Essentials of Psychology for Nurses AN Venkatesh Reddy
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IntroductionCHAPTER 1

 
INTRODUCTION
According to the history of psychology human beings have always shown utmost interest in understanding the behaviour of themselves and others who are around them. It is being continued even today. The edifice of scientific psychology was raised over the centuries by the efforts of many philosophers, thinkers, doctors and teachers who created the precondition to study the behaviour. It was not as easy as it is today, where psychology is a very wide field of inquiry. Nowadays, psychologists are using the techniques of electronics, biochemistry and cybernetics and also applying mathematical techniques for the employment of various kinds of scientific equipments including computers. But one should not forget that psychological knowledge has travelled a long period and complicated road as it developed. As Ebbinghaus, a German psychologist has rightly stated that “psychology has long past, but a short history”.
 
HISTORY AND ORIGIN OF SCIENCE OF PSYCHOLOGY
Psychology did not emerge directly as a science. It started as a branch of philosophy and continued for about 2000 years before emerging as a science. Psychology began as a result of curiosity of cosmologists to understand about the mystic experiences and activities of people and events. These include their experiences in life, dreams, materialistic life, the urges they have and peculiarities in behaviours of people in different situations.2
The term psychology was first encountered in philosophical books of the 16th century. It was formed from two Greek words ‘Psyche’ (soul) and ‘logos’ (doctrine). By soul, was meant the principle underlying all the phenomena of mental and spiritual life.
The modern ideas about mind and its functioning were derived from Greek philosophy. One of the first stones in the foundation of psychology as a science was laid by the ancient Greek physician Alcmaeon in 6th century BC, who proposed that, ‘mental life is a function of the brain’. This idea provides a basis to understand human psyche even today. The other notable Greek philosophers are Hippocrates (460-370 BC), Socrates (469-399 BC), Plato (428/7-348 BC) and Aristotle (384-322 BC).
Hippocrates known as the father of medicine classifies people, into 4 types on the basis of body humours, viz., Sanguine (blood), Melancholic (black bile), Choleric (yellow bile) and Phlegmatic (phlegm). Socrates recognised mind also in addition to soul. He had analysed the activities of mind in the form of thinking, imagination, memory and dreams. Further, his pupils Plato and Aristotle strengthened and continued the idea of Socrates. However, they did not have much belief in the existence of soul. So they stressed reasoning ability of man and called human being as a rational animal.
Plato was more interested to know the role of mind in controlling human behaviour. He was the progenitor of dualism in psychology. He regarded material and spiritual substances, the body and mind as two independent and antagonistic principles, but he could not clarify his doubt satisfactorily. Plato's dualism was largely overcome by his pupil Aristotle who reunited psychological thought with natural studies and restored its close links with biology and medicine. He forwarded the idea of the inseparability of soul and the living body. He hypothesized that mind is the result of psychological activities and said it is necessary to understand psychological processes including the activities of sense organs which help the individual to experience his environment. This assumption was accessible for verification because of its scientific base. It is true that the brain controls our 3conscious experiences and behaviour. Then came a French philosopher Rene Descartes (1596-1650), who postulated the existence of soul as a separate entity which is independent of body. He said our body is like an automobile engine which will carry on its work without the supervision of soul and hence the body and soul are separate. He declared that man has a dual nature viz., mental and physical. By this way clarified the doubt raised by Plato. He asserted that the process of doubting is the proof for existence of soul. (Cogito ergo sum – I think, therefore I am). In other words the soul must exist in me, because I can think, and thinking is the main function of soul.
Gradually as the scientific outlook was developed, philosophy started loosing its prominence, so also soul. Then psychology was defined as the ‘the study of mind’. The word mind was less mysterious and vague than soul and hence this definition was continued for some time.
Psychology came into being as a scientific discipline by the establishment of first Institute of Psychology in 1879 at Leipzig in Germany by Wilhelm Wundt (1832-1920). It is here the first professional psychologists acquired the skills of experimental work to study the mind. Wundt focussed his experiments as conscious experiences and he replaced the concept of mind with consciousness. He adopted the method of ‘Introspection’.
As the time elapsed, the development of Psychology as an independent science got impetus. Psychologists started discarding the different methods and approaches based on speculation and attempted to provide scientific base to the subject. These efforts resulted in the emergence of different schools of thought like Structuralism, Functionalism, Behaviourism, Gestaltism, Psychoanalysis, Humanistic school, etc. The formulation of these schools has led to various approaches to understand behaviour in their own ways.
A brief analysis of these approaches is as follows:
 
Structuralism
This school focused its attention to study the conscious experiences and structure of brain and nervous system which are responsible 4for such experiences. The prominent among the structuralists structuralists was EB Titchener (1867-1927) a British Psychologist who regarded psychology as a science of Consciousness. Structuralism attempted to analyse the three basic elements of consciousness viz., sensations, feelings and images and in this way provided a systematic study of mind by analysing its structure and hence named as structuralism.
 
Functionalism
Functionalism was initiated by William James (1842-1910) the father of American psychology. The other important psychologists belonged to this school were John Dewey, James Angell, etc. Functionalists advocated the functioning of mind as an important aspect. According to them the mind will always help the person to adjust to his environment. They were influenced by Darwin's theory of evolution and biology.
 
Behaviourism
This school of thought was started by JB Watson (1878-1958). The other notable psychologists include Thorndike, Pavlov, Skinner, Tolman, Hull, etc. Watson defined psychology as a science of behaviour of the organism. He focused his attention on the study of observable behaviour and rejected the invisible inner forces of mind. Watson rejected the method of Introspection as unreliable and unscientific and advocated the method of observation and checking. Behaviourism emphasised the conditioned reflexes as elements of behaviour. According to Watson conditioned reflexes are learned responses to stimuli. He emphasised the need for objective observation to study human and animal behaviour. Until the emergence of this school, psychologists concentrated only on study of human behaviour and there was no room for study of animal behaviour. Watson stressed the role of environment and stimuli in shaping behaviour. He made a statement that he can make anything out of an infant—a beggar, lawyer, scientist or criminal.5
 
Gestalt Psychology
This school of thought was established in the year 1912 by three German psychologists Max Wertheimer (1880-1941) and his colleagues Kurt Koffka (1886-1941) and Wolfgang Kohler (1887-1967). The term Gestalt means ‘Form’ or ‘Configuration’. These psychologists opposed the atomistic or molecular approach to study behaviour. They said the mind is not made up of elements and hence it can be understood better only if we study it as a whole. The main principle of Gestalt school is “whole is better than sum total of its parts”. According to it, the individual perceives a thing as a whole and not as a mere collection of elements. In the same way the sensation or perception will be experienced as a whole. For example, when we look at a wooden table, we do not look it as a bundle of different pieces, but as a whole, only then we perceive it as a meaningful object. As a result, human behaviour is characterized as an intelligent behaviour, rather than a simple stimulus-response mechanism. In this way Gestalt psychology strongly opposed the points of view of other schools.
 
Psychoanalysis
Psychology was mainly concentrating on the normal human psyche, until the arrival of Sigmund Freud (1856-1939) who founded the school of Psychoanalysis. This theory emerged from the clinical background of mental patients. Freud developed his theory based on unconscious motivation. It includes different concepts like conscious, sub-conscious, unconscious behaviour, structure of psyche, repression, catharsis, psycho-sexual development of child, libido, dream analysis, etc. which help to analyse the total human behaviour, particularly from the point of view of understanding abnormal behaviour. With the opinion that, Freud has given excessive importance to sex, two of his followers got separated and established their own school of thought. Alfred Adler (1870-1937) started ‘Individual psychology’ in which he placed power motive in place of Freud's sex and, Carl Gustav Jung (1875-1961) started ‘Analytical Psychology’, which emphasises the development of individual personality from the “Collective Unconscious”.6
Some other psychologists influenced by Freud who were known as Neo Freudians, also have contributed a lot to modern psychology. Some of the notable figures are Anna Freud (the daughter of Freud), Karen Horney, Sullivan, Eric Fromm, Erik Erickson, etc.
 
Humanistic Psychology
This school of thought was developed by psychologists like Abraham Maslow, Carl Rogers, Rollo May, Gorden Allport, etc. Humanistic psychology gives more value to the human being. Humanists believed that behaviour is controlled by our own free will and not by the unconscious or by the environment. They were more interested in solving human problem than in laboratory experiments. Humanists expect each person to reach his full potential and attain self-actualisation.
As stated in the beginning, the history of psychology is very short. But within this short duration of about 150 years, many psychologists have contributed their knowledge to make psychology a science. It is very difficult to present all the names and their contributions. However, keeping in mind the need, only some important developments have been presented here in brief. For more details the interested students may refer other books.
 
Meaning, Definition and Scope of Psychology
As already stated, psychology has become a very important and popular subject today. It deals with many problems of everyday life. Psychology helps us to understand the behaviour of people around us, to find out why they behave differently and what forces are responsible to make them so different from others. It tries to explain wide array of factors involved in what we human beings do. The principles explained by psychology give us a rational basis of understanding of what we and others do.
Psychology has been defined in many ways. In ancient days people were analysing the behavioural aspects on the basis of philosophy. They believed that there is a soul in every individual and this is responsible for all our activities. This view led to the 7opinion that the subject matter of psychology must be the study of soul. But this definition could not answer the questions regarding the existence of soul and its accessibility for study. This condition led to a new definition by Greek philosophers who defined psychology as a ‘science of mind’. But this definition was also rejected on the same grounds as soul was rejected. Later, Wilhelm Wundt a psychologist who established the first psychological laboratory at the University of Leipzig in Germany defined psychology as the study of consciousness. EB Titchener the disciple of Wundt, proposed the method of Introspection to study consciousness. But because of its subjectivity and unscientific method of study, this definition was also rejected.
Gradually, as a result of the development of scientific outlook people started thinking on scientific basis and began to define psychology as a science of behaviour. Finally, it is JB Watson (1913) defined psychology as a science of behaviour of human as well as animal beings. Today this is the most accepted definition. In this definition the term behaviour includes the cognitive activities like thinking, reasoning, intelligence, imagining, memory, etc., conative activities like walking, dancing, fighting, attacking and other action tendencies and also the affective activities like feeling, joy, happiness, sympathy, anger, jealousy, etc. in a person. This definition also includes the behaviour not only of human beings and animals, but also all living organisms and their mental processes.
Hence, today the definition given by JB Watson is accepted in its modified form as “Psychology is the study or science of behaviour of the organism and its mental processes”.
 
Nature of Psychology
Psychology has all the qualities of a science. After the establishment of psychological laboratory by Wundt, it has developed itself as a science. Psychologists do experiments and make observations which others can repeat; they obtain data often in the form of quantitative measurements which others can verify. Like any other positive science psychology is also systematic in its approach. Measurement in psychology is often more difficult of course, than 8it is in other sciences. However, psychologists have devised many ingenious tests to assign numbers to data. Psychology is following all the principles of science like principles of behaviour, objective experimentation, analysis of data and behaviour, formulation of hypothesis, verification and generalization, etc. As a result of such a scientific approach many theories have been developed to explain the behaviour. Psychology believes in cause and effect relationship in behaviour. It is considered as a behavioural science as it deals with behaviour of the organism. However, because of its objectivity in analysis of behaviour through experiments, it may be considered as a developing positive science of behaviour.
 
SCOPE OF PSYCHOLOGY
Psychology studies and explains the behaviour of entire living organisms. The term behaviour includes the cognitive, conative and affective, conscious, subconscious or unconscious, implicit or explicit. It also includes the behaviour of people from infancy to old age, the normal as well as abnormal. It is very difficult to understand all these aspects of behaviour in one sphere. Hence, in order to make it convenient to study, understand and access the behaviour at different fields of life, psychology is divided into different branches. These branches are broadly divided into two categories viz., pure and applied.
 
Pure Branches
Pure branches provide the theoretical frame work of the subject. These branches deal with formulation of principles, theories and suggest different methods for the assessment of behaviour. The pure branches also suggest certain techniques for the modification of problematic behaviour.
The important pure branches are:
  1. General psychology: This branch deals with the fundamental rules, principles and theories of psychology in relation to the study of behaviour of normal adult human beings. It explains various psychological processes like sensations, perceptions, emotions, learning, intelligence, personality, etc.
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  2. Physiological psychology: This branch describes the biological basis of behaviour. There is a close relationship between body and mind; the functions of each other are mutually influenced. The functioning of the brain, nervous system, endocrine glands and their relation to cognitive, conative and affective behaviour is explained in this branch of psychology.
  3. Developmental psychology: Human life passes through various stages of development from conception to old age. This branch explains the growth and development of various processes in relation to behaviour.
  4. Child psychology: Childhood extends from 2 to 12 years. This is a crucial period in the life. Future life depends upon development during childhood. Growth and development will be rapid during this stage. Child psychology deals with these aspects.
  5. Animal psychology: This branch deals with behaviour of animals. Many psychological experiments are conducted to know the functioning of mind in animals. Animals like rats, dogs, chimpanzees, pigeons, guinea pigs, cats are some of the animals used for experimentation.
    Findings of these experiments are many times generalized to human behaviour also.
  6. Abnormal psychology: Today the life is complex. The individual is facing a lot of competition and experiencing frustrations and conflicts. Constant pressures in life are leading to psychological abnormalities. Abnormal psychology deals with various kinds of mental disorders, their symptoms and causes.
  7. Social psychology: Human being is a social animal. Naturally the behaviour of an individual is influenced by society and in turn influences the society. Social psychology deals with interrelationships of people among themselves, likes and dislikes of people, attitudes and interests, the prejudices and social distances people have, group behaviour, group cohesiveness, group conflicts, etc.
  8. Parapsychology: Some of the psychological experiences are beyond the reach of 5 sense organs. That is why they are called 10extra sensory perceptions (ESP) or sixth sense. Some of the phenomena studied in ESP are as follows:
    1. Clairvoyance: This is referred to as television, which is seeing the distant things mentally. We perceive at times some situations or things without the help of our eyes. In total – seeing things which happen beyond our visual field through mind is called clairvoyance.
    2. Telepathy: Transformations of emotions from one person to another person who is in a far of place. For example, a person who is in death bed remembering his close relative may be experienced by the concerned person who is far away from him.
    3. Psychokinesis: Moving the objects without direct contact through power of mind is called Psychokinesis. For example, in Mahabharata, Shakuni could move dice with his power of mind.
    4. Precognition: Knowing the future happenings well in advance. At times people will gain the knowledge of future called precognition. For example, some accident or disaster that may take place after sometime will be known before time.
    5. Reincarnation: This is otherwise called rebirth. There are some instances reported where people remember their previous life details.
    6. Contacting souls: There are some reports that the souls of dead people are contacted through people called Mediums. These Mediums use a plate called Planchette or Ouija board and establish contact with souls.
 
Applied Branches
Applied branches deal with the application of psychological principles and techniques for approaching the problems in different fields of life.
  1. Educational psychology: This is the most important field where psychological principles are applied. In the field of education ‘learner’ is the focal point. Other aspects like management, teachers, teaching and learning aids are all meant for learners. Learners differ in their abilities, hence they need different 11approaches of teaching, learning material, etc. This branch addresses to the problems and improvement in teaching and learning processes.
  2. Clinical psychology: This branch deals with the therapeutic aspect of mental disorders. There are many types of mental illness requiring varied types of therapies like chemotherapy, psychotherapy, recreational and occupational therapies, behaviour therapy, etc.
  3. Industrial psychology: Human beings are different from machines. They will have many problems in their work place like adjustment, safety, security, health, financial and such other problems. Both the management and workers need to cooperate in dealing with such problems. Industrial psychology seeks application of psychological principles, theories and techniques for the study of all these problems and the industrial environment.
  4. Counselling psychology: Mental disorders may not be completely and easily cured just by drugs and other physical therapies. In addition to other therapies, these patients need counselling also. Counselling is a process in which an interaction takes place between a trained counsellar and a client. This branch also helps people to overcome adjustment problems.
In addition to the above, there are many other applied branches like military psychology, legal psychology/criminal psychology, political psychology, etc.
In this way, psychology has broadened its scope today and gaining more and more importance. It may be expected that in days to come, there cannot be any field of life without the application of psychological principles. Particularly in the field of medicine, for doctors and nurses the knowledge of psychology is very useful and also essential.
 
RELEVANCE OF PSYCHOLOGY TO NURSING
Florence Nightingale was the first nurse in the history of nursing. She rendered her services to the soldiers in the war field. From then 12onwards nursing is growing very elaborately. The nurses are the professionals meant for care of patients. The patient may be suffering from acute or chronic disease; may be male or female, young or old, will come to the hospital with so many physical and psychological problems. They will have tensions, worries, pains and also many doubts about their illness, the kind of treatment they get, the cure of disease, etc. so also the relatives of patients. The knowledge of psychology will help nurse to understand the problems and needs of patients and attend to them. She can understand the motives, attitudes, perceptions and personality characteristics of patients in a better way. This will help the patients to attain quick relief and cure—which is the basic motto of a nurse.
Psychology is relevant not only in physical health care, but also highly relevant in the field of mental health. Today we see more and more people are suffering from mental illness. Some patients may have minor problems and others may have serious illness. The knowledge of psychology will help nurses to understand such abnormal behaviours and help the patients in the management and cure. Nurses working in mental hospitals definitely need the full knowledge of general, abnormal, clinical and counselling psychology.
The nurses in community health centres may help people by recognising the mental illness in the early stages and convince them to take appropriate treatment. They can also help people to prevent mental illness by appropriate guidance to deal with stress, anxiety and other life problems.
If the nurse is healthy both physically and psychologically, she can work better and do justice to her profession. But, the nurse is also a human being who has her own emotions, feelings, attitudes, personality characteristics, etc. She has her own limitations also. The knowledge of psychology will help her to understand her strengths and weaknesses. By knowing these aspects, she can try to overcome such weaknesses which affect her work, and she may develop the good personality characteristics and abilities to carry on her responsibilities, and do her duties effectively and efficiently.
Good nursing care also depends upon the ability of a nurse to understand the situations properly, and also in obtaining the 13cooperation of other people concerned. Psychology will help nurses to understand the problematic situations properly, and also helps to understand the people related to nursing care either directly or indirectly, and seek their cooperation in managing her duties.
In this way, psychology is highly relevant to nursing today, particularly because of increasing psychosomatic illnesses due to more and more stressful life situations.
 
METHODS OF PSYCHOLOGY
As stated in definition, Psychology deals with the behaviour of the organism. In order to study the behaviour, psychologists have developed some methods. They are:
 
Introspection Method
This method was introduced by EB Titchener. This is also known as self-observation method. Introspection means ‘to look within’. It is not possible to understand the inner feelings and experiences of other persons. But the individual himself can observe and report. Example: A patient can report about his pains and other disturbances in a better way than by a nurse. He will look within himself and explain how he is feeling. This will help for a better treatment. Though Introspection is a useful method, it has some demerits also. These are: (a) We cannot verify the reports given by the observer hence we have to accept his report. At times even if he is reporting correctly there may be distortions (b) this method cannot be used to study children, animals and persons suffering from mental disorders. But this is a cheap and easy method.
 
Observation Method
This method is very useful in the areas where experiments cannot be conducted. In this method the observer will observe and collect the data. Example: In the hospital the nurse will make observation of patient's temperature, pulse, BP, facial expressions, etc. This method is very useful to study the children, mentally ill, animals and unconscious patients. At times the observer will go to the natural settings, situations, etc. in order to get the objective data. 14Because, in natural settings the person being observed will not be aware that he is being observed, his behaviour will be natural/original. Hence, this method is also known as ‘naturalistic observation’ or ‘objective observation’ method.
This is a very good and useful method. But the disadvantages here are: (a) There are chances of subjective report, and prejudices of observer may creep in. Sometimes to observe the natural behaviour the observer may have to spend more time, energy and money.
 
Experimental Method
This is the most objective way of studying the behaviour. In this method, experiments are conducted in the laboratories under controlled conditions. In experiments, usually the effect of independent variable on the dependent variable is studied. Hence, there will be two variables, viz., Independent and dependent variable. There will be some other variables which are not wanted by the experimenter, and their interference may affect the results of the experiment. Such variables are to be controlled. These unwanted variables are called ‘extraneous’ or ‘intervening’ variables. Experiments are conducted under controlled conditions in order to control the effect of these extraneous variables. Examples: The effect of music on the level of blood pressure can be studied in laboratory settings. Here, the music is independent variable and the BP is dependent variable. All other sounds other than music are extraneous variables that are to be controlled, so that the effect of only music can be assessed. Similarly the effect of different drugs, food, etc. can also be studied. Experiments may also be conducted by using two groups called experimental group and control group. In such experiments, independent variable is operated only on experimental group and the control group is kept constant. Otherwise, the experiment may be conducted on the same group under two conditions, viz., experimental and controlled conditions.
Generally the following steps are followed in an experiment:
  1. Identification of the problem
  2. Formulation of hypothesis
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  3. Designing the experiment
  4. Testing the hypothesis by experiment
  5. Analysis of results
  6. Interpretation of results.
The advantage of this method is that, the results of the experiment may be verified by repetition of the same experiment. But this method has some demerits also. They are: (a) Conducting experiment is very expensive and time consuming, (b) another feature is that the experiments cannot be conducted outside the laboratory.
 
Clinical Method/Case History Method
This method is used very commonly in hospitals and also in educational settings. In hospitals, when a patient is admitted, the nurse can collect the detailed information pertaining to the disease of the patient. The information includes the past history of the disease, treatment taken already, changes if any like improvement, present condition, probable causes, signs and symptoms, etc. This information may be obtained from the patient, his close relatives like parents, siblings or others who accompany him or from his friends, neighbours, etc.
 
Survey Method
This is used to gather the information from large number of people. Questionnaires, checklists, rating scales, inventories are used to collect the required information. This method is usually used to gather information about political opinion, customers’ preferences, etc. It may also be used to know the information pertaining to medical profession—like awareness about diseases and remedial programmes, malnutrition, opinions about health needs, health facilities available, etc.
 
Genetic Method
This method is also called as developmental method. Most of our behaviours are the result of earlier experiences. In some cases when we need to understand some behaviour we need to know their 16developmental aspects also. For example, in order to understand the behaviour of adults we need to know their childhood development. This can be done by two ways: (a) Cross-sectional study in which, the children of different age groups will be studied simultaneously, (b) longitudinal study in which, the same individual will be studied in different stages of life. This is more useful method to understand the behaviour from point of view of hereditary and environmental influences.
 
Testing Method
Different tests are developed by psychologists to study various aspects of behaviour. The attitudes, interests, abilities, intelligence, adjustments, personality and such other factors which influence behaviour, can be studied by administering the suitable tests.