Good day!

I am Dr. Dominic Paguio, a mental health psychiatric nurse, a special education specialist, an expressive
arts practitioner, and an educational psychologist. I will discuss basic theoretical frameworks that serve as
foundations in our mental health psychiatric nursing practice.

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You see on your screen the flow of this lecture. I will begin by citing the definition of MHPN as a take-
off point of the discussion. I will then discuss some nursing theories relevant to the practice of MHPN.
This will be followed by examining the biological basis of mental illness causation. After which, I will go
and cite prominent and germane psychological theories.

The knowledge of theoretical frameworks as the foundation of any professional practice is necessary, and
they serve as the backbone of the practice itself. However, Gunner and Pelivan (2015) argued that
although the importance of theoretical knowledge is indisputable, there is no formal agreement on what
should be included as the theoretical foundation of our practice. Thus, different authors of textbooks offer
different approaches to discussing this topic. This disagreement may cause confusion among nurses.
Basavanthapa (2011) mentioned that nurses experience obstacles when putting theories into clinical
practice. She further noted that nurses encountered challenges in comprehending theory's meaning and
applying it in their practice. McAllister and Moyle (2008) stated that nursing care was of higher quality,
leading to better patient outcomes when they are well-informed about the theoretical basis of their
practice. This, in turn, also improved the value for their practice, boosted their morale, and better handled
bureaucratic pressures from hospital administration because they knew the whats, hows, and whys of their
practice.

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As a springboard for our discussion, on your screens are some common definitions of MHPN.

MHPN is, first and foremost, an interpersonal process between the nurse and the patient, the nurse and the
family, and the patient. All these dynamic interactions promote the client's well-being and maintain these
behaviors to enable adaptive and integrated functioning. This practice puts a hefty premium on theories
and the therapeutic use of self—thus, the impetus for discussing theories as a basis for our practice.

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This brings us to the discussion of nursing theories unique to our practice. I will start with Dorothea
Orem's Self Care Deficit theory.

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She began her work by looking for the uniqueness of nursing. How was it different from other
disciplines? How was it similar? This search for distinctive nursing knowledge was directed toward
answering one question, "What is the domain, and what are the boundaries of nursing as a field of
practice and knowledge? Upon further reflection, she concluded that the reason why individuals could
benefit from nursing was the existence of self-care limitations". Concepts such as Self-care, self-care
agency, therapeutic self-care demand, and self-care deficit are related to the patient or the person in need
of nursing. THUS, FOR OREM, MENTAL ILLNESS IS A REFLECTION OF THE INDIVIDUAL'S
INABILITY TO FULFILL THEIR SELF-CARE NEEDS, AND THE NURSE HAS THE POTENTIAL
TO HELP THE CLIENT MEET THESE NEEDS.
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Self-Care is the performance or practice of activities that individuals initiate and perform on their
behalf to maintain life, health, and well-being. It is learned through interpersonal interactions and
relations.

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Moving forward, Hildegard Peplau's Interpersonal Theory posits that every nurse-client relationship is an
interpersonal situation in which recurring difficulties of everyday life arise.

She stressed that the kind of nurse each person becomes makes a substantial difference in what each client
will learn as they are nursed throughout their experience with illness.

Furthermore, the interaction of nurse and client is fruitful when a method of communication that
identifies and uses common meanings is at work in the situation.

She also stated that the nurse-patient relationship develops in four phases.

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The orientation phase is the stage where the initial encounter between the nurse and the patient happens.
During this phase, the nurse exerts much effort in building trust with the client by creating a consistent
and reliable environment. Also, this is where they set boundaries, level off expectations, and clarify their
roles in the relationship.

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In the identification phase, the client begins identifying their needs and problem, and where the nurse
helps them assume responsibility for meeting those needs.

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The exploitation phase is when the client works fully with the nurse since trust has been established.
Thus, the nurse can help the client work through their issues and needs and attain their goals set in the
exploitation phase. This is where a reflexive process of implementation and evaluation happens.

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Finally, in the termination phase, a sense of security is established as the patient has less reliance and
identification upon the nurse helper. Here, the client has increased self-reliance to deal with their
problems.

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Next, Joyce Travelbee proposed her Human-to-human Relationship model. Inspired by Existentialists
Viktor Frankl and Rollo May, she extended Peplau's theory.

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She stated that the goal of nursing is to assist an individual and/or the family in preventing or coping with
the experience of illness and suffering and, if necessary, to find meaning in these experiences. This is
done through the therapeutic use of the self.

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Using oneself therapeutically entails everything the nurse does for and with the patient. It is designed to
help the individual or the family cope with or bear the stress of illness and suffering in the event the
individual or the family encounters these experiences.

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This is actualized through communication techniques such as open-ended comments or questions,

Reflecting, Sharing perceptions, and the Deliberate use of cliches.

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Now, I want to shift your focus to more medical and psychological theories that are commonly utilized in
our practice and, based on my experience, have been equally valuable for the performance of my practice.
The stress diathesis model proposes that mental illness is brought about by the compounded effect of
one's inherent predisposition and the impact of stress on the person's life.

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In the illustration, you can see that if the predisposition is low, the individual may not develop mental
illness even with high stress. Vice versa, a person experiencing low-stress levels in the presence of a
predisposition may not also result in mental illness. It will yield a mental illness only with the
combination of high predisposition and stress.

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By knowing this, we can have a deeper understanding of illness causation, the role of stress, and the
importance of stress reduction interventions as part of our care.

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We now move the discussion toward psychodynamic theories. These frameworks see human functioning
based on the interaction of drives and forces within the person, mainly the unconscious, and between the
different personality structures.

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Freud's psychoanalytic theory has been strongly associated with psychiatry for the longest time because
of its comprehensiveness, structure for the personality, theory of development and consciousness, defense
mechanisms, and therapy. For Freud, the root of a person's behavior is in the unconscious mind

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Thus, therapy aims to make the individual aware of these issues in the unconscious. He also stressed that
all behavior has reason or meaning and is motivated by instinctual drives, Eros (Life) & Thanatos
(Death). He also believed that the different parts of the unconscious mind are in constant struggle
(tripartite personality) where the Id operates on the pleasure principle, the Supergo as the conscience and
the ego as the mediating element between the id and the supergo and operates on the reality principle.

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Freud also stressed that our behavior and feelings as adults are rooted and can be traced from our
childhood experiences, putting a lot of weight on early experiences and their impact on illness causation.

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He also posited that for the ego to escape from the impact of anxiety, it utilizes defense mechanisms that
initially are adaptive but eventually turn maladaptive when the individual depends on them instead of
confronting their issues. The ego uses these mechanisms to distance itself from the full awareness or
impact of stress or unpleasant thoughts, feelings, and behaviors. Here are just some of the defense
mechanisms commonly used.

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Displacement is when one discharges pent-up feelings to a less threatening object. Repression refers to
the involuntary and unconscious forgetting of painful ideas, feelings, and events. Sublimation involves
channeling instinctual drives into acceptable activities. Finally, regression refers to a return to an earlier,
more comfortable level of functioning.

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Freud also theorized the psychosexual stages of development. He said that human development was
divided into five stages and was determined by innate sexual energy, Libido, and erogenous zones.
Problems that may occur during these stages may lead to fixation and hinder proper development, which,
in turn, can lead to some maladaptive behaviors or mental illness.

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On the other hand, Erikson's psychosocial theory expands the theory of development proposed by Freud.
He stated that development is heavily influenced by the child's immediate environment, which helps him
meet his needs and resolves developmental conflicts. According to Erikson, the personality develops in a
predetermined order through eight stages of psychosocial development, from infancy to adulthood.

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During each stage, the person experiences a psychosocial crisis that could positively or negatively affect
personality development. The goal of development is striking a balance between the two opposing forces,
as manifested by the development of virtues.

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Meanwhile, Harry Stack Sullivan's Interpersonal Theory explained the role of interpersonal relationships
and social experiences concerning the shaping of personalities and the importance of life events to
psychopathology.

For him, the purpose of the behavior is for the patient to have their needs met through interpersonal
interactions, as well as decrease or avoid anxiety.
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He proposed that human development was divided into six stages: infancy, childhood, juvenile era,
preadolescence, early adolescence, and late adolescence. These stages are based on their relationships and
the processes involved in them, and these stages would end with the acquisition of learnings
developmental landmarks.

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Bronfernbrenner's Ecological Theory of Development posits that complex, integrated, nested systems
influence human development in the person's environment.

According to Bronfenbrenner, "The ecology of human development is the scientific study of the
progressive, mutual accommodation, throughout the life span, between a growing human organism and
the changing immediate environments in which it lives, as this process is affected by relations obtaining
within and between these immediate settings, as well as the larger social contexts, both formal and
informal, in which the settings are embedded."

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These environments, namely: the microsystem, mesosystem, exosystem, macrosystem, and the
chronosytem, emanate from the child based on the directness of their interaction with the child and each
other. These systems are nested within each other, like, the Russian nesting dolls.

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On the local front, Virgilio Enriquez's Sikolohiyang Pilipino explains the psychology of Filipinos'
experiences, thoughts, and orientations based on Filipino culture and language. At its core is the value of
KAPWA, the shared inner reality of Filipinos. Revolving around the core value of KAPWA are other
values that comprise and illustrate the Filipino psyche.

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Behavioral theories emphasize that all behaviors are learned through environmental interaction. For
behaviorists, behaviors are learned from the environment, and they say that innate or inherited factors
have very little influence on behavior. For them, as much as behaviors can be learned, they can also be
unlearned.

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Ivan Pavlov accidentally discovered classical conditioning while studying the intestinal processes of dogs.
Classical conditioning involves the association of a stimulus to a specific response, usually involving
unconscious or involuntary responses such as emotions.

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In his experiment, he noticed that dogs innately responded to the introduction of food but had no response
to the sound of a bell which he referred to as a neutral stimulus. Through repeated exposure to the bell
after introducing food to the dog, the dog eventually learned to respond to the bell and salivated upon
hearing the bell.
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In Operant Conditioning. BF Skinner posited that learning/ behavior modification occurs after giving
rewards and punishment after the desired/undesired behavior is elicited. The rewarded behavior is likely
to be repeated through operant conditioning, and the punished behavior will rarely occur.

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The rewards or punishments can be administered based on the action and the stimuli presented. The
stimuli can either be pleasant or unpleasant and the action, adding or removing the stimuli. By adding a
pleasant stimulus, the behavior is strengthened. Likewise, by removing the unpleasant stimuli, the
behavior is maintained. Conversely, adding an unpleasant stimulus or removing a pleasant stimulus may
lead to the extinction of the unwanted behavior.

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According to Albert Bandura's social learning theory, learning happens through imitation, modeling, and
observation and is influenced by things like motivation, attitude, and emotions. The idea takes into
account how environmental and cognitive factors interact to influence learning.
According to the hypothesis, learning happens as a result of people seeing the results of other people's
actions. Bandura's theory goes beyond cognitive theories, which take into account psychological factors
like attention and memory, and behavioral theories, which contend that all behaviors are learnt through
conditioning.
Bandura contends that people either observe conduct directly through encounters with other people in
social settings or indirectly through media. Rewarded behavior is more likely to be imitated, whereas
discouraged behavior is avoided.

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It all started with Bobo, an inflatable clown. In his laboratory, Bandura discovered that kids were more
likely to beat up Bobo the clown themselves if they saw adults beating him up. Learning can take place
through imitation and social modeling, as shown by social learning theory, which was developed from
study results based on this finding. One develops their self efficacy—or the confidence that they can
accomplish the observed skill—through this process. Bandura's work has helped professionals in the
mental health field understand that people can adapt and self-regulate to attain their desired futures and
are the agents of their own self-development.

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Lastly, Piaget's Cognitive Development theory proposes that a child develops through stages until
arriving at a stage of thinking that resembles an adult's.

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The four stages given by Piaget are (1) the sensorimotor stage from birth to 2 years, characterized by the
child's reliance on environmental stimuli, (2) the preoperational stage from 2 to 7 years, where the child
develops representational/ symbolic thinking through the development of language, (3) the concrete-
operational stage from 7 to 12 years where the child learns cognitive rules and logic, and (4) the stage of
formal operations that characterizes the adolescent and the adult where they learn abstract and critical
thinking.
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I hope with these theories, your practice will be further strengthened and reinforced. Thank you.