Foundations of Psychiatric-Mental Health Nursing & Psychosocial Theories (NUR 322)

Mental Health

State of emotional, psychological, and social wellness evidenced by satisfying relationships, effective behavior/coping, positive self-concept, and emotional stability

3 Influencing Factors of Mental Health

1.) Individual

2.) Interpersonal

3.) Social/Cultural

Mental Illness

Behavioral or psychological syndrome/pattern that occurs in an individual and that is associated with present distress or disability

Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

Taxonomy published by the American Psychiatric Association that serves to (1) standardize nomenclature, (2) present defining characteristics/symptoms, and (3) assist in identifying underlying causes of disorders

Important Objectives from Healthy People 2030

1.) ↓ Suicide rate

2.) ↑ Proportion of children/adolescents that receive treatment

3.) ↓ Proportion of persons who experience major depressive episodes

4.) ↑ Proportion of adults with mental health disorders that receive treatment

5.) ↑ Number of homeless adults with mental health problems who receive services

Linda Richards

First American psychiatric nurse; improved nursing care in psychiatric hospitals and organized educational programs in state mental hospitals (Illinois)

McLean Hospital

Located in Belmont, MA; site of first training for nurses to work with persons with mental illness

Freud’s Psychoanalytic Theory

All human behavior is caused and explainable; repressed sexual impulses and subconscious thoughts/feelings motivate behavior

3 Personality Components (Freud’s Theory)

1.) Id → Part of one’s nature that reflects basic/innate desires

2.) Ego → Balancing/mediating force between the id and superego

3.) Superego → Part of a person’s nature that reflects moral/ethical concepts, values, and parental/social expectations

Id

Part of one’s nature that reflects pleasure-seeking behavior, aggression, and sexual impulses; seeks instant gratification, causes impulsive (unthinking) behavior, and has no regard for rules or social convention

Ego

Part of one’s nature that represents mature/adaptive behavior that allows a person to function successfully in the world; causes anxiety from the attempts to balance the id and ego

Superego

Part of one’s nature that reflects moral/ethical concepts and social expectations; direct opposite of the id

5 Stages of Freud’s Psychoanalytic Model

1.) Oral (Birth to 18 months)

2.) Anal (18 to 36 Months)

3.) Phallic/Oedpial (3 to 5 years)

4.) Latency (5-11 or 13 Years)

5.) Adolescence (11 to 13 Years)

Oral Stage (Birth to 18 Months)

Major sites of gratification are the mouth, lips, and tongue (biting/sucking); the id is present at birth and the ego develops gradually from rudimentary structure present at birth

Anal Stage (18 to 36 Months)

Anus and surrounding area are major source of interest; voluntary sphincter control (toilet training) is acquired

Phallic/Oedipal Stage (3 to 5 Years)

Genitals are the focus of interest, stimulation, and excitement (masturbation common); penis is organ of interest for both sexes (penis envy is seen in females); oedipal complex is seen in males and females

Oedipal Complex

Wish to marry opposite-sex parent and be rid of the same-sex parent

Latency Stage (5-11 or 13 Years)

Resolution of oedipal complex, sexual drive channeled into socially appropriate activities such as schoolwork and sports; formation of the superego and final stage of psychosexual development.

Genital Stage (11 to 13 Years)

Begins with puberty and the biologic capacity for orgasm; involves the capacity for true intimacy

Freud’s Dream Analysis

Dreams reflect a person’s subconscious with significant meaning; involves discussing a client’s dreams to discover true meaning and significance

Transference

Occurs when the client displaces onto the nurse attitudes and feelings that the client originally experienced in other relationships (i.e. adolescent patient uses sarcastic tone)

Countertransference

Occurs when the nurse displaces onto the client attitudes or feelings from their own past (i.e. nurse uses parental/chastising tone in response)

Ego Defense Mechanisms

Freud believed that the ego uses defense mechanisms to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events

Compensation

Overachievement in one area to offset real or perceived deficiencies in another area (i.e. nurse with low self-esteem works double shifts to earn supervisor’s favor)

Conversion

Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature (i.e. teenager not allowed to see X-rated movies is tempted to do so and develops blindness)

Denial

Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue (i.e. person with diabetes eating chocolate candy(

Displacement

Ventilation of intense feelings toward people less threatening than the one who aroused those feelings (i.e. person who is mad at their boss yells at their spouse)

Dissociation

Dealing with emotional conflict by a temporary alteration in consciousness or identity (i.e. adult remembers nothing of childhood sexual abuse)

Fixation

Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage (i.e. never learning to delay gratification)

Identification

Modeling actions and opinions of influential others while searching for identity or aspiring to reach a personal, social, or occupational goal (i.e. nursing student decides to work in critical care because this is the specialty of their instructor)

Intellectualization

Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions (i.e. no emotional expression when discussing serious car accident)

Introjection

Accepting another person’s attitudes, beliefs, and values as one’s own (i.e. person who dislikes guns becomes an avid hunter, just like a best friend)

Projection

Unconscious blaming of inclinations or thoughts deemed unacceptable on an external object (i.e. person with many prejudices loudly identifies others as bigots)

Rationalization

Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect (i.e. student blames failure on teacher being mean)

Reaction Formation

Acting the opposite of what one thinks or feels (i.e. person who despises the boss tells everyone what a great boss they are)

Regression

Moving back to a previous developmental stage to feel safe or have needs met (i.e. adult pouts like a 4-year-old if they are not the center of their partner’s attention)

Repression

Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness (i.e. person has no memory before age 7, when they were removed from abusive parents)

Resistance

Overt or covert antagonism toward remembering or processing anxiety-producing information (i.e. nurse is too busy with tasks to spend time talking to a dying client)

Sublimation

Substituting a socially acceptable activity for an impulse that is unacceptable (i.e. person who has quit smoking sucks on hard candy when the urge to smoke arises)

Suppression

Conscious exclusion of unacceptable thoughts and feelings from conscious awareness (i.e. student decides not to think about a parent’s illness to study for a test)

Undoing

Exhibiting acceptable behavior to make up for or negate unacceptable behavior (i.e. person who cheats on a partner brings the partner a bouquet of roses)

Erikson’s Psychosocial Theory

Extended Freud’s work while focusing on social and psychological development in life stages; 8 psychosocial stages of development occur in sequential phases, and each is dependent on completion of the previous to achieve life’s virtues

Erikson’s 8 Stages of Psychosocial Development

1.) Trust vs. Mistrust (Infant)

2.) Autonomy vs. Shame and Doubt (Toddler)

3.) Initiative vs. Guilt (Preschool)

4.) Industry vs. inferiority (School Age)

5.) Identity vs. Role Confusion (Adolescence)

6.) Intimacy vs. Isolation (Young Adult)

7.) Generativity vs. Stagnation (Middle Adult)

8.) Ego Integrity vs. Despair (Maturity)

Trust vs. Mistrust (Infant)

Virtue of hope; viewing the world as safe and reliable; relationships are nurturing, stable, and dependable

Autonomy vs. Shame and Doubt (Toddler)

Virtue of will; achieving a sense of control and free will

Initiative vs. Guilt (Preschool)

Virtue of purpose; beginning development of a conscience; learning to manage conflict and anxiety

Industry vs. Inferiority (School Age)

Virtue of competence; emerging confidence in own abilities; taking pleasure in accomplishments

Identity vs. Role Confusion (Adolescence)

Virtue of fidelity; formulating a sense of self and belonging

Intimacy vs. Isolation (Young Adult)

Virtue of love; forming adult, loving relationships, and meaningful attachments to others

Generativity vs. Stagnation (Middle Adult)

Virtue of care; being creative and productive; establishing the next generation

Ego Integrity vs. Despair (Maturity)

Virtue of wisdom; accepting responsibility for oneself and life

Sullivan’s Personality Theory

Personality involves more than individual characteristics, particularly how one interacts with others; inadequate/nonsatisfying relationships produce anxiety (basis for all emotional problems)

Sullivan’s 3 Cognitive Modes of Experience

1.) Prototaxic Mode (Infancy to Childhood)

2.) Parataxic Mode (Early Childhood)

3.) Syntaxic Mode (School-Aged Children, More Predominant in Preadolescence)

Prototaxic Mode (Infancy to Childhood)

Involves brief, unconnected experiences that have no relationship to one another (i.e. Schizophrenia)

Parataxic Mode (Early Childhood)

Child begins to connect experiences in sequence, but may not make logical sense and view them as coincidence/chance; child seeks to relieve anxiety by repeating familiar experiences (i.e. paranoid experiences and slips of the tongue)

Syntaxic Mode (School-Aged Children, More Predominant in Preadolescence)

Person begins to perceive themself and the world within the context of the environment; able to analyze experiences in a variety of settings (i.e. maturity)

Sullivan’s 5 Stages of Development

1.) Infancy (Birth to Language Onset)

2.) Childhood (Language to 5 Years)

3.) Juvenile (5 to 8 Years)

4.) Preadolescence (8 to 12 Years)

5.) Adolescence (Puberty to Adulthood)

Infancy (Birth to Language Onset)