Self-concept
How a person sees and values themself. Learned, dynamic, lifelong.
Rogers' three components
Memory hook
"Me, myself, and my goals"
MeSelf-image: how I see my qualities (may not match reality)
MySelf-esteem: how much I value myself
GoalsIdeal self: who I want to be
Self-esteem
Ideal self
Self-image
Self-esteem
Ideal self
Self-image
Factors that shape self-concept
Emotional intelligence
Perceive, understand, control, manage, and evaluate emotions.Taking a breath before responding to an upset family member
Self-awareness
Seeing yourself clearly through reflection.Journaling, asking for feedback
Body image
Feelings about your appearance. Adolescents are most vulnerable.A teen compares their body to images on social media
Self-efficacy
Belief you can complete a task. Low = gives up quickly.A client feels confident they can manage their own ostomy care
Culture
Integrating your culture supports a healthier self-concept. Never assume everyone in a culture is the same.Family traditions help a client feel confident in who they are
Role performance
Behaviors in each role and how well you think you fill them.Student, employee, partner: how many hats do you wear?
Memory hook · the 5 EI (emotional intelligence) domains
"Smart Students Manage Emotions Smoothly"
SSelf-awareness: know your feelings and their effect on others
SSelf-regulation: think before acting
MMotivation: passion + persistence
EEmpathy: understand others' needs
SSocial skill: build rapport
Positive self-esteem + body change
Client looks for ways to cope.A client on chemo asks where to buy a wig.
Negative self-esteem + body change
Client withdraws or hides.Refuses visitors, won't look at the stoma.
Marcia's identity statuses
Two questions: did they explore, and did they commit? Identity formation is lifelong but most intense in adolescence.
Committed
Not committed
Explored
AchievementExplored, then chose.Anika shadows several careers, picks engineering.
MoratoriumStill searching, anxious.Carlos: military? law? travel?
Didn't explore
ForeclosureChose without looking.Talia becomes a teacher like her parents.
DiffusionDrifting, no direction.Klaus: "the future can wait."
Memory hook
The names tell the story
- Moratorium literally means "a pause." They want more time to decide.
- Foreclosure: they closed the door before looking inside.
- Diffusion: energy diffused everywhere and nowhere.
- Achievement: they did the work of both, so they earned it.
Stressors
Identity
Gender dysphoria, job loss, divorce or death of a spouse, discrimination. Can cause identity confusion.
Body image
Puberty, aging, stroke, diabetes, obesity, amputation, weight stigma.
Self-esteem
Disability, chronic illness, job loss, money changes, retirement, loss of a spouse, abuse or neglect.
Memory hook · role stressors
Too many roles will SOAC you
SStrain: can't meet one role's demands
OOverload: too many roles at once
AAmbiguity: no idea what's expected
CConflict: two roles, same time
Not stressors: role satisfaction, role enhancement, role clarity.
Nursing process
The 4 things you assess
Identity
"How would you describe yourself?"
Body image
"How would you describe your appearance?"
Self-esteem
"How do you respond to failure?"
Role performance
"How successful do you feel in your roles?"
Red flags
Negative self-talk, unkempt, tearful, over-apologizing, indecisive.
Plan & implement
Collaborate with client and family, let them express feelings, promote independence, name past accomplishments, connect to resources.
It worked if…
Client verbalizes self-acceptance, accepts body image, uses healthy coping. Still avoiding or overwhelmed = not yet.
Quick check
A 17-year-old is going to pharmacy school "because my parents are pharmacists" and never considered anything else. Status?
Foreclosure. Committed without exploring.
"My boss wants me Saturday, but it's my son's championship." Which role stressor?
Role conflict. Two role expectations that can't both be met at once.
Which question assesses self-esteem: "How would others describe you?" or "What accomplishments make you feel good about yourself?"
The accomplishments question. How others describe you assesses identity.
Comfort, rest & sleep
Your instructor says the test will have sleep questions. Flagged
Circadian rhythm
Your ~24-hour internal clock. Syncs with light and temperature but runs even without cues.
Sleep–wake homeostasis
Sleep pressure. The more deprived you are, the deeper you sleep next time.
Sleep vs rest
Sleep = altered consciousness in cycles. Rest = awake but relaxed; still lowers stress and sharpens focus.
Sleep strengthens the immune system, restores energy, improves coping, clears brain toxins, and moves memory from short-term to long-term.
Stages & brain waves
Known mnemonic · brain waves from awake to deep sleep
"At night, BATS Drink Blood"
BBeta: awake, alert (13–30 Hz)
AAlpha: awake, relaxed, eyes closed (8–12 Hz)
TTheta: stage 1 (your module calls it low-amplitude, mixed-frequency)
SSpindles & K-complexes: stage 2
DDelta: stage 3, deepest
BBeta again: REM (rapid eye movement) looks awake on EEG (electroencephalogram)
The word "theta" isn't in your module, but the pattern is the same one it describes.
| Stage | What's happening | Share of sleep (adults 20–35) |
|---|---|---|
| Stage 1 (non-rapid eye movement, NREM) | Lightest sleep, 1–5 min, muscle twitching possible | 2–5% |
| Stage 2 (NREM) | Harder to wake. HR (heart rate) and temp drop. Spindles and K-complexes help consolidate memory. Gets longer each cycle | 45–55% |
| Stage 3 (NREM) | Deepest. Delta waves. Tissue, muscle, and bone repair, immune boost, lowest pulse and RR (respiratory rate). Wake them and they're foggy 30–60 min | 25% |
| REM (stage 4) | Dreaming. Irregular breathing, HR may rise, muscles atonic. Starts ~90 min in, first cycle ~10 min, up to 1 hr later | 20–25% |
Memory hook · REM
Rapid Eyes, Muscles off
Your brain is busy dreaming, so your body is "paralyzed" to keep you from acting the dream out.
Adults
4–5 cycles a night. Recommended 7–9 hours.
Older adults
Less stage 3, more stage 2, fewer REM cycles, wake more often, take longer to fall asleep. Recommended 7–8 hours.
Adults 20–35 are the only age group your module gives stage percentages for.
Sleep deprivation
Types
- Total: a whole night lost
- Partial: fewer hours
- Chronic: partial that keeps going
- Selective: a specific stage lost
Effects
Impaired judgment, slow reaction time, seizures, migraines, accidents, depression, stroke, obesity, poor glucose control in T2DM.
Sensory overload
Common in acute care. Dim lights, cut noise, offer earplugs and eye masks, cluster care.
Other disruptors: phone in bed (shorter, worse sleep; depression risk), night shift (higher CVD (cardiovascular disease), obesity, diabetes risk), and menopause (sleep problems peak postmenopause).
Sleep disorders
| Disorder | The tell | Remember |
|---|---|---|
| Insomnia | Can't fall or stay asleep despite the chance | Treat with meds, sleep hygiene, CBT (cognitive behavioral therapy) |
| Obstructive sleep apnea | Airway collapses; loud snoring; exhausted all day | Diagnosed by polysomnography. Treat with CPAP (continuous positive airway pressure), weight loss, no smoking or alcohol, don't sleep on your back |
| Central sleep apnea | Brain stops signaling breathing muscles | Causes: heart failure, opioid overdose |
| Narcolepsy | Sudden, uncontrollable sleep attacks | Cataplexy: muscle tone drops with emotion, like laughter |
| Hypersomnia | Exhausted all day even with more sleep | More sleep doesn't fix it |
| Restless legs | Urge to move legs, worse at night and at rest | Linked to iron/vitamin deficiency; avoid caffeine, nicotine, alcohol |
Memory hook · night terrors vs nightmares
Terrors are early and erased. Nightmares are late and remembered.
Night terrors: NREM, first third of the night, no recall, mostly young kids. Nightmares: REM, second half of the night, you remember the dream.
Sleep medications Melatonin will be on the test
| Class | Examples | Key points |
|---|---|---|
| Melatonin | Supplement | May be first-line for all ages. Cheap, non-habit forming, few side effects. Effectiveness may be limited |
| Nonbenzodiazepine hypnotics ("z-drugs") | Zolpidem, zaleplon, eszopiclone | Most commonly prescribed. GI (gastrointestinal) upset, hallucinations, memory loss, abuse potential |
| Benzodiazepines (GABA [gamma-aminobutyric acid] agonists) | Alprazolam, clonazepam, lorazepam | Drowsiness, muscle relaxation, less anxiety, retrograde amnesia. Dependence risk, so short-term only. Caution in older adults with liver or kidney issues |
| OTC (over-the-counter) antihistamines | Diphenhydramine, doxylamine | Daytime drowsiness plus the anticholinergic effects below. Talk to the provider first |
Known mnemonic · anticholinergic side effects of OTC sleep aids
Can't see, can't pee, can't spit, can't poop
Visual disturbances, urinary retention, dry mouth, constipation.
Promoting sleep & comfort
Sleep hygiene
- No caffeine, alcohol, or nicotine 4–6 hr before bed
- Same bedtime and wake time, even on weekends
- Dark, quiet, cool room
- Bedtime routine, short naps
- Exercise, but not right before bed
- Bed is for sleep and sex only; no TV
Can't fall asleep?
Get up, go to another room, do something quiet, come back when tired. Lying there restless makes it worse.Reading on the couch until drowsy
Bedtime snack
A carb paired with a protein. Protein alone doesn't count.Toast with peanut butter
In the hospital
Cluster care, restful environment, support bedtime routines, keep them safe, teach sleep hygiene and meds. A sleep diary helps you plan together.Doing vitals, meds, and a dressing change in one visit instead of three
Nonpharm options
Acupuncture, massage, yoga, guided imagery, mindfulness, meditation, music.Soft music and guided imagery before lights out
Comfort
Relief from pain and distress. Be honest, be present, and let clients make informed choices.Answering a client's questions honestly before a procedure
Don't get tricked · exercise and sleep
Exercise improves sleep. Just not right before bed.
"Avoid exercise within a few hours of bedtime" is about timing. Your module says regular exercise improves sleep and daily exercise helps treat sleep deprivation.
Quick check
You wake a client at 0200 and they're groggy for 45 minutes. Which stage were they in?
Stage 3. Deepest sleep, with mental cloudiness for 30–60 minutes after waking.
Which snack promotes sleep: cheese cubes, candy, or toast with peanut butter?
Toast with peanut butter. Carb plus protein. Cheese alone is protein only.
Most commonly prescribed class of sleep medication?
Nonbenzodiazepine hypnotics, like zolpidem.
Stress & coping
Stressors are neutral. Your appraisal decides whether they help or hurt.
The body under stress
Fight or flight (sympathetic-adrenal-medullary, SAM, system)
Norepinephrine, epinephrine, and dopamine in seconds. HR, BP (blood pressure), cardiac output, and glucose go up. Pupils and bronchi dilate.
Cortisol
Short-term: boosts some immune function. Chronic: suppresses immunity, slows healing, drives inflammation.
Memory hook · fight or flight
Everything you need to run goes up
Heart rate, BP, breathing, blood sugar, and pupil size all rise to help you fight or flee. Digestion slows down because you don't need it to escape.
Same hormone at the bedside: epinephrine raises heart rate, blood pressure, and cardiac output. In cardiac arrest the heart stops pumping, so epinephrine is given during CPR (cardiopulmonary resuscitation) to stimulate the heart and tighten blood vessels, pushing blood to the heart and brain and improving the chance of getting a pulse back.
The HPA (hypothalamic-pituitary-adrenal) axis
Hypothalamus releases CRH (corticotropin-releasing hormone)→
Pituitary releases ACTH (adrenocorticotropic hormone)→
Adrenals release cortisol
Top of the head to the top of the kidneys: Hypothalamus, Pituitary, Adrenals, in that order.
General adaptation syndrome
Memory hook
"A-R-E you stressed?"
Alarm, Resistance, Exhaustion. Happens with good or bad stress, physical or psychological.
Alarm Flagged
CNS (central nervous system) aroused. Adrenal medulla releases epinephrine: fight or flight. HR, BP, glucose, O₂ intake, alertness up; pupils dilate.
Resistance
Body fights back. Parasympathetic system calms things down. Coping kicks in. Fatigue, irritability, poor focus.
Exhaustion
Resources used up. Illness, disease, and allostatic load (chronic HTN (hypertension), depression, autoimmune disease).
Types of stress
| Type | What it is | Example |
|---|---|---|
| Acute | Most common, brief, immediate fight or flight | Car accident, crime, losing a loved one |
| Episodic acute | Frequent bouts of acute stress; overcommitted and rushed | Always cramming at the last minute |
| Chronic | Constant, prolonged, disabling | Poverty, racism, long illness, dysfunctional family |
| Traumatic | Overwhelms coping; can lead to PTSD (post-traumatic stress disorder) | Assault, disaster |
| Environmental | Hard surroundings | Crowding, noise, food or housing insecurity |
| Psychological | Something you interpret as threatening | Finances, exams, divorce |
| Physiological | Injury or illness | Burns, fractures, hypothermia, pain |
Memory hook · ASD (acute stress disorder) vs PTSD
ASD is Acute. PTSD Persists.
ASD: starts right after the trauma and lasts up to 1 month. Past 1 month, it's PTSD: flashbacks, nightmares, sweating, fast HR, exaggerated startle.
Adverse childhood experiences (ACEs): a score of 4 or more significantly raises the risk of chronic illness as an adult.
Appraisal & coping (transactional theory of stress and coping, TTSC)
Primary appraisal
"Is this a threat?" Threat, challenge, or irrelevant.
Secondary appraisal
"Can I handle it?" Checks resources: support, skills, past wins.
Reappraisal
Keeps reassessing and adjusts coping as things change.
Problem-focused
Change the situation.Make a study schedule.
Emotion-focused
Change how you feel about it."One exam doesn't define my career."
Adaptive vs maladaptive
Adaptive helps now and later. Maladaptive helps now, hurts later (smoking, drinking, withdrawal).Going for a walk vs. smoking after a hard day
Defense mechanisms
Unconscious and automatic; they protect self-esteem and help in mild to moderate anxiety. Coping, by contrast, is conscious and deliberate.
| Mechanism | What it is | Sounds like |
|---|---|---|
| Denial | Refusing to accept reality | "The doctor is overreacting. I don't have diabetes." |
| Projection | Putting your feelings on someone else | Angry client: "Why are you so hostile?" |
| Rationalization | A logical-sounding excuse | "I failed because the test was unfair." |
| Regression | Going back to earlier behavior | A potty-trained 4-year-old wets the bed after a new baby arrives |
| Repression | Burying memories unconsciously | Has no memory of a traumatic event |
| Suppression | Pushing thoughts away on purpose | "I'll deal with that after my shift." |
| Compartmentalization | Keeping conflicting parts of life in separate boxes | A nurse sets personal beliefs aside to care for a client without bias |
Memory hook
Suppression is on purpose. Repression is buried.
Both push something out of mind; only suppression is a choice.
Crisis
4 types of crisis
Developmental
Life transitions (puberty, retirement).
Situational
Outside events (job loss, disaster).
Existential
Meaning, identity, purpose.
Psychiatric emergency
Suicide attempt, psychosis.
Mental health emergency signs: acting on a suicide threat, hostility, throwing or breaking things, threatening harm.
Roberts' seven-stage model, in order:
- Assess, including suicide and homicide risk
- Build rapport
- Identify the problem and what triggered it
- Explore feelings
- Explore past coping and alternatives
- Carry out the action plan
- Follow up
Nursing care & self-care
First action
Assess. A mental status exam comes before goals or interventions.
Priority
Find out whether the client has thoughts of self-harm.
Perceived Stress Scale
Self-report of how unpredictable, uncontrollable, and overwhelming life has felt this past month.
Trauma-informed care
Past trauma shapes responses. Build safety and trust; don't retraumatize.
Exercise
Improves mood, energy, and sleep, lowers stress, releases endorphins.
Food
Complex carbs, oranges (vitamin C), omega-3s, black tea. Alcohol raises cortisol.
Relaxation
Mindfulness, guided imagery, progressive relaxation (tense and release, head to toe), biofeedback.
Moral distress
Your actions don't match what you believe is right. Use debriefings, ethics committees, peer support, and the ANA (American Nurses Association) Code of Ethics.
Healthy Nurse, Healthy Nation
ANA program: quality of life, safety, physical activity, sleep, nutrition.
Quick check
Minutes after a car crash: HR 118, BP up, pupils dilated, glucose up. Which GAS (general adaptation syndrome) stage?
Alarm. Epinephrine drives fight or flight.
Two weeks after an assault: numb, easily startled, avoiding the street. ASD or PTSD?
ASD. It's under a month. Past a month would be PTSD.
Client in crisis is yelling and threatening self-harm. First action?
Ensure safety for the client and others.
Diversity, equity & inclusion
Always ask. Don't assume.
Culture & bias
Culture (Leininger)
Learned, shared, and passed-down values, beliefs, norms, and lifeways that guide a group's thinking and decisions.
Cultural awareness
Being willing to understand differences between your culture and others'. Starts with checking your own bias.
Cultural competence
Appreciating, accepting, and respecting beliefs, plus open communication and feedback, blending emic and etic knowledge.
Explicit bias
Conscious. You know it and can admit it.A nurse says they'd rather not care for clients of a certain religion.
Implicit bias
Unconscious. You don't notice it.Spending less time with certain clients without realizing it.
Memory hook
eMic = Members. eTic = Theory.
Emic is the insider view from members of the culture. Etic is the outsider view from research, theories, and outside observation.
Cultural diversity happens within groups too, not just between them. Two clients from the same culture can have very different practices.
Health equity
Equality
Everyone gets the same box to stand on.
Equity
Everyone gets what they need to see over the fence.
Health disparities
Differences in outcomes between groups, often driven by social determinants of health like insurance or transportation.
Personal health literacy
Can this person find, process, and understand health info?
Organizational health literacy
Does the organization equitably help people find and use info and services?
Reading level
Write health materials at an 8th-grade level or lower.
CLAS (culturally and linguistically appropriate services) standards: a blueprint for organizations to advance equity, improve quality, and eliminate disparities.
Vulnerable populations
Higher risk for poor outcomes because of barriers to social, economic, and environmental resources. Includes older adults, immigrants, marginalized ethnic groups, people in poverty, people with chronic illness or disabilities, veterans, and pregnant teens.
Demographic
Age, English proficiency, household type, population density, race and ethnicity, sex.
Health status
Chronic conditions, disabilities, insurance status.
Socioeconomic
Education, employment, household income, poverty.
Intersectionality
Several disparities at once, leading to more stress, lower self-esteem, and riskier behavior.
Population density
Nursing homes, shelters, and dorms spread infection faster.
LGBTQ+ (lesbian, gay, bisexual, transgender, queer or questioning, and more) youth
Higher risk of bullying, violence, depression, substance use, STIs (sexually transmitted infections), and suicide. Use chosen name and pronouns consistently.
Leininger's Sunrise Enabler
Five interrelated categories: the upper level (worldview), the rays of the sun (basic elements), the central core, the focus on individuals through institutions, and the three modes of care.
The rays: basic elements to assess
Technological (phone, internet access), religious and spiritual, kinship and social (support system, marital status), cultural values and lifeways, biological (personal or family illness history), political and legal, economic, educational.
Memory hook · the three modes of care
It's all PAR for the course
PPreservation & maintenance: keep the beliefArrange a female caregiver as requested
AAccommodation & negotiation: adapt it safelySmaller portions of holiday foods for a client with diabetes
RRepatterning & restructuring: change a harmful practiceHelping a client replace a practice that is harming their health
Folk (generic) care
Traditional, nonprofessional care from family or a folk practitioner.
Integrative care
The nurse bridges folk medicine and Western medicine.
Assessment & communication
Cultural health assessment
Start at the very first encounter. Name or gender may differ from records, so ask respectfully.
Language barrier
Use a certified medical interpreter. Never family or other staff: they can omit or alter info and break confidentiality. Add written instructions in the client's language.
Hearing loss
Face the client and reduce background noise. Don't shout, speed up, or write everything down.
Quick check
A client's daughter offers to interpret. What do you do?
Request a certified medical interpreter.
You read research on a culture's health practices. Emic or etic?
Etic: an outsider's, external view.
Rural clinic opens, and you arrange ride vouchers for residents without cars. Equality or equity?
Equity. You adjusted for their need.