Debra Brossett Garner
Darlene Williams is in a master’s degree program that will allow her to become an adult psychiatric/mental health nurse practitioner. In a course on the application of theory in nursing, one of her assignments is to write a paper describing how she has applied a theory in providing care for a client. Although Darlene has been working as a nurse in a psychiatric hospital for the past 10 years, she is finding this assignment difficult because, thus far in the course, the instructor has focused primarily on grand nursing theories. Darlene knows little about these theories because in her practice, she uses a broad, eclectic approach, predominantly applying theories from the behavioral sciences.
Darlene discusses her dilemma with her professor and learns that she can use any theory or set of theories for the assignment; it is not necessary to rely strictly on nursing theories. The discussion with her professor enlightens Darlene about the necessity of applying non-nursing theories to nursing practice. With the realization of the importance of theories from other disciplines to nursing, Darlene’s interest in the many psychologically based theories is piqued, and she conducts a literature review.
The person that Darlene chooses for her assignment is Alan, a 41-year-old Caucasian male, who is married and the father of two adolescents. Alan was admitted to the hospital with diagnoses of major depression, substance dependence with physiologic dependency, and hepatitis C. Assessments revealed that he had problems with his primary support group, problems related to the social environment, occupational problems, and problems related to interaction with the legal system.
Although this is Alan’s first hospitalization, he has had a long history of alcohol abuse. He also admits to using cocaine or marijuana occasionally on the weekends. His father was an alcoholic who died at the age of 44 years with cirrhosis of the liver. Although not actively suicidal, Alan expresses passive death wishes. Alan is a well-known member of the community and owns a large software business, which is on the verge of bankruptcy. His motivation for entering treatment is that his wife threatened to divorce him unless he stops using alcohol and drugs.
In reviewing Alan’s care, Darlene plans to use a holistic approach, incorporating principles and concepts from various theories. The first theory that Darlene chooses is Freud’s psychoanalytic theory because of Alan’s denial. This theory is relevant because Freud discussed how an individual uses defense mechanisms to decrease anxiety, and Darlene knows that a major defense mechanism of alcoholism is denial. Darlene also thinks the cognitive-behavioral theories are appropriate because she believes that humans need to change cognition to change behavior. Because Darlene assumes that drinking and using drugs are means of coping, she plans to use Lazarus’s coping theory to help Alan develop more effective coping strategies. Finally, Darlene plans to apply humanistic psychology because she believes that Alan, like all individuals, has the potential to change, and social psychology theories address health beliefs and intent to change.
As discussed in Chapter 1, nursing is a practice discipline, and practice disciplines are considered to be applied sciences rather than pure or basic sciences (Johnson, 1959). The object of both pure and applied sciences is the same (to achieve knowledge), but according to Folta (1968), the difference between the two is their emphasis. In pure science, the emphasis is on basic research, which focuses on the application of the scientific method to add abstract knowledge. In contrast, the emphasis in applied science is on research related to the application and testing of the abstract concepts. Thus, applied sciences use the scientific method to apply and test fundamental knowledge or principles in practice. Historically, nursing science has drawn much of its knowledge from the basic sciences and then applied that knowledge to the discipline of nursing.
In learning about theories used in nursing, it is important to remember that nursing has evolved over decades and that the knowledge base for the discipline is a compilation of phenomena from many different disciplines. In the case study, Darlene discovered the notion of “shared” or “borrowed” versus “unique” theory. Johnson (1968) has defined borrowed theories as knowledge that has been identified in other disciplines and is used in nursing. According to Johnson, knowledge does not belong to any discipline but is shared across many disciplines; thus, nursing science draws on the knowledge of other disciplines to enhance the knowledge required for nursing practice.
One of the areas from which nurses draw theoretical understanding are the psychological sciences, sometimes referred to as the behavioral sciences. The contribution of the behavioral sciences to knowledge in nursing science and nursing practice cannot be denied. Even though the basic theories, concepts, and frameworks are derived from another discipline, they are applied in nursing practice. Additionally, they are frequently applied in nursing research as well as nursing education and administration.
There are many psychological theories, and it would be impossible to cover all of them in this chapter. Major theories were chosen to illustrate concepts that are used in nursing. For the purposes of this chapter, the psychological theories will be viewed in four categories: psychodynamic theories, behavioral and cognitive-behavioral theories, humanistic theories, and stress-adaptation theories. These theories look at an individual and how an individual responds to stimuli. In psychology, there is also a special field known as social psychology, which examines how society or groups of individuals respond to various stimuli. This chapter will examine two theories of social psychology commonly used in nursing: the Health Belief Model and the Theory of Reasoned Action.
The late 1800s saw the creation of a new discipline, psychology/psychiatry, with a new body of knowledge. Before Sigmund Freud presented his radical works describing human thoughts and behaviors, people were considered to be either “good” or “bad,” “normal” or “crazy.” His work led to a major paradigm shift as scientists began to consider the thought processes of “man” and to speculate about human personality. From this paradigm shift came a number of psychological theories.
Freud’s thinking was considered radical in the early 1900s. Even now in the early 21st century, many people still consider his work radical, yet others believe it to be antiquated. Despite this, his basic ideas and concepts have been used and modified extensively in the development of numerous theories about human thought and behavior.
Psychodynamic theories attempt to explain the multidimensional nature of behavior and understand how an individual’s personality and behavior interface. They also provide a systematic way of identifying and understanding behavior. This section describes three psychodynamic theories—the works of Freud, Erikson, and Sullivan. These three theories are also called “stage theories,” meaning that they describe clearly defined stages at which new behaviors appear based on social and motivational influences. Table 14-1 compares the developmental stages of the three theories.
Table 14-1: Stages of Development
|Sigmund Freud||Psychosexual||· 1. Oral
· 2. Anal
· 3. Phallic
· 4. Latency
· 5. Genital
|Erik E. Erikson||Psychosocial||· 1. Trust versus mistrust
· 2. Autonomy versus shame and doubt
· 3. Initiative versus guilt
· 4. Industry versus inferiority
· 5. Identity versus identity confusion
· 6. Intimacy versus isolation
· 7. Generativity versus stagnation
· 8. Integrity versus despair
|Harry S. Sullivan||Interpersonal||· 1. Infancy
· 2. Childhood
· 3. Juvenile
· 4. Preadolescence
· 5. Early adolescence
· 6. Late adolescence
Psychoanalytic Theory: Freud
According to Freudian theory, behavior is nearly always the product of an interaction among the three major systems of the personality: the id, ego, and superego. Even though each of these systems has its own functions, properties, and components