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Theoretical Models for Working with Psychiatric Patients

I. PSYCHOANALYTIC -Individuals are motivated by


II. DEVELOPMENTAL unconscious desires and conflicts
III. INTERPERSONAL
IV. HUMANISTIC -THAT in order to understand the past
V. BEHAVIORAL and present behavior, is to make the
VI. NEUROBIOLOGIC unconsciousconscious
Psychoanalytic Theories
FREUDS PSYCHOSEXUAL THEORY
1. All human behavior is caused and
can be explained. Oral Stage (birth-18 months):
2. Personality conceptualized as id,
-Explores the world by using mouth
ego, and superego.
3. Behavior motivated by subcon- -Task: distinguish self from mother,
scious thoughts and feelings
4. Ego defense mechanisms establish trust and comfortable

expression and gratification of oral


PERSONALITY COMPONENT
Id- desires, pleasure-seeking behavior, needs without conflict.
aggression and sexual impulses.
Instant gratification, causes -develops body image or self concept
impulsive unthinking behavior . based on the responses he gets
-no rules or social convention.
Superego- reflects moral and ethical from others.
concepts, values, parental and
social convention. can result in oral personality
Ego-represents the mature and manifested by oral activities like
adaptive behavior that allows a excessive smoking & drinking, over
person to function successfully in eating, thumb sucking & nail biting.
the world.
-extremely dependent on objects for
Behavior motivation the maintenance of their self-esteem
Human personality functions at 3
levels of awareness : -tend to overly dependent on others
1. Conscious-perceptions, and followers
thoughts, and emotions that
-envy and jealousy are also associated
exist in the persons awareness.
with oral traits.
2. Preconscious-thoughts and
emotions that are not currently Anal Stage (18 months-36 months:
in the persons awareness but
can recall them with some effort. -Learns to control urination and
3. Unconscious-the realm of defecation
thought and feelings that
motivate a person even though -Task: Sphincter control, self-control,
totally unaware of them. (use of autonomy,separation, individuation.
defense mechanism)
-breaks symbolic ties with mother; Genital Stage (11-13 years):
as the ties are broken, the child learns
-Develops sexual maturity and learns
independence.
to establish satisfactory relationships
unresolved problem with retention with the opposite sex.
or holding (anal retentive) could
-Task: developing social control over
result in anal personality manifested
instincts and resolving dependence
by stinginess, stubbornness, and
and independence conflict.
obsession to cleanliness and excessive
orderliness. -develops sexual identity, ability to
love and work.
unresolved problem with expulsion
(anal expulsive) could result in the unresolved problem in this stage
person developing the traits of being results in difficulty in forming intimate
extravagant, dirty, messy and relationships, lack of personal goals
disorganized. and difficulty in becoming emotionally
and financially independent.
Phallic/oedipal Stage ( 3-5 years):
Implication to nursing:
-Learns sexual identity through
awareness of genital area. Nurses must be aware of the
clients defense mechanism
-Task: establishing sexual identity and
against instinctual demands and
beginning socialization:
anxiety. When we recognize that
-To gain the affection of the parent of a client is using a defense
the opposite sex, the child imitates the mechanism, we know that the
parent of the same sex, this leads to anxiety may need to reduced
the internalization of the traits of the before the defense can be
parent the child is identifying with. disengaged.

-unresolved problem can result in (Developmental model) Erik


sexual deviant behaviors and weak or Erikson (1902-1994)
confused sexual identity.
Primary focus/Key concepts:
Latency Stage (5-13 years):
0-12 trust vs. mistrust.. if needs of
-Personality development appears to the child are consistently met,
be non-active or dormant.
TRUST develops HOPE
Task: group identification
1-3 autonomy vs. shame & doubt
unresolved problem at this stage
if toilet training is not hurried,
results in deficiencies in social skills,
difficult to establish social AUTONOMY develops. Free WILL
relationship, feelings of inferiority and
inadequacy.
3-6 initiative vs. guilt mobilization and use of adaptive
coping responses.
if childs sexual curiosity is handled
w/o anxiety, -Help nurses ASSESS and MANAGE
BEHAVIORAL issues
INITIATIVE develops. PURPOSES
Cognitive Development
12 industry vs. inferiority
Jean Piaget (1896-1980)
If childs efforts at learning is
supported, 0-2 Sensorimotor : the child
develops a sense of self as separate
INDUSTRY develops.
from the environment; and the
COMPETENCE
concept of object permanence.
12-18 identity vs. role confusion Begins to form mental images.
if adolescents vocational decision is 2-6 Preoperational stage : the child
supported, to develops the ability to express self
IDENTITY develops FIDELITY verbally, understand gestures and
begins to classify objects.
18-25 intimacy vs. isolation
6-12 Concrete-operational stage :
If adolescents decisions regarding pre-logical to logical concrete thought
love relationship is supported,
12 Formal-operational stage :
INTIMACY develops LOVE thinks abstractly; develop logical
25-65 generativity vs. stagnation thinking and reasoning, achieves
cognitive maturity.
If an adult enjoys support from the
family, Implication to nursing:

GENERATIVITY developsCARE Early childhood interventions


also enable nurses to develop
65 up integrity vs. despair and implement preventive
If the elderly has a satisfying past measures that facilitate specific
development tasks.
recollection,
Assessing knowledge level of
INTEGRITY develops WISDOM
client and family education
Implication to nursing: needs is an integral part of
nursing care.
Provides a basis for client-centered
nursing intervention thru provision of Cognitive theory can guide in
therapeutic environment that enables treatment planning.
the client to master crises unique to
Interpersonal Development
various development stages that
Model
facilitates the development,
Harry Stack Sullivan (1892-1949) Late adolescence -Master
expression of sexual impulses.
0-18 mos Infancy
-Forms satisfying and responsible
Develops sense of basic trust,
associations.
security and self-worth
-Uses communication skills to
if needs are met, infant has sense of
protect self from conflicts with others.
well-being, unmet needs leads to
dread and anxiety. Young adulthood -Learns to be
economically,intellectually, and
18 mos - 5 yrs Childhood
emotionally self-sufficient.
Learns language and symbols;
If the self-esteem is intact, areas of
intuition; learns individuals have roles
concern expand to include values,
Gratification leads to positive self- Ideals, career decisions and social
esteem. Problems to this stage may concerns.
result to moderate anxiety leads to
inadequate or non-satisfying
uncertainty and insecurity; severe
relationships produce anxiety and/or
anxiety results in self-defeating
maladaptive behaviors; primarily the
patterns of behavior.
basis of all emotional problems
6-9 yrs Juvenile
Example 1: Negative experience from
Learns to accept subordinate to previous relationship leads to doubts
authority figures outside the family. and fear
-More concept of self-status and role. ayaw ng mag-boyfriend
Problems to this stage result to parehas lang kayong mga
severe anxiety needing to control or in lalaki!
restrictive, prejudicial attitude.
Relevance to Nursing practice
9-12 Preadolescence
Knowing that inadequacy or non-
Capable in participating if genuine satisfying relationships leads to
love with others. maladaptive behaviors, nurse will be
-Develop consideration and concerns able to help the patient thru CHANGE
outside self. the process of reeducation.

Capacity for attachment, love, and


collaboration emerges or fails to
develop.

12-14 Early adolescence

Attempts to integrate sex with


Hierarchy of Human Needs
other personal relationships.
Abraham Maslow (1921-1970) -people learn their behavior from
their history or past experiences
particularly those that were
repeatedly reinforced

Neurobiologic theories
Research:
-genetics and heredity
*twin studies, adoptive studies and
family studies
-Stress and Immune system
*examines the effect of psychosocial
stressors on the bodys immune
system
-Infection
1. Primary focus: *Viral
Totality of the person *relation of streptococcal bacteria
Hypothesized that basic needs and OCD and tics.
would dominate (oxygen,
water, food, sleep, sex) persons Self-Awareness Issues
behavior until those needs are No one theory or treatment
met approach is effective for all
clients
2. Relevance to Nursing practice
Using a variety of psychosocial
a. Understanding the
approaches increases nurse
Hierarchy of Needs and its
effectiveness
components help nurses
The clients feelings and
appropriately ASSESS and
perceptions are most influential
MANAGE patient maladaptive
in determining his or her
behavior/s
response
b. MOTIVATION of man is
based on satisfying Hierarchy
In a Nurse-Patient relationship, the
of Needs
nurse must exercise the following:
a. must recognize and understand
Behavioral theory
maladaptive behaviors
I. Ivan Pavlov:Classical
b. must help patient recognize
Conditioning
his/her maladaptive behaviors
II. B.F. Skinner: Operant
c. must help patient choose
Conditioning
acceptable ways of expressing
IvanPavlov: Classical
their desires and drives
Conditioning
-Behavior can be changed through
conditioning with external or
environmental conditions or stimuli.
B.F. Skinner: Operant
Conditioning

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