1. Discuss the theoretical assumptions underlying the Stuart Stress Adaptation Model of psychiatric nursing care. 2. Describe dimensions of mental health and mental illness in the United States. 3. Analyze the biopsychosocial components of the Stuart Stress Adaptation Model of psychiatric nursing care. 4. Compare coping responses, nursing diagnoses, health problems, and medical diagnoses. 5. Evaluate nursing activities appropriate to the various stages of psychiatric treatment. The second assumption of the model is that nursing care is provided within a biological, psychological, sociocultural, legal, ethical, policy and advocacy context. Each of these aspects of care is described in detail in Chapters 5 through 9. The nurse must understand each of them in order to provide competent, holistic psychiatric nursing care. The theoretical basis for psychiatric nursing practice is derived from nursing science as well as from the behavioral, social, and biological sciences. The range of theories used by psychiatric nurses includes nursing, developmental psychology, neurobiology, pharmacology, psychopathology, learning, sociocultural, cognitive, behavioral, economic, organizational, political, legal, ethical, interpersonal, group, family, and milieu. • The health/illness continuum comes from a medical world view. • The adaptation/maladaptation continuum comes from a nursing world view. This means that a person with a medically diagnosed illness may be adapting well to it. An example is the adaptive coping responses used by some people who have chronic physical or psychiatric illnesses. In contrast, a person without a medically diagnosed illness may have many maladaptive coping responses. This can be seen in the adolescent whose problematic behaviors reflect poor coping responses to the many issues that must be resolved during adolescence. These two continuums thus reflect the complementary nature of the nursing and medical models of practice. The assumptions of the Stuart Stress Adaptation Model are summarized in Box 3-1. The following six criteria are indicators of mental health: Growth, self-actualization and resilience mean that the individual seeks new experiences to more fully explore aspects of oneself. Maslow (1958) and Rogers (1961) developed theories on the realization of the human potential. Maslow describes the concept of self-actualization, and Rogers emphasizes the fully functioning person. Both theories focus on the entire range of human adjustment. They describe a self as always seeking new growth, development, and challenges. These theories focus on the total person and whether the person has the following characteristics: • Is in touch with one’s self and able to use the available resources • Has access to personal feelings and can integrate them with thoughts and behaviors • Can interact freely and openly with the environment • Can share with other people and grow from such experiences This criterion includes the concept of resilience, which is the ability to achieve, retain, or regain a level of physical or emotional health after a tragedy, trauma, adversity or significant stressor. It is the idea that some people “bounce back” after a problem, and proposes that humans must weather periods of stress and change throughout life. Successfully weathering each period of disruption and reintegration leaves the person better able to deal with the next life change (Wagnild and Collins, 2009; Resnick and Inguito, 2011). Mental disorders are a major contributor to the burden of illness in the United States (Kessler et al, 2005a,b). • Nearly 50% of all people ages 18 years and older have had a psychiatric or substance abuse disorder in their lifetimes. • Half of all these lifetime cases start by age 14 and three-fourths start by age 24. • Behavioral health is an essential part of all health. • People recover from mental health and substance use disorders. Box 3-2 presents other key facts about mental illness (SAMHSA, 2011). • Biological predisposing risk factors include genetic background, nutritional status, biological sensitivities, general health, and exposure to toxins. • Psychological predisposing risk factors include intelligence, verbal skills, morale, personality, past experiences, self-concept and motivation, psychological defenses, and locus of control, or a sense of control over one’s own fate. • Sociocultural predisposing risk factors include age, gender, education, income, occupation, social position, cultural background, religious upbringing and beliefs, political affiliation, socialization experiences, and level of social integration or relatedness.
The Stuart Stress Adaptation Model of Psychiatric Nursing Care
Theoretical Assumptions
Describing Mental Health and Illness
Defining Mental Health
Criteria of Mental Health.
Defining Mental Illness
Biopsychosocial Components
Predisposing Factors
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The Stuart Stress Adaptation Model of Psychiatric Nursing Care
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