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

• Rogers Client-centered Theory
• Frederik Perls/Gestalt Theory
• Maslows 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
• Banduras 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)

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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 TheoriesFamilyDynamics

• 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

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Social TheoriesSocial 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

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Other Social Theories

• Role Theories
• Explains individuals 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__________________. Interpe
rsonal theorists believe that behavior problems
arise from ______________________. The drives for
________________________and________________ are
critical to a persons 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.