MODULE 3

Conceptual Framework and Theories

Lesson 1: Theories of human behavior and practices

What is a theory?

• A set of concepts, definitions, relationships, and assumptions that project a systematic

view of a phenomena
• It may consist of one or more relatively specific and concrete concepts and
propositions that purport to account for, or organize some phenomenon (Barnum, 1988)

What are the components of a theory?

• Concepts – ideas and mental images that help to describe phenomena (Alligood and
Marriner-Tomey, 2002)
• Definitions – convey the general meaning of the concepts
• Assumptions – statements that describe concepts
• Phenomenon – aspect of reality that can be consciously sensed or experienced
(Meleis, 1997).

What is a paradigm?

• A model that explains the linkages of science, philosophy, and theory accepted and
applied by the discipline (Alligood and Marriner – Tomey, 2002)

What is a domain?

• The view or perspective of the discipline

• It contains the subject, central concepts, values and beliefs, phenomena of interest,
and the central problems of the discipline

How does domain relate to nursing theory?

• Nursing has identified its domain in a paradigm that includes four linkages:
1) Person/client
2) Health
3) Environment
4) Nursing

Purposes of nursing theory

What are the purposes of nursing theory?

• It guides nursing practice and generates knowledge
• It helps to describe or explain nursing
• Enables nurses to know WHY they are doing WHAT they are doing
Types of nursing theories
• Grand theories – broad and complex
• Middle-range theories- address specific phenomena and reflect practice
• Descriptive theories – first level of theory development
• Prescriptive theories – address nursing interventions and predict their consequences

Why on earth do we study nursing theory?

• Everyday practice enriches theory
• Both practice and theory are guided by values and beliefs
• Theory helps to reframe our thinking about nursing
• Theory guides use of ideas and techniques
• Theory can close the gap between theory and research
• To envision potentialities (Gordon, Parker, & Jester, 2001)

“The study and use of nursing theory in nursing practice must have roots in the
everyday practice of nurses (Gordon, Parker, and Jester, 2001).

So how do nurses use theory in everyday practice?

• Organize patient data
• Understand patient data
• Analyze patient data
• Make decisions about nursing interventions
• Plan patient care
• Predict outcomes of care
• Evaluate patient outcomes (Alligood, 2001)

How do student nurses begin to use nursing theory?

• By asking yourself two very important questions…..

Student nurse questions

• What is the nature of knowledge needed for the practice of nursing?
• What does it mean to me to practice nursing?

Nursing also utilizes non-nursing theories

Commonly used non-nursing theories

• Systems theory
• Basic Human Needs theory
• Health and Wellness Models
• Stress and Adaptation
• Developmental Theories
• Psychosocial Theories

What is the link between nursing theory and the research process?
• Theory provides direction for nursing research
• Relationships of components in a theory help to drive the research questions for
understanding nursing
• Chinn and Kramer (2004), indicate a spiral relationship between the two

Current trends that influence nursing theory

• Medical science
• Nursing education
• Professional nursing organizations
• Evolving research approaches
• Global concerns
• Consumer demands
• Technologies

“Practicing nurses who despise theory are condemned to performing a series of tasks -
either at the command of a physician or in response to routines and policies.” Leah
Curtin, RN, MS, FAAN (1989) Former Editor, Nursing Management

Human Behavior Model; General Theory of Human Behavior

Beyond All Doubt (The Explanation of Human Behavior)

12 Words Say It All

All human behavior is an attempt to remove doubt from our lives

Doubt Is the Constant in Human Behavior

1. Doubt is the engine that drives behavior

2. Doubt removal is the equivalent of gravity
3. Trying to remove doubt from our lives is the equivalent of gravity trying to pull
everything to the center of the earth
The Behavior Process
1. We consider all of the possibilities that we can see available to us at any one
moment 8
2. We consider all of the possibilities that we can see available to us at any one
moment We choose the one we have the least amount of doubt in and we act
that out 9
3. We consider all of the possibilities that we can see available to us at any one
moment We choose the one we have the least amount of doubt in and we act
that out This is all we do, we do this over and over and over again, constantly
4. We consider all of the possibilities that we can see available to us at any one
 The Behavior Cycle

The cycle has four stages

I Want I Act I Think I Judge

We start by wanting something

Do I want it? Should I want it? Can I do it/Can I get it? What’s the best plan to get what I
want? We evaluate our options; we make a judgment (decide which one we have the
least amount of doubt in) We act

Four Elements of Behavior

1. Belief Systems
2. Energy
3. Opportunity
4. Trigger

If any of these four are lacking, or are lacking sufficient quantity or quality the
specific behavior cannot take place This will become more obvious when we look
at the elements individually and look at a picture of how it all comes together, so
let’s do that now

Belief Systems

You need to believe that it’s humanly possible You need to believe that you can do it
You need to believe that you should do it If you don’t believe all three of these things,
the instance of behavior cannot take place

Energy

You need enough energy You need the right kind of energy (your mood has to match)
Some other person or thing will also need to have enough of and the right kind of
energy, if the behavior involves other people or things

Opportunity

You have to have the opportunity to engage in the behavior If you don’t have the
opportunity the behavior can’t take place If you don’t believe you have the opportunity
(even if you really do) then the behavior can’t take place

Trigger

There has to be a trigger to initiate the process It could be a physical, mental or

emotional trigger Quite often all three exist There’s always a trigger
Any specific behavior only occurs when the four elements combine in that precise way
 • Change any of the four elements and the behavior will not occur If the behavior is
already taking place the four elements need to remain stable for the behavior to
continue

• Change any of the four elements and that behavior will stop and a new behavior
based on the new configuration of the elements will begin Let’s look at it in picture form
Lesson 3: Models of Mental Health & Illness
W.H.O.s definition of Health:

"A state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity."

Mental Health is defined as

“A state of well-being in which every individual realizes his or her own potential, can
cope with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to his or her community.”

Mental Illness is defined as

“Mental illness can be seen in purely sociological terms, as a deviation from socially
approved standards of interpersonal behaviour, or as an inability to perform one’s
sanctioned social roles. In social science literature it is generally agreed that the mental
illness refers to dysfunctional interpersonal behaviour, judged to be dysfunctional in
terms of the norms and values held by the observer” (International Encyclopedia of
Psychiatry, Psychology, Psychoanalysis & Neurology, 1992).

“An illness with psychological or behavioral manifestation and/or impairment in

functioning, due to social, psychological, genetic, physical or biological disturbances”
(American Psychiatric Association).

“Mentally ill person means a person who is in need of treatment by reason of any
mental disorder other than mental retardation‖(Indian Mental Health Act, 1987).”

Mental health, Mental Ill-health and Mental Illness

 It is a commonplace to view the relationship between health and illness — and,
therefore, mental health and mental illness — as two ends of the same
 Trent (1992),
 The Canadian Ministry of National Health and Welfare (MNHW),1988
 Downie et al (1990)
 Groder, (1977)

History

 In the mid-19th century, William Sweetzer was the first to clearly define the term
"mental hygiene", which can be seen as the precursor to contemporary
approaches to work on promoting positive mental health
 An important figure to "mental hygiene", would be Dorothea Dix (1802–1887), a
school teacher, who had campaigned her whole life in order to help those
suffering of a mental illness, and to bring to light the deplorable conditions which
they were put it in. This was known as the "mental hygiene movement".
  At the beginning of the 20th century, Clifford Beers founded the National
Committee for Mental Hygiene and opened the first outpatient mental health
clinic in the United States of America.

Significance

 Evidence from the World Health Organization suggests that nearly half the
world’s population is affected by mental illness with an impact on their self-
esteem, relationships and ability to function in everyday life.
 There is growing evidence that is showing emotional abilities are associated with
prosocial behaviors such as stress management and physical health‖ (Richards,
Campania, & Muse-Burke (2010).
 The importance of maintaining good mental health is crucial to living a long and
healthy life.

Perspectives

 Sense of Responsibility
 Sense of Self-reliance
 Sense of Direction
 A Set of Personal Values
 Sense of Individuality
 Mental Well-Being
 Lack of a mental disorder
 Cultural and religious considerations

Maria Jahoda (1963) proposed the following six characteristics of the mentally healthy
individual
 Environmental mastery
 Undistorted perception of reality
 Integration Autonomy
 Growth, self-development and self-actualization
 Attitude towards Self

Models of Mental Illness

 Spiritual Model
 Moral Character Model
 The Statistical Model
 The Disease/ Medical/ Biological Model
-Genetics
-Neuroimaging
-Neurobiology
 Psychological Models
-Psychodynamic Model
-The Behavioural Model
 The Cognitive-behavioural Model
-Existential / Humanistic Model
 The Social Model
 Psychosocial Model
-The Social Learning Model
 Family Therapy Model
 Biopsychosocial Model

Spiritual Model
The first and oldest explanatory system for mental illness is spiritual. From a
traditional spiritual perspective, consciousness is seen as resulting from or deeply
connected to some supernatural force. Usually, there is a religious narrative that
explains that there are good and bad forces in the world, and that suffering is a function
of either being possessed by the bad, or through the idea that the afflicted have fallen
out of favor with the good. This generally occurs because of sin or related concept of
immoral behavior that leads to some form of badness or contamination.

Moral Character Model

The second explanatory system for mental illness is moral character. In a
nutshell, the position of moral character is that there are virtues which one must learn,
such as courage and fortitude, honesty and integrity, compassion and grace that enable
on to live the admirable life.

The Statistical Model

Derived more from mathematics than from psychology, the statistical model
concentrates on the definition of abnormality. According to this approach, abnormality is
any substantial deviation from a statistically calculated average. Those who fall within
the Golden mean‖ i.e. in short, those who do what most people do, are normal, while
those whose behaviour differs from those of the majority are abnormal.

The Medical Model

The medical model attributes mental abnormalities to physiological, biochemical,
or genetic causes and attempts to treat these abnormalities by way of medically
grounded procedures such as psychopharmacology (drug therapy), electroconvulsive
therapy (ECT), or psychosurgery (brain surgery).

Genetic
Genetic models of mental disorder suggest that psychopathology is inherited
from parents, and there is certainly evidence for the familial transmission of many
disorders.

Neuroimaging
This system explains causation of mental illness in terms of structural changes in
different parts of brain. It suggests that in various mental illness certain ventricular
atrophy, volumetric changes, reduction in cortical volume can be seen which may be
one of the various contributory factors behind the causation of illness.
Neurobiology

Here the belief is that the human is an organism that consists of natural functions
designed by nature (i.e., natural selection operating on genetics) and mental illness is
the breakdown of such functions. Thus, just as a heart attack is a biological disease
characterized by the breakdown of the functioning of the circulatory system, mental
illness stems from malfunctioning neurophysiological processes.

Psychological Models
An important explanatory system for mental illness is psychological in nature.
The general model here is that the individual develops along a path and attempts to
adapt to their environment. However, if the individual fails to learn certain crucial
elements or learns the wrong responses to new situations or adopts short term solutions
that have long term maladaptive consequences, then suffering and dysfunction result.
 Psychodynamic Model
 The Behavioural Model
 The Cognitive-behavioural Model
 Humanistic / Existential Model

Psychodynamic Model
The core assumption of this approach is that the roots of mental disorders are
psychological. They lie in the unconscious mind and are the result the failure of defense
mechanisms to protect the self (or ego) from anxiety. Problems are determined by the
history of a person’s prior emotional experiences, especially the childhood ones or to be
more specific, the negative childhood experiences.

The Behavioural Model

This system believes that, only the study of directly observable behavior, the stimuli and
reinforcing conditions that control it could serve as a basis for understanding human,
behaviour, normal or abnormal. The behavioural perspective is organized around a
central theme: the role of learning in human behaviour.

The Cognitive-behavioural Model

The cognitive model understands mental disorder as being a result of errors or
biases in thinking. It explains how thoughts and information processing can become
distorted and leads to maladaptive emotions and behaviour. Our view of the world is
determined by our thinking, and dysfunctional thinking can lead to mental disorder.
Therefore, to correct mental disorder, what is necessary is a change in thinking.

Humanistic / Existential Model

The humanistic model sees mental health problems as a signal that an individual
is failing to reach his or her potential and that psychological growth has stopped. The
humanistic perspective views human nature as ―basically good‖. It emphasizes
present conscious processes – paying less attention to unconscious processes and
past causes – and places strong emphasis on each person’s inherent capacity for
responsible self-direction. Its emphasis is thus on growth and self-actualizing rather
than on curing diseases or alleviating disorders. The humanistic model does not believe
in labeling people by diagnosing them as having specific mental disorders.

The Social Model

The social model suggests that the ways in which societies are organized, not
just biological and psychological characteristics of individuals, must be considered as
causal factors in mental illness. It does not argue that people should not be held
responsible for their behaviour because they are victims of ―society‖, but they do
suggest that social structure imposes restrictions on behaviour as surely as biological
inheritance and that the effects of social conditions on mental illness need to be
understood, to explain both individual distress and how that distress might be related to
larger forces. The social model regards social forces as the most important
determinants of mental disorder.

Psychosocial Model
This model explains the causation of mental illness due to the effect of interaction
of psychological and social factors. Psychosocial factors are those developmental
influences that may handicap a person psychologically, making him or her less
resourceful in coping with social events.

There are four basic categories of psychosocial causal factors:

 Early deprivation or trauma
 Inadequate parenting styles
 Marital discord and divorce
 Maladaptive peer relationship
 The Social Learning Model:

Family Therapy Model

Laing & Esterson (1964) were among the first British writers to express the view that
individuals with mental illness were the victims of a pathological family process. Family
therapy usually begins by an approach that encourages all members of the family to
work together in resolving the conflict. The process is designed to identify and change
relationships where necessary. Attention is paid to family interactions, especially to
alignments and discord and the engagement and disengagement of the different group
members.
 Double Bind
 Schisms and Skewed Families
 Pseudomutual and Pseudohostile Families
 Expressed Emotion

Biopsychosocial Model

Integration of:
 Biological
 Social
  Psychological (Esp. cognitive & behavioral)

Abnormality caused by:

 Interaction of these factors – no one cause
 Relative importance of each factor depends on individual and environment

Explanations of mental illness:

 Diathesis / Stress
 Physiological, sociocultural or genetic predisposition to develop disorder
 Stressor that triggers manifestation of disorder
Conclusion
 Current trends in delivery of care emphasize a collaborative team approach
 The diverse explanations provide a range of models that influence and direct
current approaches in the treatment and management of people with mental
health problems. The dominance of the biomedical model is increasingly being
challenged by other professional groups.
https://www2.slideshare.net/SudarshanaDasgupta/models-of-mental-health-illness