THEORETICAL MODELS USED IN MENTAL HEALTH NURSING

This module aligns with APNA’s “Growth & Development” specific core nursing content (American Psychiatric Nurses Association Education Council, Undergraduate Branch, 2022).

Module Outline

• Utilizing Theory to Conceptualize and Prioritize Mental Health Nursing Care

Module Learning Outcomes

• Review Leininger’s Theory of Culture Care Diversity and Universality
• Describe Sigmund Freud’s Personality Development
• Describe Ego Defense Mechanisms
• Describe Maslow’s Hierarchy of Needs
• Describe Erik Erikson’s Psychosocial Stages of Development

Leininger’s Theory of Culture Care Diversity and Universality

Dr. Madeleine Leininger’s Theory of Culture Care Diversity and Universality (Transcultural Nursing Society, 2022) supported a holistic view of health. Dr. Leininger’s Sunrise Enabler incorporated the physiological, psychological, spiritual, social, and cultural facets of health in addition to other social determinants of health (Transcultural Nursing Society, 2022). Social determinants of health are environmental components such as neighborhood, education and access to education, employment, and healthcare access that affect individuals’  health, outcomes, and health risks (Office of Disease Prevention and Health Promotion, 2021).

See Dr. Leininger’s Sunrise Enabler here (Transcultural Nursing Society, 2022)

Sigmund Freud’s Personality Development      

According to Freud, our personality has three parts – the id, superego, and ego, and from these, our behavior arises. First, the id is the impulsive part that expresses our sexual and aggressive instincts. It is present at birth, completely unconscious, and operates on the pleasure principle, resulting in selfishly seeking immediate gratification of our needs no matter what the cost. The second part of personality emerges after birth with early formative experiences and is called the ego. The ego attempts to mediate the desires of the id against the demands of reality, and eventually, the moral limitations or guidelines of the superego. It operates on the reality principle, or an awareness of the need to adjust behavior, to meet the demands of our environment. The last part of the personality to develop is the superego, which represents society’s expectations, moral standards, rules, and represents our conscience. The three parts of personality generally work together well and compromise, leading to a healthy personality, but if the conflict is not resolved, intrapsychic conflicts can arise and lead to mental disorders.

Ego Defense Mechanisms

Ego-defense mechanisms are in place to protect us and therefore can be adaptive coping mechanisms. However, ego-defense mechanisms are considered maladaptive coping mechanisms if they are misused and become our primary way of dealing with stress. They protect us from anxiety and operate unconsciously by distorting reality. Defense mechanisms include the following:

• Repression – When unacceptable ideas, wishes, desires, or memories are blocked from consciousness such as forgetting a horrific car accident that you caused. Eventually, though, it must be dealt with or the repressed memory can cause problems later in life.
• Reaction formation – When an impulse is repressed and then expressed by its opposite. For example, you are angry with your boss but cannot lash out at him, so you are super friendly instead. Another example is having lustful thoughts about a coworker that you cannot express because you are married, so you are extremely hateful to this person.
• Displacement – When we satisfy an impulse with a different object because focusing on the primary object may get us in trouble. A classic example is taking out your frustration with your boss on your wife and/or kids when you get home. If you lash out at your boss, you could be fired. The substitute target is less dangerous than the primary target.
• Projection – When we attribute threatening desires or unacceptable motives to others. An example is when we do not have the skills necessary to complete a task, but we blame the other members of our group for being incompetent and unreliable.
• Sublimation – When we find a socially acceptable way to express a desire. If we are stressed out or upset, we may go to the gym and box or lift weights. A person who desires to cut things may become a surgeon.
• Denial – Sometimes, life is so hard that all we can do is deny how bad it is. An example is denying a diagnosis of lung cancer given by your doctor.
• Identification – When we find someone who has found a socially acceptable way to satisfy their unconscious wishes and desires, and we model that behavior.
• Regression – When we move from a mature behavior to one that is infantile. If your significant other is nagging you, you might regress by putting your hands over your ears and saying, “La la la la la la la la…”
• Rationalization – When we offer well-thought-out reasons for why we did what we did, but these are not the real reasons. Students sometimes rationalize not doing well in a class by stating that they are not interested in the subject or saying the instructor writes impossible-to-pass tests.
• Intellectualization – When we avoid emotion by focusing on the intellectual aspects of a situation such as ignoring the sadness we are feeling after the death of our mother by focusing on planning the funeral.

Abraham Maslow’s Hierarchy of Needs

Abraham Maslow’s Hierarchy of Needs can be used to understand individuals’ holistic health needs and prioritize nursing care. The needs are represented in a pyramid of five levels, where the base is basic needs and progresses upwards to higher needs (i.e., self-actualization) (Toney-Butler & Thayer, 2022). Individuals will be motivated to attend to basic needs until those needs are met (Toney-Butler & Thayer, 2022). After basic needs are met, individuals may focus on higher-level needs (Toney-Butler & Thayer, 2022).

Erik Erikson Psychosocial Stages of Development

Erik Erikson described eight psychological and social stages of development that enable psychosocial growth and development (Videbeck, 2020).

Adapted from Fundamentals of Psychological Disorders 2nd Edition- Module 2 by Alexis Bridley, Ph.D. and Lee W. Daffin Jr., Ph.D. licensed under a Creative Commons Attribution 4.0 International License. Modifications: revised for clarity and flow .