Download Psychopharmacology and Other Biologic Treatments

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
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Psychodynamic Theories:
Psychoanalytic
Sigmund Freud - founder
Study of unconscious
Personality and its development
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Ego, id and superego
Sexuality is an end product of a complex process.
Psychoanalysis
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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
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Extroverted vs. introverted
Horney – Feminine Psychology
Rejected “penis envy”
 Rejected “oedipal complex”
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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
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Behavioral Theories
Stimulus-response Theories
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Pavlov and his dog
Behaviorism and John B. Watson
Reinforcement Theories
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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
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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
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Interactional view: Bateson
Problem-solving approach: Haley
Multigenerational system: Bowen
Structural family theory - Minuchin
Applicability of family theories to PMHN

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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.