Psychiatric Mental Health Nursing Theory

Development of Psychiatric and Mental Health Nursing Theory

• This unit discusses mental health and psychiatric mental health nursing theories.
• Mental health professionals use these models to determine the basis of human behavior and plan management.
• Nursing professionals use theoretical support to guide comprehensive nursing care for mental health promotion, illness prevention, and management of ill clients.

Neurobiologic Theory

• Focuses on connections between brain, emotions, and behavior.
• It explains how brain structure function influences behavior, cognition, and mental health.
• Integrates neuroscience, psychology, biology, and psychiatry.
• It elucidates human actions as results of brain chemical activities.
• Neurotransmitter dysregulation is linked to schizophrenia. This can be due to reduced glutamate, excess dopamine, reduced serotonin, or altered GABA in the prefrontal cortex.

Key Concepts in the Neurobiologic Theory

Brain Structure and Function

• Neurons communicate through synapses in the brain.
• The theory emphasizes the role of neurotransmitters like dopamine and serotonin.
• Disruptions in these processes are related to mood disorders, schizophrenia, and addiction.
• Specific brain areas like the prefrontal cortex and hippocampus handle cognitive functions and emotions.
• The amygdala is involved in emotional responses like fear.
• The prefrontal cortex is linked with decision-making and impulse control.
• Brain area interactions form behavior circuits.
• Dysregulation in circuits, like the hypothalamic-pituitary-adrenal (HPA) axis, is associated with stress and depression.

Neurotransmitter Systems

• Serotonin: Imbalances are linked to mood regulation, depression, and anxiety; SSRIs alleviate symptoms.
• Dopamine: It is essential for reward processing, motivation, and motor functions; related to schizophrenia, Parkinson's, and addiction.
• Glutamate and GABA: Glutamate is excitatory, while GABA is inhibitory; they affect neuronal excitability, learning, memory, and epilepsy.

Neuroplasticity

• The brain's ability to reorganize itself by forming new connections.
• Important for learning, memory, recovery from injury, and mental disorder treatment.
• PTSD is understood through maladaptive neuroplastic changes, "wiring" the brain for fear responses.

Developmental Theory by Erik Erikson

• Erik Erikson's theory proposes eight stages of development, each with a psychosocial crisis.
• Resolution leads to healthy development, and unresolved issues create difficulties.

Erikson's Eight Stages of Development

• Stage 1: Trust vs. Mistrust (birth to 18 months); Milestone: Feeding; Value: Hope.
• Stage 2: Autonomy vs. Shame and Doubt (10 months to 3 years); Milestone: Toilet training; Value: Will.
• Stage 3: Initiative vs. Guilt (3 to 5 years); Milestone: Exploration; Value: Purpose.
• Stage 4: Industry vs. Inferiority (6 to 11 years); Milestone: School; Value: Confidence.
• Stage 5: Identity vs. Confusion (12 to 18 years); Milestone: Social Relationships; Value: Fidelity.
• Stage 6: Intimacy vs. Isolation (18 to 40 years); Milestone: Relationships; Value: Love.
• Stage 7: Generativity vs. Stagnation (40 to 65 years); Milestone: Work and Parenthood; Value: Care.
• Stage 8: Ego Integrity vs. Despair (65+ years); Milestone: Reflection on life; Value: Wisdom.

Psycho-analytic Theory by Sigmund Freud

• Sigmund Freud founded psychoanalysis.
• Human behavior is shaped by thoughts, desires, and unconscious memories.
• Personality comprises the id, ego, and superego.
• Id: Primitive, unconscious, drives basic urges and libidinal energy.
• Ego: Conscious, operates on reality principle, ensures id's demands are met safely.
• Superego: Conscience embodies internalized morals, standards, and values.
• Cathexis: Mental energy invested in a person, idea, or object.
• Anticathexis: Ego suppresses id's unacceptable desires.
• Life instincts: Drive survival, reproduction, and pleasure.
• Death instincts: Unconscious desire for self-destruction.
• Children pass through psychosexual stages, with libidinal energy focused on different body parts.
• A healthy personality in adulthood depends on successful completion of each stage.
• Unresolved conflicts lead to fixation and lingering attachments.

Behavioral Theory by B.F. Skinner

• B.F. Skinner developed the learning theory of operant conditioning.
• Human behavior is shaped by reinforcements or punishments.
• Learning occurs through consequences; rewarded actions are strengthened, punished actions are weakened.
• Stimulus leads to individual response (behavior), which leads to consequences and learning.

Humanistic Theory (Human Motivation) by Abraham Maslow

• Abraham Maslow developed Maslow's Hierarchy of Needs.
• As basic needs are met, higher-level needs emerge.
• It emphasizes human potential for growth and fulfillment.
• The hierarchy includes physiological needs, safety, love and belonging, self-esteem, and self-actualization.
• Basic needs must be met before pursuing higher needs.
• Few fully reach self-actualization, but many experience brief moments of insight or peak experience.
• These needs act as motivational forces for personal growth.

Maslow's Hierarchy Of Needs

• Self-Actualization: morality, creativity, spontaneity, acceptance, experience, purpose, meaning and inner potential
• Self-Esteem: confidence, achievement, respect of others, the to be a unique individual
• Love and Belonging: friendship, family, intimacy, sense of connection
• Safety and Security: health, employment, property, family and social ability
• Physiological Needs

Existential Theory by Søren Kierkegaard, Friedrich Nietzsche, Jean-Paul Satre

• Søren Kierkegaard developed existential theory.
• The philosophy is centered around individual existence, freedom, and choice.
• It addresses subjective experiences, anxiety, despair, and faith.
• Each person must confront "existential dread" from freedom to choose their path.
• Meaning in life is achieved through personal commitment, often in faith.
• People must live authentically, aligning with their true selves, rather than societal expectations.
• Friedrich Nietzsche explored human existence and the quest for meaning.
• Jean-Paul Sartre asserted individuals are free to choose and shape their lives.
• Individuals create their own purpose and meaning through freedom of choice.
• "Existence precedes essence," meaning individuals define their own purpose.

Interpersonal Relationship Theory by Hildegard Peplau

• Hildegard Peplau developed the Theory of Interpersonal Relations.
• It highlights the nurse-client relationship as a cornerstone of nursing practice.
• Three phases: orientation, working, and termination.
• Orientation: Patient needs the nurse's help; nurse recognizes individuality, assesses patient needs.
• Working: Nurse provides care and education; the patient participates in treatment.
• Termination: Nurse prepares the patient for discharge and independent health management.

Cognitive Development Theory by Jean Piaget

• Jean Piaget described the stages of cognitive development.
• Children's cognitive abilities change/evolve to acquire knowledge and build a mental world model.
• Four major stages: sensorimotor, preoperational, concrete operational, and formal operational.
• Stages represent critical periods for logical reasoning and understanding.
• Children gradually build and refine cognitive frameworks interacting with their environment.

Piaget's Four Stages of Cognitive Development

• Sensorimotor (0-2 years): Understanding through sensory experiences and actions and object permanence.(e.g. Shaking a rattle)
• Preoperational (2-7 years): Language and symbolic thinking and egocentrism and lack of conservation (e.g. Pretend play stick as a sword )
• Concrete Operational (7-11 years): Logical thinking about concrete events and the understanding of conservation (Breaking cookie in pieces)
• Formal Operational (12+ years): Abstract and hypothetical thinking(Discuss complex moral dilemmas)

Interpersonal Model by Harry Stack Sullivan

• Harry Stack Sullivan focused on social relationships in shaping mental health/personality.
• Personality is largely defined by relationships and social interactions throughout life.
• One's sense of self, security, and behavior motivations are tied to interactions, especially with significant others.
• Psychological disorders have interpersonal origins in difficulties in social relationships.

Mental health and psychiatric mental health nursing theories are discussed. Mental health professionals determine the basis of human behavior and plan management using these models. Nursing professionals use theoretical support to guide comprehensive nursing care for mental health promotion.