Theoretic Basis of Nursing Practice Chapter 7

Biologic Theories General Adaptation Syndrome - Selye Linked stressful events and illness Linked stressful events and illness Some support, but not specific enough Some support, but not specific enough Diathesis-Stress Model Genetic vulnerability and environmental stressors Genetic vulnerability and environmental stressors “A Diathesis”, a constitutional predisposition towards a disorder must be challenged by a stressor “A Diathesis”, a constitutional predisposition towards a disorder must be challenged by a stressor

Psychodynamic Theories: Psychoanalytic Sigmund Freud - founder Study of unconscious Personality and its development Ego, id and superego Ego, id and superego Sexuality is an end product of a complex process. Sexuality is an end product of a complex process.Psychoanalysis A therapeutic process of accessing the unconscious and resolving conflicts that originated in childhood A therapeutic process of accessing the unconscious and resolving conflicts that originated in childhood Not effective treatment for mental disorders, but respected for enhancing maturity and growth Not effective treatment for mental disorders, but respected for enhancing maturity and growth

Neo-Freudian Models Adler – Individual Psychology Inferiority Inferiority Birth order Birth order Jung – Analytical Psychology Extroverted vs. introverted Extroverted vs. introverted Horney – Feminine Psychology Rejected “penis envy” Rejected “penis envy” Rejected “oedipal complex” Rejected “oedipal complex”

Other Psychodynamic Theories Sullivan - Interpersonal relations Great influence on psychiatric nursing Great influence on psychiatric nursing Interaction patterns and parataxic distortions Interaction patterns and parataxic distortions

Humanistic/ ExistentialTheories Roger’s Client-centered Theory Frederik Perls/Gestalt Theory Maslow’s Heirarchy of Needs Albert Ellis/ Rational Emotive Therapy

Applicability to Nursing: Psychodynamic Theories Defense mechanisms Now coping mechanisms in DSM-IV (explained in Chapter 10) Now coping mechanisms in DSM-IV (explained in Chapter 10) Transference and countertransference Object relations and identification Empathy Levels of consciousness awareness awareness unconscious unconscious

Behavioral Theories Stimulus-response Theories Pavlov and his dog Pavlov and his dog Behaviorism and John B. Watson Behaviorism and John B. Watson Reinforcement Theories Edward L. Thorndike and “stamping in” Edward L. Thorndike and “stamping in” B.F. Skinner and operant conditioning B.F. Skinner and operant conditioning Cognitive Theories Bandura’s social cognitive theory and modeling, self-efficacy Bandura’s social cognitive theory and modeling, self-efficacy Aaron Beck - thinking and feeling Aaron Beck - thinking and feeling

Applicability of Behavior Theories to PMHN Wide-spread use of behavioral theories in practice Patient education interventions Changing an entrenched habit Privilege systems and token economies

Developmental Theories Erik Erikson – Psychosocial development Jean Piaget – Learning in children Moral Development Kohlberg Kohlberg Carol Gilligan – Gender differentiation (attachment important for female identity) Carol Gilligan – Gender differentiation (attachment important for female identity)

Applicability of Developmental Theories to PMHN Research on models is ongoing. Evidence suggests that girls do not follow a staged developmental path. There are gender and cultural differences in development.

Social Theorists Social conditions are largely responsible for deviant behavior Deviance is culturally defined Social conditions can “pre-dispose” a person to mental illness.

Social Theories: FamilyDynamics Family dynamics: patterned interpersonal and social interactions Interactional view: Bateson Interactional view: Bateson Problem-solving approach: Haley Problem-solving approach: Haley Multigenerational system: Bowen Multigenerational system: Bowen Structural family theory - Minuchin Structural family theory - Minuchin Applicability of family theories to PMHN Assessment of family dynamics Assessment of family dynamics Planning interventions for families Planning interventions for families

Social Theories: Social Distance Balance theory: A balance is maintained between formal and informal support system (Litvak,1966). Formal support systems: large organizations (hospital, etc.) Informal support systems: family, friends, neighbors Individuals with strong informal support networks live longer than those without that type of support. Social distance: Degree to which values formal organization and primary group members differ When formal and informal systems begin performing the same function, the formal system increases social distance. Applicability: Practical model for understanding relationship between formal and informal systems

Other Social Theories Role Theories Explains individual’s social position and function within the environment Applies role concepts in understanding group interaction and role of patient within family and community. Sociocultural Perspectives Culture and gender – Mead Transcultural health care – Leininger Uses theories as a basis for assessing and intervening within social domain

Medical Model All mental processes derive from operations of the brain, and deviant behavior is a symptom of a brain disorder Genes and combinations of genes exert significant control over behavior. Physician as “healer” prescribes the plan

Nursing Theories Interpersonal Relations Model Hildegarde Peplau Empathic linkage Self-systemAnxiety Ida Jean Orlando Nurse-patient relationship Acute care setting

Other Nursing Theories Existential and Humanistic Joyce Travelbee Jean Watson Systems Models Imogene King Betty Newman Dorothea Orem Others Martha Rogers Calista Roy

Psychoanalysts believe that behavior problems in adulthood are caused by__________________. Interpersonal theorists believe that behavior problems arise from ______________________. The drives for ________________________and_______________ _ are critical to a person’s psychological health according to the interpersonal model. Social theorists believe that deviant behavior is caused by____________________. The existential therapeutic process focuses on the_______________. In supportive therapy a therapist plays an ___________role and regards the client as a _____in the treatment process.

Which model of psychiatric treatment do you think is most culture-bound? Which is the most culture-free? Defend your answer.