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NCM 105

CARE OF CLIENTS WITH


MALADAPTIVE PATTERNS
OF BEHAVIOR

Basic Concepts of Psychiatric Mental Health


Nursing
Louise Rebranca Shives, MSN, ARNP, CNS
Ann Isaacs, RN, CS, MS
5th Edition
Principles and Practice of Psychiatric Nursing
Gail Wiscarz Stuart, PhD, APRN, BC, FAAN
Michele T. Laraia, PhD, RN, CS
8th Edition

Course Description:
The course is designed to focus on
health and illness across the lifespan of
clients, population groups with acute
and chronic psychosocial difficulties and
psychiatric illnesses.

Course Objectives:
At the end of the course, and given actual clients with
maladaptive patterns of behavior, the student shall be able to:
1. Utilize the nursing process in the care of individuals, families
in community and hospital settings.
- Assess client/s with his/her/their condition through mental
status examination, physical examination, interpretation of
diagnostic procedures.
- Identify actual and potential nursing diagnosis. - Plan
appropriate nursing interventions with client/s and family for
identified nursing diagnosis.
- Implement plan of care with client/s and family.
- Evaluate the progress of his/her/their clients condition and
outcomes of care.

2. Apply knowledge and understanding of maladaptive


patterns of behavior in providing safe and quality care to
clients.
3. Increase self-awareness and therapeutic use of self in the
care of clients.
4. Ensure a well-organized and accurate documentation
system.
5. Relate with client/s and their family and the health team
appropriately.
6. Observe bioethical concepts/ principles, core values and
nursing standards in the care of clients.
7. Promote personal and professional growth of self and
others.

Learning Outcomes:
The students are able to describe the
evolution of nursing such that it guides
them how the nature, settings, and of
contemporary nursing practice were
develops and that could formulate them
role and functions as psychiatric nurse.

Course Outline:

I. Overview of psychiatric nursing


A. Evolution of mental health-psychiatric
nursing practice
B. The mental health nurse
1. Role
2. Essential qualities
C. Interdisciplinary team
D. The mental health illness continuum

II. Mental health-psychiatric nursing practice


A. Personality theories and determinants of
psychopathology: Implications for mental health-psychiatric
nursing practice
B. General assessment considerations
1. Principles and techniques of h-Psychiatric nursing
interview
2. Mental status examination
3. Diagnostic examinations specific to psychiatric patients
C. Building nurse-client relationship
1. Nurse-client interaction vs. nurse-client relationship
2. Therapeutic use of self

3. Therapeutic communication
a. Characteristics
b. Techniques
4. Goals in the one-to-one relationship
5. Phases in the development of nurseclient relationship

D. Documentation in psychiatric nursing


practice
1. Problem-oriented recording a.
SOAP
2. Narrative recording
3. Process recording

E. Therapeutic modalities,
psychosocial skills and
nursing strategies
1. Biophysical /somatic
interventions
a. Electroconvulsive and
other somatic therapies
b. Psychopharmacology
2. Supportive Psychotherapy
a. Nurse-patient
relationship therapy
b. Group therapy
c. Family therapy

3. Counseling
4. Mental health teaching/client
education
5. Self-enhancement,
growth/therapeutic groups
6. Assertiveness training
7. Stress management
8. Behavior modification
9. Cognitive restructuring
10. Milleu therapy
11. Play therapy
12. Psychosocial support interventions
13. Psychospiritual Interventions
14. Alternative Medicine/Therapies

F. Concept of Anxiety
1. Defining characteristics of Anxiety
2. Levels of Anxiety
3. Manifestations of Levels of Anxiety
a. Physiologic
b. Psychologic
4. Ego Defense Mechanisms
a. Four levels of Defense

G. Crisis
1. Types of crisis
2. Phases of Crisis Development
3.Characteristics of Crisis
4. Crisis Intervention

Maladaptive Patterns of Behavior

1. Age-Related Maladaptive Patterns: Disorders


Across the Lifespan
2. Anxiety-Related Disorders
a. Anxiety disorders across the lifespan
Panic Disorder
Phobias
Post traumatic stress disorder
Acute Stress disorder
Obsessive-compulsive disorder
Generalized Anxiety Disorder

b. Somatoform
disorders
Somatization
disorder
Conversion disorder
Hypochondriasis
Pain disorder
Body Dysmorphic
disorder

c. Dissociative
disorders
Depersonalization
Psychogenic
Amnesia
Psychogenic Fugue

Dissociative
Identity Disorder/
Multiple Personality
disorder

3. Psychophysiologic Response and Sleep


4. Personality Disorders
a. Childhood Personality disorders
Conduct disorder
Oppositional Defiant Behavior
b. Odd/eccentric behaviors
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

c. Dramatic,
emotional, erratic
behaviors
Antisocial
personality disorder
Borderline
personality disorder
Narsicistic
personality disorder
Histrionic
personality disorder

d. Anxious, fearful
behaviors
Obsessive
compulsive
personality disorder
Dependent
personality disorder
Avoidant
personality disorder
e. Passive aggressive

Substance-related disorders: substance


abuse, dependence, intoxication,
withdrawal and polysubstance
dependence

a. Central nervous system


depressants
Alcohol
Sedatives-hypnotics and
anxiolytics
Opioids
b. Central nervous system
stimulants
Caffeine
Nicotine
Amphetamine and cocaine

c.

Hallucinogens
d. Cannabis
e. Inhalants
f. Nursing Issues


Mood disorders

a. Reactive attachment disorder


b. Bipolar I disorder
c. Bipolar II disorder
d. Cyclothymic disorder
e. Dysthymic disorder
f. Major depressive disorder
g. Clients at risk for suicidal and selfdestructive behavior

Schizophrenia and other


Psychoses

a. Schizophrenia
Catatonic type
o Paranoid type
o Undifferentiated
type
o Disorganized
type
o Residual type

o
o
o
o
o

b. Other Psychotic
disorders
Schizophreniform
disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic
disorder

Cognitive disorders

a. Fetal alcohol
syndrome
b. Attention deficit
hyperactive disorder
c. Autism
d. Delirium
e. Dementia
f. Alzheimers
disease

g. Diffuse Lewy
body disease
h. Korsakoffs
disease
i. Huntingtons
disease
j. Picks disease
k. Vascular and
multi-infarct
dementia

Eating disorders

a. Pica
b. Rumination
c. Feeding disorders
d. Anorexia nervosa
e. Bulimia nervosa

Psychosexual disorders

a. Gender identity disorder


b. Sexual dysfunctions
c. Paraphilias

Abuse and violence

a. Victims of violent behavior


Child
Spouse
Elderly
b. Torture and ritual abuse
c. Rape and sexual assault
C. Legal issues affecting mental health nursing
D. Future trends and issues in mental health
nursing practice
E. Community-based mental health programs

2nd Semester 2016-2017

PSYCHIATRIC & MENTAL


HEALTH NURSING

By: Leonardo L. Molina, RN; MN

Overview of psychiatric nursing


Evolution Of Mental Health-psychiatric
Nursing Practice

HISTORICAL PERSPECTIVES

Linda Richards (1st American psychiatric


nurse) in 1873 graduated from the New
England Hospital for Women and Children
in Boston.

HISTORICAL PERSPECTIVES

Developed nursing care in psychiatric


hospitals and organized nursing
services and educational programs in
state mental hospitals in Illinois.

HISTORICAL PERSPECTIVES

She stands with theory of care It stands


to reason that the mentally sick should
be at least as well cared for as the
physically sick(Donna, 1984)
More important contributions was her
emphasis on assessing both the
physical and emotional needs of the
patients.

HISTORICAL PERSPECTIVES

McLean Hospital in
Waverly, Massachusetts the first school to prepare
nurses to care for mentally
ill was opened in 1882
A two year program and
the care was custodial
focused on patients
physical needs
(medication, nutrition,
hygiene, and ward
activities).

HISTORICAL PERSPECTIVES
Early period of nursing history the two
nursing education separated in two needs:
taught either in the general hospital or in
the psychiatric hospital
19th century they changed the role as
psychiatric nurse and applied the
principles of medical-surgical nursing to
the psychiatric setting (kindness and
tolerance to patient).

HISTORICAL PERSPECTIVES

- Johns Hopkins became the first


school of nursing fully developed course
for psychiatric nursing in the curriculum
& late 1930s that nursing education
recognized the importance of psychiatric
knowledge in the general nursing care
for all illnesses.

HISTORICAL PERSPECTIVES

IMPORTANT FACTOR IN THE


DEVELOPMENT OF PSYCHIATRIC
NURSING EMERGE FOR VARIOUS
SOMATIC THERAPIES

Insulin shock therapy (1935)


Psychosurgery (1936)
Electroconvulsive (1937)

HISTORICAL PERSPECTIVES
Post World War II :
Major growth and changed in psychiatric nursing
Large number of military service-related psychiatric

nursing
Increase in treatment programs offered by the Veterans
Administration demand of advanced psychiatric
nurses
Integral part of the generic nursing curriculum
Medical
Pediatric
Public health nursing

1947 eight graduate programs in psychiatric


nursing had been started

ROLE EMERGENCE

Role of psychiatric nursing began to


emerge in the early 1950s.
Weiss (1947)- published an article in
the American Journal of Nursing that
reemphasized the shortage of
psychiatric nurses outlined the
difference between psychiatric and
general duty nurses.

ROLE EMERGENCE

As psychiatric nurses = attitude


therapy as nurses directed use of
attitudes that contribute to patients
recovery; therapy that observes the
patient for small and fleeting changes;
demonstrates acceptance, respect,
and understanding of the patients;
and promotes the patients interest
and participation in reality.

Bennet and Eaton (1951)- an article in


American Journal of Psychiatry
identified the following problems
affecting psychiatric nurses:
scarcity of qualified psychiatric nurses
underuse of their abilities
the fact that very little real psychiatric

nursing is carried out in otherwise good


psychiatric hospitals and units

Psychiatrists believed that the


psychiatric nurse should join mental
health societies, consult with welfare
agencies, work in outpatient clinics,
practice preventive psychiatry, engage
in research, and help educate the public.

QUESTION:
Do you think that the problems affecting
psychiatric nurses described by Bennet
and Eaton in 1951 continue to exist in
the specialty today?

Mellow (1951) wrote of the work she did


with schizophrenic patients. She called
these activities nursing therapy.
Tudor (1952) published a study in which
she described the nurse-patient
relationships that characterized by
unconditional care, demands, and the
anticipation of patients needs.

Hildegard Peplau

Peplau (1952) published a book,


Interpersonal Relations in Nursing, in
which she described the first theoretical
framework for psychiatric nursing and
the specific skills, activities, and roles of
psychiatric nurses.

Peplau defined nursing as a significant,


therapeutic process.
While she studied the nursing process,
she saw nurses emerge in various roles:
as a resource person; a teacher; a
leader in local, national, and
international situations; a surrogate
parent; and a counselor.

Two other significant developments in psychiatry in the


1950s also affected nursings role:
1) Jones publication of The Therapeutic Community: A
New Treatment Method in Psychiatry in 1953
- method encouraged using the patients social environment to
provide a therapeutic experience.
- The premise of therapeutic community was that each patient
was to be active participant of care:
Become involved in the daily problems in the unit
Help solve problems
Plan activities
Developed the required unit rules

2) Use of psychotropic drugs


these drugs more patients became
treatable
fewer environmental constraints such as
locked doors and straitjackets were
required
more personnel were needed to provide
therapy

EVOLVING FUNCTIONS:

In 1958 the following functions of psychiatric


nurses were described (Hays, 1975):
Dealing with patients problems of attitude, mood, and

interpretation of reality
Exploring disturbing and conflicting thoughts and
feelings
Using the patients positive feelings toward the
therapist to bring about psychophysiologic homeostasis
Counseling patients in emergencies, including panic
and fear
Strengthening the well part of patients

EVOLVING FUNCTIONS:

Nurse-patient relationship was referred


to by a variety of terms:
therapeutic nurse-patient relationship
psychiatric nursing therapy
supportive psychotherapy
rehabilitation therapy
nondirective counseling

EVOLVING FUNCTIONS:

In 1960s the focus of psychiatric nursing


began to shift to Primary prevention and
implementation of care and consultation
in the community representatives of these
changes was the shift in the name of the field
from psychiatric nursing to psychiatric and
mental health nursing was stimulated by the
Community Mental Health Centers Act of
1963.

Peplau (1962) published Interpersonal


Techniques: the Crux of Psychiatric
Nursing identified the heart of
psychiatric nursing as the role of
counselor or psychotherapist

1970:
Change in the name of the field from
psychiatric and mental health nursing to
psychosocial nursing
Development of the specialty in nursing
practice:
Development standards and statements on

scope of practice.
Establish generalist and specialist certification.

The 1980s were years of exciting


scientific growth in the area of
psychobiology. New focus was placed
on:
Brain imaging techniques.
Neurotransmitters and neural receptors.
Psychobiology of emotions.
Understanding the brain.
Molecular genetics related to psychobiology.

1990s:
Faced with the challenge of integrating the
expanding bases of neuroscience into the holistic
biopsychosocial practice of psychiatric nursing.
Advances in understanding the relationships of
the brain, behavior, emotion, and cognition
offered new opportunities for psychiatric nursing
(Hayes, 1995).
The need to become realigned with care and
caring, which represent the art of psychiatric
nursing and complement the high technology of
current health care practices (McBride, 1996).

Figure 1: Elements of the psychiatric nursing role

The Role of Psychiatric Nurse Today

Psychiatric nurses are vital members of


the mental health team.
Actively direct and evaluate client
responses to stress across the life span.
Nurse continuous monitoring of clients
experiencing crises further employs the
nurses input to intervene and create
environments that minimize maladaptive
responses and promote mental health.

Role of Psychiatric Nurses in Phases Mental Health Prevention

Primary prevention: can be used to identify high-risk


groups and provide health education.
Secondary prevention: can be initiated during an
acute phase on inpatient, emergency departments, or
homeless shelters.
Tertiary prevention: role of the nurse is to prevent
disability and promote rehabilitation and health
maintenance. Aftercare programs such as Alcoholic
Anonymous (AA), Narcotics Anonymous (NA), and
Cocaine Anonymous are examples of tertiary
programs. (http://primiarty.blogspot.com/)

The mental health illness continuum

Psychoanalytic Theory

Sigmund Freud (18561939)


Father of Psychoanalysis
Psychoanalytic theory: all human behavior is
caused and can be explained (deterministic
theory)
Repressed (driven from conscious awareness)
sexual impulses and desires motive much
human behavior.
Hysterical or neurotic behaviors resulted from
unresolved conflicts (childhood trauma or failure
to complete task of psychosocial development).

Personality components

Id: part of ones nature that reflects basic


innate desires such as pleasure-seeking
behavior, aggression, and sexual impulses.
Seeks instant gratification, causes impulsive

unthinking behavior, and has no regard for rules


or social convention.

Superego: part of the persons nature that


reflects moral and ethical concepts, values,
and parental and social expectations.

Ego: balancing or mediating force between


the id and the superego
Represents mature and adaptive behavior that

allows a person to function successfully in the


world.
Anxiety: results from egos attempts to balance
impulsive instincts of the id with the stringent
rules of the superego.

Behavior motivated by
subconscious thoughts and feelings

Conscious: refers to the perceptions,


thoughts, and emotions that exist in the
persons awareness, such as being aware of
happy feelings or thinking about a loved one.
Preconscious: thoughts and emotions are
not currently in the persons awareness, but
he or she can recall them with some effortan adult remembering what he or she did,
thought or felt as a child.

Unconscious: realm of thoughts and feelings


that motivate a person even though he or she
is totally unaware of them.
Includes most defense mechanisms and

some instinctual drives or motivation.


The person represses into the
unconsciousness the memory of
traumatic events that are too painful to
remember.

Much of what we think and say is


motivated subconscious thoughts or
feelings (those in the preconscious or
unconscious level of awareness).
Freudian slip: slips of the tongue
Example, saying You look portly
today to an overweight friend
instead of saying You look pretty
today.

Five Stages of Psychosexual


Development

Sexual energy, termed libido, was the


driving force of human behavior.
Psychopathology results when a person
has difficulty making the transition from
one stage to the next or when a person
remains stalled at a particular stage or
regresses to an earlier stage.

Freuds Developmental Stages


Phase

Age

Focus

Oral

Birth to 18 months

Major site of tension and


gratification is the mouth,
lips and tongue; includes
biting and sucking
activities. Id is present at
birth. Ego develops
gradually from
rudimentary structure
present at birth.

Anal

18-36 months

Anus and surrounding


area are major source of
interest. Voluntary
sphincter control (toilet
training is acquired).

Phase

Age

Focus

Phallic/ oedipal

3-5 years

Genital is the focus of


interest, stimulationand
excitement. Penis is
organ of interest for both
sexes. Masturbation is
common. Penis envy is
seen in girls; oedipus
complex (wish to marry
opposite- sex parent
and be rid of same-sex
parents is seen in boys
and girls.

Latency

5-11 or 13 years

Resolution of oedipal
complex. Sexual drive
are channelled into
socially appropriate
activities such as school
work and sports.
Formation of the
superego. Final stages
of psychosexual
development.

Phase

Age

Focus

Genital

11- 13 years

Begins with
puberty and the
biologic capacity
for orgasm;
involves the
capacity for true
intimacy.

Ego Defense
Mechanism

Methods of attempting to protect the self


and cope with basic drives or
emotionally painful thoughts, feelings or
events.
Most defense mechanisms operate at
the unconscious level of awareness, so
people are not aware of what they are
doing and often need help to see the
reality.

EGO DEFENSE MECHANISM


Compensation

Overachievement in one area to


offset real or perceived
deficiencies in another area.
Napoleon complex: diminutive
man becoming emperor.
Nurse with low self-esteem
working double shifts so that
supervisor will like her.

Conversion

Expression of emotional conflict


through the development of
physical symptom , usually
sensorimotor in nature.
Teenager forbidden to see X-rated
movies is tempted to do so by
friends and develops blindness,
and the teenager is unconcerned
about the loss of sight.

EGO DEFENSE MECHANISM


Denial

Failure to acknowledge an
unbearable condition; failure to
admit the reality of the situation
or how one enables the problem
to continue.
Diabetic person eating
chocolate candy.
Spending money freely when
broke.
Waiting 3 days to seek help for
abdominal pain.

EGO DEFENSE MECHANISM


Displacement

Ventilation of intense feelings


toward persons less threatening
than the one who aroused the
feeling.
Person who is mad at the boss
yells at his spouse.
Child who is harassed by a bully at
school mistreats a younger sibling.

Dissociation

Dealing with emotional conflict a


temporary alteration in
conscious or identity.
Amnesia that prevents recall of
yesterdays auto incident.
Adult remembers nothing of
sexual abuse.

EGO DEFENSE MECHANISM


Fixation

Immobilization of a portion of the


personality resulting from
unsuccessful completion of tasks in
a developmental stage.
Never learning to delay
gratification.
Lack of a clear sense of identity as
an adult.

Identification

Modeling actions and opinions


of influential others while
searching for identity, or aspiring
to reach a personal, social, or
occupational goal.
Nursing student becomes a
critical care nurse because this
is the specialty of an instructor
she admires.

EGO DEFENSE MECHANISM


Intellectualization

Separation of emotions of a painful


event or situation from the facts
involved; acknowledging the facts
but not the emotions.
A person shows no emotional
emotion when discussing serious
car accidents.

Introjection

Accepting another persons


attitudes, beliefs, and values as
ones own.
Person who dislikes guns
becomes an avid hunter just like
best friend.

EGO DEFENSE MECHANISM


Projection

Unconscious blaming of
unacceptable inclinations or
thoughts on an external object.
Man who has thought about samesex relationships, but never had
one, beats a person who is gay.
Person with many prejudices
loudly identify others as bigots.

Rationalization

Excusing own behavior to avoid


guilt, responsibility, conflict,
anxiety, or loss of self- esteem.
Student blames failure on
teacher being mean.
Man says he beats his wife
because she doesnt listen to
him.

EGO DEFENSE MECHANISM


Reaction formation

Acting the opposite of what


thinks or feels.
Woman who never wanted to
have children becomes a
supermom.
Person who despises the
boss tells everyone what a
great boss she is.

Regression

Moving back to a previous


developmental stage to feel safe
or have needs met.
Five- year old asks for a bottle
when new baby brother is fed.
Man puts like a 4-year old is he
is not the center of his
girlfriends attention.

EGO DEFENSE MECHANISM


Repression

Excluding emotionally painful or


anxiety- provoking thoughts and
feelings from conscious awareness.
Woman has no memory of mugging
she suffered yesterday.
Woman has no memory before age
7, when she was removed from
abusive parents.

Resistance

Overt or covert antagonism toward


remembering or processing anxietyproducing information.
Nurse is too busy with tasks to spend
time with talking to a dying patient.
Person attends court-ordered
treatment for alcoholism but refuses to
participate.

Sublimation

EGO DEFENSE
MECHANISM
Substituting a socially acceptable
activity for an impulse that is
unacceptable.
Person who quits smoking sucks
on hard candy when the urge to
smoke arises.
Person who goes for a 15-minute
walk when tempted to eat junk
food.

Substitution

Replacing the desired gratification


with one that is more readily
available.
Woman who would like to have
her own children opens a day dare
center.

Suppression

EGO DEFENSE
MECHANISM
Conscious exclusion of
unacceptable thoughts and feelings
from conscious awareness.
Student decides not to think about
parents illness to study for a test.
Woman tells a friend she cannot
think about her sons death now.

Undoing

Exhibiting acceptable behavior to


make up for or negate acceptable
behavior.
Person who cheats on a spouse
brings the spouse a bouquet of
roses.
Man who is ruthless in business
donates a large amount of money
to charity.

Activity # 1
1.
2.
3.

4.
5.

Group into 5 members per group.


List names of member and create
name of the group.
Explore situation(s) or experience(s)
that relate about ego defense
mechanism.
Discuss with the group.
Choose one best experience and relay
to the class.

PSYCHOSOCIAL
THEORIES

ERIK ERIKSON (19021994)

Extended Freuds work on personality


development across the lifespan while
focusing on social and psychological
development in the life stages.
Described eight stages of development.
In each stage, the person must complete a
life task essential to or her well-being and
mental health.

Each stage is dependent on completion of


the previous stage and life task.
Tasks allow persons to achieve lifes
virtues:
Hope

Purpose
Fidelity

Love
Caring
Wisdom

Eriksons Stages of
Psychosocial Development
Stage

Virtue

Task

Trust vs. Mistrust


(infant)

Hope

Viewing the world as


safe and reliable;
relationships as
nurturing, stable and
dependable

Autonomy vs.
Shame and doubt
(toddler)

Will

Achieving a sense of
control and free will

Stages

Virtue

Task

Initiative vs.
Guilt
(3 6 years
old)

Purpose

Beginning
development
(preschool) of
conscience;
learning to
manage conflict
and anxiety

Stages

Virtue

Task

Industry vs.
Inferiority
(school age)

Competence

Emerging
confidence in
own abilities;
taking pleasure
in
accomplishmen
ts

(6 to 11 years
old)

Stages

Virtue

Task

Identity vs.
Role
(adolescence)

Fidelity

Formulating a
sense of
confusion self
and belonging

(12 to 20 years
old)

Adolescence years

Become more independent & begin to look at


the future in terms of career, relationships,
families & housing.
At this stage are confronted with new roles &
adult status such as vocation & career
development, & issues of romance. If
adolescents explore such roles in a healthy
manner & arrive at a positive path to follow in
life, then a positive identity will be achieved.

Adolescence years

The transition from childhood to adulthood is


most important.
Are faced with finding out who they are,
what they are all about, and where they are
going in life.
Stage where faced with major decisions to
make about their identity a term known as
IDENTITY CRISIS.

Stages

Virtue

Task

Intimacy vs.
Isolation
(young adult)

Love

Forming adult ,
loving
relationship
and meaningful
attachment to
others.

12 to 18 years
old

https://www.youtube.com/watch?v=ikGVWEvUzNM

Stages

Virtue

Generativity vs. Care


Stagnation
(middle adult)

Task

Being creative
and productive;
establishing
next
generation.

35 to 60 years old

Crisis: Generativity means the ability to contribute


to ones family, community & work and society in
a positive way, and to assist the younger
generation. Success in this stage results in feelings
of self worth & connectedness in this world.
Difficulties in this stage result in feeling insignificant,
and the feeling that activities are stagnant, trivial, or
not helping future
generations.

Stages

Virtue

Task

Ego integrity
vs. Despair
(maturity)

Wisdom

Accepting
responsibility
for ones self
and life.

65 to above death

The important event is


reflection on & acceptance of
the individuals life.
Individual is creating
meaning & purpose of ones
life & reflecting on life
achievements.
Failure to resolve this conflict
can create feelings of disdain
& despair.

Cognitive Theories

Jean Piaget (1896


1980)

Explored how intelligence and cognitive


functioning develop in children.
Human intelligence progresses through
a series of stages based on age, with the
child at each successive stage
demonstrating a higher level of functioning
than the previous age.
Biologic changes and maturation were
responsible for cognitive development.

Piagets Stages of Cognitive


Development

Sensorimotor- birth to 2 years: the


child develops a sense of self as
separate from the environment and
the concept of object permanence;
that is, tangible objects do not cease
to exist just because they are out of
sight. He or she begins to form
mental images.

Piagets Stages of Cognitive


Development
Preoperational- 2 to 6 years: The child develops
the ability to express self with language,
understands the meaning of symbolic
gestures, and begins to classify objects.
Concrete operations: 6 to 12 years: The child
begins to apply logic thinking, understands
spatiality and reversibility, and is increasing
social and able to apply rules; however,
thinking is still concrete.

Piagets Stages of Cognitive


Development
Formal operations- 12
to 15 years and
beyond: The child
learns to think and
reason in abstract
terms, further develops
logical thinking and
reasoning, and
achieves cognitive
maturity.

HUMANISTIC THEORY

Humanism: represents a significant shift


away from the psychoanalytic view of the
individual as a neurotic, impulse-driven
person with repressed psychic problems
and away from the focus on and
examination of the clients past
experiences.
Humanism: focuses on a persons positive
qualities, his or her capacity to change
(human potential), and the promotion
of self-esteem.

Humanists do consider the persons


past experiences, but they direct
more attention toward the present
and the future.

Abraham Maslow (19211970)

He studied the needs or


motivations of an individual.
He focused on the total person,
not just on one facet of the
person, and emphasized health
instead of simply illness and the
problems.

Basic needs at the bottom of the pyramid


would dominate the persons behavior until
those needs are met, at which time the next
level of needs would become dominate.
Individual differences in terms of persons
motivation is not necessarily stable throughout
life.
Traumatic life circumstances or compromised
health can cause a person to regress to a
lower level of motivation.

Behavioral Theories

Behaviorism

A school of psychology that focuses on


observable behaviors and what one can do
externally to bring about behavior changes.
It does not attempt to explain how the mind
works.
Believes that behavior can be changed
through a system of rewards and
punishments.

Ivan Pavlov (18491946)


Classical conditioning
Behavior can be changed
through conditioning with
external or environmental conditions
or stimuli.
Laboratory experiments with dogs
provided the basis for the
development of this theory.

B.F Skinner

Operant conditioning
People learn their behavior from their
history or past experiences, particularly
those experiences that were repeatedly
reinforced.
Behavior is only that which could be
observed, studied and learned or
unlearned.

Principles Of Operant
Conditioning

All behavior is learned.


Consequences result from behaviorbroadly speaking, reward and punishment.
Positive reinforcers that follow a behavior
increase the likelihood that the behavior
will recur.
Negative reinforcers that are removed
after a behavior increase the likelihood
that the behavior will recur.

Continuous reinforcement (a reward every


time the behavior occurs) is the fastest
way to increase that behavior, but the
behavior will not last long after the reward
ceases.
Random intermittent reinforcement (an
occasional reward for the desired
behavior) is slower to produce an increase
in the behavior, but the behavior continues
after the reward ceases.

Interpersonal Theories

Harry Stack-Sullivan
(1892- 1949)
Ones personality involves more
than individual characteristics,
particularly how one interacts with
others.
Inadequate or nonsatisfying
relationships produce anxiety,
which is the basis for all
emotional problems.

Stages

Virtue

Task

Stages

Virtue

Task

Five Life Stages


Stage

Ages

Focus

Infancy

Birth to onset of
language

Primary need exists for


bodily contact and
tenderness.
Prototaxic mode
dominates (no relation
between experiences).
Primary zones are oral
and anal.
If needs are met, infant
has sense of wellbeing; unmet needs
lead to dread and
anxiety.

Five Life Stages


Stage

Ages

Focus

Childhood

Language to 5

Parents are viewed as


source of praise and
years acceptance.
Shift to parataxic mode:
experiences are
connected in sequence
to each other.
Primary zone is anal.
Gratification leads to
positive self-esteem.
Moderate anxiety leads
to uncertainty and
insecurity; severe
anxiety results in selfdefeating patterns of
behavior.

Five Life Stages


Stage

Ages

Focus

Juvenile

5-8 years

Shift to syntaxic mode


begins (thinking about
self and others based on
analysis of experiences
in a variety of situations).
Opportunities for
approval and acceptance
of others.
Learn to negotiate own
needs.
Severe anxiety may
result in need to control
or in restrictive,
prejudicial attitudes

Five Life Stages


Stage

Ages

Focus

Preadolescence

. 8- 12 years

Move to genuine
intimacy with friend of the
same sex.
Move away from family
as source of satisfaction
in relationships.
Major shift to syntaxic
mode occurs.
Capacity for attachment,
love, and collaboration
emerges or fails to
develop

Five Life Stages


Stage

Ages

Focus

Adolescence

Puberty to adulthood

Lust is added to
interpersonal equation.
Need for special
sharing relationship
shifts to the opposite
sex.
New opportunities for
social experimentation
lead to consolidation of
self- esteem or selfridicule.
In the self-esteem is
intact, areas of concern
expand to include
values, ideals, career
decisions, and social
concerns.

Hildegard Peplau (1909-1999)


Therapeutic Nurse-Patient Relationship

Four phases:
Orientation phase: directed by the nurse; engaging the
client in treatment, providing explanations and information,
and answering questions.
Identification phase: the client works interdependently with
the nurse, expresses feelings, and begins to feel stronger.
Exploitation phase: client makes full use of the services
offered.
Resolution phase: client no longer needs professional
services and gives up dependent behavior; relationship
ends.

Eriksons Stages of Psychosocial


Develoment