psychology in. Nursing presentation for post Rn students

Psychology in nursing

1. DEVELOPMENTAL PSYCHOLOGY

2. INTRODUCTION Developmental Psychology: This branch of psychology describes the processes and factors that influence the growth and development in relation to the behaviour of an individual from birth o old age. It is further subdivided into branches like child psychology, adolescent, adult and old age psychology. Development psychologists try to understand complex behaviours by studying their beginning and the orderly ways in which they change or develop over the lifespan.

3. STAGES OF DEVELOPMENT STAGES AGE Infancy 0-1 year Early childhood 1-5 years Late childhood 6-12 year ( up to the onset of puberty) Adolescence 13- 19 years(From the onset of the puberty) Early adulthood 20-40 years Middle childhood 41-65 years Late adulthood or old age 66 years – till death

4. GROWTH AND DEVELOPMENT Development means a progressive series of changes that occur as a result of maturation and learning. Growth occurs due to metabolic processes, implies a quantitative change or increase in size.

5. PRINCIPLES OF DEVELOPMENT Development is continuous Early development is more critical than later development. Development is the product of maturation and learning. Development follows an orderly direction. The developmental pattern has predictable characteristics. All children follow a similar developmental pattern. Development proceeds from general to specific responses. Different areas develop at different rates. There are individual differences in development

6. FACTORS INFLUENCING DEVELOPMENT 1.Biological or internal Factors: Heredity or genetic characteristics Sex of the individual Hormones Temperament   2.Environmental or External Factors: Prenatal Environment Family Environment School environment Neighbourhood Culture

7. 3.Natural / man-made events: Wars, earthquake Epidemics   4.Personal life events: Accidents Business loss, divorce or death of a parent

8. DEVELOPMENTAL TASKS: Occur at various developmental stages which must be achieved for optimal development. PRENATAL STAGE: Physical growth is most rapid in any person’s lifespan in this period. It consists of 3 stages. 1.Germinal stage (growth of zygote and implantation in the walls of the uterus) 2.Embryonic stage ( end of the second week to the end of the eighth week- rapid growth and differentiation of body systems)

9. 3.Foetal stage ( changes in the body form and organs assume their specialised functions, this stage ends with birth) Vulnerability to environmental influences like drugs, radiation, malnutrition and disease is also great in the stage. Mother’s age below 16 years and over 35 years are at high risk for miscarriages, premature births and birth defects. Mother’s age above 40 years have a higher risk of Down syndrome 

10. INFANCY The period of infancy begins with birth and lasts for 1 year . The infant is called a neonate for the first 4 weeks after birth. During the first 12 months the infant shows very rapid motor development and learns to sit, stand and begins to walk. Infant weighs triple from birth weight by 1 year Length increases by almost 50 percent from birth. Development of the child is complex and varied. Infant shows several reflexes and earning perceptual activities that involves active exploration. Visual perception develops rapidly, so that the child can make finer discrimination. Even sixth month old infants have implicit and explicit memory.

11. Cognitive development: (Piaget) Sensory Motor stage : Children explore the world using their senses and ability to move. Development of object permanence and understands the concepts of mental images of people and events . Psychosocial Development : ( Ericksons View) Trust vs Mistrust; It is purely based on whether their needs are met or not. If their needs are met, they develop a sense of trust

12. Children in Hospital: Very small children cannot bear to be separated from parents for long. Bowlby (1951) argued strongly that disturbances in mental health and personality development resulted from maternal deprivation. There is strongly evidence that very small children suffer from a sense of loss, mourning and grief when away from their mothers

13. On admission to hospital, children experience many other distressing events, for example, the fact of being ill, strange medical and surgical procedures, different daily routines and a variety of unknown people. There may be excessive clinging, nightmares and other emotional disturbances. Nearly always, the child’s rate of progress both physically and mentally is affected when there is lengthy or repeated separation from its mother. On returning home the child may refuse to recognise his or her mother and remain detached or unresponsive for some time. Bowel and bladder control achieved may be lost.

14. ROLE OF NURSE: The nurse who is taking care of infants must realize that the primary task of an infant is to grow. Growth and development of an infant is all round and also unique. The nurse who is taking care of infant should give personal attention as much as possible such as handling, cuddling, holding and loving. This kind of care will prevent deprivation and helps for healthy all round development. Accurate observation of the infant is extremely important. Cry and restless movement is the mode of communication for the infant. Encourage the parents to comfort the infant and also involve them in providing care. During care use sensory soothing measures. The children should be given adequate love, affection and care. The use of force and violence should be avoided in dealing with the child.

15. EARLY CHILDHOOD (2-6 YEARS) The growth rate slows in most areas during this period. The average child becomes two and one half inches taller and 5to 7 pounds heavier during each year of early childhood. During this period learns to walk, run, jump and balance; he /she develops fine motor skills and muscular coordination. He/she also develops sensory perception of size and learns to speak. He/she is capable of practical thinking and solving simple problems. Learns how to dress and care.

16. Other important achievements during this period are learning how to use writing tools, identifying letters, numbers and sounds. He/ she experiences emotions of love and hate, jealousy and anxiety. He / she also learn to tolerate a certain degree of frustration and disappointment and deal with his/ her own difficulties independently. Thus it is a period of rapid physical, intellectual and socio emotional growth.

17. Psychology of the child during early childhood - Dependency on others : Child needs parents to assist in completing daily care. Child expects that everybody around hi, should love him and give him his entire affection and attention. He wants love and to be loved and in this exchange, he totally depends on the mercy of others. - Self assertion Though the child depend others, but wants to dominate them. Child thinks, child always right and all around him, should obey him. Child thinks that they are prince without crown and tries to assert themselves all the time in all situations.

18. - Period of make believe and fantasy: Children at this stage live in the world of their own creation. Child has limited potentialities and aspires more than what he can actually get in real life, child compensates him in fantasy and make – believe. -Selfish and Unsocial: Almost ego – centric and selfish. Child doesn’t want to share their toys or give any of their possessions to others, even the love, affection and admiration. Child doesn’t care for the social, moral codes and principles and places their self interest at the premium. - Emotionally unstable: In this stage, the period of violent emotional experiences. Emotions, at this stage are marked by intensity, frequency and instability.

19. Psychological needs of early childhood: It includes love, recognition, security, acceptance, Encouragement, protection, discipline, nutrition, etc. Characteristics of mental development: Developing Curiosity and questioning attitude Intellectually not developed Time concept is not developed   Sexual development: Although the sex organs at this stage are not developed, yet sex tendency is in a continuous stage of development .

20. ROLE OF A NURSE: Tender loving care and physical security continue to be important to the child during these years. It is important that the children’s routine in hospital resembles normal life as far as possible. The child’s day should be a well established routine, which includes a right time for play, stories and bath and for rest. Accurate observation is important to find out any physical or emotional problems. A cordial relationship should be established with the young patient by talking to him at his own level such as asking him his nick name and likes and dislikes.

21. Provide love and affection. Te nurse should be patient in dealing with children. The child should be encouraged to develop a spirit of independence. Allow the child to participate in care and help whenever possible. Explain the procedure in simple terms and in relation to how it affects the child. Give choices whenever possible, but avoid excessive delays. Praise the child for helping and attempting to cooperate, never shame the child for lack of cooperation. Provide privacy from peers during procedure to maintain self esteem. Opportunities for play should be provided.

22. Allow the child to choose his/her own play if possible. Drawing and scribbling is excellent for the child; picture books and puzzles are favoured when the child is old enough. Games and toys should be made available in paediatric unit. Nurses can learn to use play therapeutically. Small children do not understand the meaning of sickness very clearly. The child’s early experiences with sickness, pain, hospitalization, separation from his/ her mother and being cared for by nurses may influence attitude to sickness later in life.

23. LATE CHILDHOOD (6-12 YEARS) During this period, physical growth is slow and gradual. The average child grows 2 to 3 inches in height and gains weighs 3-5 pounds of weight in a year. Increased muscular development and resistance to fatigue makes new skills and activities possible. Children develop much smoother and well co-ordinate muscle movements during this stage. They became capable of many muscular activities such as running, swimming, riding a cycle and throwing or catching. Writing or reading and the ability to handle language are 2 important achievements during this stage.

24. The child is now able to make the fine movements necessary for writing. His/ Her thinking is more stimulated by concrete objects and situations, which can be seen. He/ she cannot handle complex arithmetic problems. The special features of the behavioural pattern depicting the psychology of children during this age span may be outlined as below: Craving for independence Emotional stability and control Developing social tendencies Realistic attitude Dormant sexual urge Demonstrates social tendency Growing intellectually Showing specific interests and aptitudes

25. Other psychological needs include: -love, affection, security, belonging needs -Understanding, attention, Physical care - Needs to exercise his/her muscles and refine motor co-ordination. - Protective environment - Encouragement - Discipline, provision for self expression - Guidance and direction to understand what kind of behaviour is expected.

26. Role of a Nurse: Love and care, emotional support Needs guidance and direction to understand what behaviour is expected from him/her or the rules to be followed during hospitalization should be clearly explained to them. Nurses should be given explanations for procedures and reasons for hospital rules and policies. Health teaching should be given directly related to illness or prevention of illness. Observation of the child’s physical condition and his behaviour is important. The intellectual development of the child can be evaluated by observing his/her ability to converse and reason, read, write or solve arithmetic problems. Games and physical exercises should be given to them.

27. ADOLESCENCE (12-19 years) Adolescence is a period of rapid physical, intellectual, emotional and social growth- a period of growing up. Physically, the boy or girl becomes an adult, sex organs mature. Adolescence begins with very rapid changes in the body. Changes in the body can be seen in weight and height, shape of body, sound of voice, presence of pubic and facial hair and other external sex characteristics. The initial spurt in growth usually begins about 2 years earlier in girls than in boys. There is intellectual growth towards a mature and abstract mode of thinking.

28. Intelligence reaches its maximum. Emotionally, the adolescent grows independent from parents and prepares himself for entering into other relationships that are needed in marriage, work and in the community. Sex conscious develops and this influences the emotional as well as the intellectual activities of the individual. Biological changes lead to moods, confusion and worries of all types. Puberty is the important physical change during adolescence. He/she becomes mature or capable or capable of sexual reproduction. Endocrine gland regulates puberty through the secretion of hormones

29. Adolescent girls and boys become very interested in sexual development and in relationships with members of the opposite sex. An adolescent has many variations in mood, variations between excessive bursts of energy and periods of laziness. They are extreme sensitive, self-consciousness, desire to be intellectually and emotionally independent

30. SPECIAL FEATURES: Perplexity with regard to somatic variation Intensification of self awareness Sexually much conscious Staunch follower of the peer group values Inflicted with the conflicting demands of Independence vs dependence Idealism vs realism Worried about vocational choice and becoming self- supported

31. Psychological needs of an adolescence : Need for status Independence Satisfying philosophy of life A proper orientation to the opposite sex and guidance in selecting vacation. Role of a Nurse: Explain each procedure with rationale Encourage questions regarding fears, options and alternativeness. Discuss how nursing procedures may affect appearance and what can be done to minimise it. Accept the regression to more childish methods of coping. Allows them to talk. Adolescence will most likely be able to make decisions about caring for himself and planning his health care

32. EARLY ADULTHOOD (20-40 YEARS) This age span can be considered the healthiest and most energetic time of one’s life. Biological function and physical performance reach their peak from 20-35 years of age, waning from after 35 years. During early adulthood, most adults reach their full height. A number of sensory and neural functions are also optimal level during this period. For women, reproductive capacity is at its peak during young adulthood. Intellectual abilities appear to peak during this period. Tasks requiring quick response time, short term memory and ability to perceive complex relations are performed more efficiently during late teens and early twenties. Certain creative skills reach highest level during young adulthood.

33. Young women have additional psychological differences related to body changes. About 75% of all women in young adulthood experience mood swings with the cycle of menstruation. These are caused due to hormonal changes in the body. Choosing a career and life partner are top priorities in this stage. Child rearing is usually an important part of young adulthood. During this period behaviour is governed more by intelligence than emotions, adults adapt easily to social situations, face reality objectively, have normal drive to work or play and act according to own age. Adults are vocationally adjusted and are able to think and decide things on their own.

34. Psychological needs of early adulthood: It includes a balance of intimacy, commitment, freedom and independence. The adult also likes the needs, security, self-realisation and recognition. Development of intimate relationship and status in society. Age of making decisions and settling down with respect to Jobs and career Relationship and marriage Size of the family and education of childhood. Role of status in community.

35. Erickson’s View on the psychology view of early adulthood: Intimacy vs Isolation: Seeks to form intimate relationship with opposite sex. In this marital relationship, they tend to risk even loss of his ego or image. If there is failure in intimate relationship, they tend to loss their relationship and tend to develop isolation .

36. Role of Nurse: Young adults are rarely hospitalised, usually for childbirth, injuries or any accident or any problems in digestive tract or genitourinary tract. Have to teach and assistance in handling babies. Explain the personality characteristics required for parental figure and that should be respected. Explanation of procedures. Assist with problem solving Help the couples to achieve intimacy with each other.

37. MIDDLE ADULTHOOD (40-60 YEARS ) Mid life brings with it dramatic changes in Physical development. The slow decline of physical development, which begins during the late years of early adulthood appears to speed up and is much more visible as a person reaches the late forties. In middle age, the skin loses some of the elasticity; hair begins to thin out and often turns grey or white. Muscular strength declines slowly, but steadily from young adulthood onwards. A major physical change comes about in CVS of a person in middle life. Narrowing of coronary arteries may occur for some mid aged persons. Cholesterol level rise and begins to collect on the walls of the arteries, which are also beginning to thicken. Changes in the reproductive system of men and women

38. Decreased production of oestrogen and testosterone. In mid- forties, women will attain menopause which is associated with a number of unpleasant symptoms have been appear which includes profuse sweating, hot flushes, dizziness, head ache, irritability, depression, insomnia and weight gain. The male climacteric occurs at about 50 years of age , during which men experience a gradual decline in testosterone.  

39. Erickson’s View : Generativity vs Stagnation:   Needs to satisfy his needs for generativity , a concern to establish and guide the next generation, this is realized through nurturing his own children, guiding and directing other young people and by engaging in some kind of creative, productive or fruitful activity that may beneficial to society. Have to participate in the welfare of the future generation. Opposite to the above is stagnation .

40. Role of nurse: Middle aged is more likely to be hospitalised for cardiovascular problems; BP, cholesterol or cancer or diabetes. Explain hospital procedures clearly. Nurse should guide the family members in personal activities of the patient. Observation of emotional and physical health is necessary to recognise signs of Physical decline. Written instructions can be provided when needed. Health teaching is important. Encourage independency

41. LATE ADULTHOOD (OLD AGE, 60 YEARS AND ABOVE) It is the period of retirement from active work. Marked by impairment of sensory function (seeing and hearing) There is a slowing down of motor functions, besides a gradual impairment in muscular co-ordination. The resistance to disease and injury diminish decline in mental ability Memory, thinking and ability to learn new things are affected. Loss in the efficacy of CVS has the maximum impact upon a person in late adulthood. Chronic diseases are common like arthritis, loss of hearing, vision and cancer. Decrease in social interaction and increased in aloofness Symptoms of irritability, short tempered and anxiety ridden responses in the behaviour.

42. Psychological needs of late childhood: Need for improvement of self image, need for normal roles and relationship. Need for love and relatedness Need to improve sense of hopefulness and need for accomplishments of tasks. Erickson’s View: Ego integrity Vs Despair: Integration or culmination of the successful resolution of all the seven previous crises in the course of one’s life. A Person with a developed sense of integrity is at peace with the life, he has lived and has no major regrets over what could have been or for what should have been done differently. Despair: Feel dissatisfied with the way they lived their lives. They thought that they have no time left for changing the course of their lives and doing what should have been done, makes them feel miserable and consequently, they are doomed to develop a sense of despair.

43. Role of a Nurse: Older adults may be hospitalized more than any other age group. Insecurities and apprehension should be relieved Prepare the patient about the outcome of terminal illness. The nurse should assess the patient’s ability to see, hear, and walk and vital signs. Closer observation for depression, poor sleep, lack of coping. Emotional help is necessary Physical protection from harm and injury should be provided. Health teaching should be provided. Memory improving techniques should be followed.

44. PSYCHOLOGY OF THE CHALLENGED The Psychology of physically or mentally challenged persons or those with special needs is an area which is gaining in importance. Challenged: Physical Mental Social Emotional

45. ( i )Physical Challenged : People who are deaf, dumb, blind, suffering from the loss of limbs like hands or legs and chronic Patients- These people will have an following typical features in the way of behaviour, personality and adjustment. Social interaction and social interests are narrow. Bound to become dependent on others for their day to day activities and survival. Bound to suffer the feelings of inferiority, insecurity, unsafe. This may give birth to depressive or hostile behaviour on their part. The frustrating reactions are manifested as anger, sadness and irritative , because of their incapability, inactivity and dependence. Self- centred- to be cared and protected by others with the least concern for others .

46. (ii) Mentally Challenged : Person who is suffering from mental disabilities, ailments and disease. Suffers with intellectual impairment, defective reasoning and thinking, dysfunction and abnormalities in the cognitive functioning and psychological maladjustment. Defective intelligence and defective cognitive functioning, so they will have poor in understanding and the following of instructions or demonstrated behaviour. Socially isolated, inferior, worthless and problematic and poor in mental functioning- it may leads to withdrawal behaviour or develop hostile tendencies, suffer with chronic anxiety, depression, fear and phobias, withdrawal and attacking behaviour, damage to the safety and security of self and others. Over- dependency in their behaviour and thus their caring and adjustment may pose a great challenge to their relatives in their day-day care, adjustment and development and nurses and other medical staff at the time of their medical care and treatment

47. (iii) Socially challenged : In this category of socially challenged, we may include the individual’s suffering from acute social adjustment, problems like delinquents, criminals, drug addicts, alcoholics, socially and culturally deprived etc. These individuals may be found to differ significantly from the normal people with respect to their behaviour characteristics and adjustment patterns in the manner given below: Mal adjustment behaviour with their social surroundings and environment. Inflicted with the feelings of inferiority, low achievement motivation, isolation from society, hesitation, fear in mixing with strangers, difficulty in adjusting to the changed environment. War with their self and society The delinquents and criminals open fronts with the society as a coverage or compensation of their failures.

48. (Iv) Emotionly Challenged: People who suffers with emotional adjustment or deviant and defective expression of their emotional behaviour, causing problems to their self and others. Behavioural Characteristics : Hyperactive, restlessness and uneasy. Greater tendency towards fighting and aggressive behaviour. Shows greater resentment and antagonism towards the authority and rules, regulations. Feel problems in concentrating or paying attention to the required things as their thoughts and feelings remain always at the wandering stage. Unexpected swings in their moods from utter depression or withdrawn behaviour to extreme elevation and excitement. Lot of difficulty in their expression or may express in an undesirable way. Difficulty in interpersonal relationship. In hospital, this people may create problems to other patients, staffs and doctors. It may bring serious psychotic and neurotic tendencies in the way of thinking, feeling and behaving turning to them into serious maladjusted personality, a bigger challenge for friends, employees and care givers.

49. IMPLICATIONS OF NURSES : Should aware of the nature of their vulnerability, behavioural characteristics, personality traits, interest. So that nurses can prepare herself to meet the challenges. Showing tolerance and patience. Learning the skilled way of dealing with vulnerable. Providing needed guidance and counselling.

50. PSYCHOLOGY OF WOMEN In this age of the equality of sexes, women’s rights, freedom and empowerment, it becomes a bit difficult to say that women are the weaker sex or vulnerable in any way in comparison to their male counterparts, Even though our women stands vulnerable in so many ways. In our society and culture, women have been treated for a long time as a commodity, selling or purchasable thing. It is happening with them till now. Abducting, trafficking, purchasing or hiring for marriage, sex etc. It is the women who have to bear the consequences in terms of willing or unwilling pregnancies, they have to keep the babies for a long period in their wombs, bear the pains and negative outcomes of the child delivery, nourish, feed and give needed care to the developing babies.

51. In case of unwanted pregnancies, through rape and other coerced measures, they have to suffer from the indignity, humiliation, defence etc. During the entire course of life, girl suffers with discrimination, negligence and oppression at the hands of male and ale dominated society. Even the elder members of her own sex pays a leading part in suppressing and oppressing her in the way possible, In male dominated society, women are considered as a symbol of aesthetic pleasure and thing of sensual satisfaction. A girl or woman is appreciated, accepted or rejected on the basis of her charming behaviour and attraction.

52. From very beginning, thus a girl may be seen to be engaged in a self-decoration and getting figure conscious in order to be judged as beautiful and attractive in the eyes of her male counterparts. Certain biological processes carried out only in women from the onset of puberty like work towards making them vulnerable in one or the other sense. Nature has made women more soft, tender and emotional in their behaviour in comparison to their male counterparts on account of designating them with the motherly affection, love, sacrifice, sympathy and care for offspring and the family.

53. General features : Anxious and worried and fearful about their safety and security. Unusual feelings of inferiority, incapacity, inability and dependability on others. More expressive, talkative, sociable and enjoying outing, purchasing and marketing. Experiences depression, unhappy, irritable and emotional and social upset for feeling the loss of not becoming a “real woman” and mother of her children” because of husband’s infertility. Engulfed with the guilty feelings, depression, over reaction as victims of rape and sexual assault. Unusual craving and distorted feelings with respect to the body image. Suitable for service providing and caring on account of their soft spoken affectionate, tolerant and helpful native. Assertiveness, Body image, depression, teen pregnancy, infertility, domestic violence and rape are the common problem.

54. PSYCHOLOGY OF THE SICK Illness and disease, if sustained and get aggravated may bring significant changes in one’s life and affect adversely, not only one’s health, but also cast serious impact over his ways of thinking, feeling and doing. As a result of the illness, he may find quite inactive or incapable of performing even the routine work of his own care. Loss in Interpersonal relationship. Feeling small and humiliated on account of their dependency on others. Anxious and fearful about their ailing states. Developing suspicious about everything Complaining nature.

55. Loss of self image and confidence Showing signs of irritability, anger or violent reactions Pessimistic attitude towards their health and well being Narrowing of the areas of social interest. Self- centered and too much concerned about their ailments. Become too childish in their behaviour with respect to cleanliness, taking of medicines and nagging. Five stages of grief: Kubler - Ross Denial Anger Bargaining Depression Acceptance

56. Nurse’s role: Lessen the feeling of insecurity by straight forward explanations. Should provide proper care and communication Educate patients regarding disease conditions Teach active and passive exercises according to their abilities.

57. PSYCHOLOGY OF GROUPS Group: Two or more individual’s who are connected to one another by social relationships- Dohelson -2006. Two or more people who influences one another through social interactions - Baron-1993.

58. Characteristics of a group: Interaction should takes place. Should perceive themselves as a part of the group. Members are interdependent Sense of solidarity among group members Common interests and objectives Goals, rules or norms should be written or unwritten. Size of the group has its own impact.

59. Types of Groups: Primary and Secondary group ( Primary – families and secondary- Political Party) Planned and Emergent ( daily – Spontaneous ) In and Out group ( In Group- People belonging to the same caste or religion or nationality and Out Group- discriminated People)

60. GROUP DYNAMICS : It is a study of inter-relationship with in a group in context to the relative force being exerted by the individual on the group and by the group on the individual. Formation of Groups : Physical Proximity or closeness Interaction among individuals Similarity in attitudes Similarity in interests Similarities of purposes Group attraction Serving specific purposes Similarity in occupation Distress or stressful situations Security

61. Group mind : The mind-set of an individual as a member of the group directing him to behave as others in the group behaves. Group Behaviour : The behaviour of a person in a group is different from his individual behaviour. Group interaction : It is a two –way process of stimulating and modifying the behaviour of the members of the group on mutual basis. Factors affecting Group behaviour: Sympathy Suggestion Imitation

62. Relevance of group Psychology for Nurses: While most nurses care for one patient at a time, public health nurses care for entire populations. Public health education can be given to improve group behaviour. Nurses have to create sense of belongingness Teamwork is much important in case of hospitalised patients. Nurses can suggest the availability of support groups to patients and also motivate caregivers in the family to join such groups. Successful nurse leaders are role models for their junior nurses. Good nursing leadership will definitely influence the quality of patient care in hospital.

63. THANK YOU