Theoretic Basis of Theoretic Basis of Nursing PracticeNursing Practice

Chapter 7Chapter 7

Biologic TheoriesBiologic Theories

General Adaptation Syndrome - SelyeGeneral Adaptation Syndrome - Selye Linked stressful events and illnessLinked stressful events and illness Some support, but not specific enoughSome support, but not specific enough

Diathesis-Stress ModelDiathesis-Stress Model Genetic vulnerability and environmental Genetic vulnerability and environmental

stressorsstressors ““A Diathesis” , a constitutional predisposition A Diathesis” , a constitutional predisposition

towards a disorder must be challenged by a towards a disorder must be challenged by a stressorstressor

Psychodynamic Theories:Psychodynamic Theories: Psychoanalytic Psychoanalytic

Sigmund Freud - founderSigmund Freud - founderStudy of unconsciousStudy of unconsciousPersonality and its development Personality and its development Ego, id and superegoEgo, id and superego Sexuality is an end product of a complex process.Sexuality is an end product of a complex process.

PsychoanalysisPsychoanalysis A therapeutic process of accessing the unconscious A therapeutic process of accessing the unconscious

and resolving conflicts that originated in childhoodand resolving conflicts that originated in childhood Not effective treatment for mental disorders, but Not effective treatment for mental disorders, but

respected for enhancing maturity and growthrespected for enhancing maturity and growth

Neo-Freudian ModelsNeo-Freudian Models

Adler – Individual PsychologyAdler – Individual Psychology InferiorityInferiority Birth orderBirth order

Jung – Analytical PsychologyJung – Analytical Psychology Extroverted vs. introvertedExtroverted vs. introverted

Horney – Feminine PsychologyHorney – Feminine Psychology Rejected “penis envy”Rejected “penis envy” Rejected “oedipal complex”Rejected “oedipal complex”

Other Psychodynamic TheoriesOther Psychodynamic Theories

Sullivan - Interpersonal relationsSullivan - Interpersonal relations Great influence on psychiatric nursingGreat influence on psychiatric nursing Interaction patterns and parataxic distortionsInteraction patterns and parataxic distortions

Humanistic/ ExistentialTheoriesHumanistic/ ExistentialTheories

Roger’s Client-centered TheoryRoger’s Client-centered Theory

Frederik Perls/Gestalt TheoryFrederik Perls/Gestalt Theory

Maslow’s Heirarchy of NeedsMaslow’s Heirarchy of Needs

Albert Ellis/ Rational Emotive TherapyAlbert Ellis/ Rational Emotive Therapy

Applicability to Nursing: Applicability to Nursing: Psychodynamic TheoriesPsychodynamic Theories

Defense mechanisms Defense mechanisms Now coping mechanisms in Now coping mechanisms in DSM-IVDSM-IV

(explained in Chapter 10)(explained in Chapter 10)

Transference and countertransferenceTransference and countertransferenceObject relations and identificationObject relations and identificationEmpathyEmpathyLevels of consciousnessLevels of consciousness awarenessawareness unconsciousunconscious

Behavioral TheoriesBehavioral Theories

Stimulus-response TheoriesStimulus-response Theories Pavlov and his dogPavlov and his dog Behaviorism and John B. WatsonBehaviorism and John B. Watson

Reinforcement TheoriesReinforcement Theories Edward L. Thorndike and “stamping in”Edward L. Thorndike and “stamping in” B.F. Skinner and operant conditioningB.F. Skinner and operant conditioning

Cognitive TheoriesCognitive Theories Bandura’s social cognitive theory and modeling, Bandura’s social cognitive theory and modeling,

self-efficacyself-efficacy Aaron Beck - thinking and feelingAaron Beck - thinking and feeling

Applicability of Behavior Applicability of Behavior Theories to PMHNTheories to PMHN

Wide-spread use of behavioral theories in Wide-spread use of behavioral theories in practicepractice

Patient education interventionsPatient education interventions

Changing an entrenched habitChanging an entrenched habit

Privilege systems and token economiesPrivilege systems and token economies

Developmental TheoriesDevelopmental Theories

Erik Erikson – Psychosocial developmentErik Erikson – Psychosocial development

Jean Piaget – Learning in childrenJean Piaget – Learning in children

Moral DevelopmentMoral Development KohlbergKohlberg

Carol Gilligan – Gender differentiation Carol Gilligan – Gender differentiation (attachment important for female identity)(attachment important for female identity)

Applicability of Developmental Applicability of Developmental Theories to PMHNTheories to PMHN

Research on models is ongoing.Research on models is ongoing.

Evidence suggests that girls do not follow Evidence suggests that girls do not follow a staged developmental path.a staged developmental path.

There are gender and cultural differences There are gender and cultural differences in development.in development.

Social TheoristsSocial Theorists

Social conditions are largely responsible Social conditions are largely responsible for deviant behaviorfor deviant behavior

Deviance is culturally definedDeviance is culturally defined

Social conditions can “pre-dispose” a Social conditions can “pre-dispose” a person to mental illness.person to mental illness.

Social Theories:Social Theories:FamilyDynamicsFamilyDynamics

Family dynamics: patterned interpersonal and Family dynamics: patterned interpersonal and social interactions social interactions Interactional view: BatesonInteractional view: Bateson Problem-solving approach: HaleyProblem-solving approach: Haley Multigenerational system: BowenMultigenerational system: Bowen Structural family theory - MinuchinStructural family theory - Minuchin

Applicability of family theories to PMHNApplicability of family theories to PMHN Assessment of family dynamicsAssessment of family dynamics Planning interventions for familiesPlanning interventions for families

Social Theories:Social Theories:Social DistanceSocial Distance

Balance theory: A balance is maintained between formal and Balance theory: A balance is maintained between formal and informal support system informal support system (Litvak,1966).(Litvak,1966).

Formal support systems: large organizations (hospital , etc.)Formal support systems: large organizations (hospital , etc.)

Informal support systems: family, friends, neighborsInformal support systems: family, friends, neighbors

Individuals with strong informal support networks live longer than those Individuals with strong informal support networks live longer than those without that type of support.without that type of support.

Social distance: Social distance:

Degree to which values formal organization and primary group members Degree to which values formal organization and primary group members differdiffer

When formal and informal systems begin performing the same function, the When formal and informal systems begin performing the same function, the formal system increases social distance.formal system increases social distance.

Applicability: Applicability:

Practical model for understanding relationship between formal and informal Practical model for understanding relationship between formal and informal systemssystems

Other Social TheoriesOther Social Theories

Role Theories Role Theories Explains individual’s social position and function within the Explains individual’s social position and function within the environmentenvironment

Applies role concepts in understanding group interaction and Applies role concepts in understanding group interaction and role of patient within family and community.role of patient within family and community.

Sociocultural PerspectivesSociocultural PerspectivesCulture and gender – MeadCulture and gender – Mead

Transcultural health care – Leininger Transcultural health care – Leininger

Uses theories as a basis for assessing and intervening within Uses theories as a basis for assessing and intervening within social domainsocial domain

Medical ModelMedical Model

All mental processes derive from All mental processes derive from operations of the brain, and deviant operations of the brain, and deviant behavior is a symptom of a brain disorderbehavior is a symptom of a brain disorder

Genes and combinations of genes exert Genes and combinations of genes exert significant control over behavior.significant control over behavior.

Physician as “healer” prescribes the planPhysician as “healer” prescribes the plan

Nursing Theories Nursing Theories Interpersonal Relations ModelInterpersonal Relations Model

Hildegarde Peplau Hildegarde Peplau Empathic linkageEmpathic linkage

Self-systemSelf-system

AnxietyAnxiety

Ida Jean OrlandoIda Jean OrlandoNurse-patient relationship Nurse-patient relationship

Acute care settingAcute care setting

Other Nursing TheoriesOther Nursing TheoriesExistential and HumanisticExistential and Humanistic

Joyce TravelbeeJoyce Travelbee

Jean WatsonJean Watson

Systems ModelsSystems ModelsImogene KingImogene King

Betty NewmanBetty Newman

Dorothea OremDorothea Orem

OthersOthersMartha RogersMartha Rogers

Calista RoyCalista 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.