Theories, Principles, and Practice of Psychiatric-Mental Health Nursing
Core Theoretical Foundations
Psychiatric-mental health nursing draws on multiple theories to guide assessment and intervention. Candidates must understand:
- Psychoanalytic theory (Freud): id, ego, superego; defense mechanisms as unconscious coping. Questions often ask you to identify the defense mechanism in a scenario (e.g., denial, projection, rationalization).
- Interpersonal theory (Sullivan): behavior is driven by the need for security and interpersonal relationships; anxiety arises from threats to self-esteem.
- Humanistic theory (Maslow, Rogers): hierarchy of needs; self-actualization; unconditional positive regard.
- Behavioral theory (Pavlov, Skinner): conditioning; reinforcement; used in behavior modification.
- Cognitive theory (Beck): thoughts influence feelings and behaviors; cognitive distortions.
- Developmental theories (Erikson, Piaget): stage-based tasks; important for age-specific interventions.
Nursing Models and Principles
- Peplau’s interpersonal relations model: orientation, working, termination phases; nurse as resource, counselor, teacher.
- Therapeutic nurse-patient relationship: empathy, genuineness, unconditional positive regard; boundaries; confidentiality.
- Milieu therapy: structured environment promoting safety and social skills.
- Recovery model: hope, empowerment, person-centered care.
Traps in Questions
- Confusing defense mechanisms: e.g., denial (refusing to accept reality) vs. projection (attributing one’s own unacceptable feelings to others).
- Mixing up transference (patient projects feelings onto nurse) and countertransference (nurse projects feelings onto patient).
- Overlooking developmental stage when selecting interventions.
Worked Example
A patient with cancer insists the test results are wrong and refuses to discuss advance care planning. Which defense mechanism is being used? Answer: Denial. Rule of thumb: if the patient rejects an obvious reality, think denial; if they accuse others of the same feeling, think projection.