During professional medical rotation of Mental health medical in Karwan-e- Hayyat, I interviewed a 34 yrs. old male patient who is identified as having schizophrenia. He desires to become a doctor but due to low marks he had not been preferred for premedical later he did his graduation and struggling to complete his studies from college or university. He's unmarried living with his parents and sibling who is mentally retarded. He's experiencing this disease since 1998; along with he has obsessive-compulsive disorder (OCD). In compulsive behaviors he repetitive perform hand washings, spend additional time in washroom. He has history of aggressive behavior, destroyed household tasks. He has auditory hallucination and distorted thinking. He's not initiating any activity; he always says "I can't get it done"; "it is very trial", "I have no durability", I cant doing any thing for my father or mother. He used to spend his by watching television; eating and sleeping. He used to have alone, he does not have any friends, and he didn't opt to go outdoors. He needs encouragement and determination in order to create confidence and self-confidence.
According to Brekke et al cited by Seo, J. M et al. (2007), "An individual with chronic mental illnesses often have low self-esteem, delay effective social relationships, and negatively impacts their abilities to handle stress and problems"(p. 317). Self-esteem is vital element to prevent the reoccurrence of health problems and help the individual to effectively utilize their coping mechanism in a positive manner.
Self-love and self-confidence will be the essences of self-esteem. Matching to Coopersmith et al cited by Lyubomirsky et al (2006), "Self esteem has been thought as a global sense of self-worth or adequacy as a person, or generalized feelings of self-acceptance, goodness, and self-respect"(p. 366). Self-esteem has two elements competence and well worth. Competence means a person view himself as a competent and able whereas worthwhile give sense of value. Relating to Erickson theory, specific is occupied with his self-esteem and self-concept, which goes on so long as the process of crystallization of person's personality continues. If this process is not negotiated effectively, the person remains puzzled, not knowing about self. This means that self-identity is very important to a person to know his important in life.
Family track record: If parents have negative actions and makes classification or labeling the kid that he is bad, losers or incorrect on ongoing basis therefore child protect his ego by suppressing his brands in the unconscious mind, which contribute to what sort of child perceives himself and affects his self-esteem.
It is quite common amongst most parents, and evidently it does not have an enormous negative impact on the emotional development of the child. If frequent parental wisdom is mixed up in upbringing of the child however, it'll lead to problems within the child's self-esteem. (p. 184)
When the child is not under great pressure he or she manages to reduce these negative labels however when child is under severe pressure these negative brands come to the surface and the child becomes aware of it in the form of fear of failing, loss of psychological stamina, poor self-confidence, and low self-esteem.
Mental health problems and stigma related to health issues is major factor of low self-esteem. Mental condition results their daily performing that hinders these to adjust themselves in the contemporary society. People with mental illness are often perceived as less qualified and violent. Corresponding to Hayward and smart (2002), "It seems that person having a serious mental illness would likely to ruin one's sense of self-confidence if they exposed to any stigma or discrimination" (p. 62). This factor may be reason behind low self worth in my own patient. Because his family will not understand his OCD symptoms and provides punishment verbally and literally because of his recurring hand washings.
Self-efficacy: According to Francis et al. (2007), "Self-efficacy is people's beliefs in their capacity to execute and behave in a manner that influence events affecting their life" (p. 23). If I compare my patient he always question in his skills and verbalized that, I can't do this activity, I am not well prepared for this activity because he assumes every job as a hard. Even he verbalized that OCD is not treatable, he is not taking initiating to change himself. Furthermore, he said my brothers are well settle in USA and they're happy but I am not.
In Pakistan I didn't find direct analysis on self-confidence and its own interventions but few studies signify that we now have certain factors, which lead to low self-esteem. Relating to Khurshid & Rehman (2006), "Juveniles having the record of child mistreatment, reported more problems with their self-esteem, and peers problems in comparison to those juveniles who have no history of child maltreatment" (p. 78).
Recent research shows the manner where the family interaction goes with their children it will effect on developmental final results. If conversation is not healthy leads to low self-confidence and do disorders. Corresponding to Shafi cited by Agha et al. (2008), "Psychosocial risk factors of heroine maltreatment in Pakistan and discovered that heroine users tended to understand low positive parental relationships, high psychosocial stress, low self esteem, high sensation seeking manners and high need for affiliation when compared with non users" (p. 121). It implies that in Pakistan child maltreatment, negative parenting and stressors of life are major factors for lower self esteem.
According to Rehman and Hussain (2009), "Shows that patients experiencing obsessive compulsive disorder put up with significant amount of decreased self-esteem". My patient is also suffering from OCD since five years. He used to reside exclusively, don't visit his friends and family after having this problem. He thinks that they are not good plus they hardly understand me.
Another factor is discussed in books is resilience. Resilience is the take action of rebounding or springing again after being stretched or recovering durability, nature, and good humor. In clinical terms "resilience" is reserved for unpredicted or markedly successful adaptations to negative life happenings, stress, stress, and other forms of risk. "(Unaiza Niaz 2006 p. 205). This means that individuals with poor resilience are unable to cope with stressful events as end result person can choose maladaptive manners.
To summarize the Pakistani literature it indicates that child mistreatment, negative parenting and stressors of life leads, maladaptive actions are major factors of cut down self esteem.
A cognitive style of low self-esteem, given by McManus (2009 p. 271). In such a model I have included my patient's scenario. First component explains to us early on experience and circumstances in life that is my patient faced academic problems, credited to which he chosen that field where he was not interested. Furthermore verbal and physical maltreatment by parents. Because of this person experience global negative attitudes about himself. In my patient he always said I can't do this task, it is very difficult and in this world everyone is working for competition. Next thing contributes to conditional/dysfunctional assumptions. In this particular stage my patient adopts these coping strategies that are aggressive behaviors, very limited socialization and not ready for task. All above situations sets off the person and at final level there are two pathways, if person not satisfied the standard leads to self-criticism and hopelessness. Second way is maladaptive manners as an result if standards could not be fulfilled. (See Appendix A).
According to books, that low self-esteem is the foundation for several problematic habits that is being inadequacy, inferiority, and shame by externalizing blame for his or her problems and failures, which contributes to aggression and assault toward others. (Ostrowsky 2010 p. 70)
Studies have mentioned the impact of low self-esteem on the vulnerability of children to risky conducts. For example start sexual intercourse with out precaution. (Biro, F. M 2006).
Assessment is basic step to apply any interventions. Diagnosis of self-esteem, which I collected from patient and data file, is stated in situation. The Rosenberg Self-Esteem Range (RSES), which is the most frequently used self article self-esteem device in the literature. You will discover 10 components of the RSES were designed to measure a center namely global self-esteem. (Lecomte, T et al. 2006 p. 100). I was able to apply this scale on patient which ultimately shows that he feels useless and don't have good attitude about self applied. For implementation I found Caring theory for mentally sick patient to increased self-esteem given by Suie, K & Sue, K. (2007). The domain name of interpersonal caring theory effects on person's determination, self-esteem and personal well worth. The domains are realizing, active listening, complimenting, hoping, participating, sharing, companioning, comforting, forgiving and acknowledging. By focusing on these domains nurse will in a position to help patient to feels good and worthwhile. Acknowledging the durability and potential and expressing appreciation for it. I could apply some of the domains on Patient. I encouraged my patient to write his advantages on a bit of paper. Furthermore I offered teaching on OCD and allowed him to read a story which summarize that life 's problems are such as this if you possess them for few minutes they seem Alright but if you hold for longer period it give ache and paralyze you. In addition, individual counseling treatment was done by psychologist, where she prompted him to take part in occupational therapy and the she determined him to work with your time and effort effectively by instructing computer skills and British words to other patients.
He also participated in-group activity, he colored picture and provided in front of others and sweets were given as an incentive to all or any patients. Furthermore, I help patient to make friends with his acquaintances and play video games with others. The goal of these activities was to understand him the importance of positive peer support.
. Through cognitive group remedy, patients often communicate mental poison about themselves and situations. It teaches patients to distinguish among events and thoughts, as well as to find their negative automatic thoughts. This helps patients to determine the cause, which affect their emotions and plan their cognitive design. (Chen, T. H et al 2006 p. 8)
It is my limitation to work with family and community but as a nurse I possibly could give teaching to family members to avoid labeling person that you are nut, you always do wrong, and you are stupid. These kinds of words can damage the feelings of your person and has negative effects for the self-concept. Positive parenting should point out during parenting guidance. Press is also play important to give recognition about mental health and illness.
Our group members gave teaching to staff on effective communication with patients. I inspired staffs to require my patient in small job. Create environment where family get psycho education. I noticed that institution should encourage inpatients to involve in therapies regarding to their needs.
Initially I experienced that by writing a scholarly newspaper would not give any benefits to patient but when I took idea of self-esteem and began reading on it. I could apply a few of the interventions that encouraged the client to think positive about do it yourself. Firstly, I learned all about the idea of self-esteem and its own results on the physical as well as psychosocial wellbeing. Self-esteem appears to be major contributing factor of mental illness. Health care team works with patients, so they feel determined towards good attitude about health. I also found that role of family and group support is vital for patient' well-being. So, as a nurse we have to make implementations in a way, where family get motivated and take part in patient's care and attention.
The important aspect of this newspaper is, I am in a position to analyze the concept of self-confidence in Pakistani framework so it offers me sense that what are the implementations can be applied in real setting and will benefits to patient. Furthermore Personally i think that if I have more times during clinical therefore i would in a position to use more interventions on patient.
To summarize, self-esteem has been conceptualized as an result, motive, and become internal buffer system for body. We some time easily neglect that like other organs, brain is also susceptible to disease and people with mental condition can show various kinds of manners which alarming us they want help, but instead of encouraging we stigmatize and discriminate them. Social skill, group remedy, cognitive behavioral therapy and family support have significant role in boosting self worth of patient by motivating to decrease the negative thoughts about themselves. By focusing on self-esteem, specific feels confidence and able to socialize with others and take interest in activity. Through this we can promote mental health and reduce the incidence of mental health problems by implementing the required interventions.
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