Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences Theories Relevant to Nursing Practice 1. ABRAHAM MASLOW’S HUMAN NEEDS THEORY According to Maslow, we have five categories of needs: physiological, safety, love, esteem, and selfactualization. In this theory, higher needs in the hierarchy begin to emerge when people feel they have sufficiently satisfied the previous need. Although later research does not fully support all of Maslow’s theory, his research has impacted other psychologists and contributed to the field of positive psychology. Maslow’s Hierarchy of Needs To better understand what motivates human beings, Maslow proposed that human needs can be organized into a hierarchy. This hierarchy ranges from more concrete needs such as food and water to abstract concepts such as self-fulfillment. According to Maslow, when a lower need is met, the next need on the hierarchy becomes our focus of attention. Maslow (1954) proposed that human beings possess two sets of needs. This five-stage model can be divided into deficiency needs and growth needs. The first four levels are often referred to as deficiency needs ( Dneeds), and the top level is known as growth or being needs (B-needs). Deficiency needs are concerned with basic survival and include physiological needs (such as the need for food, sex, and sleep) and safety needs (such as the need for security and freedom from danger). Behaviors associated with these needs are seen as ‘deficiency’ motivated, as they are a means to an end. Deficiency needs arise due to deprivation and are said to motivate people when they are unmet. Also, the motivation to fulfill such needs will become stronger the longer they are denied. For example, the longer a person goes without food, the more hungry they will become. Growth needs are more psychological and are associated with realizing an individual’s full potential and needing to ‘self-actualize’. These needs are achieved more through intellectual and creative behaviors. Growth needs do not stem from a lack of something but rather from a desire to grow as a person. Once these growth needs have been reasonably satisfied, one may be able to reach the highest level, called self-actualization. Growth needs are achieved more through intellectual and creative behaviors. Although Maslow presented his needs in a hierarchy, he also acknowledged that meeting each need is not an all-or-nothing phenomenon. Consequently, people don’t need to completely satisfy one need for the next need in the hierarchy to emerge. Maslow suggests that, at any given time, most people tend to have each of NCM 100 l THEORIES RELEVANT TO NURSING their needs partly met—and that needs lower on the hierarchy are typically the ones that people have made the most progress towards. Additionally, Maslow pointed out that one behavior might meet two or more needs. For example, sharing a meal with someone meets the physiological need for food, but it might also meet the need of belonging. Similarly, working as a paid caregiver would provide someone with income (which allows them to pay for food and shelter), but can also provide them a sense of social connection and fulfillment. The Expanded Hierarchy Of Needs It is important to note that Maslow’s (1943, 1954) fivestage model has been expanded to include cognitive and aesthetic needs (Maslow, 1970a) and later transcendence needs (Maslow, 1970b). 1. Biological and physiological needs – air, food, drink, shelter, warmth, sex, sleep, etc. 2. Safety needs – protection from elements, security, order, law, stability, freedom from fear. 3. Love and belongingness need – friendship, intimacy, trust, and acceptance, receiving and giving affection and love. Affiliating, being part of a group (family, friends, work). 4. Esteem needs – which Maslow classified into two categories: (i) esteem for oneself (dignity, achievement, mastery, independence) and (ii) the need to be accepted and valued by others (e.g., status, prestige). 5. Cognitive needs – knowledge and understanding, curiosity, exploration, need for meaning and predictability. Cognitive needs drive our pursuit of knowledge and understanding. For instance, a student’s desire to understand complex mathematical theories, a traveler’s curiosity about diverse cultures, or an individual’s quest for life’s deeper meanings all exemplify these needs. Meeting these needs facilitates personal growth, comprehension, and a deeper understanding of life and its complexities. 6. Aesthetic needs – appreciation and search for beauty, balance, form, etc. Fulfilling these needs leads to a deeper sense of satisfaction and harmony in life, as individuals seek environments and experiences that are pleasing and resonant with their sense of beauty. This involves the appreciation and pursuit of art, music, nature, and other forms of aesthetic expression. Fulfilling these needs isn’t just about physical beauty but Page 1 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences also the emotional and psychological satisfaction derived from experiencing order and elegance. altruism, spiritual connection, and helping others achieve their potential. Individuals seek experiences that move beyond personal concerns, aiming to achieve a deep sense of unity, understanding, and belonging within the vast expanse of existence. Examples of transcendence needs include mystical experiences and certain experiences with nature, aesthetic experiences, sexual experiences, service to others, the pursuit of science, religious faith, etc.). 7. Self-actualization needs – realizing personal potential, self-fulfillment, seeking personal growth, and peak experiences. 8. Transcendence needs – A person is motivated by values that transcend beyond the personal self. Beyond self-actualization, they represent the human desire to connect with a higher reality, purpose, or the universe. This level emphasizes 2. HARRY STACK SULLIVAN TRANSACTIONAL ANALYSIS (INTERPERSONAL THEORY) People develop their personalities within a social context. Without other people, humans would have no personality. Development rests on the individual’s ability to establish intimacy with another person. Anxiety can interfere with satisfying interpersonal relations. Healthy development entails experiencing intimacy and lust toward another person. Personality Personality is an energy system. ¡ Tension – potentiality for action ¡ Energy Transformations – themselves Tension Anxiety, premonitions, drowsiness, sexual excitement. Not always on a conscious level Partial distortions of reality Two Types: ¡ Needs ¡ Anxiety actions hunger, Needs Tensions are brought about by a biological imbalance between the person and the environment. Episodic Biological component and interpersonal relations. ¡ Zonal Needs – arises from a specific body part. ¡ General Needs – overall well-being of a person. ¡ Tenderness is a basic interpersonal need. Anxiety Disjunctive, diffuse and vague, call forth no consistent action for relief. Transferred through empathy. Chief disruptive force blocking the development of healthy interpersonal relations. ¡ Prevents people from learning from mistakes ¡ Persisting pursuance of childish wish for security NCM 100 l THEORIES RELEVANT TO NURSING ¡ Ensures people will not learn from experience. ¡ Its presence is worse than its absence. Energy Transformations Transformed into either overt or covert actions. Behaviors that satisfy our needs and reduce anxiety. May be observable or hidden from other people (emotions, thoughts) Evolves into dynamism Traits or habit patterns Major Classes: § Related to specific zones of the body § Mouth, anus, genitals § Those related tensions § Disjunctive (Malevolence) § Isolating (Lust) § Conjunctive (Intimacy and Self- System) Malevolence Disjunctive dynamism between evil and hatred. Feeling of living among one’s enemies 2-3 yrs, when child is rebuffed, ignored, or punished. Adoption of malevolent attitude for protection. Timidity, Mischievousness, Cruelty, anti-social behavior. Lust Assumes an isolating tendency. Auto-erotic behavior Hinders an intimate relationship. Increases anxiety and decreases self-worth. Intimacy Close interpersonal relationship between 2 people of equal status. Equal partnership Integrating dynamism that draws out loving reactions from people. Decreases loneliness and anxiety Rewarding experiences most healthy people desire. Page 2 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences Self- System Most complex and inclusive of all dynamism. The consistent pattern of behavior maintains people’s interpersonal security by protecting them from anxiety. The principal stumbling block to favorable changes in personality. Security Operations Levels of Cognition § Refers to ways of perceiving, imagining, and conceiving. § PROTOTAXIC – undifferentiated experiences that are highly personal. § PARATAXIC – communicated to others in a distorted fashion. § Syntaxic – consensually validated and symbolically communicated. Security Operations Reduces feelings of anxiety or insecurity. Two kinds: ¡ Dissociation = includes impulses, desires, and needs that a person refuses to allow into awareness. (dreams) ¡ Selective Inattention = refusal to see things that one does not wish to see. (conscious) Personifications People’s images of themselves or others Begins in infancy and continues throughout development. Bad mother – good mother Similar to Klein’s Good Breast and Bad Breast. Me § Bad Me, Good Me, Not Me § Building Blocks of Self-personification Eidetic Personifications § Imaginary Friends § Projection of traits to other people Psychological Disorders All psychological disorders have an interpersonal origin and must be understood concerning the social environment Deficiencies found in psychiatric patients are found in every person to a lesser degree Psychological difficulties are not unique, but come from the same interpersonal difficulties we all face Two broad classes of schizophrenia ¡ Organic ¡ Situational Psychotherapy A therapist is a participant observer who establishes an interpersonal relationship with the patient and provides an opportunity for syntaxic communication Sullivanian therapists attempt to help patients develop foresight, discover difficulties in interpersonal relations, and restore their ability to participate in consensually validated experiences. STAGES OF DEVELOPMENT NCM 100 l THEORIES RELEVANT TO NURSING Page 3 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 3. VON BERTALANFFY’S GENERAL SYSTEMS THEORY General system theory, therefore, is a general science of wholeness... The meaning of the somewhat mystical expression, “The whole is more than the sum of its parts” is simply that constitutive characteristics are not explainable from the characteristics of the isolated parts. The characteristics of the complex, therefore, appear as new or emergent... The system theory is the transdisciplinary study of the abstract organization of phenomena, independent of their substance, type, or spatial or temporal scale of existence. It is also a management methodology as it is a way of analyzing and thinking about organizations and also an alternative approach Simpler definition says, A theory that sees an organization as a set of interrelated and interdependent parts. The systems theory focuses on understanding the organization as an open system that transforms inputs into outputs. This theory is based on the work of a biologist, Ludwig von Bertalanffy, who believed that a general systems model could be used to unite science. Early contributors to this theory included Kenneth Boulding, Richard Johnson, Fremont Kast, and James Rosenzweig. The systems theory began to have a strong impact on management thought in the 1960s as a way of thinking about managing techniques that would allow managers to relate different specialties and parts of the company to one another, as well as to external environmental factors. The systems theory focuses on the organization as a whole, its interaction with the environment, and its need to achieve equilibrium. CHARACTERISTICS OF SYSTEMS THEORY 1. COMMUNICATION - Communication mechanisms must be in place for organizational systems to exchange relevant information with its environment. Provides for the flow of information among the subsystems. 2. SYSTEMS, SUBSYSTEMS AND SUPERSYSTEM - Systems: set interrelated parts that turn inputs into outputs through processing - Subsystems: do the processing - Super systems: are other systems in the environment 3. BOUNDARIES - Separates the system from its environment - Four types: i. Physical Boundary - prevents access (security system) NCM 100 l THEORIES RELEVANT TO NURSING ii. iii. iv. Linguistic Boundary - specialized language (jargon) Systemic Boundary - rules that regulate interaction (titles) Psychological Boundary 1. GOAL-DIRECTEDNESS - Systems are goal-oriented and engage in feedback to meet the goals of the organization. 2. HOLISTIC VIEW - Systems theory focuses on the arrangement of and relations between the parts that connect them into a whole - The mutual interaction of the parts makes the whole bigger than the parts themselves BASIC ELEMENTS OF A SYSTEM 1. Input. Maintenance Inputs (energic imports that sustain the system). Production Inputs (energic imports that are processed to yield a productive outcome). 2. Throughput. Work is done on those resources used to produce a product. 3. Output. Exit or change exiting the system. The system returns the product 4. Process. Provides a series of mechanical or chemical operations on something to change or preserve it. 5. Feedback. Information about a reaction to a product; Used as the basis for improvement. Can be: o Positive Feedback - move from status quo o Negative Feedback - return to status quo TYPES OF A SYSTEM 1. OPEN SYSTEM. Continuously interacts with the environment. There is an exchange of materials, energies, and information with the environment. 2. CLOSED SYSTEM. Theoretical systems that do not interact with the environment; Not influenced by surroundings Ludwig Von Bertalanffy (1969, 1976) developed general systems theory, which has the following assumptions: a. All systems must be goal-directed. b. A system is more than the sum of its parts. c. A system is ever changing and any change in one part affects the whole. d. Boundaries are implicit and human systems are open and dynamic. Page 4 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences 4. KURT LEWIN’S CHANGE THEORY Change is an inevitable occurrence in any organization, and successful change must be managed. Learn about Lewin's three step model for change management that includes unfreezing, changing and refreezing to transform new behaviors into an organization's new norms. 1. People grow and change throughout their lives. This growth and change are evident in the dynamic nature of basic human needs and how they are met. 2. Change happiness daily. It is subtle, continuous and manifested in both everyday occurrences and more disruptive life events. STAGE 1 - "UNFREEZING" It is a phenomenon that occurs continuously in all living systems, it means alteration in the status Quo. Kurt Lewin (1962) developed the change theory, which identifies the following six components: STAGE 2: CHANGE - OR TRANSITION 1. Recognition of the area where change is needed. 2. Analysis of a situation to determine what forces exist to maintain the situation and what forces are working to change it. 3. Identification of methods by which change can occur. 4. Recognition of the influence of group mores or customs on change. 5. Identification of the methods that the reference group uses to bring about change. 6. The actual process of change. The Unfreezing stage is probably one of the most important stages to understand the world of change we live in today. This stage is about getting ready to change. It involves getting to a point of understanding that change is necessary, and getting ready to move away from our current comfort zone. This first stage is about preparing ourselves, or others, before the change. Unfreezing and getting motivated for the change is all about weighing up the 'pro's' and 'con's' and deciding if the 'pro's' outnumber the 'con's' before you take any action. This is the basis of what Kurt Lewin called the Force Field Analysis. According to him change is not an event, but rather a process. He called that process a transition. Transition is the inner movement or journey we make in reaction to a change. This second stage occurs as we make the changes that are needed. Example- Imagine bungee jumping or parachuting. You may have convinced yourself that there is a great benefit for you to make the jump, but now you find yourself on the edge and get scared. But when you do it you may learn a lot about yourself. Using role models and allowing people to develop their own solutions also help to make the changes. STAGE 3: FREEZING CHANGE PROCESS/ PROCESS CHANGE MANAGEMENT Lewin described change as a three-stage process. This stage is about establishing stability once the changes have been made. The changes are accepted and become the new norm. People form new relationships and become comfortable with their routines. 5. ERIK ERICKSON’S PSYCHOSOCIAL DEVELOPMENT Erik Erikson was an ego psychologist who developed one of the most popular and influential theories of development. While his theory was impacted by psychoanalyst Sigmund Freud's work, Erikson's theory centered on psychosocial development rather than psychosexual development. The stages that make up his theory are as follows: STAGE 1: TRUST VS. MISTRUST (0-1 y/o) ORAL SENSORY The important event is feeding and the important relationship is with the mother. The infant must develop a loving, trusting relationship with the mother/caregiver through feeding, teething and comforting; failure to NCM 100 l THEORIES RELEVANT TO NURSING resolve this conflict can lead to sensory distortion, and withdrawal. This stage is all about fulfilling needs. The baby needs to trust the world around them to take care of their needs. If they are hungry, they need to develop trust that they will be fed. If they are not fed, or their diaper is left dirty, they may develop a mistrust in the outside world. This sense of trust of mistrust can affect us throughout the rest of our lives. STAGE 2: AUTONOMY VS. SHAME AND DOUBT (1 to 3 y/o) MUSCULAR-ANAL Page 5 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences The important event is toilet training and the important relationship is with the parents. The child’s energy is directed towards mastering physical skills such as walking, grasping and muscular control. The child learns self-control but may develop shame, doubt, impulsivity or compulsion if not handled well. groups and social influences. The teenager must achieve a sense of identity in occupation, sex roles, politics and religion. In addition, they must resolve their identity and direction. Failure to make these resolutions can lead to the repression of aspects of the individual for the sake of others (fanaticism). Autonomy vs. Shame & Doubt Autonomy means being your own boss. Here a toddler tries to control their own bodies by toilet training and their environment, by always saying "NO!!!!". Sometimes they do poopy in their pants or get yelled at by their parents, causing shame and doubt in their own abilities. If we learn how to control ourselves in reasonable ways, we develop a healthy will. We are then able to face the later challenges of life. Identity vs. Role Confusion In adolescence, Erikson believed that a teenager’s main social need is to discover his or her social identity. While searching for your identity, you may try out different roles, like trying to fit into various social groups, experimenting with drugs or sex, or just changing your wardrobe. You should be trying to find a stable sense of self now, or Erikson believed you may have an identity crisis later. STAGE 3: INITIATIVE VS. GUILT (3 to 6 y/o) LOCOMOTOR STAGE 6: INTIMACY VS. ISOLATION (20 – 40 y/o) The important event is independence and the important relationship is family. The child continues to become more assertive in exploration, discovery, adventure and play. The child may show too much force in this stage causing feelings of guilt; failure to resolve this conflict can lead to ruthlessness and inhibition Initiative vs. Guilt Here the key word in a child's life changes from "No!" to why?". In this stage children want to understand the world and they ask too many darn questions!!!! If their initiative in questioning the world is encouraged, then they will feel comfortable with expressing their curiosity throughout the rest of their life. If we discourage them and tell them to shut up, then they will feel guilty about their questioning and avoid being inquisitive later. STAGE 4: INDUSTRY VS. INFERIORITY (6 to 12 y/o) LATENCY Age (school age). The important event is school and the important relationships are teachers, friends and neighborhood. The child must learn to deal with new skills and develop a sense of achievement and accomplishment. Failure to do so can create a sense of inferiority, failure and incompetence. Industry vs. Inferiority This is where most children begin formal education (what we call school). For the first time children are being formally evaluated. If a child raises their hand in class and answers a question correctly, then he/she will feel industrious (competent). If he/she tries to answer a question but stutters to get out the wrong answer, and other students all start making fun of his/her speech impediment, then the child will feel inferior. STAGE 5: IDENTITY VS. CONFUSION (12 – 20 y/o) The important event is development of peer relationships and the important relationships are peers, NCM 100 l THEORIES RELEVANT TO NURSING The important event is parenting and the important relationships are lovers, friends and work connections. In this stage, the individual must develop intimate relationships through work and social life. Failure to make such connections can lead to promiscuity, exclusivity and isolation. Intimacy vs. Isolation Young adults (early 20s into early 30s) are trying to balance their career efforts (work, school or self- improvement) with the need to be in an intimate relationship with another person. How much time should I spend looking for a relationship? What if I don't find anybody? What if I am all alone for the rest of my life? STAGE 7: GENERATIVITY VS. STAGNATION (40 to 65 y/o) The important event is parenting and the important relationships are with children and the community. This stage is based on the idea that each adult must find a way to satisfy, support and contribute to the next generation; it is often thought of as giving back. Failure to resolve this stage can lead to overextension or rejectivity. Generativity vs. Stagnation Erikson believed that by the time we reach our mid 30s to mid 50s we start to really examine our lives and see if it is going the way we planned it or did it take a drastic turn. This is where some people take drastic steps and change their lives. You could see a lot of late divorces or extreme changes in clothes or cars- we call this experience a mid-life crisis. STAGE 8: INTEGRITY VS. DESPAIR (65 years old to death) The important event is a reflection on and acceptance of the individual’s life. The individual is creating meaning and purpose in one’s life and reflecting on life achievements. Failure to resolve this conflict can create feelings of disdain & despair. Page 6 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences Integrity vs. Despair Towards the end of our lives we look back and evaluate ourselves. Did we live a good life? Leave behind a legacy of friends or family? Or did we waste our time playing Madden 2023 on Playstation 7? If we feel like there were many lost opportunities along the way we may fall into despair. I like to use this stage to try to shape my life now- you should too. One of the strengths of psychosocial theory is that it provides a broad framework from which to view development throughout the entire lifespan. It also allows us to emphasize the social nature of human beings and the important influence that social relationships have on development. 6. LAWRENCE KOHLBERG’S MORAL DEVELOPMENT THEORY STAGES OF MORAL DEVELOPMENT Kohlberg's theory is broken down into three primary levels. At each level of moral development, there are two stages. Similar to how Piaget believed that not all people reach the highest levels of cognitive development, Kohlberg believed not everyone progresses to the highest stages of moral development. NCM 100 l THEORIES RELEVANT TO NURSING Page 7 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences LEVEL 1. PRECONVENTIONAL MORALITY Preconventional morality is the earliest period of moral development. It lasts until around the age of 9. At this age, children's decisions are primarily shaped by the expectations of adults and the consequences for breaking the rules. There are two stages within this level: Stage 1 (Obedience and Punishment): The earliest stages of moral development, obedience and punishment are especially common in young children, but adults are also capable of expressing this type of reasoning. According to Kohlberg, people at this stage see rules as fixed and absolute. LEVEL 2. CONVENTIONAL MORALITY The next period of moral development is marked by the acceptance of social rules regarding what is good and moral. During this time, adolescents and adults internalize the moral standards they have learned from their role models and from society. This period also focuses on the acceptance of authority and conforming to the norms of the group. There are two stages at this level of morality: Stage 3 (Developing Good Interpersonal LEVEL 3. POSTCONVENTIONAL MORALITY At this level of moral development, people develop an understanding of abstract principles of morality. The two stages at this level are: Stage 5 (Social Contract and Individual Rights): The ideas of a social contract and individual rights cause people in the next stage to begin to account NCM 100 l THEORIES RELEVANT TO NURSING Obeying the rules is important because it is a way to avoid punishment. Stage 2 (Individualism and Exchange): At the individualism and exchange stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. In the Heinz dilemma, children argued that the best course of action was the choice that best served Heinz’s needs. Reciprocity is possible at this point in moral development, but only if it serves one's own interests. Relationships): Often referred to as the "good boy-good girl" orientation, this stage of the interpersonal relationship of moral development is focused on living up to social expectations and roles.7 There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships. Stage 4 (Maintaining Social Order): This stage is focused on ensuring that social order is maintained. At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one’s duty, and respecting authority. for the differing values, opinions, and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Stage 6 (Universal Principles): Kohlberg’s final level of moral reasoning is based on universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules Page 8 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences NCM 100 l THEORIES RELEVANT TO NURSING Page 9 of 10 Republic of the Philippines CAMARINES SUR POLYTECHNIC COLLEGES Nabua, Camarines Sur College of Health Sciences NCM 100 l THEORIES RELEVANT TO NURSING Page 10 of 10
