Introducing Psychology for Nurses and Healthcare Professionals PDF

Introducing Psychology for Nurses and Healthcare Professionals This page intentionally left blank Introducing Psychology for Nurses and Healthcare Professionals Dominic Upton Professor of Psychology, Institute of Health and Society University of Worcester First published 2010 by Pearson Educatio...

Introducing Psychology for Nurses and Healthcare Professionals This page intentionally left blank Introducing Psychology for Nurses and Healthcare Professionals Dominic Upton Professor of Psychology, Institute of Health and Society University of Worcester First published 2010 by Pearson Education Limited Second edition 2012 Published 2013 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN 711 Third Avenue, New York, NY 10017, USA Routledge is an imprint of the Taylor & Francis Group, an informa business Copyright © 2010, 2012, Taylor & Francis. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. ISBN 978-0-273-77007-7 (pbk) British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Upton, Dominic. Introducing psychology for nurses and healthcare professionals / Dominic Upton. — 2nd ed. p. cm. Includes bibliographical references and index. ISBN 978-0-273-77007-7 1. Nursing — Psychological aspects. 2. Nurse and patient. I. Title. RT86.U68 2012 610.73—dc23 2012002670 Typeset in 9.5/13 pt Interstate-Light by 73 Contents Preface xi Acknowledgements xvii Chapter 1 Introduction: psychology in nursing care 1 Learning Outcomes 1 Your starting point 2 1.1 Introduction 3 1.2 A brief history of psychology 6 1.3 The language of psychology 10 1.4 What is a science? 10 1.5 Key qualities of a science 11 1.6 Researching psychology 12 1.7 Health and health psychology in a social world 17 1.8 The scope of psychology 21 1.9 Psychology in health and nursing care 22 1.10 Conclusion 24 1.11 Summary 24 Your end point 24 Further reading 25 Weblinks 26 Chapter 2 Psychological approaches to understanding people 27 Learning Outcomes 27 Your starting point 28 2.1 How psychology helps us to understand why people do what they do 30 2.2 The psychodynamic approach 31 2.3 Psychoanalytic theory 32 2.4 Evaluation of the psychodynamic approach 38 2.5 Behaviourism 40 2.6 Classical conditioning 40 2.7 Operant conditioning 44 2.8 Reinforcement and the token economy system 45 2.9 Evaluation of the behaviourist approach 47 2.10 Social learning theory 48 2.11 Rotter’s theory 48 2.12 Health locus of control 50 CONTENTS 2.13 Bandura’s theory 51 2.14 Self-efficacy 54 2.15 Evaluation of social learning theory 55 2.16 Cognitive psychology 56 2.17 Cognitive behavioural therapy 58 2.18 Humanistic psychology 61 2.19 Rogers’ person-centred approach 63 2.20 Evaluation of the humanistic approach 65 2.21 Conclusion 66 2.22 Summary 68 Your end point 69 Further reading 70 Weblinks 71 Chapter 3 Psychology across the lifespan 72 Learning Outcomes 72 Your starting point 73 3.1 Introduction 75 3.2 Piaget’s theory of cognitive development 76 3.3 Attachment 82 3.4 Ecological systems theory 84 3.5 Vygotsky’s socio-cultural theory of development 86 3.6 Erikson’s theory of personality development 88 3.7 Adolescence – storm and stress 90 3.8 Putting theories into action 91 3.9 Working with older adults 92 3.10 Cognitive changes in adulthood 95 3.11 Social changes in late adulthood 96 3.12 Dementia 98 3.13 Death and dying 101 3.14 Children’s understanding of loss 101 3.15 Models of grief 104 3.16 Conclusion 108 3.17 Summary 108 Your end point 109 Further reading 110 Weblinks 111 Chapter 4 Social processes 112 Learning Outcomes 112 Your starting point 113 4.1 Introduction 115 4.2 Non-verbal communication (NVC) 115 4.3 Attitudes 122 4.4 Stereotyping 125 4.5 Persuasion, conformity and compliance 127 vi  CONTENTS 4.6 Power and status and its influence on obedience 137 4.7 Conclusion 140 4.8 Summary 141 Your end point 141 Further reading 142 Weblinks 143 Chapter 5 Perception, memory and providing information 144 Learning Outcomes 144 Your starting point 145 5.1 Introduction 147 5.2 Perception 148 5.3 Memory 153 5.4 Attention 156 5.5 Information presentation 160 5.6 The role of cues 162 5.7 The role of perceived importance 163 5.8 Mnemonic aids 164 5.9 Compliance, adherence and concordance to treatment 164 5.10 Causes of non-adherence 167 5.11 Cognitive models of health behaviour 169 5.12 Social cognition models 173 5.13 Strategies for changing risk behaviour 175 5.14 Conclusion 181 5.15 Summary 181 Your end point 182 Further reading 183 Weblinks 183 Chapter 6 Stress and stress management 185 Learning Outcomes 185 Your starting point 186 6.1 Introduction 188 6.2 What is stress? 189 6.3 Models of stress 190 6.4 Coping with stress – how to do it 195 6.5 The link between stress and health 198 6.6 How does stress affect health? 201 6.7 We need friends – social support 206 6.8 How to deal with stress 210 6.9 Does it work? 213 6.10 Stress and nursing practice 213 6.11 Conclusion 214 6.12 Summary 216 Your end point 216 Further reading 217 Weblinks 218 vii CONTENTS Chapter 7 The psychology of pain 219 Learning Outcomes 219 Your starting point 220 7.1 Introduction 222 7.2 What is pain? 223 7.3 Concepts of pain 226 7.4 The gate control theory of pain 228 7.5 Psychological factors influencing pain 230 7.6 The assessment of pain 231 7.7 The management of pain 239 7.8 Behavioural approaches to pain and pain management 245 7.9 Cognitive approaches 246 7.10 Conclusion 249 7.11 Summary 250 Your end point 251 Further reading 252 Weblinks 252 Chapter 8 Psychology of mental health 254 Learning Outcomes 254 Your starting point 255 8.1 Introduction 257 8.2 What is mental health? 257 8.3 Classification of mental health 258 8.4 Evaluation of the classification system 260 8.5 Schizophrenia 261 8.6 Anxiety disorders 265 8.7 Mood disorders 272 8.8 Personality disorders 275 8.9 Eating disorders 278 8.10 Substance misuse 282 8.11 The Mental Health Act 287 8.12 Conclusion 288 8.13 Summary 290 Your end point 291 Further reading 292 Weblinks 292 Chapter 9 Developmental disorders: learning disability 294 Learning Outcomes 294 Your starting point 295 9.1 Introduction 296 9.2 Learning disabilities 297 9.3 Dyslexia 299 9.4 Attention-Deficit/Hyperactivity Disorder (ADHD) 302 viii  CONTENTS 9.5 Autism spectrum disorders 306 9.6 Communication 312 9.7 Quality of life 314 9.8 Emotional well-being 317 9.9 Psychological approaches 317 9.10 Conclusion 322 9.11 Summary 322 Your end point 323 Further reading 324 Weblinks 324 Glossary 326 References 340 Index 395 ix This page intentionally left blank Preface The role of psychology in nursing education and practice has become ever more significant in recent years and some would argue that it is the most important topic you will cover during your nursing or healthcare practitioner studies. Although psychology has always had a role in the nursing curriculum, in recent years this has come ever more to the fore. Even though psychology is a mandatory component of your programme, I hope that this text and the sug- gested additional reading will give you both an insight into, and a thirst for, psychology. More importantly, however, I hope that you will be able to use the material and the knowledge developed from this text within your practice for your clients’ and patients’ benefit. The increase in interest and acknowledgement of the value of psychology has led to an increase in the number of texts, research and policy publications linking nursing, healthcare and psychology. This substantial body of literature has formed the backdrop of this book. Some of these publications are based on the classic texts of yesteryear, while others are more recent; there are also sources that have not even been published yet. When presenting this material, however, this text has taken an academically robust approach but attempted to do this in an appealing and readable manner. Hence, for example, even though the stud- ies and reports have been read and reported here, the reference list has been kept to a minimum, although I hope the academic rigour that went into the preparation of this text comes through. There is a list of further reading for each of the topics and this will guide you into the deeper recesses of psychology (and I am sure you will want to go there...). In short, this is a textbook that is academic in tone and presentation and also useful and relevant for student nurses from all backgrounds with a range of professional aspirations. In this way this text is inclusive in nature and demonstrates the importance of psychology in both the nursing role and in healthcare in general. I am passionate about psychology and, importantly, communicating its relevance and effectiveness in nursing practice. I hope that this comes through. The aim of the text was, therefore, to be inclusive, to demonstrate the value of psychol- ogy in nursing and healthcare from a British perspective. Although there are a number of American texts dealing with psychology there are few that have a British focus. There are, of course, other texts exploring health psychology or psychology in general but these do not explicitly link psychological aspects of health to the nursing role. Therefore, we have tried in this book to cover psychological aspects and concepts that have a direct role in health and nursing care. However, this text does not claim to be comprehensive – it does not cover every single aspect of psychology, for this would be impossible; it does not even cover every single aspect of psychology related to healthcare, as this too would be impossible. What has been achieved is a text that highlights the key areas in psychology related to nursing care. Every chapter has been honed to ensure that every single element is related to either your studies or your practice. The choice, of course, is a subjective one and the decisions of what to include and what to exclude will (no doubt) be contentious – there are so many competing perspectives in psychology and its scope is so extensive (see Chapter 2 for further details). More could have PREFACE been included on social groups and the nature of group-think and social loafing (which would have helped you when working in a team) or coping with chronic illness could have been further explored or why people go to their healthcare practitioner, or the role of nurses in promoting and extending health behaviours, and many more topics besides. However, some- thing had to give – and these (amongst other things) were them. This book has been produced with a number of aims in mind. First, for the student nurse to become familiar with how the role of psychology and health psychology can be applied to nursing and healthcare practice. Second, for the student nurse to be able to apply theories and ideas to both their own placement practice and student nurse portfolios. Third, to do this in a simplistic but robust manner with an interactive and supportive style. Finally, to ensure that there is a commitment to the role of psychology in nursing care. Psychology has many perspectives which enable the student nurse to appreciate the indi- viduality and diversity of patients. This is important in the construction and delivery of indi- vidualised care plans as stated throughout nursing courses and, of course, the Nursing and Midwifery Code of Conduct. Material presented in this text includes specific material dedi- cated to explaining how this can be successfully achieved in practice. Creating a patient-led NHS – delivering the NHS Improvement Plan (DoH, 2005a) is a government health paper which highlights the importance of patient-centredness including patient choice and needs that should be addressed within any interaction with a patient. Hopefully, this book builds on the vision of such government statements and encourages the reader to appreciate the input psychology can have with such emerging visions of the future. There are, of course, many other policy developments that highlight the impor- tance of a patient-centred NHS, ill-health prevention and promoting health and well-being (e.g. Our Health, Our Care, Our Say: A New Direction for Community Services (DoH, 2006); Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England (DoH, 2005b)) in which psychology has a key role to play. Structure of this book This book contains nine relatively short chapters that will engage you every step of the way. You will read, then stop and do some activities, discuss with colleagues (or friends, families, patients or the checkout operator at the local supermarket if you wish!), and then check your progress. The book starts with Chapter 1 (where better to start?), a basic introduction to psychology – from a historical perspective (don’t yawn – it is brief and relevant), through to the role of psychology across the lifespan and its role in healthcare – from cradle to grave. That means that the roles of psychology in pregnancy, in childhood, in adulthood and in old age and death are all highlighted. Finally, the social context of psychology and healthcare is explored, dem- onstrating the interplay between psychology, the social world and other disciplines. In Chapter 2, the various schools of thought are presented. Being a relatively young sci- ence psychology has a number of ‘schools of thought’ or perspectives on how and why people behave in a certain manner. This chapter presents these various perspectives and highlights how they can be applied to your practice. Some of these perspectives will be useful for those working with children, others will be useful for those working with people with a learning diffi- culty or mental health issue and there will be other perspectives applicable across all nursing practices. However, be warned – this is a weighty chapter but it does provide an important overview of the various approaches adopted in psychology to explain how and why people behave as they do. xii  PREFACE Chapter 3 will explore psychology across the lifespan. It starts by exploring how psycholo- gists have tried to explain the development of children from birth through to adolescence. It then explores how these developmental frameworks can be applied to nursing practice – whether this be at primary prevention level, dealing with mental heath issues or dealing with healthcare issues in the acute ward. Chapter 4 looks at the social world – how we communicate with others through verbal and non-verbal means. It then looks at the power others have over us – conformity and obedi- ence. Finally, we look at how these concepts and related issues can be put into practice when we introduce adherence to medical treatments. The next chapter, Chapter 5, looks at cognitive psychology. It starts by exploring the concepts of perception and memory and how these can be related to nursing practice. The chapter then moves on from the ‘pure’ cognitive psychological areas and explores the social- cognition models of health behaviours and adherence (and the alternative forms of this term) to treatment. How these have been developed and how they can be used within practice to improve the care offered are explained. Stress is the basis of Chapter 6 – what it is, what causes it, what the consequences are. This is important from both a mental and physical health perspective as stress has the power to have negative consequences in a number of areas. The chapter finishes with some stress management techniques that are theory based – they are based on the models of stress pre- sented earlier in the chapter. The next chapter, Chapter 7, is the painful chapter. This chapter outlines the nature of pain, the models of pain and then how pain can be managed within a psychological frame- work. This is an application chapter (along with the stress chapter): you should be able to use your psychological knowledge and skills gathered from Chapters 6 and 7. Chapter 8 explores mental health. Although this is a specific branch of nursing, it is a requirement for all nurses to understand issues related to mental health. This chapter presents an overview of these issues and highlights why this is important in healthcare. An overview of mental health issues is presented, along with reflections on the treatment con- siderations for those who have mental health problems. The final chapter, Chapter 9, is also an area in which all nurses must have some exposure: learning disabilities. A broad, all-encompassing term is described and the various difficul- ties that are included within this description are outlined. The special considerations when nursing individuals with such disabilities are also outlined. Is this book for you? This book is geared towards nursing and healthcare students during their undergraduate studies, but it works equally well for those on postgraduate courses that require an addi- tional psychological component. Nursing students from any nursing branch will find the text useful, as will those on midwifery programmes. We also hope that practising nurses and other healthcare professionals will find this text valuable and a useful reference source. Features of this book We have tried to use a variety of pedagogical devices throughout this book with the intent of interesting the reader, reiterating the relevance of key points, and acting as a revision device. xiii PREFACE Here are the special features in each chapter, designed to make you a better student: LEARNING OUTCOMES Each chapter starts with the phrase ‘At the end of this chapter you will be able to’. This is to guide you and orientate you to what the chapter contains and what you can expect to have achieved by the end of the chapter. YOUR STARTING POINT A series of five multiple choice/short answer questions to test where you are starting from – these will be returned to later in the chapter. CASE STUDY A brief case study that will help exemplify some of the issues contained within the chapter and highlight why the material presented is relevant to your clinical practice. KEY MESSAGE A one-sentence summary of the key message in a section. QUICK CHECK Asks you to recall or apply what you have just read. The answers can be found in the text and you should know the answer if you have read the text properly! THINK ABOUT THIS These ask the reader to consider a specific issue related to an individual topic under discussion. Obviously you can do this by yourself or with a colleague in order to increase your learning. RESEARCH IN FOCUS In this box we will present a recent research study that has been published that has direct relevance to the material presented in the chapter. This box demonstrates the importance of research in evidence-based nursing and healthcare. SUMMARY At the end of each chapter we present a summary of the chapter in a series of bullet points. We hope that these will match the Learning Outcomes presented at the start of the chapter. YOUR END POINT Another series of questions for you to answer – if you have read the text, followed the exer- cises and discussed the issues then you should get them all correct. xiv  PREFACE FURTHER READING We have included a few items that will provide additional information – some of these are in journals and some are full texts. For each we have provided the rationale for suggesting the additional reading and we hope that these will direct you accordingly. WEBLINKS A list of useful websites ends each chapter. We hope you will access these for further information. REFERENCES All the references cited throughout the text are gathered here. If you want to explore an area further then use these, along with the Further Reading suggestions, to expand your knowledge. GLOSSARY Bold words in the text that may not be immediately familiar or are technical in nature are defined in the glossary. WARNING Finally, a warning for all readers. This text is written in a relaxed and informal style so that the key principles can be read, understood and appreciated easily. Hopefully, you will find the style appropriate so you will find the information and key principles relevant to your practice easy to digest. However, when writing your assignment, your research project, or even your journal article you should NOT copy the style of this text – you need to present your material in a formal academic style. xv This page intentionally left blank Acknowledgements This project, like all such projects, has been a major undertaking and one that (on more than one occasion) has felt more distant than it should have been. The production involved the assessment of a range of sources – whether these be academic journal articles, internet sources or popular academic textbooks. This material then had to be digested into bite-sized, conversational pieces. I hope that I have done the researchers, clinicians and policy makers justice in the interpretation. On a more personal level, several key colleagues have acted as researchers for us and have contributed their time, effort and opinions with vigour and a frankness that was as refreshing as it was useful. In particular I have to thank Danni Stephens and Felicity South who spent a summer working on updating material for this second edition and contributed to the glossary or found references for this book. I am extremely grateful for the time and effort they put into this work. Many thanks also to the team at Pearson, in particular, David Harrison, for helping drive through this project. Obviously, for a text like this the design is of key importance so thanks to all of those involved in the production of this text – the designers and production editors for enhancing the text with some excellent features, which we hope have provided guidance, direction and added value for all readers. I must offer thanks and acknowledgements to those who have supported me at both work and home. For colleagues at the University of Worcester many thanks for your help, advice, friendship and practical guidance over the gestation period of this text. Finally, I would like to thank Penney for caring. Publisher’s acknowledgements We are grateful to the following for permission to reproduce copyright material: Figures Figure 1.5 from Dahlgren, G., Whitehead M. 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm, Sweden: Institute for Future Studies; Figure 5.12 from Wolfgang Stroebe, Social Psychology and Health, 2nd edn, 2000. Reproduced with the kind permis- sion of Open University Press. All rights reserved; Figure 5.13 from Jane Ogden, Health Psychology, 3rd edn, 2004. Reproduced with the kind permission of Open University Press. All rights reserved; Figure 7.4 from Hockenberry MJ, Wilson D: Wong’s essentials of pediatric nursing, ed. 8, St. Louis, 2009, Mosby. Used with permission. Copyright Mosby. Tables Table 3.2 adapted from http://www.cancer.gov/cancertopics/pdq/supportivecare/bereavement/ Patient/allpages/ ACKNOWLEDGEMENTS Photographs (Key: b-bottom; c-centre; l-left; r-right; t-top) Corbis: Laura Dwight 80; Getty Images: Christopher Furlong/Staff 94c, Getty Images/Handout 34, Dave Hogan/Stringer 94r, Image Source 147, Jupiterimages 148r, Juan Silva 148l, Miguel Villagran/Staff 94l; Science Photo Library Ltd: BSIP Laurent 235, Doug Goodman 77. Cover images: Front: Getty Images In some instances we have been unable to trace the owners of copyright material, and we would appreciate any information that would enable us to do so. xviii  Chapter 1 Introduction: psychology in nursing care Learning Outcomes At the end of this chapter you will be able to: ✦ Understand the development of psychology as a science ✦ Appreciate some of the schools of thought in psychology ✦ Appreciate the research methods in psychology ✦ Understand the social context for health and health psychology ✦ Understand the role of psychology in many aspects of life ✦ Appreciate the role of psychology in all aspects of health and illness from the cradle to the grave. CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Your starting point Answer the following questions to assess your knowledge and understanding of the relationship between psychology and nursing and the key terms and principles underlying psychology. 1. By the 1920s a new definition of psychology had gained favour. Psychology was said to be the science of: (a) mind (b) consciousness (c) computers (d) behaviour (e) philosophy? 2. What is the independent variable, in experimental research: (a) a variable which nobody controls or changes (b) the variable which is manipulated in an experiment (c) the variable which is measured, to see results of an experiment (d) a variable which describes some durable characteristic of the subject (e) a variable which is held steady? 3. Cartesian dualism specifies that: (a) The body can interact with the mind via the pineal gland. (b) The mind can interact with the body via the pineal gland. (c) The mind and the body do not interact at all. (d) Both (a) and (b). (e) Neither (a) nor (b). 4. According to many, who was the founder of modern day psychology and first ‘psychologist’: (a) Wundt (b) Fechner (c) Weber (d) Helmholtz (e) none of the above? 5. Which of the following schools of thought would be most likely to reject the method of introspection to study human experience: (a) behaviourism (b) psychoanalysis (c) structuralism (d) functionalism (e) none of the above? 2  1.1 INTRODUCTION 1.1 Introduction Being a nurse is all about medicine and nursing practice, isn’t it? It is all about biochemistry, physiology and anatomy? As a nurse you need to understand the patient’s medical and nurs- ing history, you need to understand their diagnosis and their treatment, you need to under- stand what is going on, inside the brain, the liver, the kidneys, the heart and so on. However, a human being is more than the sum of bodily parts (see Figure 1.1) and this has an important consequence for your nursing practice and the importance of psychology in healthcare. It could be argued, of course, that your individual patient is not that concerned about their body parts – what they want is to get better in the shortest and most painless manner. They want to be treated with respect and dignity, they want to be involved in their care and they want the nurse to act in a thoroughly professional manner. All of these have a psychological element. head eyeball heart thumb nose lips ear arm tongue leg teeth foot finger Figure 1.1 The human being is more than a sum of its parts 3 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Key message Humans are more than a collection of organs. The patient also wants to know what caused their illness – is there something that can be done about it, and if so, what? How can they prevent it from occurring again and how can they be included in their care? Again, all of these have a psychological element. Key message Psychology is the most important subject you will study. We must also appreciate the definition of health as provided by the World Health Organization (WHO, 1946): ‘A complete state of physical, mental and social well-being and not merely the absence of disease or infirmity.’ This suggests that health is not simply a problem with the biochemistry, physiology or anatomy of the individual patient but that there is a con- tribution, and an equal one at that, of social and psychological factors to the state of health. And now for a bit of controversy: overall, psychology will be the most important subject you will study during your nursing degree. If we look at Table 1.1, we see on the left-hand side all the benefits that a good knowl- edge of psychology brings, and on the right-hand side, all the things you can do without knowledge of psychology. The table has been limited to just half a page because of space considerations. Key message Psychology is the most important topic known to humankind. As you can see from the table (which was completed in a totally unbiased fashion), psy- chology has many perspectives that enable the student nurse to appreciate the individuality and diversity of patients and clients. This is important in the construction and delivery of indi- vidualised care plans as stated throughout nursing courses and, of course, The Code (Nursing and Midwifery Council’s Code of Conduct, 2008). Quick check What is the definition of health according to the WHO? ✓ 4  1.1 INTRODUCTION Table 1.1 The role of psychology in nursing practice Where psychology is not The role of psychology in nursing practice involved in nursing practice ✦ Understanding of mental health issues ✦ Ability to communicate with peers ✦ Ability to communicate with patients and clients ✦ Ability to enhance adherence to treatment ✦ Ability to change maladaptive behaviour ✦ Ability to deal with the stresses and strains of practice ✦ Stress management ✦ Pain management ✦ Design of systems and operations in theatre, ITU and on the wards ✦ Ability to communicate with patients and clients irrespective of their needs, disability or health concern ✦ Understanding of human behaviour from cradle to grave The word psychology means ‘the study of the mind’ (being made up of two Greek words – psyche – mind, soul or spirit and logos – knowledge, discourse or study). Many have subse- quently defined psychology as the study of mind, behaviour, emotions and thought processes. It can assist us with understanding our patients and clients, and also ourselves. The other definition that we should provide is ‘health psychology’. This is, as the term suggests, how psychology can be applied to all aspects of health and the healthcare system – whether they be related to the aetiology of a particular condition, the treatment of a particular condition or the promotion of health in an individual’s life. A longer, more formal definition is provided below. Definition of health psychology ‘Health psychology is the aggregate of the specific educational, scientific and professional contri- butions of the discipline of psychology to the promotion and maintenance of health, the preven- tion and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction, and the analysis and improvement of the health care system and health policy formation’ (Matarazzo, 1982). Think about this What do you consider the most important topic you are studying on your ? nursing course? Why? 5 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Quick check What is the definition of psychology and health psychology? ✓ 1.2 A brief history of psychology The schools of thought, or perspectives in psychology, that we will discuss in detail later in this book are indicated in Figure 1.2. However, the historical overview provides some informa- tion on those key figures who have been influential in psychology and how this relates to the current viewpoint and the perspectives that can be applied to healthcare. The father of psychology is believed to be William Wundt, although he was originally a professor of physiology in Germany. Wundt Wundt wanted to apply the methodical, experimental methods of science to the study of human consciousness. To this end, he founded the first-ever psychology laboratory at the University of Leipzig in Germany in the 1880s. At his laboratory, Wundt spent hours exposing individuals to audio and visual stimuli and asking them to report what they perceived. In this way, he studied one component of consciousness, perception. The school of thought that arose from the work of Wundt and his colleagues is called structuralism. The basic goal of structualists was to study consciousness by breaking it down into its components – mainly perception, sensation and affection. Their basic method was to Biological perspective Humanistic Cognitive perspective perspective Psychoanalytical Behaviourism perspective Figure 1.2 Schools of thought in psychology covered in this text 6  1.2 A BRIEF HISTORY OF PSYCHOLOGY train their subjects in introspection, which was careful, systematic observation of one’s own conscious experience. Key message Wundt believed in objective measurement – the initial scientific foundation of psychology. Structuralism vs. functionalism An opposing school of thought – functionalism – was led by William James and John Dewey. While structuralists essentially wanted to determine ‘what is consciousness?’, functionalists wanted to determine ‘what is consciousness used for?’ – in other words, they wanted to study the purpose, or function, of consciousness and basic mental processes. The two camps debated passionately over which approach to psychology was best, each hoping to shape the direction of their fledging academic subject. Although neither won the war, the creative tensions led to the establishment of the first psychology lab in the USA (Johns Hopkins University). Behaviourism Around 1913, American psychologist John B. Watson founded a new movement that changed the focus of psychology. He believed that internal mental processes should not be studied, because they cannot be observed; instead, Watson advocated that psychology focus on the study of behaviour and thus his movement became known as behaviourism. As Watson saw it, behaviour was not the result of internal mental processes, but rather the result of automatic response to stimuli from the environment. Behaviourism became focused on how conditions of the environ- ment affect behaviour and, specifically, how humans learn new behaviour from the environ- ment. This movement took a strong hold in America and was the dominant school of thought for about 40 years. Watson’s successor, as the leader of behaviourism, was B.F. Skinner, who developed an influential view that operant conditioning was the mechanism for learning. Key message Behaviourism has played a significant part in mental health and learning disability nursing. Think about this In the past day, think about a time you have given a reward (i.e. reinforced a ? behaviour). What about receiving a reward (i.e. reinforcer)? Has it made the behaviour more likely? 7 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Key message Behaviourism confines itself to the effect of the environment on behaviour. Gestalt theory While behaviourism was becoming dominant in the USA, two other schools gained influence in Europe around the same time. Gestalt theorists’ basic belief was that any psychological phenomenon, from perceptual processes to human personality, should be studied holisti- cally; that is, they should not be broken down into components, but rather studied as a whole. Psychoanalysis The second major movement in Europe at this time was psychoanalytic theory. This theory, developed by Austrian psychologist Sigmund Freud, revolutionised psychology and other aspects of modern thought. Very much the opposite of behaviourism, it focused on humans’ internal workings and proposed a whole new way of explaining them. The theory developed by Freud was quite extensive and intricate, but the main principle is that the unconscious is responsible for most thought and behaviour in all people and the disorders of the mentally ill. Freud’s psychoanalytic theory gained a wide following and many of his ideas are commonly believed by the public today. However, there is limited evidence and most psychologists con- sider Freud to be of interest merely from a historical perspective. Key message Psychology owes a lot to Freud, but his theory is now considered to have a limited evidence base and hence receives limited support. Think about this Although Freud’s theory is no longer considered valid, what value do his ? methods and theory still have in nursing practice? Humanism By the 1950s, a new movement began as an alternative to behaviourism and psychoanalytic theory. The followers of this movement considered behaviourism and psychoanalytic theory dehumanising and they took the name, humanism, for their movement. Instead of behav- ing as pawns of the environment or the powerful unconscious, humanists believed humans were inherently good and that their own mental processes played an active role in their 8  1.2 A BRIEF HISTORY OF PSYCHOLOGY behaviour. Free will, emotions and a subjective view of experience were important in the humanism movement. Cognitive theory The most recent major school of thought to arise has been the cognitive perspective, which began in the 1970s. This movement is much more objective and calculating than humanism, yet it is very different from behaviourism, as it focuses extensively on mental processes. The main idea of this movement is that humans take in information from their environment through their senses and then process the information mentally. The processing of informa- tion involves organising it, manipulating it, storing it in memory, and relating it to previously stored information. Cognitive theorists apply their ideas to language, memory, learning, dreams, perceptual systems and mental disorders. Table 1.2 highlights how each of these areas is of central importance in psychology and in nursing practice and where they are covered in the following chapters of this text. Quick check Who is the founder of modern psychology? Which school of thought grew in opposition to the introspection approach? ✓ Table 1.2 Historical perspective on psychology’s development School of thought Useful in nursing practice because... Structuralism Stressed the importance of scientific study of mental processes. An obvious link to mental health nursing and how psychological processes can impact on physical health (see Chapter 6). Behaviourism Emphasis was on the behaviour and how this could be influenced by the environment (see Chapter 2). Has a key role to play in working with children, people with learning disabilities, those with mental health issues and those in pain (i.e. many of the people nurses come across). Gestalt Importantly recognising that the human should be treated holistically and not as the sum of its individual parts (covered in Chapters 1 and 5). Psychoanalysis The importance of the unconscious was revealed and the link between psychological conflict and physical health was further highlighted (Chapter 2). Humanism The root of positive nursing practice. Cognitive theory The future (as some would see it) – a more scientific and information processing perspective that explores the way in which people make sense of their environment (see Chapter 2). 9 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE 1.3 The language of psychology All subjects have their own special language – you will have come across some terms in nurs- ing that you probably have not come across before. Just as it is in nursing, so it is in psychol- ogy. Psychology has its own jargon and it is probably sensible that there is an introduction to this language before progressing any further. Psychology has its own terms including some words, phrases and approaches that may be familiar to you but mean different things to psy- chologists from normal (sic!) people. For example, if a person says ‘behaviour’ then a psychologist would say ‘define the behav- iour’. If a person says ‘personality’ then a psychologist will ask ‘which aspect of personality?’. Furthermore, psychologists from different traditions (see Table 1.2) would further refine the personality into an element that fits in with their understanding of the person. For example, a psychologist from the psychoanalytic tradition might suggest that a person has an ‘anal per- sonality’ (stemming from the anal stage, a child who becomes fixated due to over-control). This phrase may be uncommon to you (and probably to many psychologists as well) but it is there simply to demonstrate the point that individual psychologists speak a different lan- guage from other professions, and often, from each other. There are, of course, many other such examples and it would be impossible to go through all of these, but you get the point: psychologists have a language of their own, and this lan- guage may be further divided according to the psychologist’s school of thought. Having said that, however, there are a few terms that you should appreciate as being essential to the understanding of psychology. First, psychology is a scientific discipline based on models, theory, hypotheses and empirical study. Think about this List some terms you think of when thinking about psychology. ? 1.4 What is a science? One common misconception about science is that it is all about statistics and hard maths. It is not – there are plenty of scientists who produced scientific theories without reaching for the calculator (think of Darwin or Piaget, for example). Nor is science about technology – there are plenty of examples of technology that have no scientific basis (e.g. ‘lie detector’) and plenty of science that has no technology (e.g. Newton). So, this is what science is not, but what are the central qualities of science and how does this relate to psychology? Key message Psychology is a science and uses scientific methods, language and approaches. 10  1.5 KEY QUALITIES OF A SCIENCE 1.5 Key qualities of a science All sciences share a common method of investigation: they are data driven and do not rely on personal biases or superstitions. This data is produced objectively and is subject to both rep- lication by others and peer review. Hence, any study we conduct has to be clearly recorded and open to public scrutiny so it can be challenged and replicated. Furthermore, science examines solvable problems which are empirically derived and are not too all-encompassing (not looking for the meaning of life, for example). If we unpick this further, we see that for psychology to be defined as a science it has to have: ✦ A defined subject matter: we can clearly state the range of subject matter or phenomena that psychology studies. ✦ Theory construction: we can try to explain the observed phenomena in terms of theory (see Chapter 5 for how psychologists have attempted to do this). ✦ Hypothesis testing: we can make specific predictions based on our theory which we can test empirically. ✦ Empirical testing: used to collect data (or evidence) to support or refute the hypothesis. In Figure 1.3 the scientific induction–deduction method is outlined and shows how science progresses. At the first stage there is the inductive process, where psychologists (or other scientists) observe instances of a natural phenomenon and derive a general law based on Inductive process 2 Produce 3 Generate laws/theories hypothesis Deductive process 4 Test with 1 Make experiments observations 5 Reject/ refine theory Figure 1.3 The scientific induction-deduction method 11 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE these observations. Hence, they are moving from the particular to the general. The next stage suggests that we move from the general to the particular – the theory has been derived and we now want to look for instances to confirm (or refute) our law or theories. Quick check List the central characteristics of a science. ✓ Out of this perspective come a number of terms and methods that will crop up during this text: ✦ Hypothetical constructs: These are not observable but can only be inferred from behav- iour. For example, memory, intelligence and personality. ✦ Model: A metaphor, involving a single fundamental idea or image. ✦ Theory: Often the terms theory and model are used, incorrectly, interchangeably, but a model is a complex set of inter-related statements that attempt to explain certain observed phenomena. ✦ Hypothesis: A testable statement about the relationship between two or more variables, based on a theory or model. ✦ Variable: Anything that can vary and can be one of two kinds: an independent variable (IV), which the researcher manipulates to see if it affects the dependent variable (DV). One argument against psychology is that major sciences have paradigms, which are gen- eral theories that encompass many smaller theories. However, psychology does not have any of these. Instead, it has levels of explanations that are used to explain phenomena. Thomas Kuhn (Kuhn et al., 1990) said that because of this ‘psychology is a pre-science’. He meant that psychology had not quite reached the stage of being a science, but may do so one day. Think about this How would you define and measure the following: ? ✦ memory ✦ personality ✦ behaviour ✦ thinking? 1.6 Researching psychology Psychology, as you would imagine, generates a considerable number of research questions and consequently requires a range of methods for gathering evidence to answer them. This text will not consider the whole gamut of research methods available, but will just skim the 12  1.6 RESEARCHING PSYCHOLOGY surface so you understand some of the terms that may come up in this text. There are a number of textbooks related to research methods and these can be accessed for further information when you need it. Between groups design A between groups design allocates matched groups of people to different treatments. If the measures are taken at one time this is a cross-sectional design, whereas if they are tested over two or more time periods then this would be a longitudinal design. For exam- ple, if we want to see whether a certain psychological approach (e.g. behavioural) to pain management works we would have one group that has the intervention (the experimental group) and another group (the control group) that does not. If we followed these people over time to see whether the behavioural intervention worked then it would be a longitu- dinal design. We also have to remember to use an appropriate control group – we could not give the group nothing as the mere fact that the experimental group was receiving the interven- tion might be enough to cause improvement. So, we have to include a placebo control as treatment. This might be a non-specific treatment that does not involve the behavioural intervention. Within participants design This type of design is used when the same people provide measures at more than one time and differences between the measures at the different times are recorded. An example would be a measure taken before an intervention and again after the intervention. For example, you introduce a psychological intervention to try to improve the mental health of a group of peo- ple with learning disabilities living in supported accommodation. You measure the levels of mental health before the treatment, and then again after you have undertaken the interven- tion. There are obvious problems with this – did we keep everything else constant? How can you be sure that it was down to the intervention specifically? Quick check List the advantages and disadvantages of a between participants and within participants design. ✓ Cross-sectional studies These studies obtain the responses from a group of participants on one occasion only. With appropriate randomised sampling methods, the sample can be assumed to be a rep- resentative cross-section of the population under study. So, for example, we can explore how many people are under stress at any one point in time. If we collect enough par- ticipants then we can probably also compare specific sub-groups: is stress greater in men than women, is it greater in nurses or doctors (or psychologists)? These studies are quite common, but we must make sure the sample is representative and we cannot infer any cause and effect. 13 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Observations A simple kind of study involves observing behaviour in a relevant setting. Hence, we can explore interactions within a consultation setting: how do patients react to bad news? How do nurses react to giving good news? Structured interviews An interview schedule is prepared with a standard set of questions that are asked of each person, by telephone or by face-to-face interview. A semi-structured interview is more open ended and allows the interviewee to address issues that they feel are relevant to the interview. Longitudinal design These designs involve measuring responses of a single sample on more than one occasion over a period of time. These can either be prospective (where the recordings are taken and then planned for the future) or retrospective (where the recordings are obtained from already collected records). These types of designs are among the most powerful designs available for the evaluation of treatment and of theories about human behaviour. Meta-analysis This is a statistical analysis of the results from a number of studies already completed. A use- ful definition was given by Huque (1988): ‘A statistical analysis that combines or integrates the results of several independent clinical trials considered by the analyst to be “combinable”.’ Questionnaires This is a popular and frequently employed method of study in psychology. Questionnaires consist of a standard set of items with accompanying instructions. Ideally a questionnaire will be both reliable (i.e. measure the same thing on more than one occasion) and valid (i.e. meas- ure the thing that they say they are measuring). Questionnaires can be designed specifically for the study under discussion or they can be picked ‘off the shelf’ since many have already been designed (see Bowling (1995) for further details). Surveys This is a systematic method for determining how a sample of participants respond to a set of questions (or questionnaires) at one or more times. For example, we may want to know what people with alcohol problems think of the service they are receiving and how this compares to the views of the service providers. In this case we would do two surveys – one with the service users, and one with the service providers. Randomised controlled trials Randomised controlled trials (RCTs) involve the systematic comparison of interventions using a fully controlled application of one or more ‘treatments’ with a random allocation of participants to the different treatment groups. This design is the ‘gold standard’ to which 14  1.6 RESEARCHING PSYCHOLOGY much research in psychology and healthcare aspires. People are allocated at random (by chance alone) to receive one of several interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo or no intervention at all. RCTs seek to measure and compare the outcomes after the participants receive the interventions. Think about this What design would you use to investigate whether: ? ✦ a behavioural approach to pain management works in older people ✦ painting the walls blue increases the quality of life in a children’s ward ✦ people with a learning disability in supported housing have better language skills than when living within their families ✦ stress causes mental health problems ✦ ‘hard’ drug users have a different personality to non-drug users? What methodological and ethical considerations should you take into account? Qualitative techniques The methods discussed so far are quantitative techniques favoured by many in psychology and healthcare. However, there are also a number of qualitative techniques that may be of use. For example, there are diary studies which can help the researcher collect information about the temporal changes in health status (e.g. dealing with a life-limiting condition). There are also narrative approaches in which the desire is to seek insight and meaning about health and illness through the acquisition of data in the form of stories concerning personal experi- ences (e.g. dealing with substance abuse). Cases studies provide a ‘thick description’ of a phenomenon that would not be obtained by the usual quantitative or qualitative approach. Focus groups are a common approach which involves a group of participants discussing a focused question or topic which can lead to the generation of interactive data. Key message Qualitative and quantitative techniques are both useful and valid techniques. You must use the most appropriate method for your research question. Action research Action research is increasingly being used within health, nursing and psychology and has been recommended by the Department of Health as a valuable approach for public health research (DoH, 2001). At its heart is the idea of using research to directly change practice. While other quantitative and qualitative research approaches may go through a long process of data collection, analysis and eventually producing a final report which researchers hope 15 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Cycle 1 Cycle 2 Cycle 3 Study and Study and Study and plan plan plan Take action Take action Take action Collect and Collect and Collect and analyse evidence analyse evidence analyse evidence Reflect Reflect Reflect Progressive problem solving with action research Figure 1.4 The action research spiral that practitioners will use to inform their work, action research works directly with practition- ers or community members so that findings are used immediately and continually to develop practice. Hence, a core idea within action research is that it is done with participants rather than on them. Lewin, who is considered the founder of action research, suggests that it ‘pro- ceeds in a spiral of steps each of which is composed of a circle of planning, action and fact- finding about the result of the action’ (Lewin, 1946: 15). This basic principle of a spiral of steps lives on in the design of many action research stud- ies. A simple diagram of the action research spiral is shown in Figure 1.4. Many action research studies now aim to empower the disempowered and to challenge the social structures that create such power imbalances. These developments have led to what has become known as ‘participatory action research’. Participatory action research is built on the concept of a group of co-researchers working together as equal participants try- ing out various actions, evaluating and reflecting on their effectiveness as a group and then developing and, hopefully, improving their actions. Through this process the co-researchers begin not only to analyse the situation they are in, but also to build a sense of empowerment as they are able to take action to respond to their analysis. Key message Action research is a useful technique for involving users in research in order to improve services. 16  1.7 HEALTH AND HEALTH PSYCHOLOGY IN A SOCIAL WORLD 1.7 Health and health psychology in a social world The definitions of health and illness can be the subject of a book themselves – indeed many texts have been written on this subject. However, for the purposes of this book we will use the definition of health provided by the World Health Organization (1946): ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’ We will use this definition not necessarily because it is the best one, but because it is the one that all of us know and that many people cite. Despite its flaws (e.g. it is too idealistic) it does provide a good basis for future study and aspirational care. What this does suggest is that health is not merely about bugs, germs, accidents or biochemistry – it is about social and psychological variables as well. Think about this How else can you define health? ? Hence the current focus is on the biopsychosocial model of health and illness. This model considers illness to be a result of a number of factors and hence the individual is not seen as passive: the person can contribute to their health and to their ill-health. The person takes an active role in their treatment – they are responsible for taking their medication, for example, and more importantly changing their beliefs and behaviours. In contrast, the original biomed- ical model suggested that the causes of illness were outside the control of the individual – all physical disorders could be explained by disturbances in physiological processes, which result from injury, biochemical imbalance, bacterial or viral infections and so on. Psychology had very little role in either health or illness and no relationship was postulated between the mind and physical illness (the so-called Cartesian dualism). Luckily most people have come to their senses and recognise that psychology has a role to play in health and illness! If we explore what causes illness from a biopsychosocial perspective then it is not simply a case of looking for a biological causative agent or physiological or genetic marker; we have to look additionally at both social and psychological factors. Bio Psycho Social Viruses Behaviour Class Bacteria Beliefs Gender Genetics Stress Ethnicity Biological factors are, perhaps, more apparent and include such factors as the genetic make-up of the individual along with anatomy, physiology and chemical balance. Illness is caused by involuntary physical changes caused by such factors as chemical imbalance, bac- teria, viruses and genetic predisposition. Psychological factors include such variables as lifestyle (e.g. smoking, drinking) along with personality. They also include such variables as cognition – thinking and interpreting, and beliefs. Emotional factors are also important in determining whether we seek out medical 17 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE or some other form of healthcare assistance. Motivational factors are another factor under the psychological variable: if we are motivated when we start an exercise programme we are more likely to keep up with the programme. Quick check What is Cartesian dualism and how does it relate to healthcare? ✓ Social factors are both broad and deep. All of us live in a social world – we all have relation- ships with others, whether these be our family, our friends or our work colleagues. Children may start smoking if their peer group encourages it because it may make them feel more grown up. These may be referred to as social norms of behaviour (whether it is OK to smoke or thought ‘cool’ to drink to excess) and relate to social values on health. Think about this Consider an individual who comes to you with one of the following diagnoses: ? ✦ myocardial infarction/heart attack ✦ schizophrenia ✦ hepatitis ✦ kidney stones ✦ depression ✦ alcohol abuse. What biological, psychological and social factors could be implicated? Is any one of the factors alone sufficient? Now consider how you would treat them. What intervention would you suggest? How would you employ psychological and social variables? The role of social factors in health, illness and psychology is of paramount importance. In Figure 1.5, an example framework for considering the general determinants of health is presented. The framework is multi-layered like an onion with the fixed factors over which we have no control (e.g. age, sex and genetic factors) at the core but surrounded by four layers of influence that we can do something about, either through psychological or social change. This is a useful framework for understanding health and illness and the role of psychology within it. As Marks (2005) points out, the framework has six positive characteristics: ✦ It is concerned with all of the determinants of health, not simply with the course of events during the treatment of illness. ✦ It places the individual at the core but acknowledges the primary determining influence of society through the community, living and working conditions, and the surrounding socio- economic, cultural and environmental conditions. ✦ It places each layer in the context of its neighbours, reflecting the whole situation includ- ing possible structural constraints upon change. 18  1.7 HEALTH AND HEALTH PSYCHOLOGY IN A SOCIAL WORLD r a l, a n d e u ltu nv c , c v i n g and worki n ir o i Li t i g n m co n d i o n s o m on en m ec Word Com unity Unemployment environment d s n al Lif tyle Fa N ta e du c neral socio l c Ind l a et to ivi Water and a rs wo sanitation onditions Education Soci rks Health care Age, sex and services Agriculture hereditary factors and Food e Production G Housing In fluences on health Figure 1.5 A framework for the determination of health Source: Dahlgren, G. and Whitehead, M. (1991) Policies and Strategies to Promote Social Equity in Health, Stockholm, Sweden: Institute for Futures Studies. ✦ It has a true interdisciplinary flavour and is not purely a medical or quasi-medical model of health. ✦ It is even-handed and makes no claims for any one discipline as being more important than others. ✦ It acknowledges the complex nature of health determinants. Think about this In light of the framework of Dahlgren and Whitehead (1991), what factors ? would you consider to be involved in the following: ✦ myocardial infarction/heart attack ✦ schizophrenia ✦ hepatitis ✦ kidney stones ✦ depression ✦ alcohol abuse? 19 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE This means that we have to be aware of the socio-cultural variables and their poten- tial impact on both psychology and health. We should be aware of the following broad factors: ✦ Gender: in industrialised societies today men die younger than women, yet women have poorer health than men. Men tend to die, on average, 6–8 years younger than their female counterparts. However, women have higher morbidity rates – women suffer more chronic and acute illnesses than men, and visit and spend more time in the hospital. Psychosocial and lifestyle differences account for many of these differences. ✦ Ethnicity: evidence suggests that the health of minority ethnic groups is generally poorer than that of the majority population. This pattern has been consistently observed in the USA and the UK. There are many possible explanations for these health differences. For example, racism means that minority ethnic groups are the subject of discrimination at a number of different levels. Second, ethnocentrism in health services, health promotion and access to health services favours the needs of the majority population. Finally, there are cultural differences and these may be highlighted in health protective behaviours and health damaging behaviours. ✦ Socio-economic status (SES): evidence from many studies over many years has indicated that there is a strong and consistent relationship between SES (or social class) and health. Specifically, the data suggests continuously increasing poor health as SES changes from high to low. The mediators of SES effects on health experience are likely to be behavioural and psychosocial. The behavioural factors include diet, exercise and smoking while the psychosocial factors include such processes as self-efficacy, self-esteem and perceived control (Siegrist and Marmot, 2004). Think about this When treating or interacting with a patient, what psychosocial variables must ? you take into account? Key message Psychology as applied to health cannot be taken in isolation – you have to take note of the cultural context. Quick check What are the layers on the Dahlgren and Whitehead (1991) model? Why is this model of value? ✓ 20  1.8 THE SCOPE OF PSYCHOLOGY 1.8 The scope of psychology Psychology has strong links with a range of other disciplines. At one end of the spectrum we have sociology and social anthropology – exploring societies and communities. This can be linked to social psychology and, as we will see in this chapter, the link to health and health psychology is also strong. One example is stress and social support. We get considerable support from our social relationships and this can be of benefit both psychologically and physically. As we will see in Chapter 4, the benefits derived from social networks can be considerable and can reduce the impact of stress and thereby improve health and well-being. At the other end of the psychological spectrum we have the biological basis of our actions and activities. For example, when we look at pain in Chapter 7 we note that pain is both a psy- chological and a biological construct: both of these factors are central to our understanding of pain and, consequently, to its management (see Figure 1.6 for an indication of the scope of psychology and its links across to other disciplines). Think about this What other disciplines can psychology and nursing link with? Expand the ? diagram. Nursing Research Biology methods Psychiatry Clinical psychology Social Sociology Abnormal psychology psychology Psychology Learning theory Personality theory Social Intelligence anthropology Developmental Cognitive Cognitive Psychotherapy Philosophy psychology psychology Science Linguistics Artificial intelligence Figure 1.6 Scope of psychology and link to other disciplines 21 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE 1.9 Psychology in health and nursing care Given the nature of psychology and its links with a considerable number of other disciplines it will come as no surprise that psychology has a central role in health and illness. Consequently, when exploring psychological links to health, illness and healthcare, we find that at every step of the journey there is a role for psychology both through an untroubled life (see Table 1.3) and if there was an ill-health episode (see Table 1.4). Table 1.3 Psychology’s involvement across the lifespan Event Example of psychology’s input Conception Psychology can assist with family planning to ensure that either safe sex is practised (or isn’t in the case of conception!) and that the ➔ psychological and physical states are maximised for the developing foetus (e.g. behaviour change to maximise health state). Pregnancy Behaviour change to enhance health states (e.g. stop smoking sessions). ➔ Labour and birth Social support reduces time in labour and pain associated with it. ➔ Child growing up Appreciation of the cognitive stage of development and the impact this has on understanding of health and illness. ➔ Adolescence Potential optimum time to develop positive health behaviours. ➔ Mental health difficulties may appear – interventions required. Adulthood Enhancing health behaviours. ➔ Changing health behaviours. Support for any maladaptive psychological or physical ill-health. Late adulthood Coping with physical and cognitive decline. ➔ Support and methods for dealing with potential social isolation. Death and Support through bereavement, dealing with grief and preparing for bereavement death. Table 1.4 Examples of the role of psychology during health and illness Stage Example of psychology’s input Person is healthy Maintaining health. ➔ Promoting healthy behaviours. Reducing stress and promoting mental health. Reducing inappropriate health behaviours. (Continued) 22  1.9 PSYCHOLOGY IN HEALTH AND NURSING CARE Table 1.4 Examples of the role of psychology during health and illness (Continued) Stage Example of psychology’s input Person feels ill How does a person become aware of symptoms? ➔ How does a person respond to sensations? How does a person perceive that they are unwell? How does a person interpret symptoms? Plans to visit Why does a person make the choice to go to the healthcare healthcare professional at that time? professional What prompts (or who prompts) the person to go? ➔ How does the person respond to symptoms? What is the role of family and friends in deciding to visit the healthcare professional? Visits healthcare What does the person tell the healthcare professional? professional How does the person communicate (both verbally and non-verbally) in ➔ the consultation? What are the factors that influence the consultation? How does the healthcare professional react? What cognitive processing does the healthcare professional go through to reach their conclusion? Diagnosis and How does the healthcare professional come to their diagnosis and treatment choice of treatment? ➔ How does the patient react to the diagnosis? How does the patient react to the treatment plan? How does the person react to becoming a patient? Is the person satisfied with the consultation? Did they understand and remember the diagnosis and treatment? Living with an illness How does living with an illness affect the self? ➔ How has the illness affected the individual’s quality of life? What impact does the diagnosis have on family and friends? What is the role of family and friends in dealing with the diagnosis and illness? How does the illness affect the emotions of the person? How does the family and individual adjust to the diagnosis? Dealing with pain What is pain? ➔ How can pain be affected by the illness and the reaction to the illness? What is the role of the family in managing pain? How does pain influence quality of life? Coming to the end What stages does the person go through on diagnosis? of life How can the healthcare practitioner help the person come to terms ➔ with their impending death? How can the family and friends be supported? 23 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Both of these are rather extreme examples, going from a perfectly fit person through to a dead person within a few steps. However, they are there to serve a point: psychology plays an important role in our lives, whether we be healthy or ill, whether we are young or old, or whether we are at the start of our life or at the end of it. 1.10 Conclusion This book has been designed to provide you with the insight you need to demonstrate how important psychology is to your professional role. Whilst not all of the topics highlighted in Tables 1.3 and 1.4 are covered in this text, there is enough information here for you to find useful and informative, and to help move your professional career forward. 1.11 Summary ✦ Psychology has an important role to play in nursing. ✦ The WHO definition of health encompasses both biological and psychosocial elements. ✦ Psychology is the study of the mind and behaviour. ✦ Psychology has its origins in the systematic, experimental study of human consciousness. ✦ Psychology has its own language and terminology. ✦ Psychology is a science and employs a number of methods in order to complete research studies. ✦ Action research is a useful technique for involving users in research in order to improve services. ✦ The role of psychosocial factors should not be overlooked. ✦ Psychology has links with a number of other disciplines. ✦ Psychology has a role across the lifespan both in health and in illness. Your end point Answer the following questions to assess your knowledge and understanding of the relationship between psychology and nursing and the key terms and principles underly- ing psychology. 1. The cognitive revolution in psychology was a response to the limitations of which school of thought: (a) psychoanalysis (b) behaviourism (c) human information-processing (d) gestalt psychology (e) all of the above? ➔ 24  FURTHER READING 2. Psychologists employ a variety of tools and methods to study human behaviour. Which of the following methods do psychologists rely on to make systematic obser- vations and draw conclusions about human behaviour: (a) speculation and common sense (b) generalisation and common sense (c) hindsight and experimentation (d) controlled measurement and experimentation (e) personal experience and collective wisdom? 3. The study of psychology is most concerned with which field of scientific inquiry: (a) the science of philosophy (b) the science of behaviour and mental processes (c) the science of developmental processes (d) the science of physical processes (e) the science of emotional and mental processes? 4. Which of the following might affect an individual’s view about issues in psychology: (a) socio-cultural context (b) political beliefs (c) sources of funding (d) all of the above (e) none of the above? 5. What is the main focus of the nature/nurture debate in psychology: (a) child development (b) experimental studies (c) cognitive maps (d) mind reading (e) none of the above? Further reading Angoff, W.H. (1988) The nature–nurture debate, aptitudes and group differences. American Psychologist 43, 713–720. Eysenck, M.W. (2000) Simply Psychology. Hove, UK: Psychology Press. Fischer, C.T. (2006) Qualitative Research Methods in Psychology: Introduction through Empirical Studies. Boston: Academic Press. Fisher, S. and Greenberg, R.P. (1996) Freud Scientifically Reappraised: Testing the Theories and Therapy. Chichester, UK: Wiley. Gravetter, F.J. and Forzano, L.A.B. (2002) Research Methods for the Behavioural Sciences. New York: Thompson/Wadworth. Kimble, G.A., Wertheimer, M. and White, C.L. (1991) Portraits of Pioneers in Psychology. Washington, DC: American Psychological Association and Hillsdale, NJ: Lawrence Erlbaum Associates. Whitehead, D. (2001) Health education, behavioural change and social psychology: Nursing’s contribution to health promotion? Journal of Advanced Nursing 34(6), 822–832. 25 CHAPTER 1 INTRODUCTION: PSYCHOLOGY IN NURSING CARE Weblinks http://www.behavenet.com Behavioural Health Care Information. This site contains all the latest news and developments in behavioural healthcare. There are also links to the latest behavioural healthcare articles. http://www.onlinepsychresearch.co.uk Online Psychology Research. This site actually gives you the chance to take part in real psy- chology studies online. Make a contribution to psychological knowledge today. http://www.behavior-analyst-online.org Behaviour Analyst Online. This site contains links to behaviour analysis journals. http://www.all-about-psychology.com All About Psychology. This site, as the name suggests, is all about psychology. It contains definitions, history, topic areas, theory and practice. http://www.dcity.org/braingames/stroop/index.htm Stroop Test Demonstration. This site allows you to take part in a classic psychology test. The test demonstrates the difficulties we can all have in processing information. Have a go! Check point Your starting point Your end point Q1 A Q1 B Q2 D Q2 D Q3 C Q3 B Q4 A Q4 D Q5 A Q5 E 26  Chapter 2 Psychological approaches to understanding people Learning Outcomes At the end of this chapter you will be able to: ✦ Name, define and explain psychological approaches to understanding the person ✦ Understand the psychoanalytical approach to understanding the person ✦ Appreciate the concepts, terminology and approach of the behavioural explanation ✦ Develop the cognitive approach to the person and how this can be applied to nursing and healthcare ✦ Explain how social learning theory has been applied to understanding the person ✦ Understand the humanistic approach to the person ✦ Express the ideas of major theorists within each approach ✦ Evaluate each approach in terms of its strengths and weaknesses ✦ Demonstrate the application of each approach to nursing and health practice. CHAPTER 2 PSYCHOLOGICAL APPROACHES TO UNDERSTANDING PEOPLE Your starting point Answer the following questions to assess your knowledge and understanding of the psychological approaches to understanding the person. 1. Which of the following approaches to understanding the person came first: (a) psychoanalytic theory (b) behaviourism (c) cognitive psychology (d) social learning theory (e) humanism? 2. According to psychoanalytic theory: (a) All behaviour is learned. (b) Behaviour is the result of maladaptive thinking. (c) Behaviour is the result of physiological processes. (d) Behaviour is the result of innate drives and early experiences. (e) Behaviou