Chaptet 8: Theoretic Basis Of Practice Flashcards
Theories as maps
A theory is imaginative grouping of knowledge ideas and experiences that are represented symbolically and seek to illuminate a given phenomenon
The raise our maps that or any tests to our current environment and got our practice.
The visionary nightingale
Florence Nightingale was the founder of modern nursing. Her model emerged from her clinical work in hospitals. The primary focus on her model is on improving environmental conditions. She wanted to create healthy surroundings to help alleviate suffering and promote well-being. She believed giving false reassurance two sick people was unacceptable.
Interpersonal relations models
Interpersonal relations Hildegard Peplau
She believed in interpersonal relations which included interactions between person and family, parent and child, or patient and nurse. Emphasized empathic linkage. The transmission of anxiety or pain is the most common. She believed that if nurses pay attention to what they feel during a relationship with a patient they can gain invaluable observations of feelings. The self system is defined as an anti-anxiety system and a product of stabilization. The self proceeds through personal development that is always open to revision but tends toward stability. She also emphasizes the concept of need which are primary biologic origins but are met within a Socio cultural environment.
The dynamic nurse patient relationship Ida Jean Orlando
She thought a situation involves the patient’s behaviour the nurses reaction and anything that does not relieve the distress of the patient. She focusses on the whole patient rather than the disease or institutional demands.
Existential and humanistic theoretic perspectives
Seeking life meaning Joyce Travelbee
She provided an existential perspective. Existentialists believe that humans seek meaning in their life and experiences. She thought that a nurse is spiritual values and philosophical beliefs about suffering would determine the extent that a nurse could help help people find meaning in their situation. Her focus on suffering and illness helped to define areas of concern for nursing
Human becoming Rosemarie Rizzo Parse
The focus is on quality of life as perceived by the person and their family. The individual is perceived as open and free to describe meaning to life and Barris Spons ability for choices. Three principles structure her model. Meaning: structuring meaning is the imagining And valuing of language. Rhythmicity: Configuring rhythmical patterns of relation is the revealing concealing and enabling limiting of connecting separating. Transcendence: Contra sending with possible is the powering and originating of transforming.
Primacy of caring Patricia Benner
Nursing as a caring relationship. It’s guided by the moral art and ethics of care and responsibility and is based upon the lived experience of health and illness. The environment situates mean. People enter with their own set of meanings habits and perspectives that affect the way they respond in those situations.
Caring Gene Watson
Caring is the foundation of nursing. The science of caring is based on seven assumptions (Effective caring promotes health and individual or family growth) and 10 curative factors (A trusting relationship involves congruence, empathy, non-possessive warmth, and effective communication). This model evolved to address the spiritual dimension of the nurses role.
The title model of mental health recovery and reclamation Philip Barker
Incorporates the model for empowering interaction. Emphasizes the centrality of the lived experience of the person in care it is based on the assumption that people are their life stories and that they generate meaning through such stories. Focussed on helping people to recover their lives after a disruption in the flow of life such as an arrest or break down. The reclamation of one’s own life story is necessary to recovery. Change is a core element. The title model considers the domains of south world and other.
10 commitments of the title model
Value the voice. Respect the language. Develop genuine curiosity. Become the apprentice. Use the available tool kit. Craft the step beyond. Give the gift of time. Reveal personal wisdom. Know that change is constant. Be transparent.
Systems models
Health promotion the McGill model of nursing
The models forming concepts are health, family, collaboration and learning. Health is the focus on the practice of nursing. Coping and development or health processes that facilitate functioning and satisfaction with life. Family is viewed as the unit of concern. Family and person are open systems in constant interaction with her environment.This is a strength-based component instead of a deficit focus.
Goal attainment Imogen King
Three interacting systems personal, interpersonal, and social. The goal of health is adjusting to the stressors in the environment. The nurse and client set goals explore means and agree on means to achieve goals. The person is goal oriented and purposeful is reacting to stressors and is viewed as an open system interacting with the enviornment. The outcome of the interaction is a transaction defined as the transfer a value between two or more people.
Systems and stress Betty Neuman
The model guides caregivers through the assessment and intervention process by focussing on two major components. The nature of the relationship between nurse and the patient, and the patient’s response to stressors.
Self-care Dorthea Orem
The theory has three main focuses. Self-care (Those activities performed independently by an individual to promote and maintain personal well-being throughout life), self-care deficit (Occurs when an individual has a deficit in attitude or motivation, knowledge, or skill that impedes the meeting of self-care needs), the theory of nursing systems (A series of actions and nurse takes to meet patient self-care requirements). Nurses can help individuals meet self-care requests through five approaches. Acting or doing for, guiding, teaching, supporting, providing an environment to promote the patient’s ability to meet current or future demands.
Adoption Calista Roy
The model describes humans as living adaptive symptoms with two coping mechanisms. The regulator (Copes with physiologic stimuli) and the cognator (Copes with psychosociocultural stimuli). Manifestations of the coping mechanism can be assessed by for adaptive models. Physiologic needs, self-concept, role function, interdependence. The nursing process has six steps. Assessment of behavior, assessment of stimuli, nursing diagnosis, goalsetting, intervention, valuation.
Unitary human beings Martha Rogers
Central concept is energy fields which are open systems. Principles of homeo dynamics (integralize, resonance, helicy) offers a perspective of change as continuous and evolutionary. Important concepts are accelerating change, paranormal phenomenon, rhythmic manifestation of change.
Psychoanalytic theories (physiological)
Study of the unconscious
Conscious mental processes which art and awareness of events, thoughts, feelings with the ability to recall them. Unconscious mental processes our thoughts and feelings that are outside awareness and are not remembered. Preconscious describes unconscious material that is capable of entering consciousness
Personality and its development
Three parts the head which is formed by unconscious desires primitive instincts and unstructured drives including sexual and aggressive tendencies that arrive from the body. The ego which consists of the sum of certain mental mechanisms such as perception, memory and motor control. The super ego is the part of the personality associated with ethics, standards and self criticism.
Object relations and identification
Object relations is the psychological attachment to another person or object. A child’s first love object is the mother. The nature of this initial attachment influences any future relationships. The capacity for relationships progresses from a state of narcissism to social relationships.
Anxiety and defence mechanisms
Anxiety is a specific state of unpleasantness accompanied by motor discharge along definite pathways. Defence mechanisms protect a person from unwanted anxiety.
Sexuality
Libido the drive associated with sexual instinct resides in the head. When sexual desire is not expressed tension results and is transformed into anxiety. Freud believed sexuality involves areas such as oral anal and genital and corresponds to stages of relationships
Psycho analysis
Psychoanalysis is a therapeutic process of assessing the unconscious and resolving the conflicts that originated in childhood. Freud interpreted dreams and attempted to reconstruct the personality.
Transfer and counter transference
Transference is the displacement of thoughts feelings and behaviours originally associated with significant others from childhood into a person in a current therapeutic relationship. Example a woman’s feelings towards her parents as a child may be transferred to the therapist. Counter transference is the direction of all the therapists feelings and attitudes towards the patient. This may interfere with the therapists ability to understand the patient
Neo-Freudian theories
Alders foundation for individual psychology
Alfred Adler. First defected from Freud. Founded the school of individual psychology. Inferiority is major concept. Added to the understanding of human motivation.
Focussed on social aspects. Motivating force is striving for superiority. The inferiority complex. Focussed on growth. Humans are looking to realize their potential.
Jung’s analytical psychology
Carl Gustav John. After separating from Freud founded the school of psycho analytic psychology. Develops new theoretical approaches. Major concepts redefined libido, introversion, extroversion, persona. Personalities are often assessed on the introversion and extroversion dimensions.
People influenced by past and future. Proposed the collective unconscious there are arch types within this which are symbols common to all cultures (Mother hero trickster). Humans have feminine and masculine characteristics. Feminine side of the man is that anima masculine side of the woman is animus.
A persona is the masculine where is in society went public self. The shadow is the image of the Darkside of every person the one we do not like to recognize or show others. He believed in the existence of two psychological types the extravert those who find meaning in the world and the introvert those who find meaning within. Four primary modes of orientation thinking feeling intuition and sensation.
Horny’s feminine psychology
Karen horny. Opposed Freud’s theory of castration complex in women and his emphasis on the Oedipus complex. Argued that neurosis was influenced by the society in which one left. Major concepts situational neurosis, character. Beginning of feminist analytics of psycho analytic thought.
She argued that there are significant cultural reasons for women to strive to obtain qualities or privileges. Men have a deep-seated dread of women. Primary concept was on basic anxiety. Early childhood
Humanistic theories
Rogers client centred therapy
Carl Rogers. Based theory on the view of human potential for goodness. Used the term client rather than patient. Stressed the relationship between the therapist and the client. Major calm concept Empathy, positive regard. Individual therapy approach that involves never giving advice and always clarifying clients feelings. Defined empathy as the capacity to assume the internal reference of a client in order to perceive the world in the same way. The counsellor must be non-directive but not passive. The therapist develops unconditional positive regard and nonjudgmental caring for the client. Genuineness on the part of the therapist is key
Gestalt therapy
Frederick S pearls. Awareness of emotion physical state and repressed needs would enhance the ability to deal with emotional problems. Major concept reality, here and now. Used as a therapeutic approach to resolve current life problems that are influenced by old unresolved emotional problems.
Civilization produces neurotic anxiety due to repressed natural desires. To be cured unmet needs must be brought back to awareness. His exercises and to enhance a persons awareness of emotions physical state and repressed needs.
Maslow’s hierarchy of needs
Abraham Maslow of. Concerned himself with healthy rather than sick people. Approached individuals from a holistic dynamic viewpoint. Major concepts needs, motivation. Used as a model to understand how people are motivated and needs that should be met.
Major contributions to understanding human needs and motivation. People are self actualized when they are making the most of their unique human potential. Hierarchy of needs ranging from low level survival needs, such as shelter and those for belonging and esteem to finally self actualization.
Applicability of psychodynamic theories to PMH nursing
Core concepts for PMH nursing are interpersonal relationships, needs, anxiety, defence mechanisms, transference and countertransference the therapeutic relationship is also key
Behavioural theories
Stimulus response theories
Pavlovian theory
Ivan Pavlov. Classical conditioning. Unconditional stimuli, unconditioned response, conditioned stimulus. Important in understanding learning of automatic response such as habitual behaviour.
Classical conditioning with dogs.
John Watson in the behaviour list revolution
John Watson. Introduced behavioralism, believing that learning was classical conditioning called reflexes. Rejected distinction between the mind and the body. Principal a frequency, principle of recency. Focusses on the relationship between the mind and the body.
Started behavioralism. He developed two principles frequency (The more often a given responses made to a given stimulus the more likely the response to that stimulus will be repeated)and recency (The more recently a given response to a particular stimulus is made the more likely it will be repeated.).
Reinforcement theory’s
Edward L Thorndike reinforcement theory
Edward Thorndike. Believed in the importance of affects that followed behavior. Reinforcement. Important in behaviour modification programs.
Studied the problem-solving behaviour of cats to determine whether animal soft problems by reasoning or instinct. Neither choice was completely right. Animals gradually learn by stamping in the stimulus response connection. He believed in the importance of the effects that followed the response or the end reinforcement of the behavior.
BF Skinner reinforcement theory
BF Skinner. Developed an understanding of the importance of reinforcement and differentiated types and schedules. Operant behavior, respondent behavior, continuous reinforcement, intermediate reinforcement. Important in behavioural modification
Operant behaviour in response behavior. The learning is a consequence of a particular behavioural response not a specific stimulus
Cognitive theories
Albert Bandura’s social cognitive theory
Albert Bandura developed social cognitive theory a model for understanding how behaviour is learned from others. Major concepts modeling, disinhibition, elicitation, self efficacy. Important in helping patients learn appropriate behaviours
Acquiring behaviours by learning from other people. Important behaviours are learned by internalizing behaviours of others. Modelling which is pervasive imitation of one person trying to be like another. Disinhibition refers to the situation in which someone has learned not to make a response then in a given situation when another is making the inhibited response the individual becomes disinhibited and also makes the response. Elicitation Is when there is no desire present but when one person starts an activity others want to do the same. Self efficacy is a person sense of his or her ability to deal efficiently with the environment which he develops in his work. Stronger the self efficacy the higher the goals people set for themselves to further their commitment to them.
Aaron beck thinking and feeling
Aaron Beck. Conceptualize distorted cognitions as a basis for depression. Major concepts cognitions, beliefs. Important in cognitive therapy.
Looked at the understanding the relationship between cognition and mental health. Understood the importance of cognitions when treating people with depression. He believed that people with depression had faulty information processing systems that led to biased cognitions. Individuals may judge themselves to harshly and jump to an accurate conclusions. Distorted beliefs are the basis of cognitions
Kurt Lewin. Developed field theory a system for understanding learning, motivation, personality and social behavior. Major concepts life space, positive valence, negative valance. Important in understanding motivation for changing behaviour
Edward chance. Introduced the concept of cognitions and believe that human beans act on beliefs and attitudes and strive towards goals. Major concepts cognition. Important in identifying the persons beliefs.
Applicability of cognitive and behavioural theories 2 PMH nursing
Interventions are important in nursing. Example patient education interventions. Changing an entrenched habit helps people identify what motivates them and recognizes cues that proceed the behavior. Examples of cognitive and behavioural interventions used on inpatient hospital units include privilege systems, token economies, and the application of cognitive behavioural interventions
Developmental theories
Erik Erikson psychosocial development
Eric Erickson. Viewed psychosocial development as influenced by environment and a crane in stages each one having a task to resolve. Eight stages. Allows unresolved development task to be identified
Each stage has a specific task then that can be successfully or unsuccessfully resolved. Organized according to developmental conflicts by age.Example trust versus miss trust if the crisis is unsuccessfully resolved the infant moves to the next stage without a sense of trust and will have difficulty completing the next crisis
Jean Piaget learning in children
Jean Piaget. Viewed intelligence as adoption to the environment. Understood cognitive development in children to be like embryonic development, increasing differentiation in structure. Major concepts children learn particular concepts only when they have reached the appropriate stage of development. Important in assessment of children useful in age-appropriate health education for children.
Viewed intelligence as an adoption to the environment. A particular concept should be taught to children only when they have reached an appropriate stage of development.
Carol Gilligan gender differentiation
Carol Gilligan. Gender differences in moral development. Major concept found a tendency for females to be more focussed in relationships and issues of care in resolving moral problems which males tend to apply abstract principles such as Justice. Important in the evolution of gender studies.
Males tended to approach moral problems by playing abstract rules, females are more likely to be concerned with preserving the relationship of those involved and with responsibilities related to care.
Applicability of developmental theories to PMH nursing
When working with children nurses can use developmental models to help gauge development and mood. However these models do not account for gender differences and diversity in lifestyle and culture, and are based on the assumption of a linear progression through the stages.
Family dynamics
Family dynamics
Are the pattern interpersonal and social interactions that occur within the family structure over the life of a family. The family is viewed organizationally as an open system in which one members actions influence the functioning of the total system.
Applicability of family theories to PMH nursing
These models are used to help nurses for collaborative relationships with patients and families dealing with health problems. The mental health problems of a family member will have important implications for the entire family system
Roll theories
Roll theories
A rule describes an individuals social position and function within an environment. A healer role may be assumed by a nurse in one culture and a spiritual leader in another. Social expectations, social status, and rights are attached to these rules.
Applicability of rule theories to PMH nursing
PMH nurses use role concepts in understanding group interaction and the role of the patient in the family and community.
Socio-Cultural perspectives
Gender
Feminist therapists have been challenging suicidal, political and medical conventions that framed gender in oppressive and discriminatory ways. They re-introduce validity to concepts such as emotion, embodied knowledge that were previously deemed irrational and dysfunctional. Research indicates that nurses lack knowledge regarding the needs of transgender people
Culture It’s also important to see the various notions of race in class and how they function in our understanding of psychiatric nursing and mental health.
Madeline Leininger trans cultural health care
Directed towards holistic, congruent and beneficial care. Caring is culturally based. Care is the essence of nursing and manifestations include compassion, presence and enabling. Her model depicts the worldview, religion, kinship, cultural values, economics, technology, language, ethnohistory, and environmental factors that are predicted to explain and influence cultural care
Applicability of sociocultural theory’s to PMH nursing
Adequate nursing assessments and interventions are not possible without considering the role of the individual within the family and within society and the significance of family and cultural norms. Understanding cultural values is critical to meaningful interactions. Healthcare systems have their own culture and it’s important for nurses to ensure that Care environments are safe and conductive to healing
Franckles logotherapy
Each of us needs to find a reason to live. Logotherapy is focussed on helping a person find meaning in life. Love was the greatest salvation even when one’s only option is to endure suffering contemplation of a beloved an evil suffering to be in dirt in an honourable way. Based on Frankel’s experience as a prisoner in a concentration camp in World War II
