Relevant Theories and Therapies for Nursing Practice Chapter 2 Relevant Theories and Therapies for Nursing Practice Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Introduction Psychological theories help us to explain behavior Psychological therapies are treatments based on these theories An overview of theories and therapies and their relevance to nursing and psychiatric mental health nursing are described in this chapter Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Psychoanalytic Theories Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Freud’s Psychoanalytic Theory Levels of awareness Conscious Preconscious Unconscious Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Freud’s Psychoanalytic Theory (Cont.) Personality structure Id Pleasure principle Reflex action Primary process Ego Problem solver Reality tester Superego Moral component Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Freud’s Psychoanalytic Theory (Cont.) Defense mechanisms and anxiety Operate on unconscious level Deny, falsify, or distort reality to make it less threatening Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Freud’s Psychoanalytic Theory (Cont.) Experiences during the early stages of life determine Individual’s lifetime adjustment patterns Personality traits Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Freudian Theory and Nursing Formation of personality Conscious and unconscious influences Importance of individual talk sessions Attentive listening Transference Countertransference Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study A patient is admitted to your unit who has an uncanny resemblance to your older sister. As a child, your older sister bossed you around and criticized you constantly. You realize that you are responding negatively to this patient. What is going on? Countertransference - unconscious feelings the health care worker has toward the patient Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study (Cont.) What should the nurse do? The nurse should realize the importance of maintaining self-awareness and seeking supervisory guidance as the therapeutic relationship progresses. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Erikson’s Ego Theory Eight stages of development Personality continues to develop through old age Stage Age Trust vs. mistrust 0-1.5 Identity vs. role confusion 12-20 Autonomy vs. shame-doubt 1.5-3 Intimacy vs. isolation 20-35 Initiative vs. guilt 3-6 Generativity vs. self-absorption 35-65 Industry vs. inferiority 6-12 Integrity vs. despair 65+ Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Erikson’s Theory and Nursing Developmental model is important part of nursing assessment Helps determine what types of interventions are most likely to be effective Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Sullivan’s Interpersonal Theory Purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid anxiety Anxiety Security operations Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Sullivan’s Theory and Nursing Foundation for Hildegard Peplau’s theory Participant observer Mutuality Respect for the patient Unconditional acceptance Empathy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Hildegard Peplau’s Theory of Interpersonal Relationships in Nursing Peplau influenced by Sullivan’s work The art of nursing Provide care, compassion, and advocacy Enhance comfort and well-being The science of nursing Application of knowledge to Understand a broad range of human problems and psychosocial phenomena Intervene in relieving patients’suffering and promote growth Based on Sullivan’s Interpersonal Theory, Peplau is considered the “mother” of psychiatric mental health nursing. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Peplau and the Therapeutic Relationship Levels of anxiety Interventions to lower anxiety Aim to improve patient’s ability to think and function Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Behavior Theories and Therapies Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Behavior Theories Pavlov’s classical conditioning theory Watson’s behaviorism theory Skinner’s operant conditioning theory Implications for nursing Modifying or replacing behaviors Behavior management Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Behavior Therapy Modeling Operant conditioning Systematic desensitization Aversion therapy Biofeedback Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Cognitive Theories and Therapies Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Cognitive Theory Dynamic interplay between individuals and the environment Thoughts come before feelings and actions Thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Cognitive Theories Rational-Emotive Behavior Therapy (Ellis) Aims to eradicate irrational beliefs Recognize thoughts that are not accurate Cognitive-Behavioral Therapy (Beck) Test distorted beliefs and change way of thinking; reduce symptoms Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Humanistic Theories Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Maslow’s Hierarchy of Needs Human beings are active participants in life, striving for self-actualization When lower needs are met, higher needs are able to emerge Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Maslow’s Theory and Nursing Emphasis on human potential and the patient’s strengths Prioritizing nursing actions in the nurse-patient relationship Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Biological Theories Focus on How the body and brain interact to create Neurological Chemical Biological Genetic How the body and brain interact to create Emotions Memories Perceptual experiences Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Biological Theories and Nursing Consider other influences that play a role in the development and treatment of mental disorders Social, environmental, cultural, economic Focus on Qualities of a therapeutic relationship Understanding patient’s perspective Communicating to facilitate recovery Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Additional Therapy Milieu Therapy Use of total environment People, setting, structure, and emotional climate are all important to healing Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions According to Freud, which aspect of the personality motivates an individual to seek perfection? Id Ego Superego Not sure ANS: C   The superego represents the ideal rather than the real; it seeks perfection, as opposed to seeking pleasure or engaging reason. REF: 21 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions Which theorist most influenced the professional practice of psychiatric nursing? Harry Stack Sullivan Hildegard Peplau Erik Erikson Ivan Pavlov ANS: B   Peplau not only established the foundation for the professional practice of psychiatric nursing, she also continued to enrich psychiatric nursing theory and work for the advancement of nursing practice throughout her career. Invite students to identify major contributions of the other theorists listed. REF: 24 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions 3. Schemata, automatic thoughts, and cognitive distortions are terms that relate to rational-emotive behavioral therapy. cognitive-behavioral therapy. operant conditioning theory. biofeedback. ANS: B   Rapid, unthinking responses based on schemas are known as automatic thoughts. Often automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. Making changes to these cognitive errors is part of cognitive-behavioral therapy. REF: 29-31 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.