All those who dare speak from "experience"

fergus51 · Mar 4, 2002

Define psychosocial theory. Do you mean developmental stages a la Erikson and people like him?

If so, when you do a peds rotation (which was a requirement in my program) the knowledge is invaluable. We had to tailor our approach to the kids based on their developmental stage and their level of thinking according to Piaget (concrete, preoperational, all that stuff). Example, if a child is in the industry vs. inferiority stage then it is important to encourage them to participate in their care and continue to "achieve" things like making their own breakfast or whatever. We also used info from Watson and Chess about moral development. I have also used the info on med surg. One girl in particular was 19 (in that intimacy v isolation stage) with CF. She had been sick most of her life and had trouble with meeting the goal of this stage. In order to facilitate her developping needed relationships we started giving her more day passes and put her in a private room so she could have visitors past visiting hours. Also good for older people to help them work through regrets, etc....

I think the main purpose of the knowledge is for you to gain an understanding of what people in that stage should be doing, how thir illness has impacted their progress, and what you can do about it. I think we learn all this stuff because it is important for us to remember that sick people have the same needs as healthy people and those needs can't just be put on hold when they go into the hospital.

Nursing is full of vague concepts that are hard to recognize or explain until you're in the situation and using it. Believe me, I understand your frustration and the abstract seemingly fluffy things you have to take in nursing school. I felt the same way. It wasn't until I was practicing that I realized how useful all that fluffy stuff really was. And yes, part of it is getting you to think outside the box and exercise your conceptual side. Nursing isn't just about concrete skills, it's more about the ability to stretch your brain and deal with subjective experiences...:)

Peeps Mcarthur · Mar 4, 2002

Fergus,

Thank you for such a thoughtful response.

I'm truly only concerned about learning what I need to show competency in clinicals. I know I'm supposed to be all excited about the "whole" person concept of this but it would seem common sense to me that a 19 y/o has to "get out more often"

and that they would have some issues with the shut-in thing about CF. While I could likely figure out what would be bugging my 19y/o/f I would have a paticular difficult time sensing the needs of a 3y/o. Since I will only be on a peds floor for school(there isn't an administrator alive that could get me to work peds for a living ) I will only need the information required for that function.

It may be true that this is needed to make satisfactory marks in peds clinicals but I don't see this applying on an acute care floor. You've given examples of how it relates to chronic patients and I think that's where the distinction is drawn. I wasn't thinking of long-term patients because that just doesn't apply to the acutely ill. The acutely ill focus on their pathologies because they are in a kind of "culture shock" and the pathology is all encompassing for the few days they're admitted. There wouldn't be sufficient data to make an assumption.

Yup, I assume peds, rehab, and psych would all have some use for the "yuppie speak" of psychosocial theory, at least in the academic setting. An argument for disregarding psych could be made because those patients have mental disorders beyond the scope of normal development couldn't it? Therefore nullifying the study of social development in an abnormal brain chemistry.

Yes I do have a peds rotation. I dread the day it starts. I have no interest in OB/GYN either. That's the reason I'm exploring a usefulness of them somehow. I've been to both in another capacity and I can tell you I won't have academic trouble there or anywhere else unless I'm required to somehow pull psychosocial theory out of my butt and use it. I'd be an absolute phoney. The only thing I fear about Nursing school is being a phoney using all this phoney terminology. I don't remember seeing it or hearing it spoken or seeing it on a chart in my five years of clinicle work, but that was ten years ago and pehapse I have a selective memory. If I thought this was an important nursing concept I would have gone on another career path. Maybe once I get through it I'll be able to put some of it to use. Maybe I'll find that Nursing is not what it appeared to me so many years ago, but I won't know that untill I step out on the floor in my first job. I realize that school and an actual job will be two seperate worlds.

Brad

PS.

Thanks for responding.

fergus51 · Mar 5, 2002

You welcome Brad. Like I said, I know exactly how you are feeling. I HATED developmental psych and thought I would never work peds or OB. Of course, I am now an OB nurse and picking up shifts in peds:) You sound like a friend of mine who dreaded the psych rotation. She went and fell in love with it. Maybe the same will happen with you, who knows? I would DEFINITELY reccomend you know some developmental theory for your peds rotation though. If you go in a nursing book like Potter and Perry's Fundamentals of Nursing they cover Eriksons and tell you how to tailor procedures and care plans based on age. It is INVALUABLE for that rotation, even if you never use it again.

You want to alk about crap terminology? Have you done Carper's ways of knowing? Or Habermaas' worldviews? Just wait...it gets even worse. If you really hate the bs, just think of it as a hoop you have to jump through. I had a feeling it was a way of weeding out the mechanical thinkers.

I should mention, you may use this stuff on an acute floor. I worked a float shift on med-surg last night and we have a woman in her thirties with two young children who is dying. How to deal with them would be really tough if we didn't have an understanding of their development (especially the youngest one who thinks mommy is sick because he did something wrong). No matter what area you'll work in you will probably have to deal with the whole family, especially if you ever want to work emerg.

Good luck:)

Stargazer · Mar 5, 2002

Brad, I can sympathize. Hated my Psych rotation but loved my Psych professor. She was a Goddess of Common Sense which, it seemed to me, was really what Psych was supposed to be all about. I never studied for an exam and I got the highest grades in the class-- literally the only class in nursing school where my underachiever (read: lazy) tendencies served me well!

So the theory was easy for me. Practice was a little harder. At the end of my rotation in an acute VA unit my instructor told me kindly, "You need more practice working with acutely psychotic patients. You're a little too... logical for them."

Which was true. I never thought I was the kind of nurse who had Rescue Fantasies, but her remark made me face up to the fact that my mindset towards all acutely psychotic patients was that they couldn't possibly think they were being controlled by aliens from outer space, and if I just explained it better I could make them understand. It was just a matter of dragging them into the sunlight of Good Mental Health with the sheer force of my logic. Except, um, no, it doesn't work that way.

I found that I used my psych skills a LOT more in my community health rotation than I ever did in Psych. Ever heard a cop say that the most dangerous calls they go on are domestic violence calls? Same deal with comm. health nursing. Visiting dysfunctional families with violent histories in their own homes, where they feel safe and you don't, is a golden opportunity to use every iota of Psych knowledge you possess to negotiate the minefields and come through unscathed. I'm positive that my instincts based on my Psych background of the previous semester kept me safe and unharmed on more than one occasion.

As far as working with short-term hospitalized patients, I always remember something my critical-care preceptor told me: "You can't go about tearing down a person's defense mechanism unless you've got the time and the ability to help him rebuild something to replace it." You may recognize that a patient is angry, depressed, manipulative, etc., but you're not going to "fix" the problem in a 3-day stay. I think the important thing is to identify the problem/behavior, and figure out how, or if you need to, address it from a behavioral or care standpoint while you're caring for them. Just identifying the problem can help YOU feel less frustrated.

On another pragmatic note, you need Psych to pass the boards. I swear my boards were about 1/3 Psych questions.

Did that help at all?

Mary Dover · Mar 5, 2002

Brad - Mary (psych nurse) here. and you know what? I don't have a clue what you are asking. But I will attempt to add some input nonetheless, which for what you're asking, may be totally useless. I'm thinking what you are referring to is a bunch of theory crap that you have to muddle through just to get through school. You know - like for me, chemistry was the killer and I'm still clueless about that. Anyways, there are good points to the psychosocial stuff, just if you don't think about it so heavily in the theory context, but I guess if it's a matter of trying to find some meaning to it in order to get through the class , you gotta do what you gotta do.

From a psych nurse perspective in the real world (not the theory world), a person's "biopsychosocial" makeup plays a big part in who they are, the kinds of illnesses they may have to deal with, and how they cope. It has to do with biological family, personality development within that family (think functional vs dysfunctional), genetic makeup which may predispose to certain illnesses (physical and/or mental), outside social influences positive and/or negative and a whole plethora of factors which can contribute to problems as well as outcomes in one's life.

I don't know if this helps, but I felt up to a challenge tonight.

Mary

**canoehead, BSN, RN** · Mar 6, 2002

I think the psychosocial aspect is easily ignored when you barely have time to attend to physical needs, and it is easy to bypass the patient that needs "talking" help because we can't draw a lab to show that need and as we all know, if it isn't documented it doesn't exist.

But the classes on psychosocial needs are trying to put concrete linear rules on a very fuzzy subject, just because it is fuzzy doesn't make it unimportant. I agree that are some real nutcases out there for instructors, but psychosocial aspects of nursing will separate the beginners from the experts. Anyone can do a procedure or read a lab, but it takes a deft hand to encourage and motivate without sounding like a cheerleader on grass.

To illustrate, what would happen if we saved someone's body but they couldn't deal with the scaring that resulted so wouldn't go out with friends, return to school, or start a relationship? You can see that if the spirit is broken a physical cure still may not be enough.

Psychosocial needs have been neglected so the classes can be lame, but just because your school teaches the class poorly doesn't mean it isn't a subject worth your time and effort. :) You may have to do some of your own research though to find information that YOU can relate to.

Try Victor Frankl's "Man's Search for Meaning"

Anyone else have some recommended reading? We'll test him on it in May...

lever5 · Mar 6, 2002

Wow, you guys have thought this out! Wonderful responses.

Does this answer your questions, or do you need to restate?

Peeps Mcarthur · Mar 6, 2002

Folks,

I just wanted to drop a quick note to you thanking you all for your thoughtful responses. I have to run off to a full day at school and an essay assingment has been sucking the life out of me but I want to review all the posts and give just as thoughtful a response as they deserve.

Thanks. I'll try today later or tommorow at the latest.

Brad

nursy_ann · Mar 7, 2002

of course psychological course is boring for nursing students...but during my clinical I use these theories everyday. I mean... when you chat with a patient then you use what you learned in psy courses and just don't realized you're doing so.

You need psycholigy to understand what' your patient's needs, how they feel........... Finaly I guess all our nursing courses are rely to psychology.

Ann

Peeps Mcarthur · Mar 11, 2002

Folks,

A few days...........yeah, right. I think I've mastered the anatomy of the feline cardiovascular system so I have time before the practical tomorrow to respond. Yup, that will sure come in handy if I'm required to interpret a "cat scan" won't it? I'll take a break from my brooding over working during open labs and just "wing it" a little, besides I always have some life-or-death assignment to study for.

You are all correct in interpreting my desire to learn only what will get me marks in clinicals. I'm fairly certain that the sounds of screaming, crying and fussing(and that is just the mothers!) will never charm me into a peds career. Psych patients, however do make me curiouse in a sort of "National Enquirer" sort of way. I just want to learn about the manifestations of thier pathologies. I'm curiouse about what bizzare behavior a human being with an intellect equal to my species can create as "normal". I certainly will care about them as I would care for any other patient but I really can't see it being as complicated as needing any kind of theory. It has always apeared to me to be a place you would do well in if you had good reflexes(to avoid being struck with bodily fluids and other objects) and did well to remember that what patients do or say may only be misinterpreted or reinterpreted but not taken at face value. I don't think I want to constantly determine my "fleeing distance" to the nurses station either. It does hold a bystander appeal though.

I think what you are saying is that I would use psychosocial theory as a important part of accomplishing some aspect of student clinical work. That's really what I wanted to find out. I also think you are all saying that you applied psychosocial theory in an acute care setting in a clandestine manner while in the delivery of day to day duties but not as an actual overt function such as you would use ECG interpretation or knowledge of drug interactions and contraindications. The professional need for a skill of this type was another concern of mine.

Knowing that it will be needed to function as a student on a peds rotation is really all I need to know. If I get the marks to show I've mastered the required material any use of it as a professional will naturaly follow that end. If it'll help me get through school then maybe I need some of it. You would never have known about it from the nurses I've ever worked with but then maybe they were just working with it internaly and never found a need to use it or relate it to me. If it will be used to do student coursework later then I really do need to study its' many catchphrases and its' application in student clinical nursing.

Thanks,

Brad