Theories of Human Dynamics

Psychosexual Development
Sigmund Freud an Austrian neurologist and founder of psychoanalysis.

3 Levels of Consciousness

3 Psychic Energies
Pleasure Principle

Moral Principle

Reality Principle

 Libido - are the instinctual drives Regression and fixation common terms in this theory. Gave prominence feelings. to are

sexual

defined "sex" as anything that gives gratification

STAGES

Oral Stage (0-2 years) (0Gratification focus: mouth Pleasures: sucking activities like fingers, toes or nipples Dissatisfaction: resurface at a later years
overeating, smoking, nail-biting

Nursing Implication: Provide oral stimulation by giving pacifiers

Breastfeeding stimulation. may provide more

Do not discourage thumb sucking

Anal Stage (2 to 4 years)

Children's attention is focused on the anal region. Pleasure: elimination. This covers the ideal age for "toilet training" (2 1/2 years) 2 concepts:
Holding on Letting go

Possible problems: Compulsive need to be clean and orderly. Frugality and stinginess Greed Insistence on doing things at one's own rate at the expense of others Rigid training Excessive messiness and disorderly habits.

Nursing Implication: Help children achieve bowel and bladder control without undue emphasis on its importance.

Phallic Stage (4 to 6 years)

Pleasure: genital region.
activities associated with stroking and manipulating their sex organs.

Oedipus complex Electra complex Concepts

Onset of normal homosexuality

Nursing implications: Accept child's sexual interest

fondling with his / her own genitals as an area of normal exploration

Help the parents answer questions about birth or differences.

child's sexual

Latency stage (6 to 12 years)

Period of calmness / stable period. Many of the disturbing behaviors are buried in the subconscious mind. Their energies are absorbed by the concerns in:
school peers sports and other recreational activities

Nursing Implication: Help the child experiences.

have

positive

Genital Stage (12 years & up)

Oedipal feelings are reactivated toward opposite sex The person is on his way in establishing a satisfying life of his own

Nursing Implication: Provide appropriate opportunities for the child to relate with opposite sex. Allow child to verbalize feelings about new relationships.

EGO DEFENSE MECHANISMS

 These are automatic and usually unconscious processes or act by the individuals to:
reduce or cope anxiety or fear resolve emotional or mental conflict protect one's self-esteem protect one's sense of security

Becomes pathologic when overused. Used by both mentally healthy and mentally ill individuals

Common Defense Mechanisms Used

 Compensation
An attempt to overcome a real or imagined short coming, inferiority, inabilities and weaknesses. A blind woman becomes proficient in playing piano.

Conversion
Emotional problems are converted to physical symptoms A student unprepared for a report suffered headache the day she is supposed to deliver her report.

 Denial
Failure to acknowledge an intolerable thought, feeling, experience or reality A middle-aged man after being admitted to the CCU because of an AMI, insists that he is in the hospital for just a diagnostic work-up.

Displacement
the redirection of feelings to a less threatening object An adolescent boy, after an argument with his father, goes to the room and kicked his rooms door.

 Fantasy
Conscious distortion of unconscious feelings or wishes A boy who is being bullied by his friends wished he had the power of Superman.

Fixation
An unhealthy mechanism which is an arrest of maturation at certain stages of development. A boy never overcame being fully reliant from his mother.

 Introjection Symbolic assimilation or taking into oneself a love/hatred object;accepting another persons attitude,beliefs and values as ones own. Common to depressed clients. *person whom likes guns becomes an avid hunter like his bestfriend. Identification An individual integrates certain aspects of someone else's personality into one's own. A young school teacher adopts his former mentor's teaching style when conducting class sessions.

 Intellectualization
An overuse of intellectual concepts by an individual to avoid expression of feelings A man who was asked to share a memorable experience about his grandmother who died discussed the stages of death and dying by Elizabeth Kubler Ross.

Projection
Attributing to others one's unconscious wishes/fear. Literally, this means to "throw off. A student who failed a subject blames his failure on poor teaching. Man who has thought about same gender relationship,but never had one beats a man whos gay

 Rationalization
An individual finds a justifiable cause and acceptable reasons just to be saved from an embarrassing and anxiety producing thoughts or situations. A basketball player claims that he missed the shot and lost the game because of the distractions made by the audience.

Regression
Is the turning back to earlier patterns of behavior in solving personal conflicts. Commonly seen to schizophrenic patients A person who becomes ill in the face of disappointment has regressed to a form of childish behavior.

 Repression
It is the involuntary or unconscious forgetting of an unpleasant ideas or impulses. Woman who has no memory before age 7, when she was removed from an abusive parents.

 Suppression
Permits the individual to store away or consciously forget the unpleasant, painful and unacceptable thoughts, desires, experiences and impulses. "I'll think it about tomorrow", "I'd rather go now", "Can we change the topic?" A boy walked out from the group and said "I have to go now", when he was asked what was happened to their relationship with his girlfriend.

 Substitution
Replacing the desired unattainable goal with one that is attainable A woman who failed the nursing board exam 3 times, worked as a nursing aide just to be in the hospital.

Sublimation
The redirection of unacceptable instinctual drive with one that is socially acceptable Instead of harming his mother, a man expressed his anger by composing a song.

 Symbolization
Less threatening object is used to represent another A woman, missing her husband finds comfort in hugging her son who looks like his father.

Undoing
An attempt to erase an act, thought, feeling, guilt or desire A man gives her wife a bunch of roses after their argument last night.

Oral Regression Displacement Substitution Compensation Fixation Anal Suppression Reaction Formation Identification Introjection Sublimation Repression Phallic Rationalization Latency Projection Symbolization Conversion Fantasy Isolation Dissociation Undoing/Restitution Condensation Denial

The Psychosocial Development Theory

Erik Erikson

Erik Erikson
Childhood is very important in personality development. Rejected Freud's attempt to describe personality solely on the basis of sexuality,
Believed that social factors greatly affect an individuals personality felt that personality continued to develop beyond five years of age.

 Identified 8 developmental stages throughout the whole life cycle. Stages 1-5 - childhood and adolescent Stages 6-8 - Adulthood

STAGE 1
Period of Life Psychosocial Crisis Relationship with Infant, 0-18 months, (Hope) Trust vs. Mistrust Maternal person

Experiences, To get, to give in return Decisions, Choices Positive Resolution Reliance on the caregiver Development of trust in the environment

Negative Resolution

Fear, anxiety and suspicion Lack of care, both physical & psychological by caretaker leads to mistrust of environment

Stage 2
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Toddler, 18 mos. to 3 years (Willpower) Autonomy vs. Shame/doubt Paternal person To hold on, to let go

Sense of self-worth Assertion of choice and will Environment encourages independence, leading to sense of pride

Negative Resolution Loss of self-esteem Sense of external control may produce self-doubt in others

Stage 3
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Preschool, 3 to 6 years (Purpose) Initiative vs. Guilt Family To make, to make like

The ability to learn to initiate activities, to enjoy achievement and competence The inability to control newly developed power Realization of potential failure leads to fear of punishment and guilt

Negative Resolution

Stage 4
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Schooler, 6 to 12 yrs. (Competence) Industry vs. Inferiority Neighbors/School To make things, to make together

Learning the value of work Acquiring skills and tools of technology Competence helps to order life and make things work Repeated frustrations and failures lead to feelings of inadequacy and inferiority that may affect their view of life

Negative Resolution

Stage 5
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Negative Resolution Adolescent, 12 to 18 yrs, (Fidelity) Identity vs. Role confusion Peer group To be oneself, to share being oneself Experiments with various roles in developing mature individuality Pressures and demands may lead to confusion about self

Stage 6
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Young Adult, 18 to 54 yrs., (Love) Intimacy vs. Isolation Partners in friendship Sex competition To lose and find oneself in another

A commitment to others Close heterosexual relationship and procreation Withdrawal from such intimacy, isolation, self-absorption and alienation from others

Negative Resolution

Stage 7
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Middle Adult, 24 to 54 yrs., (Care) Generativity vs. Self-absorption Partner To make be, to care of

The care and concern for the next generation Widening interest in work and ideas Self-indulgence and resulting psychological impoverishment

Negative Resolution

Stage 8
Period of Life Psychosocial Crisis Relationship with Experiences, Decisions, Choices Positive Resolution Late Adult, 54 yrs. to death, (Wisdom) Integrity vs. Despair Mankind To be, through having been, to face not being Acceptance of ones life Realization of the inevitability of death Feeling of dignity and meaning of existence Disappointment of ones life and desperate fear of death

Negative Resolution

Cognitive Development Theory

Author: Jean Piaget (A Swiss biologist)

Stages

Sensorimotor (0-2 years)

Reflex to complex Begins to organize visual images and control motor responses. Coordinates sensory impressions. Pre-verbal stage

Preoperational Stage (2-7 years)

Transitional period Egocentric and irreversible thinking Words become symbols for objects symbolic thinking

 Formation of ideas of categorization. Lack of ability to go back and rethink a process or concept.

 Mental image the symbolic process which are evident in plays Construction of verbal schemas preconcepts

Concrete Operations (7 11 years)

Thinking appears to be stabilized
ability to think of the possible consequences of actions

Logical implications

Formal Operations (11 years to adulthood) Full patterns of thinking Ability to use logic and symbolic processes
mathematical and scientific reasoning

Combinatorial thinking multidimensional approach

hypothetic or hypothetico-deductive reasoning

Interpersonal Theory

Harry Stack Sullivan

Concepts:
Focused on the role of the environment and interpersonal relations as the most significant influences on a individuals development. Human personality is the context of social interactions with other human being. Anxiety is communicated interpersonally.

Three personification of the Self:

Good me Bad me Not me

Stages of Healthy Interpersonal Development:

Infancy
Experiences maternal tenderness and intuits maternal anxiety Struggles to achieve feelings of security

Childhood
Modifies actions to suit social demands in sex roles training, peer play, family events. Uses language and movement to avoid anxiety.

 Juvenile
Learns to accept subordinate to authority figures outside the family. More concepts of self status and role.

Pre-adolescence
Capable of participating in genuine love relationships with others. Develop consideration and concerns outside the self.

 Early adolescence
Heterosexual contacts enter into personal relationship. Attempts to integrate sex with other personal relationship.

Late adolescence
Master expression of sexual impulses. Forms satisfying and responsible associations. Uses communication skills to protect self from conflict with others.

Hildegard Peplau: Interpersonal Theory

 influenced by Sullivans interpersonal theory, developed the first systematic theoretical framework for psychiatric nursing, the one-toone nurse-patient relationship.  She described four phases of the interpersonal process: orientation, identification, working phase, and resolution, and stated the nursepatient relationship should have the following characteristics: the focus is on the patient, the nurse is a participant observer, the nurse has an awareness of role, nursing is primarily investigative, the nurse will use theory.  She described the effects of different levels of anxiety (mild, moderate, severe, and panic) on perception and learning and promoted interventions that would lower anxiety.

Peplau's Six Nursing Roles illustrate the dynamic character roles typical to clinical nursing.

Stranger role Resource role Teaching role Counseling role Surrogate role Active leadership

The Moral Development Theory

Author: Laurence Kohlberg

Levels

Level One (Preconventional Morality)

Childrens judgments are based on external criteria. Standards of right and wrong are absolute and laid down by authority.

Stage 1 Behavior is based on the desire to avoid severe physical punishment by a superior power. Right or wrong is based on consequences to him. Punishment = wrong act

Level Two (Conventional Morality)

Childrens judgments are based on the norms and expectations of the group. Stage 2 Actions are based largely on satisfying ones own personal needs.

Stage 3 Good behavior is that which pleases others and judgments are based on intentions. Children conform to rules to win the approval of others and to maintain good relationships.

Stage 4 What is right is what is accepted. If the social accepts rules as appropriate for all group members, children will conform to them to avoid social disapproval and censure.

Level Three (Post Conventional Morality)

1. The individual recognizes the arbitrariness of social and legal conventions. 2. The individual attempts to define moral values that are separate from group norms.

Stage 5 Behavior recognizes the arbitrary and changeable.

laws

as

For aspects of life not governed by laws, right and wrong are personal decisions based on agreement and contracts.

Stage 6 Morality is based on respect for others rather than on personal desires. The individual conforms to both social standards and to internalized ideals to avoid self-condemnation rather than to avoid social censure.

 Human Motivational Need Model. (Abraham Maslow) Hierarchy of needs in order of importance Primary needs (physiologic) need to be met prior to dealing with higher level needs.

Abraham Maslow
Maslow offered a theory of human motivation developed as a hierarchy of deficiency needs, each of which must be met before moving to a new level: physiological, safety and security, love and belonging, self-esteem, and selfactualization. He offered the following beliefs.

Maslow offered the following beliefs:

1. Humans are neither inherently good nor evil. All have inherent drives toward self-actualization and drives toward more regressive behaviors that are influenced by interpersonal and social events. 2. A person does the very best he or she can at the time. 3. When adequate information is given in a form that the person can use, a person will make a good decision for him- or herself. 4. Man has a higher and transcendent nature.

Abraham Maslow
Maslows positive view of the human potential for dynamic growth provides nurses with a framework for holistic intervention.