Theoretic Basis of Nursing Practice

1. Theoretic Basis of Nursing Practice Chapter 7

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

3. Psychodynamic Theories:Psychoanalytic • Sigmund Freud - founder • Study of unconscious • Personality and its development • Ego, id and superego • Sexuality is an end product of a complex process. • Psychoanalysis • 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

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

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

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

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

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

9. 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

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

11. 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.

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

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

14. 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

15. 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

16. 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

17. Nursing Theories Interpersonal Relations Model • Hildegarde Peplau • Empathic linkage • Self-system • Anxiety • Ida Jean Orlando • Nurse-patient relationship • Acute care setting

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

19. 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.

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