Self-Esteem and Nursing When I first began to study and learn about nursing, I never thought very much of what the concept of self-esteem meant to me. Self-esteem seemed like an abstract psychological concept, and I still was mainly preoccupied with the demands of nursing as a physical profession that required technical expertise. However, as I grew wiser, I began to see how my initial assumptions were fundamentally in error. People may know that certain health practices are required to improve their sense of well-being, such as quitting smoking, exercise, or eating a healthy diet. However, there are often vastly different levels of personal self-empowerment regarding the ability to make such changes. It is very common to speak of 'willpower,' but we must ask why certain people seem to have stronger willpower than others. Self-esteem is often the answer.

Self-esteem is not having a falsely high opinion of one's self. It is having a positive and realistic opinion of your ability to change and to make change in the world. Self-esteem is not simply the knowledge of what you need to do to accomplish your goals, but also possessing the belief that you have the power to make changes. Of course, the greater your success in the past in making positive changes, the higher your self-esteem is likely to be. That is why 'success begets success.' In the ideal nursing scenario, both the nurse and his or her patients have high self-esteem. This facilitates communication and better enables both parties to work together to achieve common health goals and to improve the health of the patient.

Every human being has a certain 'self-concept' which affects his or her state of mental, physical, and social health. It is important that nurses understand 'self-esteem' and how it relates to patients' perceptions of themselves to optimize nursing care. "Self-concept is an individual's perception of self, including self-esteem, body image, and ideal self" (Chapter 15: Self-image, n.d., Cengage Learning: 316). A client's self-description and self-esteem will affect his or her state of health. "A healthy self-concept is necessary for overall physical and mental wellness" (Chapter 15: Self-image, n.d., Cengage Learning: 316). Nurses themselves must have a sense of healthy self-esteem to be able to engage in care-giving in an effective manner. "Three basic components of self-concept are the ideal self, the public self, and the real self…The ideal self is the person the client would like to be…real self (how the client really thinks about oneself)…. Public self is what the client thinks others think of him and influences the ideal and real self) (Chapter 15: Self-image, n.d., Cengage Learning: 316).

The concept of self-esteem is critically related to nursing care given that patients who engage in effective self-care often have higher self-esteem and a more realistic self-concept. Someone who thinks: 'I am a weak person, I am destined to be overweight' will struggle more with changing ingrained behaviors regarding exercise and eating than someone who sees him or herself as fundamentally a 'good' and 'healthy' person. Critical components of a positive self-concept include confidence, the ability to set attainable and realistic goals, the ability to accept criticism and make changes, and also the willingness to take risks (Chapter 15: Self-image, n.d., Cengage Learning: 316). Self-esteem is defined as "a personal opinion of oneself and is shaped by individuals' relationships with others, experiences, and accomplishments in life. A healthy self-esteem is necessary for mental well-being and a positive self-concept (Chapter 15: Self-image, n.d., Cengage Learning: 318).

A nurse must also have healthy self-esteem to be effective as a nurse. Nursing is an incredibly demanding position, and often requires the nurse to ignore her needs for the sake of others. Patients in difficult circumstances may berate the nurse, and even if the nurse knows that rationally she is not at fault, this can still be a blow to her sense of self-worth,...

"High nursing turnover and lack of adequate nurse staffing is linked to decreased nurses' work satisfaction, decreased patient satisfaction with the quality of nursing care, and poorer health outcomes for patients" (Moody & Pesut 2006). A nurse with high self-esteem will be better able to endure criticism and view her experiences with a proper perspective. She will not view challenges brought upon by understaffing, for example, as a reproach to her essential competence as a nurse.
Self-esteem is also a critical component of being able to engage in the care of others. It has often been observed that it is almost impossible to bestow self-care if one does not 'care' for one's self in a meaningful fashion. Rather than seeing the care of others as being motivated by a lack of self-esteem, quite often it is motivated by the opposite -- a fundamentally positive sense of self. "In fields such as health care in which human health and safety are a top priority, it is important to be aware of research across the disciplines in order to understand the biological, emotional, and motivational processes that influence an individual's skill and behavioral capacity to engage in astute cognitive decision-making at any given point in time" (Moody & Pesut 2006). Nurses must understand what psychologically motivates patients and also what motivates themselves. When they feel angry or frustrated, it is important to ask: 'why is this the case? Is the patient or staff member truly making me angry, or is it my own lack of self-worth?'

For example, patient's family members frequently feel as if their loved ones are not receiving appropriate care in the form of 'enough' attention. While understaffing is a real concern, and can lead to errors, sometimes the family's fears and complaints may seem over-exaggerated. A patient whom has received a great deal of attention and care by the nursing staff may still not satisfy the demands of the patient's family. The woman's children themselves may lack a sense of secure self-worth, feeling guilty that they did not spend 'enough' attention with their elderly mother. Instead of lashing out at one another, they lash out at the nurse.

A nurse with high self-esteem can use her knowledge of the psychology of victim's families not to take their complaints personally and help show them how they are irrational and give the children ways to feel positive, validated, and secure about the care their mother is receiving. A nurse with low self-esteem may be more apt to lash out at the family, take the complaints personally, and feel aggrieved. Once again, this shows how high self-esteem is very different from self-centeredness and egoism. Self-esteem allows a nurse to put aside her needs of self-validation from others because she already knows she is a good and worthy nurse, and can instead focus upon healing the pain of the patient, the patient's family, and work to create a realistic yet supportive understanding of the patient's illness.

Low self-esteem can also create barriers between colleagues and make it difficult to create needed changes in the nursing environment. "One strong indicator of low self-esteem is an inability or unwillingness to deal with issues directly at the source and a propensity to find alternative inappropriate ways to communicate (e.g., talking behind people's back, putting other's down to make themselves look good, etc.)" (Nurses with low self-esteem please seek help, 2012, All Nurses). Rather than trying to focus on the problems and create change, low self-esteem can cause people to focus instead upon what they do not like about people in their organization, not upon the systemic factors that are usually larger than any single individual. Focusing on personalities and one's personal slights makes rifts impossible to heal, because no one can apologize 'enough;' while focusing on the tasks at hand make obstacles to change seem surmountable.

Being in the 'caring' profession requires the nurse to 'care'…