NCMA110 FINALS

11
Dr. Ma. Luisa Uayan / First Semester
Transcriber: Kathleen Venus 22

NON-NURSING THEORIES RELEVANT TO NURSING PRACTICE

OUTLINE
I. Maslow’s Hierarchy of Needs
II. Interpersonal Theories: Harry Stack Sullivan
A. Harry Stack Sullivan
B. Interpersonal Behavior
C. Sullivan’s take on Psychiatry
i. Child’s Sense of Self
ii. Psychotherapy
III. General Systems Theory: Ludwig Von Bertalanffy
A. Ludwig Von Bertalanffy
B. General Systems Theory
i. Assumptions
ii. Characteristics
iii. Holistic View
iv. Principles and Application to Nursing
C. The Revolution of General Systems Theory to
sfdNursing
i. Conceptual Framework
IV. Change Theory of Nursing: Kurt Lewin
A. Kurt Lewin
B. Change Theory
i. Nursing Process
V. Developmental Theories: Erik Erikson
A. Key Insights
B. Erik Erikson
C. Stages of Psychosocial Development
VI. Cognitive Stages of Development: Jean Piaget
VII. Psychoanalytic Theory: Sigmund Freud
A. Psychoanalytic Theory
i. Psychosexual Stages of Development
VIII. Moral Development: Lawrence Kohlberg
A. 3 Levels of Moral Reasoning
IX. Social Cognitive Theory: Albert Bandura
A. Learning Through Observation
i. The BOBO Doll Experiment
ii. Types of Models
iii. Observational Learning
iv. Factors that influence Modeling
v. Reinforcement in Observational Learning
B. Aggression & Inhumane Behavior
C. Moral Disengagement & Self-Efficacy
D. The Essence of Social Cognitive Theory
MASLOW’S HIERARCHY OF NEEDS
- Maslow's hierarchy of needs is a motivational theory
in psychology comprising a five-tier model of human
needs, often depicted as hierarchical levels within a
- Maslow (1943) initially stated that individuals must
satisfy lower-level deficit needs before progressing on to
meet higher-level growth needs. However, he later
clarified that satisfaction of a need is not an “all-or-none”
phenomenon, admitting that his earlier statements may
have given “the false impression that a need must be
satisfied 100 percent before the next need emerges”
- When a deficit need has been 'more or less satisfied
it will go away, and our activities become habitually
directed towards meeting the next set of needs that we
have yet to satisfy. These then become our salient
needs. However, growth needs continue to be felt and
may even become stronger once they have been
engaged.
- The more we learn about man’s natural tendencies,
the easier it will be to tell him how to be good, how to be
happy, how to be fruitful, how to respect himself, how to
love, how to fulfill his highest potentialities … The thing to
do seems to be to find out what one is really like inside;
deep down, as a member of the human species and as a
particular individual
1. Physiological Needs
- these are biological requirements for human
survival, e.g. air, food, drink, shelter, clothing, warmth,
sex, and sleep
- If these needs are not satisfied the human body
cannot function optimally. Maslow considered
physiological needs the most important as all the other
needs become secondary until these needs are met
2. Safety Needs
- Once an individual’s physiological needs are
satisfied, the needs for security and safety become
salient. People want to experience order, predictability,
and control in their lives. These needs can be fulfilled by
the family and society (e.g. police, schools, business, and
medical care)
- For example, emotional security, financial security
(e.g. employment, social welfare), law and order,
freedom from fear, social stability, property, health, and
wellbeing (e.g. safety against accidents and injury).
3. Love & Belongingness Needs
- after physiological and safety needs have been
fulfilled, the third level of human needs is social and
involves feelings of belongingness. The need for
interpersonal relationships motivates behavior
- Examples include friendship, intimacy, trust, and
acceptance, receiving and giving affection and love.
Affiliating, being part of a group (family, friends, work)
4. Esteem Needs
- the fourth level in Maslow’s hierarchy which Maslow
classified into two categories:
o Esteem for oneself: dignity, achievement,
mastery, independence
o The desire for reputation or respect from
others: e.g., status, prestige
- Maslow indicated that the need for respect or
reputation is most important for children and adolescents
and precedes real self-esteem or dignity
5. Self-actualization Needs
- are the highest level in Maslow's hierarchy, and
refer to the realization of a person's potential, self-
fulfillment, seeking personal growth and peak
experiences.
- Maslow (1943) describes this level as the desire to
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accomplish everything that one can, to become the most

pyramid. that one can be
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INTERPERSONAL THEORIES: - the therapist is not a disembodied spirit but rather
HARRY STACK SULLIVAN affects the patient in significant ways that have to be
taken into consideration.
One’s personality involves more than individual
- The therapist must be a “participant observer” in the
characteristics, particularly how one interacts with
sense that he must both interact with the patient and, at
others
the same time, monitor the interaction from the
standpoint of an outside, objective observer
HARRY STACK SULLIVAN - The closest most of us come to true communication
- was an American psychiatrist who extended the is what Sullivan called the “syntaxic” mode, the situation
theory of personality development to include the when both individuals are using the same words to mean
significance of interpersonal relationships. the same things. But this type of communication is
- Sullivan established five life stages of development impeded by two other modes of interpreting another
each focusing on various interpersonal relationships: person's meaning.
o infancy - What the other individual says is always interpreted
o childhood in the context of how he says it—his facial expression,
o juvenile tone of voice, and gestures. This mode of interpretation
o preadolescence Sullivan calls “prototaxic.” In addition, what the other
o adolescence individual says is also interpreted in terms of who he is—
Definition of Malleability of Source of the same words coming from a child and from an adult
Personality Personality Threats are interpreted in quite different ways. When a remark is
Personality so interpreted, Sullivan speaks of the “parataxic” mode.
“relatively
Importance of
enduring pattern “Illusion of PSYCHOTHERAPY
“chums”
of recurrent individuality”
(peers) - seeks to help people overcome their prototaxic and
interpersonal
parataxic distortions so that they can arrive at a correct,
situations”
or syntaxic,understanding of other persons' expressions.
Healthy/ The process of arriving at this correct understanding of
We become Unhealthy other people is what Sullivan called “consensual
Interpersonal “different” psychological validation.”
theory of people in development due - The aim of therapy is to do the same thing and thus
psychiatry different to help the patient refurbish his sense of self‐esteem and
social situations reactions of respect. While the treatment process is obviously more
peers complex than what has been described here, its aim is
In each situation always to help the individual to the point where his sense
we of positive self-regard outweighs his sense of being
Sullivan blames
imagine how worthless and unhuman.
society
others
for most
think of us and
problems GENERAL SYSTEMS THEORY:
respond
accordingly LUDWIG VON BERTALANFFY
- Nursing theory has drawn from the work of von
INTERPERSONAL BEHAVIOR Bertalanffy on systems theory.
o Newman’s system theory
Negativistic Person
o Roger’s theory
- who feels insecure and inadequate and who
o Roy’s adaptation model
accentuates his own significance by constantly
o Imogene king’s theory
disagreeing with others.
o Orem’s self-care deficit theory
Self-Absorbed People
o Johnson’s behavior system theory
- in Sullivan's scheme, are those who relate to others
on an all‐or‐nothing basis:
- “People whom I like are all good while people whom LUDWIG VON BERTALANFFY
I dislike are all bad.” - Systems theory was proposed in the 1940s by the
- In each case, the person must be described by his biologist Ludwig von Bertalanffy and furthered by Ross
typical ways of relating to other people, not by a list of Ashby (1964).
self‐ contained symptoms. - Von Bertalanffy was reacting against both
reductionism and attempting to revive the unity of
SULLIVAN’S TAKE ON PSYCHIATRY science.
- He is considered to be the founder and principal
- Sullivan wanted psychiatry to emphasize man's
author of general systems theory.
humanness, the fact that man's feelings, motives,
thoughts, and values are uniquely human and have no
counterpart at the animal level. GENERAL SYSTEMS THEORY
- This theory may be considered a specialization of
CHILD’S SENSE OF SELF Systems Thinking and a generalization of Systems
Science
- If this caretaker is loving, comforting and meets the
- General Systems Theory is a General Science of
infant's needs, the infant has a generalized feeling of
“Wholeness”
“good me”
- This Theory also has been applied in developing
- if the caretaker is anxious, tense, and rejecting, this
Nursing Theories and conducting Nursing Research
too is communicated to the infant, who experiences a
o System: a set consisting of integrated,
generalized feeling of “bad me”
interesting parts or components that
- The caretaker communicates to the infant primarily
function as a whole. Each part is
by means of a process that Sullivan calls “empathy.”
necessary to make a complete and
Sullivan was the first to recognize that:
meaningful whole.
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ASSUMPTIONS
- All systems must be goal-directed
- A system is more than the sum of its parts
- A system is ever-changing, and any change in one
part affects the whole
CHARACTERISTICS
- SYSTEMS refer specifically to Self Regulating
Systems
- SYSTEMS are Self Correcting through Feedback
- SYSTEMS have a structure that is defined by its
parts and process
- SYSTEMS are Generalizations of Reality
- Every living organism is essentially an Open System
HOLISTIC VIEW
- SYSTEMS THEORY is focused on the arrangement
of and relationship between the parts which connect
them as a Whole.
- A mutual interaction of the parts makes the Whole
bigger than the parts of themselves
PRINCIPLES AND APPLICATION TO NURSING
1. The Principle of Wholeness
- It is the core of General system theory
- This principle provides guidance or methodology to
us in order that we can study all kinds of objects
effectively.
2. The Principle of Optimization
- The principle of optimization of a system is to
achieve an optimal state in a certain condition and to
perform its best function by organization and coordination
THE REVOLUTION OF GENERAL SYSTEMS
THEORY TO NURSING
- To look at a person with a systematic viewpoint
- The human being is the object of Nursing.
- The human being is a system that is composed of
many elements such as:
o physiological
o psychological
o social
o spiritual
o cultural elements
- The human being is a natural system
o A basic condition of life activities and
health of human beings is harmony and
equilibrium of the internal and external
environment in the human body
o A human being is an open and dynamic
system
o A human being exchanges energy, matter,
and information with its environment
constantly, as well as within its body to
maintain life and health.
o A Human being is an system with a
subjective activity
o A human being is conscious and able to
supervise and control his / her state of
functions
- To understand nursing with a systematic viewpoint
o Nursing system is a system with a
complicated structure
o Nursing system is an open system
o Nursing system is a dynamic system
o Nursing system is with the function of
decision-making and feedback
CONCEPTUAL FRAMEWORK
CHANGE THEORY OF NURSING: KURT LEWIN
KURT LEWIN
- Born on September 1890
- Died on February 1947
- a German-American psychologist known as one of
the modern pioneers of social, organizational, and
applied psychology in the United States.
- During his professional career, Lewin applied
himself to three general topics:
o applied research
o action research
o group communication
- recognized as the "father of social psychology" and
was one of the first to study group dynamics and
organizational development.
- A Review of General Psychology survey, published
in 2002, ranked Lewin as the 18th-most cited
psychologist of the 20th century.
CHANGE THEORY
3 MAJOR CONCEPTS
1. Driving Forces
- are those that push in a direction that causes
change to occur.
- They facilitate change because they push the
patient in a desired direction.
- They cause a shift in the equilibrium towards
change
2. Restraining Forces
- are those forces that counter the driving forces.
- They hinder change because they push the patient
in the opposite direction.
- They cause a shift in the equilibrium that opposes
change
3. Equilibrium
- is a state of being where driving forces equal
restraining forces, and no change occurs.
- It can be raised or lowered by changes that occur
between the and restraining forces
UNFREEZING STAGE
- is the process which involves finding
a method
of making it possible for people to let go of
an old pattern
that was somehow counterproductive.
- It is necessary to overcome the
strains of individual resistance and group
conformity.
3 METHODS THAT CAN LEAD TO THE ACHIEVEMENT
OF UNFREEZING
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1. to increase the driving forces that direct behavior
away from the existing situation or status quo
[NCMA110] 1.11 NON-NURSING THEORIES RELEVANT TO NURSING PRACTICE – Dr. Ma. Luisa Uayan
2. decrease the restraining forces that negatively
affect the movement from the existing equilibrium
3. finding a combination of the first two methods
CHANGE STAGE
- also called "moving to a new level" or
"movement," involves a process of change
in thoughts, feeling, behavior, or all three,
that is in some way more liberating or more
productive.
REFREEZING STAGE
- is establishing the change as the new
habit, so that it now becomes the
"standard operating procedure." Without
this final stage, it can be easy for the
patient to go back to old habits
THE NURSING PROCESS
- Theory and phases are interrelated and used in the
nursing process:
1. Assessment
- Lewin’s Unfreezing stage
2. Planning & Implementation
- Lewin’s change/ moving stage
3. Implementation & Evaluation
- Refreezing stage
PSYCHOANALYTIC THEORY: SIGMUND FREUD
DEVELOPMENTAL THEORIES: ERIK ERIKSON
- present systematic ways of thinking about how
human beings grow from babies to adolescents to adults
to elderly people, and the various changes they undergo
as they make this passage.
- Different developmental theories describe different
types of changes.
KEY INSIGHTS
1. Development is best understood as progress
through an ordered series of increasingly complex
progressive stages.
2. Early developmental delays (interrupting progress
towards a particular stage) threaten the developing
person's overall progress
3. Uneven or incomplete development in any
important life domain can lead to serious life
problems. It is important to identify and correct
developmental delays while they are first occurring
and as soon as possible, so as to minimize the
cumulative damage that delays may cause.
ERIK ERIKSON
- was a German-born psychoanalyst who extended
Freud’s work on personality development across the life
span while focusing on social and psychological
development in the life stages.
- In his view, psychosocial growth occurs in
sequential phases, and each stage is dependent on the
completion of the previous stage and life task.
STAGES OF PSYCHOSOCIAL DEVELOPMENT
COGNITIVE STAGES OF DEVELOPMENT:
JEAN PIAGET
- Jean Piaget explored how intelligence and cognitive
functioning develop in children.
- He believed that human intelligence progresses
through a series of stages based on age, with the child at
each successive stage demonstrating a higher level of
functioning than at previous stages.
- Sigmund Freud (1856-1939) developed
psychoanalytic theory in the late 19th and early 20th
centuries in Vienna, where he spent most of his life.
- Freud believed that repressed (driven from
conscious awareness) sexual impulses and desires
motivate much human behavior.
PSYCHOANALYTIC THEORY
Personality Components
- Freud conceptualized personality structure as
having three components:
o Id: is the part of one’s nature that reflects
basic or innate desires such as pleasure
seeking behavior, aggression, and sexual
impulses.
o Ego: that portion of the human personality
which is experienced as the “self” or “I”
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and is in contact with the external world
through perception.
[NCMA110] 1.11 NON-NURSING THEORIES RELEVANT TO NURSING PRACTICE – Dr. Ma. Luisa Uayan
o Superego: is the part of a person’s nature
that reflects moral and ethical concepts, SOCIAL COGNITIVE THEORY: ALBERT BANDURA
values, and parental and social - emphasizes that learning occurs in a social context
expectations, therefore it is in direct and that much of what is learned is gained through
opposition to the id. observation.

PSYCHOSEXUAL STAGES OF DEVELOPMENT LEARNING THROUGH OBSERVATION

*Most human behavior is learned observationally
The mouth: through modeling…” –Albert Bandura, 1977
EGO
Oral sucking,
DEVELOPS
swallowing, etc THE BOBO DOLL EXPERIMENT
The anus: - The Bobo Doll experiment confirmed that people
Anal Withholding or learn/ imitate behaviors that they observe (or have
expelling feces observed) in other people
The penis or
SUPEREGO
Phallic clitoris:
DEVELOPS TYPES OF MODELS
Masturbation
1. A Live Model
Little or no
2. Verbal Instruction Model
Latent sexual motivation
3. Symbolic (fictional character)
present
The penis or
vagina: OBSERVATIONAL LEARNING
Genital - In his early writing, Bandura emphasizes the power
Sexual
intercourse and pervasiveness of social modeling and the process of
learning through observation
- Bandura suggests that observational learning
MORAL DEVELOPMENT: LAWRENCE KOHLBERG
occurs either intentionally or accidentally
- Psychologist Lawrence Kohlberg (1927–1987) - Observational learning is done through imitation or
extended upon the foundation that Piaget built regarding modeling.
cognitive development.
- Kohlberg believed that moral development, like
FACTORS THAT INFLUENCE MODELING
cognitive development, follows a series of stages.
- Kohlberg reviewed people’s responses and placed Characteristics of the Model
them in different stages of moral reasoning. • We are more likely to be influenced by someone
- According to Kohlberg, an individual progresses who we believe is similar to ourselves rather than
from the capacity for preconventional morality (before by someone who is different.
age 9) to the capacity for conventional morality (early • According to research, people who are physically
adolescence), and toward attaining post-conventional attractive influence more people.
morality (once formal operational thought is attained), Attributes of the Observer
which only a few fully achieve. • People who are lacking in self-esteem or who are
3 LEVELS OF MORAL REASONING incompetent are especially prone to follow the
structure and style of the model.
Stage 1: Punishment and
obedience orientation: • A highly motivated individual will also emulate a
Doing what is right because model in order to master a desired behavior.
of fear of punishment • Reward consequences associated with the behavior
Level 1
Stage 2: Hedonistic • Participants are more likely to emulate a behavior if
Pre-Morality they believe that such actions will lead to positive
orientation:
Doing what is right for short- or -long term results.
personal gain, perhaps a
reward
Stage 3: Interpersonal
concordance orientation:
Doing what is right
according to the majority to
Level 2 be a good boy/girl
Conventional Morality Stage 4: Law and Order
Orientation:
Doing what is right because
it is your duty and helps
society
Stage 5: Social contract or
legalistic orientation:
Doing what is right even if it
is against the law because REINFORCEMENT IN OBSERVATIONAL
the law is too restrictive LEARNING
Level 3 Step 6: Universal Ethical Extrinsic Reinforcement
Post-conventional Principles Orientation: - Being rewarded with objects and stuff
Morality Doing what is right because o Example: Winning a competition and being
of our inner conscious rewarded with a medal
which has absorbed the Intrinsic Reinforcement
principles of justice and - Being rewarded by the feedback or the outcome of
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equality and sacredness of the behavior done

life.
[NCMA110] 1.11 NON-NURSING THEORIES RELEVANT TO NURSING PRACTICE – Dr. Ma. Luisa Uayan
o Example: Playing a difficult piece of music
well leads to feeling of accomplishment
- Self-satisfaction
Vicarious Reinforcement
- Is learning by observing others
- If people can learn by watching, they must be
focusing their attention, construct images, remember,
analyze, and make decisions that affect learning.
o Example: A child who sees a sibling being
spanked for a misdemeanor quickly learns
not to do the same thing.
Self-Reinforcement
- Controlling your own reinforces
- This reinforcement is important for both students
and teachers
- We want our students to improve not because it
leads to external rewards, but because the students
value and enjoy their growing competence
o Example: One runner might be satisfied by
completing a mile in five minutes; another
would want to finish it in less time

AGGRESSION & INHUMANE BEHAVIOR

Multiple Effects of Violence
- Overwhelming of the nervous system
- Aggressive style behavior
- Desensitization or habituation of
- viewers to violence (emotional numb)
- Shaping the image of reality (distorted)

MORAL DISENGAGEMENT & SELF-EFFICACY

Self-Efficacy
- Is defined as the people’s belief that they can
successfully perform behaviors that will produce desired
effects.
- Central mechanism of self-regulation
- Govern our thoughts, motivations, and actions

THE ESSENCE OF SOCIAL COGNITIVE THEORY

- Social influences shaped our behavior
- Humans are products of learning
- Emotional arousal stemming from aversive
experiences motivates aggression
- Observational models may strengthen or weaken
every existing response.

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