Theoretical foundation

Psychiatric Nursing

Theoretical Foundations



Learning Objectives:
On completion of this unit the learner will be able to:
1- Discuss basic assumptions of some theoretical approaches
2- Suggest special strategies to modify or change behavior
3- Identify some concepts (milieu therapy& therapeutic relationship)
4- Understanding the level of needs in Maslow Hierarchy.
5- Identify the principle of OPRANT conditioning therapy


? Theoretical frameworks
? allow the systematic organization of knowledge
? guide data collection
? provide explanations for assessed behaviors
? guide care plan development
? provides rationales for interventions and
? determine evaluation criteria
? Guide research by providing assumptions to be tested.


1- Psychoanalytic Theories
The Pioneer Sigmund Freud (1856–1939) from Vienna

? This theory supports the notion that EVERY human behavior is caused and can be explained

? Freud believes that “repressed” sexual urges, desires, impulses or drives motivated much human behavior
Personality Stages and Functional Awareness
? Conscious – perceptions, thoughts and emotion that exist in the person’s awareness
? Pre-conscious/Subconscious- Thoughts and emotions not currently in awareness but can be recalled with effort
? Unconscious- thoughts, drives and emotions totally a person is Unaware


According to this theory, much of our behavior is motivated by our SUBCONSCIOUS thoughts or
feelings
Five Stages of psychosexual development
1. Oral
2. Anal
3. Phallic or Oedipal
4. Latency
5. Genital
Phase Age Focus
Oral 0-18 months Site of gratification: Mouth
Anal 1 ½ - 3 years Site of gratification: Anus
Phallic 3- 5 years Site of gratification: Genitals
Latency 6- 12 years Site of gratification: (School Activities)
Genital 12 & above Site of gratification: Genitals


Psychosexual/Psychoanalytical

Freud s Sit of gratification

















Developmental tasks


Phase Age Focus
Oral 0-18 months Major task: Weaning
Anal 1 ½ - 3 years Major task: Toilet training
Phallic 3- 5 years Major task: Oedipal & Electra complex
Latency 6- 12 years Major task : School activities
Genital 12 & above Major task: Sexual intimacy




Psychosexual model (Freud)


1. Oral
a. 0-18 months
b. Pleasure and gratification through mouth
c. Behaviors: dependency, eating, crying, biting
d. Distinguishes between self and mother
e. Develops body image, aggressive drives Dissatisfaction: resurface later by overeating, smoking, nail-biting





2. Anal
a. 18 months - 3 years
b. Pleasure through elimination or retention of feces
c. Behaviors: control of holding on or letting go
d. Develops concept of power, punishment, ambivalence, concern with cleanliness or being dirty

Possible problems

? Compulsive need to be clean and orderly.
? Frugality and stinginess
? Greed
? Insistence on doing things at one s own rate at the expense of others
? Rigid training
? Excessive messiness and disorderly habits.
? Nursing Implication: Help children achieve bowel and bladder control without undue emphasis on its importance.

3. Phallic/Oedipal
a. 3 - 6 years
b. Pleasure through genitals
c. Behaviors: touching of genitals, erotic attachment to parent of opposite sex
d. Develops fear of punishment by parent of same sex, guilt, sexual identity


Possible problems

? Oedipus complex
? Electra complex
? Nursing implications:
? Accept child s sexual interest
? Help the parents answer child s questions about birth or sexual differences.

4. Latency
a. 6 - 12 years
b. Energy used to gain new skills in social relationships and knowledge
c. Behaviors: sense of industry and mastery
d. Learns control over aggressive, destructive impulses
e Acquires friends

5. Genital
a. 12 - 20 years
b. Sexual pleasure through genitals
c. Behaviors: becomes independent of parents, responsible for self
d. Develops sexual identity, ability to love and work

Psychoanalysis

? Freud developed psychoanalysis, a therapeutic process of accessing the unconscious and resolving the conflicts that originated in childhood with a mature adult mind.
? As a system of psychotherapy, psychoanalysis attempted to reconstruct the personality by examining free associations (spontaneous, uncensored verbalizations of whatever comes to mind) and the interpretation of dreams. Therapeutic relationships had their beginnings within the psychoanalytic framework.

Unconscious Ego defense mechanism

? These are PSYCHOLOGIC adaptive mechanisms
? Mental mechanisms that develop as the personality attempts to DEFEND itself, establishes compromises among conflicting impulses and allays inner tensions



? The unconscious mind working to protect the person from anxiety
? Releases tension


Ego Defense Mechanisms

? Compensation: Covering up weaknesses by emphasizing a more desirable trait



? Denial: Attempt to ignore unacceptable realities by refusing to acknowledge them

? Displacement: Discharging emotional reactions from one object to a LESS threatening object/person


? Identification: Imitation of someone feared or respected

? Intellectualization: Use of rational explanations that remove from the event any personal significance and feelings


? Introjections: Acceptance of other’s norms as oneself

? Regression: Resorting to an earlier, more comfortable level of functioning that is less demanding

? Repression: Unconscious mechanism of keeping threatening desires or thoughts from becoming CONSCIOUS

? Sublimation: Re-channeling of aggressive energies into socially acceptable activities


? Substitution: Replacement of a highly valued object by a LESS valuable or acceptable and available object.

? Undoing: Actions or words designed to cancel some disapproved thoughts, impulses , or acts in which the person relieves GUILT by making reparation



? PROJECTION: Blaming someone else for one’s difficulties or placing one’s unethical desires on someone else.
Involves in the development of DELUSIONS;

A nursing graduate blamed a dean of a nursing school in Recto for not passing the nursing exam.




CONVERSION: The unconscious expression of intrapsychic conflict symbolically through physical symptoms.

A nursing student suddenly went blind after her recent nursing board exam.



Psychosexual/Psychoanalytical:

Transference and Counter-transference
? TRANSFERENCE is the clients feeling toward nurse arising from unconscious experiences with early significant others
? COUNTER TRANSFERENCE is the nurse’s feelings toward the patient arising also form previous experiences


The Freudian View of Mental Illness
? All behavior has meaning
? Mental illness and manifestations are caused by unconscious INTERNAL conflict arising from unresolved issues in early childhood
? Ego defenses are utilized to relieve inner tension