1. Relevant Theories and Therapies for Nursing Practice
Chapter 2
Relevant Theories and Therapies for Nursing Practice
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2. Introduction Psychological theories help us to explain behavior
Psychological therapies are treatments based on these theories
An overview of theories and therapies and their relevance to nursing and psychiatric mental health nursing are described in this chapter
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3. Psychoanalytic Theories
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4. Freud’s Psychoanalytic Theory
Levels of awareness
Conscious
Preconscious
Unconscious
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5. Freud’s Psychoanalytic Theory (Cont.)
Personality structure Id
Pleasure principle
Reflex action
Primary process
Ego
Problem solver
Reality tester
Superego
Moral component
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6. Freud’s Psychoanalytic Theory (Cont.)
Defense mechanisms and anxiety
Operate on unconscious level
Deny, falsify, or distort reality to make it less threatening
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7. Freud’s Psychoanalytic Theory (Cont.)
Experiences during the early stages of life determine
Individual’s lifetime adjustment patterns
Personality traits
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8. Freudian Theory and Nursing
Formation of personality
Conscious and unconscious influences
Importance of individual talk sessions
Attentive listening
Transference
Countertransference
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9. Case Study
A patient is admitted to your unit who has an uncanny resemblance to your older sister. As a child, your older sister bossed you around and criticized you constantly. You realize that you are responding negatively to this patient.
What is going on?
Countertransference - unconscious feelings the health care worker has toward the patient
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10. Case Study (Cont.) What should the nurse do?
The nurse should realize the importance of maintaining self-awareness and seeking supervisory guidance as the therapeutic relationship progresses.
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11. Erikson’s Ego Theory Eight stages of development
Personality continues to develop through old age
Stage
Age
Trust vs. mistrust
0-1.5
Identity vs. role confusion
12-20
Autonomy vs. shame-doubt
1.5-3
Intimacy vs. isolation
20-35
Initiative vs. guilt
3-6
Generativity vs. self-absorption
35-65
Industry vs. inferiority
6-12
Integrity vs. despair
65+
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12. Erikson’s Theory and Nursing
Developmental model is important part of nursing assessment
Helps determine what types of interventions are most likely to be effective
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13. Sullivan’s Interpersonal Theory
Purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid anxiety
Anxiety
Security operations
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14. Sullivan’s Theory and Nursing
Foundation for Hildegard Peplau’s theory
Participant observer
Mutuality
Respect for the patient
Unconditional acceptance
Empathy
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15. Hildegard Peplau’s Theory of Interpersonal Relationships in Nursing
Peplau influenced by Sullivan’s work
The art of nursing
Provide care, compassion, and advocacy
Enhance comfort and well-being
The science of nursing
Application of knowledge to
Understand a broad range of human problems and psychosocial phenomena
Intervene in relieving patients’suffering and promote growth
Based on Sullivan’s Interpersonal Theory, Peplau is considered the “mother” of psychiatric mental health nursing.
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16. Peplau and the Therapeutic Relationship
Levels of anxiety
Interventions to lower anxiety
Aim to improve patient’s ability to think and function
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17. Behavior Theories and Therapies
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18. Behavior Theories Pavlov’s classical conditioning theory
Watson’s behaviorism theory
Skinner’s operant conditioning theory
Implications for nursing
Modifying or replacing behaviors
Behavior management
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19. Behavior Therapy Modeling Operant conditioning
Systematic desensitization
Aversion therapy
Biofeedback
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20. Cognitive Theories and Therapies
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21. Cognitive Theory
Dynamic interplay between individuals and the environment
Thoughts come before feelings and actions
Thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality.
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

22. Cognitive Theories Rational-Emotive Behavior Therapy (Ellis)
Aims to eradicate irrational beliefs
Recognize thoughts that are not accurate
Cognitive-Behavioral Therapy (Beck)
Test distorted beliefs and change way of thinking; reduce symptoms
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23. Humanistic Theories
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24. Maslow’s Hierarchy of Needs
Human beings are active participants in life, striving for self-actualization
When lower needs are met, higher needs are able to emerge
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25. Maslow’s Theory and Nursing
Emphasis on human potential and the patient’s strengths
Prioritizing nursing actions in the nurse-patient relationship
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26. Biological Theories Focus on How the body and brain interact to create
Neurological
Chemical
Biological
Genetic
How the body and brain interact to create
Emotions
Memories
Perceptual experiences
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27. Biological Theories and Nursing
Consider other influences that play a role in the development and treatment of mental disorders
Social, environmental, cultural, economic
Focus on
Qualities of a therapeutic relationship
Understanding patient’s perspective
Communicating to facilitate recovery
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28. Additional Therapy Milieu Therapy Use of total environment
People, setting, structure, and emotional climate are all important to healing
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29. Audience Response Questions
According to Freud, which aspect of the personality motivates an individual to seek perfection? Id
Ego
Superego
Not sure
ANS: C
The superego represents the ideal rather than the real; it seeks perfection, as opposed to seeking pleasure or engaging reason.
REF: 21
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30. Audience Response Questions
Which theorist most influenced the professional practice of psychiatric nursing?
Harry Stack Sullivan
Hildegard Peplau
Erik Erikson
Ivan Pavlov
ANS: B
Peplau not only established the foundation for the professional practice of psychiatric nursing, she also continued to enrich psychiatric nursing theory and work for the advancement of nursing practice throughout her career. Invite students to identify major contributions of the other theorists listed.
REF: 24
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31. Audience Response Questions3.
Schemata, automatic thoughts, and cognitive distortions are terms that relate to
rational-emotive behavioral therapy.
cognitive-behavioral therapy.
operant conditioning theory.
biofeedback.
ANS: B
Rapid, unthinking responses based on schemas are known as automatic thoughts. Often automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. Making changes to these cognitive errors is part of cognitive-behavioral therapy.
REF: 29-31
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