B.F. Skinner’s behavioral theory Behavioral theories supply techniques that patients can use to modify or replace behaviors. This is an important concept in psychiatric nursing management and is the basis of several approaches that research has shown to be successful in altering specific behaviors. B. F. Skinner, a prominent behaviorist, researched operant conditioning , the process through which consequences and reinforcements shape behaviors. Behavioral therapy is grounded in the assumption that maladaptive behaviors can be changed, and positive and negative reinforcements can be used to help modify behavior. Aaron Beck’s cognitive behavioral therapy Whereas behaviorists focus on the belief that behaviors can be changed, other researchers focus on cognition or thoughts involved in behaviors. Aaron Beck developed cognitive behavioral therapy after working with depressed patients. Cognitive behavioral therapy is based on cognitive psychology and behavioral therapy. Beck believed that depression was the Humanistic Theories Humanistic theories focus on the potential and the free will of patients. These theories emphasize self-actualization, the highest potential and productivity that an individual can achieve in life. For example, Abraham Maslow believed that motivation is driven by a hierarchy of needs that leads to becoming the
Behavioral therapy is often used in treating people with phobias, alcoholism, and anxiety. Another type of behavioral therapy is modeling, in which the therapist or nurse role-plays specific behaviors so that the patient can learn through imitation. Role-playing allows the patient to practice modeled behaviors in a safe environment. Another form of behavioral therapy is systematic desensitization, which targets a patient’s specific fears and proceeds in a step-by-step manner to alleviate those fears with the help of relaxation techniques (Keltner, 2018). result of distorted thinking processes and negative self-concept (https://www.ncbi.nlm.nih.gov/books/NBK470241/). Using this approach, the nurse can help the patient identify negative thought patterns and then help the patient recondition these cognitive distortions into more appropriate beliefs that are based on facts (https://www.ncbi.nlm.nih.gov/books/NBK470241/). best person possible. This model allows the nurse to work with the patient to create an individualized care plan based on the current hierarchical needs of the patient https://www.ncbi.nlm. nih.gov/pmc/articles/PMC4130906/.
THE STRESS-DIATHESIS MODEL
The Stress-Diathesis Model was originally developed to explain schizophrenia during the 1960s, but later adapted to study depression during the 1980s (Colodro-Conde, et.al, 2018). According to this model, stress activates certain vulnerabilities
(diathesis), which predisposes the individual to psychopathology. This model has been criticized for its vagueness, yet these principles are used to understand other psychiatric disorders.
BIOLOGICAL MODEL
Mental health nurses also attend to the physical needs of psychiatric patients. The nurse may administer prescribed medication, nutrition, and hydration to ensure optimal physiological functioning of the patient. The biological model of mental illness focuses on the chemical, biological, and genetic makeup of mental illness. This model seeks to understand how the body and brain interact to create experiences and emotions, and how social, environmental, cultural, spiritual, and educational factors influence individuals (Halter, 2018). All the theories discussed in this section play a vital role in how the nurse cares for the patient with a mental health disorder.
Self-Assessment Quiz Question #1 Which best describes Aaron Beck’s Contribution to the mental health profession? a. Hierarchy of needs. b. Cognitive behavioral therapy.
c. Empathetic linkages. d. Operant conditioning.
ETHICAL, LEGAL, AND CULTURAL CONSIDERATIONS
A thorough understanding of general ethical principles is necessary to make reasonable, fair, and sound judgments in providing care. Nurses who choose to work in the specialty of mental healthcare will encounter ethical questions on almost a daily basis. Issues such as autonomy, confidentiality, patient protection, therapeutic relationships, mental health competency, and mental health admissions are particularly complicated. To better guide the nurse in making ethical choices, an understanding of the American Nurses Association Code of Ethics and the five basic principles of bioethics is useful.
The term ethics refers to an individual’s beliefs about right and wrong and societal standards regarding right and wrong. Bioethics refers to ethical questions related specifically to healthcare (Halter, 2018). Ethics are linked to cultural values. Societal standards and values can be determined only within a specific group. However, fundamental principles of ethics exist in all cultures and are inherent in all human beings. Understanding how cultures view mental illness and the accompanying patient symptoms can influence how decisions, particularly ethical decisions, are made. Nurses can be an instrumental part of effective decision making when cultural values and societal standards differ. American Nurses Association Code of Ethics The American Nurses Association (ANA) established an ethical standard for the nursing profession that guides ethical analysis and decision making (ANA, 2015). Ethics is a branch of philosophy where one reflects on morality, which is the person’s character, values, and conduct in a particular situation (ANA, 2015). The Code of Ethics is the foundation for nursing theory and practice where values and obligations shape the nursing profession (ANA, 2015). This living document changes based on nursing’s social context, with a revision occurring at minimum
every 10 years (ANA, 2015). The ANA Code divides ethical issues into nine provisions, based on general ethical principles: ● Provision 1 ○ The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person, including self-determination (ANA, 2015).
● Provision 2 ○
The nurse’s primary commitment is to the patient, whether an individual, family, group, community or population (ANA, 2015).
Book Code: ANCCUS3023
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