Non-Nursing Theory Presentation 2

Class Presentationon

Application of non-nursing theories to clinical practice:

Erikson: Theory of Psychosocial Development

andBowen: Family Theory

PRESENTERS:

ARELIS GONZALEZ

ALAN HIPPLEHEUSER

BRIGITTE KINDAMarch 11, 2016

Introduction Origin of Bowen’s Family Theory:

This theory was developed from psychiatric research It is a theory backed up by a growing body of empirical research It is the foundation for Bowen concept that the primary source of

human emotional experience is the extended family unit. For Bowen the degree of differentiation determines the capacity

of a person to manage his or her emotion, thinking, individuality and connections to others (Brown, 2012)

Origin of Erikson’s Psychosocial Development Theory: This theory emerged as an expansion of Freud’s concept of ego. In Erikson’s theory, special stages of a person’s life from birth to

death are formed by social influences that interact with the physical/psychological, maturing, organism.

Erikson developed the concept of ego to incorporate qualities that expanded the Freudian concept. He believed the ego is the most powerful of the three parts of the personality (id, ego, and superego) and described the ego as being robust and resilient (McEwen and Wills, 2014, p. 310).

The Nursing MetaparadigmBowen’s Family Theory

Person: Each individual goes through developmental stages throughout their lifespan Nursing: A better understanding of the stages of development help nurses to give a nursing

diagnosis related to the patient psychosocial development based on his or her stage of development.

Health: A positive resolution through the developmental stages influence how an individual reaction to stress situation.

Environment: Social interaction of an individual throughout his or her lifespan influences his or her stages of development.

Erikson’s Psychosocial Development Theory Person: Allow each member to have their own emptiness and period of pain, without rushing

to resolve or protect them from the pain and thus prohibit growth. Differentiation of the person from the family members lead to optimal family development.

Nursing: Adjusted families are aware of influences from outside the family, such as emotional processes, as well as from within the family.

Health: Family who are adjusted view emotional problems as coming largely from the greater system but as having some components in the individual member.

Environment: Adjusted families are balance in terms of their togetherness and separateness, and can adapt to changes in the environment

Bowen’s Key Concepts Triangles – Three-person relationship system. Building block of large emotional systemPattern in a triangle change with increasing tensionContribute significantly to the development of clinical problemsDifferentiation of self – Individuals vary in their susceptibility to a “group think”, feel, and act, but individuals vary in the amount of pressure they exert for conformityThe less develop a person’s “self,” the more impact others have on his or her functioning and more he or she tries to control, actively or passively, the functioning of others. A person with a well-differentiated “self” recognizes his or her realistic dependence on others, but he or she can stay calm and clear headed enough in the face of conflict, criticism, and rejection to distinguish thinking rooted in a careful assessment of the facts from thinking clouded by emotionalityFamily emotional – Clinical problems or symptoms usually develop during periods of heightenedand prolonged family tensionFour basic patterns: marital conflict, dysfunction in one spouse, impairmentof one or more children, emotional distance

Bowen’s Key Concepts (cont.)

Family projection process – The projection process follows three steps:(1) the parent focuses on a child out of fear that something is wrong with the child;(2) the parent interprets the child’s behavior as confirming the fear; and(3) the parent treats the child as if something is really wrong with the child.Multigenerational transmission – The combination of parents actively shaping the development of their offspring, offspring innately responding to their parents’ moods, attitudes, and actions, and the long dependency period of human offspring results in people developing levels of differentiation of self-similar to their parents’ levelsEmotional cutoff – People reduce the tensions of family interactions by cutting off, but risk making their new relationships too important. For example, the more a man cuts off from his family of origin, the more he looks to his spouse, children, and friends to meet his needsSibling position – The sibling or rank positions are complementary in the first case and each spouse is familiar with living with someone of the opposite sexThe sibling positions of a person’s parents are also important to considerSocietal emotional – Human societies undergo periods of regression and progression in their history. The current regression seems related to factors such as the population explosion, a sense of diminishing frontiers, and the depletion of natural resources (Bowen center, 2016).

Erikson’s Key Concepts

Stage 1- (0-1 year) – trust vs. mistrust, Occurs between birth and one year of age and is the most fundamental stage in life. Based on the development and quality of the child’s caregiversFailure to develop trust will result in fear and a belief that the world is inconsistent and unpredictableLeads to hope

Stage 2 – (1 – 3 years) – Autonomy vs shame and doubt,Focused on children developing a greater sense of personal controlToilet trainingLeads to will, which is the belief that children can act with intention, within reason and limits

Stage 3 – (3 – 6 years) – Initiative vs guilt,IndependenceResponsibilityLetting children do things on their ownLeads to purpose

Stage 4 (6 – 12 years) – Industry vs. inferiority Through social interactions, children begin to develop a sense of pride in their accomplishmentsEncouragement is keyLeads to competence

Erikson’s Key Concepts (cont.)

Stage 5- (12 – 19 years) – Identity vs. confusionChildren explore their independence and develop a sense of selfLeads to fidelity, which Erikson described as an ability to live by society’s standards and expectations

Stage 6 – (20 – 25 year) – Intimacy vs. isolation People are exploring personal relationshipsForms committed and secure relationshipsA strong sense of personal identity is important for development intimate relationshipsLeads to love

Stage 7- (26 – 64 years) – Generativity vs. stagnationContinuing to build our lives, focusing on our career and familyContributing to the worldLeads to care

Stage 8 – (65 – Death years) – Integrity vs. despairReflecting back on lifeFeel a sense of integrity if successful, if unsuccessful may feel as if their life was a wasteLooking back with few regrets and a general feeling of satisfactionLeads to wisdom, even when confronting death (Shic, A., & Burdalic, A., 2013)

An example of a client situation where the Bowen’s Family Theory and Erikson’s Psychosocial Developmental Theory may be applied is a follows:

A person with Alzheimer lives alone and has two children. The oldest child lives 15 minutes away and the youngest child lives two hours away. The daughter who lives closer is frequently visiting her mother and finds herself providing 24/7 care as the primary caregiver, which allows her mother to stay home. Despite being obvious that she needs help, it seems that her younger sister is unwilling to help their mother even on weekends, which would provide the older the sister some much-needed relief. The older sister is upset with the younger sister because she offers advice but does not help with the mother’s care. The younger sister thinks the older sister is being unreasonable by not taking her advice to place their mother in a long-term care facility. She thinks that they should just place their mother in a facility so that neither of them would be overwhelmed with daily caregiving. Therefore, since the older sister will not place their mother in a long-term care facility, she refuses to help. Now the caregiving sister has lost her job and is living with her mother to provide full-time to care.

Client Situation

Theory Specific Diagnosis for each Theory

Bowen’s Family Theory is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. It is the nature of a family that its members are intensely connected emotionally. Two main variables is: 1) Degree of anxiety and 2) Degree of integration of self.

Using the “Triangle” concept, I would use Anxiety relating to Caregiver Role Strain as a Diagnosis for the child who has taken the role of the caregiver.

(The Bowen Theory Education CTR, 2016)

According to Erikson’s Psychosocial Development Theory in each stage, the person confronts, and hopefully masters, new challenges. Each stage builds upon the successful completion of earlier stages. The challenges of stages not successfully completed may be expected to reappear as problems in the future.

Erikson’s Psychosocial Crisis of Integrity vs. Despair is used best to relate to the mother with Alzheimer’s Disease with a Diagnosis of Impaired memory related to Alzheimer's Disease evidenced by memory loss.

(McLeod, 2013)

Bowen’s Family Theory can be used to design Nursing Interventions by: Bowen’s Family Theory can be used to design an

intervention by first implementing a care plan to resolve/support the nursing diagnosis identified by the nursing assessment to meet the clients' needs.

Using the Triangle concept of Bowen’s Theory and the diagnosis for Anxiety relating to Caregiver Role Strain as an example we can provide goals or desired outcomes for the caregiver such as: Family will report low or no feelings of burden or distress measured by relief stated by family.

Nursing interventions or orders are instructions for the specific activities that will perform to help the patient achieve the health care goal.

Ultimately evaluating the client’s progress towards the goals effectiveness of the nursing care plan.

(McLeod, 2013)

Bowen’s Family Theory helps the reader understand that a family is composed of a unit, and any change in one person’s functioning predicted to cause changes in the functioning of others.

One person inevitably affects the other and vice-versa. Because of this tension stress is experienced. To relieve the stress another member must reveal new and more effective options for solving that which is causing tension.

Erikson’s Psychosocial Developmental Theory can be used to design Nursing Interventions by:

Nurses help identify a client’s faulty behavior based on past experiences and stages and help the client seek psychological assistance such as a counselor.

Nurses use Erikson’s developmental model as an important part of patient assessment. Analysis the behavior patterns identify age-appropriate or arrested development of normal interpersonal skills

(McEwen & Wills, 2014)

Erikson’s developmental framework helps the nurse know what types of interventions are most likely to be effective.

For example, elderly patients respond to a life review strategy that focuses on the integrity of their life as a tapestry of experience.

During the assessment process the nurse can determine age appropriateness or arrested development.

By assessing the developmental stage of an adult and elderly person, data can be collected about interpersonal skills and behaviors that need to be addressed in client care.

(McLeod, 2013)

Components of Bowen’s Theory and Erikson’s Theory that need more research before it can be applied to clinical practice is:

Erikson’s Theory can relate to many people in various stages of the life cycle through their own experiences. However, Erikson is rather vague about the causes of development. What kinds of experiences must people have in order to successfully resolve various psychosocial conflicts and move from one stage to another; or what about those adults who rediscover themselves and develop a different understanding of their lives due to life's changes and experiences? It may be possible for an individual to change throughout life despite the need to resolve one stage before moving on to the other.

(McLeod, 2013) Bowen’s Theory consist of the family as a unit, a family system. Once the research view

shifts from the individual to the family, the scene looks entirely different and research doesn’t employ cause-effect linear models. This makes research from a systems perspective somewhat complex. If a person does clinical outcome research and only measures the presence or absence of a symptom in one family member, the systems view has been lost. Multiple variables affect the system. Researchers guided by systems thinking holds multiple variables and their interactions with each other, simultaneously in their thinking.

(Kerr, 2000)

(The Bowen Theory Education CTR, 2016)

Diagram 1: Concepts that apply to practice

Practice area: Hospital in-patient ICU, PCU, Med-Surge areas

BOWMAN

Stage Assessment

Current research for specific illness/stage

Design care around stage and stage strengths

Talk with patient about life stage

Recognize underlying family system anxieties

Apply skills to help strengthen triangles

Improve differentiation through tea

ERIKSON STAGES

Diagram 2: Areas needing future refinement or research

Practice area: Hospital in-patient ICU, PCU, Med-Surge areas

BOWMAN

Research how to use assessment to determine Erikson stage, strengths and weakness, and application and how to use the assessment in client communication

Research specific illnesses for specific Erkson stages: design care plans based on research.How family anxiety can be relieved and teaching, learning, and integration can take place in an ICU with Bowman’s Theory

ERIKSON STAGES

Research how to teach nurses to interact better in family systems

How applying theory to clinical practice has increased our use of current literature and research findings.

The client’s developmental strength. Looking for ways to serve clients from different Erikson development ages and how identification of a patient’s strengths during assessment can improve communication and teaching of patient family: conducting literature searches.

Example: Research by Nyman and Szymcznska (2016) indicates that patients with dementia can benefit through Erikson’s generativity vs stagnation by storytelling, re-identification of leisure time activities, therapeutic life review, spiritual and religious activities for death preparation, hope for new creative activities, and intergenerational contribution.

Specific examples of how applying theory helped us to evaluate our clinical practice and approach to patient care.

Using Erikson stage in assessment. Using Erikson’s theory, we question as to how family theory and psychosocial theory can be used to impact the overall health of the patient including the psyche, and the effect of care that considers a patient’s psychosocial stage, and accomplishments with the stages as well as a person’s relationship to their family in terms of Bowen’s triad.

This question helped us evaluate our current assessment of the developmental life stage, it’s significance to the individual’s health and/or illness, where the patient has developmental strengths and how these strengths can be applied to help the individual to make health life choices (McEwen and Wills, 2014, p. 310).

Specific examples of how applying theory helped us to evaluate our clinical practice and approach to patient care (cont.)

Using Bowman’s Family Theory to communicate. Next, we take research from Tarnowski and Hanson (1999) for critical care and improve nurse-family communication through understanding and interacting in the whole family system, as proposed by Bowman.

This requires recognizing triangling and family roles, reducing family anxiety through increasing family awareness of individuality and family member roles.

Even small gains in this area can make a great difference as families relieve stress and understand the critical care system better.

summary Clinical examples include assessing for Erikson stage

and active listening to help patients use their developmental strengths to cope, heal, learn and change.

Further research areas include study of how to assess for Erikson stages and apply the information to improved in-hospital stays, and how to teach nurses about Bowman Systems theory to reduce family stress in critical situations.

Erikson's theory offers a useful framework for analyzing developmental histories making the nurse more aware of the client’s inability to cope with problems as an adult, in turn helping the client seek psychological assistance such as a counselor, or merely being more compassionate.

According to Bowen, persons are reasonably adaptable to anxiety. Tension develops either within the person or in the unit/the family. The tension produced by enduring anxiety precipitates symptoms, dysfunction or sickness. The characteristics can be impulsiveness, withdrawal or social misbehavior in a person; or by emotional or behavioral dysfunction.

ReferencesBrown, J. (2012). What is Bowen Theory? Who is Dr Murray Bowen? Retrieved March 8,

2016, from http://www.thefsi.com.au/us/bowen-theory/ Goodell, T., & Hanson, S. (1999). Nurse-family interactions in adult critical care: a Bowen

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Retrieved from http://www.bowentheoryeducationcenter.org/the-bowen-theory

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