Women with Surgeries- Surgeries that Impact Body Image

Perez, Maria Althea Sabrina L.
Executive-4


“When you look in the mirror, what do you see? Do you like what you see?” these are the frequently asked questions seen in the television or heard elsewhere. Women are under pressure to measure up to a certain social and cultural ideal of beauty, which can lead to poor body image. Women are constantly bombarded with "Barbie-like" doll images. By presenting an ideal difficult to achieve and maintain, the cosmetic and diet product industries are assured of growth and profits. It's no accident that youth is increasingly promoted, along with thinness, as an essential criterion of beauty. If not all women need to lose weight, for sure they're all aging — which is a "disaster" sure to happen — as described by older women.

For women, surgery is not just an option, they think it’s the SOLUTION.

According to the American Society of Plastic Surgeons (ASPS), there are two categories of patients who are good candidates for surgery. The first includes patients with a strong self-image, who are bothered by a physical characteristic that they'd like to improve or change. The second category includes patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. It's important to remember that cosmetic surgery can create both physical changes and changes in self-esteem.

According to the National Mental Health Center in the United States, some women choose surgery not because of physical flaws but as an escape from an emotional turmoil in their lives. The American Society of Plastic Surgeons summed up a list of inappropriate candidates for cosmetic surgery.
• Patients in crisis, such as those who are going through divorce, the death of a spouse, or the loss of a job. These patients may be seeking to achieve goals that cannot be obtained through an appearance change-goals that relate to overcoming crisis through an unrelated change in appearance is not the solution. Rather, a patient must first work through the crisis.
• Patients with unrealistic expectations, such as those who insist on having a celebrity's nose, with the hope that they may acquire a celebrity lifestyle; patients who want to be restored to their original "perfection" following a severe accident or a serious illness; or patients who wish to find the youth of many decades past.
• Impossible-to-please patients, such as individuals who consult with surgeon after surgeon, seeking the answers they want to hear. These patients hope for a cure to a problem, which is not primarily, or not at all physical.
• Patients who are obsessed with a very minor defect, and may believe that once their defect is fixed, life will be perfect. Born perfectionists may be suitable candidates for surgery, as long as they are realistic enough to understand that surgical results may not precisely match their goals.
• Patients who have a mental illness, and exhibit delusional or paranoid behavior, may also be poor candidates for surgery. Surgery may be appropriate in these cases if it is determined that the patient's goals for surgery are not related to the psychosis. In these cases, a plastic surgeon may work closely with the patient's psychiatrist.
Aesthetic Surgery Journal (2006) released new data from a study on the impact of aesthetic plastic surgery on body image and sexual satisfaction. Women who undergo common elective cosmetic surgery procedures not only feel better about their bodies, but also have higher degrees of satisfaction with their sex lives, including ability to orgasm. Women in the study who had undergone aesthetic procedures were more sexually satisfied, reported that their partners were more sexually satisfied, dressed to enhance their new figures, and were apt to try more and different sexual activities post-surgery. The greatest benefits were seen in women who had breast augmentation/breast lift and/or body contouring procedures.

In an alternative approach to understanding weight concern, research has examined the role of ethnicity. Akan and Grilo (1995) reported that although the African-American subjects in their college sample had a significantly higher body mass index (BMI), the white subjects showed higher degrees of disordered eating. Similarly, white subjects have frequently been found to report greater body dissatisfaction and eating concerns than both Asian and Black subjects (Powell and Kahn, 1995).

Building a healthy lifestyle that includes a healthy diet and physical activity is important to improving body image. Women want to look their best, but a healthy body is not always linked to appearance. In fact, healthy bodies come in all shapes and sizes! Developing and nurturing a positive body image and a healthy mental attitude is crucial to a woman's happiness and wellness.
It is important to remember that when you change your body image, you don't change your body, you change the way you think about your body.
Essentials to developing healthy body image include:
• eating healthy
• regular exercise
• plenty of rest
Eating healthy can promote healthy skin and hair, along with strong bones; exercise has been showed to increase self-esteem, self-image, and energy; and plenty or rest is the key to stress management - all of these can make you feel good about your body.
With a positive body image, a woman has a real perception of her size and shape and feels comfortable and proud about her body. With a negative body image, a woman has a distorted perception of her shape and size, compares her body to others, and feels shame, awkwardness, and anxiety about her body. A woman's dissatisfaction with her body affects how she thinks and feels about herself. A poor body image can lead to emotional distress, low self-esteem, dieting, anxiety, depression, and eating disorders.

References:

L. Abrams & C. Stormer (2000). Sociocultural Variations in the Body Image Perceptions
of Urban Adolescent Females. Journal of Youth and Adolescence, Vol. 31, No. 6, December 2002, pp. 443–450

Abell, S., and Richards, M. (1996). The relationship between body shape satisfaction and self-esteem: An investigation of gender and class differences. J. Youth Adolesc. 25(5): 691–704.

Anderson-Fye, E., and A.E. Becker 2004 Socio-Cultural Aspects of Eating Disorders. In Handbook of Eating Disorders and Obesity. J.K. Thompson, ed., pp. 565–589. Wiley.

J. Ogden (1997). The Role of Family Status and Ethnic Group on Body Image and Eating Behavior. Department of General Practice, UMDS, London University, London, United Kingdom

Honigman R, Phillips KA, Castle DJ (2004) A review of psychosocial outcomes for patients seeking cosmetic surgery. Plast Reconstr Surg, 113.

National Plastic Surgery Procedural Statistics, 2006. Arlington Heights, III, American Society of Plastic Surgeons, 2007


- my apologies for posting a late reply regarding this discussion, i had a problem with my computer kasi.

Hello everyone!

I had a great time reading your posts. All of you were able to obtain in depth understanding of how body image is affected by physical, psychological, cultural and social factors and how these factors can affect the way a woman behaves and see herself. I want to recognize some of you who shared their own personal experience of dealing with their own struggle of holding an image that is ideal.

Each individual holds an idealized mental picture of his or her physical self; he or she uses this image to measure concepts related to body image. Once an individual's percepts or concepts of this body image are altered, emotional, perceptual and psychosocial reactions can result.

Body image is the mental picture a person forms of his or her physical self. According to Kolb (Kolb LC. 1959), each individual holds an image of the body that he or she considers the ideal in relation to his or her own body. An alteration in a person's body image sets up a series of emotional, perceptual and psychosocial reactions (Kolb LC. 1975)

As I was reading your answers, I noticed that all of us agreed that there are different aspects and conditions that can change women’s view of body image. Disabilities which are phenomenon that may be caused by several conditions (aging, diabetes, cancer and others) can have an impact on the way a woman view herself. It can limit the activities of women that can hinder her from conforming on the image set and accepted by the society. This distortion can lead to women seeing their imperfect bodies as indicators of an imperfect person (Brownell, 2005. It can negatively influence women’s experiences, feelings and attitudes toward their own bodies. (Taleporos, 2002).

Aside from disabilities, most of you also mentioned the influence of culture and society specifically the mass media on body image of women. Researches put special consideration on factors stemming from social and cultural forces that play a role in determining body image. A woman’s attitude about body image is formed within her cultural environment and is the result of sociocultural experiences (Arena, 2003). Different cultures have different beliefs and influences on what are considered valued behaviors. Moreover, society places value on youthful (and gorgeous) physical appearance, physical disabilities can negatively affect a woman's body image and in turn decrease her self esteem. Socially constructed differences toward appearance contribute toward “thinness” standards for women. Many women in American society are identified by their body type. This unrealistic standard of beauty has been further distorted in the mass media.

Women changes their view of what ideal body image is. It is hard to find a woman who likes her body. (Brownell, 2005)Women are always dissatisfied on how they look because of the belief that they have to conform on the stereotyped body image portrayed by society particularly the media.

We all agreed to the fact that mass media has a special contribution in setting up the standard of beauty for women. We see different advertisements on the television that shows sexy body, beautiful skin and face which can change our idea of body image. (Kaminski, 2005). But may we come to realize that these media and the advertisements that they show can be biased. They show us what is not realistic at hand. They try to persuade women and send message that if we look like not the same us their models, we are not acceptable. So we have to use their products. Messages from the advertisements show that losing weight is easy and that if you are not similar to the picture you are lazy and fat. Many women who want to meet the unrealistic standard of media come into a point that they will develop eating disorders in an effort to become thin (Elliot, 2006). And when these women were not able to achieve it they may have poor body image.

It is good that most of you also mentioned developmental factor influencing body image in women. Dissatisfaction is prevalent among women and girls. (Choate, 2005) In children, female dissatisfaction with appearance and poor body image begins at very early age. Studies have reported body dissatisfaction prevalence greater than 60 percent for high school aged females and higher than 80 percent for women in universitys (Choate, 2006). A large percentage of younger women feel that their body weight is too high and are trying to lose weight even when their weights are within, or below, the range that is considered healthy (Clay, 2005). In middle aged women, they are more conscious of their body image and believe that they no longer conform to society’s youth and beauty which can lead to their low-self-esteem, depression and anxiety.
Ara also included pregnancy as part of developmental factor wherein there are resultant changes in all factors of self-concept.As the pregnancy progresses, the woman’s body image adjusts to accommodate the idea that the baby is a separate individual. Also there are changes in physical appearance during delivery like increase in weight, visible stretch marks for some, darkening of the armpit and neck.. These make women feel insecure and afraid that their husband will look for someone that is more beautiful than they are. In this case, they have to feel secured and reassured. (can you recall Jonnah’s experience?) After delivery, the woman who has positive self-esteem will accept and love the baby. One who feels unlovable or unattractive may make disparaging remarks about the infant, and have difficulty bonding appropriately and adjusting to the life changes a new baby introduces.

Several researches that you stated for body image intervention include:
• Obesity, Stigma and Public Health Planning
• Body Image Among Women with HIV: A Cross Sectional Evaluation
• The Effect of Gender in Improving Body Image and Self Esteem, Australia Research review on Body programs
• Australia A Research Review of Body Image Prout school-based interventions, Adolescent Community-Based Interventions, University Interventions, Adult Community Interventions and Self-esteem interventions
• Cognitive Dissonance Intervention

With regards to the nursing role, all of us have the same view on how we are going to provide interventions for patients with this condition. First is that we have to be aware of ourselves so that we can use our own selves in rendering care and comfort to these patients. Some mentioned of allowing the patient to verbalize their feelings. Therapeutic communication will play an important role here. Encouraging the client to verbalize will help the nurse identify the learning needs of the patient and will allow the nurse to provide information and appropriate intervention that will satisfy patient’s doubts about her condition.


Thank you classmates for imparting your knowledge and sharing your experiences.

Let me leave you with this:

“Do not look on his appearance or on the height of his stature, because I have rejected him. For the Lord sees not as man sees: man looks on the outward appearance, but the Lord looks on the heart.” (1 Samuel 16:7)

Thanks again. Have a great day!

<ANGEL>

PORTILLO, Maria Santa R.
MCN – EXEC 4

1. What is the impact of certain disabilities on the body image of women?

It is notorious that women are really “vain” when it comes to their selves. Even the ancient times, females will strive their best to look good and presentable. That’s why the concept of beauty products came into being. Given this reality, disabilities affecting women will definitely create a great impact their body image. Same with jonnah, I have an encounter with this patient (who is in her 30’s) when I’m still a student. She’ll be undergoing mastectomy and with my dealings with her during the pre-op stage, aside from her anxieties to the operation, she would verbalize her worries of how it is to live without one of her breasts and how will her husband looks at her after it. And for me, this is really a big concern for all the girls.

Still, the severity of the impact among the women depends on many factors. First, it addresses the woman’s own perception of herself given that disability – to grieve at the early stage of it is part of the process but later on, her coping mechanism (together with her values in life) will play a great role. Second, the support system available can either help a lot or make her suffer more. If acceptance among the people around her is present, coping is easy; but if such acceptance is absent, it is really a great challenge for her.

2. Aside from disabilities, other factors play a role in influencing women’s perception of herself. How can cultural, social and developmental factors affect how a woman perceives her body image?
According to Schilder, perception of self is influenced by one’s own attitudes and values placed on her body in comparison with others; and by social experiences, with ongoing interactions between what others say with the physical appearance and her personal reactions to these impressions (Breakey, 1997).

Between the two, social factors have the great driving force in the way body image is viewed. The culture that the woman grew up with is one. In countries where inequalities between gender in the culture exists, specially those paying more importance to the males will produce women whose view of themselves are always lesser, someone who has limited access and rights to many things. (Cases like this is shown from our readings). Also, each culture has their own definitions and standards of what is beautiful and what is not. And women would make those as a guide in evaluating themselves, being able to fit themselves with the standards given, the more welcome they feel they are. This is the same with the culture being exposed in the media. It is a mentality nowadays that whatever is being flashed in front of the television screens becomes the society’s measure on what is acceptable and nice. So if you are “in” or “out” with the portrayed trend will affect how you will be evaluated by those around you and also, how you will evaluate yourself.

Development transitions also affect women’s view on body image. For example, pregnancy is a process with resultant changes in all these factors of self-concept. In the early part of pregnancy, the woman incorporates the baby into her self-image. As the pregnancy progresses, the woman’s body image adjusts to accommodate the idea that the baby is a separate individual. After delivery, the woman who has positive self-esteem will accept and love the baby. One who feels unlovable or unattractive may make disparaging remarks about the infant, and have difficulty bonding appropriately and adjusting to the life changes a new baby introduces. Another is menopause. Some people view the female climacteric (menopausal phase) as an indication of loss of femininity with resultant decrease in value as a person. Other women view menopause as a sign of freedom from the risk of childbearing (Edelman & Mandle, 1997).

3. Are there specific researches done to determine body image interventions that focus on an individual and in a larger population?

Most of the researchers available includes exploration of the extent of effects of body image disturbance (due to different causes) among women in order to propose for sound interventions or approaches for care. However, search for studies concerning about interventions will yield research concerning interventions specific for a particular cause of body image disturbance. Examples are as follows:

• Obesity, Stigma and Public Health Planning - In North America, stigma is associated with obese people. Much is written in the literatures about his stigmatization but few guidelines are available for public health workers who design and implement obesity prevention programs to minimize the stigma. The authors, then examine the stigmatization of obese people and the consequences of this social process, and discuss how stigma is manifest in health service provision; then, they give suggestions for designing non-stimagtisizing obesity prevention public health programs (MacLean, et al., 2009).
• Body Image Among Women with HIV: A Cross Sectional Evaluation – The study demonstrated that HIV and lipodystrophy status among women is associated with poor body image. The authors call for universal efforts should be made in the HIV medical community to recognize body image issues particularly among persons affected by lipodystrophy so that appropriate intervention and support may be provided (Huang et el., 2006).
• The Effect of Gender in Improving Body Image and Self Esteem - There is considerable agreement that physical activity is associated with improvements in self-esteem and body image perception, however it would seem that these effects are not the same for both genders. This study examines the differences between the sexes on the affect of activity on self-esteem and body image. In conclusion the present study gives support for the notion that participation in a worthwhile activity can improve body image and self-esteem. In this study body image improved as a consequence of aerobic exercise, whilst self-esteem improved following a computer course but both of these effects were seen only in men. This generates the interesting question of if one were to design an intervention bring about a positive change in self esteem and body image whether the nature of it (for example duration, intensity, style) should be different depending on the gender of the target group (Murray, G., & Kirby, S., 2009)

4. As a nurse, what will be your role in taking care of a woman with disrupted body image due to disabilities?

As nurses, it is a challenging role for us to deal with women suffering from disrupted body image due to disabilities. An advantage that we have (for female nurses) is that we know how hard it is to be in such conditions. But hopefully, this advantage will not be the means for us to be so immersed to the client’s case to the extent that we can no longer perform what is expected of us.

Our roles will be to attend to their physical needs associated with their disabilities and to provide also for their psychological needs. Being attentive listeners to their concerns will be of great help. Telling them that being sad about it is just normal. Also, we need to aid them to utilize healthy defense mechanisms. Later on, once they have accepted it, we can propose and help them decide for alternatives like use of a wig, hat, etc.

References:
Breakey J. 1997. Body Image: the Inner Mirror. Retrieved June 25, 2009. Available at: http://www.oandp.org/jpo/library/1997_03_107.asp
Edelman, C. L., & Mandle, C. L. (1997). Health promotion throughout the life span (4th ed.). St. Louis: Mosby.

DeLaune, S., & Lander, P., 2002. Foundations of Nursing Practice, 2nd Ed. Thomson Learning Inc.

MacLean, L., Edwards, N., Garrad, M., Jones, N., Clinton, K., Asheley, L., 2009. Obesity, Stigma and Public Health Planning. Health Promotion International Advance Access published online on January 8, 2009. Availalbe at http://heapro.oxfordjournals.org/cgi/content/abstract/dan041v1

Huang, J.S., Harrity, s., Lee, D., Becerra, k., Santos, R., Mathews, C., 2006. Body image in women with HIV: a cross sectional evaluation. AIDS Research and Therapy 2006, 3:17. Electronic version available at http://www.aidsrestherapy.com/content/3/1/17

Murray, G., & Kirby, S., 2009. The Effect of Gender in Improving Body Image and Self Esteem. Online journal of Sports Psychology. Available at http://www.athleticinsight.com/Vol9Iss3/GenderandPositiveChange.htm

Ma. Cristina D. Arroyo Women’s Health
MSNMCN E4 Prof. Mae Nierras

Women and Disabilities

Impact of certain disabilities on the body image of women
All research to date on body image shows that women are much more critical of their appearance than men (Fox, 1997).
Disability is a natural phenomenon which occurs in every society, in every generation. Disabilities may result from several causes: prenatal factors, birth injuries, disease, traumatic injuries, physical or mental stress.
Disability is not an illness, although some disabilities are caused by illness. Rather, disability is a chronic or long-term condition which substantially limits an individual in performing one or more activities of daily living (ADL's). Activities of daily living include walking, seeing, hearing, learning, caring for oneself, breathing, lifting, and so on. Girls and women with disabilities, especially physical disabilities, often notice that they do not conform to dominant cultural and/or commercial images of feminine beauty. As a result, people living with facial and physical differences and/or disabilities are often subject to negative or inaccurate perceptions of their bodies and lives, encountering judgmental comments, intrusive stares, and questions about their bodies (Rice, 2003). The mass media, as well as individual interactions, seem to emphasize a particular ideal of perfection, which disabled women may feel is unattainable. Women who are able to understand, analyze, and reject those images may develop a stronger sense of their own unique beauty (Hershey, 2000).
Bodily impairment had a negative influence on the participants’ psychological experiences, feelings and attitudes toward their own bodies (Taleporos, 2002).
Many people with disabilities feel hurt and angry because of the way able-bodied people speak to them. Conversation levels and voice tones that are often used are not age-appropriate or are on topics, particularly about relationships and sexuality which are inappropriate, offensive or which can raise false hopes and expectations.


Cultural, Social and Developmental factors of Body Image
Body image may be considered as the total, constantly changing and evolving perception of one's physical self as separate and distinct from all others. This perception is based on inner sensations and functioning as well as on information derived from the external environment (Scott, 2009).

Social Factors
Society plays a significant factor in honing body image of a person especially of women. In society, reflects the what-to and what-not-to, further forming the images of little girls as what to become as they grow up. In society also that people conform into whatever is in and whatever the society accepts.
• Attractive children are more popular, both with classmates and teachers. Teachers give higher evaluations to the work of attractive children and have higher expectations of them.
• Attractive applicants have a better chance of getting jobs, and of receiving higher salaries. (one US study found that taller men earned around $600 per inch more than shorter executives.)
• In court, attractive people are found guilty less often. When found guilty, they receive less severe sentences.
• The 'bias for beauty' operates in almost all social situations – all experiments show we react more favourably to physically attractive people.
• We also believe in the 'what is beautiful is good' stereotype – an irrational but deep-seated belief that physically attractive people possess other desirable characteristics such as intelligence, competence, social skills, confidence – even moral virtue. (The good fairy/princess is always beautiful; the wicked stepmother is always ugly) (Social Issues Research Centre, 2009).
• People around us affect the way we see ourselves. It started back in childhood, when often mothers will dress up their children and boast to her friends. Another aspect of peer influence is the exposure to older children. It has been speculated that older children who have already internalized the cultural norms for body shapes may display these attitudes to the younger children who spend time with them. Consequently, this involvement between different age groups could lead to further awareness and internalization of body image by younger children.

A major factor that reflects the society’s picture is through media. Many people especially children watch between two and four hours of television per day. The presence or absence of role models, how women and men, girls and boys are presented, and what activities they participate in on the screen powerfully affect how girls and boys view their role in the world. Studies looking at cartoons, regular television, and commercials show that although many changes have occurred and girls, in particular have a wider range of role models, for girls "how they look" is more important than "what they do." (National Institute on Media and Family)

Developmental
Children
Female dissatisfaction with appearance – poor body-image – begins at a very early age. Human infants begin to recognize themselves in mirrors at about two years old. Female humans begin to dislike what they see only a few years later.
Teasing factor: If you were teased about flaws in your appearance (particularly your size or weight) as a child or teenager, your body image may have become permanently disturbed and Touch-deprivation factor: People suffering from extreme body-image disturbance report a lack of holding and hugging as children.
Adolescents
Boys do go through a short phase of relative dissatisfaction with their appearance in early adolescence, but the physical changes associated with puberty soon bring them closer to the masculine ideal – i.e. they get taller, broader in the shoulders, more muscular etc.
For girls, however, puberty only makes things worse. The normal physical changes – increase in weight and body fat, particularly on the hips and thighs, take them further from the cultural ideal of unnatural slimness.
Adults
Among women over 18 looking at themselves in the mirror, research indicates that at least 80% are unhappy with what they see. Looking through the changes that are happening, looking to what they lack instead of what they have.
• Aging
In a society that places much value on youth, a woman's body image can be affected by aging in many ways. Physical changes such as weight gain, hair loss, and wrinkles can affect a woman's self-esteem. Menopause can be a stressful time for women due to hormonal changes. Osteoporosis can lead to broken bones and fractures, affecting a woman's independence. Women can often have two stressful roles - as caregiver and caretaker - raising children and taking care of elderly parents. Women can also feel lonely and less useful as they age, leading to depression.
Culture
Black and Asian women generally have a more positive body-image than Caucasian women, although this depends on the degree to which they have accepted the beauty standards of the dominant culture.
Culture plays in influencing body image especially on women as women are seen as object for men. Culture presents high regards to body image, where women must look good in order to marry a ‘someone’ in the society and must stay looking good in order for the husband to stay and not look for another else.

Researches done to determine body image interventions
Yes, there are actually existing researches that will tackle about body image interventions. However, there are only few studies in this particular issue.
Dworkin, Sari H.; Kerr, Barbara A.Comparison of Interventions for Women Experiencing Body Image Problem. Journal of Counseling Psychology. Volume 34 (2).
Rumsey N. Harcourt D. 2004. Body image and disfigurement: issues and interventions.Body Image. Volume 1 (1).
Paxton S., Hay P. 2009. Interventions for Body Image and Eating Disorders Evidence and Practice.
Nurse’s Role in Body Image Disturbance
Nurses can promote peace between mind and body through the nursing process, role modeling, and community involvement. Body image should be assessed, particularly during vulnerable periods, such as adolescence, pregnancy, postpartum, and menopause. Planning, intervention, and evaluation should focus on self-acceptance and emotional and physical well-being, rather than on changing one's appearance (Low,1993).
The most vital role of the nurse is to encourage the patient's verbalization about her concerns and fears (Fortune, 2005).
Nurse’s Role: (Sharma, 2002)
1. Spend Time with Patients
Calling a patient by his name, just remaining with him to listen to what he his to say, is a great contribution to his comfort and well being.
2. Verbalization of Feelings
The single most useful thing is to encourage and support the verbalization of emotions. In itself, putting worry into words very often brings about a tremendoes relief of tension.
3. Handling the Crying of Patient Verbalization of distress is often accompanied by tearfulness. In our culture, is unacceptable for men to cry, and so you may find this behavior in a man upsetting. Many women get great relief from a `good cry' , men should not be denied too, it is just a manifestation. Any crying should be handled with care and privacy and support given until composure is regained.
4. Orientation of Patient to Health Care Facility
Provide detailed explanation of the care patient receives and of rationale behind various medical and nursing procedures that the patient has to undergo, with constant reassurances all along. This will alleviate the fear of 'unknown' in patients.
5. Identification of Learning Needs of Patients
In course of interacting with the patient and especially when distress is verbalized, learning needs of patients will be identified, e.g. a patient before surgery may worry about prognosis, pain, ambulation, dependency etc. Imparting information on these aspects will satisfy patients' need to know about his condition, treatment etc. and thus reduce anxiety.
6. Act as a Resource Person
When you identify learning needs of patients, that are best met by some other members of the health care team, act as a resource person and arrange for the, patient to receive that information.
7. Diversional Activities
Encourage diversional activities within the permissible limits of patients' condition, that are pleasurable and tension reducing. Many chronically anxious people either do not recognize or are uncomfortable with their need for recreation. Activities should not require intensive or prolonged concentration and should be in group rather than solitary.
8. Performance of ADL
Patients should be encouraged to carry out daily activities as physical condition permits. At the same time,-Nurses should be prepared to help as much and for as long as necessary.

References:
Rice C.2003. Talking about Body Image, Identity, Disability and Difference. Building Bridge, Toronto, Ontario.
Hershey L. 2000. Women with Disabilities: Health, Reproduction and Sexuality. Available at
Fortune E. 2005. A nursing approach to body image and sexuality adaptation in the mastectomy patient. Sexuality and Disability.Volume 2(1).
Taleporos G., McCabe M. 2002. Body image and physical disability—personal perspectives.Social Science Medicine. Volume 54(6).
Fox K.1997. Mirror, mirror A summary of research findings on body image. Social Issues Research Centre. Available at
National Institute on Media and Family. Media's Effect On Girls: Body Image And Gender Identity. Available at
Scott C. 2009. Factors that Influence Body Image. Health and Wellness. Available at
Brown University Health Education.Body Image. Available at

I would like to agree with miguela.. Yes all of us ladies have always dreamed of having the appearance of a beauty queen. And we find it great or inspiring (or rather we feel envious) to read/hear of true life stories of women who grew up from an "Ugly Duckling" into a "Beautiful Swan", and we (at some point in our lives) would also wish that we could have that same story. I mean, who wouldn't want to have a face (or better yet an image) that could launch a thousand ships (or even more! ) Let's face it. Women value their body image because they equate it to self esteem. If your pretty then you feel good about yourself.

In one study, the authors suggests that the development of body image starts in her childhood years. In childhood a woman learns what her body can and cannot do, what her body looks like, and whether she is a boy or a girl. At the same time she also develops a value for herself, her self-esteem, (described as how she judge her own abilities and worth). The opinions of other people also plays an important role in this process.

Now in a society that places value on youthful (and gorgeous) physical appearance, physical disabilities can negatively affect a woman's body image and in turn decrease her self esteem. Physical abilities are those that can be caused by health condition or illness, surgeries or treatments as well as those natural life events that women experience. All these can affect a woman's body image.

One qualitative study that was done among 31 women with disabilities , they identified "body image" as a key theme that impacted participants' sense of self. When a participant described how she felt about her body or how others viewed her body, she seemed often to be reflecting others' own sense of self. Themes identified in this study that related to body image were as follows:

o For some women with disabilities, body image seemed to be part of their definition of sexuality or their view of themselves as attractive sensual women.

o Body image was also linked to personal attributes, such as physical characteristics (bone size, weight) and their impact on the qualitative attributes ascribed to them (beauty or unattractive beliefs).

o As expected, body image was linked to social comparison, or how a woman with a disability compared herself to other people in the community. Women with disabilities (like all women) are constantly exposed to unrealistic ideals of women portrayed in the media. Scars and deformity related to disability were identified as impacting body image and self-esteem. Women with disabilities living in this society are not exempt from the influence of messages that attempt to dictate what is desirable and what is not in a woman. These messages are often internalized, and have an impact on how women with disabilities see themselves.

o Clothing and grooming were linked to body image. Several women with disabilities discussed using clothing as a way to make themselves feel more attractive. Some women with disabilities discussed using clothing to hide or mask their disability.

o One woman described her body image being related to a lack of physical boundaries in her life and feeling that her body did not really belong to her.

o Several women with disabilities had come to a point of being comfortable and accepting their disability as part of their body image. These women spoke of acceptance and realizing their inner beauty.

It has been suggested that it is very important for a woman with a disability to appreciate her own value, assert her right to make choices that will improve her life, feel ownership of her body, restrict the limitations resulting from her disability to physical functioning only and not her body, and take action to enhance her attractiveness.impose those limitations on her sexual self, be accepting, not ashamed of. As a primary health provider, i think we should facilitate and help women with disabilities go through the process of developing and nurturing a positive body image and a healthy mental attitude which is very crucial to their happiness and wellness, as they move through the different stages of their lives.

It would be beneficial to include the partners of these women. Partners can go a long way to be loving and supportive in regards to woman's changing body image. Expressing acceptance and encouragement as a woman makes changes in wardrobe, hairstyle, or even diet and exercise can help her adjust and finally regain her esteem.

Also early identification and treatment of body image dissatisfaction may help prevent the development of depression and other psychosocial impairment in women with disabilities.

This is a quote from an Asian woman with tetraplegia that was quoted in one of the articles I've read.

"You lost most of the confidence when you become disabled. Before that I like to wear fashion clothes, spend more time with myself like what kind of make-up and what kind of hairstyle I'd like to have today. After the accident, since I cannot do it myself, then you cannot be so picky when other people do it for you. It makes it very difficult at first because I was just not happy with the way that I looked, at first once I became disabled. Now I can accept it more, but I just don't think of myself as attractive as before."


REFERENCES:

How Breast Cancer May Affect Body Image retrieved June 25, 2009 from http://breastcancer.about.com/lw/Health-Medicine/Conditions-and-diseases/How-Breast-Cancer-May-Affect-Body-Image.htm

Psychosocial Health--Body Image BCM Center for Research on Women with Disabilities retrieved June 25,2009 from http://www.bcm.edu/crowd/?pmid=1421

Women and Body Image retrieved June 25, 2009 from http://www.medicinenet.com/script/main/art.asp?articlekey=19804[i]

As I looked into different articles relating surgeries and body image, it was fairly noted that surgeries and practices that involves femininity and sexuality of women are often being linked and studied to be relevant in determining the body image of women. And this observation directed me to found a very relevant quote which says that:
“To men a man is but a mind. Who cares what face he carries or what he wears? But woman’s body is the woman” (Ambrose Bierce, 1958).
Women’s perception of self and her body had been influenced by a lot of factors that somehow led to a struggle of contentment and insecurity. Media, most especially, had contributed a lot to how women dramatically behave and see themselves as woman. Multi-media advertisement displaying beautiful and almost perfect cover girls and endorsers had even more sensationalize how a woman should appear. Long-legged, meztiza-looking, with long black hair and a coca-cola body are being portrayed to represent women in general; thus, resulting to more body-conscious women of generation.

As someone who is expected to provide holistic care to patients across lifespan, encouraging them in verbalizing their thoughts and express their emotions about themselves and their condition is very critical; however, there are instances that in as much as we want to relieve this patient from the burden of losing her identity and esteem, it is as if (personally) become very difficult to deal with. I remember a friend quoting that: you’re saying it’s alright because you are not in the same position as what the person is in now. And you are not feeling the same emotions as hers, not unless you’ve been there. Truly I can say that you cannot give what you don’t have. And I also believe that nurses are present to encourage and provide support to this kind of patients, whether through palliative care, and the rest of the healing and acceptance should start from the person with disability.