and Psychoanalytic Theory
Cognitive Theories of
Existential and Humanistic
Behaviorist and Learning
Freud’s Psychoanalytic Theory
Developed by Sigmund Freud
Developed to find the root of unconscious thoughts and feelings
that cause the client’s anxiety
He had the client talk openly about whatever came to their mind
about their early experiences.
He believed that early experiences continue to influence people
throughout their lives.
Id- part of the personality containing basic instincts and urges.
Ego- the “I” part of the personality that develops to respond to the
realities and problems of everyday life.
Superego- is a person’s conscience and the internalized concept of
Freud’s Psychosexual Development
Freud believed that the child progresses through the oral
stage, the anal stage, the phallic stage, the latency stage, and
the genital stage.
Human development is complete when the person reaches
Much of this theory has been refuted and is no longer
However, several points of this research continue, such that all
behavior is motivated (not accidental), although the motivation
is often not conscious.
Jung and Erik Erikson began with
Freud’s ideas and went on to create their
own theories of personality.
Jung’s theory called the analytic psychology divided the mind
into the conscious ego, the personal conscious, and the
He described the collective unconscious as psychic elements
or memories inherited through generations via an unconscious
channel and shared with all humans.
He introduced that culture plays and important role in personal
Jung asserted that people’s individual motives and goals
were more important than sexual urges in determining the
course of their lives.
Erikson created his own personality theory based on psychosocial
This theory is developed in 8 stages that are built on each other.
Each of his stages represent a conflict or core problem that the
individual strives to overcome at a critical period of development.
A person must resolve each conflict in order to master the next
It is important to know these developmental stages for assessing
a person’s developmental, identifying developmental needs, and
for planning nursing interventions.
Erikson’s Stages of Psychosocial
Trust vs Mistrust
6 to 12 years
Generativity vs Stagnation
12 to 18 years
Intimacy vs Isolation
3 to 6 years
Industry vs Inferiority
Identity vs Role Confusion
1 to 3 years
Initiative vs guilt
Birth to 1 year
Autonomy vs Shame and Doubt
Ego Integrity vs Despair
If a pediatric patient in the stage of industry vs inferiority is
hospitalized, what kind of activities would you as a nurse
provide for this client?
The activity should promote the child’s achievement of the
developmental task of industry. These projects will provide a sense
Consider the case of 2 patients with a broken femur, one is 2
and one is 40 years of age.
The childs development is autonomy vs shame and doubt, his
task is to be independent of his parents, so motility is a priority for
The 40 year old is in the stage of generativity vs stagnation, this
stage requires him to get back to work. If he has a desk job, maybe
some work could be brought home to him, or maybe he could
answer the phone while he is recovering.
theorists believe that people are born with
certain predispositions and abilities that affect
other theorists who assert that environment
and life experiences shape personality, the biological
theorists state that people are born with what makes
way people respond to stress, their
susceptibility to developing mental disorders, even
how they feel and act are caused by
genetic, chemical, and physiological forces.
He thought that human personality is rooted in our genetics
Nature vs Nurture----is our personality due to biology or to
environment and experiences?
Studies of identical twins that were separated have shown that they
chose the same career path (showing that genetics play a large role
Some studies showed that whether identical or fraternal, twins are
found to be less alike as they get older (showing that environment
plays a large role in personality)
The real answer is is that both biology and environment play a
larger role in personality development.
take a holistic approach to patient
theories recognize the client as a
whole person make of mind, body, and spirit
who is influenced by internal (biological)
and external (environmental) factors.
Behaviorist and Learning Theories
behaviorist theories are based on the idea that a
behavior persists if it is positively reinforced.
believe that personality is completely shaped
by an individual’s life experiences.
intended to change a behavior includes
planning and practicing a new behavior that will be
reinforced so the desired behavior will continue.
B.F. Skinner, Ivan Pavlov
Studied classical conditioning
When he rang a bell before he
gave food to a dog, they would
He rejected any idea of biological
foundations for personality.
His principle of operant conditioning
stated that behavior is changed by its
If a student is reinforced by receiving
and “A” everytime he writes with a
blue pen, he will continue the blue
pen using behavior even after a clear
cause and effect have stopped.
Skinner believed that people have no
free will to determine their behavior:
all behavior is the result of
This is a classic experiment in
modification with positive reinforcement is
often used with children (the nurse may give a
colorful sticker when the child is cooperative with a
reinforcement is not commonly used.
example of behavior therapy with negative
reinforcement is the drug (Antabuse) which makes
people violently ill when they drink alcohol.
Cognitive Theories of Personality
cognitive theorists believe that
it is human
perception, thinking, and judgment
that make us human.
developed a theory about the
cognitive development of children.
described 4 stages of intellectual
development, with each stage building
on the previous one.
Jean Piaget’s Stages of
Stage- Birth to 2 years
Stage- 2 to 7 years
Operations Stage- 7 to 11
Operations Stage- 11 to 15
When teaching patients, knowledge of cognitive development is
especially important to nurses.
For example, diabetic teaching plans for 7 year olds and 17
year olds would have to be different based on the patients
different cognitive levels.
Teaching for 7 year olds would have to include concrete
instruction about what they need to do in the short term, how to
test blood sugar, and how to inject insulin.
Teaching for 17 year olds could also include the
pathophysiology of the disease, consequences of nonadherence with the treatment plan, and planning how to do
blood glucose checks while they are at school.
Existential and Humanistic Theories
theorists seek the meaning of
life or of human existence.
theorists are more subjective
than other theorists.
theory studies people’s subjective
experiences or perceptions.
He focused on human needs and the most highly evolved state
of human development.
He placed human needs within 5 categories in a hierarchy.
hierarchy of needs provides nurses with a
basis for prioritizing patient needs and nursing
a patient has low self-esteem and also has
inadequate nutrition, the nutritional needs must take
priority because they are lower on Maslow’s
needs must be met before the client is able to
focus on esteem, and before nursing plans for
esteem-building are implemented.
interpersonal theorists believe that
personality constantly changes as a
result of interaction with others.
the interpersonal approach, the
therapist helps the patient develop
trusting relationships, first with the
therapist, then with others.
She was the first nurse to identify psychiatric-mental health
nursing as an essential part of general nursing and as a
Peplau was the first nurse theorist to propose the nurse-patient
relationship as the foundation of nursing practice.
Orientation phase- expectations discussed and goals set.
Working phase- indentification of the problem and use of the
process to enhance the patient’s personal growth.
Resolution or termination phase- relationship is
terminated, outcomes summarized.
Nurses must be aware of their own role in the therapuetic
interaction and of the role the patient may be expecting.
Patients might want the nurse to fill the role of
Participant in the patient’s problem
None of this is useful in providing care to patients.
The social and personal needs of the nurse should not be part
of the nurse-patient relationship.