Repeated projection of falsely positive self-evaluation based on a
self-protective pattern that defends against underlying perceived
threats to positive self-regard
• Denial of obvious problems
• Projection of blame
• Denial of obvious weaknesses
• Projection of responsibility
• Difﬁculty establishing
• Rationalization of failures
• Ridicule of others
• Difﬁculty in perception of
• Superior attitude toward
• Conﬂict between self-perception
• Low level of conﬁdence in
and value system
• Fear of failure
• Low level of self-conﬁdence
• Fear of humiliation
• Fear of repercussion
• Unrealistic expectation of
• Lack of resilience
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
The patient will
• State the reason for hospitalization.
• Verbally describe self-perception, body image, success, and failures.
• Engage in decision making about care.
• Express a responsible attitude toward own behavior.
• Demonstrate follow-through in decisions related to healthcare.
• Interact with others in a socially acceptable manner.
SUGGESTED NOC OUTCOMES
Acceptance: Health Status; Coping; Self-Esteem; Social Interaction
INTERVENTIONS AND RATIONALES
Determine: Assess patient’s understanding of current illness; relation-
ships with family and friends; self-esteem; self-perception; support
systems; spiritual support. Speciﬁc assessment information will assist
in developing an accurate plan of care for the individual.
Perform: Assist patient to compile a list of this that he likes and dis-
likes about his present situation. Performing this exercise can help
the patient identify aspects of self and identify changes he would
like to make with speciﬁc variables.
Have patient perform as many self-care activities as possible, and
make treatment-related decisions to encourage a sense of autonomy
and promote compliance.
Provide a structured daily routine. Structure may help provide an
alternative to self-absorption.
Inform: Teach patient relaxation techniques such as guided
imagery, deep breathing, meditation, aromatherapy, and progres-
sive muscle relaxation. Purposeful relaxation efforts helps reduce
Teach patient strategies for positive thinking. Work speciﬁcally
to identify negative thoughts and rephrase them in a positive way.
Making the patient conscious of negative thoughts will help
reinforce the need to think about things and people in a more
Attend: Arrange for interaction between the patient and family
or friends and observe the interaction patterns. This allows
the nurse to provide feedback about the effectiveness of communi-
Allow time for patient to talk about his or her frustration. Speak-
ing to a sensitive listener may help to reduce some frustration and
may lead to new ideas about how to help the patient resolve his or
Provide positive feedback to patient when he or she assumes
responsibility for his or her own behavior in order to reinforce posi-
tive coping behaviors.
Manage: Encourage the patient to meet with someone who is coping
successfully with a similar problem. This may assist the patient to
work toward a positive outcome.
Encourage the patient to consider participating in a support
group. Participation in such a group may help the patient cope
more effectively, as well as establish new relationships.
Refer to case manager/social worker to ensure that follow-up is
SUGGESTED NIC INTERVENTIONS
Calming Techniques; Coping Enhancement; Emotional Support; Self-
Awareness Enhancement; Self-Responsibility Enhancement
Schwinghammer, S. A., et al. (2006). Different selves have different effects:
Self-activation and defensive social comparison. Personality and Social
Psychology Bulletin, 32(1), 27–39.