Peplau’s model provides nurses with a framework to interact with clients, many of whom are fixed in—or because of illness have regressed to—an earlier level of development. She suggested roles that nurses may as- sume to assist clients to progress, thereby achieving or resuming their appropriate developmental level. Ap- propriate developmental progression arms the individ- ual with the ability to confront the recurring problems of life. Nurses serve to facilitate learning of that which has not been learned in earlier experiences.
Summary and Key Points
■ Growth and development are unique with each in- dividual and continue throughout the life span.
■ Personality is defined as the combination of char- acter, behavioral, temperamental, emotional, and mental traits that are unique to each specific individual.
■ Sigmund Freud, who has been called the father of psychiatry, believed the basic character has been formed by the age of 5.
■ Freud’s personality theory can be conceptualized ac- cording to structure and dynamics of the personality, CHAPTER 3 ■ Theoretical Models of Personality Development 43 4092_Ch03_027-046 25/07/14 10:23 AM Page 43
44 U N I T 2 ■ Foundations for Psychiatric/Mental Health Nursing topography of the mind, and stages of personality
development.
■ Freud’s structure of the personality includes the id, ego, and superego.
■ Freud classified all mental contents and operations into three categories: the conscious, the precon- scious, and the unconscious.
■ Harry Stack Sullivan, author of the Interpersonal The- ory of Psychiatry, believed that individual behavior and personality development are the direct result of interpersonal relationships. Major concepts include anxiety, satisfaction of needs, interpersonal security, and self-system.
■ Erik Erikson studied the influence of social processes on the development of the personality.
■ Erikson described eight stages of the life cycle from birth to death. He believed that individuals strug- gled with developmental “crises,” and that each must be resolved for emotional growth to occur.
■ Margaret Mahler formulated a theory that describes the separation-individuation process of the infant from the maternal figure (primary caregiver).
Stages of development describe the progression of the child from birth to object constancy at age 36 months.
■ Jean Piaget has been called the father of child psychology. He believed that human intelligence
progresses through a series of stages that are re- lated to age, demonstrating at each successive stage a higher level of logical organization than at the previous stages.
■ Lawrence Kohlberg outlined stages of moral devel- opment. His stages are not closely tied to specific age groups or the maturational process. He believed that moral stages emerge out of our own thinking and the stimulation of our mental processes.
■ Hildegard Peplau provided a framework for “psy- chodynamic nursing,” the interpersonal involve- ment of the nurse with a client in a given nursing situation.
■ Peplau identified the nursing roles of stranger, re- source person, counselor, teacher, leader, technical expert, and surrogate.
■ Peplau described four psychological tasks that she associated with the stages of infancy and childhood as identified by Freud and Sullivan.
■ Peplau believed that nursing is helpful when both the patient and the nurse grow as a result of the learning that occurs in the nursing situation.
Additional info available at www.davisplus.com
Review Questions
Self-Examination/Learning Exercise
Select the answer that is most appropriate for each of the following questions:
1. Mr. J. is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J.?
a. Intimacy vs. isolation
b. Generativity vs. self-absorption c. Trust vs. mistrust
d. Autonomy vs. shame and doubt
2. Mr. J. has been diagnosed with schizophrenia. He refuses to eat, and told the nurse he knew he was
“being poisoned.” According to Erikson’s theory, in what developmental stage would you place Mr. J.?
a. Intimacy vs. isolation
b. Generativity vs. self-absorption c. Trust vs. mistrust
d. Autonomy vs. shame and doubt
3. Janet, a psychiatric client diagnosed with borderline personality disorder, has just been hospitalized for threatening suicide. According to Mahler’s theory, Janet did not receive the critical “emotional re- fueling” required during the rapprochement phase of development. What are the consequences of this deficiency?
a. She has not yet learned to delay gratification.
b. She does not feel guilt about wrongdoings to others.
c. She is unable to trust others.
d. She has internalized rage and fears of abandonment.
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CHAPTER 3 ■ Theoretical Models of Personality Development 45
Review Questions—cont’d
Self-Examination/Learning Exercise
4. John is on the Alcohol Treatment Unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel and says, “That’s a stupid program! I want to watch something else!” In what stage of development is John fixed according to Sullivan’s interpersonal theory?
a. Juvenile. He is learning to form satisfactory peer relationships.
b. Childhood. He has not learned to delay gratification.
c. Early adolescence. He is struggling to form an identity.
d. Late adolescence. He is working to develop a lasting relationship.
5. Adam has antisocial personality disorder. He says to the nurse, “I’m not crazy. I’m just fun-loving. I believe in looking out for myself. Who cares what anyone thinks? If it feels good, do it!” Which of the following describes the psychoanalytical structure of Adam’s personality?
a. Weak id, strong ego, weak superego b. Strong id, weak ego, weak superego c. Weak id, weak ego, punitive superego d. Strong id, weak ego, punitive superego
6. Larry, who has antisocial personality disorder, feels no guilt about violating the rights of others. He does as he pleases without thought to possible consequences. In which of Peplau’s stages of develop- ment would you place Larry?
a. Learning to count on others b. Learning to delay gratification c. Identifying oneself
d. Developing skills in participation
7. Danny has been diagnosed with schizophrenia. On the unit he appears very anxious, paces back and forth, and darts his head from side to side in a continuous scanning of the area. He has refused to eat, making some barely audible comment related to “being poisoned.” In planning care for Danny, which of the following would be the primary focus for nursing?
a. To decrease anxiety and develop trust b. To set limits on his behavior
c. To ensure that he gets to group therapy d. To attend to his hygiene needs
8. The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with major depressive disorder. The nurse says to Nancy, “Please tell me what it was like when you were growing up.” Which nursing role described by Peplau is the nurse fulfilling in this instance?
a. Surrogate b. Resource person c. Counselor d. Technical Expert
9. The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with major depressive disorder. The nurse says to Nancy, “What questions do you have about being here on the unit?” Which nursing role described by Peplau is the nurse fulfilling in this instance?
a. Resource person b. Counselor c. Surrogate d. Technical Expert
Continued 4092_Ch03_027-046 25/07/14 10:24 AM Page 45
References
Black, D.W., & Andreasen, N.C. (2011). Introductory textbook of psychiatry (5th ed.). Washington, DC: American Psychiatric Publishing.
Marmer, S.S. (2003). Theories of the mind and psychopathology.
In R.E. Hales & S.C. Yudofsky (Eds.), Textbook of clinical psychia- try (4th ed.) pp. 107–154. Washington, DC: American Psychiatric Publishing.
Murray, R.B., Zentner, J.P., & Yakimo, R. (2009). Health promotion strategies through the life span (8th ed.). Upper Saddle River, NJ:
Prentice Hall.
Peplau, H.E. (1991). Interpersonal relations in nursing. New York, NY: Springer.
Classical References
Chess, S., & Thomas, A. (1986). Temperament in clinical practice.
New York, NY: Guilford Press.
Erikson, E. (1963). Childhood and society (2nd ed.). New York, NY: WW Norton.
Freud, S. (1961). The ego and the id. Standard edition of the com- plete psychological works of Freud (Vol. XIX). London, UK:
Hogarth Press.
Fromm, E. (1949). Man for himself. New York, NY: Farrar &
Rinehart.
Kohlberg, L. (1976). Moral stages and moralization: The cognitive- development approach. In T. Lickona (Ed.), Moral development and behavior: Theory, research, and social issues (pp. 170–205).
New York, NY: Holt, Rinehart and Winston.
Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant. New York, NY: Basic Books.
Piaget, J., & Inhelder, B. (1969). The psychology of the child.
New York, NY: Basic Books.
Sullivan, H.S. (1953). The interpersonal theory of psychiatry.
New York, NY: WW Norton.
46 U N I T 2 ■ Foundations for Psychiatric/Mental Health Nursing
Review Questions—cont’d
Self-Examination/Learning Exercise
10. The nurse has just admitted Nancy to the psychiatric unit. The psychiatrist has diagnosed Nancy with major depressive disorder. The nurse says to Nancy, “Some changes will have to be made in your behavior. I care about what happens to you.” Which nursing role described by Peplau is the nurse fulfilling in this instance?
a. Counselor b. Surrogate
c. Technical Expert d. Resource Person
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4
Concepts of Psychobiology
CORE CONCEPTS
genetics
neuroendocrinology psychobiology psychoimmunology psychotropic medication
47
C H A P T E R O U T L I N E
Objectives
Homework Assignment
The Nervous System: An Anatomical Review Neuroendocrinology
Genetics
Psychoimmunology Psychopharmacology Implications for Nursing Summary and Key Points Review Questions
K EY T E R M S
axon cell body circadian rhythms dendrites genotype limbic system
neurons neurotransmitter phenotype receptor sites synapse
O B J EC T I V E S
After reading this chapter, the student will be able to:
1.Identify gross anatomical structures of the brain and describe their functions.
2.Discuss the physiology of neurotransmission in the central nervous system.
3.Describe the role of neurotransmitters in human behavior.
4.Discuss the association of endocrine func- tioning to the development of psychiatric disorders.
5.Describe the role of genetics in the development of psychiatric disorders.
6.Discuss the correlation of alteration in brain functioning to various psychiatric disorders.
7.Identify various diagnostic procedures used to detect alteration in biological functioning that may be contributing to psychiatric disorders.
8.Discuss the influence of psychological factors on the immune system.
9.Discuss historical perspectives related to psychopharmacology.
10.Describe the physiological mechanism by which various psychotropic medications exert their effects.
11.Discuss the implications of psychobiological concepts to the practice of psychiatric/
mental health nursing.
H O M E W O R K A S S I G N M E N T
Please read the chapter and answer the following questions:
1.A dramatic reduction in which neurotrans- mitter is most closely associated with Alzheimer’s disease?
2.Anorexia nervosa has been associated with a primary dysfunction of which structure of the brain?
3.Many psychotropics work by blocking the reuptake of neurotransmitters. Describe the process of reuptake.
4.What psychiatric disorder may be linked to chronic hypothyroidism?
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48 U N I T 2 ■ Foundations for Psychiatric/Mental Health Nursing In recent years, a greater emphasis has been placed
on the study of the organic basis for psychiatric ill- ness. This “neuroscientific revolution” has placed an emphasis on the biological basis of behavior, and several mental illnesses are now being considered as physical disorders that are the result of malfunctions and/or malformations of the brain.
This is not to imply that psychosocial and socio- cultural influences are totally discounted. Such a no- tion would negate the transactional model of stress/
adaptation on which the framework of this textbook is conceptualized.
The systems of biology, psychology, and sociol- ogy are not mutually exclusive—they are interact- ing systems. This is clearly indicated by the fact that individuals experience biological changes in response to various environmental events. In- deed, each of these disciplines may be, at various times, most appropriate for explaining behavioral phenomena.
This chapter focuses on the role of neurophysiolog- ical, neurochemical, genetic, and endocrine influences on psychiatric illness. A discussion of psychopharma- cology is included, and various diagnostic procedures used to detect alteration in biological function that may contribute to psychiatric illness are identified. The implications for psychiatric/mental health nursing are discussed.