Chap. 2 - theoretical basis of care Flashcards
4 core concepts of the PMHNP role
Mental health
Mental illness
Therapeutic relationship
Growth and development
Mental health, defined
The totality of the individual’s ability to function in and to interact with the world
Factors that compose mental health
Humor Productivity Relationships Flexibility Coping Responsibility Insight
Mental illness, defined
A clinically significant behavioral/psychological syndrome or pattern that occurs in an individual and that is associated with persistent distress, disability, or risk of death, pain, or important loss of freedom
Therapeutic relationship, defined
The mutual experience that forms the context for care
Growth and development, defined
The principle of normal adaptive changes that allow an individual to exhibit dynamic changes on both the cellular and social levels
PC names for “mental illness”
Psychiatric disorders
Behavioral health disorders
Do mental illnesses have biological basis?
Yes they do.
DSM multiaxial system
I - clinical disorders II - personality disorders and MR III - general medical conditions relevant to Axis I or II IV - Psychosocial/environmental problems V - GAF
Erikson’s Stages of Development (8)
Infancy (0-1) Early childhood (1-3) Late childhood (3-6) School age (6-12) Adolescence (12-20) Early adulthood (20-35) Middle adulthood (35-65) Late adulthood (>65)
Erikson’s developmental tasks (8)
Infancy = Trust vs Mistrust Early childhood = Autonomy vs Shame and Doubt Late childhood = Initiative vs Guilt School age = Industry vs Inferiority Adolescence = Identity vs Role Confusion Early adulthood = Intimacy vs Isolation Middle adulthood = Generatively vs Self-absorption or stagnation Late adulthood = Integrity vs Despair
Trust vs mistrust
Infancy, age 0-1. Ability to form meaningful relationships, trust in others.
Autonomy vs shame and doubt
Early childhood, age 1-3. Self-control, self-esteem, willpower.
Initiative vs guilt
Late childhood, age 3-6. Self-directed behavior, goal formation, sense of purpose.
Industry vs inferiority
School age, age 6-12. Ability to work; sense of competency and achievement.
Identity vs role confusion
Adolescence, age 12-20. Personal sense of identity.
Intimacy vs isolation
Early adulthood, age 20-35. Committed relationships, capacity to love.
Generativity vs self-absorption or stagnation
Middle adulthood, age 35-65. Ability to give time and talents to others, ability to care for others.
Integrity vs despair
Late adulthood, age >65. Fulfillment and comfort with life, willingness to face death, insight and balanced perspective on life’s events.
MR - typical age of onset
Infancy
ADHD - typical age of onset
4-6 years
SZO - typical age of onset
Men 18-25
Women 25-35
Major depression - typical age of onset
Late adolescence to young adulthood
Dementia - typical age of onset
Most common after age 85
Psychodynamic/psychoanalytic theorist
Freud
“All behavior has meaning.” Other than Gestalt, which theory is this?
Psychodynamic/Freud
Principle of Psychic Determinism
Freud - even apparently meaningless, random, or accidental behavior is motivated by underlying unconscious mental content
Freud’s psychosexual stages of development
Oral: 0-18 months Anal: 18 months - 3 years Phallic: 3-6 years Latency: 6 years - puberty Genital: Puberty and beyond
Oral stage
0 - 18 months
Sucking, chewing, feeding, crying
Failure of oral stage linked to which disorders?
SZO
SUD
Paranoia
Anal stage
18 - 36 months
Sphincter control; expulsion and retention
Failure of anal stage linked to which disorders?
Depressive
Phallic stage
3-6 years
Masturbation, castration anxiety, exhibitionism
Failure of phallic stage linked to which disorders?
Sexual identity disorders
Latency stage
6 years - puberty
Peer relations, motor skills, socialization
Failure of latency stage linked to which disorders?
Social relational disorders
Genital stage
Puberty and beyond
Integration of earlier stages, genital-based sexuality
Failure of genital stage linked to which disorders?
Sexual perversions
Freud’s three primary psychic structures
Id, ego, superego
Id
Primary drives or instincts (hunger, sex, aggression)
Present at birth and motivates the infant
Says “I want”
Ego
Rational mind
Logical and abstract thinking
Use of defense mechanisms
Says “I think, I evaluate”
Superego
Sense of conscience or “right-and-wrong”
Aspirations and moral values
Regulated by guilt and shame
Says “I should” or “I ought”
Conflict between psychic structures is experienced as…
Anxiety
Conflict is dealt with through the use of…
Defense mechanisms
Characteristics of defense mechanisms
Unconscious
Used to reduce anxiety
Are fixed in neurosis
Denial
Avoidance of unpleasant realities by unconsciously ignoring their existence
Projection
Rejections of unacceptable beliefs or actions by attributing them to other people, situations, or events
Regression
In response to threat, a return to more comfortable thoughts or behaviors used in earlier stages of development
Repression
Unconscious exclusion of unwanted thoughts, feelings, or impulses from conscious awareness
Suppression
Conscious denial of a disturbing situation, feeling, or event
Is suppression or repression the more mature defense mechanism?
Suppression is more mature, as it is a conscious expulsion of unwanted thoughts
Reaction formation
Overcompensation
Banishment of unacceptable thoughts or behaviors by displaying and acting on the opposite feeling or behavior
Rationalization
Justification of illogical, unreasonable ideas, feelings, or actions by developing an acceptable explanation the satisfies the person
Undoing
Behaviors that attempt to make up for (or “undo”) unacceptable feelings or impulses
Intellectualization
Attempts to master a stressor through expanded knowledge or explanation
Sublimation
Substitution of socially acceptable, constructive activity for unacceptable impulses
Altruism
Meeting the needs of others in order to expel one’s own conflicts or stressors
Piaget’s theory of development
Cognitive theory
Cognitive theory states that…
Human development evolves through learning and comprehending
Piaget - nature, nurture, or both?
Both!
Piaget’s stages of development (4)
Sensorimotor (birth - 2 years)
Preoperational (2-7 years)
Concrete operations (7-12- years)
Formal operations (12-adult)
Sensorimotor
Birth - 2 years
Object permanence is the critical achievement (peek-a-boo)
Preoperational
2 - 7 years
Language, symbolism, magical thinking
Concrete operations
7 - 12 years
Reversibility and conservation
Reversibility
In Piaget’s concrete operations, the realization that one thing can change to another and back (water and ice)
Conservation
In Piaget’s concrete operations, the ability to recognize that while a shape may change its essential characteristics remain the same (clay)
Formal operations
12 and up
Abstract, formal, logical thought
Sullivan’s theory
Interpersonal theory
Sullivan’s stages of interpersonal development
Infancy (birth-18 months) - oral gratification
Childhood (18 months-6 years) - delayed gratification
Juvenile (6-9 years) - forming of peer relations
Preadolescence (9-12) - same-sex relations
Early adolescence (12-14) - opposite-sex relations
Late adolescence (14-21) - self-identity development
Sullivan’s infancy developmental task
Oral gratification
Sullivan’s childhood developmental task
Delayed gratification
Sullivan’s juvenile developmental task
Forming of peer relations
Sullivan’s preadolescent developmental task
Same-sex relations
Sullivan’s early adolescent developmental task
Opposite-sex relations
Sullivan’s late adolescence developmental task
Self-identity development
Maslow’s theory
Hierarchy of needs
Maslow’s hierarchy (5)
Survival needs (water, air, food, sleep) Safety/security (protection from harm) Love/belonging (affection and intimacy) Self-esteem (sense of worth) Self-actualization (being all one can be)
Becker’s model
Health belief model (people’s perceptions influence their health behaviors)
Trans-theoretical model of change
The stages of change (precontemplation, contemplation, preparation, action, maintenance, relapse)
Bandera’s theory
Social learning theory (also known as self-efficacy theory)
Individuals learn by watching and modeling
Leininger’s nursing theory
Theory of cultural care
Orem’s nursing theory
Theory of self-care
Parse’s nursing theory
Human becoming theory
Pender’s nursing theory
Health promotion theory
Peplau’s nursing theory
Therapeutic nurse-client relationship
Sister Callista Roy’s nursing theory
Theory of adaptation
Jean Watson’s nursing theory
Caring theory
