KINGS GOAL ATTAINMENT THEORY

Index:- Taken hour – 1hr

1. Introduction + Back ground

2. Major concepts Personal system

Inter personal system

Social system

3. Assumptions
4. Metaparidism
5. Role of Nurse
6. Strengths + weakness
7. Application
8. Conclusion

Kings Goat Allainment Theory

Introduction about the theorist/ back ground

1. Imagine king completed her basic nursing education in 1945.

2. She received her diploma in nursing from st.John’s hospital
school of Nursing st.Louis
3. 1948 she received herbs in nursing education
4. In 1957 she received her MS in Nursing from st. Louis
University.
5. 1961,she was awarded a doctorate in education, from
teachers college, Colombia University
6. She held positions in Nursing education, administration and
practice.
 7. 1971,she published Towards a theory on general system
theory the behavioural sciences, and deductive and
inductive reigning.

KINGS OPEN SYSTEMS FRAME WORK

MAJOR CONCEPTS

Frame work of King’s goal alignment theory

The frame work is composed of three interacting systems,

which include

1. Personal systems (Individual)

2. In for personal system (friends, small, large grips)
3. Social system (Family,school,industry,social organizations
+ health care delivery systems)

For each system of a comprehensive or major concepts with

additional su8b- concepts is identified

 Personal System

She conceives each individual in a personal system. Here the

relevant concepts are

1. Perception
 2. Self
3. Growth and development
4. Body image
5. Space
6. Learning
7. Time
1. PERCEPTION – It refers to the persons representation of
reality, it is universal, it highly subjective and unique to reach
person.
2. SELF – It refers to a person’s subjective environment, which
constitutes everything that makes up the person, It includes
ideas, attitudes, values and commitments.
3. GROWTH AND DEVELOPMENT – It refers to all the changes
(cellular, molecular, and behavioural occurring in a person .
There changes are usually predictable.
4. BODY IMAGE – It refers to the manner in which one proceeded
onus’s body and the reaction of others to it. It is highly
subjective and change on the person change physically or
emotionally.
5. SPACE – It refers to the immediate physical territory occupied
by a person and to the person’s behaviours.
6. TIME – It refers to a sequence of to and their relationship to
each other.
7. LEARNING - It a process of sensory perception
conceptualization, and critical thinking involving multiple
experiences in which changes in concepts, skills, symbols habit
and values can be evaluated in observable behaviour.

INTERPERSONAL SYSTEMS : (dyadic or triadic or small grip)

It requires an understanding of the concepts of communication,

infraction, rob, stress/stressors and transaction.
 1. Infraction :- It refers to verbal and nonverbal behaviours
between on individual and environment.

OR

It is an act of two or more persons in mutual presence.

2. Communication: - it refers to the transmission of information

from one person to another either directly or in directly. It is
mainly through face to face meeting, telephone call or written
msg.
3. Transaction:- It is a process of interaction between a person
and another person oar person and the environment to achieve
goals that are valued.
4. Role:- Set of behaviours expected when occupying a position in
social system.
5. Stress:- It is a dynamic state where bya human being interacts
with the environment to maintain balance for growth
development and performance which involves an exchange of
energy and information between the person and the
environment.

SOCIAL SYSTEM

When the interpersonal systems come together they form larger

system cuffed social system, which include families religious groups,
schools work place and groups. This system includes.

 Organization
 Authority
 Power
 Status
 Decision Making
1. Organization:- It refers to a group of people with similar
infroent who have roles and position to achieve the person and
organizational goals.
2. Authority:- It refers to the observable behaviours of providing
guidance and order and being responsible for action.
3. Power:- Which is situational dynamic and goal directed . It is
characterized by the ability to use resources for goal
attainment.
4. Status:- It refers to the position occupied by a person in a group
or the position occupied by a group in relation to other groups
in an organization.
5. Decision Making:- It results from developing and acting on
perceived choice for goal attainment.

Goal Attainment Theory:- It is based on the concepts of the

personal and interpersonal systems. It including interaction,
perception communication,transaction,strem, growth and
development time and space.

1. Interaction:- According to king?, each individual brings to an

interaction a different set of values, ideas attitudes and
perception to exchange
2. Perception:- Each person’s representation OF REALITY. The
individual then exports this energy an demonstrated by
observable behaviour
3. Communication:- A person provides information directly or
indirectly to another person. The person receives this
information and processes it.
4. Transaction:- Two individuals mutually identify goal and the
means to achieves it they reach an agreement about low do
attain these goals then set about to relay them.
5. Role:- Each person occupies a position in a social system that
has specific ruler and obligations. It can be consider in conflict.
6. Stress:- When an individual interacts with the environment an
energy response occurs to objects, events and person . The
individual user this energy response to maintain balance for
growth and development.
7. Growth and development:- Individuals are in a constant state
of molecular cellular and behavioural change, As these changes
occur, transactions are made moving the individual toward a
level of maturity and self actualization
8. Time:- A person experiences a sequence of events that towards
the future.
9. Space:- It is the behaviour of their individual occupies.

ASSUMPTIONS

 Basic assumption of goal attainment theory is that nurse and

client communicate information, set goal mutually and then
act to attain those goals is also the basic assumption of
nursing process.
 Perceptions, goals, need and values of the nurse and client
influence interaction process.
 Individuals have the right to knowledge about themselves
and to participate in decisions that influence their life, health
and community services.
 Health professionals have the responsibility that helps
individuals to make informed decisions about their
healthcare.
 Individuals have the right to accept or reject health care.

Defention of metaparidigm
 1. Person :- May represent an individual, family common or all
of mankind. And has the right to self knowledge
participation in decision making that affect life and health,
and acceptance or rejection of health care
2. Environment: - May represent the immediate person’s
physical surroundings, the community, or the universe and
all that it contains.
3. Health :- It represents a state of wellness mutual decided by
the client and the nurse
4. Nursing: - nursing is the practice of the science and art of the
discipline.

ROLE OF NURSE

 Observes nurse client infraction

 Activity participate in client care
 Promote, maintains and restores health and cares for the
sick injured or dying client
 Nurse shout meets a social needs
 Planning, implementing and evaluating scare
 Use goal oriented approach

Additional Roles:-

 Consultant
 Health teacher
 Tuter
 Manager Of envy
 Mediator
 Administrator
 Recorder
 Observe
 Researcher
Strengths and Weakness

Strengths:-

1. It given simplicity and adaptability in various settings.

Weakness

 There are major concepts making the theory complex

 Same of the definitions lack clarity
 More empirical listing needs to be done
 Limited applications where interactions are difficult. C
comatose clients ,newborns, some psychiakic conditions.

Conclusion

Kings theory needs to be used more in nursing research, nurses

needs to know and understand the theory as well as critically
analyze heretical frameworks .

UNIT 3

Allowed hrs:8hr

Assessment Of Mental Health status

1. History taking 1 hr
2. Mental status Examination 1hr3
3. Mini mental status Examinations 1hr ½
4. Neurological Examination Revisers ½
5. Investigations retted Blood Chemistry, Erg CT and MRI
6. Psychological tests 1 hr
7. Role and Responsibilities of Nurse ½

UNIT 3
 Assessment of mental health status

Index:

1. Introduction

Factors influencing Assessment

2. History taking.
 Identification data
 Presenting complaints
 Present psychiakic history
 Family history
 Personal history

3. Mental status Examination
 General appearance and bur
 Speech
 Thought
 Mood and affect
 Perception
 Cognitive function
4. Monumental status examination
5. Neurological Examination (Review)
6. Investigation related to blood chemistry, EEG, Ct, MRI
7. Psychological tests- personality, intelligent, mood
8. Role of a nurse
9. Conclusion

Unit 3 – 8hrs

ASSESSMENT OF MENTAL HEALTH STATUS

 Inttroduction
 Assessment is the first step of nursing process and
involves the collection, organization and analysis of
information about the dent’s Health. In psychiatric mental
health nursing, this process is often referred to as a
psychosocial assessment which includes a mental status
Examination. This assessment serves as the basic for
developing a plan of care to meet the client’s needs.

 FACTORS INFLUENCING ASSESSMENT

1. Client participation /feed back

A thorough and complete psychosocial assessment

requires active dent’s participation. If the client is
unable or un will be incomplete or vague.

For. Eg: Depressed patient

2. Client Health status

The client’s health also can affect the psychosocial

assessment. If the client is anxious, tired or in pain,
the nurse may have difficulty in eliciting the client’s
full participation in the assessment.

3. Client’s previous Experiences/ Misconception’s About

healthcare.

The client’s perception of his or her circumstances

can elicit emotions that interfere with obtaining an
accurate psychosocial assessment. If the client is
reluctant to seek treatment or has had previous
unsatisfactory experiences with the health care
system, he /she may have difficulty in answering
 questions directly. The Nurse must address the
client’s feelings and perceptions to establishing a
trusting, working relationship before proceeding
with the assessment.

4. Clients ability to understand

The nurse also must determine the clients ability to

hear, read and understand the language being used
in the assessment. It the client’s primary language
differs from that of the nurse, the client may
misunderstand or misintercept what the nurse is
asking which result in inaccurate information . A
client with impaired hearing also may fail to
understand what the nurse is asking.

5. Nurses attitude and Approach

If the client perceiurs the nurse’s questions to be

short and curt or feels rushed or pressured of
complete the assessment, he or she may provide
only superficial information or exit discussing
problems in same are altogether. The client also
may refrain from providing sensitive information if
he or she procedure the nurse and none accepting,
defensive or non judgemental.

How to phrase the questions

The nurse may use open ended questions to start the

assessment. It allows the client to being as he or she feels
comfortable, and also given the nurse an idea about the client
perception of his or her situations.

Eg :

 What bring you here today?

 Tell me about has happening to you?
 How can we help you?

If the client has difficulty in answering open-ended

questions the nurse may need to are more direct questions to obtain
information.

Eg :

 How many hours did you sleep last night?

 Have you been thinking about suicide?
 How much alcohol have you been drinking?
 How well have you been sleeping?

The nurse should are a non-judgemental font and

language particularly when asking about sensitive
information such as drug, alcohol use sexual bhr abuse or
violence.

CONTENTOF THE ASSESSMENT

The information gathered ina psychosocial assessment can be

organized in many different ways. Most assessment tools or
conceptual frame works contains similar categories with some
variety in arrangement or order. The nurse should are some kind of
organizing frame work so that he or she can assess the client in a
through and systematic way that leads itself to analysis and seruls as
a basic for client’s care. The frame work for psychosocial assessment
discussed all
  History taking
 Mental status examination
 Neurological examinations
 Inwestigations related blood chemistry, EGG, CT, MRI
 Psychological test
1. HISTORY TAKING

History taking proceeds through different headings as follows

 Identification snd demographical details

 Presenting complaints and durations
 History of present illness
 Past psycheakic history
 Family history
 Personal history
 Premoobid personality
1) Identification and demographical details

This includes the patient’s name, age, sex, religion,

address, socio economic status, hospital number marital
status, occupation, monthly income, language known, Dali
of admission, identification mark, details of informant and
information relevant or not adequate or not.

2) Presenting chief complaints

The symptoms are listed in a homological order with their

duration. Sometimes the patient may deny the existence
of any symptoms and say that he was forcefully brought
to the hospital by his relatives. in such cases the
information were collected from the relatives. Here we
are using the patient’s own words verbatim without
translating or interpreting their meaning.
 E.g. : sleeplessness – 3wks,loss of appetite- 2wks

The mode of onset of the illness may be acute, or

insidious, sub acute etc.

3) History of present illness

It is helpful in identifying the client’s problems) illness and

making diagnosis as it provides in detail the chronological
events up to the present situation in the client’s life.

Key elements includes:-

 Onset
 Precipitants
 Symptoms (positive and negative)
 Course
 Treatment
 Reason for mow seeking treatment
 Referral source

Post psychiakic history

Past history informs present illness in regard to both diagnosis

treatment.

 Onset
 Precipitants
 Symptoms
 Course
 Treatments
 Hospitalizations
 Outpatient treatment
 Suicide attempts and other self injury.
 Injury to others
 Substance use history

It is the uital part of every psychiatric history their type of

patient fund to under estimate and deng their use.

 Alcohol
 Skeet drug
 Rx drug
 Tobacco
 Family history

This provides information on the genetic disposition of

the patient enquire about the type and size of family and
the general family environment. The presence of
psychiakic illness on the paternal or material side should
be routinelyasked. It will help for the conskuction of the
family tree depiciting the living members, their
age,decased members and their age of death. Mark any
of them has or had and the outcome. Not the history

Of suicide, mental retardation epilepsy or any genetically

transmittabl;e disorders.

 Personal history

It includes the develop,mental, educational occupational

as well as the sexual history. The developmental history
includes details of pregnancy and delivery developmental
millstones, health during child hood adolescence, neurotic
symptoms and occurrence of any significantevent.
(separation from parent, bereavements, etc)

 Educational
 In occupational history relates to details regarding the
level of performance in school, relationship with peers
and teachers academic activities

 Occupational

In occupational history enquiry should be made about the

types of work, job satisfaction, whether jobs were
changed frequently and if so the reason’s for this , work
skills and relationship with colleagues.

 Marital

Marital history enquiry should be made about the type of

marriage , duration of relationship, children’s on
commercial relationship

 Sexual

Sexual history includes details about sexual development,

practise and attitudes towards sex.

 Premorbid

Personality of a patient consists of those habitual

attitudes and patterns of behaviour which characterize an
individual. The nurse has to get a description of the
personality before the onset of the illness and aim to
build up a picture of the individual. And also enquiries
with respect to the following areas has to be made.

 Attitude to others in social, family and sexual relationship

Ability to trust other, make and sustain relationship

anxious or secure, leader or follower, participation,
 responsibility capacity to make decision, dominant or
submissive, friendly or emotionally cold etc.

 Attitude to self

Egocenkic ,selfish, indulgent, dramatizing,

critical,depreciatory ouer concerned,self conscious,
satisfaction or dissatisfaction with work. Attitude towards
health and bodily functions. Attitude to past
achievements and failure, and to the future.

 Moral and religious attitude and standards

Evidence of rigidity or compliance, permissiveness or over

conscientiousness, conformity or rebellion. Enquire
specifically about religious beliefs, excessive religiusing.

 Mood

Enquires about stability of mood swings, whether anxious,

irritable, worrying or tense. Whether lively or gloomy.
Ability to express and control feelings of anger anxiety or
depression.

 Leisure activities and hobbies

Interest in reading, play, music, movies etc. Enquire about

creature ability. Whether leisure time is spent alone or
friends. The circle of friends large of small.

 Fantasy of life

Enquire about content of day dreams and dreams.

Amount of time spent in day dreaming.
 1. Reaction pattern to skess

Ability to tolerate fruskations, losses, dis appointment and

circumstances arousing anger, anxiety or depression..
evidence for the excessive use of particular defense
mechanisms such as denial, rationalization projection etc.

II MENTAL STATUS EXAMINATION (MSE)

The MSE is used to determine whether a patient is

experiencing abnormalities in thinking and reasoning ability
feelings or behaviour. The MSE includes observations and
questions in the following cate gorien.

a. General appearance and behaviour

b. Speech
c. Thought
d. Mood and affect
e. Perception
f. Cognitive functions
 General appearance and behaviour

Describe patient’s appearance and behaviour, it is dressed

properly?. Assess the patient’s sensorium. Is he alert?
Drowsy? Stuporous? Comatose? Is he co-operative for
the examination, does he makes eye contact with the
examiner? What is his level of activity? Is he excited?
Retarded? Hyperactive? Results? Does he have any
mannerisms? Gestures? Ties? Involuntary movements?

 Speech

The manner of speaking and its defects are recorded

under speech where as the content and form of speech
are recorded under thought disorders. Does he speak
 spontaneously or only responding to questions passed to
him? Assess the rate, quantity and flow of speech it is
worthwhile to record a sample of speech or later analysis.

 Thought

Inference about the process and to disorders are made

from the speech sample or the writing sample of the
patient. Disorders of form, progression, content and
possession may be present. Assess for delusion, obsessive
ruminations and thought alienations how does the
delusion affect his behaviour.

 Mood and affect

The patient should be asked about his affective state.

Compare the subjective report with what is objectively
observed. Ishis mood appropriate or not. Congruent or in
congruent? Is the emotional expression blunt? Is the
affective expression adequate and appropriate?

 Perception

Has the patient perceptual abnormalities like illusions and

hallucinations. If hallucinating, what is the type of
hallucination and what is his reaction?

 Cognitive function

Is the patient affective? Can his attention be early aroused

and sustained. How is his concentration, to assess
cognitive function some simple tests can be administered.
The patient is asked to name the days of the week or
names of the months forwards abd back wards. He may
 be asked to serially subtract 7 or from 100 and tell the
numbers.

Orientation to time involves ability to tell correctly

the time of the day , date, wet, mouth, year and other
related data. Orientation to a place include correct
information about his whereabouts, correct identification
of people around him ensure orientation to other person.

Patient’s intelligence can be inferred from his

conversation and behaviour, educational level,
vocabulary, ability for abstract thinking and reasoning,
general information.

Specific tests are used when a more accurate

measurement of intelligence is needed. The patient’s
awareness of his abilities and disabilities, and readiness
for the treatment are reflected in sight. Judgement may
be interested from for the future.

III MINI MENTAL STATUS EXAMINATION

The mini mental state examination is a cognitive test used to

screen for the presence of cognitive impairment.

 Use of mmse :- it provides measures of orientation, registration

and short form memory, attention, voluntary movement and
language function.

The shortened version of the mini mental state examinations is an

accurate predictor dementia

 Scoring:- it is a reliable test, with scores of 25-30 considered

normal 18-24 indicative of mild to moderate score of 17 or less
correlate with substantial impairment in activities of daily
 living. Social back ground, educational level and verbal ability
can infuse results and should be taken in to account in their
interpretation.
 Components of MMSE
- Orientation
- Registration
- Attention
- Calculation
- Recall
- Language

IV NEUROLOGICAL EXAMINATION (REVIEW)

The purpose of neurological examination is to determine

the presence or absence in the nervous system. Nurses are
involved in examining the neurological and physical status of
the patient as a part of the total physical assessment.

Aspects of neurological examination

1. Level of consciousness
2. Mental status examination
3. Special cerebral functions
4. Cranial nerve function
5. Motor function
6. Sensory function
7. Cerebella function
8. Reflexes
1. Level of consciousness

Assessment of level to consciousness includes following

categories.
a) Alertness :- patient is a wake, responds, immediately and
appropriately to all verbal stimuli.
b) Lethargic: - patient is drowsy and inattentive but arouses easily ,
frequently off to sleep.
c) Stupor us :- he arouser with great difficulty and co-operates
minimally when stimulated.
d) Semi- comatose: - the patient has lost his ability to respond to
verbal stimuli. There is some response to painful stimuli, little
motor function is seen.
e) Comatose :- when the patient is stimulated there is no response
to verbal or painful stimuli, no motor activity measure the
patient’s level of consciousness. Glasgow coma scale

Best ghopening response

Best eye : spontaneously 4

: To speech 3

: To pain 2

: No response 1

Best motor response : obeys verbal command 6

: Localize pain 5

: Flexion 4

: Flexion abnormal 3

: Extension 2

: No response 1

Best verbal response : Oriented to time place, person 5

: Conversation confused 4

: Speech in appropriate 3

: Sound incomprehensive 2

: No response 1

Total score - 15
  High score of 15 would reflect a fully alert, well oriented
person.
 While of 7 or less can be considered to be agenerally
accepted level for coma and needs for nursing care.
2. Mental status examination

The components of mental status examination includes

the assessment for following categories, general
appearance, speech, thought process, mood, cognitive
functions, attention, concentration, orientation, memory,
general knowledge, abstract reasoning, judgement and
insight.

3. Special cerebral functions

Assess for amnesia ,apraxia, and aphasia

Agnosia :- In a ability to recognize aommon objects through the

sense

Aproxia :- patient cannot carry out skilled act in the absence of

paralysis

Aphasia :- In ability to communicate.

Cranial nerve examination

It provide information about the brainstem and related

pathways.

 Olfactory nerve
 Oplic nerve
 Octomotor
 Trochlear
  Adduces
 Trigeminal nerve
 Facial nerve
 Vestibulococblear
 Acoustic pharyngeal
 Vague
 Spinal accessory nerve
 Hypoglossal nerve
4. Motor function

Assessment of motor function involves assessing for

muscle size, muscle strength, muscle tone, muscle co-
ordination gait and movement

5. Sensory function

Sensory assessment involves testing for touch pain,

vibration, position and discrimination. A complete sensory
examination is possible only on a conscious and co-
operative patient. Always test sensation with the patient’s
eyes closed.

Assessment of cerebellar function

For evaluation of balance and co-ordination the tests used are

 Finger to finger test

 Finger to nose test
 Romberg test
 Random walking test
8. Reflect activity

Reflect testing evaluation the integrity of specific sensory

and motor pathways. Reflex activity assessment always a
 part of neurologic assessment. It provides information
about the nature, location and progression of neurologic
disorders.

IV INVESTIGATIONS IN PSYCHIATRY

Investigations are useful to detect alteration in biologic

function and to screen for medical disorders causing psychiatric
symptoms.

1. Routine investigations
 A complete hierogram (total and differential blood
count, haemoglobin ESR) and urine analyse are the
basic routine tests.
 Renal function test – treatment with lithium
 Liver function test – for all alcoholic patients
treatment with carbomazepine,
antipsycholitcs,lithium.
 Blood glucose – routine screen above 35 years ass
 Thyroid function test - depression, treatment with
lithium antidepressants, ECT ,antipsychotics
 Hiv testing – iv drug users, suggestive sexual history,
aids, dementia.
 Vdrl – suggestive sexual history
 Serum cpk – neuroleptic malignant syndrome
 Chest – x – ray – before treatment with ECT
 Drug level estimation – drug levels are indicated to
test for therapeutic blood levels for toxic blood
levels and for testing drug compliance
2. Electro physiological tests
  Electroencephalogram gram : (EEG) :- measures brain electrical
activity, identifies dysrhythmias and asymmetrien used in the
diagnosis of seizure, dementia, neoplasm,stroke, metabolic or
degenerative diseases.
 Polysamnography /sleepstudies:- used in the diagnosis of sleep
disorders and seizures.
3. Brain imaging tests

Computed tomography scan – It measures accuracy of brain

structure to defect possible lesions,abscesses, areas of infraction or
aneurysm.

Magnetic resonance imaging (MRI) – It measures the anatomic and

biochemical status of various segments of the brain, defects brain
edema , ischemia, infection, neoplasm,kauma and other changes.

 Other tests are positon emission tomography.

4. Neuro- endocrine tests

Commonly used neuro-endocrine tests are dexametha some

suppression test, TRH stimulation test, serum protection
levels, serum 17- hydroxyl cardio steroid, serum melatonin
in levels.

5. Genetic tests

Cytogenetic work up is advised in some cases of MRI.

IV PSYCHOLOGICAL TESTS :- Psychological testing of patients is

ideally conducted by aclinical psychologist, who has been trained in
the administration. Scoring and interpretation of these procedures.

 Instruments for assessment of symptoms

 Breif psychiatric raiting scale
 Psychiatric symptom check list
 Clinical global impression
 Anxiety self rating scale
 Hamilton anxiety scale
 Beck’s anxiety scale
 Beck;s depression scale

 Hamilton depression scale

 Manic state rating scale

 Yate brown obsessive compulsive scale

 Suicide in text scale

 Extra pyramidal symptom rating scale

 Global assessment of functioning scale

 In sight and treatment attitude questionnaire

 The cage questionnaire

 Child behaviour check list

 Minimental status examination

 Instruments for assessment of personality acts and disorders

- Minnesota multiphase personality inventory
- Cattle’s 16 factor personality inventory
- Eysenck personality inventory.
 Instruments for assessment of cognitive functioning
- Wechsler adult intelligence scale
- Sechsler intelligence scale for children
- Benet Klamath test of intelligence
- NIMHANS neuropsychological battery of lobe function
 Instruments for assessment of psycho dynamics
- Rorschach inkblot test
- Thematic apperception test

 Instruments for assess,ent of environmental shessors

- Social adjustment scale
- Marital satisfaction inventory.

VII ROLE OF A NURSE

1. Assess the orient of the patient’s problems

2. Making an accurate diagnosis
3. Foliow up patient progress ower time
4. Proper documenting
5. Nurse should become familiar with the standardized
psychological tests.
6. A nurse should have knowledge about all the
psychological fests, which will enable her to clarify the
patient’s and relatives doubts.
7. The nurse should reassure the patient about the safety
of the tests
8. Provide calm suitable environment to the patient
9. Collect the history in detail
 10. Assess the current level of dysfunction
11. Thorough mental status examination should be
done and recorded accuralily
12. During the examination the nurse should maintain a
good with patient and family member.

Unit VI

PSYCHOLOGY OF PEOPLE DURING THE LIFE CYCLE

Index :-

Allotted hr
-7hr

1. Developmental psychology
2. Psychology of people at different ages from intancy to old age
3. Psychology of valerable inviduals – challenged

4. Psychology of groups.

Unit- IV

Motivation, emotions, stress, attitude and their influence on

behaviour

1. Introduction
2. Motivations and emotional processer
a) Motivations:
- Meaning
- Concepts
- Types
 - Theories
- Motives and behaviour
- Conflicts and fruskation
- Conflict resolution
b) emotions and skess
- definition
- components, changes in emotions
- theories, emotional adjustment
- emotions in health and illness
c) sheets
 stressors, cycle,effect,adaptation and coping

d) Attitude
 Meaning, nature development, factors, affecting
 Behaviour and attitudes
 Attitudinal change
 Psychometric assessments of emotions and
attitudes
 Alteration in emotions applications
II Conclusion

Index :-

I introduction

II motives

a) Introduction
b) Definition
c) Concepts
d) Types
e) Theories
f) Motives/bhr
g) Definition components
h) Physiological changes
i) Changes the emotional reactions
j) Theories of emotion
k) Emotional adjustments
l) Emotional health + illness

III Frustration

a) Introduction
b) Definition
c) Characteristics
d) Types
e) Cause
f) Reaction
g) Management

VI STRESS

a) Introduction
b) Definition
c) Types of stressors
d) Stress cycle
e) Effects of stress
f) Adaptation
g) Coping with stress

h) Mgt
IV Conflict

a) Introduction
b) Definition
c) Conflict response
d) Types
e) Effect
f) Management

VII attitude

a) Definition
b) Meaning
c) Characteristics
d) Formation and development
e) Behaviour/attitude
f) Attitudinal change
g) Health education

V Emotion

Introduction

VIII psychometric assessments

IX alteration in emotion during illness/App

X Nursing implications

XI Questions

Conclusion
 MOTIVES

I Introduction

A motive etymologically means that ‘which moves’. A

motive may be considered as an energetic force or tendency
(learned) working within the individual to compel, persuader inspire
him to act for the satisfaction of his basic needs or attainment of
some specific purpose

II (a) Definitions

1. A need given rise to one or more motives. A motive is a

rather specific process, which has been learned. It is directed
towards a goal

( carol-1969)

2. A motive may be defined as a rediness or disposition to

reopend in some ways and not others to a variety of
situations

(Rosen, Fox and Gregory-1972)

II(b) Concepts of motivation

 Motivation is generated through basic needs driven

 It compels an individual to respond by creating a kmind of
tension or urge to act
 It is a goal directed activity, till the attainment of the goal
 Attainment of a goal helps in the release of tension
around by a specific motive change in goal may bring
changes in the and strength of the motive
  Motivation is an inner state or an arounded feeling
 We experience motives an feelings of want, need and
desire
 Motive may be considered as a learned response or
tendency
 We cannot see motives directly but must in for them from
the behaviour of people.

II (c) Types:-

Psychologists have motives in various ways, some of them

are

1. Jnnale or unlearned
2. Acquired or learned motivation can also be
classified as

1. Psysiological or primary motive

Social or secondary motives

Personal motives

Un conscious motives

1. Physiological dries or motives

Physiological drier are called biological dries organic
needs. There dries become active when the physiological
balance within our body, called homeostasis is disturbed.
Under such conditions, tensions are produced in our body
 and this tension driven us to some specific activity which
relive the tensions

Some of the important biological driers are

1. The hunger drive

2. The thirst drive
3. The sex drive
4. The need for oxygen or the air hunger
5. The need for rest and sleep
6. The need to avoid or seat relief from pair
7. The need for activity
8. The elimination needs
1. Hunger drive:- The urge for food is the result of certain
periodic and important biological changes which are taking
place in the tissue of the body. Their food supply is being fast
what food we eat and how we eat to satisfy this hunger
depends on our training, climatic conditions and socio
economic factors.

2. The Thirst drive :- It is similar to the hunger drive, the amount

of fluid gets reduced in the tissues of the body. This causes the
mulour membranes in the throat to become dry, resulting i8n
the sensations of thirst. The body become restless and active.

3. The sex Drive :- It is a powerful drives, but the biological

satisfaction is not essential to life. The drive becomes active as
results of glandular functioning. Its expression however, is
subject to social and moral code and civil law, when the drive is
active it creates a lot of restlessness and major activity in the
organism
4. The oxygen hunger or the Respiratory drive :- it must be
satisfied constantly if late is to continue. When an individual
suffers from oxygen want, his memory, sensory activity and
muscular control are seriously impaired. He suffers from
dizziness and confused thinking, secure oxygen deprivation for
a short length of time results in neural damage in an infant and
may cause mental deficiently.

5. The need for Rest and the need to sleep :- it is the fundamental
drive in animal and human belongs .continued activity the
amount of carbon dioxide and lactic acid and reduces the
amount of on in the blood it result fatigue, as such the need for
rest become imperative. Sleep is another important need of the
body. Deprivation of sleep carve annoyance and discomfort

6. The need for activity :- there seems to be an organic need for

activity after rest and sleep . In a well rested organism
there ions a positive real for activity. There activity depend on
the hormones and vitamins and an the rested state of muscles,
sense organs, and brain . this problems are most commonly
seen in adults children

7. The elimination needs :- The distension of the bladder or of the

large intestine responsible for the eliminate tensions. They
cause discomfort and restless behaviour. This continues until
the tensions are relieved.
There needs become urgent if and when not promptly met

II Social or secondary motives

 Human beings are not only biological , but also social
human behaviour is activated by social motives such as activation
motives, need for status, power motives and social approval.
These motives develop through relationship with peoples.

1. Affiliation motives :- In general, pleasure of life cannot be

enjoyed without company. We all resent loneliness. Even the
simple routine activities of eating and drinking cannot be
enjoyed without company. The need to be with other people
is referred to as affiliation need. This motive of affiliation is
universally seen in all human cultures.
2. Need for status:- almost all individuals have a desire to have
some standing or position among the people of his society or
group
3. Power motile :- The desire to be in a position of control to be
the boss to give to command respect and obedience is called
power motive. Power motive directs the behaviour of
dictators, gang leaders and the builders of fraudulent
financial empires.
4. Social approval :- we try our best to avoid doing anything
that may evoke social disapproval we often show an almost
compulsive tendency to conform to the norms set by our
social groups

III Personal motives :- Personal motives are allied with

physiological needs and common social motives, but they are
so much individualized that they are no longer common. They
are wants and which are not shared commonly by others

They are:

1 Need for Achievement:- Achievement motivation refers

to a drive towards some standard of excellence. People with
 high need for achievement prefer which would promise
success and are moderately difficult. David c m c cell and
has found that while high achievers tend to succeed, low
achievers
Tend to avoid failures. High achievers challenge failures and
work larder, while loco achievers accept failures and go for less
difficult fast.

High achievers prefer personal responsibility and like get feel

back about their works.
2. Vocational Ambitions and life goals :- There discourse are
common to many others but there is something unique about
each one’s driver. There are powerful determinants of our
behaviour.
3. Levels of aspiration :- Levels of aspiration imty degree of
expectation which a person has ie, how much he expects to
accomplish or achieve. Inch general people tend to set their
goals slightly higher than the level they are sure of attaining.
This is a healthy ardency for progress. There are a few who set
their level of aspiration much higher or lower in comparison to
their actual level of per aspiration much higher or lower in
comparison to their actual level of performance leading to
frustrations and level of aspiration.
4. Force of Habit :- a habit which has been formed acts as arrive
and compels us to continue the accustomed ways of doing
things. In other words habit once formed persist and influence
our behaviour greatly.
5. Interests and attitudes:- The interests we have developed and
the attitudes are have formed colour our everyday bhr in many
ways
6. Curiosity:- This is a motive, which is close exploration.
Exploration is a drive that aids the satisfaction of curiosity. The
extent opt man’s knowledge and experience widens as result of
this drive.
7. Fear :- fear is a burned motive. It motivation individuals is
escape from fear producing situation. Fear may al so interfere
with the satisfaction of other motives
8. Unconscious motives :- There are certain and motives of which
we are unaware we are seldom conscious of all the various
motives that influence our behaviours. Even though we try,
frequently we are unable to analyze our motives and identify
the reasons for our behaviour. Their motives are called
unconscious motives. They are in the form of our repressed
desires or wishes repressed emotional tensions or complexes.

II (d) THEORIES OF MOTIVATION:-

Theories of motivation try to provide general sets of

principles to guide our understanding of the urge wants, needs,
desires and goals which fall under the category of motivation.
They are given below

1. Instinct theory of motivation

2. Drive theory ( push theory of motivation )3
3. Arousal theory of motivation
4. Incentive theory of motivation (pull theory)
5. Maslow is hierarchy of needs .
 1.Instinct theory of motivation :- peoples all motivated to
behave in certain way because they are evolutionarily
programmed to do so.

William James created a list of human instincts that

includes such things as attachment ,play , shame, anger4 fear,
shyness, modesty and love . the main problem with this theory
is that it did not really explain behaviour, it just described it.

According to William MC Doug all all behavioural acts are

essentially instinctive and this instinctive behaviour is found to
have three aspects.

1. Cognitive (knowing)
2. Affective (feeling)
3. Co native (acting or doing)

Eg: ashen a child sees a monkey coming towards him, first, he

sees the monkey, second he experiences an emotion of fear
and third he listen to run away. All human behaviours could be
explained in terms of some instinct.

2 Drive theory ( push theory of motivation):-

It was developed by claret Leonard Hall in 1943.

According to the drive theory of motivation people are
motivated to take certain actions in order to reduce the
internal tension that is caused by unmet reach. This is useful in
explaining behaviours that have asking biological component,
such as hunger or thirst. The problem with the drive theory of
motivation is that these behaviours are not always motivated
purely by physiological needs .for examples people offers eat
even when they are not really hungry.
 Drive theories might be described as the “push the men
of motivation “, Behaviour is pushed towards goals by driving
states within the person. When internal drive state is aroused,
the individual is pushed to engage in behaviour, which will lead
to a goal. Reducing the intensity of the drive state motivation
consists of

1. A drive state
2. Goal directed bhr initiated by the drives state
3. The attainment of an appropriate goal
4. The reduction of the drive state and subjective

Satisfaction and relief when the goal is reached. The

sequence of events is called motivational cycle. Drive
includes the influence of learning in secondary drives .
primary driven are there which arrives from basic biological
needs such as hunger, thirst and elimination. Through the
conditioning and learning’s, peoples can acquire other
driven, its known an secondary driven. Their will help the
person do attain a particular goal.

3 Arousal theory of motivation

b) safety and security needs :- ones the physiological needs
are fairly well satisfied safety and securely needs
predominate the main needs are need for security of body,
employment, resources, morality family and health, safely
needs are of greater important you in childhood. The failure
to satisfy the needs of children may make them fearful.
c) Need for low and belongingness:- there needs become
prominent when the physiological and safety security needs
have been met. The person at them lows long for a
affectionali relationship with others, for a place in his family
 and social groups. The sec urea individual will behave to
reach our for friends, affiliate with a group and ultimately
take on the responsibilities in marriage of being both a
spouse And apparent.

Self Esteem Needs:- Here the people want self respect and
the respect, confidence and admiration of others. Maslow
divided then needs in to two types. Self respect and respect,
self respect includes a person’s desire for
competence,confidence,achiewmentand in dependence,
respect from others include his desive for
prestigue,reputation,status, recognilion,appreciation and
from others. Satisfaction of their needs generation feelings
of self confidence, self worth and a since of being useful and
necessary in the world.
e) Self- Actualization :- it is the highest human motive. It is
needed for self fulfilment, the sense that one is becoming
everything that he is capable of being the self actualized
persons is someone who has reached the peak of his potential .

II (e) MOTIVES AND BEHAVIOR

 Motives act on the immediate force to energy to

direct, sustain and stop a behaviour
 Motives are a powerful tool for explaining behaviour
 Motives help us to make predictions about
behaviour in many different situations.
 Motives do not tell us exactly what will happen, they
gives as an idea about the range of things a person
will do
  Motives are inner forces that control an individual’s
behaviour in a subtle manner.

III a) FRUSTRATION

Introduction:- every action arises in response to a need. So it is

always directed towards a goal. The blocking of activity directed
towards a goal results in frustration. It always produce unpleasant
feelings like anger ,irritation, anxiety etc. Then produce mental
tension.

III b)

Definitions: - frustration refers to the blocking of behaviour directed

towards the goal . frustration means emotional tension resulting
from the blocking of a desire or need

2 frustration is an emotional tension resulting from the blocking

of a desire or need.

3 frustration is the feeling of being blocked or satisfying a need or

attaining a goal, individual perceives as significant ( kolesnic)

III (c) characteristics :-

 Produces an emotional sate which is always

unpleasant
 It creates tension or stress which varies from simple
annoyance to heated anger.
 The tention or stress aroused by frustration affects
the vital balance.
  It is a stage or condition failure dominates the
attempt
 The cause of frustration lies both in the individual
himself and his environment.

III (d) Types:-

Internal :- caused by conditions with in self

External :- caused by conditions outside of self

III (e) causes

1) Internal cause
 Physical abnormalities or defects
 Conflict of motives with in the individual
 Individual morality and high ideas
 High level of aspirations (lope+ )
 Lack of persistence and sincerity in effort

2) External
 Physical, social economic.
 Physical – natural calamities obstracles in the
environment to reach a goal environmental
situations or conditional which cannot control
 Eg: contagious disease, death of a friend or
bellowed one
 Social – conflict with other people,
customs,saditions,reskictions, taboos, laws. Codes
etc.
 Economic –financial problems
III (f) reactions to frustrations

 Direct approaches
 Restlessness and tension
 Aggression
 Apathy
 Fantasy
 Sterol type
 Regression
1. Direct approaches
 Increasing trails or improving efforts
 Changing the goal to one can be attainable
 Adopt to compromising means
2. Restlessness and tension
 When increased effort and variation in attack facials
and substitute goals are unavailable and
unacceptable
3. Aggression
 Direct aggression- directly against the individual or
subject
 Displaced aggression- displaced aggressive action
against innocent person or object rather than actual
causes of the frustration.-

Apathy :- there have no power to satisfy their needs by

means of their own action or whose aggressive outburst
are never successful. Leader to apathy and withdrawal
when confronted with frustrating situations.
 Fantasy:- when problems become too much for an
individual the sometimes seeks the solution of escape in
to a dream world.

Stereotype :- repetitive fixed behaviour

Person will stupidly make the same effort again and again
through experience has shown its facility

Regression:-

 Refers to primiliur modes of behaviour that is to

modes of behaviour characterizing a younger age.
 Show considerable variability in behaviour when
their goal seeking behaviours blocked

CONFLCT

Introduction:-

 It is painful state or condition of an individual

 Conflict in life cause stress
 It produce intense emotional tension
 It occurs when one has to choose between equally
desirable or equally undesirable goals
 While the desires are contradictory- it becoming a
vitamin of two opposing desires, he suffers from an
inner conflict to satisfy or not satisfy one or the
other desire

IV (b) Definition :- conflict means a painful emotional state

which results from a tension between oppered and contradictory
wishes

( Douglas and Holland)

Iv (c) conflict Response :-

1. Emotional response – feelings are experience in conflict- range

from anger and fear to despair and confusion
2. Cognitive Responses – our ideas and thought about conflict
such as the inner voice or internal observation.
3. Physical Response :- include such response tight stress,
bodily,tention,increased perspiration, shallow or accelerated
breathing

nausea, and rapid heart beat.

Iv (d) Types of conflict:-

 Approach- approach conflict

 Avoidance- avoidance conflict
 Approach- avoidance conflict
 Multiple approach- avoidance conflict
 Internal conflict.

Approach –approach conflict:-

Occurs when a person is forced with two attractive alternatives

while only one of them can be selected . it is easy to be resolve. They
become serious if the choice of one alternative means the loss of
extremely attractive alternatives.

Avoidance – Avoidance conflict:- Arises when a person faces two

undesirable situations, and avoidance of one forces exposal to the
other it is very difficult to resolve and create intense emotions

Eg: A women trying to chose between continuing pregnancy and

getting an abortion done.
APPOROACH-AVOIDANCE CONFLICT:- exist when one event or
activity has both attractive and unattractive features. It results in
oscillation between approach and avoidance. It create a great deal of
emotional conflict and stress.

Eg: Marry or not to Marry

Multiple approach avoidance conflict:- exist when a choice must be

made between two or more alternatives, each of which has both
positive and negative features. There are most difficult to decide in a
double approach. Avoidance conflict people usually vacillate waver
or go back and forth between two

choices. Either choice has a positive and a negative quality . so which

one does he chose? The choice will be based on the person involved
and his feelings about the pay or work involved Eg: a person may
have the alternative of accepting any of the two jobs of which one
may be boring but with a very good pay and other may be interesting
but with a very poor pay

Internal conflict:- may be between one person and another or

between person and his environment or may be with in the person
himself. Most dangerous is with in a person this is called internal
conflict. Conflict between motives, desires, sentiments and attitudes.

IV (e) effects of conflict on health :-

 Trust ration and conflict lead to stress and anxiety

causing harm to the body
 Some common reactions to frustration are
persistence escape and aggression.

IV (f) coping with frustration and conflict:-

  Identify the sources of frustration try to change or
control it.
 Decide important things carefully, check everything
carefully before taking a decision
 Review the situation
 Change our goals or modify our decision
 Substitute our goals by others which are equally
satisfying but are different and obtainable
 Seeks advice from experts, friends or relation
 Encourage full expression of positive and negative
feelings within an accepting atmosphere
 Avoid in decision

IV (g) conflict management :-

Time out – find a quiet place where you can collect yours
thought’s count to before doing or saying anything.

Postponing your response :- I am so angry about things I can’t flak

about it now I’ll you later.

Make note :- write down your angry thoughts and then most
important remember to up. it is not for anyone else’s eyes.

Visualisation:- when one is attached to both choice, seeing the

positives and negatives of both choice and going back and forth
before deciding.

V EMOTION

V (a) Introduction:-
 Etymologically the word ‘emotion” is derived from the
Latin word “ mover” which means “ to stare up or to excite”. Feelings
are simple experiences, it may be pleasant or unpleasant. Emotions
are more complex affective experiences in which the whole
individual is stirred up. Emotions are some sort of feelings of
affective experiences, which are some sort of feelings or affective
experience which are characterized by some physiological changes
that generally lead them to perform some or the other types of
behavioural acts .

V (b) Definitions:-

Emotions is an affective experience that accompanies

generalized inner adjustment and mental and physiological stirred
up states in the individual and that shows itself in his overt
behaviour’

(crow and crow-1973)

V (c) Components of Emotion :-

 Dennis coon described four components of emotion

1. Subjective feeling
2. Emotional expression
3. Physiological changes
4. Conscious experience

Subjective feelings:-

There are what you believe and what you are feeling. It is
conscious and an intellectual perception of a situation. If the
situation is indorse enough it may provoke an emotion. Emotional
feelings are experienced before expression
 (2) Emotional Expression or Expressive Behaviour:-

There are three ways in which an emotion can be

expressed

 Facial
 Vocal
 Bodily movements/ Gesture

Facial : the face is believed to be the most express ire part of the
body. Some emotions like guilt, joy, anger, etc. It can be accessed
through facial expression.

Vocal: - Voice also tells an about as emotional state of an individual .

a scream communicates fear, surprise plan, a trembling voice means
sorrow or disappointment a loud , sharp, high- pitched voice means
anger, irritability or slow monotonous voice unusually communicates
sadness.

Bodily movements or Gestures:- bodily movements and gestures

also indicate the emotional state of an individual. In anger a person
clencher his fists and moves forward to attack infear aperson runs
away ,in joy the person is excited his head high and chest out.

Physiological changes :- an emotion manifests as a pshyiological

reaction or arousal. Sucha a reaction causes shifts in heartrate,
blood pressure, respiration,etc. Most of these changes are caused by
hormonal changes, resulting from the activity of nervous system .
many external changes are also occurs during emotional exclaiming,
like voice,gestuern, facial expressions etc.
Conscious experience :- an emotion is not only a pattern of bodily
changes but also an experience emotional experience is generally a
conscious feeling.

Changes in emotional reactions:- emotional reactions affect the

autonomic nervous system the most . the following eternal, internal
and psychological changes occur during emotional station

1. External changes
a) Facial expressions :- they differ in different emotional reactions
the face is flushed in anger and pale in fear. Mouth turns down in
unpleasant emotions and turns up in pleasant emotions
b) Bodily movement and gestures:- unexpected fearful situation
might cause a startle pattern in which the eyes close. Mouth
widens, head and neck are thrust forward.
c) Voice disturbances:- a tenor or break in the voice may denote
deep sorrow. A loud , sharp, high pitched voice usually denotes
anger. Speech is low and monotonous in dejection and sadness
and rapid in tension and excitement
d) Internal changes:- during fear and anger, the pulse sate or heart
rate increases. Blood pressure increases during emotional
excitement. During excitement breathing is in short quick grapes,
but in depression it is slow.

Psychological changes :- during emotional experiences, perception,

learning, consciousness and memory are affected.

Theories of emotion :- emotions very widely and so debates have

lead to the development of many the oies about emotion. The major
theories are.

James Lange theory:- the American psychologist William James and a

Danish physiologist cart Lange independently proposed more or less
similar explanations for emotions. Their explanation known as James
Lange theory of emotion. Before their time, the commonsense
knowledge was that emotions cause physiological arousal and
behaviour accordingly when a person sees a bear, he becomes
frightened and the emotion of fear makes him run away from the
since of danger . the bodily changes would occur as result of the
(fright sight)

According to this theory, emotion results from own

perception of external stimuli. They argued that the bodily changes
resulting from such perception of the situation also changes which
subsequently produces the subjective feelings.

In the above examples the person run not only because he is

frightened but also his running causes greater feel chichi is
sustained.

Cannon bard theory:- W B cannon and D. Bard conducted a number

of experiments and found that the structure of hypothalamus in the
brain was responsible for emotions. So they put forward the
proposition that physiological changes and the activity of the
hypothalamus. It means that both the activity of the hypothalamus.
It means that both the physiological and emotional changes occurs
at the sometime. All the activity of hypothalamic and thalamic
activity of the brain. here the experience of fear and tuning. Start
literally at thr sometime.

Character singer theory (1962):- Two factor theory of emotion

scatter proposed that emotional states are a function of the
infraction of cognitive factors and a state of physiological arousal.
This theory takes a more cognitive approach to the issue. He
believes that an event course physiological around but that you
must then identify a reason for the around before you label the
emotion. The conscious experience of emotion involved the
integration of information from three sources:

1. Feedback to the brain from the informal organs and other

body parts activated by the sympathetic nervous system
2. Subject interpretation of a rounded state
3. Information stored in memory and the perception of what is
taking place in the environment i.e., memory of past
experience and appraisal of current situation.

Examples : You are taking the last bus of the night and you are
the only passenger. A single man gets on and sits in the row
behind you. When your stop comes around , he also gets off
the bus and starts walking behind you . you feel down your
spine with a rush of adrenaline you know that there have been
several muggings in your city ours the past few weeks, so you
feel facade.

Lazarus theory :- the Lazarus theory builds on the Schechter

singer theory taking it to another level a cognitive appraisal is
made (either consciously or sub

Emotional Adjustments:- It is also referred to as emotional

equilibrium emotional stability, personal adjustment or
psychological adjustment is the maintained of emotional
equilibrium in the face of external and internal stressors. This
will promote the adjustment.

Autonomic Nervous system:- Ait prepare the body for

emotional responses by its two divisions- sympathetic and
parasympathetic nervous system. Sympathetic nervous system
is more active in unpleasant situations. Parasympathetic
nervous system is more active in pleasant situations.

Brain structures:- Hypothalamus and limbic system are the

structures which control emotional system by signalling the
pituitary gland to realise epinephrine, which is associated with
the sympathetic nervous system.

Amygdale is another key player within the limbic system

receive information from the cortex and thalamus involves in
processing emotions right hemisphere regulates the facial
expression.

Hormones :- Hormones play an important role in regulation of

emotions when there is increased emotional level in the blood
and urine.

EMOTIONS IN HEALTH AND ILLNESS:-

Dr. Schindler Says by conducting our own emotions

we can eliminate half of our problems.

- Intense and unpleasant emotions disturb the whole

individual
- Physiological reactions during are emotion facilitate
the adjustment psychometric disorders, skin
reactions
- Modern medicine shows that un controlled
emotionality
 Plays a major role in the cause of diseases sexual
reactions respiratory reactions.

Introduction :-

It is the universal phenomenon. All people experience it stress

can have both positive and negative effects. It is produced by a
change in the environment that is perceived as a challenge, threat or
danger. Stress is a condition in which the human system responds to
changes in its normal balanced state. When a person face a stressor
responses are referred to as coping response or coping mechanisms.

Definitions :-

1. Stress is the venom –specific response of the body to any

kind of demand made up on it”

(Sclye-1956)

2. Stress is the arousal of mind and body in response to

demands made upon them.

Stressors:-

Stressors can be any stimulus that causes an individual to

experience skess. The three major calicoes of stressors are:-

1. Catastrophic events

2. important life events (personal scissors)

3. daily hassles (background stressors)

Catastrophic Events : - It is large scale disaster that affects numerous

people and causes extensive damage . it includes earthquakes,
hurricane, war toxic, waste contamination and nuclear accidents.
Important life events :- major life events such as the death of a
family members, parents, spouse),the loss of one’s job diagnosis of
life threatening illness, parents or relatives in family getting very sick)
breaking up with a friend starting a new job brother or sister getting
married.

Daily Hassles :- There are the minor irritants of lights- i.e.: traffic
delays noise, pollution weather, social events, work demands,
dissatisfaction, with or job, being in an unhappy ,relationship,
irritating behaviour.

Stress Cycle:- Stress follows a cycle of events, which circle around

and around. Each step increase the security of next step.

1. Stressor

Stressors can be any similar that causes an individual to

experiences stress. Stressors include either positive or negative
life events eg: death , divorce, new job, marriage ,etc.

Ways to reduce stress :- Avoiding or managing the stress,

choosing what is important in life time management, simple
living, learning to say no .

Reaction of stress:- Once there is a stressor our body will react

to it. Reactions to stress relation to perception of the stress.
When a person feel stressed from the stressor, the body beings
to release chemicals to comfort the stressor , the

Reducing the reactions to stress:- Asking God for help, spiritual

practise, cognitive behaviour therapy, visualization of results.

Wear and tear on the body and organ system.

 When a person becomes stressed and does not correct
the stressor the same stress reactions with helped in the
beginning to scope, begin to wear one self down .

Remedies:- Improving diet, regular exercises, yoga, meditation

4 Reduced optimum Health:- After a sustained period of chromic

stress the body wears down, which can invite more serious diseases
like light BP, heart problems, diabetes skin conditions, asthma,
arthritis.

Remedies:- consulting allopathic or homeopathic, doctor or

acupunctures or naturopath.

Increased sensitivity to stress:- while once body is worn down and

emotions worn and exhausted, sensitivity to stress increases.

Remedies :- Try deep breath in or meditation. Taking walks or talking

with an objective friend may help to reduce sensitivity to stress.

EFFECT OF STRESS:- stress is not always harmful low level of stress

can help for better performance.

1. The body reacts to stressors by initiating a complex sequence of

responses.
2. Chromic stress can lead to physiological disorders such a as
high Bp and heart diseases.
3. Stress may affect health directly by creating chronic over
around of the sympathetic division of the nerve or the adrenal
cortical system.

Or by impair the immunes system

- People under stress may not engage in positive

health related behaviours and this may lead do
illness
 - During stress some non consume excessive amount
of alcohol and smoke excessively.
- Stress may indirectly affect health by reducing rates
of positive health related bhrs and increasing rates
of negative behaviours.

ADAPTATION TO STRESS:- All of us face stress in our lives some of

psychologist believe that daily life actually involves series of repeated
consequence of perceiving a threat considering ways to cope with it
and ultimately adapting to threat with greater or lesser success.
Adaptation is often minor and occurs without our awareness;
adaptation requires major efforts when the stress is more or long
lasting.

General adaptation syndrome (GAS) Hans selye,1945:- it is a

biochemical model of stress developed by Hans Selye 1976. The GAS
describes the body’s general response to stress, a concept essential
in all areas of nursing care. There stages in the GAS

Alarm reaction:- when a person perceives a specific stressor, various

defense mexhanism are activated . autonomic nervous system
intiates the flight response preparing the body
 Index

Psychological Assessments and Role of

Nurse

I. Introduction
II. Definition
III. Characteristics
IV. Principles
V. Types of psychological assessments

i. Based on construction and administration.

ii. Based on knowledge, skills and abilities.
VI. Developments
VII. Uses
VIII. Limitations
IX. Role of nurse in psychological assessment
X. Conclusion

Unit-VII
 PSYCHOLOGICAL ASSESSMENTS AND ROLE OF NURSE

I. Introduction
Psychology has a long tradition of scientific research
on human behavior and personality. Through the research, a
multitude of psychological assessment scales have been
developed to objectively and precisely measure various
aspects of psychological functioning and personality
characteristics.

II. Definition
1. Psychological tests are standard measures devised to
assess behavior objectively and used by the
psychologists to help people make decisions about
their lives and understand more about themselves.
2. Psychological assessment is a process that involves
the integration of information from multiple sources,
such as psychological tests and other information’s
such as personal and medical history, description of
current symptoms and problems by either self or
others.

III. Characteristics of psychological tests

Psychological tests have several characteristics.

They are

1. Standardization
2. Objectivity
3. Based on sound norms
4. Reliability
 5. Validity

1. Standardization
It refers to the consistency or unfortunately of the
conditions and procedures for administering a test .To achieve
this people must be tested under uniform conditions.
2. Objectivity
It refers primarily to the scoring of the test results.
The scoring process must be free of subjective judgment or bias
on the part of the scores.
3. Test norms
To interpret the result of a psychological test, a frame
of reference or point of comparison must be established so that
the performance of one person can be compared with the
performance of others. This is accomplished by means of test
norms.
4. It refers to the consistency of a persons score.
For eg.
A body takes a cognitive ability test and achieves a
mean score of 100 and after one week if we repeat the test and
he achieves a mean score of 72, we could describe the test as
un reliable.
5. Validity
It refers to the test accuracy in measuring what it is
supposed to measures.
E.g. If a test is a valid measure of intelligence, people’s scores
on that test should be strongly correlated with their grades in
school.

IV Principles;
 1. Testing should be done and the results interpreted in a
particular time.
2. The result should be interpreted on the basis of life patterns
of Indians.
3. Assessment procedures that is used to get the information
and its depends up on the situation.
4. Proper environment.
5. Subtle implicit test taking bhr should be given importance.
6. Any information about the client should be given importance
and should be related to the results got from the test
administration

V. Types of psychological tests.

Psychologists categorized tests in two ways based
on how they are constructed and administered and based on
skills and abilities they are designed to measures.
 Classification based on construction and administration.
1. Individual and group tests
2. Speed and power tests
3. Computer assisted tests
1. Individual and group tests
Individual psychological tests are designed to be
administered to one person at a time. Group tents are designed
to be administered to a large number of people at the same
time.
2. Speed and power tests:- Speed test have a fixed time limit, at
which point everyone taking the test must stop. Power tests
have no time limit,applicants are allowed as much time as
needed to complete the test.
3. Computer assisted test
 It is a meansof administering psychological tests to
large groups of applicants in which an applicants response
determines the level of difficulty of succeeding items.
For example in computer assisted testing individual
does not have to waste time answering question below his
level of ability. The computer programs begins with a question
of average difficulty and if the individual answers correctly, it
proceeds to questions of greater difficulty.
4. Paper pencil and performance tests:-
They are in printed form, answers are recorded on a
standard answer sheet. Performance test assess complex skills,
such as word processing or mechanical ability for which paper-
pencil tests are not appropriate.
 Classification based on tests of knowledge, skills and abilities.
1. Achievement tests
2. Aptitude tests
3. Intelligence tests or cognitive ability tests
4. Interest tests
5. Neuropsychological tests
6. Occupational tests
7. Personality tests
8. Specific clinical tests
1. Achievement tests
They are used in educational and employment settings
and they attempt to measure the achieved knowledge such as
mathematic or spelling.

Eg:- Team ending Exams

2. Aptitude tests
 These test measures specific abilities such as mechanical
or clerical skills. These include measurement of perceptual
speed and accuracy, attention to detail, principles of
mechanical operations, ability to operate computer.

Eg:- General Aptitude test Bateery (GATB)

Defferential Aptitude Test (DAT)

Type of Aptitude test

 Academic aptitude test

 Vocational aptitude test
 Multifactor aptitude test

 Academic aptitude test :- It assess cognitive capacity or

potential that predicts how an individual will perform
according to some criterion prior to receiving training or
instructions. Eg:- Graduates Records Examination, Scholastic
aptitude test.

 Vocational aptitude test :- Use for measuring potential of

candidates for specific occupation. Eg:- Pilot aptitude test.

 Multifactor Aptitude Test :- It contains a number of sub tests

that measure different aptitudes.
Eg:- General Aptitude Test Battery- Test were developed for
the use of employment counseling.
Eg:- Differential Aptitude Test- it is intended to use in the
vocational and educational programs. The important
subtests are verbal reasoning, numerical ability, abstract
reasoning etc.
  Other Aptitude Tests :- They are

 Art aptitude test

 Clerical aptitude test
 Manual aptitude test
 Mechanical aptitude test
 Medical aptitude test
 Nursing aptitude test
 Scholastic aptitude test
 Scientific aptitude test
 Teacher aptitude test
 Performance test

3. Intelligence test:

These tests are attempts to measure intelligence ie, basic

ability to understand the world around.

A good intelligence test measures capacity such as a child

potential for school learning or on adults ability to cope with general
intellectual problems.

Eg :- Bhatia’s battery of performance of intelligence.

Typs:

a) Classification based on administrative pattern.

 Individual test:-
In which only one individual is tested at a time
 Group test
In which a group individual are tested at a time
b) Classification based on the form of the test.
 Verbal test or Language test
 These tests make use of language

Eg :- Sand ford – Binet intelligence scale, Weschler’s

scale.

 None verbal test or none language test.

These test involve such activities in which the use of
languages is not necessary.

Eg :- Raven’s progressive matreces.

Measurement of intelligence:

William sterm

IQ = Mental Age x 100

Chronological age
Binet scale : Binet and Simon
 Sand ford – Binet Intelligence scale 1905,1908,1911,1916
- 30 problems
4. Interest test :-
Psychological test to assess a person’s interest and
preferences used primarily for career counseling.

5. Neuro Psychological test:-

These tests measure deficits in cognitive functioning. (ability to

think, speak, reason etc). The deficit in cognitive functioning may
result from some sort of brain damage such as stroke or brain
injuary.

6. Occupational test :-
 They attempt to match interests which the interests of person’s
in known career.

7. Personality test:-

They attempt to measure basic personality style. The most well

known personality tests are:

 The Minnesota Multiphasic personality Inventory

 The Rorschach ink bolt test.

8. Specific – clinical test:

They attempt to measure Specific clinical matters, such as

current level of anxityer depression.

VI . DEVELOPMENTS

The main steps are.

1. analysis of the situation

2. Tentative selection of the test item
3. Development of standardized procedure
4. Administration of the test to a representative group
5. Final selection of the test items
6. Evacuation of final test

1. Analysis of the situation

In this test detailed analysis of the psychological
processes required for successful performance of the task in
question is carried out.
 2. Tentative selection of the test item

In the second step after the analysis has been made the
psychologist selects tests already available devices tests which
he feels will measure the processes.

3. Development of standardized procedure.

Psychological test to be administered and scored in the
same way for every individual tested in order to obtain
consistent results.

4. Administration of the test to a representative group

In this step psychologist administrators the test to
representative group of subjects to see if they scored the way
expert judgment or other evidence suggests.

5. Final selection of the test items

In this process many test items are either discarded or
revised so that they contribute more directly to the overall
purpose of the test. This procedure is called item analysis.
6. Evacuation of final test
Effectiveness of the final test is evacuated in terms of a
specified criterion.

VII. USES OF PSYCHOLOGICAL ASSESSMENT

1. It is easier to get information from testes than by electrical

interview.
2. Screening and classification of diseases
3. Personally description
4. Self understanding
5. Prediction of the future behavior of an individual
 6. Assist in formulation of psychopathology

USES FOR THE STUDENTS

1. To help students at choice critical point when they have fake a

decision.
2. To help in the selection of students for admission.
3. To help in the psychological diagnosis of the students.
4. To help the teacher in dealing the scholastic and behavioral
problems.
5. To identify the abnormal pattern of personality.
6. To help in the treatment of psychosocial problems.
7. To diagnose students problems.

VIII. LIMITATION:-

 No psychological test is ever completely valid or reliable

because the human psyche is complicated.
 Many applicants experience considerable text anxiety.
 Negative attitudes towards psychological test may also lower
applicant’s motivation.
 Administration and interpretation of test is done only by
qualified psychologists.

IX. ROLE OF NURSE IN PSYCHOLOGICAL ASSESSMENT

The should become familiar with the many standardized

psychological test, that are available to enhance each stage of the
nursing process. It help the nurse to proceed care. The nurse should
have knowledge about all the psychological tests. The nurse should
reassure the patient about the safety of the test and confidentially
of the observations of the psychologist.
Signature of HOD
Signature of principal

UNIT. 7 Hrs : 8

CHARACTERISTICS OF MENTALLY HEALTY PERSON

1. Mental hygiene and mental health (concepts)

2. Characteristics of mentally healthy person
3. Warning sign of poor mental health
4. Promotive and preventive mental health strategies and service.
5. Ego defense mechanisms and implications
6. Personal and social adjustments
7. Guidance and counseling
 8. Role of nurse.

UNIT. 7 Hrs : 8

CHARACTERISTICS OF MENTALLY HEALTY PERSON

Index:-

1. Introduction
2. Mental health (Meaning, Definition, Concepts)
3. Mental hygiene (Definition, Concepts)
4. Factors affecting mental health and hygiene
5. Characteristics of a mentally healthy person
6. Warning sign of poor mental health
7. Promotive and preventive mental health strategies and service.
(primary, secondary, tertiary)
8. Mental health services
9. Ego defense mechanisms
10. Personal and social adjustments
11. Guidance and counseling
 Definition
 Principles
 Types
 Phases
 Skill needed
12. Nurses role
13. Conclusion

I. Introduction
Man is an integrated psychosomatic unit and his/her
behavior is determined by both physical and mental factors.
 The modern concept of health also consider mind and body as
an integrated unit. One should have
A sound efficient mind and should control his emotions to be
healthy in body and mind on should work efficiently and
harmoniously.

II. Mental health

a. Meaning and nature
A healthy individual is not only physically healthy but also
mentally healthy. The modern concept of health extents
beyond the proper functioning of the body. It is include a
sound, efficient mind and controlled emotions. Health is a state
of being hale, sound or whole in body and mind. It means that
both body and mind are working efficiently and harmoniously.
Mental health is an important aspect of one’s total health
status and it is a basic factor that contribution to maintance of
physical health and social effectiveness. It means the ability to
balance feelings, desires, ambitions and ideas in ones daily life.
If means the ability to face and accept the realities of life,
Mental hygiene is the ability to understand stress.
Thus the world of today emphasized mental well being as
one of its most important goals. Mental health is a basic factor
in the maintance of physical health as well as social
effectiveness. Because of the significance of individual and
social aspects some psychologist have defined mental health as
the ability of the individual to make personal and social
adjustment.

b. Definition
1. Mental health is defined as the capacity in an individual
to form harmonious relations with others and to
 participate in our contribute constructively to the
changes in his social and physical environment.
(Who)
2. Mental health is the full and harmonious functioning of
the whole personality.
J A.
Hadfield
3. Mental health is defined as the adjustment of human
being to the world and each other with a maximum of
effectiveness and happiness. It is the ability to maintain
even temper an alert intelligence socially considerate
behavior and happy disposition.
K A.
Menninger

c. Definition of mental hygiene

Mental hygiene is an art and science which
includes application of scientific principles and practices
for the promotion, preservation and maintenance of
mental health and prevention of mental disorders, enjoys
healthy practices to lead productive, happy and
contented life.

III. FACTORS INFLUENCING MENTAL HEALTH AND HYGIENE

There are few basic factors on which the mental health of any
individual depends.

a. Heredity or hereditary factors.

b. Physical factors.
 c. Social factors.
o The home
o The school
o The community
d. Satisfaction of fundamental or basic needs.
e. Environmental factors.

a. Hereditary factors.

It provides a raw material, or the potentialities of the

individual. It sets the limit for his mental health. What individual
inherits is the potentialities in relation to growth, appearance,
intelligence and the life. The development and utilization of these
potentiality is determined to a large extent by environmental
opportunities. In the words of waltin, defective hereditary may
furnish a fertile soil for development of mental and nervous diseases.

b. Physical factors

physical health factor make a significant contribution to mental

health. An erect posture, a winning smile, colour in the cheeks, a
feeling of exhilaration promote a sense of a personal security and
have a marked influence on other people. An individual with a
feeling of physical well being ordinarily a good disposition and is
enthusiastic and intellectually alert. Sick people find it more difficult
to make adjustments the new situations than healthy people.

c. Social factors.

Social factor pertains to the individual’s society in which he lives,

the interactional process and his social functioning which other
person’s. Every individual is born in to a society which influence the
content of his behavior. Our social factors, the most important are
the home, the school and the community.

d.Satisfaction of fundamental or basic needs.

Our basic needs are physical, organic as well as emotional or

psychological. Hunger, thirst, fatigue, lack of sleep, physical pain,
exercise, heat or cold and the like set up certain tension in the
individuals which must be relived.

e.Environmental factors.

I has now been established account of various researchers in

the field of mental hygiene that environmental factors – family,
school and society are more responsible for bringing mental illness
than the hereditary or constitutional force.

IV. CONCEPTS OF MENTAL HYGIENE

 Prevention:-
The measures to be followed in preventing merital illness
are.
 Identifying the cause leading to mat adjustment
 Suggesting ways and means for achieving emotional and
social adjustment.
  Suggesting methods for resolving inner conflicts and
frustration for getting rid of anxieties, tension and
emotional disturbeness.

 Preservation:-
Once can enjoy good mental health, if suitable care is
taken for its preservation and promotion. The following
activities preserve mental health.
 Develop the inner potential of individual
 Attain emotional maturity and stability
 Achieve personal and social security and adequacy
 Promote healthy human relationships and group
intraction

 Curative Measures

An individual can enjoy good mental health to the extent

one is cured as early as possible of mental illness and diseases,
he is suffering from. The following are curative measures.

 Leading happy and controlled life

The ability of an individual to lead a fuller and a happier life is
directly proportional to the mental health enjoyed by them. So
the individuals always strive to get a well environment and
avoid unnecessary anxieties, conflicts and frustrations.

V. CONCEPT OF MENTAL HEALTH – I A H O D A (1958)

 A positive attitude towards self

 It includes an objective view to self, including
knowledge and acceptance of strengths and limitations.
The individual feels a strong sense of personal identity
and security within the environment.

 Growth, development and the ability for self

actualization
It is the indicator correlates with whether the
individual successfully achieves the tasks associated with
each level of development.

 Integration
It includes the ability to adaptively respond to the
environment and the development of a philosophy of life.
Both of which help the individual maintain anxiety at a
manageable level in response to stress test situation.

 Autonomy
It refers to the individual ability to perform in an
independent self directed manner. The individual makes
choices and accepts responsibilities for the outcomes.

 Perception of reality
It includes perception of the environment without
distortion as well as the capacity for empathy and social
sensitivity.
 Environmental mastery
 This suggest that the individual has achieved a
satisfactory role within the group, society, or
environment. He is able to love and accept the love of
others.

VI. CHARACTERISTICS OF A MENTALLY HEALTHY PERSON

 He has an ability to make adjustment

 He has a sense of personal worth , feel worth wile and
important.
 He solve his problems legally by his own effort and make
his own decisions.
 He has a sense of personal security and feel secure in a
group shows understanding of other people’s problems
and motives.
 He has sense of responsibility
 He can give and accept love
 He lives in a world of reality rather than fantasy
 He shows emotional maturity in his behavior and
develops a capacity to tolerate frustrations and
disappointments in his daily life.
 He has developed a philosophy of life that gives meaning
and purpose to his daily activation.
 He has a variety of interests and generally lives a well
balanced life of work, rest and recreation.

VII. WARNING SIGN OF POOR MENTAL HEALTH

The signs and symptoms depends up on the types and
severity of the condition. They are,
In younger children
 Change in the school performance
 Poor grades despite strong effort
 Excessive worrying or anxiety
 Hyper activity
 Persistent night mares
 Persistent disobedience
 Aggressive bhr
 Frequent temper tankums

In order children and adolescents

 Abuse of drugs and alcohol

 In ability to cope with daily problems and activity
 Changes the sleeping and eating habits
 Excessive complaints of physical problems
 Defying authority, skipping school, stealing or
damaging property
 Intones fear of gaining weight
 Long - lasting negative mood, often along with poor
appetite and thoughts of death.
 Frequent out burts

In adult

 Confused thinking
 Long – lasting sadness or irritability
 Extreme highs and low in mood
 Excessive fear, worrying or anxiety
 Social withdrawal
  Dramatic changes in eating and sleeping habits
 Increased anger
 Delusions or hallucination
 In ability to cope with daily problems and activities
 Thoughts of suicide
 Denial of obvious problems
 Abuse of drugs and alcohol

Intervention’s oriented to keep function infact

 Extending mental health education services at child

guidance clinics about child rearing practices
 Strengthening social support for the frustrated aged
and helping them to retain their usefulness
 Promoting educational services in the field of mental
health and mental hygiene.
 Developing parent – teacher associations.
 Rendering home maker services
 Proceeding marital counseling

Intervention’s for families in crisis

The crisis Interventions can be given at

 Mental hygiene clinics

 Psychiatric - first aid center
 Walk in clinics

Mental health education

  Conduct mass health education program
 Educating the health workers regarding the prevention
of mental illness

Society – centered preventive measures

 Community development
 Culturally deprived families need biological and
psychological supplies.
 Collection and evacuation of epidemiological,
biostatistical data

Secondary prevention

Secondary prevention targets people who show early

symptoms of mental health disruption, but regain
premorbicl level of functioning through aggressive
treatment.

Role of nursing in secondary prevention

 Early diagnosis and case finding

This can be achieved by educating the public,
community leaders, industrialists etc. case finding
through screening and periodic examination of
population at risk, monitoring of the patients etc.
 Early reference
The public should be educated to refer these case to
proper hospital as soon as they recognize early
symptoms of mental illness.
 Screening programs
 Simple questionnaires should be developed to
identify the symptoms of mental illness and
administration of the same in the community for early
identification of cases. These questionnaires can be
simplified in local languages and used widely in
collages, schools, industries, etc.
 Training of health personnel
Orientation course should be provided to health
workers to detect case in the course of their routine
work.
 Consultation service
Nurse working in general hospitals may come across
various conditions such as puerperal psychosis, anxiety
states, peptic celler , collective colitis bronchitis,
asthma, etc. These case givens needs consultation and
care.
 Crisis Intervention
It crisis is not tackled in time, it may lead to mental
disorder or even suicide. Sometimes anticipating the
crisis situation and guiding the individual in time can
help them to cope with crisis situation in a better way.
 Tertiary prevention
Tertiary prevention targets those with mental illness
and help to reduce the security discomfort and
disability associated with their illness. Here community
mental health nurses play a vital role in monitoring the
progress of discharged patients in half way homes,
houses etc.

Role of nurse in Tertiary prevention

  Family members should be involved activity in the
treatment program.
 Occupational and recreational activities should be
organized in the hospitals
 Community based programs can be launched by
meeting the family members when they needed for
discharge from the hospital should be emphasized.
 Nurse need to be familiar with the agencies in the
community that provide the services.
 Provide emotional supports
 Monitor community attitudes and help in fostering a
realistic attitude towards the mentally ill.
VIII. MENTAL HEALTH SERVICE
 Mental health agencies- Government at national
level.

There are 42 mental hospitals in the country with a bed

availability of 20,893 in the government sector.

In the private sector, there are 5096 beds. These facilities have to
manage an estimated 1.02 crore people with savior mental illness
and 5.92 crore people with common mental disorders.

 Mental health agencies- voluntary

They are a valuable community resource for mental health. They

are often more sensitive to the local realities than centrally driven
programs and are usually strongly committed to innovations and
changes.

These organization can specially play an important role in

developing suicide prevention and crisis support, formation of self
help of families, organizing community based housing facilities for
chronic patients. They are setting up to day care center, sheltered
employment facilities, life skills programs for school-dropouts and
public mental health education.

 None Governmental Organization

They are recognized Governments as non- profit or welfare

organizations, which play a key role as advocates, service providers,
the main services are.

1. Partial hospitalization

It is an innovative alternative in hospitalization it is ideally suited

to most of the psychiatric syndromes particularly chronic psychotic
and neurotic disorders. Day care center, day hospital and day
treatment program come under partial hospitalization. The main
advantages is lesser separation from families, more involvement in
the treatment program and lessening of patient’s preoccupation with
the illness.

2. Quarter way homes

It is a place usually located with the hospital campus itself, but

not having the regular services of a hospital. These may not be
routine nursing staff or routine rounds and most of the activities of
the place are taken care of by the patient.

3. Half way home

It is a transitory residential center for mentally ill patients who no

longer need the full services of a hospital but are not yet ready for a
completely independent living.

4. Self help groups

 Self help groups are composed of people who are trying to cope
with a specific problem or life crisis and have improved the
emotional health and well- being of many people. A distinguishing
characterization of self –help groups in their homogeneity.

5. Suicide prevention center

There are many suicide prevention centers in India in voluntary

sector doing good work and helping these need. Some of them are

1) Helping hands and medico – pastoral association

2) Sneha in Chennai
3) Sneha in Mumbay
6. Other mental health services.
1) Community group home
2) Large homes for long – term care
3) Hostel
4) Home care programs
5) District rehabilitation centers.

11. EGRO DEFENCE MECHANISMS AND JMPLICATIONS

The mechanisms used for maintaining harmony with
environment can be grouped in to two categories derect and indirect
methords.
Direct methords
Direct methods are employed by the individual internationally at
the conscious level. there include
 (i). Increasing trials r improving efforts
When one finds it difficult to solve a problem or faces
obstacles in the path , to cope with his environment, he can attempt
with a new zeal by increasing his efforts and improving his
behavioural process.

(i) Increasing kials or improving efforts

When ane find it difficult to solve a problem or faced

obstacle in the path to cope with his enviorment , he can
attempt with a new zeal by increasing his efforts and
inproving his behavioural process.

(ii) Adopting compromising means

For maintaining harmony between his self and the

environment one may adopt the compromising postures.

(iii) Withdrawal and submissiveness

one may learn to cope with ones enviorment by just
accepting defeat and surrendering oneself to the
powerful forces of environment and circumstances.

INDIRECT METHORD:-
These are there methods by which a person tries to seek
temporary adjustment to protect him for the time being against
 a phychological danger . these are purely phychic or mental
devices.
The ego usually copes with anniety through rational means
when anncity is too painful, the individual copes by using
defencemechanisms to protect the ego and diminish anciety .
Such mechanisms are also called mental mechanisms or ego
defence mechanism
Ego Defence Mechanisms
These are the methods of attempting to protect self and cope
with basic drives or emmtionally painful thoughts, feelinga or
events. It is also referred to an defence mechanisms are
conscdered as protective barriers to manage instinct and affect
in skessful situation.
Purposes :-
1. To reduce or eliminate annciety
2. It is used to resolvea mental conflict
3. Used to reduce anniety or fear
4. To protect ones self esteem or protect one’s sense of security

DEFENCE MECHANISM AND DESCRIPTION

1. Rpression :- Uncosious and involuntary forgetting of painful

ideas events and conflicts.
Eg. Forgetting a loued one’s birthday after a fight
2. Dencal :- Unconssious refusal to an unaccectable ideas or
behaviour
Eg. the mother of a child who is fatally ill may refuse ao
admit that there is anything wrong , even though she is fuly
informed of the diagnosis and expected out come. it is because
she canot tolerate the pain that acknowlding reality would
produce.
3. Displacement : - Unconsciously discharging pent –up feeling to a
less thereatening object
Eg. a husband comes home after a bad day work and gells at
his wife.
4. Reaction formation : - Replacing unacceptable feeling with their
exact opposites.
Eg. A jealous boy who hates his elder brother may show him
exaggerated respect and affection towards him.
5. Rationalization :- It is process in which an individual justities his
failures and socially unacceptable behaviour by giving socially
approved reasons.
Eg. A student who fails in the examination may complain that
the hostel atmosphere is not favourable and has resulted in his
failure.
6. Sublimation :- Consciously or unconsciously channelling
institutual drives in to acceptable activites.
 Eg. Aggressivenes might be transformed in to
competativeness in business or sports.
7. Compensation :- Consciously covering up for weaknessby over
emphasizing or making up a destrable kait.
Eg. A student who fails in his studies may compensate by
becoming the college champion in athletics.
8 . Protection :- Unconsciously or consciously blaming some one
else for ones difficulties.
Eg. a person who blames another for his own mistakes is
using the projection mechanism. A surgen whose patient does
not respend as he anticipated , may tend to blame the theter
nurse who helped that surgeon at the time of operation.
9 Intellectualization :- Undue emphasis is focused on the
inanimale in order to zvoid intimacy with people , attention ois
paid to exornal reality to avoid the expression is paid and stress
is excessively placed on irrevelent details to avoid perceiving the
whole.

Eg. Person shows no emotional expression when discussing a

serious car accident

10.Undoing :- Trying to resperse or ‘Undo’ a thought or feeling by

performing an action
that

signifies an opposite feeling than orginal thoughy or feeling

 Eg. You have feelings of dislike for someone . So you bau them
a gift.

11.Regression :- Reuerting to an older less mature way of handing

stresses and feelings.

Eg. An adult throws a temper tantium when be does not get his
own way.

12.Dissociation :- The unconscious separation of painful feeling

and emotions from an
un acceptable ideas situation or object.

Eg. Amnesia that prevents recalls of previous days auto

accident .Adult remembers nothing of child hood sexualahuse.

13.Conversion :- The unconscious expression of instapsychic

conficult symbolically through physical symptoms.

Eg . A student awakens with a migraine headache the morning

of final examination and feels too ill to take the test

14.Suppression :- Voluntary rejection of un acceptable thoughts or

feelings from conscious awareness.

Eg. Student who failed in an examination states he is not ready

to talk about his markes.
15. Substitution :- Unconscious replacement of un acceptable
inpulses attitudes needs or emotions with those that are more
acceptable.
Eg. A student nurse decides to wort is teaching side because
she is unable to master clinical competencies
16. Isolation :- Attemting to avoid a painful thought or feeling by
abjectifing and emotionally detaching oneself from the feeling.

Eg. Acting aloof and indifferent towards some one when you
really dislike that person.

TYPE OF DEFENCE MECHANISMS

Defence mechanism can be devided in to adaptive and

maladaptive mechanisms.

Implication :-

- It help the person to restore conflics

- Diffeculties only occure if the defence mechanisms are
inadequale to deal with anniety or inappropriate to the situation
in which they are used .
- Many mental mechanisms are a means of compromising with
forhidden desires, feeling of guilt etc.
- When mental mechanisms are used moderalely they are
harmiess and help to face conflicts and frustrafions easly and
protect ego and also help to relive tensions and feel comfortable.
 - Excessive and persistent use of these defence mechanisms is
harmful. They donot solve the problem but only releeve the
related anniety.

11. PERSONAL AND SOCIAL ADJUSTMENT

Introducton : -

Many individual have a desire to attain great wealth or to

become extremely popular or famous, but hardly a few of them
attain these. Those of them who take their failures realistically
become satisfied with what they have attained and face the world
squarely . They can be called well adjusted individuals.

Definition’s

Adjustment means the modification to componesate for or

meet special conditions

( Wehster – 1951)

Adjestment is the intraction between a person and his

environment. How one adjusts in a particular situation depend upon
one’s personal ocharacteristics as also the circumstance of the
situation . In other words both personal and environmental factors
work side by side in adjustment. An individual is adjusted, if he is
adjusted to himself and to his environment.
 ( Arkoff –
1968)

Areas of Adjustment

- Health adjustment
- Emotional adjustment
- Social adjustment
- Home adjustment
- School or protessional adjustment

Adjustment of a person is based on the harmony between his

personal characteristics and the demand of the environment of
which he is a part.

1. Personal Adjustment
Personal adjustment is a procedd of harmony between the
individual and his environment the individual purposefully
applies efforts and energy not onle to accommodate perfectly
which is the socity and the environment but also to fulfil his
needs and lead a happy social life.
Characteristics of a well adjusted person
 Basic needs are satisfied
 leads balanced life
 Respects self and others
 Has realistic goals
  A warw of one’s own skengths and weakness
 Flexible mind set
 Ability to deal with adverse circumstances.
 Realistic perception of the world
 Comfortable with the surrounding environment
 Absence of fault finding attitude
2. Social Adjustment

Social adjustment can be defiend as a psychological process. It

frequently involves coping with new standerds and values in the
socity . In the technical language of phychology , getting alending
with the members of the society as best as one can is called
social adjustment

12. GUIDANCE AND COUNSELING

Introduction

One of the most important areas in education which has

acquired considerable importance and received much attention
in recent years is guidance and counselling. Present day nurse
have to acqure some specialized knowledge regarding guidance
and counselling in order to guide the patients factfully in this
highly competitive work.
Defenition :-

Guidance is the assistance made available by qualified and

trained person to an individual of any age to help hiro to manage
his own life activities develop his own point of view make his
own decision and carry on his own burden

( Crow and Crow

1951)

Principles of Guidance :-

The basic aim of guidance is to help the individual to attain his

full personal, social, professional, cultural and spirictual
development. According to crow and crow (1951) , there are 14
principles in guidance.

1. Energy aspect of an individual complex personality patterns

constitutes a significant factor of his total display of attitude
and behaviours.
2. Al though all human beings are similar in many ways individual
difference must be recognized.
3. The function of guidance is to help a person :-
Formulate and accept stimulating worth while and
attainable gaals of behaviour
Applay these objectives is conducting his affairs.
4. Existing social economical and political unrest is giving rise to
mony maladjustive factors that require the co- operation of
experienced guidance workers.
5. Guidance is a continuous process.
6. Guidance is not limited toa few
7. Guidance is education , but not all education is guidance
8. Genorally accepted areas of guidance include concern with
the extant to which an individual physical, mental health
interference with his adjustment to home , school and
vocational demands.
9. Guidance is fundamentally the responsibility of parents is the
home and teachers in the school.
10. Specific guaidance problems in any age level should be
referred to presence trained to deal with particular areas of
adjustments.
11. Programms of individual evaluation and research should
be conducted and progree and achievement made accessible
to guidance workers.
12. The guidance programm should be flexible in terms of
individual and community needs or else it will lose its value.
13. Continuos or periodic appraisals should made.
14. Guidance is preventure rather than curative.

Type of Guidance
 Thre are several areas can be classified in to education ,
vocation , personal , social avocation, health moral, religion
and financial.

1. Educational Guidance

It help the students to get maximum bepetit out of

education and solve their problems related to education .
It will providing assistance to students to perform
satisfaction in their academic work. Choose the
appropriate course of study over come learning
difficulties, Faster creativity improve levels of motivation.

2. Vocational Guidance
It is assistance provided for selection of a vocation and
preparation for the same. It will help to acquire
information about carrer opportunities , career growth
and kaining facilities.

3. Personal Guidance
Personal guidance refors to the guidance offered to
students enabling them to adjust themselves to thir
environment , so that they become effient citizens.
4. Social Guidance
 Social guidance enables the student to make substantioal
condributions to the socity, assume leadership conform to
the social norms, work as themmembers develop healthy
and positive attitude , perseverance and friendship.

5. Avocational Guidance

It is the assistance to be produced to students to spend

their available ieisure time protitably

6. Health Guidance

Health guidance implies the assistantance rendered to

students for maintaining sound health . This type of
guidance focuses on enabling students to appreciate
conductions for good health.

7. Finacial Guidance

It is to help the needy students in determining the

financial assistance they need in the light of the expected
expenses and to get it from financial organization after
compleating the formalition.

COUNSELING

Definition :- It is an accepting , trusting and safe relation

ship in which clients learn to discuss openly . what worries
and upsets them , to define precise behaviour goals to
 acquire essential social skills and to develop the courage
and self confidence to implimnent the desired new
behaviours.

( Merle M ohlsen –
1977)

Principles of Counseling

1. Respect : -Counselors ability lies in communicating to the client

the belief that every person possesses an inherent skenghth
and capacity the right to choose his own alteratives and make
his own decisions.
2. Authenticity :- Counselor should have genuineness honestly
and simplicity and avoid superiorly feeling.
3. Non – possessive warmith :- Demonstration of concern interest
and value for other and a deep concern for the well being of
the ather person.
4. Non Judjmental attitude :- Avoid bian making assumption or
judjment about the client.
5. Accurable understatnding of the client :- It include precise
evaluation of the perceptual and cognitive behaviour of the
individual.
6. Recognizing the client’s potential :- Recognizing the strength
and abilities of the cliens.
 7. Confidentiality :- Maintain confidentially anol develop trust.
Avoid revealing client’s indentity, personal details and other
information with out consent.

Type of Conseling :-

1. Individual Counseling :- It is one helping relation ship between

the counsellor and the counselled. It is focused upon the
individual need for the growth and adjustment, problem
solving and decision making.
2. Group Conselling :- It is the form of counselling is sometimes
successful with clients who have not responded well to
individual counselling.

PHASES OF CONSELLING

During the process of counselling in Accordance with the

nature of the person being helped gives us defferent approaches to
counselling the main phases are.

1. Phase I- Establishing relationship :- Is the core phase in the

process of counselling it affects the progress of the process and
acts as a curative agent in itself. It should be recognized that
each counsellee- counsellor relation ship is unique and hence it
is not possible to have ageneralized relation ship . The relation
ship is not established in just a single session but mag require
 several sessions before he / she becomes comfortable with you
and accept you in to her inner world
2. Phase II – Assessment :- Assessment phase is concerned with
data collection analyzing the data and clarification of
expectations, The counselle is encorraged to talks about his
problems and ventricle his feelings . Whre as the counsellor
asks question, collects information , observes and possibly
helps the counselee to clearly state his problem.
3. Phase III – Setting Goals :- In seting goals phase the counsellor
explains to the individual what is possible. Goals may be two
types immediate and long term goals . short term goals
ultimately lead to the attainment of long term goals.
4. Phase IV- Intervention : - In this phase counsillor explains to
the individual how the goals can be achieved. The interventions
employed will depend upon the technique used by the
counsellor. The main aspect in this phase includes developing
insight and putting it to work
5. Phase V – Termination and Follow – up :- It must be done
without destroying the accomplishment gained and should be
done in a phased manner covering few sessions. planning for
the next sessions if needed should also be carried out. The
relationship should be planned and the client should be well
prepared for termination.
 Skills required for a counsellor
- Pretrainning attributes
- Good psychological health
- Sensitivity
- Open mindedness
- Objectivity
- Trust worthiness
- Approachability

Techniques / Approaches to Counselling

Based on the nature of the counselling process and the role of

the counsellor there are three approaches they are

1. Directive or counselor centered counselling :- The counsellor is

active and direct the individual is making decisions and fincling
solutions to problem . The counsellor does not force the
individual but directs the process of thinking of counselee by
informing , explaining , intereprting and advising
2. Non Directive or Client – centered counselling : - In non
directive counselling , counselee is guided to use his own inner
resourses to solve the problem
3. Electric counselling :- In electric counselings the stsategy
anises out of the appropriate knowledge of individual
behaviour and a combination of directive and other approaches
ROLE OF A NURSE :-

1. Recognize the need for guidance and counselling and give

their support.
2. Educate the board of directiors to the value of guidance.
3. Be responsible for the appointment of the guidance
committee.
4. Select the best qualified person
5. Developing a positive attitude towaech pupils.
6. Understanding the pupils observations.
7. Providing information and assistance and counselling.
8. Proper recording and reporting
9. Nurse should help to take a decision.

stories are likely to involve conflict, affection, fear,

PERSONALITY

1. Introduction :- The word personality has been derived from

the hatin word “persona” . at first this word used for most
worm by the actors in ancient times to indicate to the
audinence whether they played the villain’s or the hero’s role
in a drama.
Personality is the total quality of an individual behaviour as it is
shown in the habits, thinking, attitudes, interests, the manner
of acting and the personal philosophy of life.
2. Definitions of personality
 Personality consists of the distinctive patterns of
behaviour including thought and emotions that characterize
each individual’s adaption to the situationa of his or her life.
(waller Mishel- 1976)
 Personality is the sum of activities that can be discovered
by actual observations over along enough period of time to give
reliable information.

3. Topography of personality.
 One of the most important characteristics of personality is
that it is a product of heredity and environment. The social and
cultural factors as well as the various experience influence the
development of personality.
 Personality includes the cognitiue , affective and
psychomotor behaviours and couers all the conscious ,
subconscious, and un conscious also.
 It is specific and unique for each and every individual
 It is not Static, but dynamic in nature . Personality of an
individual keeps adjusting itself to the environment on a
continous basis.
TYPE OF PERSONALITY

A type of personality is a class of individual who shre a common

collection of traits together in an individual .

The main types are :-

1. Hippocrates Classification
2. Kretschmer’s classification
3. Sheldon’s classification
4. Jung’s classification
5. Allport classification

Hippocrates Classification :-

Hippocrats traid to classify all human beings in to four

characteristic groups according to their temperament as follows-

a. Sanguaine
b. Phlegmatic
c. Melancholic
d. Chleric

Type of
Personality
Fluid in Temperamental Characteristics
Type
the Body
 Blood Sanguine Optimistic, happy, hopeful
accommodating and light indifferent
Phlegm Phlegmatic Cold, Calm, Slow and indifferent
Sad, Depressed, Pessimistic, dejected
Black Bila Melancholic
depolarable, and self – inrolved
Irritable, Passionate, Strong, Active,
Yellow Bile Choleric
Imaginative

Kretschmer’s classification

Kretschmer’s classified all human beings in to certain biological

types according to their physical structure.

Personality Type Personality Characteristics

Phyknic (having fat Sociable, jolly, easy going and good
bodies) nature
Athletic ( Balanced body) Energetic , optimistic and adjustable.
Heptosomatic ( Lean and Unsociable, reserved, shy, sensitive, and
thin) pessimistic.

Sheldon’s Classification

Sheldon’s classified human beings into certain types according

to their physical structure and attached certain temperamental
characteristic to them as given below

Name Description Characteristics

Endomorphic Person having highly Easy going, sociable,
developed viscera, affectionate and
 weak somatic
fond of eating
structure
Balanced
Craving for muscular
development of
Mesomorphi activity , self assertive loves
viscera and strong
c risk and adventure, energetic
somatic structure-
assertive and bold tempered
muscular
Weak somatic
Pessimistic, unsociable,
structure as wellan
Ectomorphic reserved, brainly, artistic and
undeveloped viscera
introvert
thin , long, fragile

4. Jung’s classification

Dr Kart. G. Jung proposes to classify all individual in to two man

groups. They are;

Exkoverts Inkoverts
 The Exkoverts are  Interested themselves,
interested in the world their own feelings,
around them emotions and are unable to
 They are sociable, friendly, adjust easily to social
not easily upset by situation
difficulties  Socially they are aloof and
 They are men of action withdrawn
rather than reflection  They are shy and reserved.
 They are successful in  They prefer to work alone
adjusting to the realities of and avoid social contacts,
their evnt are socially active they are inclined to worry
and more interested in and get easily embarrassed.
leaving a good impression  Inkoverts are persons who
on others. seek manifestation of their
 Their behavior is influenced life through inner.
 more by physical  Philosophers, scientists,
stimulation than by their writers etc fall in this
inner thought and ideas. category.
 Political, social workers
lawyers insurance agents,
salesman etc fall in this
category.

5. All port Classification

According to him all individuals in to two types they are

ascendants and descendents.

Ascendant Descendant
 The ascendant type tends  The Descendant person is
to dominate a situation. inclined
 He is outgoing and is  He is day dreaming and
interested in the world withdraws from social or
around him. competitive situation.

v. Theories of Personality Development

Developmental theories identify behaviors associated with

various stages through which individuals pass, thereby specifying
what is appropriate or in appropriate of each developmental level.
The main theories of personality are,

1. Psycho analytic theory

2. Psycho social theory
 Roger’s person centered
 Maslow’s Hierarchy of needs
3. Humanistic Approach
4. Trait and type theory of personality
  Gordon All ports theory (1937)
 Raymond Chattel’s theory (1965)
 Hans Eysenck’s theory
1) PHYCHO ANALYTIC THEORY (Sigmund Freud 1856-1939)
Introduction
Sigmund Freud is a Austrian neurologist is considered as
the father of psycho analytic theory. He emphasized the
unconscious processed or psycho dynamic factors as the basis
for motivation and behavior.
Freud categorized his personality theory according to
structure, dynamic and development. He mainly organized the
structure of personality in to three major components. They
are,
 Id – store house biologically based urges
 Ego – generally adjusting etc reality of life
 Super ego – Wright+ wrong

The id contains all our biologically based drives, it operates

according to the` pleasure principle ‘. Id driven behaviors are
impulsive and may be irrational

The ego functions on the basis of” reality principle”. It

maintains harmony between the external worlds, the id and
the superego.

The superego is as the “perfection principle”. The

superego is referred to as the “perfection principle”. The
superego is important in the socialization of the individual as it
assists the ego in the control of id impulses.

A person who is well adjusted or mentally healthy, has all

three components of personality. Any of the components is
absent or out of balance to display maladaptive behaviors.
Defense mechanism has been associated strongly with Freud’s
theories.

He believes that all behavior resulting from in effective

personality development is unconscious. These in effective
personality development was in some way related to the
relationship of the child with the parent and that it was related
to what be called psychosexual development.

Dynamics of personality

1. Freud believed that `psychic energy’ is the force or impetus

required for mental functioning. Originating in the id, it
fulfills basic physiological needs. As the child matures, is
diverted from the ego and then from the ego to form the
superego.
2. The largest share is to maintain a balance with id the
impulsive behavior and the idealistic behavior of the
superego. If an excessive amount of psychic energy is stored
in one of these personality components, behavior will reflect
that part of the personality.
3. Over investment in the ego will reflect self absorbed or
narcissistic behaviors and an excess within the superego will
result in rigid, self depreciating bhr.
4. The human personality functions on three levels of
awareness, conscious, precocious and unconscious.
5. Consciousness refers to the perception, thoughts and
feelings existing in person’s immediate awareness.
6. Preconscious content on the other hand, is not immediately
accessible to awareness. Unlike conscious and preconscious
content in the unconscious remain inaccessible for the most
part.
 7. The unconscious affects all the three personality structure.
Id, ego and superego.
8. Some ideas, memories, feeling or motives which are
disturbing, Forbidden and unacceptable and anxiety
producing are repressed from consciousness.

Freud’s stages of personality development

Stages of Main Successful task Examples of

Development characteristics completion Unsuccessful
task completion
1. Oral Use month and Oral Smoking,
Birth-2 years tongue to deal gratification alcoholism,
with anxiety. obesity, nail
E.g. Sucking, biting, drug
feeding Addiction
difficulty in
hasting others
2.Anal Muscle control Bowel and Constipation,
2- 3 years in bladder bladder control Perfectionism,
rectum, Anus obsessive
provides compulsive
sensual disorder.
pleasure. Toilet
training can be
a crisis.
3.Phallic Learn sexual Becomes away Homosexuality
3- 7 years identity and of sexuality. transsexuality
awareness of Sexual identity
genital areas as Problems in
a source of general
pleasure. The Difficulties in
development of accepting
Electra complex authority
 and Oedipus
complex occurs
during this stay.
4. Latency Quite stage in Learns to Inability to
7- 11 yrs sexual socialize conceptualize
development. lack of
Motivation in
schools and
jobs.
5.General Sexual maturity Sexual maturity Firelights,
11years- Adult and satisfactory importance
hood relationship premature
with the ejaculate
opposite sex. unsatisfactory
relationship.

2) THEORY OFPSYCHOSOCIAL DEVELOPMENT (Erik Erikson)

Erik Erikson (1902-1994) was a German Psychologist
who extended Freud’s work

On personality development across the lifespan while focusing in

social and psychological development in the life stage.

Psychosocial growth occurs in sequential phases and each

stages is dependents on completion of previous stages and life task.

For Eg: In the infant stages, the infant must learns to develop basis
must such an that here she will be fed and taken care of. The
formation of trust is essential mistrust, the negative outcome of this
stages.

3) HUMANISTIC APPROACH

When personality development focuses up on the

development of self, it is called
Humanism. Humanists like Carl Rogers and Abraham Maslow reject
the internal conflicts of Freud’s view and the mechanistic nature of
behaviorism. They believe that each person is creative and
responsible free to choose and each strives for fulfillment or self
actualization.

This tells the importance of people’s subjective attitudes,

feelings and beliefs especially with regard to the self. Cat Rogers
theory focuses on the impact of disparity between a person’s ideals,
self and perceived real self Maslow focuses on the significance of self
actualization.

i) Roger’s person centered Approach

Roger’s emphasized that each of us interprets the same

set of stimuli differently, so there are as many different` real worlds’
as there are people on this planet.

 Self Actualization

He used the term self actualization to capture the

nature underlying the

Tendency of humans to move forward and fulfill their due potential.

He argued that people strive towards growth even in less favorable
surroundings.

 Personality Development
Carl Rogers proposed that even young children need
to be highly regarded by

Other people. Children also need positive self regards to be

esteemed by self as well as others . He believed that everyone
should be given unconditional positive regard, which is a non
judgmental and genuine love without any strings attached.
 ii) Maslow’s Hierarchy of Needs

 The basis themes underlying Maslow’s theory is that

motivation affects the person an a

Whole, rather than just in part. Motivation makes their

lives regarding and meaningful.

 Abraham Maslow suggested that five basic classes of

needs or motives influence human behavior. According to
him needs at the lowest level of the hierarchy must be
satisfied before people can be motivated by higher level
goals.
 Psychological needs
 Safety and Security
 Need for love
 Self esteem needs
 Self actualization

4)TRAIT AND TYPE THEORIES OF PERSONALITY

Personality is a dynamic organization with in the

individual of those psychophysical systems that determine
his/her unique adjustments to his environment.

Two major themes underlie trait and type theories of

personality

 No two individuals are elite

 People posses broad predispositions or traits
to respond in certain ways in diverse situation:
It means that people display consistency in
 their actions, thoughts and emotions across
time events and experiences.
 Gordon All port’s Theory (1937)
 He says that no two individuals are alike. All port
regarded traits an being responsible for these
individual differences. Traits is a predisposition to
act in the same way in a wide range of situation
 He distinguished between common traits and
individual traits. Common traits are shared by
several people within a given culture. Individual
traits are peculiar to the person and do not permit
comparisons among people.
 All ports call the individual traits as `personal’
dispositions and proposed that there are three types
of personal dispositions.

a) Cardinal disposition

A cardinal disposition is dominant that all

actions of the person are

Guided by it. Very few people posses’ cordial dispositions. E.g.:

Nightingale

b) Central disposition
There are not an dominant as coordinal but it
influence the person’s

Behavior in a very prominent way. So it is called the building blocks

of personality. (Functionality, responsibility, attentiveness, honesty,
loyalty)

c) Secondary disposition
 There are not very consistent and are thus less
relevant in reflecting the

Personality of the individual. E.g.: clothing preference specific

attitudes. Etc

 Raymond chattel’s Theory (1965)

Chattel’s spoke of the multiple traits that comprise the
personality, the extent to which
These traits are genetically and environmentally determined and the
ways in which genetic and environmental factors interact to
influence behavior.

Personality is that which permits us to predict what a person will do

in a given situation. And redeveloped a specific equation.

R = f (s, p)

R = response of the person is the

F = function of the

S = stimulus at a sawn movement of time and of the

P = existing personality structure

- Traits is defined as the individuals stable and predictable

characteristics.
- Catelli divided trails in to surface traits and source traits.
Surface traits do not have much value in according for
individual’s personality. Source traits are the basic building
blocks of each personality which determine the consistencies of
each person’s behaviour outer an extended period of time.
- Catelli identified sixteen source traits that constitute the
underlying structure of personality.( outgoing- reserved, stable,
emotional, self sufficient, dependent. He constituted a scale to
measure these source traits. When came to be known as
sixteen personalise factor questionnaire

LEARNING THEORY OF PERSONALITY

It is concentrating towards the learning and objectivity.

2 theories

1. Dollard And Miller’s Learning Theory

 The development of personality is on the basis of the
responses and bhr learnt thr the process of motivation T
reward
 This theory Stressed abt habit formation is through the
process of learning
 Learning grows on the basis of experiences and
interactions with one’s envt,
 Then one’s habits are reorganized, new habits are learned
 Personality is modified.
 2. Bandura and Walter’s Social Leaning the
 Came the innovative approach to personally in the form
of their social learning they
 Personality is structuring, restructuring of social learning
 Imitated in situation

VI

Assessing means to measure or evaluate. The person ablity

assessment is very important because

- They provide a means for studying personality

- Help for employment selection
- Personality is that which permits us to predict what a person
will do in a given situation. And he developed a specific
equation.

R = f (s, p)

R = response of the person is the

F = function of the

S = stimulus at a sawn movement of time and of the

P = existing personality structure

- Traits is defined as the individuals stable and predictable
characteristics.
- Catelli divided trails in to surface traits and source traits.
Surface traits do not have much value in according for
individual’s personality. Source traits are the basic building
blocks of each personality which determine the consistencies of
each person’s behaviour outer an extended period of time.
- Catelli identified sixteen source traits that constitute the
underlying structure of personality.( outgoing- reserved, stable,
emotional, self sufficient, dependent. He constituted a scale to
measure these source traits. When came to be known as
sixteen personalise factor questionnaire
 Han’s Eysenck’s Theory ( Traffic – type)

Personality is more or less stable and during organization

of a person’s character, natural emotional temperament
and physique, which determine the unique adjustment to
the environment.

Says about the

- Elements of personality can be arranged personally

- Focus has been on a small number of personality types, defined
by two major dimensions, version, extra version, stability-
instability.
- 3 rd type of dimension to personality called ara iotacism super
ego strength. People belonging to this energy are selfish
impulsive and opposed to social terms.
- Constructed Eisenach personality questionnaire
 - Explained Eisenach personality questionnaire
- Explained in details about the role of the confer, autonomous
nervous system, lumbarisation reticular activating system in
explaining

VI PSYCHOMETRIC ASSESSMENTS OF PERSONALITY

Assessing means to measure or evaluate the personality

assessment is very important because-

- They provide a means for studying personality

- Help for employment selection
- Helpful for an individual to assess his/her own personality so
that he/she can better understand himself/herself and others

There are number of procedures and techniques that are being used
for proper evaluation they are

- Interview method
- Observation method
- Personality inventories (rating scale and questionnaires)

- Projective techniques
- Situational tests

1. Interview method

It is defined as a face to face conversation carried an with

some basic goals. Two broad types of interview are
structured and unstructured interview.
 a) Structured interview

Predetermined questions are asked for which answers are

also highly specific.

b) Unstructured interview

It is an open interrogation, here the interviewer questions or

lets the individual speak freely so as to get a clear picture of the
individual.

- Interview is a highly flexible tool

- Person can be observed for body language in addition to what
is said
- It is highly subjective
- It is time consuming and at times costly
- It requires a well trained and competent person
- It must be long and comprehensive to give a true picture of the
individuals personality

Eg : The seven point plan (Royer-1974) – job interviewing

Areas:-

1. Physical characteristics or ability which are important to the

job, for example good health, vision, hearing and speech.
2. Attainments which include education, personal and
professional back ground and an assessment of how well the
candidate has done in these areas.
3. Over all general ability especially general intelligence and
cognitive skills.
 4. Special aptitudes through desirable at an interview for selection
of nursing to social skills are important
5. Interests and how they are pursed with are occupationally
significant
6. Personality attributes such as self perception reliability
sociability

 Observation method :-

In this method the individual is observed in various

situations for several days and some conclusions are
formulated.

Types

There are mainly 2 types

 Direct
 Indirect

One of the disadvantages of observation in the possibility of

prejudice in the observer.

 Personality inventories

A personality inventory is a printed form containing

statement, questions or adjectives which apply to human
behaviour. One of the most commonly used personality
test is the ‘ Minnesota multiphase personality inventory ‘
also called the MMPI . personality questiooaires are used
in psychology for counselling and for research purpose.
 They are also used in selection process for employment or
promotion.

2. Projective

There are based on the principle that responses the

response to unstructured stimuli a subjects underlying
motives, attitudes, fear and inspiration.

In projective tests on individual is presented with a

relatively unstructured or ambiguous task like a picture,
ink blot or incomplete sentence, which permits a wide
variety of interpretations by the subject.

The most commonly used projective techniques are

1. Rorschach inkblot test

2. Thematic apperception test
3. Word association or free association test
4. Sentence completion test, situational

1. Rorschach inkblot test

It was developed by Herman Rorschach in 1921 . This test

involces test cards containing inkblots shown to the
subject one at a time is a prescribed order. The subject is
instructed to state whatever he/she sees in them or
whatever they bring to mind. Based on subject’s
statement, assumptions are made on the nature of the
personality.

2. Thematic apperception test

 This test was developed by CD Morgan and Henry A
Murray in 1935. The assumption is that the meaning
which we see in a picture reveals something of our past
experience, feelings, attitudes and motives.

In this test, subject is shown ambiguous double

pictures and asked to make up a story for each one. These
contentment or achievement assumed to be determined
partly by the subjects underlying concerns.

 Word association test

Here the subjects is informed that the examiner would

alter a series of words, one word at a time and subject
should immediately alter the first word which comes to
his mind and that there are no right or wrong answer. The
examiner then records the reply to each word spoken by
him/her the reaction time and any unusual speech or
behaviour manifestations which might accompany a given

Response the examiner evaluates the individual’s

personality. In this test people were read a standard array
of 100 terms for example, head to sin, to pray, bride, to
abuse and insulted to respond to each term an quickly as
possible with the first word that occurs to subject’s mind.

 Sentence Completion Test

In this, a number of incomplete sentences are given and

the subject is required to complete the sentence as he or
 she feels and the responses are analysed for indications of
one’s personality. A basic problem with these tests is that
the interpretation of response is very subjective and
based on the experience of the examiner.

 Situational tests

Situational tests consist of certain real life situation.

Where the subjects have to perform certain given
activities. Subject’s performance and behaviour with
respect to such situations helps us to understand his/her
personality. Here the subjects are evaluated by some
trained judges.

ALTERATION IN PERSONALITY DUE TO ILINESS

Illness is highly personal state in which the persons

physical, emotional, intellectual, social developmental or spiritual
functioning is thought to be diminished or impaired compared with
previous experience.

Common Behavioural Changes due to illness

- Withdrawn behaviour
- Changes in self concept, body image and lifestyle
- Self centeredness
- Demanding and dependent behaviour
- Unco – operations
- History
- Shame and guilt feeling

Nursing Interventions
1. Nurse need to help patients express their thoughts and feelings
and to provide care that helps the patient effectively cope with
change.
2. Feelings of in securing can be lesser by straight forward
explanation of hospital conditions and procedures including
details of routine by being warm and reassuring in her manner
and through sincerity of personal interest in the patient
3. Provide gentle encouragement to talk , to express feelings and
relate to the nurse
4. Nurse should spend time with the patient
5. Explore the reasons for anxirty and communicate clearly
6. Connery enthusiastic readiness to care for the patient
7. Negative feelings must be replaced by positive
8. Build a healthy personal relationship
9. Patient should not be allowed to regress but should be
encouraged to participate in recreational activities individually
and in groups

10. Nurses should find out the reasons for anger

11. Help to verbalize his feelings

ALTERATIONS IN PERSONALITY DUE TO PERSONALITY

DISORDERS

An abnormal personality is one in which there are deeply

ingrained maladaptive patterns of behaviours recognizable lye the
time of adolescence or earlier and convincing through most of
 adult life. Because of this the patient suffers have to suffer and
there is an adverse effect on the individual or on society.

Classification of personality disorders

1. Paranoid personality disorder( suspicious)

2. Echinoids personality disorder (social withdrawal )
3. Dissocial (antisocial) personality disorder (violating)
4. Histrionic personality disorder (persuade pattern of
excessive emotion seeking)
5. Narcissistic personality disorder
6. Borderline personality disorder
7. Anteon personality disorder
8. Dependent personality disorder
9. Obsessive compulsive personality disorders

APPLICATIONS

- A good understanding will help the nurse to predict her

behaviour as well as she behaviour of other
- Major decisions in life depend up on this knowledge

For e.g. : selection of a career, spouse etc.

- The nurse should not only acquire stills and knowledge, but
also develop a pleasing and strong personality if she should be
successful
- Patients appreciate a nurse who brings physical comfort to
them with her skills and who is prepared to understand their
emotional reactions and difficulties which have been caused by
illness
- Helps to improve the personal qualities
- The nurse deals with different age groups, a good sensitive
should be aware of their personality.

COPING WITH STRESS

Copying refers to the thoughts and behaviours we use to

handle stress or anticipated stress. It includes efforts to control,
reduce or learn to tolerate the threats that occur due to stress.
The coping strategies fall in to 3 categories

1. Emotion – focused coping

2. Problem - focused coping
3. Avoidance coping

1. Emotion- focused coping

In this coping people try to manage their emotions in the

face of stress, seeking to change the way feel about or perceive a
problem.

2 Problem - focused coping

It includes taking direct action to solve problems as well
as changing or modifying the stressful problem or the
source of stress. Problem – focused strategy lead to
 change in behaviour or to the development of a plan of
action to deal with stress.
3 Avoidance coping

To this coping style people try to minimize or avoid

threatening event. People who cope using avoidance may
not make enough cognitive and emotional efforts to
anticipate and manage long- term problems.

VII ATTITUDE

(a) Meaning :- (attitude is a specific mental state of an

individual towards something) according to which his
behaviour towards it is moulded, attitude is way we
perceive, think, feel and react more or less permanently in
relation to something

Definition:-

It is defined on an enduring organization of motivational,

emotional, perceptual and cognitive processes with respect some
aspect of the individual’s world

( trench and crutch field-1948)

(b) Characteristics/ nature of attitude

1. Attitudes are not innate – attitudes are formed or
learnt by the individual
2. Attitudes are more or less lasting- attitudes are
long-lasting inuring
3. Attitudes imply a subject- object relationship:- it
is always formed in relation to certain persons,
groups or institutions so attitudes are not just
 internal factors without any relationship to the
environment.
4. Attitudes are related to image, thoughts and
external objects
5. Attitudes guide the behaviour of the individual in
an particular direction
6. Various kinds of affective experiences are also
attached to attitudes
7. The unconscious motive is an important factor in
the creation of attitudes.
8. Attitudes are related to the person’s needs and
problems
9. Through a simple traumatic experience , we may
also develop attitudes
10. attitude may formed through imitation
Behaviour and attitudes:-
1. attitudes are the motivating forces behind man’s social
behaviour) . it is because of attitude that the individual
behaviour exhibits consistency
2. attitudes also influence the individuals abnormal
behaviours.

3. An individual not only formulation attitudes towards

external object, but possessors attitudes even about
him.
4. Attitudes are our expressions of the likes and dislikes
towards the people and the objects
 5. An individual’s entire personality structure and
behaviour may be through of as organized around a
control value system compressed of many related
attitudes

ATTITUDINAL CHANGE

Once the attitudes have been formed they have a tendency to

persist or continue. In order to change attitude are should

1. Change perceptions by new experience and factual

knowledge.
2. Provide information to the persons concerned who has a
negative attitude to consider person
3. Group support
4. Provide an opportunity for much contact with the
object/person concerned.

HEALTH EDUCATION CONCERNED

Teaching helps the patient to cope up with the disease very

often attitudes interfere with health and well being of the patient.
The initial step of the health educator is to eradicate negative
attitudes that the person may hold towards himself, this illness and
his further life. Through health education cognitive component of an

a attitude leading to emotional component being altered partially

FACTORS AFFECTING ATTITUDINAL CHANGE

1. Cognitive distance :-
 It is the safe of un pleasant psychological tension that
motivates us to reduce our cognitive inconsideration

By making our belies more consistent with each other

2. Counter attitudinal advocacy:-

It is the proven by which individual are induced to state

publicity an opinion or attitude that runs counter to their
own private attitudes.

3. Self perception :-

First are observe and perceive our own behaviour and

them changes our attitudes.

PSYCHOMETRIC ASSESSMENT OF MOTIVATION

,EMOTION,ATTITUDE

 For motivation
1. Projective techniques
a) TAT
2. Personality inventories
a) Pencil paper questionnaires
b) True – false
c) Multiple choice

3. Situational tests
 For emotion
1. Galvanic skin response
2. ECG
 3. EEG
 For attitudes
1. Measurement of attitudes
a) Likest scale
b) Semantic differential /socimetry
2. Opinion surveys and self report methods
3. Attitudes scales
4. Voluntary behavioural methods

ALTERATION IN EMOTION DURING ILLNESS

Individuals emotional reactions depend on the nature of the

illness, attitude and reaction of others to its patient perception of
illness, visibility of symptoms, availability of support system,
economic variables and patient’s coping skills . secure illness
particularly one that is life threatening can bud to more extensive
emotional reaction such as anxiety , shock, feal, anger, deniol and
depression.

NURSSING IMPLICATION

MOTIVES:-

 The nurse should know how behaviours is motivated by

different needs

 The nurse should know the role of motives in human

behaviour
 The nurse should understand her own motives, then only she
can able to understand others motives.
 It helps to recognize patients needs and desires
 Satisfy patient’s needs
 To promote healing and health in the patient.

EMOTION:-

 The nurse has to substitute patient’s negative emotion by

positive emotions
 The nurse should avoid tensions at all costs, she should
develop a sound philosophy of life and learn self- control

ATTITUDE:-

 The nurse should recognize her attitudes and present them

from interfering with nursing care
 The nurse should try to understand patient’s attitudes
 The nurse should try to bind out the cause of unfavourable
attitudes, and change them to favourable.
 The nurse needs to develop and cultivate professional
attitudes.

QUESTIONS:-

 Explain theories of emotion( mar12)

 Explain theorioes and concepts of motivation (sep 11)
 Define motivation, explain the social motives (mar 11)
 Explain Marlow’s theory of motivation ( aug 10)