School of Health and Social Care Psychology of Health and Illness unit Observational record template What happened Initial thoughts Whilst at work I saw the nurse take bloods from a patient which was a monthly routine for the patient it has always gone ok and the patient has been fine with having her bloods taken before. The nurse told the patient it wouldn’t hurt at all. Something happened whereby the nurse couldn’t get the blood and had to re-attempt the procedure.
The patient also experienced some pain during this procedure which she wasn’t expecting, the patient found this a quite traumatic experience The patient was elderly and appeared confused. The patient became anxious and next time a blood test was due became increasingly worried and reluctant to have the procedure. She appeared frightened of the needle What happened My initial thought was why did the procedure not go to plan and why did the patient react in the way she did.
The previous procedure was fine and she knew what it involved she had her arm out ready for her bloods to be taken, she thought it wouldn’t hurt because it has always gone ok for her with minimal distress and pain so she wouldn’t be expecting that experience. Now the behaviour has changed and gets distressed when she sees the nurse with the needle. Another thought would be is she afraid of the nurse or the needle. Does the patient feel under pressure now to have her bloods taken. Initial thoughts One of my family members called may has lost both of her sons in the same year a few years ago they were both identical twins.
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This caused her to feel very low and had become depressed whilst grieving for her sons. Her husband has recently become disabled and is unable to cope alone at home. It is coming up to the twins birthday and she is feeling low she said to myself that she doesn’t think she can be happy and she always has bad luck. The other day she forgot she was cooking and burnt her food and also has forgot she is suppose to be at work . She has lost a lot of weight since she has been at home more helping her husband. She has been a light smoker most of her life but is not smoking a lot more.
May is not the lady’s real name it is used for confidentiality reasons. My first thoughts is that the patient could be stressed after the life events that have occurred There are the daily pressures of work and general life with her still grieving for her sons, then on top her husband is recently disabled. The build up can be the stressor she could suffer with burnout if she is stressed for too long which could also lead back to depression. She is blaming external forces her saying that she always has had bad luck.
Her feelings and thoughts in the mind is with her forgetting things, is this because she has other things on her mind due to pressure and replacing her long term memory with new memories. Not many of her needs have been met to achieve a sense of wellbeing. Another thought is how would she cope with the situation in hand which way would she go, good or bad meaning action response or palliative coping. If the patient is controlled by others or feels disempowered then they could become increasingly helpless whereby they completely rely on others and depend on them to make decisions for them this could also Increase stress.
This essay will provide a definition of the term psychology and look at a brief history of how psychology originated. It will discuss psychological theorists and look at how their studies influenced how we view psychological concepts today. The essay will relate how psychological studies and theories can inform nursing care. It will outline a selection of psychological approaches such as the biological, humanistic and psychodynamic. It will discuss in further detail and focus upon the behaviourist and cognitive approaches. It will then go on to explore how the observations A and B can be explained within psychological theory.
Observation A will apply the behaviourist approach to the situation and try to explore how this theory relates to the observation. It will discuss how a routine procedure could impact upon a person and their behaviours. Observation B will utilise the cognitive approach and apply this to the experiences of a person experiencing stressful life challenges it will explore key issues such as coping and information processing. The concept of Psychology originated from philosophy and biology which are two factors used in psychology today (Eysenck 2009).
Psychology represents ‘study of the mind’ (Gross 2005). Psychology is a type of science which studies the behaviour of humans and animals, psychology tries to understand why people behave in certain ways taking into consideration their thoughts and feelings (Eysenck 2009). The term psychology was founded from the Greek word, psyche which means mind, soul or spirit combined with the Latin word logos which means’ the study of’ (Gross 2005). Psychology dates back to ancient civilizations who were interested in workings of the the mind and behaviours (Payne and Walker 2003).
Wilhelm Wundt opened the first psychological laboratory in 1879 (Glassman 2008). Wundt and his co workers studied the structures that make up the mind, he was the first theorist to use psychology as a self conscious experiment studying perceptions and conscious awareness (Gross 2005). Psychology is relevant to nurses and health care professionals because both nurses and psychologists seek to understand the range of needs of an individual (Barker 2007). They also look at ways of adapting behaviours to make it possible for the individual to achieve a sense of well being. Barker 2007). According to the NMC (2008) nursing focuses on the individual as a whole taking in their physical, psychological, social or cultural needs rather than a specific aspect of an individual. Psychology gives nurses an insight into human behaviour and can inform them when providing care for people (Payne and Walker 2003). There are certain psychological based therapies in place such as person centred counselling and cognitive behavioural therapy to help people deal with anxiety and depression (Gross 2005).
The biological approach assumes that our individual behaviour and experiences happen because of the activity in the nervous system (Glassman and Hadad 2004). Our central nervous system (CNS) is made up of neurons which are billions of nerve endings within the body (Glassman and Hadad 2004). According to this approach it is believed that a person’s thoughts feelings and actions are caused by the CNS (Livingstone 2009). Charles Darwin (1809-1882) was the first to suggest that we should view behaviour from a biological perspective. He saw the importance of children resembling their arents and the variations in humans and how individuals inherit genes as a cause of evolution (Eysenck 2009). The humanistic approach concentrates on a person’s individual perceptions and understanding of their own actions (Payne and Walker 2003). Individuals have their own free will to choose how they act in situations(Gross 2005). Carl Rogers explored the theory of self concept (Gross 2005). He believed individuals are at their happiest when they have a positive regard of themselves, to achieve this status they must have an unconditional positive regard from other individuals (Payne and Walker 2003).
If the individual does not have this they will not achieve a sense of worth. Abraham Maslow suggested the person centred theory of the hierarchy of needs ( 1943 cited Barker 2007). This suggests individuals have a responsibility to themselves to reach self actualization (Barker 2007). This theory is popular in the health profession because it looks at a person as a whole (Eysenck 2009). The psychodynamic approach suggests behaviour forms from our unconscious mind (Glassman and Hadad 2004). The forces in a person’s personality motivate different types of behaviour for example the unconscious and subconscious (Glassman and Hadad 2004).
Sigmund Freud influenced the psychodynamic approach through his psychoanalytic theory of personality (WJEC 2009). Behaviour can be influenced by three parts of the mind; Id, Ego and Superego (Gross 2005). Id is an impulsive part of an individual’s personality, the Id influences basic biological drives such as eating and drinking (Glassman and Hadad 2004) . The aim of Id is to get what you need at any cost to maintain basic survival needs (WJEC 2009). The Ego is where individuals become rational, the ego balances the needs of the Id and Superego.
The superego understands right from wrong, it rationalises behaviour that is learnt by parents and other surrounding influences (WJEC 2009). The ego will protect itself from unwanted thoughts for example painful memories can be pushed into the unconscious mind which can then be forgotten (Glassman and Hadad 2004). It is suggested behaviour is influenced by childhood experiences, while in the stage of childhood the ego is not developed enough to deal with a life event such as a traumatic experience (WJEC 2009).
The behaviourist approach assumes the way we behave is the result of an experience, the approach looks at the environmental stimuli which could be an experience and how this influences the way in which someone learns (Glassman and Hadad 2004). Watson researched ways in which this theory could be measured and observed (Glassman and Hadad 2004). One of his studies was the ‘Little Albert’ whereby he thought children have three basic emotional reactions fear, rage, and love. He wanted to prove these three reactions could be conditioned in children.
Watson used Albert to test his theory, He repeatedly presented Albert a rat in combination with a sudden, loud noise to classically condition fear (Gross 2005). ). Ivan Pavlov researched classical conditioning, while looking at the salivation of dogs he noticed what he called psychic salivation (Gross 2005). This is where a dog would salivate before it was given food (Gross 2005). Pavlov founded a basis for what we now call classical conditioning (Glassman and Hadad 2004). The theorist Skinner researched operant conditioning, one of his studies was a ‘skinner box’.
A rat or pigeon would be studied doing certain tasks for example pushing a lever in the box for a reward thus becoming conditioned (Gross 2005). There are two forms of conditioning; classical and operant. Within classical conditioning an unconditioned response (UR) is when a response is not conditioned (Eysenck 2009). A neutral stimulus (NS) is the object which causes the UR (Gross 2005). The conditioned stimuli (CS) is an object which is associated with the NS pairing these two together after a number of attempts will soon create a conditioned response (CR) which would be classical conditioning (Eysenck 2009).
If the CS is used by its self for a while the response will become extinct, after extinction it is possible to introduce the NS again and this creates spontaneous recovery (Eysenck 2009). In operant conditioning there are positive reinforces which are things given to strengthen the behaviour for example the rats used in the skinner box were given food every time they pushed the button (Gross 2005). A negative reinforce is something which is taken away to increase a behaviour (Glassman and Hadad 2004).
Punishment is a form of a negative reinforce this could be something like a slap on the wrists for a child showing naughty behaviour this may result in a decrease of the response (Glassman and Hadad 2004) This essay will discuss how the behaviourist approach can be applied to observation A and how conditioning applies. Within classical conditioning the neutral stimulus and unconditional stimulus needs to be paired multiple times to achieve the conditioned response. If the patient in the observation viewed the pain as a traumatic experience then the neutral stimulus and unconditioned stimulus ill only need to be paired once to get the conditioned response. Before learning the neutral stimulus would be the needle and the unconditioned response would be the patient in distress. The unconditioned stimulus would be the pain so during the observation, the needle is the neutral stimulus which before would give the patient no response. Then during the procedure the neutral stimulus (needle) gives the patient an unpleasant pain which is the unconditioned response. The next time the patient’s routine bloods were due when she saw the needle which is the conditioned stimulus it gave the patient distress which is the conditioned response.
Applying the approach to the observation the patient appears to have been classically conditioned. This is because before the observation when the patient had the procedure they appeared fine. During the observation the patient appeared to experience pain which lead her to become distressed because of the discomfort. After the conditioning when the nurse came in the room the patient associated the procedure with the pain so was scared to have the procedure, she is showing signs of fear when associating needle and pain.
Although the needle could be viewed as a NS the nurse also could be, because in the patients mind the nurse gave her the pain. Other factors could also incorporate conditioning such as the environment for example if the patient was hot and uncomfortable can also be a trigger for becoming distressed. The cognitive approach looks at the role of the thought processes within the mind such as memory and information processing (Payne and Walker 2003). Cognitive psychologists are interested with brain thoughts that guide and cause different behaviour (Gross 2005).
Until the 1990’s the cognitive approach only assumed how information was stored in the brain (Glassman and Hadad 2004). More enhanced technology including brain imaging techniques which helped psychologists and neuroscientists to map out brain function in coalition with behaviour (Payne and Walker 2003). Studies have shown that the relationships between thinking and languages can influence the way we think (Payne and Walker 2003). The information processing model has broadened our understanding of memory and problem solving (Glassman and Hadad 2004).
Cognitive psychologists see the human mind as an information processor; we take the information from an environment and interpret in our own way to produce behaviour (Glassman and Hadad 2004). The response model of stress defines stress as the reactions of the person by the demands (Gross 2005). Stress can fall under 3 categories stress can be a stimulus, response or an interaction between an individual and its environment (Gross 2005). The categories of stress can correspond to the three models of stress (Cox 1978 cited in Gross 2005).
Holmes and Rahe (1967 cited Eysenck 2009) developed the social readjustment rating scale (SRRS) to assess life events. They suggested that if a person has had many life events they are likely to be stressed (Gross 2005). Rotter (1966 cited Gross 2005) found that life events are more stressful if their locus of control was external. An external locus of control means that their behaviour is guided by fate, luck or other external circumstances such as other people (Barker 2007). According to Martin Seligman (1967 cited in Gross 2005), learned helplessness can happen when individuals have no control over their life or situation.
They begin to think they are helpless, people who have learned helplessness appear to miss the opportunities to help change their situation (Gross 2005). Walter Canon (1932) suggested the principle of the fight or flight response, fight or flight means we prepare ourselves for attack harm or threat, when an individual is stressed the body reacts to make the fight or flight response (Gross 2005). According to Gross (2005) Hans Selye (1956) further developed this to create the general adaptation syndrome (GAS).
GAS stands for the body’s way of defending against stress, individuals will act in response to any stressor in the same way within the body (Gross 2005). According to Gross (2005) coping means dealing with a situation to act and overcome a situation. Cohen and Lazarus (1979) classified different ways in which individuals cope (Eysenck 2009). Direct coping is when a person deals with the situation by changing, or removing the stressor. The individual looks at the situation to understand it, then if a similar stressor arises the individual can deal with it (Gross 2005).
Emotion focused coping looks at trying to take away the off putting emotion to make the individual feel better for example ignoring the stress and doing something that makes the individual feel good (Gross 2005). Palliative coping is when the individuals turn to relief which is short term they will change the internal environment for example alcohol (Gross2005). When applying the cognitive approach to observation B, May appears to be stressed. The information processing model has taken the information from the stimulus which is May’s ife events which and interpreted it into stress (Glassman and Hadad 2004). This applies to the information processing model because she is taking information from the environment and situation to interpret it in her own way formulating negative thoughts and behaviours (Gross 2005). She is responding to the events that have occurred in her life, for example her sons dying and her husband becoming recently disabled, she has had to try and balance her daily life demands and incorporate caring for her husband at the same time.
When there is an imbalance it is likely stress can occur, this applies to May. According to the SRRS May has had many major life events which can cause her a high level of stress and she had already suffered with depression which is proved to be significant on the scale (Eysenck 2009). May’s locus of control is external, this is because according to May she does not think she will ever be happy again, and she has bad luck her emotions are low so her helplessness can result in stress (Barker 2007).
May also maybe stressed due to the fight or flight response, this is because she is perceiving her life experiences and current situation as a threat (Gross 2005). May has not yet seen any opportunity to help herself from this stress she has not yet looked at a way of removing the stress if she stays in this situation she may have learned helplessness (Gross 2005). Applying to Mays way of coping, she appears to be palliative coping, this is because she has turned to short term relief such as smoking which is changing her internal environment (Gross 2005).
In conclusion this essay has given a definition of psychology, It has understood why psychology is relevant to the nursing profession. The essay has given an overview of the biological approach which assumes that person’s behaviour happens because of the CNS. It has also given an overview of the humanistic approach which explains a person has their own perceptions and understanding of their actions, the approach is more relevant to nursing because it takes into consideration the whole aspects of a person to help achieve self actualisation.
The essay has given an overview of the psychodynamic approach which suggests that behaviour forms from our unconscious mind. It has given an explanation of the behaviourist approach explaining classical and operant conditioning. Then given an overview of how this approach has applied to observation A, using classical conditioning. Finally this essay has explained the cognitive approach relating it to the model of stress & coping and explained how observation B can be demonstrated within the cognitive approach. References Barker. S. , 2007.
Vital notes for nurses: Psychology. Oxford: Blackwell publishing. Glassman. W and Hadad. M. , 2004. Approaches to psychology. 4th edition. Buckingham: open university press. Gross. R. , 2005. Psychology the Science of Mind and Behaviour. 5th edition. London: Green Gate. Livingstone. C. , 2009. Psychology and sociology applied to medicine. 3rd edition. London: Harcourt publishers. Nursing and Midwifery council. , 2008. The code. UK: nursing midwifery council. Available from: http://www. nmc-uk. org/Documents/Standards/The-code-A4-20100406. df [accessed 14/02/12] Payne. S. and Walker. J. , 2003. Psychology for nurses and the caring professionals. Berkshire: Open university press. Royal College of Nursing. , 2003. P. 3, Defining Nursing. London: The Royal College of Nursing. Available from: http://www. rcn. org. uk/__data/assets/pdf_file/0008/78569/001998. pdf [accessed 14/02/12] WJEC. , 2009. Psychology AS. Dublin: Folens publishers. available from: http://onlineclassroom. tv/files/posts/the_psychodynamic_approach_free_chapter/document00/WJEC_AS_Ch_03. pdf [accessed 9/02/12]
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