Body image An individuals perception of their own body. Part of self-concept. Related to social standards and cultural concepts. Partly determined by a persons attitude to body traits. This attitude is effected by the attitude of others. Relates to self-esteem and social confidence. This will therefore effect many other areas of life e.g. avoidance of certain situations. Once an evaluation of ones own body is made a person can: - Challenge the social norm concerning the trait - Try to change his/her body - Change his/her attitude to the trait Body image develops and changes from early childhood. Ways of change - Clothing - Cosmetics - Dieting - Exercise - Social strategies - Other aids - Prostheses - Cosmetic surgery These may generate a more secure body image improving self-consciousness and security. DISTORTED BODY IMAGE eg. anorexia nervosa. Body image as related to sexuality. SEXUALITY AND HEALTH CARE The aim of taking sexuality into account in health care, according to the World Health Organisation (Mace, Bannerman and Burton, 1974) is to promote sexual health. This is defined as:- 1. A capacity to enjoy and control sexual and reproductive behaviour in accordance with a social and personal ethic. 2. Freedom from fear, shame, guilt, false beliefs and other psychological factors inhibiting sexual responses and impairing sexual relationships. 3. Freedom from organic disorders, diseases and deficiencies that interfere with sexual and reproductive functions. CHANGES IN BODY IMAGE Anything basic to an individuals concept of self will be mourned when lost, or even if such loss is merely threatened. (Engel 1962). Husbands may bear the same emotional problems as their wives. (Gaylin 1977). ENFORCED CHANGE IN BODY IMAGE Amputation Hysterectomy Masectomy Ileostomy Colostomy In fact any surgery depending on individual attitude and the attitude of significant others. Great effect if something is removed? Skin conditions or burns, obesity, Cancer, Long term disease, or wounds. Almost any medical condition depending on the interaction between condition and individual. NURSING PRINCIPLES - Assessment of the individuals perception of the condition. - Assisting the person to maintain a realistic perception of the threat in relation to the total self-image. - Assisting in identifying useful coping mechanisms. - Identification of support systems. - Use of communication skills eg active listening and perception of body language. - Ensure patient is pain free, eg phantom pain. - Advise about prostheses. - Use of helpful agencies eg mastectomy society. - Help with special need eg. to adapt the home, ramps, etc. EXAMPLES OF TYPES/CATEGORIES OF ALTERED BODY IMAGE Congenital Muscular dystrophy Spina bifida Hereditary Huntingdon’s chorea Reproductive Pregnancy Sterility Miscarriage Premature ejaculation Medical Arthritis Anorexia nervosa Bulimia Obesity Skin diseases Multiple sclerosis Sensory impairment Trauma Burns Surgery (encompasses oncology) Ageing Balding Obesity Revealed Head/neck Amputation Concealed Stoma Breast Gynae Impotence Teratoma Sterility Incontinence Permanent Stoma Head/neck Breast Brain tumour Temporary Alopecia Stoma Incontinence Fistula SHORT QUESTION Discuss the factors to be considered in assisting patients to cope with altered “body image”, prior to, and following, below knee amputation. 100% SUGGESTED ANSWER GUIDE Consider admission - List/emergency Age of person - young, middle aged, elderly Family details - gender. - married, single Occupation - employment? self employed Perception - intelligence. Personality - understanding of information Home - special needs Coping - mechanisms - previous experiences Problem solving approach - assessment needs and problems problems implementation evaluation re-assessment Psychological care - bereavement altered body image agencies that may be able to assist how well informed was/is the patient Communication - Active listening Body language - observations of this Mobility - advise on prostheses - teaching of exercises (contractures) Pain - pre and post-operative use of analgesics explanation of phantom pain benefits of amputation a,b,c,d,e,f,g,h.