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Transcript
Theoretic Basis of Nursing Practice Chapter 7 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 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 Neo-Freudian Models Adler – Individual Psychology Inferiority Birth order Jung – Analytical Psychology Extroverted vs. introverted Horney – Feminine Psychology Rejected “penis envy” Rejected “oedipal complex” Other Psychodynamic Theories Sullivan - Interpersonal relations Great influence on psychiatric nursing 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) Transference and countertransference Object relations and identification Empathy Levels of consciousness awareness unconscious 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 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 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 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 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-system Anxiety 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 Which model of psychiatric treatment do you think is most culture-bound? Which is the most culture-free? Defend your answer.