Stress Coping the Importance of Self Concept Self Care

Self-care is the foundation needed to fulfill psychologic, emotional, biologic and social needs. Participating in self-care activities is instrumental in providing a positive outcome for patients not only in physical health, but in illness prevention and mental health. Self-care is the concept of health promotion and illness prevention in order to motivate individuals to enhance themselves in a positive, healthy way (Potter et al., 2017).

According to Maslow's hierarch, self-actualization is considered the highest form of expression of a person's basic needs. This theory recognizes the importance of the holistic view of patient needs, creating an individualized process accounting for emotional wellbeing (Potter et al., 2017).

Factors contributing to psychological well-being have been linked to independence and competence. Stress can interfere and complicate disease process while creating emotional turmoil, decimating sense of self-worth and interfering with personal identity. While some physiological changes induced by stressors may benefit health, chronic stress can inhibit return to baseline, especially after repeated disturbances. Psychological and emotional stress can affect the outcome of care, illness, or activities of daily living. This type of stress is common in American society and among college students, 25% of those surveyed have reported high stress and 50% of those events have occurred in the past year. While there are negative effects of stress, a positive impact of resilience and stability can be achieved as the brain establishes increased understanding of the environment. Using positive self-concept to create a unique strategy to assist patients with motivation and an understanding that they can take control of their life, can be as imperative as using medication to treat illness (Oken et al., 2015, Raj, 2016, Potter et al., 2017).

Assessment

Assessing life stress over a year to score indicators of using The Holmes-Rahe Life Stress Inventory, indicates an 80% probability in stressed induced mental or health breakdown. Various factors contribute to the student's stress including environmental changes, inadequate support system, rapid changes and decreased resources (Y. van & Dhurup, 2016, Holmes-Rahe, 2017).

Factors of self-care that are prioritized by the patient can show areas where they may be lacking or deem unimportant. In assessing these areas, the nurse may be able to assist the patient with coping techniques under these dimensions. In this case the focus will be on elements of psychological and emotional maintenance. Lifestyle behaviors have been reviewed and found multiple negative and positive techniques have been implemented by the individual. Negative reinforcement is noted to be prevalent in-patient coping mechanisms. Subjective responses suggest risk and reward tendency toward short term influences in order to cope with external stressors, corresponding to the results of the Self-care assessment (Lifestyle Behaviors, 2018, Saakvitne et al., 1996, Oken et al., 2016).

Diagnosis

The student has acknowledged deficits in the areas relating to psychological and emotional dimensions as defined by the Self-care assessment; warranting the nursing diagnosis of Readiness for enhanced self-concept as evidenced by willingness to explore sense of self-worth, thoughts of self, and personal identity. She expresses a need to be confident in her abilities, accept strength and weaknesses, with focus on positive thoughts of self, body image and role performance.

Self-affirmation as an intervention can improve the positive image of self-limiting negative outcomes. These intercessions can have lasting effects and encourage the adaptive capability that is necessary over time in order to expand the view of self and decrease the allusions of threat to personal integrity; while improving outcomes in education, health and relationships. Expected outcome is increased self-concept and positive reinforcement of goals and achievements (Cohen & Sherman, 2014).

Improved body image by increased exercise. Individuals who participate in cardiovascular exercise tend to develop as strong self-concept due to positive experiences during activities such as hiking, jogging, or climbing stairs. Expected outcome is improved body image with subsequent weight loss and increased energy (Babic et al. 2014, Lemoyne et al., 2015).

Plan

In order to improve body image plan with patient to increase cardiovascular exercise by increasing step count to 10,000 steps at least three days per week and try to jog two to three days per week. Increase sense of worth by giving affirmations to self at least once per day or during periods of negativity.

Identify comforting activities, such as drawing, painting, reading or welding and attempt to incorporate them into schedule at least once per week, attempt to include children during these activities, thereby encouraging interaction. Encourage contact with those that are important in life, such as mother and grandmother, call at least once per week.

Attempt to get out with friends at least once per month. Attend to minimizing life stressors by compiling a list in order of due dates.

Implementation

Plan to implement exercise and daily affirmations on October 29, 2018 and evaluate outcomes on November 27, 2018. Organize schedule to allow time for comforting activities and socializing with friends. Attempt to plan an outing with friends. Weekly calls to mother and grandmother starting Saturday, November 3.

Evaluation

After one month the patient returns having attempted to implement positive changes in her lifestyle and thought processes. She states that she attempted to start an exercise routine and managed to go for a jog two days per week for the first two weeks, weather changes and increased work load interfered with accomplishing original goal. Outcome for improved body image was not met however, the patient states that the weeks with exercise she had increased energy, improved sleep and had some weight loss. Daily step count was difficult for patient to track as her phone is not always on her person, she also states that since she works night shift her daily steps were segmented after midnight and calculating total steps was more difficult than anticipated, her daily steps were approximately 8-10,000 two to three days a week, which met goal. Patient will attempt to start outdoor exercise program during more appropriate weather, she will attempt to take the stairs more often, and perform mini workouts throughout the day instead of attempting thirty to sixty minutes at the end of her day.

The student compiled a list of due dates for assignments and was able to update her calendar to include class, work and appointment scheduling, creating a single point of reference. She states that it is helpful to have the reminders at the touch of her hand.

Self-affirmation on a daily basis was achieved, the capability to create an encouraging thought about herself at least once per day was difficult at first. The patient felt that it had a healthy impact on her daily outlook and positively impacted her impression of self-worth. There was some difficulty maintaining optimistic, confident, or positive thoughts during adverse situations. She observed that the attempts to remain confident during adverse experiences further the impression that she has encouraged personal resilience.

The patient states that she began calling her mother and grandmother on her way home from work each morning, she states that it not only helped keep her awake for the hour drive home, but family members look forward to the call. She notes that she feels more in control and assured after the phone call. She finds the conversations to be therapeutic, even if it is just discussing how her night was and the events of the previous week. She feels that it has encouraged her to be more confident in other interactions as well, she is not as snippy when she gets home and does not require the extended time to decompress after a work shift as she did prior to beginning this routine. As a parent she found that creating time to indulge in comforting activities once per week, also allowed time to spend with her children doing fun, art activities, she was able to include reading after bedtime at least two days per week.

Scheduling time to go out with friends within the time frame was problematic, attempting to find time between multiple schedules, it was decided to try for an outing during winter break from school. The patient states that she is looking forward to the arrangement and is hopeful that it will promote the goal of stress release.

Consideration of how stress affects individuals differently and creating a unique plan of care within the patient's capabilities and priorities can support positive impact on personal resilience. Encouraging active involvement in self-care promotes satisfaction, competence, the individual's perception of themselves and confidence; reducing the undesirable influence of quotidian stress. Self-care should be a primary focus in order to support psychological, emotional, biologic and social requirements (Potter et al. 2017, Oken et al., 2015).

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