PSYCHIATRIC NURSING NCM117 - WEEK 2

A. PSYCHOSOCIAL THEORY IMPLICATIONS FOR MENTAL HEALTH - PSYCHIATRIC NURSING PRACTICE

  • Based on Sheila L. Videbeck - Psychiatric-Mental Health Nursing

I. PERSONALITY: AN OVERVIEW

  • Definition of Personality:

    • According to Sheila Videbeck, personality is:

    • "The combination of emotional, attitudinal, and behavioral response patterns of an individual."

    • It determines how a person:

    • Thinks

    • Feels

    • Behaves

    • Relates to others

    • Copes with stress

    • Personality develops over time and is influenced by various factors:

    • Biological

    • Psychological

    • Social

II. MAJOR PERSONALITY THEORIES

A. Freudian Theory: Levels of Awareness (According to Sheila L. Videbeck)

  1. CONSCIOUS LEVEL

    • Definition:

      • The conscious level includes all experiences that are within the individual’s immediate awareness.

    • Components:

      • Thoughts

      • Feelings

      • Perceptions

      • Sensations occurring at the moment

    • Characteristics:

      • Easily verbalized

      • Logical and reality-based

      • Influenced by the ego

      • Smallest part of the mind

  2. PRECONSCIOUS LEVEL

    • Definition:

      • Involves experiences, thoughts, feelings, and memories

      • Not in immediate awareness but can be easily brought into conscious awareness.

  3. UNCONSCIOUS LEVEL

    • Definition:

      • Experiences that are not available to conscious awareness, also referred to as "Subconscious".

    • Characteristics:

      • Contains repressed memories, emotions, wishes, and conflicts.

      • Not directly accessible but influences behavior, dreams, and emotions.

B. Freud’s Iceberg Model of the Mind

  • Conscious Mind:

    • Represents the tip of the iceberg, encompassing current thoughts, feelings, and perceptions.

    • Example: What you are thinking or feeling right now.

  • Preconscious Mind:

    • Just below the surface; contains memories that are not currently in awareness but can be recalled.

    • Example: Remembering your birthday when asked.

  • Unconscious Mind:

    • The largest part of the iceberg, containing repressed materials.

    • Influences: Affects dreams and emotions without direct access.

Psychoanalytic Theory

A. Components of Personality Structure

  1. ID

    • Definition: The most primitive part of personality present at birth.

    • Characteristics:

      • Operates on the pleasure principle

      • Focuses on instincts, impulses, and immediate gratification

      • Utilizes primary process thinking (illogical, fantasy-based)

  2. EGO

    • Definition: The “self” or “I” component.

    • Characteristics:

      • Operates on the reality principle

      • Tests reality and makes logical decisions

      • Balances the demands of the id, superego, and reality

      • Utilizes secondary process thinking (logical, problem-solving)

  3. SUPEREGO

    • Definition: The moral component of personality.

    • Characteristics:

      • Represents conscience and internalized values

      • Develops from parental and societal standards

      • Judges actions as right or wrong

B. Examples of Personality Components

  • ID:

    • Represents primitive instincts and desires.

    • Example: A child wanting immediate gratification: "I want to eat all the cookies now."

  • EGO:

    • Mediates between id and reality.

    • Example: "I will have one cookie now and more later."

  • SUPEREGO:

    • Represents ideals and conscience.

    • Example: "I will feel guilty for wanting to eat all the cookies."

DEVELOPMENTAL THEORY

A. Developmental Concepts: Sigmund Freud's Psychosexual Stages

  1. ORAL STAGE (0-1 year)

    • Definition: Pleasure centers on the mouth (e.g., sucking, eating).

    • Fixation may lead to habits like smoking or overeating.

  2. ANAL STAGE (1-3 years)

    • Definition: Focus on bowel and bladder control.

    • Fixation may lead to obsession with cleanliness or messiness.

  3. PHALLIC/OEDIPAL STAGE (3-6 years)

    • Definition: Focus on the genitals.

    • Oedipus complex: A child’s desire for the opposite-sex parent.

  4. LATENCY STAGE (6-12 years)

    • Definition: Sexual impulses are subdued; focus on learning and peer relationships.

  5. ADOLESCENT/GENITAL STAGE

    • Definition: Sexual instincts mature; develops adult interests and relationships.

C. Defense Mechanisms

  1. Repression

    • Definition: An involuntary process of submerging painful thoughts into the unconscious.

    • Example: A patient forgets a painful surgery but feels nervous when discussing hospitals.

  2. Sublimation

    • Definition: Channeling unacceptable urges into positive actions.

    • Example: An individual who feels angry for being not selected by a company works hard and starts their own venture.

  3. Suppression

    • Definition: Intentional exclusion of anxiety-producing situations from awareness; voluntary forgetting.

    • Example: Blocking out thoughts about unpleasant things.

  4. Reaction Formation

    • Definition: Replacing unacceptable feelings with their opposites.

    • Example: A person acts overly friendly to someone they genuinely dislike.

  5. Rationalization

    • Definition: Justifying unacceptable feelings or behaviors with excuses to maintain self-respect.

    • Example: "I failed the test because my teacher hates me."

  6. Regression

    • Definition: Reverting to an earlier stage of development when facing unacceptable thoughts or impulses.

    • Example: An adult throwing a temper tantrum when things don't go their way.

  7. Projection

    • Definition: Attributing one's insecure feelings to others.

    • Example: A nurse feels anxious and believes that the doctor does not trust her, reflecting her own insecurities.

  8. Undoing

    • Definition: Attempting to erase an experience or action that has occurred, often symbolically.

    • Example: Compensating with good behavior to alleviate guilt.

  9. Compensation

    • Definition: Making up for deficiencies by directing energies to another area of personality where no deficiency exists.

  10. Displacement

    • Definition: Transferring feelings from the original person or object to a less threatening one.

  11. Denial

    • Definition: Refusing to accept painful aspects of reality.

    • Example: A battered wife claiming her husband is just a social drinker.

  12. Identification

    • Definition: Patterning oneself after an admired person.

    • Example: A new nurse emulates the head nurse she admires.

  13. Introjection

    • Definition: Unconscious integration of an admired person's beliefs into one’s ego, altering self-identity.

  14. Conversion

    • Definition: Transforming emotional conflicts into physical symptoms unconsciously.

  15. Dissociation

    • Definition: Temporarily altering consciousness to cope with emotional conflict, often seen in traumatic experiences.

  16. Intellectualization

    • Definition: Deflecting emotional expression by focusing on the intellectual aspects of a situation.

    • Example: Discussing the technicalities of an exam failure rather than feelings associated with it.

  17. Resistance

    • Definition: Antagonism towards processing anxiety-provoking thoughts, often resulting in memory lapses regarding studying.

  18. Substitution

    • Definition: Replacing an unreachable desire with a more attainable goal or one that is more socially acceptable.

  19. Fixation

    • Definition: Immobilization of a personality aspect due to unresolved developmental tasks or conflicts.

  20. Fantasy

    • Definition: Escaping demands through daydreaming.

  21. Isolation

    • Definition: Separating thoughts or feelings from consciousness to handle them without overwhelming emotions.

D. Transference and Countertransference

  1. Transference

    • Definition:

      • Patient → Nurse/Therapist dynamic, involving redirection of past feelings onto the nurse/therapist.

    • Example: A client with a strict father seeing the nurse as a father figure.

  2. Countertransference

    • Definition:

      • Nurse/Therapist → Patient dynamic, where the caregiver projects their own feelings onto the patient.

    • Example: A nurse feeling irritated with a patient for reasons linked to her rebellious sibling.

E. SULLIVAN'S INTERPERSONAL THEORY

Concept

  • Anxiety:

    • An interpersonal phenomenon experienced during conflicts in significant relationships.

    • Basic needs include satisfaction (biological) and security (emotional and social).

F. ERICKSON'S THEORIES

Application to Nursing

  • Nurses assess a client’s psychosocial development based on age norms.

  • Knowledge of developmental tasks aids in intervention selection.

  • Nurses encourage healthy behavior and instill hope for relearning.

G. BEHAVIORAL THEORIES

Humanistic Theory - Maslow’s Hierarchy of Needs by Abraham Maslow

  • Existential Theory (Viktor Frankl, Rollo May):

    1. Search for Meaning:

    • Humans are driven to find meaning and purpose, even in suffering.

    1. Personal Responsibility:

    • Recognizing the freedom to choose one's attitudes and actions influences mental health positively.

    • Individuals must accept responsibility for their decisions and actions.

    1. Existential Anxiety:

    • Arises from feelings of meaninglessness and fear of death or isolation.

    • This anxiety is normal but becomes unhealthy when overwhelming.