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IMPACT OF NURSING MODELS IN A PROFESSIONAL SETTING INTRODUCTION People of all ages and life circumstances are bringing to nurses increased numbers of complaints about being depressed. Nursing practitioners in diverse settings are well aware of this increase. The growing incidence of depression is often attributed to factors in contemporary society such as depersonalization, loss of the capacity to trust, interpersonal destructiveness in transitory but intense relationships, and a loss of control over ones destiny. This paper shall look into the aspects of depression among children, especially adolescents, as well as approaches and benefits and implications of the issue using three nursing models. It would seem that candidates for depressive episodes are people who have reached their unique tolerance level for managing events that threaten their self-esteem and their need for emotional support. Some individuals are predisposed to depressive reactions because of early childhood frustrations.

The childs response to frustration forms a prototype response pattern used when later frustrations and threats to dependency needs and self-esteem occur (Laughlin, 1967). Beck (1967) reviewed evidence that suggests a genetic predisposition to depression, but concluded that available research data does not establish conclusively whether affective disorders are genetic, environmental, both or neither (p. 132). At present, there does not appear to be any evidence on which the practitioner can rely that identifies factors such as social class, nationality, race, ethnic group, and personality typologies as predisposition al in the development of depression. Candidates for depression may be defined as those people who, because of past learning, character traits or psychodynamic reasons, will find it difficult to manage one of the following common precipitants of depression: perceived threat to self-worth; actual, assumed or predicted loss of a love object or person; fear or failure after achieving success. THE EXPERIENCE OF DEPRESSION Depressions seem to run a particular, but general, course from onset to termination.

Most depressions seen in counseling are reactive, i. e. , they are triggered by identifiable external events of loss, threat, or disappointment. Depressions may have acute onsets, although some seem to develop gradually until the person cant take it anymore. Acute onsets usually bring about dramatic behavior changes which are of concern to the client and to those in his or her environment.

Depressions tend to get worse before they get better. The client is increasingly negative, pessimistic and helpless in outlook. There is an understandable wish to escape from the discomfort of the depression. The depressed client feels worn-out and complains of vague aches and pains.

As experience and research accumulate, providing a base for theoretical formulation, a coherent body of knowledge emerges. Theory at its best links explanation to method. This understanding is, of itself, a useful part of any treatment or educational program. When methods are tied to a rationale, improved understanding of either component will usually effect a corresponding improvement of the other, thus providing for continued growth and effectiveness of the procedure.

Psychoanalytic theory and practice today (e. g. Black and Black, 1974) is far different from Freud's original formulations due to the continuous work of his followers in modifying both theory and technique with the knowledge derived from additional experience. The primary task of the theory-based approach lies in a tendency to overvalue the accuracy and effectiveness of the approach. Followers act as though the theory was a fact instead of an evolving set of beliefs. Another risk is that proponents of one theory may try to fit everyone into that model, failing to acknowledge its limits of application.

Client-centered counseling is of proven utility with many verbal college students, but can be harmfully misapplied to crisis intervention. A situation calling for concrete action may deteriorate further if the counselor insists on gradual exploration. At the heart of case-based intervention is evaluation on an individual basis. Each person or situation is considered unto itself. The helping person brings to the assessment / intervention process all the theoretical and technical ability that can be mustered toward an understanding of how to assist the client.

The parameters of that assessment usually include the following features: (Sayre, Joan. 2000). Severity of the anxiety Mild to moderate. The clients functioning is impaired but not immobilized by the anxiety. Alice gets restless and nervous every morning on her way to work. The crowds on the train bother her. Coming home is not quite as bad.

Phobic. The clients functioning is virtually paralyzed in a specific area of everyday life. Every time Jack enters an elevator, he begins to sweat. He gets dizzy and nauseous and feels like he will pass out unless he gets off the elevator.

Panic. The client verges on terror, often with no specific cause. No distractions or reassurance are helpful. Sue feels like shes losing her mind.

She cant think or concentrate. She keeps having this terrible feeling she can barely describe. Source of anxiety Historic. The anxiety may be of recent origin or of long standing. Jim reports, Ive had this nervous stomach for as long as I can remember. Precipitant.

Anxiety attacks are triggered by an event or person (s) in the clients life. Ive been like this ever since my marriage broke up. Kind of Anxiety Focal. Anxiety is evoked at particular times, by particular conflicts or conditions, conscious or unconscious. I dont know why, but it happens every time Hal comes by. Diffuse.

Anxiety is ever present, widely experienced, unrelated to time, place or person. That uneasy feeling is always there. I cant get rid of it. Nature of the anxiety Situational. The most common cause of anxiety is a situation which is perceived as threatening, whether or not the danger is objectively real. Alex gets sweaty palms and rapid heartbeat whenever someone asks him for a favor.

Developmental. Moving from one developmental period to another requires a change and adjustment that is often stressful. The person may be too well-rooted in the present stage and unwilling to change (e. g.

the campus hero who is about to graduate). The impending life stage contains threatening elements (e. g. acknowledging that one is no longer youthful).

Unresolved earlier issues conflict with developmental demands (e. g. repressed anger at mother inhibits relating to female peers). Need frustration or deprivation. The pressure to satisfy blocked or unfulfilled needs creates anxiety. Linda gets severe headaches whenever she tries to diet.

Incremental. Oftentimes a variety of smaller stresses accumulate, erode the persons coping resources, and precipitate an anxiety attack, My wife is pregnant, my father just had a heart attack, business is bad, I cant take much more of this (client begins to cry). Traumatic. A sudden or unexpected emotional shock will almost invariably elicit manifestations of anxiety and mental illness, often severe reactions, Oh, my God. (shouting, thrashing arms about) Help me! Hes dead! In the course of looking at the theories behind this issue, it is important to analyze this concern using nursing models conceptual models.

This paper shall examine three nursing models. MYRA LEVINES CONSERVATION MODEL One of this is Myra Levine's Conservation Model. This model stipulates that individuals are holistic beings and which happens to be the major concern for nurses in the maintenance of a persons wholeness. (Polit & Henderson p. 10). Indeed, mental illness can assume many forms and many levels of severity, even though, in addition, anxiety can sometimes be inferred from its apparent absence. Certain situations are of sufficient threat value to justify an expectation of anxiety arousal.

When the person acknowledges no awareness or overt sign of anxiety, a nursing practitioner will look for indications that a defense mechanism has been invoked to dispel the perceived threat. Since mental illness is such a potentially disruptive experience, the nursing practitioner must be sensitive to any clues which indicate that the client is unable to deal effectively with the experience. More specifically, does the anxiety cause personal fragmentation or activate rigid defense mechanisms? Or, is the person able to utilize coping mechanisms to resolve the conditions giving rise to anxiety? Intervention then can be thought of as a procedure utilized by a nurse to assist a client in more effective management of anxiety. Intervention strategy is the selective use of intervention modalities, based on an assessment of the individual clients needs in managing anxiety.

As the nurse tunes in to the clients comments and behavior, he or she will be attempting to make sense out of that material on several levels of understanding. 1) How severe is the clients illness? Does it prevent functioning (e. g. , eating, sleeping. Studying) or interfere with functioning? 2) Is the anxiety focused (on a time, place, person, etc) or is it more generalized? 3) What does the clients reaction to anxiety indicate about his or her ego strength are both coping and defense mechanisms used?

Is there evidence of fragmentation of impaired reality testing? Is there evidence of resiliency? (Sayre, Joan. 2000). As this assessment proceeds, the nurse understands the client better. This, in turn, provides her with a better sense of how to respond to the client.

The nurses response then truly becomes an intervention, designed to help that client at that point in time. The particular modality chosen is, therefore, a tool used by the counselor in the service of an intervention strategy (Sayre, Joan. 2000). ROYS ADAPTATION MODEL In Roy's Adaptation Model, humans are biospychosocial and change through the process of adaptation. (Polit & Henderson p. 104). It was shown that professionals need to improve their practice by knowing that the effects of patients subjective assessments on their responses. Professionals need to assist their patients well in the stigmatizing effects of a psychiatric diagnosis (Sayre, Joan 2000). And the first step in being able to help eliminate myths, misconceptions and stereotypes is to understand what a psychiatric illness is.

By and large, psychiatric illness refers to significant clinical patterns of behavior or emotions associated with some level of distress, suffering or impairment in one or more areas of functioning. At the root of this impairment are symptoms of biological, psychological or behavioral dysfunction or a combination of these (Sayre, Joan 2000). Since depression is such a potentially disruptive experience, the nursing practitioner must be sensitive to any clues which indicate that the client is unable to deal effectively with the experience. More specifically, does the anxiety cause personal fragmentation or activate rigid defense mechanisms? Or, is the person able to utilize coping mechanisms to resolve the conditions giving rise to anxiety? Intervention then can be thought of as a procedure utilized by a nurse to assist a client in more effective management of anxiety.

Intervention strategy is the selective use of intervention modalities, based on an assessment of the individual clients needs in managing anxiety. As the nurse tunes in to the clients comments and behavior, he or she will be attempting to make sense out of that material on several levels of understanding. 1) How severe is the clients illness? Does it prevent functioning (e. g. , eating, sleeping. Studying) or interfere with functioning? 2) Is the anxiety focused (on a time, place, person, etc) or is it more generalized? 3) What does the clients reaction to anxiety indicate about his or her ego strength are both coping and defense mechanisms used? Is there evidence of fragmentation of impaired reality testing?

Is there evidence of resiliency? (Sayre, Joan. 2000). COGNITIVE THEORY The last major cognitive theory of depression has been developed by Beck (1967, 1976). Depression is considered to be a thought disorder rather than an affective or mood disorder. Depression is a series of reactions to meaningful loss. The loss diminishes the person, whether the loss is actual, imagined or the result of deprivation over time. The depressed person experiences unpleasant and disturbing feelings which are the consequences of the persons thinking about self, world and the future.

Beck (1967) states, If the patient was rejected, he would experience negative affect. Similarly, is he simply thought he was rejected, he would experience the same negative affect (p. 261). The treatment of the feeling states of depressed client demands counselor patience and creativity. Feelings are automatic consequences of thoughts and to change feelings, it is necessary that thoughts be altered. It is rarely productive to offer contrast to the feelings of the client. A depressed child feels miserable there is nothing to be gained by a nurse suggesting that the client does not or ought not to feel that way.

Feelings are changed by changing their antecedents and consequences, which takes time. Thus, affective disorders are secondary to and caused by cognitive disorders. The cognitive disorders are due to interpretations (thoughts) about data and events. Beck identified a primary cognitive triad that operates in depression by progressively dominating thinking. The major characteristics of the cognitive triad are the distortion of reality and a systematic bias against the self. The cognitive triad includes the elements of interpretation of experience, a negative view of self and a negative view of the future.

As this assessment proceeds, the nurse understands the client better. This, in turn, provides her with a better sense of how to respond to the client. The nurses response then truly becomes an intervention, designed to help that client at that point in time. The particular modality chosen is, therefore, a tool used by the counselor in the service of an intervention strategy (Sayre, Joan. 2000). CONCLUSIONS Having analyzed all these, it seems logical, somehow, to suppose that an entity that understands must be more complex than the object being understood. One can therefore argue that all the abstruse facets of modern mathematics and physical science are but reflections of those facets of the physical universe which are simpler in structure than the human mind, Where the limit of understanding will be, or whether it exists at all, we cannot well predict, for we cannot measure as yet the complexity of either the mind or the universe outside the mind (Zide, M and Gray, S. 2001).

However, even without making measurements, we can say as an axiom that a thing is equal to itself, and that therefore, the human mind, in attempting to understand the workings of the human mind, faces us with a situation in which the entity that must understand and the object to be understood are of equal complexity. Depression has a multiplicity of causes. At its most fundamental meaning, mental illness, like other pain is a signal. The helper makes a real contribution by assisting clients to interpret those signals.

Optimum management of mental illnesses involves tolerance and modulation, not avoidance or abolition. A general theory of anxiety management must take as its basic orientation, the utilization of anxiety as naturally as one would hunger pangs. Learning to respect its value, interpret its signals, and moderate its intensity will contribute to a richer quality of life. The contemporary professional helper is more than a therapist, but functions also as a counselor, educator, advocate and consultant. To parallel this more sophisticated definition of professional role, the concept of mental illness should be freed from its one-dimensional definition. Billions of dollars are spent in order to solve mental illness.

This amount accounts for the payment to doctors, patient care and losses caused by people missing days of work or lower worker productivity. That is why it is important that there is proper education, understanding and creative solutions in dealing properly with depression. Nurses need to be more accurately attuned to the processes of interpersonal persuasion operative in counseling and psychotherapy today, than even a decade ago (Frank, 1973)... REFERENCES Beck, A. T. Depression: Causes and treatment.

Philadelphia: University of Pennsylvania, 1967. Bobgan, M and Bobgan, D. 1987. Mental Illness is Not a Disease. Mental Illness. Greenhaven Press. Clinton, H, and Hyman, S.

Mental Illness is a Disease, Opposing Viewpoint Series. Greenhaven Press. 2000. Washington, D. C. Depression and Heart Disease, National Institute of Mental Health, Article Accessed: 27 Jan 2006 at: web Frank, J. D.

Persuasion and healing (Rev. Ed) Baltimore: John Hopkins, 1973. Hillary Rodham Clinton, The White House. Article Accessed: 27 Jan 2006 at: web Laughlin, H. P. The neurosis.

Washington: Butterworths, 1967. McGrath, P. & Hole, H. (2004). Mental Health and Palliative Care: Exploring the Interface. International Journal of Psychosocial Rehabilitation. 9, (1) 107 - 119 Accessed 27 Jan 2006 at: web Sayre, Joan. (2000). The Patients Diagnosis: Explanatory Models of Mental Illness. Qualitative Health Research.

Vol. 10 No. 1. Hunter College of the City, University of New York. Zide, M and Gray, S. 2001. Psychopathology: A Competency-Based Model for Social Work.


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