Psychiatric Mental Health Nursing

Relevant Theories For Psychiatric Mental Health Nursing

A Review

2-22-2

The mind as an iceberg

(Fig. 2-1)(Fig. 2-1)

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Freud

Personality Structure Id Ego Superego

Levels of Awareness Conscious Preconscious Unconscious

Developmental Stages

Oral

Anal

Phallic

Latency

Genital

Developmental Stages

Oral

Anal

Phallic

Latency

Genital

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Erikson

Trust v. mistrust Autonomy v. shame and doubt Initiative v. guilt Industry v. inferiority Identity v. role confusion Intimacy v. isolation Generativity v. stagnation Wisdom v. despair

Erikson

• stressed ego

• psychosocial aspects of development

• considers life span development

• studied healthy people

Freud

• stressed id

• psychosexual aspects of development

• personality formed by age of 5

• studied neurotic people

Erikson vs. Freud

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Sullivan

Needs Satisfactions Security

Anxiety Empathetic between child and mother Can be described; observable behaviors Individuals strive for anxiety reduction

Self System Good-me

Bad-me

Not-me

Security Operations Selective

inattention

Dissociation

Self System Good-me

Bad-me

Not-me

Security Operations Selective

inattention

Dissociation

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Peplau

4 Phases of Interpersonal Process Orientation Identification Exploitation Resolution

Described 4 Levels of Anxiety Mild-Moderate-Severe-Panic

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Peplau, cont.

Ideas about Nursing Focus is on client Nurse is participant observer Nurse has awareness of role Nursing is investigative Nurses use theory Developed process recording

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Piaget

Stages of Cognitive Development Sensorimotor Preoperational Concrete operations Formal operations

Schema Developed to organize and understand the world

Processes Used to Develop Schemata Assimilation Adaptation

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Maslow

Needs Hierarchy Physiological needs Psychological needs Meta-needs

Beliefs about Humankind Needs are fulfilled by and through other humans A person does the best he/she can at the time With adequate understandable information, a person

will make good decisions Man has a higher nature

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Kohlberg

Level I Preconventional (ages 4-10) Emphasis on external control, avoiding punishment

Level II Conventional Role Conformity (ages 10-13) Want to please other and be considered “good” Develop social concern and conscience

Level III Autonomous Moral Principles (after age 13, if ever) Acknowledges the possibility of conflict between 2

accepted standards and tries to decide between them Acts in accord with internalized standards

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Psychotherapies

Psychodynamic/Psychoanalytic Focus:

- internal experience

- defense mechanisms

- transference and past relationships Therapist: more non-directive

Cognitive Therapy Focus:

- thoughts/cognitions

- correcting cognitive distortions Therapist: active and directive

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Psychotherapies, cont.

Interpersonal Therapy Focus: interpersonal relationships Problems:

- Grief- Role disputes- Role transition- Interpersonal deficit

Therapist: active and directive

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Psychotherapies, cont.

Behavioral Therapy Focus: learning more adaptive behavior Applications: - Operant conditioning

Positive reinforcement Negative reinforcement Punishment

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Methods for Behavior Modification

ModelingSystematic DesensitizationImplosions (Imagery)Flooding

Aversion therapy Relaxation Assertiveness