoccupation
28. Self-accusatory
29. Demanding reassurance but not accepting it
30. Hostile behavior
31. Angry at self and others but unable to express
these feelings directly
32. Decreased ability to meet responsibilities
33. Decreased interest, motivation, concentration
34. Decrease in self-care, hygiene

32. BOUNDARIES
• The word boundary is used to denote the
personal space, both physical and psychological,
that individuals identify as their own.
• Boundaries are sometimes referred to as limits:
the limit or degree to which individuals feel
comfortable in a relationship.
• Boundaries define and differentiate an
individual’s physical and psychological space from
the physical and psychological space of others

33. Types of physical boundaries include :
- Physical closeness, touching, sexual behavior, eye contact,
privacy (e.g., mail, diary, doors, nudity, bathroom,
telephone), and pollution (e.g., noise and smoke), among
others.
- Examples of invasions of physical boundaries are reading
someone else’s diary, smoking in a nonsmoking public area,
and touching someone who does not wish to be touched.
Types of psychological boundaries include :
beliefs, feelings, choices, needs, time alone, interests,
confidences, individual differences, and spirituality, among
others.
- Examples of invasions of psychological boundaries are being
criticized for doing something differently than others;
having personal information shared in confidence told to
others; and being told one “should” believe, feel, decide,
choose, or think in a certain way.

34. • Boundary Pliancy:
Boundaries can be rigid, flexible, or enmeshed.
The behavior of dogs and cats can be a good illustration of
rigid boundaries and flexible boundaries.
Most dogs want to be as close to people as possible. When
“their people” walk into the room, the dog is likely to be all
over them. They want to be where their people are and do
what they are doing. Dogs have very flexible boundaries.
Cats, on the other hand, have very distinct boundaries.
They do what they want, when they want. They decide how
close they will be to their people, and when. Cats take
notice when their people enter a room but may not even
acknowledge their presence (until the cat decides the time
is right). Their boundaries are less flexible than those of
dogs.

35. • Rigid Boundaries
Individuals who have rigid boundaries often
have a hard time trusting others. They keep
others at a distance, and are difficult to
communicate with. They reject new ideas or
experiences, and often withdraw, both
emotionally and physically.

36. Example:
• Fred and Alice were seeing a marriage counselor because
they were unable to agree on many aspects of raising their
children and it was beginning to interfere with their
relationship. Alice runs a day care service out of their
home, and Fred is an accountant.
• Alice states, “He never once changed a diaper or got up at
night with a child. Now that they are older, he refuses to
discipline them in any way.”
• Fred responds, “In my family, my Mom took care of the
house and kids and my Dad kept us clothed and fed. That’s
the way it should be.
• It’s Alice’s job to raise the kids. It’s my job to make the
money.
• Fred’s boundaries are considered rigid because he refuses
to consider the ideas of others, or to experience alternative
ways of doing things.

37. Flexible Boundaries:
• Healthy boundaries are flexible. That is,
individuals must be able to let go of their
boundaries and limits when appropriate.
• In order to have flexible boundaries, one
must be aware of who is considered safe and
when it is safe to let others invade our
personal space.

38. Example:
• Nancy always takes the hour from 4 to 5 p.m. for her
own. She takes no phone calls and tells the children
that she is not to be disturbed during that hour. She
reads or takes a long leisurely bath and relaxes before
it is time to start dinner.
• Today her private time was interrupted when her 15-
year-old daughter came home from school crying
because she had not made the cheer leading squad.
• Nancy used her private time to comfort her daughter
who was experiencing a traumatic response to the
failure.

39. • Sometimes boundaries can be too flexible. Individuals
with boundaries that are too loose are like
chameleons.
• They take their “colors” from whomever they happen
to be with at the time. That is, they allow others to
make their choices and direct their behavior.
• For example, at a cocktail party Smith agreed with one
person that the winter had been so unbearable she
had hardly been out of the house.
• Later at the same party, she agreed with another
person that the winter had seemed milder than usual.

40. Enmeshed Boundaries:
• Enmeshed boundaries occur when two
people’s boundaries are so blended together
that neither can be sure where one stops and
the other begins, or one individual’s
boundaries may be blurred with another’s.
• The individual with the enmeshed boundaries
may be unable to differentiate his or her
feelings, wants, and needs from the other
person’s.

41. Examples:
• Fran’s parents are in town for a visit. They say to Fran,
“Dear, we want to take you and Dave out to dinner
tonight. What is your favorite restaurant?” Fran
automatically responds, “Villa Roma,” knowing that the
Italian restaurant is Dave’s favorite.
• For example, Aileen got her hair cut without her
mother’s knowledge. It was styled with spikes across
the top of her head. When her mother saw it, she said,
“How dare you go around looking like that! What will
people think of me?”

42. Establishing Boundaries
• Boundaries are established in childhood.
Unhealthy boundaries are the products of
unhealthy, troubled, or dysfunctional families.
• The boundaries enclose painful feelings that have
their origin in the dysfunctional family and that
have not been dealt with.
• McKay and Fanning (2003) explain:
– the correlation between unhealthy boundaries and
self-esteem disturbances and how they can arise out
of negative role models:

43. • Modeling self-esteem means valuing oneself
enough to take care of one’s own basic needs.
When parents put themselves last, or chronically
sacrifice for their kids, they teach them that a
person is only worthy insofar as he or she is of
service to others.
• When parents set consistent, supportive limits
and protect themselves from overbearing
demands, they send a message to their children
that both are important and both have legitimate
needs.

44. • In addition to the lack of positive role models,
unhealthy boundaries may also be the result
of abuse or neglect.
• These circumstances can cause a delay in
psychosocial development.

45. THE NURSING PROCESS
• Assessment:
– Symptoms
– Self-Esteem Inventory
• Diagnosis/Outcome Identification

46. Care Plan for the Client with Problems
Related to Self-Esteem
1. NURSING DIAGNOSIS: CHRONIC LOW SELF-
ESTEEM
• RELATED TO: Childhood neglect/abuse;
numerous failures; negative feedback from
others
• EVIDENCED BY: Long-standing self-negating
verbalizations and expressions of shame and
guilt

47. 1. Be supportive, accepting, and respectful
without invading the client’s personal space.
2. Discuss inaccuracies in self-perception with
client.
3. Have client list successes and strengths.
Provide positive feedback.
4. Assess content of negative self-talk.

48. 2. NURSING DIAGNOSIS: SITUATIONAL LOW
SELF-ESTEEM
• RELATED TO: Failure (either real or perceived)
in a situation of importance to the individual
or loss (either real or perceived) of a concept
of value to the individual
• EVIDENCED BY: Negative self-appraisal in a
person with a previous positive self-evaluation

49. 1. Convey an accepting attitude; encourage client to express
self openly.
2. Encourage client to express anger. Do not become defensive
if initial expression of anger is displaced on nurse/therapist.
Assist client to explore angry feelings and direct them
toward the intended object/ person or other loss.
3. Assist client to avoid ruminating about past failures.
Withdraw attention if client persists.
4. Client needs to focus on positive attributes if self-esteem is
to be enhanced. Encourage discussion of past
accomplishments and offer support in undertaking new
tasks. Offer recognition of successful endeavors and
positive reinforcement of attempts made.

50. 3. NURSING DIAGNOSIS: RISK FOR SITUATIONAL
LOW SELF-ESTEEM
• RISK FACTORS: Developmental or functional
changes; disturbed body image; loss; history
of abuse or neglect;
• unrealistic self-expectations; physical illness;
failures/rejections

51. 1. Provide an open environment and trusting relationship.
2. Determine client’s perception of the loss/failure and the meaning of
it to him or her.
3. Identify response of family or significant others to client’s current
situation.
4. Permit appropriate expressions of anger.
5. Provide information about normalcy of individual grief reaction.
6. Discuss and assist with planning for the future. Provide hope, but
avoid giving false reassurance.