theoretic basis of nursing practice chapter 7. biologic theories general adaptation syndrome - selye...
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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.