CHAPTER II LITERATURE

A. Definition According to Potter and Perry (2005:500) self-esteem or sense of us about the values of an evaluation of a person to make or defend themselves. Self-esteem is related to an individual evaluation of the effectiveness of a school, the workplace, in family and social environment. The effectiveness is closely related to the idea of self-esteem (for example self-assessment of competence of a person in performing various tasks). Self-esteem can be understood by thinking about the relationship itself is an individual assessment of personal values obtained by analyzing how her behavior in accordance with the ideal self. On the other hand, according to Wartonah (2003:95), self-esteem is the evaluation of results achieved with the analysis, the extent to which the behavior of an ideal self-fulfilling. If the individual is always successful then her self-esteem tends to be high and if fail will be low self-esteem. Selfesteem can be found from own self and another person. And then according to Suliswati, and fellow comrades (2005:92) self-esteem is personal assessment from result that be reach with analyzed how much compatibility attitude with ideal self.

Low self-esteem or disturbance of self-esteem includes condition where individual or risk of negative self evaluation from ability or self (Carpenito,2001:353). So it can be concluded if self-esteem is a think or self-esteem assessment that is described as negative feeling directly or indirectly related to self ideal.

B. Vulnerable self-concept response according to Stuart (2006:187) 1. Self-actualization is the highest adaptive response because individuals can express their abilities. 2. Positive self-concept is able to identify individual capabilities and weaknesses honestly and in assessing something individual problems in a positive and realistic thinking (Suliswati, 2005:91) 3. Positive self-esteem are individuals tend to rate themselves negatively and feel lower than others 4. Poisoning is a failure of individual identity to integrate various identification of children into adult psychosocial harmonious 5. Personalization is a feeling that not realistic and felt stranger with own self (Stuart,2006:187)

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C. Etiology According to Suliswati (2005:95) factors that influence changes of self concept are: 1. Predisposition Factor a. Predisposition Factor of body image disorder 1) Lost or deformity of body image (anatomy and function) 2) Changes of size, form, and appearance or body (affect of growth and development or disease) 3) Pathology process and effect to structural of body function 4) Medication procedure such as radiation, Chemotherapy,

transplantation b. Predisposition factor of self-esteem disorder 1) Refused from another people 2) Less of honor 3) Wrong pattern of caring: over banned, over control, over spoiled, over prosecuted, and inconsistency 4) Competition between brother 5) Repetition of false and fail 6) Unable to reach standard that was concluded c. Predisposition factor of role disorder 1) Role transition that often happen to develope process, condition changed, health-sick condition

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2) Doubt of the role of, when individual lack of knowledge about specific role opportunity and confused about appropriate attitude 3) Tension of role, when individual face two opportunities that contraindication as continuously where cannot be reached 4) Too much role d. Predisposition factor of self-identity disorder 1) Distrust of parents in children 2) Pressure from friend 3) Change of social structure 2. Precipitation factor a. Transition of development Every development can occur threat to every stage of identity that must be passed by individual with finishing development task that differently, this is can be stressor for self-concept. b. Transition of condition Occur throughout the year, increasing or decreasing the mean for birth or death, for example self status, became second person or became a parent. Change in status causes changes in role that can cause tension of role or role conflict, unclear or over role c. Transition of health sick Stressor of body can cause self-description disorder and cause of self-concept changes. Changes of body can influence all of self-

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concept component there is self-description, self-identity, role, and self-esteem (Sujono Riadi, 2009:80)

D. Sign and Symptoms According to Fitria (2009:6), sign and symptoms of low self-esteem disorder client are: 1. Self-criticism 2. Inability feeling 3. Negatives of life description 4. Refuse am praise 5. Decreasing of productivity 6. Refused to self-ability 7. Lack of self-care attention 8. Untidy wearing 9. Anorexia 10. Afraid to face hearer 11. More often to down 12. Speaking slowly with weak intonation

E. Process problems According to Nanda (2008:186), low self esteem can occur: 1. Situational low self-esteem Is the development of negative self-perceptions in response to a situation that is happening. For example should the operation, accident,

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injured husband, dropped out of school, dropped out of employment relationships, feelings of shame for something to happen (a victim of rape, accused of corruption, jailed suddenly. Characteristic limit from situational low self esteem include: a. Revealed situational challenges is going to self esteem b. Revealed self that was negative c. Hesitate, non aseptic attitude d. Evaluated own self cannot handle a situation e. Express inability and useless 2. Chronic low self esteem Revealed long condition about self evaluation or feeling self or negative self ability. Characteristic limit Chronic low self esteem include: a. Avoid the fact or refuse positive cross pass and enlarge negative cross pass about own self (chronic) b. Revealed own self was negative (chronic) c. To try new thing or situational (chronic) d. Expressing shy and guilty (chronic) e. Lack of eyes contact f. Passively g. Not success to work or repetition incident 1) Excessive adjustment to rely on other people's opinions 2) Hesitate

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To Hospitalized client low self-esteem happen because: a. Privation where attention, for example physical examination randomly, installation of inappropriate equipment (pubis shaving, installing catheter, perinea assessment). b. Whishes of structural, form and function of body where not reach because of hospitalized or sick, or disease. c. Treatment health officer which is not praise, for example assessment without explanation, treatment without agreement

F. Coping Mechanism According to Suliswati (2003: 99) client with self-concept disorder use coping mechanism which can be categorized into two: 1. Short-term coping, namely short-term coping characteristics a. Activities that can provide temporary escape from the crisis of opportunity, such as watching television, hard work, exercise, weight, etc. b. Activities that can provide temporary replacement of identity, such as join the social activities of political, religious. c. Activities that can provide temporary strength or support to the self concept. For example activity that is competent academic or sporting achievement. d. Activities that represent the short distance to make the problem of identity become less meaningful in life such as substance abuse.

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2. Long-term coping Long-term coping can be categorized in two things include: a. Closing identity Closing identity is identity assumption premature that wanted by someone that important for individual without saw aspiration and potential whishes. b. Negative identity Negative identity is assumption of identity that is not fair to be accepted by the community norms and expectations.

G. The Way to Express Individual ways to express directly the low self-esteem according to Stuart and Sundeen in Sujono Riyadi, 2009:83: 1. Bullying or critic own self Someone who has a negative thinking about him self. He often says him self fool, and know nothing. 2. Debasing and lessen prestige Avoid, disregard or refuse ability which is owned 3. Guiltiness and worries Someone punish own self. This can be presented in the form of phobia, obsession. He refuses his self. 4. Clinical manifestation Including high blood pressure, psychosomatic disease and abuse of essen.

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5. Delaying decision Very hesitating in taking decision and threatened 6. Disturbance correlate This behavior is withdrawing or isolation because of worthless feeling. 7. Withdrawing from reality If worries because of denial own self become heavy or panic. Patient maybe experience of the association disturbance, hallucination, suspicious, jealous or paranoid. 8. Self defeating A low self esteem could push someone to end his life. 9. Harming and hurt others Dislike and denial own self can be expressed to the environment by hurting others

H. Characteristic of Low self esteem The characteristics of low self-esteem according to (Carpenito 2000:353) 1. Expressing self was negative 2. Expressing shy or gulty 3. Rationalizing the refusal or away from the positive feedback and negative feedback to raise self 4. Inability to setting purpose 5. Hesitate

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6. Lack or poor of problem resolved 7. Showed depression syndrome 8. Look for agreement or connection over 9. Bad appearance 10. Self abuse behavior (vandalism, suicide, nail biting, drug abuse, a victim) 11. Refuse to try a new thing 12. Denial the real problem 13. Guilty or responsibility to problems 14. Rationalization personal fail 15. Hypersensitivities to mild critic 16. Full of grandiose words

I. Management 1. Medical According to Stuart (2006:193) medication to response self concept is psychodynamic psychotherapy, hyposis, and parkocyntheses amital are choice to that condition according to case report. 2. Nursing Management according to Carpenito (2001:355) includes: a. Apply trust relationship between nursing and client 1) Individual support to express feeling about client way to descrite or thinking about own self.

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2) Support individual to ask question, about problem, handle, development, health prognoses. 3) Give information that can be trusted and support information that was given. 4) Refine the errors of individuals familiar with the concept of self, client or nurse. 5) Avoid negative critic. 6) Give privation and safe environment b. Stage of social interaction 1) Help individual to accept help from another people 2) Avoid over protection with limited individual whishes 3) Support movement 4) Support family when their was being adapted c. Explore power and resource to individual d. Discussing a whishes 1) Discuss is realistic 2) Explore realistic alternative e. Refer to community source if indicated (for example counseling, assertive group)

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J. Pathway Risk for injury other person and environment

Change of sensory perception; hallucination

Verbal communication disturbance

Social isolation; withdrawal

Risk violent behavior

Altered self concept; low self esteem

Ineffective individual coping

(Susilawati, et, (2005: 101)

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K. Nursing Diagnosis 1. Nursing problem a. Social isolation: withdrawal b. Disorder of self concept c. Change of sensory perception: hallucination d. Risk of self injured, others and the environment

L. Nursing problem and data that need to be assets 1. Nursing Problem a. Social isolation: withdrawal b. Disorder of self concept: low self esteem c. Ineffective of individual coping 2. Data that need to be asses a. Social isolation: withdrawal 1) Subjective Data Difficult to obtain if clients refused to communicate, sometimes only be answered with a quick yes or no 2) Objective Data Apathy, sad expression, the effects of blunt, alone, avoiding others or does not exist (silence) lack of eye contact (down), refusing to relate to others, less of personal care, positive sleep like a baby.

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b. Disorder of self concept: low self esteem 1) Subjective Data Clients said I can not be able, can not, did not know what anything, stupid, self-criticism, expressing feelings of shame about themselves. 2) Objective Data Client looked more like him, confused if given the choice of alternative actions, to injure them or wish to finishing life. c. Ineffective of individual coping 1) Subjective Data Client said he cannot do anything, asking help to another, client said was shy, and said was lazy to do something. 2) Objective Data Look depend on another, looked sad and did not indulge in accordance to be done, the face looked sad

M. Focus of Intervention According to work shop Prof.dr. Soeroyo Magelang Psychiatric Hospital (2007:97) 1. Self concept disorder: low self esteem a. General Purpose After doing implementation, client can interact with other people optimally.

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b. Specific Purpose After doing nursing care, client have positive self concept c. Intervention Client SpIP 1) Build trust relationship 2) Identify ability and positive aspect that client have 3) Help client to measure client ability that can be used 4) Help client choice activity that can be train appropriate with client ability 5) Teach client appropriate with ability that was choose 6) Give praise with client success 7) Suggest client join in Activity daily schedule SpIIP 1) Evaluate client activity schedule 2) Teach secondary ability 3) Suggest client join daily activity schedule 2. Social isolation: withdrawal a. General Purpose After being done nursing care, client can interact with other. b. Specific Purpose After being done nursing care, client can interact with other people, individual or group.

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c. Intervention Client SpIP 1) Build trust relationship 2) Identify social isolation causing 3) Discuss with client advantage if interact with other people 4) Discuss with client disadvantage if not interact with other people 5) Teach client how to introduce with one person 6) Suggest client to join conversation training with other people in daily activity SpIIp 1) Evaluate client daily activity schedule 2) Give client opportunity to introduce with one person 3) Help client to join conversation activity with other people as a one of daily activity SpIIIP 1) Give daily activity schedule to client 2) Give client opportunity to introduce to one person 3) Suggest client to join daily activity schedule 3. Change of sensory perception: hallucination a. General Purpose After being done nursing care, client can control hallucination

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b. Specific Purpose After being done nursing care, client can know and controlled hallucination. c. Intervention Client SpIP 1) Build trust relationship 2) Identify kind of hallucination 3) Identify time of hallucination 4) Identify frequency of hallucination 5) Identify of situation that can occur hallucination 6) Identify of client response with hallucination 7) Teach client to scold hallucination SpIIP 1) Evaluate daily activity client schedule. 2) Teach client to control hallucination by speaking with other people. 3) Teach client to daily activity schedule SpIIIP 1) Evaluate daily activity schedule 2) Teach client to controll hallucination by doing activity 3) Suggest client to join daily activity schedule SpIVP 1) Evaluate daily activity schedule

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2) Give health education about drug used with regular 3) Suggest client to input into daily activity schedule. 4. Risk of self injured, others and the environment a. General Purpose After being done nursing client can controlling violence behavior b. Specific Purpose After being done nursing care, client can prevent injured own self, other people, and environment. c. Intervention Client SpIP 1) Build trust relationship 2) identify causing of violence behavior 3) identify send and symptom 4) identify violence behavior that was done 5) identify influence of violence behavior 6) mention how to control violence behavior 1 7) help client to practice how to physical control 8) suggest client to input in daily activity schedule SpIIP 1) evaluate activity daily schedule 2) teach how to control violence behavior by physical 2 3) suggest client to join daily schedule

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SpIIIP 1) Evaluate activity daily schedule 2) Teach how to control violence behavior verbal 3) Suggest client to join daily schedule SpIVP 1) Evaluated activity daily schedule 2) Teach how to control violence behavior by spiritual 3) Suggest client to input in daily schedule