Benedict James R.
Bermas
BSN-3
Psychoanalytic Model
Psychoanalytic theory is the theory of personality organization and the dynamics
of personality development that guides psychoanalysis, a clinical method for
treating psychopathology. First laid out by Sigmund Freud in the late 19th
century, psychoanalytic theory has undergone many refinements since his work.
Freud developed the psychoanalytic theory of personality development,
which argued that personality is formed through conflicts among three
fundamental structures of the human mind: the id, ego, and superego.
Three levels of consciousness:
o Conscious: what we are thinking about or experiencing at any given
moment
o Preconscious: what we can readily call to consciousness (memories,
knowledge)
o Unconscious: thoughts, desire, and impulses of which we’re not aware;
this is the largest level of consciousness.
Personally Processes
o Id- pleasure principle, primary-process thoughts
o Ego – reality principle, secondary process thoughts
o Superego – morality principle, secondary thoughts
Psychosexual Development
o Oral (birth 1-5) – autonomy, shame and doubt
o Anal (1.5-3) – Oedipal complex
o Latency (5-puberty) – industry vs inferiority
o Genital (puberty-beyond)
This can be used by psychiatric nurses by means of making a specific patient plan
that can further enhance their development in a more rapid rate, by means of
meeting a more specific goal to every a specific patient, which will benefit them
more.
Developmental Model
Trust vs. Mistrust
From birth to 12 months of age, infants must learn that adults can be trusted. This occurs
when adults meet a child’s basic needs for survival
Autonomy vs. Shame/Doubt
As toddlers (ages 1–3 years) begin to explore their world, they learn that they can control
their actions and act on their environment to get results. They begin to show clear
preferences for certain elements of the environment, such as food, toys, and clothing.
Initiative vs. Guilt
Once children reach the preschool stage (ages 3–6 years), they are capable of initiating
activities and asserting control over their world through social interactions and play.
Industry vs. Inferiority
During the elementary school stage (ages 6–12), children face the task of industry vs.
inferiority. Children begin to compare themselves with their peers to see how they
measure up.
Identity vs. Role Confusion
In adolescence (ages 12–18), children face the task of identity vs. role
confusion. According to Erikson, an adolescent’s main task is developing a sense of self.
Intimacy vs. Isolation
People in early adulthood (20s through early 40s) are concerned with intimacy vs.
isolation. After we have developed a sense of self in adolescence, we are ready to share
our life with others.
Generativity vs. Stagnation
When people reach their 40s, they enter the time known as middle adulthood, which
extends to the mid-60s. The social task of middle adulthood is generativity vs.
stagnation. Generativity involves finding your life’s work and contributing to the
development of others through activities such as volunteering, mentoring, and raising
children.
Integrity vs. Despair
From the mid-60s to the end of life, we are in the period of development known as late
adulthood. Erikson’s task at this stage is called integrity vs. despair. He said that people
in late adulthood reflect on their lives and feel either a sense of satisfaction or a sense of
failure.
This can be used in psychiatric nursing in means of maximizing patient care based from
what developmental stages they’re in, this way it will provide individual counseling to
patients and families to help them understand the illness.
Interpersonal Model
the theory of personality developed by Harry Stack Sullivan, which is based on the belief
that people’s interactions with other people, especially significant others, determine their
sense of security, sense of self, and the dynamisms that motivate their behavior.
They are as follows:
o Other to Self: The component “other to self” represents an individual’s
awareness of his partner’s attitude, thoughts and beliefs towards himself. The
other to self component is more to do with the awareness of an individual as to
how his/her partner treats him/her.
o Self to Other: The “self to other” component signifies an individual’s awareness
of his own behaviour, attitude towards his/her partner. How an individual treats
the other person in relationship is denoted by self to other component.
Assistive Polarity
Assistive Polarity further consists of the following:
1. Assistive Attitude: Assistive attitude consists of actions and behaviour which are in
favour of the other person.
2. Resistive Attitude: Resistive attitude consists of actions and behaviour of an individual
which are against the recipient and tend to make the other person weak.
3. Level of Intentionality: Level of intentionality further consists of following three levels:
i. Hypo telic Level of intention: Sometimes an individual is unaware of the other
person’s aspirations and intentions and unknowingly comes in his/her way
without realizing its harm. Hypotelic level signifies resistance to other person’s
aspirations unknowingly.
ii. Telic or Meta telic Level of Intention: There are several cases where individuals
deliberately stop the other person from doing something clearly knowing how
much it would affect the other person. An individual intentionally obstructing
aspirations of an individual comes under telic or meta telic level of intention.
iii. Degree of Autonomy: Degrees of autonomy are further classified into the
following:
According to interpersonal relationship model, the degree of assistance and
obstruction arise out of following:
Auonomous Agency: Autonomous agency comes into picture when both
resistance as well as acceptances arises out of either of the two partner’s
personal wishes, choices and interests. None of the partners is influenced
by a third party.
Proxy Agency: Proxy agency comes into play when resistances and
acceptances are due to an external party often called the third party. Here
the third party influences the decisions of the two individuals in
relationship often called as Targets
iv. Hildegarde Peplau
The theory explains the purpose of nursing is to help others identify their felt difficulties
and that nurses should apply principles of human relations to the problems that arise at all
levels of experience.
Man
Peplau defines man as an organism that “strives in its own way to reduce
tension generated by needs.” The client is an individual with a felt need.
Health
Health is defined as “a word symbol that implies forward movement of
personality and other ongoing human processes in the direction of
creative, constructive, productive, personal, and community living.”
Society or Environment
Although Peplau does not directly address society/environment, she does
encourage the nurse to consider the patient’s culture and mores when the
patient adjusts to hospital routine.
Cognitive model
o Jean Piaget's theory of cognitive development suggests that children move
through four different stages of mental development. His theory focuses not only
on understanding how children acquire knowledge, but also on understanding the
nature of intelligence. Piaget's stages are:
Sensorimotor stage: birth to 2 years
Preoperational stage: ages 2 to 7
Concrete operational stage: ages 7 to 11
Formal operational stage: ages 12 and up
o This can be utilized by psychiatric nurses in the means of enhancing the cognitive
development specifically for children, this can not only benefit the mental state of
children but also their moral decision of determining what is right and wrong
from a younger stage, nursing does not only apply to physical care, but also the
mental state of mind.
Understanding Stress
o Acute and long-term stress
Physical Response - When the body is stressed, muscles tense up. Muscle
tension is almost a reflex reaction to stress this is the body’s way of
guarding against injury and pain. With sudden onset stress, the muscles
tense up all at once, and then release their tension when the stress passes.
Chronic stress causes the muscles in the body to be in a constant state of
guardedness. When muscles are taut and tense for long periods of time,
this may trigger other reactions of the body and even promote stress-
related disorders.
Psychological Responses - When you are stressed you may experience
many different feelings, including anxiety, fear, anger, sadness, or
frustration. These feelings can sometimes feed on each other and produce
physical symptoms, making you feel even worse. For some people,
stressful life events can contribute to symptoms of depression.
General Adaptation Syndrome (GAS)
o The general adaptation syndrome (GAS), developed by Hans Selye, describes
the pattern of responses that the body goes through after being prompted by a
stressor. There are three stages: alarm, resistance, and exhaustion.
Alarm – This occurs when we first perceive something as stressful,
and then the body initiates the fight-or-flight response (as discussed
earlier).
Resistance – If the perceived stress continues, the body stays activated
at a higher metabolic level in an effort to offset the persistent stress.
The body cannot maintain this level indefinitely, and its resources will
eventually deplete.
Exhaustion – Prolonged exposure to the stressor will result in the
depletion of the body’s resources, and the resulting wear and tear will
suppress the immune system and cause bodily functions to deteriorate.
This can lead to a variety of health issues and illnesses, including heart
disease, digestive problems, depression, and diabetes.
o Psychoneuroimmunological Mode
Psychoneuroimmunology is the study of the interactions among
behavioral, neural and endocrine, and immune processes. The brain
communicates with the immune system through autonomic nervous
system and neuroendocrine activity.
o Measuring stress and coping styles
The Perceived Stress Scale (PSS) is the most widely used psychological
instrument for measuring the perception of stress. It is a measure of the
degree to which situations in one's life are appraised as stressful. Items
were designed to tap how unpredictable, uncontrollable, and overloaded
respondents find their lives.
Commonly used coping mechanisms include changing one's perception of
the issue at hand, using humor, using problem solving skills, employing
stress management and relaxation techniques, seeking out and using the
support of others, ventilating feelings, embarking on a physical exercise
and activity routine, decreasing personal expectations, and avoiding self-
blame.